Remodelamento ventricular esquerdo reverso em pacientes com miocardiopatia submetidos a cirurgia de revascularização do miocárdio: uma análise pela ressonância magnética nuclear
Remodelamento ventricular esquerdo reverso em pacientes com miocardiopatia submetidos a cirurgia de revascularização do miocárdio: uma análise pela ressonância magnética nuclear
Data
2019
Autores
Weigert, Guilherme de Souza
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Fundamento: A cirurgia de revascularização miocárdica pode promover o
remodelamento reverso nos pacientes com miocardiopatia dilatada de origem
isquêmica.
Objetivo: Avaliar o impacto da cirurgia de revascularização do miocárdio sobre
o remodelamento reverso do ventrículo esquerdo no seguimento de seis meses
após a cirurgia, identificando potenciais preditores associados ao
remodelamento.
Métodos: Foram selecionados, para análise retrospectiva, uma coorte de 19
pacientes submetidos a cirurgia de revascularização miocárdica no período entre
junho de 2015 e janeiro de 2017, no Instituto Nacional de Cardiologia, hospital
público de complexidade quaternária, localizado no Rio de Janeiro, Brasil. Foram
coletadas as características demográficas e clínicas gerais dos participantes e
avaliados por, análise univariada, os fatores associados ao seguintes desfechos:
incremento de fração de ejeção acima de 5% e 10%, obtidos por ressonância
magnética cardíaca, através da comparação da fração de ejeção do período préoperatório
com a do período de 6 meses de pós-operatório.
Resultados: Foi observado que 42% dos pacientes submetidos a cirurgia de
revascularização tiveram incremento de fração de ejeção de ventrículo esquerdo
(FEVE) acima de 5% e 31,5% apresentaram incremento na FEVE acima de 10%.
Essa diferença não foi significativa do ponto de vista estatístico.
A presença de viabilidade miocárdica em parede anterior não foi fator preditivo
para incremento na FEVE.
Conclusão: Não houve remodelamento reverso de ventrículo esquerdo nos
pacientes com miocardiopatia isquêmica submetidos a cirurgia de
revascularização miocárdica. Adicionalmente, não foram encontrados fatores
preditivos associados ao remodelamento reverso de ventrículo esquerdo.
Background: Myocardial revascularization surgery may promote reverse remodeling in patients with dilated cardiomyopathy of ischemic origin. Objective: To evaluate the impact of myocardial revascularization surgery on left ventricular remodeling after six months after surgery, identifying potential predictors associated with remodeling. Methods: A cohort of 19 patients submitted to myocardial correction surgery in June 2015 and January 2017 at the National Institute of Cardiology, located in Rio de Janeiro, Brazil, were selected for retrospective analysis. The general characteristics of the participants were collected and evaluated by univariate analysis, the factors associated with two endpoints: ejection fraction increase above 5% and 10%, analyzed by cardiac magnetic resonance and comparing the ejection fraction of the preoperative period with the postoperative period. Results: We evaluated 19 patients submitted to myocardial revascularization surgery who presented cardiac magnetic resonance in the preoperative period and 6 months after surgery. It was observed that 42% of the patients undergoing revascularization surgery had an increase in left ventricular ejection fraction (LVEF) above 5% and 31.5% presented an increase in LVEF above 10%. The difference was not statistically significant. In addition, there was reduction of LV end systolic and diastolic volumes. The presence of myocardial viability in the anterior wall was not a predictive factor for an increase in LVEF. Conclusion: There was no left ventricular remodeling in patients with ischemic cardiomyopathy who underwent myocardial revascularization surgery. In addition, no predictive factors associated with left ventricular remodeling were found.
Background: Myocardial revascularization surgery may promote reverse remodeling in patients with dilated cardiomyopathy of ischemic origin. Objective: To evaluate the impact of myocardial revascularization surgery on left ventricular remodeling after six months after surgery, identifying potential predictors associated with remodeling. Methods: A cohort of 19 patients submitted to myocardial correction surgery in June 2015 and January 2017 at the National Institute of Cardiology, located in Rio de Janeiro, Brazil, were selected for retrospective analysis. The general characteristics of the participants were collected and evaluated by univariate analysis, the factors associated with two endpoints: ejection fraction increase above 5% and 10%, analyzed by cardiac magnetic resonance and comparing the ejection fraction of the preoperative period with the postoperative period. Results: We evaluated 19 patients submitted to myocardial revascularization surgery who presented cardiac magnetic resonance in the preoperative period and 6 months after surgery. It was observed that 42% of the patients undergoing revascularization surgery had an increase in left ventricular ejection fraction (LVEF) above 5% and 31.5% presented an increase in LVEF above 10%. The difference was not statistically significant. In addition, there was reduction of LV end systolic and diastolic volumes. The presence of myocardial viability in the anterior wall was not a predictive factor for an increase in LVEF. Conclusion: There was no left ventricular remodeling in patients with ischemic cardiomyopathy who underwent myocardial revascularization surgery. In addition, no predictive factors associated with left ventricular remodeling were found.
Description
Palavras-chave
Coronary artery bypass, Heart failure, Ventricular remodeling, Cirurgia de revascularização miocárdica, Insuficiência cardíaca, Remodelamento reverso ventricular
Citação
Weigert GS. Remodelamento ventricular esquerdo reverso em pacientes com miocardiopatia submetidos a cirurgia de revascularização do miocárdio: Uma análise pela Ressonância Magnética Nuclear. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]; 2019.