Avaliação do prognóstico de pacientes com cardiomiopatia chagásica em relação às não chagásicas através do teste cardiopulmonar de exercício
Avaliação do prognóstico de pacientes com cardiomiopatia chagásica em relação às não chagásicas através do teste cardiopulmonar de exercício
Data
2015
Autores
Souza, Fernando Cesar de Castro e
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacioal de Cardiologia
Resumo
Introdução: A insuficiência cardíaca (IC) é uma síndrome sempre progressiva e com elevada mortalidade, que nas suas fases avançadas pode requerer tratamentos mais complexos e dispendiosos como os cardiodesfibriladores implantáveis e o transplante cardíaco. A IC de etiologia chagásica parece ter maior mortalidade que as de outras etiologias que cursam com importante disfunção sistólica. O Teste cardiopulmonar de exercício (TCPE) é uma ferramenta de avaliação prognóstica de reconhecida utilidade, mas ainda pouco estudada na cardiopatia chagásica. Objetivo: Avaliar se o TCPE pode discriminar as diferenças prognósticas da IC grave de etiologia chagásica das não chagásicas e verificar quais das suas variáveis são preditoras independentes de mau prognóstico. Métodos: Análise retrospectiva de 21 pacientes com IC grave de etiologia chagásica e 76 pacientes de etiologia isquêmica ou dilatada encaminhados ao TCPE em um centro cardiológico terciário no período de junho de 2005 a dezembro de 2011, e seguidos quanto a sua mortalidade em dois anos. Doze variáveis do TCPE foram avaliadas, as categóricas analisadas pelo teste do qui-quadrado ou exato de Fisher e as contínuas pelo teste U de Mann-Whitney. A curva de sobrevida de Kaplan-Meier e a análise de regressão logística foram utilizadas para avaliar as variáveis do TCPE independentes para óbito. Resultados: Durante os dois anos de seguimento houve óbito em 5 pacientes no grupo chagásico (GC) e 25 no grupo não chagásico (GNC), com uma mediana de tempo de 304 e 176 dias, respectivamente (p=0,87). A curva de Kaplan-Meier não mostrou diferença na curva de sobrevida entre os grupos (p=0,43 log rank). A análise de regressão logística encontrou a potência circulatória como a única variável preditora independente para óbito para ambos os grupos, com uma razão de risco para o GC de 17,3 (IC95% 1,39-217,0; p=0,027) e no GNC de 4,8 (IC95% 1,59-14,6; p=0,005). A curva ROC para esta variável encontrou uma área de 0,91 (IC95% 0,78-1,00; p=0,006) com um valor de corte 1280 mm Hg.mL.kg-1.min-1 no GC e uma área de 0,75 (IC95% 0,64-0,86; p<0,0001) com um valor de corte de 1245 mm Hg.mL.kg-1.min-1 no GNC. Conclusão: Na população estudada não foram encontradas variáveis do TCPE que predissessem de modo diferente a mortalidade entre a IC de origem chagásica da não chagásica. A potência circulatória foi a única variável preditora para o óbito em dois anos em ambos os grupos
Introduction: Heart failure (HF) is an always progressive and with high mortality syndrome, which in its advanced stages may require more complex and costly treatments such as implantable cardioverter-defibrillator and cardiac transplantation. Chagas’ heart disease seems to have higher mortality than the other etiologies which are associated with severe systolic dysfunction. The cardiopulmonary exercise testing (CPET) is an assessment tool of recognized prognostic usefulness, but still little studied in the Chagas’ heart disease. Objective: To evaluate if the CPET can discriminate the prognostic differences of severe heart failure due to Chagas disease of non-chagasic and determine which of its variables are predictors of poor prognosis. Methods: Retrospective analysis of 21 patients with severe HF of chagasic etiology and 76 patients of ischemic or dilated etiology referred to CPET in a tertiary cardiology center from June 2005 to December 2011, and followed for mortality in two years. Twelve CPET variables were evaluated, the categorical analyzed by chisquare or Fisher’s exact test and continuous by Mann-Whitney U test. The Kaplan-Meier survival curve and the logistic regression analysis were used to evaluate the CPET independent variables to death. Results: During the two years of follow-up death occurred in 5 patients in the chagasic group (CG) and 25 in the non-chagasic group (NCG), with a median of 304 and 176 days, respectively (p=0.87). The Kaplan-Meier curve showed no difference in the survival curve between the groups (p=0.43 log rank). The logistic regression analysis found the circulatory power as the only independent predictor variable of death in both groups, with a hazard ratio for the GC 17.3 (95% HF1.39 – 217.0; p=0.027) and in NCG of 4.8 (95% 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91(95%HF 0.78-1.00; p=0.006) with a cutoff value 1280 mm Hg.mL.kg-1.min-1 in the CG and an area of 0.75 (95%HF 0.64-0.86; p<0.0001) with a cutoff value of 1245 mm Hg.mL.kg-1.min-1 in NCG. Conclusion: In the population studied CPET variables that could differently predict mortality between HP of chagasic etiology of the non-chagasic were not found Circulatory power was the only predictor variable for death in two years in both groups
Introduction: Heart failure (HF) is an always progressive and with high mortality syndrome, which in its advanced stages may require more complex and costly treatments such as implantable cardioverter-defibrillator and cardiac transplantation. Chagas’ heart disease seems to have higher mortality than the other etiologies which are associated with severe systolic dysfunction. The cardiopulmonary exercise testing (CPET) is an assessment tool of recognized prognostic usefulness, but still little studied in the Chagas’ heart disease. Objective: To evaluate if the CPET can discriminate the prognostic differences of severe heart failure due to Chagas disease of non-chagasic and determine which of its variables are predictors of poor prognosis. Methods: Retrospective analysis of 21 patients with severe HF of chagasic etiology and 76 patients of ischemic or dilated etiology referred to CPET in a tertiary cardiology center from June 2005 to December 2011, and followed for mortality in two years. Twelve CPET variables were evaluated, the categorical analyzed by chisquare or Fisher’s exact test and continuous by Mann-Whitney U test. The Kaplan-Meier survival curve and the logistic regression analysis were used to evaluate the CPET independent variables to death. Results: During the two years of follow-up death occurred in 5 patients in the chagasic group (CG) and 25 in the non-chagasic group (NCG), with a median of 304 and 176 days, respectively (p=0.87). The Kaplan-Meier curve showed no difference in the survival curve between the groups (p=0.43 log rank). The logistic regression analysis found the circulatory power as the only independent predictor variable of death in both groups, with a hazard ratio for the GC 17.3 (95% HF1.39 – 217.0; p=0.027) and in NCG of 4.8 (95% 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91(95%HF 0.78-1.00; p=0.006) with a cutoff value 1280 mm Hg.mL.kg-1.min-1 in the CG and an area of 0.75 (95%HF 0.64-0.86; p<0.0001) with a cutoff value of 1245 mm Hg.mL.kg-1.min-1 in NCG. Conclusion: In the population studied CPET variables that could differently predict mortality between HP of chagasic etiology of the non-chagasic were not found Circulatory power was the only predictor variable for death in two years in both groups
Description
Palavras-chave
Doença de Chagas, Insuficiência cardíaca, Prognóstico, Cardiopulmonary exercise testing, Chagas’ disease, Heart failure, Prognosis
Citação
Souza FCC. Avaliação do prognóstico de pacientes com cardiomiopatia chagásica em relação às não chagásicas através do teste cardiopulmonar de exercício. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2016.