Fátima Saraiva

Prognostic implications of left ventricular end-diastolic pressure in acute coronary syndromes with left ventricular ejection fraction of 40% or over

Abstract Introduction There is still debate concerning the impact of left ventricular end-diastolic pressure (LVEDP) on long-term prognosis after an acute coronary syndrome (ACS). Objective To assess LVEDP and its prognostic implications in ACS patients with left ventricular ejection fraction (LVEF) ≥40%. Methods We performed a prospective, longitudinal study of 1329 ACS patients from a single center between 2004 and 2006. LVEDP was assessed at the beginning of the coronary angiogram. Patients with LVEF >40% were included (nxa0=xa0489). The population was divided into three groups: A — LVEDP ≤19xa0mmHg (nxa0=xa0186); B — LVEDP >19 and ≤27xa0mmHg (nxa0=xa0172); and C — LVEDP >27xa0mmHg (nxa0=xa0131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results Mean LVEDP was 22.8xa0±xa07.8xa0mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, pxa0 Conclusion In selected population LVEDP was a significant prognostic marker of future admission for congestive heart failure.

Distrofia muscular de Emery-Dreifuss : a propósito de um caso clínico

Emery-Dreifuss muscular dystrophy type 1 (EDMD1) is a familial disease with X-Linked recessive transmission, caused by a mutation in a nuclear envelope protein, emerin. Clinical manifestations usually occur in adolescence and include contractures, muscle atrophy and weakness, and cardiac conduction disturbances. We describe the case of a young male, aged 16, with first-degree atrioventricular (AV) block and limited extension of both forearms. He had elevated CK, and cardiac monitoring showed severe conduction tissue disease, with significant sinus pauses, chronotropic incompetence and periods of AV dissociation during exercise. Immunohistochemical staining using an emerin antibody showed absence of the protein in a fragment of muscle tissue and genetic study identified a mutation associated with EDMD1. Study of his brother, aged 21, also established a diagnosis of EDMD1. Both individuals received a permanent pacemaker but musculoskeletal manifestations at that time did not warrant any other intervention: Screening for certain genetic diseases, including muscular dystrophies, is mandatory following identification of conduction abnormalities in young people.

Implicações prognósticas da pressão telediastólica do ventrículo esquerdo nas síndromes coronárias agudas com fracção de ejecção maior ou igual a 40

INTRODUCTIONnThere is still debate concerning the impact of left ventricular end-diastolic pressure (LVEDP) on long-term prognosis after an acute coronary syndrome (ACS).nnnOBJECTIVEnTo assess LVEDP and its prognostic implications in ACS patients with left ventricular ejection fraction (LVEF) ≥40%.nnnMETHODSnWe performed a prospective, longitudinal study of 1329 ACS patients from a single center between 2004 and 2006. LVEDP was assessed at the beginning of the coronary angiogram. Patients with LVEF >40% were excluded (n=489). The population was divided into three groups: A - LVEDP ≤19 mmHg (n=186); B - LVEDP >19 and ≤27 mmHg (n=172); and C - LVEDP >27 mmHg (n=131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission.nnnRESULTSnMean LVEDP was 22.8±7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p<0.01), higher peak levels of cardiac biomarkers, and lower LVEF (56.5±7.0 vs. 55.3±7.6 vs. 53.0±7.5%, p<0.01). There were no significant differences between the groups in terms of coronary anatomy, medical therapy during hospital stay and at discharge, or in-hospital mortality. With regard to the primary endpoint, cumulative freedom from congestive heart failure was higher in group A patients (99.4 vs. 97.6 vs. 94.4%, log rank p=0.02). In a multivariate Cox regression model, a 5-mmHg increase in LVEDP (HR 1.97, 95% CI 1.10-3.54, p=0.02) remained an independent predictor of the primary endpoint when adjusted for age, systolic function, atrial fibrillation, peak troponin I, renal function, and prescription of diuretics and beta-blockers.nnnCONCLUSIONnIn selected population LVEDP was a significant prognostic marker of future admission for congestive heart failure.Resumo Introducao Permanecem duvidas sobre o impacto prognostico a longo prazo da pressao telediastolica do ventriculo esquerdo (PTDVE) no contexto de uma sindrome coronaria aguda (SCA). Objectivo Caracterizar a PTDVE e o seu impacto prognostico numa populacao de doentes com SCA e fraccao de ejeccao ventricular esquerda (FEVE) ≥ a 40%. Populacao e metodos Estudo prospectivo, longitudinal e continuo de 1329 doentes admitidos (nxa0=xa0489) numa unidade de cuidados intensivos coronarios entre 2004 e 2006. Foram seleccionados os doentes submetidos a uma estrategia invasiva, no qual foi determinada a PTDVE, com FEVE ≥ 40%. A populacao foi divida em tres grupos: A — PTDVE ≤ 19xa0mmHg (nxa0=xa0186); grupo B — PTDVE > 19 ≤ 27xa0mmHg (nxa0=xa0172) e; grupo C — PTDVE > 27xa0mmHg (nxa0=xa0131). O resultado primario desta analise foi a readmissao por insuficiencia cardiaca congestiva (ICC) no ano seguinte a SCA. Resultados A PTDVE media da populacao foi de 22,8xa0mmHgxa0±xa07,8 mmHg. Os grupos eram homogeneos entre si no que disse respeito ao genero, idade, factores de risco cardiovascular, historia cardiovascular e medicacao previa a admissao. Quanto maior a PTDVE maior a probabilidade de uma admissao por enfarte agudo do miocardio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7%, pxa0 Conclusao Na populacao referida a PTDVE teve um impacto prognostico importante a longo prazo relativamente a readmissao, hospitalar por ICC.