Henrique Miller Balieiro

β-adrenergic receptor polymorphisms in susceptibility, response to treatment and prognosis in heart failure: Implication of ethnicity

Common functional polymorphisms in β-adrenergic receptor (βAR) genes have been associated with heart failure (HF) phenotypes and pharmacogenetic interactions with βAR blockers. This study evaluated the association between βAR polymorphisms and carvedilol drug response and prognosis in patients with HF. In this prospective cohort controlled study, 326 volunteers were enrolled [146 HF patients (ejection fraction (EF)<50% by Simpson) and 180 healthy controls]. Drug response was evaluated by echocardiography and outcomes were mortality and hospitalization. DNA was extracted from peripheral blood leukocytes, fragments were amplified by the polymerase reaction and genotyped by restriction fragment length polymorphism (RFLP) for Ser49Gly and Arg389Gly βAR-1 polymorphisms and Gln27Glu and Arg16Gly βAR-2 polymorphisms. The study population was in Hardy‑Weinberg equilibrium. The survival rate was adjusted using the Kaplan-Meier method. HF patients showed the following characteristics: EF 35±9%, 69.9% male, age 59±13 years, 50.7% self-identified as black, 46% had ischemic etiology. The mean follow-up of 23 months showed 18 mortalities and 46 hospitalizations. The genotypes Glu27Glu (24.7 vs. 6.1%, p=0.0004) and Arg16Arg (72.6 vs. 22.8, p<0.0001) of βAR2 polymorphisms and Gly49Gly (33.6 vs. 4.3%, p<0.0001) of the βAR1 polymorphism were higher in HF patients compared with controls. Patients with hospital admission showed a significantly higher Gly389 allelic frequency (54.9 vs. 42.1%, p=0.039), and the trend prevailed among patients who succumbed to the disease (61.1%, p=0.047). Black patients with the Ser49Ser genotype showed a reduced survival compared with the Gly49Gly or Ser49Gly genotypes (p=0.028). There was no association between improved LVEF >20% and βAR polymorphisms. HF patients with β-blocker therapy and the Gly389 allele have reduced event-free survival compared to those carrying the Arg389 allele. Additionally, systolic HF outpatients undergoing β-blocker therapy, self‑identified as black and homozygous for Ser49Ser may have reduced event-free survival, while Glu27Glu, Arg16Arg and Gly49Gly genotypes may be associated with risk for HF.

Clinical and demographic profile and quality indicators for heart failure in a rural area

Metodos: Estudio de cohorte transversal, incluyendo 166 pacientes del area rural del municipio de Valenca – RJ. Despues de la evaluacion de los datos clinicos, de laboratorio y ecocardiograficos, y utilizados el test de chi-cuadrado y el exacto de Fisher para el analisis de las proporciones, asi como el test t de Student para las variables numericas, con el objetivo de establecer las caracteristicas de la poblacion.BACKGROUND data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fishers exact tests were used for analysis of proportion, as well as the Students t-test for numeric variables, in order to establish the populations characteristics. RESULTS Mean age was 61+/-14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant. CONCLUSION In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.

Perfil clínico-demográfico e indicadores de qualidade da insuficiência cardíaca em uma área rural

Metodos: Estudio de cohorte transversal, incluyendo 166 pacientes del area rural del municipio de Valenca – RJ. Despues de la evaluacion de los datos clinicos, de laboratorio y ecocardiograficos, y utilizados el test de chi-cuadrado y el exacto de Fisher para el analisis de las proporciones, asi como el test t de Student para las variables numericas, con el objetivo de establecer las caracteristicas de la poblacion.BACKGROUND data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fishers exact tests were used for analysis of proportion, as well as the Students t-test for numeric variables, in order to establish the populations characteristics. RESULTS Mean age was 61+/-14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant. CONCLUSION In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.

Genetic polymorphism G894T and the prognosis of heart failure outpatients

Background Previous studies have analyzed the role of the genetic polymorphism of endothelial nitric oxide synthase on heart failure prognosis. However, there are no studies relating the G894T and heart failure in Brazil. Objective To evaluate the association between G894T GP and the prognosis of a sample of Brazilian outpatients with heart failure. Methods Cohort study included 145 patients with systolic heart failure, followed for up to 40 months (mean = 22), at two university hospitals, in the State of Rio de Janeiro. We evaluated the relationship between G894T and the following outcomes: reverse remodeling, improvement in functional class (NYHA), and mortality and hospitalization rates. The diameters of the left atrium and ventricle, as well as the ejection fraction of the left ventricle, were evaluated at baseline and at 6 months to assess reverse remodeling. The improvement in functional class was evaluated after 6 months, and mortality rate and hospitalization were evaluated during follow-up. Race was self-declared. G894T polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Results The genotypic frequencies were GG (40%), GT (48.3%) and TT (11.7%). The allele frequency was guanine (64.1%) and thiamine (35.8%). There were no differences between the genotype or allelic frequencies according to self declared race, either as baseline characteristics. There was no relationship between genotype or allele frequency and the outcome measures. Conclusion No association was observed between the G894T polymorphism (Glu298Asp) and prognosis in this sample of Brazilian outpatients with systolic heart failure.

Perfil clínico demográfico e indicadores de calidad de la insuficiencia cardíaca en un área rural

Metodos: Estudio de cohorte transversal, incluyendo 166 pacientes del area rural del municipio de Valenca – RJ. Despues de la evaluacion de los datos clinicos, de laboratorio y ecocardiograficos, y utilizados el test de chi-cuadrado y el exacto de Fisher para el analisis de las proporciones, asi como el test t de Student para las variables numericas, con el objetivo de establecer las caracteristicas de la poblacion.BACKGROUND data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fishers exact tests were used for analysis of proportion, as well as the Students t-test for numeric variables, in order to establish the populations characteristics. RESULTS Mean age was 61+/-14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant. CONCLUSION In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.