Ricardo Mourilhe-Rocha

Angiotensin-converting enzyme genetic polymorphism: its impact on cardiac remodeling

Background The role of angiotensin-converting enzyme genetic polymorphisms as a predictor of echocardiographic outcomes on heart failure is yet to be established. The local profile should be identified so that the impact of those genotypes on the Brazilian population could be identified. This is the first study on exclusively non-ischemic heart failure over a follow-up longer than 5 years. Objective To determine the distribution of angiotensin-converting enzyme genetic polymorphism variants and their relation with echocardiographic outcome of patients with non-ischemic heart failure. Methods Secondary analysis of the medical records of 111 patients and identification of the angiotensin-converting enzyme genetic polymorphism variants, classified as DD (Deletion/Deletion), DI (Deletion/Insertion) or II (Insertion/Insertion). Results The cohort means were as follows: follow-up, 64.9 months; age, 59.5 years; male sex, 60.4%; white skin color, 51.4%; use of beta-blockers, 98.2%; and use of angiotensin-converting-enzyme inhibitors or angiotensin receptor blocker, 89.2%. The angiotensin-converting enzyme genetic polymorphism distribution was as follows: DD, 51.4%; DI, 44.1%; and II, 4.5%. No difference regarding the clinical characteristics or treatment was observed between the groups. The final left ventricular systolic diameter was the only isolated echocardiographic variable that significantly differed between the angiotensin-converting enzyme genetic polymorphisms: 59.2 ± 1.8 for DD versus 52.3 ± 1.9 for DI versus 59.2 ± 5.2 for II (p = 0.029). Considering the evolutionary behavior, all echocardiographic variables (difference between the left ventricular ejection fraction at the last and first consultation; difference between the left ventricular systolic diameter at the last and first consultation; and difference between the left ventricular diastolic diameter at the last and first consultation) differed between the genotypes (p = 0.024; p = 0.002; and p = 0.021, respectively). Conclusion The distribution of the angiotensin-converting enzyme genetic polymorphisms differed from that of other studies with a very small number of II. The DD genotype was independently associated with worse echocardiographic outcome, while the DI genotype, with the best echocardiographic profile (increased left ventricular ejection fraction and decreased left ventricular diameters).

Long-term analysis in acute coronary syndrome: are there any differences in morbidity and mortality?

FUNDAMENTO: La insuficiencia cardiaca (IC) tiene gran importancia como predictor de morbimortalidad en pacientes con sindrome coronario agudo (SCA). OBJETIVO: Evaluar los predictores de morbimortalidad en la SCA a largo plazo. METODOS: Fue un estudio de cohorte de 403 pacientes consecutivos con quejas de dolor toracico. Se describieron datos demograficos, clinicos, de laboratorio y terapeuticos, siendo evaluados durante la internacion y hasta ocho anos despues del alta, en relacion a la presencia o ausencia de eventos cardiovasculares y obitos. RESULTADOS: Fueron 403 pacientes con quejas de dolor toracica, en que 65,8% presentaban diagnostico de SCA sin supra de ST, 27,8% SCA con supra de ST y 6,5% sin SCA. De estos, fueron evaluados los 377 pacientes con SCA, en que 37,9% eran del sexo femenino, y la media de edad fue de 62,2±11,6 anos. La presencia de IC antes o durante la hospitalizacion influencio la mortalidad. De los factores pronosticos, la creatinina inicial merece destacarse, siendo el punto de corte de 1,4mg/dL (precision=62,1%; HR=3,27; p<0,001). Notamos peor pronostico para cada aumento de diez anos de edad (HR=1,37; p<0,001) y para cada incremento de 10lpm en la frecuencia cardiaca (HR=1,22 p<0,001). En cuanto a las terapias utilizadas antes y despues de 2002, hubo aumento de uso de betabloqueantes, inhibidores de la enzima conversora de la angiotensina (IECAs), estatinas y antiplaquetarios, teniendo impacto en la mortalidad. CONCLUSION: Presencia de IC admisional, creatinina, edad y FC fueron predictores independientes de mortalidad. Se observo que pacientes con IC atendidos antes de 2002 presentaron peor sobrevida en relacion a los atendidos despues de 2002 y que el cambio en la terapia fue el responsable por eso.BACKGROUND Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS). OBJECTIVE To evaluate the predictors of morbidity and mortality in ACS in the long term. METHODS A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths. RESULTS There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality. CONCLUSION HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it.

Análise em longo prazo na síndrome coronariana aguda: existem diferenças na morbimortalidade?

FUNDAMENTO: La insuficiencia cardiaca (IC) tiene gran importancia como predictor de morbimortalidad en pacientes con sindrome coronario agudo (SCA). OBJETIVO: Evaluar los predictores de morbimortalidad en la SCA a largo plazo. METODOS: Fue un estudio de cohorte de 403 pacientes consecutivos con quejas de dolor toracico. Se describieron datos demograficos, clinicos, de laboratorio y terapeuticos, siendo evaluados durante la internacion y hasta ocho anos despues del alta, en relacion a la presencia o ausencia de eventos cardiovasculares y obitos. RESULTADOS: Fueron 403 pacientes con quejas de dolor toracica, en que 65,8% presentaban diagnostico de SCA sin supra de ST, 27,8% SCA con supra de ST y 6,5% sin SCA. De estos, fueron evaluados los 377 pacientes con SCA, en que 37,9% eran del sexo femenino, y la media de edad fue de 62,2±11,6 anos. La presencia de IC antes o durante la hospitalizacion influencio la mortalidad. De los factores pronosticos, la creatinina inicial merece destacarse, siendo el punto de corte de 1,4mg/dL (precision=62,1%; HR=3,27; p<0,001). Notamos peor pronostico para cada aumento de diez anos de edad (HR=1,37; p<0,001) y para cada incremento de 10lpm en la frecuencia cardiaca (HR=1,22 p<0,001). En cuanto a las terapias utilizadas antes y despues de 2002, hubo aumento de uso de betabloqueantes, inhibidores de la enzima conversora de la angiotensina (IECAs), estatinas y antiplaquetarios, teniendo impacto en la mortalidad. CONCLUSION: Presencia de IC admisional, creatinina, edad y FC fueron predictores independientes de mortalidad. Se observo que pacientes con IC atendidos antes de 2002 presentaron peor sobrevida en relacion a los atendidos despues de 2002 y que el cambio en la terapia fue el responsable por eso.BACKGROUND Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS). OBJECTIVE To evaluate the predictors of morbidity and mortality in ACS in the long term. METHODS A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths. RESULTS There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality. CONCLUSION HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Background Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Análisis a largo plazo en el síndrome coronario agudo: ¿Existen diferencias en la morbimortalidad?

FUNDAMENTO: La insuficiencia cardiaca (IC) tiene gran importancia como predictor de morbimortalidad en pacientes con sindrome coronario agudo (SCA). OBJETIVO: Evaluar los predictores de morbimortalidad en la SCA a largo plazo. METODOS: Fue un estudio de cohorte de 403 pacientes consecutivos con quejas de dolor toracico. Se describieron datos demograficos, clinicos, de laboratorio y terapeuticos, siendo evaluados durante la internacion y hasta ocho anos despues del alta, en relacion a la presencia o ausencia de eventos cardiovasculares y obitos. RESULTADOS: Fueron 403 pacientes con quejas de dolor toracica, en que 65,8% presentaban diagnostico de SCA sin supra de ST, 27,8% SCA con supra de ST y 6,5% sin SCA. De estos, fueron evaluados los 377 pacientes con SCA, en que 37,9% eran del sexo femenino, y la media de edad fue de 62,2±11,6 anos. La presencia de IC antes o durante la hospitalizacion influencio la mortalidad. De los factores pronosticos, la creatinina inicial merece destacarse, siendo el punto de corte de 1,4mg/dL (precision=62,1%; HR=3,27; p<0,001). Notamos peor pronostico para cada aumento de diez anos de edad (HR=1,37; p<0,001) y para cada incremento de 10lpm en la frecuencia cardiaca (HR=1,22 p<0,001). En cuanto a las terapias utilizadas antes y despues de 2002, hubo aumento de uso de betabloqueantes, inhibidores de la enzima conversora de la angiotensina (IECAs), estatinas y antiplaquetarios, teniendo impacto en la mortalidad. CONCLUSION: Presencia de IC admisional, creatinina, edad y FC fueron predictores independientes de mortalidad. Se observo que pacientes con IC atendidos antes de 2002 presentaron peor sobrevida en relacion a los atendidos despues de 2002 y que el cambio en la terapia fue el responsable por eso.BACKGROUND Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS). OBJECTIVE To evaluate the predictors of morbidity and mortality in ACS in the long term. METHODS A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths. RESULTS There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality. CONCLUSION HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it.