RESUMO
The prognosis of dilated cardiomyopathy due to hypertension (HT-DCM) is surprisingly unknown, particularly in the absence of coronary disease and diabetes. We aimed at investigating the long-term outcome and the predictors of mortality in patients with left ventricular systolic dysfunction exclusively due to hypertension. From October 1995 to May 2001, 90 consecutive patients with echocardiographic fractional shortening (FS) < 30% and 29 control patients with FS > or = 30% were included. Obstructive coronary disease was excluded by dipyridamole myocardial perfusion imaging in all patients and coronary angiography in 60. After a mean follow-up of 4.3+/-1.6 years, the total mortality rate of HT-DCM was twice as much higher than that of patients without left ventricular systolic dysfunction (P = 0.01). In HT-DCM, the 5-year mortality rate was 26%. Univariate analyses selected age and creatinine for being positively related to mortality, and body mass index, FS and blood pressure during follow-up for being negatively related to mortality. Neither the improvement of left ventricular FS nor the decrease in left ventricular mass index was related to survival. Multivariate analysis identified (hazard ratio; 95% confidence interval) age (1.08; 1.02-1.13), body mass index (0.86; 0.75-0.98), and baseline FS (0.88; 0.78-0.98) as independent predictors of mortality. In conclusion, poor survival in HT-DCM can be anticipated by the severity of left ventricular systolic dysfunction and advanced age. Instead of ominous signs, high blood pressure and body mass may predict a more favourable prognosis.
Assuntos
Cardiomiopatia Dilatada/etiologia , Hipertensão/complicações , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Angiografia Coronária , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Fatores de Tempo , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: A new pregnancy is usually discouraged in patients with peripartum cardiomyopathy (PPCM), particularly when there is persistent left ventricular dysfunction. This study was undertaken to evaluate left ventricular systolic function after a new pregnancy in patients with PPCM. METHODS AND RESULTS: Nine of 44 patients with PPCM became pregnant and were selected for this study. Two patients were lost to follow-up, 1 immediately after the new pregnancy diagnosis, and the other 1 after the latest delivery, and, thus, were excluded. The remaining 7 patients had regular clinical and obstetric examinations until delivery, continued follow-up, and were submitted to echocardiography 6 to 12 months thereafter. Pregnancy was relatively well tolerated in the patients, and they gave birth to 7 healthy newborns. After this latest pregnancy, 4 patients with heart failure functional class II and 2 patients with functional class III remained unchanged. A patient, initially in functional class III, improved and was then in functional class II. Although left ventricular end-diastolic diameter did not change (61 to 58 mm), left ventricular end-systolic dimension decreased (50 to 47 mm, P =.008), resulting in a significant increase in left ventricular fractional shortening (19% to 23%, P =.02). CONCLUSION: Although based only in a small number of patients, the present results suggest that cardiac function does not deteriorate during a new pregnancy in patients with PPCM.
Assuntos
Cardiomiopatias/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Transtornos Puerperais/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adolescente , Adulto , Cardiomiopatias/diagnóstico , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Pessoa de Meia-Idade , Gravidez , Transtornos Puerperais/diagnóstico , Fatores de TempoRESUMO
BACKGROUND: Chagas' disease is a known dilated form of cardiomyopathy. However, a great number of patients, although showing electrocardiographic (ECG) well-recognized changes, maintain normal ventricular chamber dimensions and are asymptomatic. The aim of the present study was to objectively characterize functional capacity in asymptomatic patients with Chagas' disease and normal left ventricular function. METHODS AND RESULTS: Eighteen asymptomatic male patients with Chagas' disease, aged 33+/-6 years, were selected for the study. All showed ECG changes typical of the disease, as well as left ventricular fractional shortening (LVFS) greater than 0.30 on M-mode 2-dimensionally guided echocardiography. Twenty sedentary normal male patients, aged 29+/-6 years, served as controls. Both groups were submitted to ergoespirometry testing for assessment of exercise functional capacity. Patients with Chagas' disease, when compared with controls, showed lower (P < .001) maximal O2 consumption (VO2max, 24.3+/-4.2 v 37.0+/-5.4 mL x kg(-1) x min(-1) respectively); O2 pulse rate (PO2max, 10.5+/-1.4 v 15.1+/-2.5 mL/beat, respectively); maximal ventilation (VEmax, 50.1+/-13.5 v 113.0+/-17.6 L x min(-1), respectively); anaerobic threshold of maximal O2 consumption (VO2-AT, 15.8+/-3.6 v 24.6+/-4.7 mL x kg(-1) x min(-1), respectively); and maximal heart rate (HRmax, 154+/-21 v 186+/-7 beat x min(-1), respectively). CONCLUSIONS: Asymptomatic patients with Chagas' disease, although presenting normal left ventricular systolic function at rest, display a substantial impairment of exercise functional capacity.