Cardiologia/Coração/CirurgCardíaca

Em um grande estudo de sobrevivência (1906 pacientes), os pacientes com doença arterial coronária (DAC; n = 995) documentada foram comparados aos pacientes com cardiomiopatia dilatada idiopática (CDI; n = 429). Em um sub-estudo menor, os neuro-hormônios plasmáticos foram determinados em 270 e 37 pacientes (com DAC e CDI, respectivamente). Todos os pacientes tinham ICC avançada (classe funcional III-IV da New York Heart Association). A média de idade basal dos pacientes foi de 64 ± 10 anos e a média de fração de ejeção do ventrículo esquerdo foi de 0,26 ± 0,08. A taxa de filtração glomerular basal (TFG) foi calculada com a Equação de Cockcroft-Gault.

A TFG foi um forte preditor para mortalidade em ambos os grupos na análise multivariada. O risco relativo foi de 3,04 para os pacientes com CDI (P  0,01 para o quartil mais baixo  53 mL/min) e de 1,81 para os pacientes com DAC (P = 0,01 para o quartil mais baixo  42 mL/min). Os neuro-hormônios plasmáticos mostraram uma relação com a TFG em ambos os grupos.

Impaired renal function in patients with ischemic and nonischemic chronic heart failure: Association with neurohormonal activation and survival - American Heart Journal; 2004; 148 (1): 165

Impaired renal function in patients with ischemic and nonischemic chronic heart failure: Association with neurohormonal activation and survival

Tom D. J. Smilde, MD a * [MEDLINE LOOKUP] Hans L. Hillege, MSc, MD, PhD a [MEDLINE LOOKUP] Gerjan Navis, MD, PhD b [MEDLINE LOOKUP] Frans Boomsma, MD, PhD c [MEDLINE LOOKUP] Dick de Zeeuw, MD, PhD d [MEDLINE LOOKUP] Dirk J. van Veldhuisen, MD, PhD a [MEDLINE LOOKUP]

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Abstract

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Background Renal dysfunction is a strong predictor of mortality in chronic heart failure (CHF). Most patients with CHF have atherosclerotic vascular disease, and several authors have suggested that impaired renal function is only a marker of advanced atherosclerosis. We compared renal function in patients with ischemic and nonischemic CHF and examined associations with prognosis and extent of neurohormonal activation.

Methods In a large survival study (1906 patients), patients with documented coronary artery disease (CAD, n = 995), were compared with patients with idiopathic dilated cardiomyopathy (IDC, n = 429). In a smaller substudy, plasma neurohormones were determined in 270 patients and 37 patients (CAD and IDC, respectively). All patients had advanced CHF (New York Heart Association functional class III–IV). At baseline, the mean patient age was 64 ± 10 years, and the mean left ventricular ejection fraction was 0.26 ± 0.08. The baseline glomerular filtration rate was calculated with the Cockcroft-Gault equation (GFRc).

Results GFRc was a strong predictor for mortality in both groups on multivariate analysis. The relative risk was 3.04 for patients with IDC (P .01, for the lowest quartile 53 mL/min), and the relative risk for patients with CAD was 1.81 (P = .01 for the lowest quartile 42 mL/min). Plasma neurohormones showed a relation with GFRc in both groups.

Conclusions GFRc is related to survival and plasma neurohormones in both patient groups. In patients with IDC, this association appears to be at least as strong as in patients with CAD.
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