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Cerqueira-Silva T, Gonçalves BM, Pereira CB, Porto LM, Marques ME, Santos LS, Oliveira MA, Félix IF, de Sousa PRP, Muiños PJ, Maia RM, Catto MB, Andrade AL, Jesus PA, Aras R, Oliveira-Filho J. Chagas disease is an independent predictor of stroke and death in a cohort of heart failure patients. Int J Stroke 2021; 17:180-188. [PMID: 33724086 DOI: 10.1177/17474930211006284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Chagas disease is a common cause of heart failure (HF) and death in developing countries. Although stroke is known to occur in these patients, an accurate estimate of stroke incidence is lacking. We aimed to determine the incidence of stroke and death in patients with HF, comparing Chagas and non-Chagas etiologies. METHODS Cohort of stroke-free patients with HF (Framingham criteria) followed in a university-based outpatient clinic in Brazil. Baseline characteristics included sociodemographic, risk factor assessment, echocardiographic and electrocardiographic findings. Chagas disease was defined by appropriate serologic tests. Cause-specific Cox regression was used to search for predictors of stroke or death as separate outcomes. RESULTS We studied 565 patients with HF between January 2003 and December 2018, mean age 54.3 ± 12.9 years, 305 (54.0%) females, 271/535 (50.7%) with Chagas disease. Chagas patients were older (55.5 vs. 53.1 years), more frequently women (60.5% vs. 47.3%), less frequently harbored coronary artery disease (14.5% vs. 34.1%) when compared to non-Chagas patients. Echocardiography showed more severe disease among non-Chagas patients [median left ventricle ejection fraction (LVEF) 37.3% vs. 47.0%]. Over a mean 42.9 (±34.4) months, we followed 404 (71.5%) patients, completing 1442 patient-years of follow-up. Stroke incidence was higher in Chagas when compared to non-Chagas patients (20.2 vs. 13.9 events per 1000 patient-years), while death rate was similar (41.6 vs. 43.1 deaths per 1000 patient-years). In the multivariable analysis for stroke outcome adjusted for LVEF and arrhythmias, cause-specific hazard ratio (CSHR) for Chagas was 2.54 (95% confidence interval 1.01-6.42, p = 0.048). Chagas disease was also associated with increased risk of death (CSHR 1.83; 95% confidence interval 1.04-3.24, p = 0.037). CONCLUSION Chagas disease is associated with increased risk of stroke and death when compared to other etiologies of HF, independently of HF severity or cardiac arrhythmias, suggesting other factors contribute to increased stroke risk and mortality in Chagas disease. Early prevention and treatment of Chagas disease is imperative to reduce a later risk of stroke in endemic areas.
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Affiliation(s)
- Thiago Cerqueira-Silva
- Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Brazil.,Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Beatriz Mm Gonçalves
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Camila B Pereira
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Louise M Porto
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Maria El Marques
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Leila Sb Santos
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Murilo A Oliveira
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Iuri F Félix
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Paulo Rs P de Sousa
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Pedro Jr Muiños
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Renata M Maia
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Marília B Catto
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Alisson L Andrade
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Pedro Ap Jesus
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
| | - Roque Aras
- Stroke and Cardiomyopathy Clinics, Federal University of Bahia, Salvador, Brazil
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Dominguez RF, da Costa-Hong VA, Ferretti L, Fernandes F, Bortolotto LA, Consolim-Colombo FM, Egan BM, Lopes HF. Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival. SAGE Open Med 2019; 7:2050312118823582. [PMID: 30671246 PMCID: PMC6327325 DOI: 10.1177/2050312118823582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%-47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values <0.01). Left ventricular ejection fraction increased in 69% of patients. Patients who did not have improved left ventricular ejection fraction had nearly six-fold higher mortality than those that improved (relative risk; 5.7, 95% confidence interval: 1.3-25, p = 0.022). Conclusion Carvedilol reduced cardiac dimensions and improved left ventricular ejection fraction and cardiac remodeling in patients with hypertensive heart disease. These treatment-related changes had a favorable effect on survival.
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Affiliation(s)
| | - Valeria A da Costa-Hong
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Luan Ferretti
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil
| | - Fabio Fernandes
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Luiz A Bortolotto
- Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fernanda M Consolim-Colombo
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil.,Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Brent M Egan
- Care Coordination Institute, Greenville, SC, USA.,Department of Medicine, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Heno F Lopes
- Universidade Nove de Julho-UNINOVE, São Paulo, Brasil.,Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Pereira VFA, de Carvalho Frimm C, Rodrigues ACT, Cúri M. Coronary reserve impairment prevents the improvement of left ventricular dysfunction and adversely affects the long-term outcome of patients with hypertensive dilated cardiomyopathy. ACTA ACUST UNITED AC 2010; 4:14-21. [PMID: 20374947 DOI: 10.1016/j.jash.2009.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 12/22/2009] [Accepted: 12/24/2009] [Indexed: 11/30/2022]
Abstract
In hypertension, left ventricular (LV) hypertrophy develops as an adaptive mechanism to compensate for increased afterload and thus preserve systolic function. Associated structural changes such as microvascular disease might potentially interfere with this mechanism, producing pathological hypertrophy. A poorer outcome is expected to occur when LV function is put in jeopardy by impaired coronary reserve. The aim of this study was to evaluate the role of coronary reserve in the long-term outcome of patients with hypertensive dilated cardiomyopathy. Between 1996 and 2000, 45 patients, 30 of them male, with 52+/-11 years and LV fractional shortening <30% were enrolled and followed until 2006. Coronary flow velocity reserve was assessed by transesophageal Doppler of the left anterior descending coronary artery. Sixteen patients showed >/=10% improvement in LV fractional shortening after 17+/-6 months. Coronary reserve was the only variable independently related to this improvement. Total mortality was 38% in 10 years. The Cox model identified coronary reserve (hazard ratio=0.814; 95% CI=0.72-0.92), LV mass, low diastolic blood pressure, and male gender as independent predictors of mortality. In hypertensive dilated cardiomyopathy, coronary reserve impairment adversely affects survival, possibly by interfering with the improvement of LV dysfunction.
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Magnusson M, Jovinge S, Rydberg E, Dahlöf B, Hall C, Nielsen OW, Grubb A, Willenheimer R. Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients. Blood Press 2009; 18:196-203. [DOI: 10.1080/08037050903083298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim H, Cho YK, Jun DH, Nam CW, Han SW, Hur SH, Kim YN, Kim KB. Prognostic Implications of the NT-ProBNP Level and Left Atrial Size in Non-Ischemic Dilated Cardiomyopathy. Circ J 2008; 72:1658-65. [DOI: 10.1253/circj.cj-07-1087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Dong-Hwan Jun
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seong-Wook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
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Persic V, Ruzic A, Miletic B, Balen S, Jovanovic Z, Vcev A, Racki S, Vujicic B. Left ventricle diastolic dysfunction in obese patients with newly diagnosed arterial hypertension. Wien Klin Wochenschr 2007; 119:423-7. [PMID: 17671824 DOI: 10.1007/s00508-007-0818-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The frequent coexistence of obesity and arterial hypertension is well known. Although both conditions have been identified as independent risk factors for impaired left ventricular diastolic function, there is a paucity of data on the dysfunction among obese patients with newly diagnosed arterial hypertension. The study was performed to determine the prevalence of diastolic dysfunction in obese individuals with newly diagnosed arterial hypertension and to compare it with the prevalence in normotensive obese persons. METHODS We enrolled 125 obese patients: 65 with newly diagnosed hypertension and 60 normotensive patients matched for age, sex and body mass index. Left ventricular diastolic function was assessed from the following Doppler-echocardiographic measurements: mitral inflow velocities (E and A wave), E wave deceleration time, isovolumetric relaxation time, left atrial and left ventricular diameters, left ventricular wall thickness and left ventricular heart mass index. Diastolic dysfunction was considered when the E/A ratio was <1. RESULTS We found significantly higher A wave, lower E/A ratio, longer E deceleration time and a bigger left atrium in obese patients with newly diagnosed arterial hypertension. We did not find significant differences in E wave peak velocities between the two groups. Although there was no difference in left ventricle heart mass or the prevalence of left ventricle hypertrophy, the prevalence of diastolic dysfunction was higher in the group with newly diagnosed arterial hypertension. CONCLUSION This study suggests that newly diagnosed arterial hypertension significantly contributes to impairment of left ventricular diastolic function in obese patients before development of structural aberrations detectable on echocardiography.
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Affiliation(s)
- Viktor Persic
- Department of Cardiology, Thalassotherapia Opatija, M. Tita 188, 51410 Opatija, Croatia
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MacFadyen RJ, Goyal D, Lip GYH. How far can population epidemiology contribute to defining the relationship between hypertension and left ventricular systolic dysfunction? J Hum Hypertens 2005; 19:919-22. [PMID: 16195708 DOI: 10.1038/sj.jhh.1001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R J MacFadyen
- University Department of Medicine, City Hospital, Birmingham, UK.
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