Preditores clínicos e ecocardiográficos de remodelação ventricular esquerda após infarto agudo do miocárdio de parede anterior
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Data
2019-06-14
Autores
Silveira, Caroline Ferreira da Silva Mazeto Pupo da
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A doença arterial coronariana é a primeira causa isolada de morte e responsável por elevado número de hospitalizações em todo o mundo. O desenvolvimento de remodelação ventricular está associado com pior prognóstico após o infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST), representando fator de risco para a disfunção ventricular e insuficiência cardíaca. Objetivos: Identificar quais variáveis são preditoras da remodelação ventricular após o IAMCST e avaliar as características clínicas, laboratoriais e ecocardiográficas em pacientes na fase aguda do IAMCST de parede anterior submetidos à angioplastia primária e após seis meses do infarto. Metodologia: Foi realizado um estudo prospectivo, observacional e longitudinal, composto por pacientes com diagnóstico de IAMCST de parede anterior admitidos na Unidade Coronariana (UCO) do Hospital das Clínicas da Faculdade de Medicina de Botucatu no período de julho de 2017 a agosto de 2018. Foram incluídos 50 pacientes, sendo que quatro perderam o seguimento em seis meses e cinco evoluíram a óbito no mesmo período. Durante o período da internação na UCO, os pacientes foram avaliados diariamente e submetidos ao primeiro ecocardiograma em 2 a 3 dias após o IAMCST. No sexto mês após o IAMCST, os pacientes foram submetidos à reavaliação clínica e a novo ecocardiograma, conforme protocolo do serviço. A remodelação cardíaca foi considerada como aumento no volume diastólico superior a 15%. Análise estatística: as variáveis contínuas de distribuição normal e não normal foram apresentadas em média e desvio padrão ou mediana e percentis 25 e 75% e comparadas pelo teste T de Student e de Mann-Whitney, respectivamente. As variáveis categóricas foram analisadas pelo teste de Qui-quadrado ou de Fisher. Para avaliar a associação das variáveis com os desfechos remodelação, mortalidade e piora da classe funcional em seis meses utilizamos a regressão logística multivariada. As variáveis incluídas na regressão foram aquelas que apresentaram diferença estatisticamente significante na análise univariada. O nível de significância adotado foi de 5%. Resultados: Não foi possível determinar preditores clínicos, laboratoriais ou ecocardiográficos para piora de classe funcional ou mortalidade. Para o desfecho remodelação ventricular, entre os que remodelaram e não remodelaram houve diferença no pico da CKMB (Não: 323,7 ± 228,2; Sim: 522,4 ± 201,6, expressos em média ± desvio-padrão, p=0,008) e na relação E/E’ (Não: 9,20 [8,50-11,25] e Sim: 12,60 [10,74-14,40], expressos em mediana e intervalos interquartis, com p=0,004), sendo que as diferenças se mantiveram após regressão logística multivariada. Conclusões: O presente estudo identifica a presença da disfunção diastólica e o pico da CKMB na fase aguda do IAMCST como preditores de remodelação ventricular após o IAMCST.
Introduction: Coronary arterial disease is the first isolated death cause and is responsible for an elevated number of hospitalizations all over the world. The development of ventricular remodeling is associated with worse prognosis after ST segment elevation myocardial infarction (STEMI), representing a risk factor for ventricular dysfunction and heart failure. Objectives: To identify which variables are predictors of ventricular remodeling after STEMI and to evaluate clinical, laboratorial and echocardiographic characteristics of patients early post anterior STEMI who went through primary percutaneous intervention and six month after infarction. Methods: This was a prospective, observational and longitudinal study, with anterior STEMI patients admitted to the coronary care unit (CCU) of the Botucatu Medical School Clinics Hospital within July 2017 and August 2018. A total of 50 patients were included, four lost follow-up in six months and five died within the same period. During CCU stay, patients were daily evaluated and submitted to an echocardiogram within the first three days after STEMI. After six months, patients were submitted to a new clinical evaluation and a new echocardiogram, according to local protocol. Ventricular remodeling was considered as a raise in diastolic volume greater than 15%. Statistical analysis: continuous variable both normal and non-normal distribution were presented in either average and standard deviation or median and 25 and 75 percentiles, and compared with Student’s T test and Mann-Whitney test, respectively. Categorical variables were analyzed by either Chi-Square test or Fisher test. To evaluate the association of such variables with the outcomes of remodeling, mortality and worsening of functional classification a multivariate logistic regression was employed. Variables included in regression were those with statistically significant difference in univariate analysis. The level of significance was of 5%. Results: It was not possible to determine clinical, laboratorial or echocardiographic predictors for worsening of functional class or mortality. For the outcome ventricular remodeling, there was a difference between those who remodeled and those who didn’t as to CKMB peak (Control group: 323.7 ± 228.2; Abstract 6 Remodeling group: 522.4 ± 201.6, expressed in average ± standard-deviation, p=0.008) and as to E/E’ ratio (Control group: 9.20 [8.50-11.25] and Remodeling group: 12.60 [10.74-14.40], expressed in median and interquartile interval, p=0.004), sustained after multivariate logistic regression. Conclusions: This study identifies the presence of diastolic dysfunction and the CKMB peak in acute phase of STEMI as predictors of ventricular remodeling after STEMI.
Introduction: Coronary arterial disease is the first isolated death cause and is responsible for an elevated number of hospitalizations all over the world. The development of ventricular remodeling is associated with worse prognosis after ST segment elevation myocardial infarction (STEMI), representing a risk factor for ventricular dysfunction and heart failure. Objectives: To identify which variables are predictors of ventricular remodeling after STEMI and to evaluate clinical, laboratorial and echocardiographic characteristics of patients early post anterior STEMI who went through primary percutaneous intervention and six month after infarction. Methods: This was a prospective, observational and longitudinal study, with anterior STEMI patients admitted to the coronary care unit (CCU) of the Botucatu Medical School Clinics Hospital within July 2017 and August 2018. A total of 50 patients were included, four lost follow-up in six months and five died within the same period. During CCU stay, patients were daily evaluated and submitted to an echocardiogram within the first three days after STEMI. After six months, patients were submitted to a new clinical evaluation and a new echocardiogram, according to local protocol. Ventricular remodeling was considered as a raise in diastolic volume greater than 15%. Statistical analysis: continuous variable both normal and non-normal distribution were presented in either average and standard deviation or median and 25 and 75 percentiles, and compared with Student’s T test and Mann-Whitney test, respectively. Categorical variables were analyzed by either Chi-Square test or Fisher test. To evaluate the association of such variables with the outcomes of remodeling, mortality and worsening of functional classification a multivariate logistic regression was employed. Variables included in regression were those with statistically significant difference in univariate analysis. The level of significance was of 5%. Results: It was not possible to determine clinical, laboratorial or echocardiographic predictors for worsening of functional class or mortality. For the outcome ventricular remodeling, there was a difference between those who remodeled and those who didn’t as to CKMB peak (Control group: 323.7 ± 228.2; Abstract 6 Remodeling group: 522.4 ± 201.6, expressed in average ± standard-deviation, p=0.008) and as to E/E’ ratio (Control group: 9.20 [8.50-11.25] and Remodeling group: 12.60 [10.74-14.40], expressed in median and interquartile interval, p=0.004), sustained after multivariate logistic regression. Conclusions: This study identifies the presence of diastolic dysfunction and the CKMB peak in acute phase of STEMI as predictors of ventricular remodeling after STEMI.
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Palavras-chave
remodelação ventricular, infarto agudo do miocárdio, ecocardiografia, preditores, ventricular remodeling, acute myocardial infarction, echocardiography, predictors