Avaliação de risco cardiovascular perioperatório em pacientes submetidos a transplante renal no Hospital de Clínicas de Porto Alegre

O transplante renal é o tratamento padrão ouro para pacientes com doença renal crônica terminal. Doença cardiovascular é a principal causa de morte nesses pacientes. A avaliação de risco cardiovascular perioperatório visa identificar e tratar esses pacientes de maior risco. Entretanto, as diretrizes atuais divergem quanto às recomendações. Realizamos uma revisão não sistemática abordando as evidências atuais sobre o impacto da doença cardiovascular nessa população. Realizamos também estudo de coorte retrospectiva com 325 pacientes submetidos a transplante renal no Hospital de Clínicas de Porto Alegre avaliando a acurácia do Índice Cardíaco Revisado de Lee (RCRI). A incidência de eventos cardiovasculares maiores (MACE) foi de 5,8% em 30 dias. O RCRI apresentou área sob a curva (AUC = 0,64; IC 95% 0,49 - 0,78) e nenhuma de suas categorias apresentou capacidade de predizer MACE em 30 dias ou 1 ano após o transplante renal.Kidney transplantation is the gold standard treatment to end-stage kidney disease. Cardiovascular disease is the leading cause of death in these patients. Perioperative cardiovascular evaluation is critical to risk stratify these patients. However, current guidelines differ on recommendations. We did a non-systematic review addressing the current evidence of the impact of cardiovascular disease on this population. Also, we performed a retrospective cohort with 325 deceased-donor kidney transplantation patients at the Hospital de Clínicas de Porto Alegre. The incidence of MACE was 5.8% at first 30 days after transplantation. The RCRI presented AUC = 0.64 (CI 95% 0.49 - 0.78) and none of the categories were able to predict MACE at 30 days after surgery

Characterization of advanced glycation end products and their receptor (RAGE) in an animal model of myocardial infarction

Circulating advanced glycation end products (AGE) and their receptor, RAGE, are increased after a myocardial infarction (MI) episode and seem to be associated with worse prognosis in patients. Despite the increasing importance of these molecules in the course of cardiac diseases, they have never been characterized in an animal model of MI. Thus, the aim of this study was to characterize AGE formation and RAGE expression in plasma and cardiac tissue during cardiac remodeling after MI in rats. Adult male Wistar rats were randomized to receive sham surgery (n = 15) or MI induction (n = 14) by left anterior descending coronary artery ligation. The MI group was stratified into two subgroups based on postoperative left ventricular ejection fraction: low (MIlowEF) and intermediate (MIintermEF). Echocardiography findings and plasma levels of AGEs, protein carbonyl, and free amines were assessed at baseline and 2, 30, and 120 days postoperatively. At the end of follow-up, the heart was harvested for AGE and RAGE evaluation. No differences were observed in AGE formation in plasma, except for a decrease in absorbance in MIlowEF at the end of follow-up. A decrease in yellowish-brown AGEs in heart homogenate was found, which was confirmed by immunodetection of N-ε-carboxymethyl-lysine. No differences could be seen in plasma RAGE levels among the groups, despite an increase in MI groups over the time. However, MI animals presented an increase of 50% in heart RAGE at the end of the follow-up. Despite the inflammatory and oxidative profile of experimental MI in rats, there was no increase in plasma AGE or RAGE levels. However, AGE levels in cardiac tissue declined. Thus, we suggest that the rat MI model should be employed with caution when studying the AGERAGE signaling axis or anti-AGE drugs for not reflecting previous clinical findings

Causas e preditores de mortalidade intra-hospitalar em pacientes que internam com ou por insuficiência cardíaca em hospital terciário no Brasil

Background: Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective: To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods: Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results: A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion: Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital. (Arq Bras Cardiol. 2017; 109(4):321-330

Causas e preditores de mortalidade intra-hospitalar em pacientes que internam com ou por insuficiência cardíaca em hospital terciário no Brasil

Background: Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective: To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods: Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results: A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion: Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital. (Arq Bras Cardiol. 2017; 109(4):321-330