Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

BackgroundThe obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population.MethodsWe analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56–70), BMI 18.5–24.9 = 35.1%, 25–29.9 = 37.2%, 30–34.9 = 17.8%, 35–39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing.ResultsBMI 30–34.9 and BMI 18.5–24.9 had the best prognosis, BMI 25–29.9 had an average performance, and BMI –39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30–34.9 group had a better prognosis compared to the BMI 35–39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI.ConclusionIn not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor

Accuracy of probabilistic record linkage for identifying deaths in a cohort of patients with decompensated heart failure

Submitted by Fábio Marques ([email protected]) on 2018-03-27T16:44:01Z No. of bitstreams: 1 ve_Pedro_Spinet_Andrea_Souza_etal_INI_2016.pdf: 79799 bytes, checksum: 9e140727a9da490467a0e992e60606f7 (MD5)Approved for entry into archive by Raquel Dinelis ([email protected]) on 2018-04-10T16:55:38Z (GMT) No. of bitstreams: 1 ve_Pedro_Spinet_Andrea_Souza_etal_INI_2016.pdf: 79799 bytes, checksum: 9e140727a9da490467a0e992e60606f7 (MD5)Made available in DSpace on 2018-04-10T16:55:38Z (GMT). No. of bitstreams: 1 ve_Pedro_Spinet_Andrea_Souza_etal_INI_2016.pdf: 79799 bytes, checksum: 9e140727a9da490467a0e992e60606f7 (MD5) Previous issue date: 2016Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Hospital Pró-Cardíaco. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.O relacionamento probabilístico de registros vem sendo cada vez mais empregado na identificação de desfechos em estudos de coorte. O objetivo deste trabalho foi avaliar a acurácia deste método na identificação de óbitos em uma coorte de 450 pacientes admitidos em um hospital universitário por insuficiência cardíaca descompensada, em um período de seis anos. O estado vital dos membros da coorte foi determinado a partir dos registros no prontuário eletrônico dos pacientes (padrão-ouro). O software OpenRecLink foi utilizado para relacionar os registros da coorte com aqueles da base do Sistema de Informações de Mortalidade, visando à identificação de óbitos. Apenas 53,6% pacientes apresentavam estado vital conhecido ao final do seguimento e destes 59,3% haviam falecido. O método apresentou sensibilidade de 97,9%, especificidade de 100%, valor preditivo positivo de 100%, valor preditivo negativo de 97% e acurácia de 98,8%. Esses resultados sugerem que o relacionamento probabilístico de registros é uma valiosa ferramenta na identificação de óbitos para estudos de coorte.Probabilistic record linkage has been used increasingly to identify outcomes in cohort studies. This study aimed to assess the method's accuracy for identifying deaths in a cohort of 450 patients admitted to a university hospital for decompensated heart failure over a six-year period. Vital status of cohort members was determined from electronic patient file data (gold standard). OpenRecLink software was used to link cohort records with those from the Mortality Information System, aimed at identifying deaths. Only 53.6% of patients had vital status known at the end of follow-up, and 59.3% of these had died. The method showed 97.9% sensitivity, 100% specificity, 100% positive predictive value, 97% negative predictive value, and 98.8% accuracy. The results suggest probabilistic record linkage as a valuable tool for identifying deaths in cohort studies

Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy.

AimCardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.Methods and resultsA total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).ConclusionThe response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications

Role of Myocardial Fibrosis in Hypertrophic Cardiomyopathy: A Systematic Review and Updated Meta-Analysis of Risk Markers for Sudden Death

Abstract Background: Hypertrophic cardiomyopathy (HCM) is associated with sudden death (SD). Myocardial fibrosis is reportedly correlated with SD. Objective: We performed a systematic review with meta-analysis, updating the risk markers (RMs) in HCM emphasizing myocardial fibrosis. Methods: We reviewed HCM studies that addressed severe arrhythmic outcomes and the certain RMs: SD family history, severe ventricular hypertrophy, unexplained syncope, non-sustained ventricular tachycardia (NSVT) on 24-hour Holter monitoring, abnormal blood pressure response to exercise (ABPRE), myocardial fibrosis and left ventricular outflow tract obstruction (LVOTO) in the MEDLINE, LILACS, and SciELO databases. We used relative risks (RRs) as an effect measure and random models for the analysis. The level of significance was set at p < 0.05. Results: Twenty-one studies were selected (14,901 patients aged 45 ± 16 years; men, 62.8%). Myocardial fibrosis was the major RISK MARKER (RR, 3.43; 95% CI, 1.95-6.03). The other RMs, except for LVOTO, were also predictors: SD family history (RR, 1.75; 95% CI, 1.39-2.20), severe ventricular hypertrophy (RR, 1.86; 95% CI, 1.26-2.74), unexplained syncope (RR, 2.27; 95% CI, 1.69-3.07), NSVT (RR, 2.79; 95% CI, 2.29-3.41), and ABPRE (RR, 1.53; 95% CI, 1.12-2.08). Conclusions: We confirmed the association of myocardial fibrosis and other RMs with severe arrhythmic outcomes in HCM and emphasize the need for new prediction models in managing these patients

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BackgroundThe obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population.MethodsWe analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56–70), BMI 18.5–24.9 = 35.1%, 25–29.9 = 37.2%, 30–34.9 = 17.8%, 35–39.9 = 7%; BMI 40 groups were eliminated from the central analyzes because of scarce testing.ResultsBMI 30–34.9 and BMI 18.5–24.9 had the best prognosis, BMI 25–29.9 had an average performance, and BMI –39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30–34.9 group had a better prognosis compared to the BMI 35–39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI.ConclusionIn not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.</p