Brazilian Journal of Cardiovascular Surgery (Sep 2005)
Impacto da troponina I cardíaca sérica na evolução tardia de pacientes submetidos a ressincronização com estimulação biventricular: seguimento de até 59 meses Impact of serum troponin I in the long-term evolution of patients submitted to resynchronization with biventricular stimulation: follow-up of up to 59 months
Abstract
OBJETIVO: Analisar evolução e a influência prognóstica dos níveis séricos da troponina I cardíaca nos pacientes com insuficiência cardíaca congestiva (ICC) submetidos a ressincronização interventricular (RV), com seguimento de até 59 meses. MÉTODOS: Foram analisados 33 pacientes com miocardiopatia dilatada idiopática em classe funcional III/IV da NYHA, submetidos a RV. A qualidade de vida (QV) foi analisada pré e pós-operatoriamente com o Minnesota Code e a função ventricular através da ecocardiografia. Os níveis séricos da troponina I foram dosados em 23 pacientes, utilizando o teste exato de Fischer para avaliar sua relação com o evento óbito, e a curva de Kaplan-Meier para análise da taxa de sobrevivência. RESULTADOS: A QV foi significantemente melhor após a RV, com mediana de 73 pontos, no pré e 36, no pós (pOBJECTIVE: To analyze the evolution and prognostic influence of the cardiac troponin I serum levels in patients with congestive heart failure (CHF) submitted to interventricular resynchronization (VR) over a 59-month follow-up period. METHOD: Thirty-three patients with idiopathic dilated myocardiopathy in NYHA functional classes III and IV were submitted to VR. The pre- and post-operative quality of life (QV) was analyzed using the Minnesota Code and the left ventricle function was assessed by echocardiography. The cardiac troponin I levels were compared in 23 patients utilizing the Fisher exact test to analyze the correlation with death and the Kaplan-Meier curve was used to analyze the survival rate. RESULTS: The QV was better after VR with a median of 73 points in the pre-operative period and 36 in the postoperative period (p-value < 0.0001). The left ventricle diastolic diameter (LVDD) reduced from 65 mm in the preoperative period to 60 mm in the postoperative period (p-value = 0.0014) with an increase in the ejection fraction from 37 to 47% (p-value = 0.0004). In 15 patients with normal cardiac troponin I levels, no deaths occurred and of the 8 patients with high levels, six died (p-value = 0.0003). The actuarial survival curve showed a survival rate of 47.1 ± 13.3% at the end of 59 months. CONCLUSION: VR in patients with CHF improves the QV and echocardiographic parameters (ejection fraction and LVDD). It is a good alternative for functional class III and IV patients. The serum levels of cardiac troponin I are predictors of risk to life.
Keywords
