Arquivos Brasileiros de Cardiologia (Apr 2010)
Prevalência e impacto prognóstico da disfunção diastólica na doença renal crônica em hemodiálise Prevalencia e impacto pronóstico de la disfunción diastólica en la enfermedad renal crónica en hemodiálisis Prevalence and prognostic impact of diastolic dysfunction in patients with chronic kidney disease on hemodialysis
Abstract
FUNDAMENTO: Disfunção diastólica é frequente em pacientes de hemodiálise, mas seu impacto na evolução clínica é incerto. OBJETIVO: Avaliar a prevalência e o impacto prognóstico da disfunção diastólica (DD) avançada (DDA) do ventrículo esquerdo (VE) em pacientes de hemodiálise. MÉTODOS: Ecocardiogramas foram realizados em pacientes no primeiro ano de hemodiálise, em ritmo sinusal, sem doença cardiovascular manifestada, excluindo-se aqueles com valvopatia significativa ou derrame pericárdico. Pela avaliação integrada dos dados ecodopplercardiográficos, a função diastólica foi classificada como: 1) normal, 2) DD discreta (alteração do relaxamento) e 3) DDA (pseudonormalização e fluxo restritivo). Os desfechos pesquisados foram mortalidade geral e eventos cardiovasculares. RESULTADOS: Foram incluídos 129 pacientes (78 homens), com idade 52 ± 16 anos e prevalência de DD de 73% (50% com DD discreta e 23% com DDA). No grupo com DDA, demonstrou-se maior idade (p FUNDAMENTO: Disfunción diastólica es frecuente en pacientes de hemodiálisis, pero su impacto en la evolución clínica es incierto. OBJETIVO: Evaluar la prevalencia y el impacto pronóstico de la disfunción diastólica (DD) avanzada (DDA) del ventrículo izquierdo (VI) en pacientes de hemodiálisis. MÉTODOS: Se realizaron ecocardiogramas en pacientes en el primer año de hemodiálisis, en ritmo sinusal, sin enfermedad cardiovascular manifestada, excluyéndose aquellos con valvulopatía significativa o derrame pericárdico. Por la evaluación integrada de los datos del ecocardiograma Doppler, la función diastólica fue clasificada como: 1) normal, 2) DD discreta (alteración de la relajación) y 3) DDA (seudonormalización y flujo restrictivo). Los desenlaces investigados fueron mortalidad general y eventos cardiovasculares. RESULTADOS: Fueron incluidos 129 pacientes (78 hombres), con edad 52 ± 16 años y prevalencia de DD del 73% (50% con DD discreta y 23% con DDA). En el grupo con DDA, se presentó mayor edad (p BACKGROUND: Diastolic dysfunction (DD) is frequent in patients on hemodialysis (HD), but its impact on the clinical evolution is yet to be established. OBJECTIVE: To evaluate the prevalence and prognostic impact of left ventricular (LV) advanced diastolic dysfunction (ADD) in patients on hemodialysis. METHODS: The echocardiograms were performed during the first year of HD therapy, in patients with sinus rhythm, with no evidence of cardiovascular disease, excluding those with significant valvopathy or pericardial effusion. The combined assessment of the Doppler echocardiographic data classified the diastolic dysfunction as: 1) normal diastolic function; 2) mild DD (relaxation alteration) and 3) ADD (pseudonormalization and restrictive flow pattern). The assessed outcomes were general mortality and cardiovascular events. RESULTS: A total of 129 patients (78 males), aged 52 ± 16 years, with a DD prevalence of 73% (50% with mild DD and 23% with ADD) were included in the study. The group with ADD was older (p < 0.01) and presented higher systolic (p < 0.01) and diastolic BP (p = 0.043), LV mass (p < 0.01), left atrial volume index (p < 0.01) and number of diabetic patients (p = 0.019), as well as lower ejection fraction (EF) (p < 0.01). After 17 ± 7 months, the general mortality was significantly higher in individuals with ADD, when compared to those with normal function and mild DD (p = 0.012, log rank test). At Cox multivariate analysis, ADD was predictive of cardiovascular events (hazard ratio 2.2; confidence interval: 1.1-4.3; p = 0.021) after adjusted for age, gender, diabetes, LV mass and EF. CONCLUSION: The subclinical ADD was identified in approximately 25% of the patients undergoing hemodialysis and had a prognostic impact, regardless of other clinical and echocardiographic data.
