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      Valor prognóstico do índice do volume do átrio esquerdo em pacientes em hemodiálise Translated title: Prognostic value of left atrial volume index in hemodialysis patients

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          Abstract

          OBJETIVO: Avaliar o valor prognóstico do índice do volume do átrio esquerdo (IVAE) no curso clínico dos pacientes de hemodiálise (HD), comparando com parâmetros clínicos e ecocardiográficos previamente estabelecidos. MÉTODOS: Foram realizadas ecocardiografias em 118 pacientes de HD, que foram acompanhados por 19 ± 8 meses. O desfecho pesquisado foi composto de mortalidade geral e eventos cardiovasculares não-fatais. O valor prognóstico independente do IVAE foi testado pela análise multivariada de Cox. RESULTADOS: O IVAE e outros parâmetros clínicos e ecocardiográficos foram preditores do prognóstico na análise univariada. Na análise multivariada, o IVAE foi preditor independente do prognóstico (hazard ratio, 1,03 por ml/ m²; intervalo de confiança de 95%, 1,01 a 1,05; p=0,014) e adicionou informação incremental ao modelo contendo preditores tradicionais de risco cardiovascular, como massa ventricular esquerda, fração de ejeção e variáveis clínicas (p=0,02). CONCLUSÃO: O IVAE é preditor independente do prognóstico em pacientes de HD, provendo informação incremental aos dados clínicos e Doppler ecocardiográficos tradicionais.

          Translated abstract

          OBJECTIVE: To evaluate the prognostic value of left atrial volume index (LAVi) in the clinical course of hemodialysis (HD) patients, compared with previously established echocardiographic and clinical parameters. METHODS: Echocardiograms were obtained from 118 hemodialysis patients, who were then followed for 19 ± 8 months. Study endpoint was a composite of all-cause mortality and nonfatal cardiovascular events. Cox multivariate analysis was used do assess the independent prognostic value of LAVi. RESULTS: On univariate analysis, LAVi and other clinical and echocardiographic parameters were predictive of prognosis. Multivariate analyses showed that LAVi was an independent predictor of prognosis (hazard ratio 1.03 per ml/m², 95% confidence interval: 1.01 to 1.05, p=0.014), and added incremental information to the model containing traditional predictors of cardiovascular risk, such as left ventricular mass, ejection fraction, and clinical variables (p=0.02). CONCLUSION: LAVi is an independent predictor of prognosis in HD patients, providing incremental information to traditional clinical and Doppler echocardiographic data.

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          A formula to estimate the approximate surface area if height and weight are known

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            Cardiovascular disease in chronic renal failure: pathophysiologic aspects.

            Cardiovascular complications are the leading cause of mortality in patients with end-stage renal disease (ESRD). The excess cardiovascular risk and mortality is already demonstrable in early renal disease and in patients with chronic renal failure (CRF), with the highest relative risk of mortality in the youngest patients. The high risk for cardiovascular disease (CVD) results from the additive effect of multiple factors, including hemodynamic overload and several metabolic and endocrine abnormalities more or less specific to uremia. CVD includes disorders of the heart (left ventricular hypertrophy [LVH], cardiomyopathy) and disorders of the vascular system (atherosclerosis, arteriosclerosis), these two disorders being usually associated and interrelated. LVH is the most frequent cardiac alteration in ESRD, resulting from a combined pressure and volume overload. LVH in general is an ominous prognostic sign and an independent risk factor for arrhythmias, sudden death, heart failure, and myocardial ischemia. Regression of LVH needs a combined intervention to reduce hemodynamic overload and is associated with improved prognosis and survival. Clinical studies have shown that damage of large conduit arteries is a major contributing factor for the high incidence of congestive heart failure (CHF), LVH, ischemic heart disease (IHD), sudden death, cerebrovascular accidents, and peripheral artery diseases. Damage to large conduit arteries is principally related to highly calcified occlusive atherosclerotic lesions and to stiffening of large capacitive arteries. These two complications are independent risk factors for survival, and improvement of arterial stiffness is associated with better prognosis and survival. The present review summarizes the most recent works dealing with the pathophysiology of CVD and some aspects of the therapeutic approach.
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              The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study.

              To assess the prevalence, characteristics, and correlates of echocardiographically determined left ventricular hypertrophy (echo LVH) in a free-living population, 510 men and 855 women from the original Framingham cohort (age 59 to 90 years) were studied by M-mode echocardiography. Offspring and offspring spouses (1718 men and 1892 women; age 17 to 75 years) were similarly studied. The severity of echo LVH, as reflected by left ventricular mass indexed to body surface area, ranged from 101 g/m2 (women) and 132 g/m2 (men) to more than 400 g/m2. The prevalence of electrocardiographically assessed LVH increased proportionately with increased echocardiographic left ventricular mass. Women with echocardiographic left ventricular mass indexes exceeding 200 g/m2 were three to four times more likely to have electrocardiographic LVH than men with similar elevations of echocardiographic left ventricular mass index. The prevalence of echo LVH ranged from 6.6% in the younger (offspring study) women to 33% in the older (original cohort) women (8.6% and 23.7%, respectively, for men) and included a spectrum of forms--eccentric-dilated, eccentric-nondilated, concentric, and disproportionate septal thickness--which varied in prevalence in the various age-sex groups. Each of these forms of echo LVH was associated with higher systolic blood pressures at the time of echocardiographic examination and over the previous 30 years when compared with blood pressures of Framingham subjects without echo LVH.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                abc
                Arquivos Brasileiros de Cardiologia
                Arq. Bras. Cardiol.
                Sociedade Brasileira de Cardiologia - SBC (São Paulo )
                1678-4170
                June 2007
                : 88
                : 6
                : 643-650
                Affiliations
                [1 ] Pontifícia Universidade Católica do Paraná Brazil
                Article
                S0066-782X2007000600004
                10.1590/S0066-782X2007000600004
                dfd805c5-bf84-4d86-85c5-20453475827a

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0066-782X&lng=en
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS

                Cardiovascular Medicine
                Hypertrophy, left ventricular,renal dialysis,risk assessment,echocardiography, Doppler,Diálise renal,hipertrofia ventricular esquerda,medição de risco,ecocardiografia Doppler

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