Prevalência de arritmia ventricular e fatores associados em pacientes com doença renal crônica não dialítica.
Data
2014
Autores
Bonato, Fabiana Oliveira Bastos 
Orientadores
Canziani, Maria Eugênia Fernandes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução e objetivos: A morte subita e a causa mais comum de obito entre os pacientes com doenca renal cronica, e ocorre na maior parte das vezes secundariamente a arritmias ventriculares. Neste estudo, o objetivo foi investigar a prevalencia de arritmia ventricular e os fatores associados com sua ocorrencia em pacientes com DRC em fase nao dialitica. Desenho e metodos: Trata-se de um estudo transversal, que avaliou 111 pacientes com doenca renal cronica nao dialitica (TFGe: 34,7 ± 16,1 mL/min por 1,73m², 57 ± 11,4 anos, 60% homens, 24% diabeticos). Arritmia ventricular foi acessada atraves do eletrocardiograma de 24 horas. Hipertrofia ventricular esquerda (ecocardiograma), Monitorizacao Ambulatorial da Pressao Arterial, calcificacao arterial coronariana (tomografia computadorizada de coronarias) e exames laboratoriais tambem foram avaliados. Resultados: Arritmia ventricular foi encontrada em 35% dos pacientes.Pressao arterial nao controlada foi observada em 21% dos pacientes, ausencia de descenso sistolico noturno em 29%, hipertrofia ventricular esquerda em 27%, disfuncao sistolica em 10% e calcificacao arterial coronariana em 49%. Pacientes com arritmia ventricular eram mais velhos (p<0,001), predominantemente homens (p=0,009), tinham TFGe (p=0,03) e hemoglobina (p=0,005) maiores, e iPTH (p = 0,024) e triglicerides (p = 0,011) menores, quando comparados aqueles sem arritmia ventricular. Alem disso, os pacientes com arritmia ventricular apresentavam: indice de massa ventricular esquerda (p=0,002) e escore de calcio em coronarias (p=0,002) maiores, e fracao de ejecao de ventriculo esquerdo menor (p=0,001). Na analise de regressao logistica multipla, idade mais elevada, niveis aumentados de hemoglobina e reducao na fracao de ejecao foram independentemente relacionados a presenca de arritmia ventricular. Conclusoes: Arritmia ventricular e prevalente nos pacientes com doenca renal cronica nao dialitica. Idade, niveis de hemoglobina e fracao de ejecao foram os fatores associados com arritmia ventricular nesta populacao
Background and objectives: Sudden cardiac death is the most common cause of mortality in chronic kidney disease patients, and it occurs mostly due to ventricular arrhythmias. In this study, we aimed at investigating the prevalence of ventricular arrhythmia and the factors associated with its occurrence in nondialyzed chronic kidney disease patients. Design, setting, participants and measurements: This crosssectional study evaluated 111 chronic kidney disease patients (eGFR 34.7±16.1 mL/min/1.73m², 57±11.4 years, 60% male, 24% diabetics). Ventricular arrhythmia was assessed by 24hour electrocardiogram. Left ventricular hypertrophy (echocardiogram), 24hour ambulatory blood pressure monitoring, and coronary artery calcification (multislice computed tomography) and laboratory parameters were also evaluated. Results: Ventricular arrhythmia was found in 35% of the patients. Noncontrolled hypertension was observed in 21%, absence of systolic decency in 29%, left ventricular hypertrophy in 27%, systolic dysfunction in 10%, and coronary artery calcification in 49%. Patients with ventricular arrhythmia were older (p<0.001), predominantly men (p=0.009), had higher eGFR (p=0.03) and hemoglobin (p=0.005), and lower iPTH (p = 0.024) and triglycerides (p=0.011) when compared to patients without ventricular arrhythmia. In addition, a higher frequency of left ventricular mass index (p=0.002), coronary calcium score (p=0.002) and lower ejection fraction (p=0.001) was observed among patients with ventricular arrhythmia. In the multiple logistic regression analysis, aging, increased hemoglobin levels and reduced ejection fraction were independently related to the presence of ventricular arrhythmia.
Background and objectives: Sudden cardiac death is the most common cause of mortality in chronic kidney disease patients, and it occurs mostly due to ventricular arrhythmias. In this study, we aimed at investigating the prevalence of ventricular arrhythmia and the factors associated with its occurrence in nondialyzed chronic kidney disease patients. Design, setting, participants and measurements: This crosssectional study evaluated 111 chronic kidney disease patients (eGFR 34.7±16.1 mL/min/1.73m², 57±11.4 years, 60% male, 24% diabetics). Ventricular arrhythmia was assessed by 24hour electrocardiogram. Left ventricular hypertrophy (echocardiogram), 24hour ambulatory blood pressure monitoring, and coronary artery calcification (multislice computed tomography) and laboratory parameters were also evaluated. Results: Ventricular arrhythmia was found in 35% of the patients. Noncontrolled hypertension was observed in 21%, absence of systolic decency in 29%, left ventricular hypertrophy in 27%, systolic dysfunction in 10%, and coronary artery calcification in 49%. Patients with ventricular arrhythmia were older (p<0.001), predominantly men (p=0.009), had higher eGFR (p=0.03) and hemoglobin (p=0.005), and lower iPTH (p = 0.024) and triglycerides (p=0.011) when compared to patients without ventricular arrhythmia. In addition, a higher frequency of left ventricular mass index (p=0.002), coronary calcium score (p=0.002) and lower ejection fraction (p=0.001) was observed among patients with ventricular arrhythmia. In the multiple logistic regression analysis, aging, increased hemoglobin levels and reduced ejection fraction were independently related to the presence of ventricular arrhythmia.
Descrição
Citação
BONATO, Fabiana Oliveira Bastos. Prevalência de arritmia ventricular e fatores associados em pacientes com doença renal crônica não dialítica. 2013. 97 f. Dissertação (Mestrado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2014.