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Impact of the therapeutical optimization of cardiac failure in the reverse remodeling of the ventricular function: morphologic, electric and functional analysis

Abstract

Cardiac remodeling is one of the principal mechanisms of progression of Heart Failure (HF). The use of beta-blockers (BB) modified the morbidity and mortality of patients with HF, causing reduction of approximately 34% into the risk of death or hospitalization.In addition to the influence on survival of patients with HF, the use of BB promotes reversal of the cardiac remodeling resulting in an augmentation of 29% of ejection fraction, analyzed by two-dimensional echocardiogram.The reduction of mortality of patients treated with BB is not attributed only by reduction in the progress of cardiac dysfunction but by reduction on sudden death approximately in 40%. High levels of catecholamines in patients with HF change the automaticity, trigger activity and reenter mechanisms into myocardium. The role of BB on prevention of sudden death is related to its capacity of counteract the arrhythmogenic effect from catecholamines.Three-dimensional echocardiography (ECHO-3D) allows the identification of cardiac structure in real time in multiples plans of observation. Therefore ECHO-3D provides a better anatomic evaluation of the heart than two-dimensional echocardiogram.T-Wave Alternans (TWA) is defined as a periodic fluctuation on amplitude or morphology of T-wave. Heart failure patients with induced ventricular tachycardia or TWA positive have major heterogeneities on ventricular repolarization than patients without induced VT or TWA negative. The use of BB to the treatment of HF could reduce the heterogeneities on repolarization ventricular, explaining the reduction on sudden death.In resume the treatment optimize to HF, mainly with the use of BB, reduces the progression of ventricular dysfunction and the incidence of sudden death. This study intends to demonstrate using advanced methods (ECHO -3D and TWA) the rate of reversal of the ventricular remodeling after the optimization of therapeutics to HF.Objectives: Study the effect of optimization of treatment to heart failure into the reverse ventricular remodeling using ECHO -3D and TWA.Methodology: 25 patients with heart failure class functional II - IV, ejection fraction less than 45% and not in use of BB will be selected. These patients will be submitted to ECHO-3D, TWA, cardiopulmonary stress test and determination of BNP and catecholamines on inclusion and after six months (when heart failure treatment will be optimized). (AU)