Impact of the Therapeutic Optimization of Heart Failure in the Reverse Remodeling of the Ventricular Function: Quality of Life association with Morphologic, Eletric and Functional Analysis.

• Grant number: 09/09244-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: September 01, 2009
• End date: August 31, 2010
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Edimar Alcides Bocchi
• Grantee: Marcos Blini Pereira
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

The current treatment of heart failure (HF) changed importantly the prognostic of the pacients with this syndrome, effectively reducing mortality. This effect is obtained in a great part because of the cardiac reverse remodeling that occurs in vigency of the optimized treatment.However, despite the great importance of reverse remodeling in the effectiveness HF treatment, the methods used for analysis of parameters related to it have deficiency in some morphological, electrical and functional aspects. This deficiency is mainly observed in the echocardiographic analysis of cardiac chambers of patients with HF, which is widely used as a parameter of the patients follow up and presents strong limitations to the use of two-dimensional echocardiography. Facing these issues, this study aims to analyze the cardiac reverse remodeling through advanced methods (three-dimensional echocardiography, micro T-wave alternation, ergospirometry, plasmatic BNP and catecholamines), before optimal treatment introduction and 6 months later. Furthermore in order to better evaluate the treatment impact in quality of life, a questionnaire (Minnesota Living with Heart Failure Questionnaire) will be applied at baseline and after 6 months of treatment, allowing correlation of the variables studied and our patients quality of life.Methodology: 25 patients will be selected from the outpatient unit of Heart Failure and Transplantation of the INCOR-FMUSP with the diagnosis of HF functional class II-IV and ejection fraction <45% that havent started the use of beta-blockers yet. The patients selected for the study will be submitted to two stages of analysis through the ECO-3D, MAOT, ergospirometry, dosage of BNP, plasma catecholamines and "Minnesota Living with Heart Failure Questionnaire." The first stage will occur in the patients inclusion in the study. The second stage will be held six months after the first, with the patient in vigency of HF optimal treatment, in continuous use of maximum tolerated doses of beta-blocker and inhibitor of angiotensin converting enzyme or angiotensin receptor blocker in order to observe changes induced by pharmacological treatment applied in these patients, correlating them with the patients quality of life.