Publications by authors named "Dora V Palombini"

5 Publications

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Characteristics associated with mortality in patients with chronic obstructive pulmonary disease (COPD)-heart failure coexistence.

Prim Health Care Res Dev 2018 11 21;19(6):570-574. Epub 2018 Feb 21.

1Hospital de Clinicas de Porto Alegre (HCPA),Universidade Federal do Rio Grande do Sul (UFRGS),Porto Alegre,RS,Brazil.

AimTo investigate if cardiac/pulmonary functional tests and variables obtained from clinical practice (body mass index, dyspnea, functional class, clinical judgment of disability to perform an exercise test and previous hospitalization rate) are related to mortality in patients with overlap chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). BACKGROUND: Although the coexistence of COPD and CHF has been growingly reported, description of survival predictors considering the presence of both conditions is still scarce. METHODS: Using a cohort design, outpatients with the previous diagnosis of COPD and/or CHF that performed both spirometry and echocardiography in the same year were followed-up during a mean of 20.9±8.5 months.FindingsOf the 550 patients initially evaluated, 301 had both spirometry and echocardiography: 160 (53%) with COPD on isolation; 100 (33%) with CHF on isolation; and 41 (14%) with overlap. All groups presented similar mortality: COPD 17/160 (11%); CHF 12/100 (12%); and overlap 7/41 (17%) (P=0.73). In the overlap group (n=41), inability to exercise and hospitalization rate were the unique parameters associated with higher mortality (seven events) in univariate analyses. In conclusion, inability to exercise and hospitalization rate emerged as the unique parameters associated with mortality in our sample.
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November 2018

Serum procollagen type III is associated with elevated right-sided filling pressures in stable outpatients with congestive heart failure.

Biomarkers 2009 Sep;14(6):438-42

Division of Cardiology, Hospital de Clínicas de Porto Alegre, Post-graduate Program of Cardiovascular Sciences: Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Elevated filling pressures are associated with heart failure deterioration, but mechanisms underlying this association remain poorly understood. We sought to investigate whether or not elevated filling pressures are associated with increased collagen turnover, evaluated by procollagen type III aminoterminal peptide (PIIINP) levels, in stable systolic heart failure. Eighty patients with heart failure with severe systolic dysfunction (ejection fraction 26 +/- 7%) were included. Patients underwent simultaneous echocardiogram with evaluation of haemodynamic parameters and blood sampling for PIIINP measurement. Mean PIIINP level was 6.11 +/- 2.62 microg l(-1). PIIINP was positively associated with estimated right atrial pressure (RAP) (r = 0.36; p = 0.001). Mean PIIINP values were 5.04 +/- 2.42 microg l(-1) in patients with estimated RAP < or = 5 mmHg, and 7.59 +/- 2.54 microg l(-1) in those with RAP > 15 mmHg (p < 0.01). In conclusion, elevated right-side filling pressures are associated with evidence of active extracellular matrix turnover, as indicated by elevated PIIINP levels, in stable systolic heart failure. Activation of extracellular matrix turnover may be implicated in the accelerated progression of heart failure syndromes seen in patients with persistent congestion.
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September 2009

A hemodynamically oriented echocardiography-based strategy in the treatment of congestive heart failure.

J Card Fail 2007 Oct;13(8):618-25

Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.

Background: The therapeutic applicability of echocardiographic evaluations remains poorly defined in heart failure (HF). We hypothesized that an individualized echocardiography-guided strategy would be feasible and significantly reduce morbidity compared with the conventional clinically oriented treatment.

Methods And Results: We conducted a single-center clinical trial comparing an echocardiography-guided strategy aimed at achieving a near-normal hemodynamic profile and a conventional clinically oriented strategy for HF management. The echocardiography-guided strategy was based on sequential echocardiograms to evaluate hemodynamically derived parameters. Pharmacologic therapy was guided according to a predefined protocol. The primary efficacy end point was time to the first event of combined all-cause mortality and all-cause hospitalization or emergency department visit up to 1 year of follow-up. We studied 96 outpatients with HF, enrolled from 1999 to 2003, with predominantly nonischemic cause and a mean left ventricular ejection fraction of 26% +/- 6%. Event-free survival at a mean follow-up of 230 days was 58.5% with the echocardiography-guided strategy and 36.5% with the clinically based strategy (relative risk = 0.54, 95% confidence interval = 0.31-0.97, P = .04). More patients in the echocardiography-based group received high-dose loop diuretics (absolute difference of 19%, P = .02) and hydralazine (absolute difference of 30%, P < .001). Significant reductions of estimates of pulmonary artery systolic pressure (mean difference of -9 mm Hg, P = .02) and systemic vascular resistance index (mean difference of -700 dyn x sec x m2 x cm5, P = .02) were observed in the echocardiography-guided group.

Conclusion: A hemodynamically oriented echocardiography-based strategy is feasible and decreases HF morbidity. This benefit could be attributed in part to the rational and individualized use of higher doses of diuretics and vasodilators.
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October 2007

Reliability and prognostic value of traditional signs and symptoms in outpatients with congestive heart failure.

Can J Cardiol 2004 May;20(7):697-702

Cardiovascular Division, Hospital de Clínicas de Porto Alegre and Cardiovascular Post-Graduation Program, School of Medicine from Rio Grande do Sul Federal University (UFRGS), Brazil.

Background: Previous validation studies of congestive heart failure (CHF) signs and symptoms were performed in acute settings. Few data have supported the validity of CHF clinical findings during the chronic stages of the disease. This study was designed to evaluate the reliability and prognostic value of traditional signs and symptoms in stable CHF outpatients.

Methods: Sixty CHF outpatients who underwent 102 simultaneous clinical and echocardiographic evaluations were prospectively examined. A clinical congestion score was built summing all grades of CHF signs and symptoms. Hemodynamic parameters were estimated according to previously validated echocardiography-based protocols. Major cardiac events were evaluated after 180 days.

Results: Most CHF patients were male (67%), middle-aged (56+/-15 years) and in Specific Activity Scale functional classes I to II (70%). Isolated clinical findings demonstrated limited sensitivity and specificity to identify hemodynamic parameters. Absence of all signs of congestion, however, had a predictive value of 95% for a left atrial pressure less than 20 mmHg. Patients with no CHF signs or symptoms (score of 0) had significantly lower right (P<0.001) and left (P=0.03) atrial pressures compared with those with higher scores (scores of at least 5). In multivariate analysis, a congestion score of at least 3 (RR 4.8, 95% CI 1.3 to 17.4, P=0.02) and beta-blockers use (P=0.02) remained associated with future cardiac events.

Conclusions: Although CHF signs and symptoms did not accurately identify hemodynamic parameters, combined data from history and physical examination provided meaningful information to guide clinical decisions and for prognostication.
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May 2004