Avaliação do efeito do carvedilol sobre o remodelamento reverso cardíaco através de medidas morfo funcionais em cardiomiopatia hipertensiva

Abstract

The cardiac remodeling (RC) associated with systemic arterial hypertension (SAH) culminates in changes of the shape, geometry, composition and function of the cardiac muscle that makes up the hypertensive cardiomyopathy. These modification results from the hemodynamic burden on the heart associated with ischemia, neurohumoral changes and action of inflammator cytokines. The hypertensive cardiomyopathy includes the heart failure (HF), left ventricular hypertrophy (LVH), arrhythmias and myocardial ischemia. Carvedilol, a special beta blocker, presents anti remodeling action. The aim of this study was to evaluate the effects of carvedilol for at least six months in patients treated for hypertension, including an inhibitor of the renin-angiotensin-aldosterone axis, whom have ejection fraction (EF) < 55%. We made a chart review of 98 patients above 18 years-old, which were followed between 2003 and 2013 in the Heart Institute of São Paulo (InCor). The present study analised reverse remodeling by measuring post-treatment FE by bidimensional Doppler echocardiography. We considered any FE improvement. of Hemodynamic, laboratorial and demographics variables were analyzed too, before and after treatment. The sample were composed by men in the majority, who were predominantly White, with median age of 55 years old; half of them were overweight. According to Wilcoxon’s test for paired samples, after treatment there was a significant improvement of the ejection fraction (p<0,001), and their median rose 11 points. Almost 70% of the sample benefited from the use of carvedilol. There was a significant reduction of the diastolic diameter of LV, LVEDD (p=0,001); systolic diameter of LV, LVESD (p=0,001); cardiac mass index, CI (p=0,001); arterial systolic pressure, SBP (p=0,004), arterial diastolic pressure, DBP (p<0,001), mean arterial pressure, PAM (p<0,001) and heart rate (HR) (p<0,001); blood glucose presented a significant, but unobtrusive increase (p=0,036) and body mass index had too (p=0,003).Considering significance of 5%, only the variable EF showed difference in pre treatment, comparing the group improved with not improved EF, using Mann-Whitney test for independent samples (p=0,001). In this comparison, the group that had rise in EF, presented the median EF pre treatment 34%, against the median 45% of the group that did not improve. Improve in EF was associated to death risk reduction about 6 times, according to exact Fischer’s test (RR=5,7, p=0,02). In the Kaplan Meier curve, the survival by 10 years was 95% in the improved FE group and 57% for the group whom has not improved (p=0,009). We concluded that carvedilol favored reduction of blood pressure, HR, cardiac dimensions and improved EF in patients with hypertensive cardiomyopathy. These changes pos treatment had a favorable effect on suvival, but it occurred along with the worsening levels of the glycemia and the BMI.