Repercussão nutricional na insuficiência cardíaca avançada e seu valor na avaliação prognóstica

Abstract

Since the beginning of medicine, malnutrition is acknowledged as a manifestation associated to congestive heart failure (CHF), especially in its more advanced stages. Among the list of classical manifestations of cardiac diseases we find many levels of proteincaloric depletion, even the extreme clinical features, generically called cardiac cachexia 1,2 . The clinical and experimental data available indicate a causeeffect relation between CHF and malnutrition 3,4 . There are questions about which mechanisms lead to malnutrition and the importance of each mechanism in the maintenance and aggravation of the features 5,6 . Along with the questions concerning the physiopathology, there are others on the assessment way. The nutritional assessment, which is usually done in hospitalized patients is inaccurate and can use many parameters to achieve a general impression on the existence or not of protein-caloric malnutrition. The key point to determine the malnutrition level, as well as the best assessment parameters, has not been properly defined and standardized yet [7][8][9][10] . This study had as objective to assess the behavior of many indexes of malnutrition status in a group of chronic CHF carriers as a consequence of left ventricular dysfunction due to dilated cardiomyopathy, in an advanced stage of the disease. It also aimed at verifying whether the compromising level of nutritional parameters has any relation with the time of evolution of its symptoms, if the intensity of compromising of indicators of the nutritional status of the disease is related to the level of left ventricular systolic dysfunction, and if its changes have a prognostic value in advanced chronic CHF. MethodsThe nutritional status of 95 carriers of congestive heart failure due to dilated cardiomyopathy in functional class III/IV, hospitalized at Hospital Auxiliar de Cotoxó (HCFMUSP) for compensation, was assessed.The patients were selected among those 1,176 hospitalized during the 12 months of sample selection for the study, from which 412 were carriers of congestive heart failure.The exclusion criteria of the study were situations that could cause changes in the nutritional situation of the patients or modify the natural history of the disease: age < 15 or > 65 years old; valvar dysfunctions subjected to surgical corrections; coronary failure; symptomatic cardiac arrhythmias; diastolic blood pressure at admission ConclusionMalnutrition is frequent in patients with advanced heart failure and dilated cardiomyopathy. The reduced body mass was a better predictor of survival than the left ventricular ejection fraction in patients under advanced stage of myocardial compromising.

Anemia, disfunção renal e desnutrição associadas à insuficiência cardíaca em pacientes valvopatas

“…The available clinical and experimental data indicate an association between HF and malnutrition 27 . There are some doubts on which mechanisms lead to malnutrition and what the importance of each mechanism is in the maintenance and aggravation of the condition 28 .…”

“…Veloso et al 27 suggest that the impact of the nutritional status on advanced heart failure, although it results from the left ventricular contractile dysfunction as a common etiological factor, have as its main determinant factors, in each individual, other factors that go beyond the involvement of the cardiac pump. The nutritional involvement could be better understood within the scope of the complex peripheral adaptation and the neurohumoral response to myocardial failure 27 …”

“…The nutritional involvement could be better understood within the scope of the complex peripheral adaptation and the neurohumoral response to myocardial failure 27 …”

Nutritional risk and associated factors in elderly patients with congestive heart failure in a Brazilian cardiology hospital

“…Varying degrees of protein-calorie depletion can be observed. 9 A Brazilian study in 53 patients hospitalized for CHF with a mean age of 57.7 years using Subjective Global Nutritional Assessment reported a prevalence of malnutrition of 60.4%. 10 Cardiac patients with moderate or severe calorie malnutrition were found to have twice the mortality risk.…”

Prescrição de dieta na insuficiência cardíaca crônica: por que não fazemos?

“…Patients with heart failure secondary to Chagas' disease are subject to the effects of a lower socio-economic status, which may directly affect their dietary habits. Although the degree of left ventricular systolic dysfunction did not involve the level of malnutrition in heart failure patients in some studies 9,10 , this is still a controversial issue, as the weight loss observed in these patients is linked to more intense neuro-humoral and immunological changes 9 .…”