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C Mady

Publications and source records attributed to C Mady.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Relationship between ventricular arrhythmia and cardiac function in Chagas disease].

PURPOSE: It is well established the association between heart failure and arrhythmias in different cardiopathies. There are no studies in Chagas' myocardiopathy that analyze the relation between arrhythmias and left ventricular function. METHODS: We studied 629 patients with Chagas' disease, divided in 3 groups, according to ejection fraction obtained through echocardiographic study (normal, between 0.64 and 0.45, and below 0.44). RESULTS: At conventional ECG, the presence of ventricular arrhythmias was respectively in the 3 groups: 15%, 36% and 64%, showing higher incidence when left ventricular function was getting worse. CONCLUSION: Ventricular arrhythmias in Chagas' disease are frequent in patients with normal ejection fraction, and become more intense as ventricular dysfunction progresses.

Adolescent↗
PubMed1995

[Magnetic resonance imaging in chronic Chagas cardiopathy. Correlation with endomyocardial biopsy findings].

PURPOSE: To study the correlation between magnetic resonance imaging of the heart and right ventricle endomyocardial biopsy results in chronic Chagas' heart disease. METHODS: Ten patients with Chagas' disease, mean age 47 +/- 7 years, all males, in congestive heart failure with New York Heart Association class II (2 patients), III (6) and IV (2) were studied. Mean left ventricular ejection fraction was at echocardiogram 36 +/- 6%. The patients were submitted to right ventricular endomyocardial biopsy and magnetic resonance imaging of the heart. The results of this group were compared with a control group of patients with idiopathic dilated cardiomyopathy, with mean age of 46 +/- 10 years and left ventricular ejection fraction of 30 +/- 4%, in heart failure with functional class II (1 patient), III (5) and IV (1). RESULTS: All patients with Chagas' heart disease presented an increase in magnetic ressonance imaging signal of the heart after gadolinium use. The septal signal intensity changed from 0.87 +/- 0.06 to 1.54 +/- 0.16 (p < 0.001). In the control group the mean septal signal intensity was 0.93 +/- 0.07 before and 0.89 +/- 0.06 after the gadolinium (p = ns). Eight patients of the Chagas' disease group had biopsy proven myocarditis and two had borderline myocarditis. However, only one patient of the control group had diagnosis of borderline myocarditis. CONCLUSION: Myocarditis is frequently found in Chagas' heart disease patients and who unlike controls present a significant increase in myocardial signal intensity after gadolinium infusion. The magnetic resonance imaging of the heart seems a promising alternative method for the diagnosis of an inflammatory process in Chagas' heart disease.

Adult↗
PubMed1994

Survival and predictors of survival in patients with congestive heart failure due to Chagas' cardiomyopathy.

BACKGROUND: The fundamental determinant of the natural history of Chagas' disease is cardiac involvement. METHODS AND RESULTS: We studied 104 male patients with congestive heart failure due to Chagas' disease to estimate the survival distribution function and to evaluate age, functional class (FC), maximal oxygen consumption (VO2max), and ejection fraction (EF) as predictors of survival. Statistical evaluation was performed through univariate (Student's t test and chi 2 test) and multivariate analyses (Cox's regression model). Overall survival was 66% at 1 year, 56% at 3 years, and 48% at 5 years. Ages were not statistically different (P = .9811) between survivor (40.3 +/- 8.7) and nonsurvivor (40.3 +/- 9.4) groups. The ejection fraction(s) were statistically different (P = .0001) between survival (43.6 +/- 9.9) and nonsurvival (30.6 +/- 8.1) groups, as was VO2max (P = .0001) (21.0 +/- 4.7 and 15.0 +/- 4.9, respectively). Most of the surviving patients were in FC II and most of the nonsurvivors were in FC IV (P = .0001). VO2max (P = .0001) and EF (P = .0008) are highly associated with survival time in the multivariate analysis, but FC (P = .0578) is less important. Age (P = .9811) did not influence survival. CONCLUSIONS: We conclude that 50% of the patients with heart failure due to Chagas' disease die in 47 months and that VO2max and EF are important indices of survival in this group.

Adolescent↗
PubMed1994

[Comparative study between ibopamine and captopril in mild and moderate heart failure. A double-blind study].

PURPOSE: To evaluate the effect on symptoms, exercise capacity (stress test) and myocardial response (Echo, and Holter) of ibopamine or captopril in patients with congestive heart failure. METHODS: Double-blind, parallel randomized study of 18 patients, 9 in each group, studied during three months at the outpatient clinic. Twelve were male, 6 female, all in heart failure functional class II or III. The age ranged from 27 to 67 year-old (mean 48.7 years). The patients received captopril 50 mg tid or ibopamine 100 mg tid. RESULTS: The patients presented clinical improvement in both groups. At the stress test there was an increase of exercise time from 9 to 17 minutes and from 12 to 16 minutes with captopril and ibopamine respectively. The Echo study showed respectively to captopril and ibopamine groups a left ventricular and diastolic diameter increase from 72 to 74 and from 74 to 75mm and a increase from 0.35 to 0.38 and from 0.35 to 0.39 of the left ventricular ejection fraction. The incidence of ventricular arrhythmias was similar in both groups. CONCLUSION: These data show that ibopamine improved cardiac function, increasing the cardiac output, ejection fraction and exercise time and did not increase the incidence of arrhythmias. This effect is similar to that observed with captopril.

Adult↗
PubMed1993

Maximal functional capacity in patients with endomyocardial fibrosis.

We evaluated objectively the cardiocirculatory dysfunction of patients with EMF, and related the functional class (FC-NYHA) to the data obtained by analysis of maximal functional capacity. We studied 55 subjects, divided into three groups: group 1 (G1) 21 (38.1%) normal persons, group 2 (G2) seven (12.7%) patients with EMF who were in FC I or II, and group 3 (G3) 27 (49%) patients in FC III or IV. Maximal oxygen consumption (VO2max) and O2 pulse index (PO2max) were obtained using a Beckman computerized gas analyser. The mean values were significantly different among the three groups. We conclude that the greater the clinical impairment, the greater the alterations that occur in the indices of cardiac function.

Adult↗
PubMed1993

[Idiopathic restrictive cardiomyopathy].

PURPOSE: To characterize the idiopathic restrictive cardiomyopathy (RCM) through clinical manifestations and complementary tests and to analyze the surgical benefit on the correction of tricuspid regurgitation. METHODS: Five patients with RCM idiopathic were retrospectively studied, 4 female and 1 male, with ages ranging from 30 to 59 (mean 40) years. The patients presented heart failure due to restrictive syndrome and were submitted to chest X-ray, EKG, echocardiogram, right ventricular endomyocardial biopsy, hemodynamic study and surgery. RESULTS: X-ray showed heart enlargement in all patients, but only one had pulmonary venous capillary congestion. EKG presented atrial fibrillation, complex QRS with low voltage on frontal axis, abnormal ventricular repolarization, right bundle branch block, inactive area and right ventricular hypertrophy. Complete atrioventricular block was observed in one patient. The echocardiogram study showed biatrial enlargement in all patients, and left ventricular dilatation in one patient with left ventricular dysfunction. Mild tricuspid regurgitation were observed in one patient and moderate in four. Two patients had mild mitral regurgitation. Diastolic dysfunction were observed at Doppler-cardiography in all patients. Right ventricular endomyocardial biopsy showed interstitial fibrosis, myocytes hypertrophy and myofibrils disarray. The hemodynamic study disclosed right ventricular hypertension in all patients. Three patients had hypotension in left ventricle and aorta. The left ventricular end diastolic pressure and pulmonary capillary pressure (pulmonary wedge pressure) were elevated in all patients. Dilated left ventricle with mild hypokinesia and right ventricular inferior hypokinesia and diastolic restriction were observed in one patient. One patient had similar pattern without diastolic restriction. Mild tricuspid regurgitation was observed in one patient, moderate in three and severe in one. Mild mitral regurgitation were observed in two patients. The restrictive pattern (deep and plateau) was present in three patients. Surgery were performed in all patients, and confirmed the mild tricuspid regurgitation in one and the moderate in four. De Vega plastia were performed in four patients. CONCLUSION: Among the complementary methods, echocardiogram and hemodynamic study were those of higher contribution to the diagnosis of idiopathic RCM. The disease has a poor evolution, even with clinical or surgical treatment. Heart transplantation may would be the best procedure on patients with symptomatic idiopathic restrictive cardiomyopathy.

Adult↗
PubMed1993

[Male sex. Prognostic factor in Chagas' disease].

PURPOSE: To verify if the ventricular function and the incidence of arrhythmias in patients of both sexes could be predominant in male patients with Chagas' disease. METHODS: Six hundred and thirty one patients were studied, 329 female and 302 male, with age of 10 to 64 years old (mean 40). All patients were submitted to M mode echocardiographic study to analyse the ejection fraction (EF). To verify the importance of the ventricular dysfunction in male and female patients, they were divided according to the EF in three groups: A) normal EF, B) EF between 0.64 and 0.45 and C) EF less than 0.44. The incidence of ventricular tachycardia was analyzed at the stress test or 24h Holter studies. RESULTS: The number of patients with depressed EF was more frequent on male patients (p < 0.0001). The incidence of ventricular tachycardia was similar in both sexes, however it was more frequent in patients with ventricular dysfunction. CONCLUSION: Our results show that there are greater myocardial dysfunction on male patients, what could explain the worse prognosis observed on patients of this sex.

Adolescent↗
PubMed1993

[Beneficial effects of enalapril on the diastolic ventricular function in Chagas myocardiopathy].

PURPOSE: To verify the effect of enalapril on ventricular function and on the incidence of ventricular arrhythmias in patients with Chagas' disease with congestive heart failure. METHODS: We studied 20 patients with Chagas' disease, aged between 24 to 64 (mean 44) years. There were 17 male. All patients have positive serologic blood tests for Chagas' disease (immunofluorescence and Machado-Guerreiro test), left ventricular diastolic diameter superior to 55mm and ejection fraction less than 0.60. The patients were divided aleatory in two groups: control group (CG) with 9 patients receiving conventional treatment (digital and diuretics) and enalapril group (EG), with 11 patients where enalapril was added to conventional treatment. The treatment was maintained during two months and the patients were evaluated at the beginning and at the end, when they were submitted to clinical examination, echo-doppler-cardiogram, stress test and 24h Holter monitoring. At two dimensional echocardiographic study we evaluate left ventricular and left atrial diameters, at doppler study the E/A relations, the systolic volume and cardiac index. At the stress test and Holter monitoring we evaluate the incidence of ventricular arrhythmias. RESULTS: The comparison between initial and final evaluations, showed that there was a significant improvement of diastolic function (p = 0.04) and a trend to improvement of systolic function (great systolic volume and cardiac index) at EG. The incidence of non sustained ventricular tachycardia was the same in the two groups. CONCLUSION: In Chagas' disease enalapril improves significantly diastolic dysfunction in patients with heart failure. After two months of treatment we observed tendency to improvement of systolic dysfunction and the incidence of arrhythmias induced by stress test.

Adult↗
PubMed1992

[Acute aortic dissections. Hospital outcome of 186 cases].

PURPOSE: To determine in hospital outcome acute aortic dissection patients. METHODS: We revised 186 consecutive cases (up to 14 days of dissection), in a period of 6 years. The patients were divided according to Daily's classification (types A and B). RESULTS: Type A--127 cases: a) 75 were surgically treated (37 died); b) 2 were medically treated (both died); c) 39 died before the definitive treatment could be initiated; d) 11 died misdiagnosed or undiagnosed. The total mortality was 70.0%. Type B--59 cases: a) 11 complicated cases were surgically treated (6 died); b) 40 were medically treated (8 died); c) 7 died before the definitive treatment could be initiated; d) one died misdiagnosed. The total mortality was 37.25%. In summary, 41.4% of the patients survived. 28.4% died despite the definitive treatment, 24.7% died before the definitive treatment could be initiated and 6.4% died without the correct diagnosis. CONCLUSION: The acute aortic dissection is a dramatic situation, mainly type A. In this type of dissection many patients (41%) died misdiagnosed, undiagnosed or without enough time to surgical therapy. So, an earlier diagnosis and treatment are imperative.

Acute Disease↗
PubMed1992

[The electrocardiogram in endomyocardial fibrosis].

PURPOSE: To detail the most common electrocardiographic findings on the endomyocardial fibrosis and to correlate with the ventricular form. METHODS: One hundred patients with endomyocardial fibrosis (68 female) with ages between 5 and 64 years old (mean 34 years). According to ventriculographic aspect the patients were divided in three groups: group I--11 patients with predominant right ventricular compromise; group II--58 patients with biventricular involvement, but not necessarily similar in intensity; group III--31 patients with predominant left ventricular compromise. RESULTS: On patients with predominant right ventricular compromise, the electrocardiographic pattern was of QRS complex of low voltage in the frontal plane, presence of incomplete right bundle block and QRS complex with low voltage and with qr or qs aspect in V1 contrasting with QRS complex of great amplitude on V2 and V3. Left anterior hemiblock, aspect of inactive area, and R waves of high voltage on left precordial leads were observed on patients with predominant left ventricular involvement. CONCLUSION: The electrocardiogram of endomyocardial fibrosis, in spite of inespecific, may help in the identification of ventricular involvement.

Adolescent↗
PubMed1991

[Ergospirometry as a method for predicting the clinical course of ischemic, Chagas and idiopathic myocardiopathy].

PURPOSE: To compare and evaluate the modifications variables obtained through spyroergometry in groups of patients with ischemic cardiomyopathy (IS), Chagas' disease (CH), and idiopathic cardiomyopathy (ID). To study tolerance to anaerobic conditions of patients from the above groups who died. METHODS: A study was carried with 50 male patients, 10 of which were found in normal conditions whereas 40 presented cardiomyopathy with compensated heart failure. We observed that from the 40 patients from the cardiomyopathy groups, nine died, subgroups OB--during the study period of 1.005 days. These were compared to subgroups NOB--the remaining 31 patients. These patients were evaluated under 4 conditions--Rest (Rep), anaerobic threshold (LA), power peak of the exercise (P) and in the fourth minute recovery (REC). The investigation was based on data collected by means of spyroergometry: oxygen consumption (MET), production of CO2-(VCO2), respiratory equivalent of oxygen (VE/VO2), oxygen pulse (VO2/FC) and the time elapsed between LA and P. RESULTS: There were significant differences when the three pathological groups (IS, CH, ID) were compared with the control groups (N). There were no significant differences when the three pathological groups compared among themselves. In relation to tolerance to anaerobic conditions significant differences were found among the patients of subgroup OB--1.33 min--who died when compared to subgroup NOB--3.26 min (time elapsed between LA and P). CONCLUSION: The authors conclude that the variables studied, obtained through spyroergometry may indicate important data towards the prognosis with heart failure.

Adult↗