ABC | Volume 114, Nº1, January 2019

Original Article Left Ventricular Remodeling Patterns in Primary Healthcare Roberto de Castro Meirelles de Almeida, 1 Antonio José Lagoeiro Jorge, 1 Maria Luiza Garcia Rosa, 1 Adson Renato Leite, 1 Dayse Mary S. Correia, 1 Evandro Tinoco Mesquita, 1 Sergio Chermont, 1 Jocemir Ronaldo Lugon, 2 Wolney de Andrade Martins 1 Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), 1 Niterói, RJ – Brazil Curso de Pós-Graduação em Ciências Médicas da Universidade Federal Fluminense (UFF), 2 Niterói, RJ – Brazil Mailing Address: Antonio José Lagoeiro Jorge • Universidade Federal Fluminense - Rua Marquês de Paraná, 303. Postal Code 24033-900, Centro, Niterói, RJ – Brazil E-mail: lagoeiro@globo.com Manuscript received October 03, 2018, revised manuscript February 13, 2019, accepted March 10, 2019 DOI: https://doi.org/10.36660/abc.20180258 Abstract Background: Left ventricular remodeling (LVR) is related to both non-fatal and fatal outcomes. Objective: To describe the geometric patterns of the LV and their associations. Methods: A total of 636 individuals between the ages of 45 and 99 years in Rio de Janeiro, Brazil, were submitted to clinical evaluation, laboratory tests, electrocardiogram, and tissue Doppler echocardiography (TDE). The difference between categories was tested with Kruskall-Wallis with post hoc tests, once all variables studied are non-normally distributed and Pearson’s Qui-square (categorical variables). Gross and adjusted ORs were estimated by logistic regression. The level of significance was 5% for all tests. Subjects had LVR characterized as: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results: The prevalence of altered patterns was 33%. Subjects presented NG (n = 423; 67%); EH (n = 186; 29%); CH (n = 14; 2%); and CR (n = 13; 2%). The variables of gender, age, level of education and albumin/creatinine ratio (A/C), showed a relationship with the chance of EH even after adjustment. Conclusion: Approximately one third of the studied individuals had LVR and were at risk for developing heart failure. Altered A/C in urine was associated with EH, indicating an early relationship between cardiac and renal dysfunction. (Arq Bras Cardiol. 2020; 114(1):59-65) Keywords: Cardiovascular Diseases/physiopathology; Ventricular Remodeling; Hypertrophy, Left Ventricular; Heart failure; Renal Insufficiency; Risk Factors/complications; Comorbidity. Introduction Ventricular remodeling is a continuous process of responses to the various injuries to the myocardium. Changes in left ventricular (LV) geometry, in its various patterns, are related to the incidence of non-fatal cardiovascular outcomes and long-term mortality, which are well-known markers of poor prognosis in various cardiovascular and systemic diseases. 1-6 Changes in ventricular geometry are considered target organ lesions on the heart and make individuals with these lesions classified as being in stage B of heart failure (HF) as it is proposed by the American College of Cardiology Foundation and American Heart Association (ACCF/AHA). 7 The pathophysiological mechanisms of ventricular remodeling vary according to the determining etiology. The diseases lead to pressure overload with increased systolic wall stress, gene activation, or direct myocardial injury followed by cell proliferation, fibrosis, collagen deposition, apoptosis, and remodeling of the ventricular geometry. The conditions that occur with volume overload lead to increased diastolic wall stress with linear stretching of cardiomyocytes, proliferation in parallel, and increased cavity diameters. 8 Epidemiological data on the prevalence and incidence of changes in ventricular geometry in population seen in primary care are scarce and knowledge of different remodeling patterns may assist in the implementation of strategies for risk stratification in this population. The aim of this study was to describe the geometric patterns of the LV in the population aged ≥ 45 years assisted in primary care, and to examine the association between ventricular remodeling and demographic and clinical variables. Methods This study is part of the Digitalis trial that aimed to determine the prevalence of HF in the population studied. 9 Procedures for random sample selection and patient inclusion We selected 26 primary care units in the city of Niterói, Rio de Janeiro, Brazil, between July 2011 and December 2012. The selection of units was done by a computer-generated random sequence program, in which the weight of each unit was proportional to the number of individuals assisted. In each unit, 50 subjects were randomly selected, including 59