Associação entre padrões pressóricos de 24 h e remodelamento cardíaco ao ecocardiograma em pacientes com insuficiência cardíaca de ejeção reduzida: subanálise do estudo IMPACT-HF

Abstract

This research is a cross-sectional, descriptive, and exploratory analytical study of patients with heart failure with reduced ejection fraction (LVEF < 40%) included in the IMPACT-HF study, who underwent ambulatory blood pressure monitoring (ABPM) and echocardiography before the start of the intervention. The recruitment period was from September 2024 to February 2026, totaling a sample size of 21 patients with a mean age of 52.4 ± 9.0 years, predominantly male (66.7%; 95% CI: 46.4% – 86.9%). Its objective is to correlate ABPM blood pressure patterns with echocardiographic phenotypes in this group of patients, in order to evaluate the association between ABPM patterns and echocardiographic markers of remodeling. To assess the associations between the qualitative variables of ABPM and the echocardiographic domains, the Chi-square test of independence or, preferably, Fisher's exact test was applied, with the level of statistical significance set at 5% (p < 0.05) for all tests performed. The data obtained revealed a negative correlation between the percentage of nocturnal decrease in systolic blood pressure and the E/A ratio (r = -0.527; p = 0.017), highlighting that the "Non-Dipper" and "Riser" patterns are associated with worsening diastolic dysfunction indices and increased filling pressures of the cardiac chambers. The "Non- Dipper" pattern was also associated with ventricular remodeling, accounting for 40% of all cases of hypertrophy and chamber dilation. Altered systolic pressure load (≥ 20%) showed a strong positive association with relative left ventricular wall thickness (r = 0.557; p = 0.009) and an inverse association with indexed end-diastolic volume (r = -0.502; p = 0.020), relating increased pressure load to myocardial thickening and consequent restriction of the ventricular cavity's dilation and accommodation capacity. Finally, this study did not correlate a more stringent blood pressure target (SBP < 120 mmHg) with echocardiographic worsening in this patient profile.