ABSTRACT
OBJETIVO: Determinar se os níveis de NT pro-BNP encontram-se elevados em pacientes com afecções pericárdicas e avaliar a sua relação com medidas ecocardiográficas de disfunção diastólica. MÉTODOS: Vinte e cinco pacientes foram divididos em dois grupos: 1) derrame pericárdico (DP), 15 pacientes; 2) pericardite constritiva (PC), 10 pacientes. Foi constituído um grupo controle de 30 indivíduos sem doença cardíaca. O grau de derrame pericárdico foi avaliado pelo ecocardiograma bidimensional e a restrição avaliada pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: Dos 15 pacientes com DP, 14 apresentavam DP importante e apenas 1, moderado. Log NT pro-BNP esteve aumentado no DP (p <0,05), com média de log 2,31 pg/ml e PC (p <0,05), com média de log 2,67 pg/ml, quando comparados ao grupo controle, média de log 1,32 pg/ml. Não houve diferença entre DP e PC (p = 0,149). O log NT pro-BNP correlacionou-se com o pico de velocidade da onda E (r = 0,845; p = 0,001) e com a relação E/A (r=0,717; p= 0,003). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas afecções pericárdicas e apresenta relação com o grau de disfunção diastólica, podendo servir como método adicional na quantificação de restrição.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Pericardial Effusion/diagnosis , Pericarditis, Constrictive/diagnosis , Biomarkers/blood , Diastole/physiology , Echocardiography, Doppler, Color , Epidemiologic Methods , Pericardial Effusion , Pericarditis, ConstrictiveABSTRACT
Mulher de 70 anos, com antecedentes de diabetes mellitus e hipertensão arterial sistêmica, em acompanhamento ambulatorial por anemia crônica após cirurgia corretiva de angiodisplasia de jejuno proximal, apresentou imagem de mixoma em átrio esquerdo em exame ecocardiográfico transtorácico de rotina. Foi submetida a investigação ecocardiográfica transesofágica multiplanar e a estudo ecocardiográfico tridimensional. O ecocardiograma tridimensional propiciou melhor detalhamento anatômico da tumoração. A paciente foi submetida a exérese da massa, com confirmação anatomopatológica. O ecocardiograma tridimensional mostrou ser técnica que apresenta contribuição adicional à investigação diagnóstica das cardiopatias estruturais.
Subject(s)
Humans , Female , Aged , Echocardiography, Three-Dimensional , Heart Neoplasms , Myxoma , Heart AtriaABSTRACT
We compared plasma tumor necrosis factor-alpha (TNF-alpha) levels among asymptomatic/"indeterminate" Chagas disease patients (ASY) and patients across the clinical spectrum of chronic Chagas disease cardiomyopathy (CCC). Idiopathic dilated cardiomyopathy (DCM) patients and normal controls (NC) were included as controls. ASY Chagas disease patients had significantly higher plasma TNF-alpha levels than NC. TNF-alpha levels among severe CCC patients with significant left ventricular (LV) dysfunction were similar to those of DCM patients, showing average 2-fold higher levels than CCC patients without LV dysfunction and ASY patients, and 8-fold higher levels than NC. In Chagas disease, chronic TNF-a production prior to heart failure may play a role in CCC progression
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Cardiomyopathy, Dilated , Chagas Disease , Tumor Necrosis Factor-alpha , Aged, 80 and over , Chagas Cardiomyopathy , Chronic Disease , Severity of Illness Index , Statistics, Nonparametric , Ventricular Dysfunction, LeftABSTRACT
OBJECTIVE: To assess, in a prospective way, the experience with video-assisted pericardioscopy obtained in patients with pericardial effusion of unclear etiology in the preoperative period. METHODS: From January 1998 to June 2000, 20 patients were operated upon with the aid of video-assisted pericardioscopy. On echocardiography, 17 of these patients had significant pericardial effusion, and 3 had moderate pericardial effusion. Video-assisted pericardioscopy was performed through a small incision of the Marfan type. RESULTS: The diagnosis of pericardial effusion was established as follows: idiopathic in 9 (45 percent) patients, neoplastic in 4 (20 percent), resulting from hypothyroidism in 3 (15 percent), tuberculous in 2 (10 percent), due to cholesterol in 1 (5 percent), and chylopericardial in 1 (5 percent). The biopsy was positive in 30 percent of the patients, and the etiology could not be defined in 45 percent of the patients. CONCLUSION: Video-assisted pericardioscopy proved to be a method with low morbidity and a high index of diagnostic positivity. A high percentage of pericardial effusions are caused by viral infections, which are not diagnosed through current methods, being, therefore, classified as idiopathic
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pericardial Effusion , Pericardium , Thoracic Surgery, Video-Assisted , Pericardial Effusion , Prospective StudiesABSTRACT
OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16 + or -18 years). RESULTS: Most tumors were located in the left side of the heart (72 percent), myxoma being the most common (84 percent) histologic type. The other histologic types found were as follows: fibroma (4 percent), lipoma (2 percent), rhabdomyosarcoma (2 percent), hemangioma (2 percent), sarcoma (2 percent), angiosarcoma (2 percent), and lymphoma (2 percent). Diagnosis was established by echocardiography in 94 percent of the cases. Clinical findings were as follows: dyspnea (36 percent), weight loss (20 percent), palpitations (18 percent), chest pain (16 percent), fever (8 percent), and arthralgia (6 percent). All patients with thromboembolic phenomena (10 percent) had left atrial myxoma. Approximately 20 percent of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Heart Neoplasms/pathology , Myxoma/pathology , Heart Neoplasms/diagnosis , Heart Neoplasms/physiopathology , Myxoma/diagnosis , Myxoma/physiopathology , Retrospective StudiesABSTRACT
OBJETIVO: Comparar portadores de miocardiopatia chagásica com insuficiência cardíaca congestiva (ICC) e consumo máximo de oxigênio (VO2 max) acima de 20mL/kg-1/min-1 com grupo normal, e rediscutir o conceito de normalidade do método.MÉTODOS: Foram estudados 104 pacientes com ICC. O grupo controle (G2) constituiu-se de 23 indvíduos normais sedentários. Analisamos os pacientes pela VO2max e fraçäo de ejeçäo (FE) de ventrículo esquerdo. As médias foram comparadas utilizando o teste t. RESULTADOS: Dos 104 pacientes, 37 (35,6por cento) apresentaram VO2max acima de 20 mL/kg-1/min-1(GI), com valores entre 20,5 e 30,5 (24,5+/-2,9) e FE entre 19 e 63 (42+/-11,7). G2 apresentou VO2max entre 21 e 42 mL/kg-1/min-1 (33,3+/-5,6) e FE entre 70 e 82 (75,1+/-3,2). Näo houve diferença significante (p=0,1136) entre as idades. Houve diferença entre as médias de VO2max e FE (p<0,0001).CONCLUSAO: Estes pacientes atingiram VO2max acima de 20mL/kg-1/min-1, e apresentaram Subject(s)
Humans
, Oxygen Consumption
, Heart Failure/epidemiology
, Chagas Cardiomyopathy/epidemiology
, Case-Control Studies