Valor prognóstico independente da relação E/e' na miocardiopatia dilatada chagásica / Independent prognostic value of E/e´ratio dilated chagas cardiomyopathy

Introdução: A insuficiência cardíaca (IC) é a manifestação clínica mais grave da doença de Chagas. Parâmetros ecocardiográficos de elevação das pressões de enchimento do ventrículo esquerdo (VE) apresentam valor prognóstico na IC, podendo ser importante na estratificação de risco dos pacientes chagásicos. O objetivo do presente estudo foi identificar parâmetros ecocardiográficos de função diastólica, preditores de sobrevida em pacientes com miocardiopatias chagásica. Métodos: O estudo inclui, prospectivamente, 224 pacientes (137 homens, idade de 48 + ou menos 12 anos), encaminhados para avaliação cardiológica no Ambulatório de Referência em doença de Chagas. Os pacientes foram selecionados se apresentassem sorologia positiva para doença de Chagas e miocardiopatia dilatada. O desfecho analisado foi morte cardíaca ou necessidade de transplante. Resultados: Durante um período de acompanhamento de 37,7 meses, 83 pacientes morreram e 8 submeteram-se ao transplante cardíaco de urgência. A relação E/ e'destacou-se como preditor independente de sobrevida, apresentando valor prognóstico adicional aos fatores clínicos, fração de ejeção do VE, função ventricular direita e volume do átrio esquerdo indexado pela superfície corpórea. Curva de Kaplan-Meier mostrou uma maior mortalidade entre os pacientes com E/ e' > ou igual 15, em relação aos pacientes com E/ e' , 15 (log-rank 23, p<0,001). Conclusão: A relação E/ e' apresentou informação prognóstica adicional e independente da classe funcional da NYHA e de parâmetros ecocardiográficos de sobrevida incluindo fração de ejeção do VE, função ventricular direita e volume do átrio esquerdo. A relação E/e' parece ser uma ferramenta útil na estratificação de risco dos pacientes com doença de Chagas.

Brain natriuretic peptide and left ventricular dysfunction in chagasic cardiomyopathy

Global left ventricular (LV) systolic dysfunction is the strongest predictor of morbidity and mortality in Chagas disease. Echocardiography is considered the gold standard for the detection of LV dysfunction, but not always available in endemic areas where chagasic cardiomyopathy is most common. Brain natriuretic peptide (BNP) is a neurohormone that has been recently described as a simple and inexpensive diagnostic and prognostic marker for patients with congestive heart failure. Chagasic patients (n = 63) and non-infected healthy individuals (n = 18) were recruited prospectively and underwent complete clinical examination, echocardiography and 24-h Holter monitoring. BNP was measured from thawed plasma samples using the Triage BNP test. We observed high levels of BNP in association with depression of LV ejection fraction, with increase of LV end-diastolic diameter and with LV premature complexes. An elevated concentration of BNP, defined as a concentration of 60 pg/ml or more, had a sensitivity of 91.7 percent, specificity of 82.8 percent, positive predictive value of 52.4 percent, and negative predictive value of 98 percent for detecting LV dysfunction (LV ejection fraction < 40 percent).BNP measurement using a simple, relatively inexpensive and rapid test has a promising role in identifying LV dysfunction associated with chagasic cardiomyopathy. Equally important, patients with Trypanosoma cruzi infection who have low levels of BNP level in plasma have a very low likelihood of severe cardiac involvement, and echocardiography is probably not necessary.

Pulmonary involvement in Schistosomiasis mansoni

The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.