RESUMO
RESUMEN Introducción: La miocardiopatía del cirrótico es la disfunción sistólica y/o diastólica del ventrículo izquierdo en reposo o estrés, en ausencia de otras condiciones cardiovasculares que lo explique, y que empeora el pronóstico post trasplante u otros procedimientos quirúrgicos hepáticos. Objetivo: El objetivo del estudio fue caracterizar la función auricular izquierda con speckle tracking en pacientes cirróticos. Material y métodos: Se incluyeron 99 pacientes consecutivos con cirrosis hepática de diferente etiología. A todos pacientes se les realizó estudio ecocardiográfico en reposo con medición de la función ventricular y auricular isquierda con técnicas tradicionales, mediciones tridimensionales y speckle tracking. Resultados: La mediana de edad fue de 50.9 años y 40% de los pacientes fueron hombres. No se observaron alteraciones de la función sistólica del ventrículo izquierdo. El 27% de los pacientes presentó disfunción diastólica y dilatación de la aurícula izquierda, está última con incremento significativo según el estadío Child y se observaron alteraciones de la función de bomba de la aurícula izquierda en el 29% de los casos. Conclusión: Los pacientes cirróticos presentan disfunción diastólica ventricular izquierda y alteraciones de la función sistólica de la aurícula izquierda medida por speckle tracking.
ABSTRACT Background: Cirrhotic cardiomyopathy is the systolic and/or diastolic dysfunction of the left ventricle at rest or stress, in the absence of other cardiovascular conditions, and worsens the prognosis after transplant or other liver surgical procedures. Objective: The aim of the study was to characterize left atrial function with speckle tracking in cirrhotic patients. Methods: Ninety-nine consecutive patients with liver cirrhosis of different etiology were included in the study. All patients underwent rest echocardiographic evaluation with measurement of left ventricular and atrial function using traditional techniques, three-dimensional measurements and speckle tracking. Results: Median age was 50.9 years and 40% were men. No alterations of left ventricular systolic function were observed. Twenty-seven percent of patients had diastolic dysfunction and dilatation of the left atrium, the latter with a significant increase according to the Child stage and left atrial pump function was altered in 29% of cases. Conclusion: Cirrhotic patients present left ventricular diastolic dysfunction and alterations of left atrial systolic function measured by speckle tracking.
RESUMO
Abstract Background: Few reports exist on the relationship of the left ventricular diastolic dysfunction (LVDD) with its most important features including enlargement of the left atrium and left ventricular hypertrophy (LVH), and with the right ventricular (RV) function. Objective: To determine the correlation between the left atrial size and the RV function and dimensions in patients with and without LVDD and LVH. Methods: Fifty patients were included, 25 (40% men) of them with LVDD, aged 67.1 ± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9 ± 16.3 years (control group). Patients underwent transthoracic echocardiography with evaluation of the left atrial size and volume (LAV), LVDD, LVH, and RV function and dimensions. P-values < 0.05 were considered statistically significant. Results: LAV > 34 mL/m2 and left atrial size > 40 mm were associated with lower absolute values of tricuspid annular plane systolic excursion (TAPSE) and RV lateral S' (p ≤ 0.001, Pearson's correlation coefficient -0.4 and -0.38, respectively) in the study group. Patients in the study group showed higher incidence of LVH (p = 0.02) and greater left atrial diameter (p = 0.03) compared with the control group. In addition, greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found in patients with LVDD grade II compared with LVDD grade I. Conclusions: The present study determined, for the first time, the correlation of left atrial enlargement with progressive RV dysfunction in patients with LVDD.
Resumo Fundamentos: A relação entre a disfunção diastólica do ventrículo esquerdo (DDVE), seus achados mais importantes, como aumento do átrio esquerdo e hipertrofia ventricular esquerda (HVE), e a função do ventrículo direito (VD) tem pouca documentação na literatura científica. Objetivo: Avaliar a correlação entre o tamanho atrial esquerdo em indivíduos com e sem DDVE e HVE e função e dimensões do VD. Métodos: Foram selecionados 50 pacientes, sendo 25 com DDVE (grupo de estudo [GE]; 67,1 ± 10,6 anos; 40% homens) e 25 sem DDVE (grupo-controle [GC]; 49,9 ± 16,3 anos; 52% homens). Os pacientes foram submetidos a ecocardiografia transtorácica com avalição do tamanho e volume atrial esquerdo (VAE), DDVE, HVE, dimensões e função do VD. Valores de p < 0,05 indicaram significância estatística. Resultados: VAE > 34 ml/m2 e tamanho atrial esquerdo > 40 mm apresentaram menores valores absolutos de excursão sistólica do plano do anel tricúspide (TAPSE) e S' lateral do VD (p ≤ 0,001, coeficiente de correlação de Pearson de -0,4 e -0,38, respectivamente) no GE. O GE apresentou maior incidência de HVE e maior diâmetro atrial esquerdo quando comparado ao GC (p = 0,02 e p = 0,03, respectivamente). O GE apresentou maior diâmetro e VAE nos indivíduos com DDVE grau II quando comparados aos indivíduos com DDVE grau I (p = 0,02 e p = 0,01, respectivamente). Conclusões: O presente estudo permitiu correlacionar de maneira inédita o aumento atrial esquerdo com diminuição progressiva da função ventricular direita em pacientes com disfunção diastólica de VE.