Açäo benéfica do enalapril sobre a funçäo diastólica ventricular na miocardiopatia da doença de Chagas / Beneficial Effects of Enalapril on the Diastolic Ventricular Function in Chagas' Disease Myocardiopathy

RESUMO

Objetivo - Verificar o efeito do enalapril na funçäo ventricular e na incidência de arritmia ventricular em portadores de doença de Chagas e insuficiência cardíaca congestiva (ICC). Métodos - Foram estudados 20 pacientes com doença de Chagas, com idades variando de 24 a 64 (media 44 anos, sendo 17 do sexo masculino. Todos tinham reaçöes sorológicas positivas para doença de Chagas, diâmetro ventricular diastólico final superior a 55mm e a fraçäo de ejeçäo menor que 0,60. Os pacientes foram divididos aleatoriamente em 2 grupos: grupo controle (GC) com 9 pacientes tratados com terapêutica convencional e grupo enalapril (GE) com 11 pacientes que além da terapêutica convencional receberam enalapril. O tratamento foi mantido por 2 meses e os pacientes foram avaliados no início e ao final sendo submetidos a exame clínico, ecodopplercardiograma, teste de esforço e Holter de 24h. No estudo ecocardiográfico avaliaram-se os diâmetros ventriculares e pela dopplercardiogrfia, a relaçäo E/A, o volume sistólico e o débito cardíaco. Ao teste de esforço e Holter avaliou-se a incidência de arritmia ventricular. Resultados - Quando comparadas as avaliaçöes inicial e final, houve melhora significativa (p = 0,04) da funçäo diastólica (relaçäo E/A) e tendência de melhora da funçäo sistólica (aumento de volume sistólico e débito cardíaco) no grupo enalapril. A incidência de taquicardia vantricular näo sustentada teve tendência em aumentar no GC e näo variou no GE. Conclusäo - Na miocardiopatia chagásica, enalapril melhora signficantemente a disfunçäo diastólica da ICC. Com dois meses de terapêutica observou-se tendência de melhora da funçäo sistólica e menor incidência da arritmia induzida pelo esforço

ABSTRACT

Purpose - To verify the effect of enalapril on ventricular function and on the incidence of ventricular arrhythmias in patients with Chagas' disease with congestive heart failare. Methods - We studied 20 patients with Chagas' disease, aged between 24 to 64 (mean 44) years. There were 17 male. All patients have positive serologic blood tests for Chagas' disease (immunofluorecence and Machado-Guerreiro test), leit ventricular diastolic diameter superior to 55mm and ejection fraction less than 0.60. The patients were divided aleatory in two groups: control group (CG) with 9 patients receiving conventional treatment (digital and diuretics) and enalapril group (EG), with 11 patients where enalapril was added to conventional treatment. The treatment was mantained during two months and the patients were evaluated at the beginning and at the end, when they were submitted to clinical examination, echodopplercardiogram, stress test and 24h Holter monitoring. At two dimensional echocardiographic study we evaluate left ventricular and leit atrial diameters, at doppler study the E/A relations, the systalic volume and cardiac index. At the stress test and Holter monitoring we evaluate the incidence of ventricular arrhythmias. Results - The comparison between initial and final evalu ations, showed that there was a significant improvement of diastolic function (p=0.04) and a trend to improvement of systolic function (great systolic volume and cardiac index) at EG. The incidence of non sustained ventricular tachycardia was the same in the two groups. Conclusion - In Chagas' disease enalapril improves significantly diastolic dysfunction in patients with heart failure. After two months of treatment we observed tendence to improvement of systolic dysfunction and the incidence of arrhythmias induced by stress test