Analysis of Diastolic Left Ventricular Function in Adolescents with Juvenile Systemic Lupus Erythematosus

Abstract Background Juvenile systemic lupus erythematosus (JSLE) is a chronic inflammatory disease that affects the heart in 50% of cases. The behavior of diastolic function in adolescents and the predictors of its occurrence by conventional echocardiography are poorly established. Objectives This study aimed to evaluate diastolic function in adolescents with JSLE and to identify possible predictors of its occurrence by conventional echocardiography. Methods Cross-sectional, observational, control group study in a tertiary hospital of 49 adolescents with JSLE and 49 controls, using the EACVI 2016 guideline classification. Statistical methods used were Fisher and Mann-Whitney tests. Multivariate logistic regression models were constructed. A significance level of 5% was adopted. Results Among 98 patients, the JSLE group had higher indexed left atrial volume (p <0.001), lower lateral E' value (p<0.001) and lower E/A ratio value (p<0.001). The diagnosis of JSLE was associated with a higher chance of increased left atrial index volume (OR 3.3; p value 0.03). Conclusions Based on the 2016 guideline, no diastolic dysfunction was found in JSLE. However, differences in the analyzed echocardiographic parameters were found in these adolescents.

Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension / Avaliação da Função Ventricular Esquerda na Associação de Cardiomiopatia Hipertrófica e Hipertensão Arterial Sistêmica pela Técnica de Strain

Abstract Background: Hypertrophic cardiomyopathy (HCM) is the most common heart disease of genetic origin in the world population, with a prevalence of at least 1/500. The association with systemic arterial hypertension (SAH) is not uncommon, as it affects approximately 25% of the world population. Most studies aim at the differential diagnosis between these diseases, but little is known about the magnitude of this association. Objective: To compare left ventricular global longitudinal strain (GLS) in HCM patients with and without associated SAH. Methods: Retrospective cross-sectional study that included 45 patients with HCM and preserved ejection fraction, with diagnosis confirmed by magnetic resonance imaging, including 14 hypertensive patients. Transthoracic echocardiography was performed, with emphasis on left ventricular myocardial strain analysis using GLS. In this study, p < 0.05 was considered statistically significant. Results: Left ventricular strain was significantly lower in hypertensive individuals compared to normotensive individuals (-10.29 ± 2.46 vs. -12.35% ± 3.55%, p = 0.0303), indicating greater impairment of ventricular function in that group. Mean age was also significantly higher in hypertensive patients (56.1 ± 13.9 vs. 40.2 ± 12.7 years, p = 0.0001). Diastolic dysfunction was better characterized in hypertensive patients (p = 0.0242). Conclusion: Myocardial strain was significantly lower in the group of patients with HCM and SAH, suggesting greater impairment of ventricular function. This finding may be related to a worse prognosis with early evolution to heart failure. Prospective studies are required to confirm this hypothesis.

Resumo Fundamentos: A cardiomiopatia hipertrófica (CMH) é a doença cardíaca de origem genética mais frequente na população mundial, com prevalência de, pelo menos, 1/500. A associação com hipertensão arterial sistêmica (HAS) não é incomum, uma vez que esta acomete aproximadamente 25% da população mundial. A maioria dos estudos objetiva o diagnóstico diferencial entre essas doenças, mas pouco se sabe sobre a magnitude dessa associação. Objetivo: Comparar o strain longitudinal global (SLG) do ventrículo esquerdo em pacientes portadores de CMH com e sem HAS associada. Métodos: Estudo transversal retrospectivo que incluiu 45 pacientes portadores de CMH e fração de ejeção preservada, com diagnóstico confirmado por ressonância magnética, sendo 14 hipertensos. Realizada avaliação ecocardiográfica transtorácica com ênfase na análise da deformação miocárdica do ventrículo esquerdo por meio do SLG. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A deformação do ventrículo esquerdo foi significativamente menor nos hipertensos quando comparada aos normotensos (-10,29 ± 2,46 vs. -12,35% ± 3,55%, p = 0,0303), indicando maior comprometimento da função ventricular naquele grupo. A média de idade também foi significativamente maior nos hipertensos (56,1 ± 13,9 vs. 40,2 ± 12,7 anos, p = 0,0001). A disfunção diastólica foi melhor caracterizada nos pacientes hipertensos (p = 0,0242). Conclusão: A deformação miocárdica foi significativamente menor no grupo de pacientes com CMH e HAS, sugerindo maior comprometimento da função ventricular. Esse achado pode estar relacionado a um pior prognóstico com evolução precoce para insuficiência cardíaca. Estudos prospectivos são necessários para confirmar essa hipótese.

Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common heart disease of genetic origin in the world population, with a prevalence of at least 1/500. The association with systemic arterial hypertension (SAH) is not uncommon, as it affects approximately 25% of the world population. Most studies aim at the differential diagnosis between these diseases, but little is known about the magnitude of this association. OBJECTIVE: To compare left ventricular global longitudinal strain (GLS) in HCM patients with and without associated SAH. METHODS: Retrospective cross-sectional study that included 45 patients with HCM and preserved ejection fraction, with diagnosis confirmed by magnetic resonance imaging, including 14 hypertensive patients. Transthoracic echocardiography was performed, with emphasis on left ventricular myocardial strain analysis using GLS. In this study, p < 0.05 was considered statistically significant. RESULTS: Left ventricular strain was significantly lower in hypertensive individuals compared to normotensive individuals (-10.29 ± 2.46 vs. -12.35% ± 3.55%, p = 0.0303), indicating greater impairment of ventricular function in that group. Mean age was also significantly higher in hypertensive patients (56.1 ± 13.9 vs. 40.2 ± 12.7 years, p = 0.0001). Diastolic dysfunction was better characterized in hypertensive patients (p = 0.0242). CONCLUSION: Myocardial strain was significantly lower in the group of patients with HCM and SAH, suggesting greater impairment of ventricular function. This finding may be related to a worse prognosis with early evolution to heart failure. Prospective studies are required to confirm this hypothesis.

Epidemiological and clinical profile of infective endocarditis at a Brazilian tertiary care center: an eight-year prospective study.

INTRODUCTION: Infective endocarditis (IE) is a systemic infectious disease requiring a multidisciplinary team for treatment. This study presents the epidemiological and clinical data of 73 cases of IE in Rio de Janeiro, Brazil. METHODS: This observational prospective cohort study of endocarditis patients during an eight-year study period described 73 episodes of IE in 70 patients (three had IE twice). Community-associated (CAIE) and healthcare-acquired infective endocarditis (HAIE) were diagnosed according to the modified Duke criteria. The collected data included demographic, epidemiologic, and clinical characteristics, including results of blood cultures, echocardiographic findings, surgical interventions, and outcome. RESULTS: Analysis of data from the eight-year study period and 73 cases (70 patients) of IE showed a mean age of 46 years (SD=2.5 years; 1-84 years) and that 65.7% were male patients. The prevalence of CAIE and HAIE was 32.9% and 67.1%, respectively. Staphylococcus aureus (30.1%), Enterococcus spp. (19.1%), and Streptococcus spp. (15.0%) were the prevalent microorganisms. The relevant signals and symptoms were fever (97.2%; mean 38.6 + 0.05°C) and heart murmur (87.6%). Vegetations were observed in the mitral (41.1%) and aortic (27.4%) valves. The mortality rate of the cases was 47.9%. CONCLUSIONS: In multivariate analysis, chronic renal failure (relative risk [RR]= 1.60; 95% confidence interval [CI] 1.01-2.55), septic shock (RR= 2.19; 95% CI 1.499-3.22), and age over 60 years (RR= 2.28; 95% CI 1.44-3.59) were indirectly associated with in-hospital mortality. The best prognosis was related to the performance of cardiovascular surgery (hazard ratio [HR]= 0.51; 95% CI 0.26-0.99).

Epidemiological and clinical profile of infective endocarditis at a Brazilian tertiary care center: an eight-year prospective study

Abstract INTRODUCTION: Infective endocarditis (IE) is a systemic infectious disease requiring a multidisciplinary team for treatment. This study presents the epidemiological and clinical data of 73 cases of IE in Rio de Janeiro, Brazil. METHODS This observational prospective cohort study of endocarditis patients during an eight-year study period described 73 episodes of IE in 70 patients (three had IE twice). Community-associated (CAIE) and healthcare-acquired infective endocarditis (HAIE) were diagnosed according to the modified Duke criteria. The collected data included demographic, epidemiologic, and clinical characteristics, including results of blood cultures, echocardiographic findings, surgical interventions, and outcome. RESULTS: Analysis of data from the eight-year study period and 73 cases (70 patients) of IE showed a mean age of 46 years (SD=2.5 years; 1-84 years) and that 65.7% were male patients. The prevalence of CAIE and HAIE was 32.9% and 67.1%, respectively. Staphylococcus aureus (30.1%), Enterococcus spp. (19.1%), and Streptococcus spp. (15.0%) were the prevalent microorganisms. The relevant signals and symptoms were fever (97.2%; mean 38.6 + 0.05°C) and heart murmur (87.6%). Vegetations were observed in the mitral (41.1%) and aortic (27.4%) valves. The mortality rate of the cases was 47.9%. CONCLUSIONS: In multivariate analysis, chronic renal failure (relative risk [RR]= 1.60; 95% confidence interval [CI] 1.01-2.55), septic shock (RR= 2.19; 95% CI 1.499-3.22), and age over 60 years (RR= 2.28; 95% CI 1.44-3.59) were indirectly associated with in-hospital mortality. The best prognosis was related to the performance of cardiovascular surgery (hazard ratio [HR]= 0.51; 95% CI 0.26-0.99).

Características epidemiológicas e preditores de mortalidade em pacientes maiores de 70 anos submetidos à revascularização miocárdica cirúrgica / Epidemiological characteristics and mortality predictors in patients over 70 years submitted to coronary artery bypass grafting

Fundamento: A doença arterial coronariana é a principal causa de morte no mundo, e a idade é fator de risco independente de mortalidade em pacientes submetidos à revascularização cirúrgica. Objetivo: Avaliar os fatores preditores de risco de óbito em pacientes submetidos à revascularização miocárdica com mais de 70 anos. Métodos: Trata-se de uma coorte retrospectiva de banco de dados de cirurgia cardíaca. Foi utilizada a regressão logística para avaliar os preditores independentes de óbito. Resultados: Foram 372 pacientes submetidos à revascularização cirúrgica de 2004 a 2012. O principal fator de risco cardiovascular foi a hipertensão arterial sistêmica, seguida do diabetes melito. A mortalidade em 30 dias foi de 19,35%. A presença de doença vascular periférica (OR: 2,47), cirurgia de emergência (OR: 4,86) e procedimento valvular combinado (OR: 3,86) foram os preditores independentes de óbito. Conclusão: O procedimento cirúrgico em pacientes idosos apresentou mortalidade maior que da população geral. Doença vascular periférica, cirurgia de emergência e procedimento valvular combinado aumentaram o risco de óbito nesses pacientes

Background: Coronary artery disease is the leading cause of death worldwide, with age being an independent risk factor for mortality in patients submitted to surgical revascularization. Objective: To evaluate the mortality risk predictors in patients older than 70 years submitted to myocardial revascularization. Methods: This is a retrospective cohort study of a cardiac surgery database. Logistic regression was used to assess independent death predictors. Results: A total of 372 patients submitted to surgical revascularization from 2004 to 2012 were assessed. The main cardiovascular risk factor was hypertension, followed by diabetes mellitus. Mortality at 30 days was 19.35%. The presence of peripheral vascular disease (OR: 2,47), emergency surgery (OR: 4,86) and combined valve procedure (OR: 3,86) were independent predictors of death. Conclusion: The surgical procedure in elderly patients showed a higher mortality than in the general population. Peripheral vascular disease, emergency surgery and combined valve procedures increased the risk of death in these patients

Left ventricular structural and functional changes evaluated by echocardiography and two-dimensional strain in patients with sickle cell disease.

INTRODUCTION: Patients with sickle cell disease have increased left ventricular size, which is not usually accompanied by changes in systolic function indexes. We assessed echocardiographic abnormalities present in patients with sickle cell anemia (SCA) and compared echocardiographic parameters to other sickle cell diseases (OSCD). MATERIAL AND METHODS: A blind cross-sectional study with 60 patients with SCA and 16 patients with OSCD who underwent transthoracic echocardiography was performed. RESULTS: Echocardiographic findings were: left atrial volume index 47.7 ±11.5 ml/m² in SCA group and 31.7 ±8.42 ml/m² in OSCD group (p < 0.001); left ventricular diastolic diameter index 3.47 ±0.37 cm/m² in SCA group and 2.97 ±0.41 cm/m² in OSCD group (p < 0.001); left ventricular systolic diameter index 2.12 ±0.31 cm/m² in SCA group and 1.86 ±0.28 cm/m² in OSCD group (p < 0.001). There were no differences in the left ventricular ejection fraction: 68.2 ±6.69% in SCA group and 67.1 ±6.21% in OSCD group (p = 0.527). The ratio between mitral E wave and mean mitral annulus e' wave velocities was higher in the SCA group (7.72 ±1.54 vs. 6.70 ±1.65; p = 0.047). Mitral A wave correlated significantly with hemoglobin levels (r = -0.340; p = 0.032). CONCLUSIONS: There was an increase of left ventricular and left atrial sizes in patients with SCA, compared to patients with OSCD, without changes in systolic or diastolic function in both groups. This could be due to the hyperkinetic state due to the more severe anemia in the SCA subjects.

Correlation between Diastolic Function and Endothelial Function in Patients with Type 2 Diabetes and Hypertension.

BACKGROUND: Endothelial dysfunction may be involved in the pathophysiology of cardiac abnormalities in patients with diabetes mellitus (DM). A correlation between endothelial dysfunction and diastolic dysfunction in patients with type 1 DM has been demonstrated, but this relationship has not been well investigated in type 2 DM. OBJECTIVE: Compare groups of patients with type 2 DM and hypertension with and without diastolic dysfunction using endothelial function indexes, and to assess whether correlations exist between the diastolic function and the endothelial function indexes. METHOD: This was a cross-sectional study of 34 men and women with type 2 DM and hypertension who were aged between 40 and 70 years and were categorized based on assessments of their Doppler echocardiographic parameters as having normal (14 patients) and abnormal (20 patients) diastolic function. Flow-mediated dilatation (FMD) assessments of the brachial artery evaluated the patients' endothelial function. RESULTS: The mean maximum FMD was 7.15 ± 2.80% for the patients with diastolic dysfunction and it was 11.85 ± 4.77% for the patients with normal diastolic function (p = 0.004). Correlations existed between the maximum FMD and the E/e' ratio (p = 0.040, r = -0.354) and the early wave velocity (e') at the lateral mitral annulus (p = 0.002, r = 0.509). CONCLUSION: The endothelial function assessed by FMD was worse in hypertensive diabetic patients with diastolic dysfunction. There were correlations between the diastolic function indexes and the endothelial function indexes in our sample.

Vascular or chronological age: which is the better marker to estimate the cardiovascular risk in patients with type 1 diabetes?

AIMS: To evaluate whether using vascular age (VA) instead of chronological age (CA) in the Framingham score would enhance the cardiovascular disease (CVD) risk estimation in patients with type 1 diabetes (T1D). METHODS: This was a cross-sectional study comprising 58 T1D patients and 38 control subjects matched by age, gender and body mass index. To estimate the VA, we used carotid intima-media thickness normality estimation tables that took into account age, gender and ethnic group. RESULTS: Compared to the control group, T1D patients had an older VA with an 8.8-year difference (p < 0.001), a higher CVD risk stratification comparing CA and VA (p < 0.001). In the group of T1D patients, there was a 9.4-year difference between VA and CA (p < 0.001), mainly due to a greater increase in women compared to men (11.2 vs 6.4 years, respectively) and 29.3 % of the patients with T1D increased their CVD risk stratification using VA as a parameter. Still, in the group of T1D patients, women had a higher increase in VA for each 1-year increase in CA than men (1.2 years vs 0.8 years, respectively, p < 0.001). This difference persisted as we compared women with T1D with women in the control group (0.4 years), p = 0.006. CONCLUSIONS: T1D patients have an increased VA, a marker of subclinical atherosclerosis. The use of VA age may contribute to the identification of high CVD risk in T1D. In patients with T1D, a younger chronological age, particularly in women, might not be a protective factor for CVD.

Evolution of Heart Failure-related Hospital Admissions and Mortality Rates: a 12-Year Analysis / Insuficiência Cardíaca: Análise de 12 Anos da Evolução em Internações Hospitalares e Mortalidade

A insuficiência cardíaca (IC) é a via final de todas as cardiopatias. Com o avanço tecnológico, asobrevida do cardiopata vem aumentando. Paralelamente observa-se o aumento da incidência da IC. Há poucosdados em relação à evolução tecnológica e seu real impacto na mortalidade desses pacientes. Objetivo: Avaliar a evolução dos índices de internações hospitalares em pacientes adultos com insuficiência cardíaca, taxa de permanência e mortalidade no Sistema Único de Saúde. Métodos: Os dados foram obtidos no DATASUS, referentes ao período de 2001 a 2012. Foram avaliados: a incidência de internações hospitalares gerais e por IC, a média de permanência, a mortalidade e o custo hospitalar, estratificados por sexo, faixa etária e local de internação hospitalar.Resultados: No período estudado ocorreram 91272037 internações hospitalares, sendo 3,96% por IC. Pacientes do sexo masculino corresponderam a 50,76%. O número absoluto de internações por IC diminuiu de 379463 em 2001 para 240 280 em 2012. A média de permanência global foi 5,8 dias em 2001 e 6,6 dias em 2012. A taxa de mortalidade esteve em ascensão, iniciando com 6,58% em 2001 e chegando a 9,5% em 2012 (aumento de 46,1%). O custo da AIH média aumentou de R$ 519,54 em 2001 para R$ 1209,56 em 2012 (aumento de 132,8%). Conclusão: Mesmo com a diminuição das internações hospitalares, a IC é uma síndrome de elevado custo para o Sistema Único de Saúde, com elevados índices de mortalidade que paradoxalmente aumentaram ao longo do tempo apesar do avanço tecnológico ocorrido...

Heart failure (HF) is the final common event of all cardiac diseases. Technological advances have allowed for significant improvement to survival rates in cardiac patients. Correspondingly, an increase in the HF incidence has been observed. Few dataare available on technological advances and their actual impact on the mortality rate of these patients. Objective: To assess the progress of hospital admission rates of adult patients with heart failure, average length of stay and mortality rate in the Brazilian SUS (Unified Health System). Methods: DATASUS data for the 2001-2012 period were obtained. An assessment was performed of data such as all-cause hospital admissions and heart failure-related admissions, average length of stay in hospital, mortality rate and hospital costs, after being stratified by sex, age and place of hospitalization. Results: Over the study period, there have been 91,272,037 hospital admissions, of which 3.96% were due to HF. Male patients accounted for 50.76%. The absolute number of HF-related hospital admissions decreased from 379,463, in 2001, to 240,280, in 2012. The average overall stay in hospital was 5.8 days, in 2001, and 6.6 days, in 2012. The mortality rate was on the rise, from 6.58%, in 2001, to 9.5%, in 2012 (a 46.1% increase). The average cost of AH increased from R$ 519.54, in 2001, to R$ 1,209.56, in 2012 (a 132.8% increase). Conclusion: Despite the decline in hospital admissions, HF is a highly costly syndrome for the Brazilian Unified Health System, with high mortality rates, which paradoxically increased over time, despite technological advances...

Influence of a family history of type 2 diabetes, demographic and clinical data on carotid intima-media thickness in patients with type 1 diabetes: a cross-sectional study.

BACKGROUND: Intima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD). Identifying the factors associated with a higher IMT may contribute to the identification of subjects with higher CVD risk. Our objective was to compare the common carotid IMT of type 1 diabetes patients to healthy control subjects. The secondary objective was to determine factors associated with a higher carotid IMT. METHODS: We conducted a cross-sectional study between March 2009 and October 2013, comprising 127 type 1 diabetes patients and 125 control subjects matched by age, gender and body mass index (BMI). Carotid IMT was measured using semi-automated edge detection software. RESULTS: Type 1 diabetes patients had a higher median IMT compared with control subjects (0.538; IQR: 0.500-0.607 vs 0.513 mm; IQR: 0.481-0.557, respectively p = 0.001). Women with type 1 diabetes had a higher median IMT difference compared to the control group (0.537; IQR: 0.495-0.596 vs 0.502 mm; IQR: 0.472-0.543, respectively p = 0.003) than did men with type 1 diabetes (0.547; IQR: 0.504-0.613 vs 0.528 mm; IQR: 0.492-0.575, respectively p = 0.2). Age and diabetes duration had an additive effect on the IMT of type 1 diabetes patients. Multivariate gamma regression model analysis showed that in type 1 diabetes patients, the IMT was associated with age (Exp (ß) = 1.006, p < 0.001), duration of diabetes (Exp (ß) = 1.004, p = 0.001), BMI (Exp (ß) = 1.005, p = 0.021), family history of type 2 diabetes (Exp (ß) = 1.044, p = 0.033), total cholesterol (Exp (ß) = 0.999, p = 0.001) and creatinine clearance (Exp (ß) = 1.000, p = 0.043). CONCLUSIONS: Patients with type 1 diabetes have increased IMT, a marker of subclinical atherosclerosis. The CVD risk may be similar between men and women with type 1 diabetes, suggesting a loss of gender protection. Also, CVD risk may be higher in those with a family history of type 2 diabetes. Prospective studies are needed to confirm the predictive value of these findings and the causal effect between IMT and CVD in patients with type 1 diabetes.

Papel da ecocardiografia na avaliação dos tumores cardíacos e de massas cardíacas não infecciosas / Role of echocardiography in the evaluation of cardiac tumors and non-infectious cardiac masses

O ecocardiograma é um exame não invasivo, prático e rapidamente disponível, que pode ser realizado à beira do leito e servir não apenas para a evidenciação das massas intracardíacas não infecciosas, mas também para o auxílio na sua definição etiológica. O papel da ecocardiografia na avaliação de massas intracardíacas,especialmente na avaliação de massas tumorais é importante na definição etiológica e na avaliação das possíveis abordagens terapêuticas, quer através de métodos invasivos quer seja por conduta expectante. Este trabalho tem por objetivo fazer uma revisão do papel da ecocardiografia na diferenciação dos tipos de massas cardíacas e demonstrar de que forma a ecocardiografia pode contribuir para a diferenciação dos tipos histológicos de tumor, bem como para a definição das massas intracardíacas não tumorais não infecciosas.

Papel do ecocardiograma na avaliação da cardiotoxicidade no tratamento do câncer de mana: [revisão] / Role of echocardiograms for evaluating cardiotoxicity in breast cancer treatment: [review]

O câncer de mama é um dos mais importantes problemas de saúde pública no Brasil. A estimativa para 2010 foi 49.400 novos casos, sendo que de 25% a 35% dos pacientes já chegam aos centros especializados de tratamento oncológico em estádios avançados, necessitando de tratamento quimioterápico. A doxorrubicina e o trastuzumab são atualmente as drogas mais ativas para o câncer de mama, porém apresentam como efeito colateral o dano ao miocárdio. Dentre os métodos de diagnóstico e acompanhamento das lesões causadas por antineoplásicos, o ecocardiograma é o método mais utilizado. Isto se deve a vários fatores como: apresentar resultados altamente confiáveis, estar disponível mesmo em centros de baixa complexidade, ser de baixo custo, não ser invasivo e de fácil realização. A baixa reprodutibilidade dos resultados e o fato de ser a fração de ejeção o único indicador da função cardíaca, apontados como limitações da ecocardiografia, ficam sem sustentação com a incorporação do Doppler tecidual, da análise dafunção diastólica, do strain e do eco tridimensional ao método. Este artigo faz uma revisão do que há de mais recente em técnicas ecocardiográficas e sua aplicação na Cardio-oncologia.

Viabilidade miocárdica na lesão uniarterial: papel da ecocardiografia de estresse com dobutamina / Myocardial viability in a single-vessel disease: the role of a dobutamine stress echocardiography

OBJETIVO: Estudar um grupo de pacientes com lesão significativa em apenas uma artéria coronária e demonstrar se a ecocardiografia de estresse com dobutamina (EED) tem boa sensibilidade e especificidade na avaliação de viabilidade miocárdica nesse grupo de pacientes. MÉTODOS: Foram estudados 20 pacientes submetidos a angioplastia coronariana transluminal percutânea (ATC). Esse grupo foi avaliado 2 a 7 (3,65 ± 1,69) dias antes do procedimento, e 2 a 5 (4 ± 0,80) dias depois, realizando-se EED. Para a determinação de viabilidade miocárdica foi utilizado ecocardiograma bidimensional três meses após o procedimento. Doze pacientes foram submetidos a ATC de artéria descendente anterior (DA), 7 de artéria coronária direita (CD) e 1 de circunflexa (CX). Apenas um procedimento (CD) não obteve pleno êxito. RESULTADOS: Dos 340 segmentos estudados, 99 (29,18 por cento) demonstraram alterações contráteis, sendo 63 hipocinéticos (63,4 por cento), 28 acinéticos (28,28 por cento) e 8 discinéticos (8,08 por cento). Quanto aos segmentos envolvidos, obtivemos sensibilidade de 92,59 por cento, especificidade de 84,45 por cento, acurácia de 88,88 por cento para o exame EED. O único caso de ATC de CX demonstrou sensibilidade de 100 por cento; para DA, sensibilidade de 88,58 por cento, especificidade de 95 por cento e acurácia de 90,91 por cento. Para segmentos da CD, sensibilidade de 91,30 por cento, especificidade de 83,33 por cento e acurácia de 88,71 por cento. Todos os segmentos discinéticos eram inviáveis. Dos 63 hipocinéticos, a EED previu recuperação em 91,48 por cento. CONCLUSÃO: A EED é útil na avaliação de viabilidade miocárdica em pacientes com lesão significativa de apenas uma artéria.

[Myocardial viability in a single-vessel disease: the role of a dobutamine stress echocardiography]. / Viabilidade miocárdica na lesão uniarterial: papel da ecocardiografia de estresse com dobutamina.

OBJECTIVE: To investigate a group of patients that have a significant lesion in a single-vessel and to demonstrate whether or not the sensitivity and specificity of a dobutamine stress echocardiography (DSE) was valuable in the evaluation of myocardial viability for these patients. METHODS: Twenty patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) were studied. This group was evaluated 2 to 7 days (3.65 +/- 1.69) before the procedure and 2 to 5 days (4 +/- 0.80) after the procedure with a DSE. Myocardial viability was assessed three months after the procedure using a two dimensional echocardiogram. Twelve patients underwent PTCA on the left anterior descending artery (LAD), 7 on the right coronary artery (RC) and 1 on the circumflex artery (CX). Only one right coronary artery procedure was not 100% successful. RESULTS: From the 340 segments that were studied, 99 (29.18%) demonstrated contractile alterations of which 63 were hypokinetic (63.4%), 28 akinetic (28.28%) and 8 dyskinetic (8.08%). In reference to the segments involved, we obtained a sensitivity of 92.59%, specificity of 84.45%, and accuracy of 88.88% for the DSE. The solitary case of PTCA for the circumflex artery demonstrated 100% sensitivity. The LAD demonstrated a sensitivity of 88.58%, specificity of 95% and accuracy of 90.91%. For the RC segments, sensitivity was 91.30%, specificity 83.33% and accuracy 88.71%. All dyskinetic segments were unviable. The DSE predicted a 91.48% recovery rate for the 63 hypokinetic segments. CONCLUSION: The DSE is an effective test for evaluating myocardial viability in patients with a significant single-vessel disease.

How can the echocardiogram be useful for predicting death in children with idiopathic dilated cardiomyopathy?

OBJECTIVE: To determine the echocardiographic predicting factors of death in children with idiopathic dilated cardiomyopathy. METHODS: A retrospective study of 148 children with idiopathic dilated cardiomyopathy diagnosed between September 1979 and March 2003 was carried out. The inclusion criteria were as follows: heart failure and a reduction in contractility on the echocardiogram in the absence of congenital or secondary heart disease. Four hundred and seventy examinations during a period of 244.8 months of evolution were analyzed. The following parameters were assessed: left atrial dimension (LAD); left atrium/aorta ratio (LAD/Ao); left ventricular systolic (LVSD) and diastolic (LVDD) dimensions; left ventricular mass (LVmass); right ventricular dimension (RVD); left ventricular ejection fraction (LVEF); left ventricular shortening fraction (% SH); severity of the insufficiency of the atrioventricular and pulmonary valves; and right ventricular systolic (RVSP) and diastolic (RVDP) pressures. The significance level adopted was alpha < 0.05. RESULTS: The mean age was 2.37 years, and 35 patients died (23.7%--95 CI = 17.1% to 31.2%). The analysis of variance showed the following: LAD (p<0.0001); LAD/Ao (p<0.0001); LVSD (p=0.0061); LVDD (p=0.0086); LVmass (p<0.0001); LVEF (p=0.0074); %SH (p=0.0072); and RVD (p<0.0001). Worsening of mitral (MI) (p=0.0113) and tricuspid (TI) insufficiencies (p=0.0044) were markers of death, and the presence of MI, TI, and moderate/severe pulmonary insufficiency were deleterious to survival. The Cox proportional hazards regression model showed the following independent predictors of death: LAD/Ao (p=0.0487); LVEF (<0.0001); and the presence of moderate/severe MI (p=0.0419). CONCLUSION: Patients with a progressive increase in LAD/Ao, a reduction in LVEF, and progressive worsening of MI, regardless of the clinical treatment, should be considered for early heart transplantation.

Como o ecocardiograma pode ser útil em predizer a morte em crianças com cardiomiopatia dilatada idiopática? / How can the echocardiogram be useful for predicting death in children with idiopathic dilated cardiomyopathy?

OBJETIVO: Determinar os fatores preditores ecocardiográficos de morte em crianças com cardiomiopatia dilatada idiopática. MÉTODOS: Estudo retrospectivo de 148 crianças com cardiomiopatia dilatada idiopática diagnosticadas entre setembro/1979 a março/2003. Critérios para inclusão: insuficiência cardíaca e redução da contratilidade no ecocardiograma, na ausência de cardiopatia congênita ou secundária. Foram analisados 470 exames, durante 244,8 meses de evolução. Parâmetros analisados: dimensão do átrio esquerdo (DAE), relação átrio esquerdo/aorta (DAE/Ao), dimensão sistólica (DSVE) e diastólica (DDVE) do VE, massa do VE (massa), dimensão do ventrículo direito (DVD), fração de ejeção do VE (FE), percentagem de encurtamento do VE ( por centoEC), gravidade da insuficiência das valvas atrioventriculares e da valva pulmonar e medida da pressão sistólica (PsVD) e diastólica (PdVD) do VD. Foi considerado significativo erro alfa <0,05. RESULTADOS: Idade média de 2,37 anos, ocorridos 35 óbitos (23,7 por cento - IC95=17,1 por cento a 31,2 por cento). ANOVA demonstrou: DAE (p<0,0001), DAE/Ao (p<0,0001), DSVE (p=0,0061), DDVE (p=0,0086), massa (p<0,0001), FE (p=0,0074), por centoEC (p=0,0072) e DVD (p<0,0001). O agravamento da insuficiência mitral (IM) (p=0,0113) e tricúspide (IT) (p=0,0044) foram marcadores de óbito e a presença de IM, IT e insuficiência pulmonar moderada/grave foram deletérias à sobrevida. A análise de Cox demonstrou como preditores independentes da morte: DAE/Ao (p=0,0487), FE (<0,0001) e presença de IM moderada/grave (p=0,0419). CONCLUSAO: Os pacientes com aumento progressivo da DAE/Ao, redução da FE e agravamento progressivo da IM, a despeito do tratamento clínico, devem ser considerados precocemente em programa de transplante cardíaco.

Estudo da hipertensão arterial pulmonar no lúpus eritematoso sistêmico / Study of pulmonary artery hypertension in systemic lupus erythematosus

Objetivo: Discutir os mecanismos patogênicos da hipertensão arterial pulmonar (HAP) no lúpus eritematoso sistêmico (LES), como: (1) redução da vasculatura, por doença intersticial; (2) redução da luz dos vasos por trombose ou embolia pulmonar; (3) vasoconstrição pulmonar. Métodos: Foram avaliados 14 pacientes com LES e HAP (grupo 1) e um grupo de controle de 14 pacientes com LES sem HAP (grupo 2), pareado para idade, sexo e tempo de doença. Todos os pacientes foram submetidos à avaliação clínica (com ênfase à presença do fenômeno de Raynaud e eventos trombóticos), pesquisa do anticorpo anticardiolipina e tomografia computadorizada de alta resolução (TCAR). Lavado bronco alveolar (LBA) foi realizado somente nos pacientes com LES e HAP. Resultados: Vinte e seis pacientes eram do sexo feminino e 2 do sexo masculino. O tempo médio de duração do LES foi de 13,2 anos nos pacientes do grupo 1 e 9,2 anos no grupo 2 (p > 0,05). Fenômeno de Raynaud esteve presente em 71,4 dos pacientes do grupo 1 e 64,2 do grupo 2. Tromboses e abortamentos ocorreram em 7,1 dos pacientes no grupo 1 e em 21,4 no grupo 2. A pesquisa do anticorpo anticardiolipina foi positiva em 28,5 dos pacientes com HAP e 42,8 no grupo 2. O LBA evidenciou citometria compatível com alveolite em 76,9 dos pacientes com HAP. O padrão de “vidro fosco” na TCAR, sugestivo de alveolite, foi encontrado em 85,7 dos pacientes no grupo 1 e 14,2 no grupo 2 (p < 0,05). Conclusões: A alveolite pareceu-nos ser o principal mecanismo envolvido na gênese da HAP, no grupo de pacientes lúpicos avaliado. Não conseguimos demonstrar a participação do vasoespasmo, expresso perifericamente pelo fenômeno de Raynaud, ou dos fenômenos tromboembólicos no leito vascular pulmonar, na fisiopatogenia da HAP em nossos pacientes.

Tamponamento cardíaco no lúpus eritomatoso sistêmico. Relato de quatro casos / Cardiac tamponade in systemic lupus erythematosus. Report of four cases

OBJECTIVE: To report and assess the incidence of cardiac tamponade in systemic lupus erythematosus as a cardiac manifestation of the disease. METHODS: We reviewed the medical records of 325 patients diagnosed with systemic lupus erythematosus according to the American Rheumatism Association and their complementary laboratory tests compatible with cardiac tamponade. RESULTS: In the 325 medical recors reviewed, we found 108 patients with pericardial effusions corresponding to 33.2 percent of the total and 54 percent of the patients studied in the active phase of the disease. Clinical assessment and transthoracic echocardiogram allowed the clinical diagnosis of cardiac tamponade in only 4 (1.23 percent) patients, 3 of whom were females, white, with ages ranging from 25 to 44 years. The pericardial fluid was hemorrhagic or serosanguineous with high levels of FAN and positivity for LE cells. In the treatment, we successfully used pericardicentesis associated with high doses of corticosteroids. In clinical and laboratory follow-up performed for a period of 3 years, neither recrudescence of the pericardial effusion nor evolution to constriction occurred. CONCLUSION: Even though rare (1.23 percent), cardiac tamponade in patients with systemic lupus erythematosus has a benign evolution when properly treated, according to our experience