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Maria do Carmo Pereira Nuneshttp://lattes.cnpq.br/7052421532116243Tereza Cristina de Abreu FerrariMaria do Carmo Pereira NunesTereza Cristina de Abreu Ferrarihttp://lattes.cnpq.br/3734010867387726Maria Betânia Solis Resende2019-09-30T15:04:32Z2019-09-30T15:04:32Z2018-05-24http://hdl.handle.net/1843/30153A doença falciforme (DF) é uma doença multissistêmica causada por uma mutação no gene da hemoglobina que leva à formação de eritrócitos anormais resultando em anemia hemolítica, fenômenos de vaso-oclusão e danos isquêmicos aos tecidos. A identificação precoce das anormalidades cardiovasculares permite estabelecer estratégias terapêuticas eficazes com impacto direto na morbi-mortalidade da doença. A ecocardiografia bidimensional utilizando a técnica do Speckle-Tracking strain (STE) tem sido cada vez mais utilizada na detecção de alterações miocárdicas precoces em vários processos fisiopatológicos do coração. OBJETIVOS: analisar o valor do STE na predição de eventos clínicos em pacientes com DF e avaliar os parâmetros ecocardiográficos relacionados à gravidade da doença. MÉTODOS: foram avaliados prospectivamente 233 pacientes adultos portadores de DF. Os pacientes realizaram o ecocardiograma bidimensional com Doppler. As medidas do strain global longitudinal do VE e do VD foram quantificadas e analisadas. O desfecho do estudo foi um composto dos seguintes eventos: (1) mortalidade por todas as causas, (2) três ou mais crises álgicas que necessitaram hospitalização em um ano, (3) síndrome torácica aguda e (4) hospitalização por outras complicações da doença. RESULTADOS: 165 pacientes (72,7%) eram portadores de HbSS, 56 pacientes HbSC (24,7%) e 06 pacientes Sβ0 talassemia (2,6%). A idade média dos pacientes foi de 33 ± 11 anos (variando de 18-69 anos). O seguimento médio foi de 32 meses (variando de 1,2 a 82,6 meses). Durante o seguimento, 69 pacientes (32%) apresentaram evento clínico desfavorável, incluindo 08 mortes decorrentes da DF (3,6%). A maioria dos pacientes apresentava função sistólica preservada, com aumento dos diâmetros do VE e do AE. O volume indexado do átrio esquerdo e a massa miocárdica indexada do VE estavam aumentados. Não se observou diferença nos parâmetros de função diastólica nos grupos com e sem eventos. A função sistólica do ventrículo direito foi semelhante em ambos os grupos, incluindo o strain global longitudinal. O strain global longitudinal do VE variou de 12,25 a -25,44 (média -20,26 ± 2,3). Diversas variáveis clínicas, laboratoriais e ecocardiográficas foram testadas para avaliar uma possível associação com eventos adversos. Na análise multivariada, a velocidade máxima da regurgitação tricúspide, a fração de ejeção do ventrículo esquerdo, a massa indexada do VE, o volume indexado do AE e o strain global longitudinal do VE correlacionaram-se a eventos adversos. CONCLUSÃO: o strain global longitudinal do VE aumentado foi um preditor independente de desfecho adverso em pacientes com DF, agregando valor prognóstico incremental aos demais parâmetros ecocardiográficos. A avaliação do strain tem valor potencial para estratificação de risco clínico em pacientes com DF.Sickle cell disease (SCD) is a multisystem disease caused by a mutation in the globin gene, leading to the formation of abnormal hemoglobin resulting in haemolytic anemia, vaso occlusion phenomena and ischemic tissue damage. Early identification of cardiovascular abnormalities in patients with SCD allows establishing effective therapeutic strategies with direct impact on morbidity and mortality. Two-dimensional speckle-tracking strain echocardiography (STE) has been increasingly used for detection of early myocardial changes in a number of pathophysiological processes of the heart. OBJECTIVES: the study was designed to examine the prognostic value of STE in predicting clinical outcome in patients with SCD and to assess echocardiographic parameters that indicate disease severity. METHODS: A total of 233 SCD adult patients were prospectively enrolled. Patients performed two-dimensional Doppler echocardiography. Measurements of STE were quantified and evaluated. The study endpoint was a composite of the following events during the follow-up: (1) all-cause mortality, (2) three or more acute painful episodes that require hospitalization in one year, (3) acute chest syndrome and (4) hospitalization for disease complication. RESULTS: 165 patients (72.7%) carrying hemoglobin (Hb) SS, 56 patients (24.7%) HbSC and 6 patients (2.6%) with sickle cell-beta zero thalassemia (HbS-β0-thal). The mean age of the patients was 33 ± 11 years (range 18-69 years). During the mean follow-up of 32 months (ranging from 1.2 to 82.6 months), 69 patients (32%) had reached the endpoint, including 8 deaths due to SCD (3.6%). The majority of the patients had preserved systolic function, with LV and LA diameters enlargement. Left atrial volume index and LV indexed mass were increased. No difference was observed in the parameters of diastolic function when we compared the groups with and without adverse events during the follow up. Right ventricle (RV) systolic function was similar in both groups, including RV global longitudinal strain. LV global longitudinal strain ranged from -12.25 to -25.44 (mean -20.26 ± 2.3). Several clinical, laboratory and echocardiographic variables were tested to evaluate a possible association with adverse events. In the multivariate analysis, the maximal velocity of tricuspid regurgitation, LV ejection fraction, LV indexed mass, LA volume index and LV global longitudinal strain were associated with adverse events. CONCLUSION: Higher LV global longitudinal strain was an independent predictor of adverse outcome in patients with SCD, adding incremental prognostic value to the other echocardiographic parameters. Strain assessment has a potential value for clinical risk stratification in SCD patients.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina TropicalUFMGBrasilMEDICINA - FACULDADE DE MEDICINAAnemia FalciformeÍndice de Gravidade de DoençaDoença falciformeEcocardiografiaParâmetros ecocardiográficos indicadores de gravidade na doença falciforme: valor do strain bidimensionalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALDISSERTAÇÃO DE MESTRADO - MARIA BETÂNIA SOLIS RESENDE.pdfDISSERTAÇÃO DE MESTRADO - MARIA BETÂNIA SOLIS RESENDE.pdfAbertoapplication/pdf1057342https://repositorio.ufmg.br/bitstream/1843/30153/1/DISSERTA%c3%87%c3%83O%20DE%20MESTRADO%20-%20MARIA%20BET%c3%82NIA%20SOLIS%20RESENDE.pdfc1eb4652028d6d89fa69333f1a89ea23MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/30153/2/license.txt34badce4be7e31e3adb4575ae96af679MD52TEXTDISSERTAÇÃO DE MESTRADO - MARIA BETÂNIA SOLIS RESENDE.pdf.txtDISSERTAÇÃO DE MESTRADO - MARIA BETÂNIA SOLIS RESENDE.pdf.txtExtracted texttext/plain152469https://repositorio.ufmg.br/bitstream/1843/30153/3/DISSERTA%c3%87%c3%83O%20DE%20MESTRADO%20-%20MARIA%20BET%c3%82NIA%20SOLIS%20RESENDE.pdf.txt3f899bf10e9c90acaa38219411267bb7MD531843/301532019-11-14 12:37:04.478oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2019-11-14T15:37:04Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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