Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real

Detalhes bibliográficos
Autor(a) principal: Mancuso, Frederico Jose Neves [UNIFESP]
Data de Publicação: 2011
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
dARK ID: ark:/48912/0013000015gxp
Texto Completo: http://repositorio.unifesp.br/handle/11600/9120
Resumo: Background: Although there is anatomopathological evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. The aim of this study was to evaluate LA volumes and function in CCM patients with real-time three-dimensional echocardiography (RT3DE) and to compare it with idiopathic dilated cardiomyopathy (DCM) patients, correlating the findings with clinical and echocardiographic variables. Methods: Thirty patients with CCM, 30 with DCM, and 20 normal subjects used as the control group (CG) were studied. With RT3DE, we measured LA maximum (maxLAV), minimum and pre-atrial contraction volumes and calculated total (TLAEF) and active (ALAEF) LA emptying fraction. Clinical variables and other echocardiographic variables were evaluated in the patients. The data were compared with statistical tests (ANOVA); significant if p . 0,05. The Pearson correlation coefficient was used between clinical and echocardiographic continuous variables. With multiple regression model we identified the determinants of increasing maxLAV e of the ALAEF worsening, in CCM patients. Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m2 was larger in CCM than in DCM (76.9 }21.9 ml vs. 59.1 }26.0 ml; p<0.01), and both were significantly larger than in the CG (p<0.01). TLAEF was lower in CCM patients than in DCM (30 } 10% vs. 40 } 12%; p<0.01), and both were lower than in the CG (p=0.01). ALAEF was also lower in CCM than in DCM (22 } 0.09% vs. 28 } 11%; p<0.01), and both were lower than in the CG (p=0.01). The E/e f ratio was higher in CCM than in DCM (21 }10 vs. 15 }6; p<0.01), and both were greater than in the CG (p<0.01). In a multiple regression model, the E/e L ratio and the mitral regurgitation were predictors of a increasing in MaxLAV, meanwhile the E/e L ratio was the only independent predictor of a worsening ALAEF. Conclusion: The MaxLAV were greater in CCM than in DCM and the LA function is more compromised in CCM than in DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy.
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spelling Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo RealStructural and functional evaluation of the left atrium in the chagasic cardiomiopathy compared to idiophatic dilated cardiomiopathy. A study with real time three-dimensional echocardiographyCardiomiopatia chagásicaEcocardiografia tridimensionalÁtrio esquerdoÁtrios do coraçãoBackground: Although there is anatomopathological evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. The aim of this study was to evaluate LA volumes and function in CCM patients with real-time three-dimensional echocardiography (RT3DE) and to compare it with idiopathic dilated cardiomyopathy (DCM) patients, correlating the findings with clinical and echocardiographic variables. Methods: Thirty patients with CCM, 30 with DCM, and 20 normal subjects used as the control group (CG) were studied. With RT3DE, we measured LA maximum (maxLAV), minimum and pre-atrial contraction volumes and calculated total (TLAEF) and active (ALAEF) LA emptying fraction. Clinical variables and other echocardiographic variables were evaluated in the patients. The data were compared with statistical tests (ANOVA); significant if p . 0,05. The Pearson correlation coefficient was used between clinical and echocardiographic continuous variables. With multiple regression model we identified the determinants of increasing maxLAV e of the ALAEF worsening, in CCM patients. Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m2 was larger in CCM than in DCM (76.9 }21.9 ml vs. 59.1 }26.0 ml; p<0.01), and both were significantly larger than in the CG (p<0.01). TLAEF was lower in CCM patients than in DCM (30 } 10% vs. 40 } 12%; p<0.01), and both were lower than in the CG (p=0.01). ALAEF was also lower in CCM than in DCM (22 } 0.09% vs. 28 } 11%; p<0.01), and both were lower than in the CG (p=0.01). The E/e f ratio was higher in CCM than in DCM (21 }10 vs. 15 }6; p<0.01), and both were greater than in the CG (p<0.01). In a multiple regression model, the E/e L ratio and the mitral regurgitation were predictors of a increasing in MaxLAV, meanwhile the E/e L ratio was the only independent predictor of a worsening ALAEF. Conclusion: The MaxLAV were greater in CCM than in DCM and the LA function is more compromised in CCM than in DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy.Introdução: Embora existam evidências anatomopatológicas de comprometimento atrial na cardiomiopatia chagásica (CMPC), o impacto sobre a função do átrio esquerdo (AE) ainda não é conhecido. O objetivo deste estudo foi avaliar os volumes e a função do AE em pacientes com CMPC pela ecocardiografia tridimensional em tempo real (E3DTR) e compará-los com pacientes com cardiomiopatia dilatada idiopática (CMPD), correlacionando os achados com variáveis clínicas e ecocardiográficas. Métodos: Trinta pacientes com CMPC, 30 com CMPD e 20 indivíduos normais que formaram o grupo controle (GC), foram estudados. Com a E3DTR, medimos os volumes máximo (VolmaxAE), mínimo (VolminAE) e pré onda P do ECG (VolpreAAE) do AE e calculamos a fração de esvaziamento total (FETAE) e ativa (FEAAE) do AE. Outras variáveis ecocardiográficas, bem como variáveis clínicas também foram analisadas nos grupos. Os resultados foram comparados por testes estatísticos (ANOVA) ao nível de significância de p<0,05. Correlação de Pearson foi utilizada entre variáveis contínuas ecocardiográficas e clínicas. Por meio de análise multivariada por regressão linear, identificamos as variáveis independentemente relacionadas ao aumento do VolmaxAE e à piora da função atrial ativa no grupo CMPC. Resultados: A fração de ejeção do ventrículo esquerdo e a insuficiência mitral foram semelhantes nos grupos CMPC e CMPD. O VolmaxAE/m2 foi maior na CMPC do que na CMPD (76,9 ± 21,9 ml vs. 59,1 ± 26,0 ml; p<0,01), ambos significativamente maiores do que no GC (p<0,01). A FETAE foi menor nos pacientes com CMPC do que nos pacientes com CMPD (30,5 ± 10,5% vs. 39,9 ± 11,8%; p<0,01), e ambas foram menores do que no GC (p=0,01). A FEAAE também foi menor no grupo CMPC do que no grupo CMPD (21,9 ± 9,5% vs. 28,2 ± 11,1%; p<0,01), ambas menores do que no GC (p=0,01). A relação E/e´ foi maior no grupo CMPC do que no grupo CMPD (21 ± 10 vs. 15±6; p<0,01), e ambos os grupos apresentaram relações maiores do que o GC (p<0,01). No modelo de regressão múltipla, a relação E/e´ e a insuficiência mitral foram as variáveis independentemente associadas ao aumento do VolmaxAE, enquanto que a relação E/e´ foi a única variável independentemente associada à piora da FEAAE. Conclusão: O VolmaxAE é maior na CMPC do que na CMPD, assim como a função ativa do AE é mais comprometida na CMPC do que na CMPD. Estes achados indicam um comprometimento miocárdico maior e mais extenso na cardiomiopatia chagásica, provavelmente relacionado ao aumento da pressão diastólica do ventrículo esquerdo e à miopatia atrial.TEDEBV UNIFESP: Teses e dissertaçõesUniversidade Federal de São Paulo (UNIFESP)Campos Filho, Orlando [UNIFESP]Universidade Federal de São Paulo (UNIFESP)Mancuso, Frederico Jose Neves [UNIFESP]2015-07-22T20:49:37Z2015-07-22T20:49:37Z2011-05-25info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersion79 p.application/pdfMANCUSO, Frederico Jose Neves. Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real. 2011. Tese (Doutorado) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2011.Publico-12568.pdfhttp://repositorio.unifesp.br/handle/11600/9120ark:/48912/0013000015gxpporinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-06T16:09:25Zoai:repositorio.unifesp.br/:11600/9120Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-12-11T20:57:41.324789Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
Structural and functional evaluation of the left atrium in the chagasic cardiomiopathy compared to idiophatic dilated cardiomiopathy. A study with real time three-dimensional echocardiography
title Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
spellingShingle Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
Mancuso, Frederico Jose Neves [UNIFESP]
Cardiomiopatia chagásica
Ecocardiografia tridimensional
Átrio esquerdo
Átrios do coração
title_short Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
title_full Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
title_fullStr Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
title_full_unstemmed Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
title_sort Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
author Mancuso, Frederico Jose Neves [UNIFESP]
author_facet Mancuso, Frederico Jose Neves [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Campos Filho, Orlando [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Mancuso, Frederico Jose Neves [UNIFESP]
dc.subject.por.fl_str_mv Cardiomiopatia chagásica
Ecocardiografia tridimensional
Átrio esquerdo
Átrios do coração
topic Cardiomiopatia chagásica
Ecocardiografia tridimensional
Átrio esquerdo
Átrios do coração
description Background: Although there is anatomopathological evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. The aim of this study was to evaluate LA volumes and function in CCM patients with real-time three-dimensional echocardiography (RT3DE) and to compare it with idiopathic dilated cardiomyopathy (DCM) patients, correlating the findings with clinical and echocardiographic variables. Methods: Thirty patients with CCM, 30 with DCM, and 20 normal subjects used as the control group (CG) were studied. With RT3DE, we measured LA maximum (maxLAV), minimum and pre-atrial contraction volumes and calculated total (TLAEF) and active (ALAEF) LA emptying fraction. Clinical variables and other echocardiographic variables were evaluated in the patients. The data were compared with statistical tests (ANOVA); significant if p . 0,05. The Pearson correlation coefficient was used between clinical and echocardiographic continuous variables. With multiple regression model we identified the determinants of increasing maxLAV e of the ALAEF worsening, in CCM patients. Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m2 was larger in CCM than in DCM (76.9 }21.9 ml vs. 59.1 }26.0 ml; p<0.01), and both were significantly larger than in the CG (p<0.01). TLAEF was lower in CCM patients than in DCM (30 } 10% vs. 40 } 12%; p<0.01), and both were lower than in the CG (p=0.01). ALAEF was also lower in CCM than in DCM (22 } 0.09% vs. 28 } 11%; p<0.01), and both were lower than in the CG (p=0.01). The E/e f ratio was higher in CCM than in DCM (21 }10 vs. 15 }6; p<0.01), and both were greater than in the CG (p<0.01). In a multiple regression model, the E/e L ratio and the mitral regurgitation were predictors of a increasing in MaxLAV, meanwhile the E/e L ratio was the only independent predictor of a worsening ALAEF. Conclusion: The MaxLAV were greater in CCM than in DCM and the LA function is more compromised in CCM than in DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy.
publishDate 2011
dc.date.none.fl_str_mv 2011-05-25
2015-07-22T20:49:37Z
2015-07-22T20:49:37Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv MANCUSO, Frederico Jose Neves. Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real. 2011. Tese (Doutorado) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2011.
Publico-12568.pdf
http://repositorio.unifesp.br/handle/11600/9120
dc.identifier.dark.fl_str_mv ark:/48912/0013000015gxp
identifier_str_mv MANCUSO, Frederico Jose Neves. Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real. 2011. Tese (Doutorado) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2011.
Publico-12568.pdf
ark:/48912/0013000015gxp
url http://repositorio.unifesp.br/handle/11600/9120
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 79 p.
application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
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institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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