2017;30(4) – ABC CARDIOL

Liver transplantation (LT) is a huge surgery performed to treat patients with advanced liver cirrhosis and is associated with several risks. For this reason, is necessary to stratify the risk in the pre-transplantation period through the evaluation of myocardial function and ischemia

Objective

To demonstrate the applicability of cardiac magnetic resonance (CMR) in cardiac morphologic and functional evaluation, as well use in the evaluation of myocardial ischemia in pre-transplantation.

Methods

Retrospective, descriptive study. Data from patients with cirrhosis referred to the liver transplant outpatient clinic from January 2014 to July 2016 were analyzed they underwent CMR for cardiac evaluation and as provocative test of myocardial ischemia.

Results

135 patients were referred of these, 39 performed CMR. The mean age was 60 (50 to 71). About 87% (n = 34) were males. Alcoholic etiology prevailed 56% (n = 22). Most were of CHILD C patients with MELD ≥ 18, (n = 26). CMR showed myocardial ischemia in 03 patients (7,6%). Coronary angiography was performed and presence of severe coronary artery disease (obstruction > 70%) was confirmed, with consequent myocardial revascularization. At a follow-up of 2 years and 7 months, the survival of transplanted patients was 87%, without cardiologic complications.

Conclusions

The realization of CMR in the evaluation of cirrhotic patients in the pre-transplantation proved to be a safe strategy by showing presence of morphologic and functional changes of the cirrhotic cardiomyopathy and the presence of myocardial ischemia. However, more studies should be performed to standardize methods and criteria for cardiovascular evaluation in cirrhotic patients before the liver transplantation. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(4):119-125)

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Aberrant Right Subclavian Artery and Lusoria Dysphagia

Milton Sérgio Bohatch Júnior et al. Amanda Fernandes Vidal da Silva Ademar Regueira Filho Marcelo Haddad Dantas Roberto Teodoro Beck

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Original Article

Analysis of Right Ventricular Function in Patients with Hypothyroidism

Gustavo Demasi Quadros de Macedo et al. Mario Jorge Quadros de Macedo Jean Jorge Silva de Souza Maria Luiza Gazzana

Summary

Background

After many studies about the left ventricle (LV), little is known about the effect of thyroid hormones deprivation at the right ventricle (RV).

Objective

This study was aimed to evaluate the right ventricular function in patients who had hypothyroidism in different degrees of disease severity.

Methods

Eighteen patients with primary hypothyroidism were submitted to two-dimensional echocardiography evaluation, of which 10 (55,6%) had TSH 12 mIU/L (highest TSH group).

Results

By comparing the two groups, there were no differences in respect of LV global systolic function or diastolic function. There was neither difference related to right atrium or RV dimensions. About the right ventricular function, it was shown a difference in the myocardial performance index (Tei index), which was higher in patients who had TSH > 12 compared with patients who had TSH < 12 (0.52 ± 0.13 vs. 0.39 ± 0.08; p < 0.05), indicating worse right ventricular global function in those patients with the highest TSH levels. No differences were observed between these groups related to other variables, which are: percentage of systolic change in the VD area, TAPSE and peak systolic velocity. Variables of RV diastolic function (E/A tricuspid ratio and E/E’ tricuspid ratio), as well as pulmonary vascular resistance and pulmonary artery systolic pressure were not different between groups.

Conclusion

Patients with hypothyroidism who had the highest TSH levels, as compared to those with less high TSH, presented with a reduction at the overall right ventricular function, evaluated by myocardial performance index, not observed in other parameters of RV function evaluation. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(4):126-131)

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Review Article

Strain Echocardiography in Patients with Diastolic Dysfunction and Preserved Ejection Fraction: Are We Ready?

Renato Hortegal et al. Henry Abensur

Abstract

The study of diastolic function in echocardiography has the following primary tasks: 1) Recognizing/categorizing diastolic dysfunction and 2) identifying signs of increased left ventricular filling pressures. The ASE 2016 guideline for the evaluation of left ventricular diastolic function opens possibilities for the use of new technologies that support the diagnostic process. A literature review on the clinical evidence and on the applicability of parameters of strain echocardiography in the evaluation of diastolic function in patients with preserved ejection fraction was carried out.

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