2018;31(3) – ABC CARDIOL

Dobutamine-atropine stress echocardiography (DASE) is an accessible and important test, especially in patients under investigation for coronary artery disease. However, it is necessary to evaluate its safety, as it is used in patients with increasingly complex and serious conditions and in seniors.

Objective

To confirm the safety of DASE and evaluate the predictors of arrhythmias in a non-hospital setting.

Methods

DASE was performed to evaluate ischemia using the standard protocol of dobutamine infusion of 5 to 40 mcg/kg/min associated with atropine.

Results

From September to November 2010, 227 patients were evaluated prospectively. The mean age was 60.7 +/- 12.5 years old and 60.8% were females. Mean ejection fraction was 67.9 +/- 9. Among the adverse events, 12 patients presented hypertensive response, 466 had arrhythmia, 58 had headaches and 57 had precordial pain. No patient had acute myocardial infarction, ventricular fibrillation, cardiac rupture, asystole or death. As for the onset of significant arrhythmia, three patients had atrial fibrillation, 16 had sustained supraventricular tachycardia, 19 had non-sustained ventricular tachycardia and 2 had sustained ventricular tachycardia. In these patients, age (OR = 1.0559, p = 0.0002) and segmental contractility index at rest (SCIr) > 1 (OR 2.5039, p = 0.0354) were independent predictors for the onset significant arrhythmia during the test.

Conclusion

DASE was proven safe in this group of patients in a non-hospital setting. Age and SCIr > 1 were independent predictors for the onset of significant arrhythmia during the test. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):168-174)

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Review Article

What’s New in Cardiac Amyloidosis?

Priscila Cestari Quagliato et al. Elry M . Vieira Segundo Neto Jorge Eduardo Assef Rodrigo B. de Mattos Barretto … Edilaide de Barros Correia Felicio Savioli Neto Hui Tzu Lin-Wang Mario Hiroyuki Hirata Paola Emanuela Poggio Smanio

Abstract

These are

Amyloidosis is characterized by the localized or systemic deposition of proteins with unstable tertiary structure, which aggregate and form amyloid fibrils. Cardiac amyloidosis is a frequently underdiagnosed condition and it is an important cause of heart failure. There are more than 30 known types of amyloid proteins, but only five often infiltrate the heart, causing cardiac amyloidosis. light chain immunoglobulin, heavy chain immunoglobulin, transthyretin, serum amyloid A and apolipoprotein AI, mostly in light chain immunoglobulin or transthyretin forms. According to the type of fibrillar protein deposited, cardiac amyloidosis has different clinical courses, prognosis and different forms of treatment. In this review, we address new techniques that allow the diagnosis of this entity, especially in situations of heart failure with preserved ejection fraction and restrictive heart diseases. Early diagnosis is fundamental in defining the best therapeutic approach and in the prognosis of these patients.

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Original Article

Transthoracic Echocardiographic Assessment of Thoracic Aorta: Correlation with Cardiovascular Risk Factors

Alexandre Sartori Barbosa et al. Ana Cristina Camarozano Daniela de Castro Carmo Daniane Rafael … Jerônimo Antonio Fortunato Rubens Zenóbio Darwich Liz Andréa Villela Baroncini

Abstract

Background

Thoracic aorta dimensions have been poorly correlated with cardiovascular risk factors such as systemic arterial hypertension (SAH), diabetes mellitus (DM) and coronary artery disease (CAD).

Objectives

To correlate the thoracic aorta diameter assessed by transthoracic echocardiography (TTE) with SAH, DM, dyslipidemia, CAD, smoking, age, gender, weight, height, body mass index (BMI) and body surface area (BSA) and continuous use of drugs with cardiovascular protective action.

Methods

Observational, cross-sectional and retrospective study. The study included 203 individuals (62.1 ± 15.3 years of age; 57.1% female) who underwent TTE with thoracic aorta evaluation at 6 sites: (1) aortic valve annulus; (2) sinus of Valsalva; (3) sinotubular junction; (4) ascending proximal aorta; (5) aortic arch and (6) descending aorta.

Results

Age (p < 0.05), male gender (p < 0.001), weight (p < 0.001), height (p < 0.05), and BSA (p < 0.001) were associated with greater thoracic aorta diameters at all sites evaluated. Multivariate analysis identified that age, male gender and BSA, together, explain the variation of aortic annulus diameters in 17.3%, in the sinus of Valsalva in 30.7%, in the sinotubular junction in 17.7%, in the proximal ascending aorta in 21.9%, in the aortic arch in 19.8% and in the descending aorta in 21.4%. There was no association between aortic diameters and the risk factors assessed and continuous use of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Conclusions

Age, male gender and body surface area correlated positively and significantly with the thoracic aorta diameters. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):191-197)

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Editorial

Cardiac Involvement in Infectious Diseases

João Marcos Bemfica Barbosa Ferreira

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Original Article

Echocardiographic Evaluation of Late Cardiac Abnormalities Caused by the Chikungunya Fever

José Maria Del Castillo et al. Gabriela Marques Pereira de Alencar Marcus Vinicius Dantas da Nóbrega Carlos Mazzarollo … Jonny Vitor Diniz Eugenio Soares de Albuquerque Antônia Dulcineide Medeiros Sena Carlos Antônio da Mota Silveira Oscar Francisco Sanchez Osella

Abstract

Background

Chicungunya fever causes highly debilitating joint pains. Complications are rare and may affect the cardiovascular system.

Objective

To evaluate, with echocardiography and two-dimensional strain, the cardiovascular changes in the chronic phase of the Chikungunya infection.

Methods

The study included 32 patients, mean age 56 ± 14 years divided into Group A, with < 12 months evolution (12 patients) and Group B, with ≥ 12 months evolution (20 patients). The cardiac dimensions, left ventricular end-diastolic volume indexed to body surface, left ventricular ejection fraction, left ventricular global longitudinal strain and left atrial longitudinal strain were determined. The groups were compared using unpaired analysis. The p significance was < 0.05.

Results

Most Group A patients presented diffuse hypocontratility and decreased left ventricular ejection fraction (45.5 ± 10.4%) with normal left ventricular diastolic indexed volume (58.7 ± 24.9 mL/m²). Most Group B patients presented diffuse hypocontratility (ejection fraction 38.2 ± 6.4%) and increased left ventricular diastolic indexed volume (88.3 ± 26.4 mL/m²). There was segmental changes in 22% of the patients, and hypertrophy or remodelling in seven cases of each Group. There was decreased global longitudinal strain in both Groups (-11.9 ± 4.4% in Group A and -10.3 ± 3.8% in Group B). Lef atrial longitudinal strain were 37.9 ± 17.3% in Group A and 27.5 ± 15.2% in Group B. Patients with pericarditis had normal left ventricular dimensions and function.

Conclusion

The cardiac complications of Chikungunya fever was diffuse hypocontratility with left ventricular normal size observed in the first year of chronic evolution and diffuse hypocontratility with left ventricular dilation observed in later evolution. Patients with pericardial thickening did not present myocardial issues. Echocardiography can be used as an important tool in patients with Chikungunya fever, since it can detects early abnormalities in the cardiovascular system. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):183-190)

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Case Report

Myocardial Viability in a Patient with Systemic Lupus Erythematosus

Elisa Carla Hilgemberg et al. Ursula Cristina Barbosa de Almeida Daco Roessler Larissa Ticiane Machado dos Santos Alair Sarmet Damas Claúdio Tinoco Mesquita

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Case Report

Left Ventricle Pseudoaneurysm After Mitral Valve Replacement: Case Report and Literature Update

Pedro Rafael de Oliveira Nascimento et al. Gustavo Henrique Belarmino de Góes Diana Patricia Lamprea Sepulveda Ricardo Carvalho Lima … José Maria Del Castillo Dário Celestino Sobral Filho

[…]

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Original Article

Correlation between Degrees of Pulmonary Hypertension and Findings in Complementary Tests

João Arthur Pazello et al. Ana Cristina Camarozano

Abstract

Introduction

Pulmonary hypertension is potentially fatal and courses with important day-to-day limitation. While the treatment is capable of slowing the disease’s progression, increase in life expectancy is directly linked to early diagnosis and treatment.

Objectives

To analyze the relation between alterations detectable on routine exams performed on pulmonary hypertension patients (echocardiography, electrocardiography and computerized tomography) and increases on pulmonary artery systolic pressure.

Methods

We analyzed the recordings of patients presented with pulmonary hypertension, and separated them in two groups based on their echocardiography-estimated pulmonary artery systolic pressure. Group 1 was composed of patients with pulmonary artery systolic pressure between 35 mmHg and 65 mmHg, and Group 2 of patients with pulmonary artery systolic pressure > 65 mmHg. We analyzed the prevalence of alterations suggestive of pulmonary hypertension on echocardiography, electrocardiography and computerized tomography. A descriptive analysis of the findings was conducted, followed by comparative analysis between the groups.

Results

We analyzed 101 patients (43 from Group 1 and 58 from Group 2). Most were women (82). Higher pulmonary artery systolic pressure values were correlated with right-heart dilation on echocardiography (p < 0.001). Electrocardiography findings revealed that right-heart hypertrophy and ventricular strain pattern were more common on Group 2 (p < 0.05). Computerized tomography analysis showed Group 2 patients had superior pulmonary artery diameters (p < 0.05). There was correlation between high pulmonary artery systolic pressure and clinical progression of the disease measured via the NYHA score (p < 0.05).

Conclusion

It is possible to make use of clinical examination and a simple electrocardiography to stratify the severity of a pulmonary artery patient. Computerized tomography and echocardiography should be used to confirm these findings. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):175-182)

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