O índice de performance miocárdica do ventrículo direito na avaliação da pressão pulmonar de pacientes com esquistossomose mansônica hepatoesplênica

• Ano de defesa: 2008
• Autor(a) principal: Vinicius Tostes Carvalho
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Índice de performance miocárdica; Esquistossomose hepatoesplênica; Dopplerecocardiograma; Hipertensão pulmonar; Ventrículos do Coração; Ecocardiografia doppler; Medicina tropical; Esquistossomose mansoni
• Link de acesso: http://hdl.handle.net/1843/ECJS-7K7J2N

The prevalence of pulmonary hypertension in patients with hepatosplenic schistosomiasis varies from 20% to 30%. The Doppler-derived right ventricle myocardial performance index (RV-MPI) has been used to assess the arterial pulmonary pressure in many diseases but it has never been used to evaluate pulmonary pressure in schistosomiasis mansoni. The aim of the present study is todefine the prevalence of pulmonary hypertension and the value of RV-MPI in the evaluation of pulmonary pressure in patients with hepatosplenic schistosomiasis. Eighty-three patients with schistosomiasis attending the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias / UFMG / Secretaria Municipal de Saúde, Belo Horizonte, Brazil, have been selected for this study. Patients were divided into 2 groups. In Group 1, 44 patients had hepatosplenic schistosomiasisdiagnosed by clinical and ultrasonographic examination. In Group 2, 39 patients had the hepatointestinal form of schistosomiasis. All the patients underwent a comprehensive Doppler echocardiogram with color flow mapping and the following parameters were measured: RV-MPI, the right ventricular outflow tract flow acceleration time (TAC), and, whenever possible, the Doppler-determined peak systolic tricuspid pressure gradient (TRIC GRAD). Pearson or Spearman correlation was used according to variables distribution. ROC curve was used to establish the optimal cut-point that could predict TRIC GRAD above 30 mmHg(suggesting pulmonary hypertension). Eleven out of 44 patients (25%) had pulmonary hypertension in Group 1, and none in Group 2. In Group 1, there was a significant correlation for the variables studied: RV-MPI versus TRIC GRAD (r = 0,578; p< 0,0001) and RV-MPI versus TAC (r = - 0,52; p = 0,001). No statistical significant correlation was found for the same variables in Group 2. The ROC curve´s analysis was able to predict, with a sensitivity of 82% and a specificity of 81%, that patients with a RV-MPI > 0,29 had a TRIC GRAD > 30 mmHg. In short, the RV-MPI is a good alternative to traditional methods of estimating pulmonary pressure in patients with hepatosplenic schistosomiasis and pulmonaryhypertension.