Avaliação da função cardíaca por métodos ecocardiográficos em pacientes assintomáticos com lúpus eritematoso sistêmico / Assessment of cardiac function by echocardiographic methods in asymptomatic patients with systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) é doença autoimune crônica. Uma das suas importantes complicações é o dano cardiovascular. O objetivo deste trabalho foi estudar a prevalência de disfunção cardíaca em uma população local com LES e verificar se o grau de disfunção está associado com o a atividade da doença medida pelo SLEDAI (Systemic Lupus erythematosus activity index). Foram selecionados 19 pacientes assintomáticos do ponto de vista cardiovascular com diagnóstico de LES e que preenchiam os critérios classificatórios. A atividade de doença foi medida pelo SLEDAI e a função cardíaca por ecocardiografia transtorácica. Em conclusão, não foi possível identificar disfunção cardíaca na amostra estudada. Pontuações mais altas no índice de atividade do lúpus demonstraram correlação com aumento de massa de ventrículo esquerdo e fração de ejeção.

Systemic lupus erythesis (SLE) is a chronic autoimmune disease. One of the important complications of this disease is the cardiovascular damage The objective of this work was to study the prevalence of cardiac dysfunction in a local population with SLE and to verify whether the degree of dysfunction is associated with the disease activity measured by SLEDAI (Systemic Lupus erythematosus activity index). Were selected 19 patients asymptomatic from cardiovascular point of view diagnosed with SLE and who met the classification criteria for SLE. Disease activity was measured by SLEDAI and cardiac function was evaluated by transthoracic echocardiography. In conclusion, cardiac dysfunction could not be identified in the sample studied. Higher scores in the lupus activity index showed a correlation with increased left ventricle mass and ejection fraction.

Carotid intima-media thickness in spondyloarthritis patients.

CONTEXT AND OBJECTIVE: Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT) in spondyloarthritis (SpA) patients and correlate this with clinical parameters and inflammatory markers. DESIGN AND SETTING: Cross-sectional analytical study at Rheumatology Outpatient Clinic, Evangelical University Hospital, Curitiba. METHODS: IMTs (measured using Doppler ultrasonography) of 36 SpA patients were compared with controls. The IMT in SpA patients was associated with inflammatory markers, like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); and with clinical parameters, like axial or peripheral involvement, dactylitis, HLA B27, uveitis occurrence, Bath Ankylosing Spondylitis Functional Index (BASFI) and lipid profile. RESULTS: The mean IMT in SpA patients was 0.72 ± 0.21 mm; in controls, 0.57 ± 0.13 mm (P = 0.0007). There were no associations with ESR, CRP, BASDAI or clinical data. In univariate analysis, greater IMT was seen in patients with longer disease duration (P = 0.014; Pearson R = 0.40; 95% confidence interval, CI = 0.06 to 0.65); higher triglycerides (P = 0.02; Spearman R = 0.37; 95% CI = 0.03 to 0.64); and older age (P = 0.0014; Pearson R 0.51; 95% CI = 0.21 to 0.72). CONCLUSION: SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients.

Concomitância entre fraturas diafisárias e metafisárias do fêmur em acidentados com motocicleta / Concomitance between diaphyseal and metaphyseal femur fractures in victims of motorcycle accidents

Objetivo: Verificar a prevalência da concomitância de fraturas diafisárias e metafisárias do fêmur em pacientes, vítimas de acidente por motocicleta, atendidos no pronto socorro de Curitiba/PR em um período de sete anos e comparar os resultados com os dados presentes na literatura nacional.Metodologia: Realizou-se um estudo descritivo, retrospectivo e observacional da prevalência de fraturas de diáfise do fêmur concomitantemente à metáfise proximal ou metáfise distal do fêmur ipsilateral. Os dados foram obtidos através da análise de todos os prontuários do período de janeiro de 2007 a dezembro de 2013 catalogados no arquivo médico do HUEC. Considerou-se para análise o número de vítimas, sexo, idade e lado da fratura. Resultados: Foram identificados 40 pacientes: 87,5% do sexo masculino e 12,5% do sexo feminino. Houve predomínio de pacientes entre 19 e 29 anos. A média de idade foi de 31,9 anos. 24 vítimas foram diagnosticadas com fratura de diáfise do fêmur associada à fratura de metáfise proximal ipsilateral, sendo 16 do lado esquerdo e 8 a direita. 16vítimas foram diagnosticadas com fratura de diáfise do fêmur associada à fratura de metáfise distal ipsilateral, sendo 8 do lado direito e 8 a esquerda. Conclusão:O perfil de vítima mais prevalente foi o de adulto jovem do sexo masculino e a associação mais encontrada foi a de fratura da diáfise do fêmur concomitante à fratura da metáfise proximal do fêmur ipsilateral à esquerda

Objective: Verify the prevalence of concomitance between diaphysis and metaphysis femur fractures in patients, victims of motorcycle accidents, seen at the Emergency Departmentof Hospital Universitário Evangélico de Curitiba (HUEC), in a period of sevenyears, as well as compare the results with data from literature. Material and Methods:This is a retrospective, descriptive, observational study of prevalence of diaphysis femur fractures simultaneously with ipsilateral proximal metaphysisordistal metaphysis femur fractures. The information was obtainedfrom the analysis of all the medical records from January 2007 to December 2013 belonging to the hospital archives. The analysis considered the number of victims, gender, age and affected side.Results:40 victims have been identified. 87.5% being male whereas 12.5% being female. The victims were predominantly between 19 and 29 years old. The average age of thevictims was 31.9 years old. 24 victims were diagnosed with diaphysis femur fracture associated with ipsilateral proximal metaphysis, 16 were on the left and 8 were on the right. 16 victims were diagnosed with diaphysis femur fracture associated with ipsilateral distal metaphysis, 8 were on the right and 8 were on the left. Conclusion: The most prevalent victim profile was that of a young adult male and the most frequent association was the concomitant fracture of femur fracture of the proximal metaphysis of the ipsilateral femur left

Luxação pura da articulação carpometacárpica: relato de 02 casos / Isolated carpometacarpal dislocation: 02 case report

As luxações carpometacárpicas (CMC) são raras, sendo decorrentes de trauma axial de alta energia e correspondem a menos de 1% das lesões da mão e do punho, podendo o seu diagnóstico passar despercebido.Objetivo: Apresentar o relato de dois casos de luxação pura carpometacárpica, ambos do 2º ao 4ºdedos, atendidos em Hospital Universitário referência no atendimento de Trauma, assim como discutir o tratamento, seguimento clínico e revisão da literatura.Conclusão: O tratamento com redução e fixação precoce, traz vantagens como pouca dor residual e bom desempenho funcional

Dislocations carpal metacarpal (CMC) are rare, and due to high energy trauma axial and account for less than 1% of the hand and wrist injuries, can the diagnosis go unnoticed. Objective: To present the report of two cases of pure dislocation carpal metacarpal, both from 2nd to 4th fingers treated at University Hospital in reference trauma care, as well as discuss the treatment, clinical follow-up and review of the literature. Conclusion: Treatment with reduction and early fixation brings advantages such as good low residual pain and functional performance. Keywords: Carpometacarpal dislocations, hand and wrist lesions

Ausência de correlação entre ocorrência de anticorpos anticardiolipina e lesão valvular detectada à ecocardiografia transtoracica na população lúpica de Curitiba / Lack of correlation between antibody occurrence anticardiolipin injury valvular detected the transthoracic echocardiography in lupus population Curitiba

Objetivo: Verificar a associação entre ocorrência de anticorpos antifosfolipideos e lesões valvulares detectadas pela ecocardiografia em portadores de LES. Material e Métodos: Foram analisados 93 pacientes com pelo menos 4 critérios diagnóstico do American College of Rheumatology de LES para achados ecocardiográficos e presença de anticorpos anticardiolipinas (ACA) IgG e IgM e de lupus anticoagulante (LAC). Os dados foram estudados por tabelas de freqüência e contingência com testes de Fisher e do qui quadrado. Significância adotada de 5%. Resultados: 15,05% dos pacientes eram positivos para ACA IgG; 12,9 % eram positivos para ACA IgM e 20% eram positivos para LAC. Em cerca de 6% dos pacientes existiam os 3 anticorpos. Encontrou-se lesão valvular em 22,5%. Não se encontrou correlação entre lesão valvular e ocorrência de ACA Ig G (p=0,202); ACA IgM (p=0,458) ou LAC (p=0,686). Conclusão: Em nossa população lúpica não se encontrou associação entre a presença de anticorpos antifosfolípides e a lesão cardíaca valvular

Objective: To verify if there is association between antiphospholipid antibodies and the presence of cardiac valvular lesions seen by echocardiography in lupus patients. Methods: We studied 93 patients with at least 4 American College of Rheumatology criteria for lupus with echocardiography and presence of anticardiolipin antibodies (ACA- Ig G and Ig M) and lupus anticoagulant (LAC). The data were studied by frequency and contingency tables with Fisher and chi square tests. Significance adopted was of 5%. Results: 15,05% of patients had ACA IgG, 12,9% had ACA IgM and 20% had LAC. In 6% of patients we found the 3 antibodies. 22,5% of patients had valvular lesions. We did not find a correlation of cardiac valvular lesion and ACA Ig G (p=0,202); ACA IgM (p=0,458) or LAC (p=0,686). Conclusion: There is no association between antiphospholipid antibodies and cardiac valvular lesions in our lupus population

Fibromialgia e qualidade de vida: um estudo comparativo com portadores de artrite reumatóide / Fibromyalgia and quality of life: a comparative study with arthritis patients with rheumatoid

Portadores de fibromialgia queixam-se de dor generalizada, fadiga e distúrbios do sono. Os exames laboratoriais são caracteristicamente negativos nesta patologia. Devido à natureza pouco específica dos sintomas e a falta de provas palpáveis de um processo inflamatório, estes pacientes nem sempre têm as suas queixas devidamente valorizadas. No presente estudo procurou-se demonstrar o grande impacto desta patologia na qualidade de vida de seus portadores comparando-a com a de portadores de artrite reumatóide. Além disso procurou-se verificar se este prejuízo estava associado com o grau de dor percebido pelo paciente ou com o número de pontos sensíveis encontrados ao exame físico

Fibromyalgia patients complain of generalized pain, fatigue and sleep disturbance. Laboratory exams are typically negative in this pathology. Due to this lack of symptom's specificity and palpable proofs of inflammatory disease, these patients complaints are not taken seriously. In this study we try to demonstrate the high impact of fibromyalgia in the patient's life quality comparing them with rheumatoid arthritis patients. We also try to verify the relationship between poor life quality with generalized pain and number of tender points at physical examination

Ausência de correlação entre ocorrência de anticorpos anticardiolipina e lesão valvular detectada à ecocardiografia transtoracica na população lúpica de Curitiba / Lack of correlation between antibody occurrence anticardiolipin injury valvular detected the transthoracic echocardiography in lupus population Curitiba

Objetivo: Verificar a associação entre ocorrência de anticorpos antifosfolipídeos e lesões valvulares detectadas pela ecocardiografia em portadores de LES. Material e Métodos: Foram analisados 93 pacientes com pelo menos 4 critérios diagnóstico do American College of Rheumatology de LES para achados ecocardiográficos e presença de anticorpos anticardiolipinas (ACA) IgG e IgM e de lupus anticoagulante (LAC). Os dados foram estudados por tabelas de frequência e contingência com testes de Fisher e do qui quadrado. Significância adotada de 5%. Resultados: 15,05% dos pacientes eram positivos para ACA IgG; 12,9 % eram positivos para ACA IgM e 20% eram positivos para LAC. Em cerca de 6% dos pacientes existiam os 3 anticorpos. Encontrou-se lesão valvular em 22,5%. Não se encontrou correlação entre lesão valvular e ocorrência de ACA Ig G (p=0,202); ACA IgM (p=0,458) ou LAC (p=0,686). Conclusão: Em nossa população lúpica não se encontrou associação entre a presença de anticorpos antifosfolípides e a lesão cardíaca valvular.

Objective: To verify if there is association between antiphospholipid antibodies and the presence of cardiac valvular lesions seen by echocardiography in lupus patients. Methods: We studied 93 patients with at least 4 American College of Rheumatology criteria for lupus with echocardiography and presence of anticardiolipin antibodies (ACA- Ig G and Ig M) and lupus anticoagulant (LAC). The data were studied by frequency and contingency tables with Fisher and chi square tests. Significance adopted was of 5%. Results: 15,05% of patients had ACA IgG, 12,9% had ACA IgM and 20% had LAC. In 6% of patients we found the 3 antibodies. 22,5% of patients had valvular lesions. We did not find a correlation of cardiac valvular lesion and ACA Ig G (p=0,202); ACA IgM (p=0,458) or LAC (p=0,686). Conclusion: There is no association between antiphospholipid antibodies and cardiac valvular lesions in our lupus population.

Valvular involvement in patients with rheumatoid arthritis.

BACKGROUND: Although pericarditis is the most commonly recognized cardiac lesion in Rheumatoid Arthritis (RA), this disease affects all the three cardiac layers. OBJECTIVE: To study valvular lesions in RA, trying to correlate them with other clinical variables, auto antibodies and functional class. METHODS: One hundred twenty two controls and 184 patients with RA without cardiac symptoms were studied using bidimensional echocardiography. We also studied smoking habits, age and disease duration, rheumatoid factor, antinuclear antibody, anticardiolipin antibodies, rheumatoid nodules and functional class in RA patients. RESULTS: We found that 28 RA patients (15.2%) had valvular lesions and that the aortic valve was the most affected. Valvular lesions were more common in patients with disease duration longer than 15 years (p=0.013). No association was found between valvular lesions and sex, age, tobacco exposure, rheumatoid factor positivity, presence of antinuclear antibodies, rheumatoid nodules, anticardiolipin antibodies or functional class. CONCLUSION: A small part of RA patients had asymptomatic valvular lesions which occurred more frequently in patients with long disease duration.

Accuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula.

Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of stenosis was confirmed by Doppler ultrasound (DU). Sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (PNV), and accuracy were calculated for the two early detection tests. According to DU, 50 (59%) AVF were considered positive for the presence of stenosis. Fifty-six (66%) AVF were considered positive for the presence of stenosis by PE and 34 (40%) by IAP. S, SP, PPV, and NPV for PE and IAP were 96%, 76%, 86%, and 93% and 60%, 88%, 88%, and 60%, respectively. The accuracy for PE and IAP was 88% and 71%, respectively. PE proved to be an accurate method for the diagnosis of stenosis and should be part of all surveillance protocols of stenosis detection in AVF.

Carotid intima-media thickness in spondyloarthritis patients / Espessamento da camada média-íntima da carótida em pacientes com espondiloartrite

CONTEXT AND OBJECTIVE Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT) in spondyloarthritis (SpA) patients and correlate this with clinical parameters and inflammatory markers. DESIGN AND SETTING Cross-sectional analytical study at Rheumatology Outpatient Clinic, Evangelical University Hospital, Curitiba. METHODS IMTs (measured using Doppler ultrasonography) of 36 SpA patients were compared with controls. The IMT in SpA patients was associated with inflammatory markers, like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); and with clinical parameters, like axial or peripheral involvement, dactylitis, HLA B27, uveitis occurrence, Bath Ankylosing Spondylitis Functional Index (BASFI) and lipid profile. RESULTS The mean IMT in SpA patients was 0.72 ± 0.21 mm; in controls, 0.57 ± 0.13 mm (P = 0.0007). There were no associations with ESR, CRP, BASDAI or clinical data. In univariate analysis, greater IMT was seen in patients with longer disease duration (P = 0.014; Pearson R = 0.40; 95% confidence interval, CI = 0.06 to 0.65); higher triglycerides (P = 0.02; Spearman R = 0.37; 95% CI = 0.03 to 0.64); and older age (P = 0.0014; Pearson R 0.51; 95% CI = 0.21 to 0.72). CONCLUSION SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients. .

CONTEXTO E OBJETIVO A aterogênese acelerada tem se tornado um grande problema nas doenças reumáticas inflamatórias. O objetivo foi analisar a espessura da camada íntima-média (ECIM) da carótida em pacientes com espondiloartrite (ES) e relacioná-la com parâmetros clínicos e marcadores inflamatórios. TIPO DE ESTUDO E LOCAL Estudo transversal analítico no Ambulatório de Reumatologia do Hospital Universitário Evangélico de Curitiba. MÉTODOS A ECIM (medida por Doppler) de 36 pacientes com ES foi comparada com controles. A ECIM de pacientes com ES foi associada com marcadores inflamatórios, como velocidade de hemossedimentação (VHS), proteína C-reativa (PCR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), e com parâmetros clínicos, como envolvimento axial e periférico, dactilite, HLA B27, ocorrência de uveíte, Bath Ankylosing Spondylitis Functional Index (BASFI) e perfil lipídico. RESULTADOS A ECIM média em pacientes com ES foi de 0,72 ± 0,21 mm, enquanto nos controles foi de 0,57 ± 0,13 mm (P = 0,0007). Não se encontrou associação com VHS, PCR, BASDAI e dados clínicos. Em análise univariada, maior ECIM foi encontrado nos indivíduos com maior duração de doença (P = 0,014; R Pearson = 0,40; 95% intervalo de confiança, IC = 0,06 to 0,65), aumento nos triglicerídeos (P = 0,02; R Spearman = 0,37; 95% IC = 0,03 to 0,64) e maior idade (P = 0,0014; R Pearson 0,51; 95% IC = 0,21 to 0,72). CONCLUSÃO Pacientes com ES têm maior grau de aterosclerose subclínica do que controles, dando suporte às evidências clínicas de aumento de risco cardiovascular em pacientes com doenças reumáticas. .

Prevalence of deep vein thrombosis in patients with paraplegia caused by traumas / Prevalência de trombose venosa profunda em paraplégicos de causa traumática

BACKGROUND: Deep vein thrombosis is a common disease among people who are immobilized. Immobility is inherent to paraplegia and leads to venous stasis, which is one of the factors covered by Virchow's triad describing its development. Trauma is the primary cause of paraplegia and is currently increasing at a rate of 4% per year. OBJECTIVE: To determine the prevalence of deep vein thrombosis in paraplegic patients whose paraplegia was caused by traumas, using color Doppler ultrasonography for diagnosis. METHODS: This was a cross-sectional observational study of 30 trauma-induced paraplegia patients, selected after analysis of medical records at the neurosurgery department of a University Hospital in Curitiba, Brazil, and by a proactive survey of associations that care for the physically disabled. The prevalence of deep vein thrombosis was analyzed using 95% confidence intervals. RESULTS: Spinal cord trauma was the cause of paraplegia in 29 patients. The most common cause of trauma was gunshot wounding, reported by 17 patients. Deep vein thrombosis was diagnosed by color Doppler ultrasonography in 14 patients in the sample. The most often affected vein was the posterior tibial, in 11 patients. The left lower limb was involved three times more often than the right. Edema was observed in 25 individuals, cyanosis in 14, ulcers in 8 and localized increase in temperature in 13. CONCLUSIONS: Deep vein thrombosis was prevalent, occurring in 46.7% of the patients. .

CONTEXTO: A trombose venosa profunda é uma doença comum em indivíduos imobilizados. A imobilização, inerente aos pacientes paraplégicos, gera a estase venosa, que é um dos fatores descritos da tríade de Virchow para o seu desenvolvimento. O trauma é a principal causa de paraplegia e, atualmente, vem aumentando a uma taxa de 4% ao ano. OBJETIVO: Avaliar a prevalência de trombose venosa profunda em paraplégicos, em que o trauma foi o agente causal da paraplegia, utilizando como método diagnóstico o eco Doppler colorido. MÉTODOS: Estudo observacional transversal, composto por 30 pacientes paraplégicos por trauma, selecionados segundo uma análise de prontuários do Serviço de Neurocirurgia de um Hospital Universitário de Curitiba e por busca ativa em associações de assistência aos deficientes físicos. A análise da prevalência de trombose venosa profunda foi efetuada pelo intervalo de confiança de 95%. RESULTADOS: O traumatismo raquimedular foi a causa da paraplegia em 29 pacientes. A causa mais frequente do trauma foi o ferimento por arma de fogo, relatado por 17 pacientes. A presença de trombose venosa profunda diagnosticada por eco Doppler colorido foi observada em 14 pacientes da amostra. Dentre estes, a veia mais acometida foi a tibial posterior, em 11 pacientes. O membro inferior esquerdo foi três vezes mais acometido que o direito. O edema foi observado em 25 indivíduos, a cianose em 14, a úlcera em oito e o aumento de temperatura local em 13. CONCLUSÃO: A trombose venosa profunda foi prevalente, ocorrendo em 46,7% dos pacientes. .

Associations between renal function, volume status and endotoxaemia in chronic kidney disease patients.

Inflammation is an important predictor of increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD), but the mechanisms behind the chronic activation of the immune system are not clearly understood. CKD patients develop fluid overload, which has been proposed to be a stimulus for inflammatory activation due to the translocation of macromolecules from the gut. We hypothesize that fluid overload is associated with signs of systemic inflammation and endotoxaemia in stages 1-5 CKD patients. The aim of this prospective study was to evaluate the associations between renal function, fluid status [evaluated by the inferior vena cava diameter (IVCD) and the collapsibility index (CI)], systemic inflammation [plasma levels of C-reactive protein (CRP), fibrinogen and albumin] and endotoxaemia (through the Limulus amebocyte lysate enzymatic assay) in a group of CKD patients in our out-patient clinic. The population consisted of 74 (mean of 57; range 23-83 years of age; 47% males) CKD patients with glomerular filtration rate (based on the mean of urea and creatinine clearances) of 34 ml/min. Both albumin (Rho = 0.25; P = 0.05) and fibrinogen (Rho= - 0.48; P < 0.0001) were significantly correlated to glomerular filtration rate (GFR). According to the IVCD, 84% of the patients were fluid overloaded, while 83% were considered overloaded by the CI. Signs of endotoxaemia were detected in all patients. Endotoxin levels were higher in patients with signs of fluid overload (0.85 +/- 0.11ng/l) when compared with patients with normal values of IVCD (0.61 +/- 0.05 ng/l; P < 0.05). Endotoxin levels correlated to both IVCD (Rho=0.33, P < 0.005) and CI (Rho = -0.25, P < 0.05). There was no correlation between endotoxin levels and GFR, CRP or fibrinogen. In summary, although most CKD patients presented signs of fluid overload that was associated with endotoxaemia, there was no association between endotoxaemia and systemic inflammation, suggesting the endotoxaemia may not be the main determinant of the inflammatory status in this group of patients.

Changes in P-wave after percutaneous mitral valvuloplasty in patients with mitral stenosis and left atrial enlargement.

OBJECTIVE: To investigate potential clinical, echocardiographic and/or hemodynamic predictors of the regression of electrocardiographic (ECG) signs of left atrial enlargement (LAE) after successful percutaneous mitral valvuloplasty (PMV). METHODS: We studied 24 patients (75% female, mean age =37.1 +/- 11.9 years) with moderate to severe mitral stenosis (MS), sinus rhythm (SR) and ECG signs of LAE who underwent successful PMV between 2002 and 2004. At least 6 months after the procedure (388.2 +/- 192.9 days), the patients returned for clinical, ECG and echocardiographic follow-up. They were then divided in 2 groups: patients of group 1 (n = 8; 33.3%) still had ECG signs of LAE, and patients of group 2 (n = 16; 66.6%), had normal P wave. A multivariate analysis of clinical, ECG, echocardiographic and hemodynamic variables was performed. RESULTS: The mitral valve area (MVA) increased from 1.12 +/- 0.15 cm2 to 1.9 +/- 0.35 cm2 immediately after the procedure (p < 0.0001) and decreased to 1.89 +/- 0.41 cm2 at follow-up (p = NS). Left atrium diameter decreased from 48 +/- 2.9 mm pre-procedure to 43 +/- 4.8 mm at follow-up (p = 0.0001). P-wave duration decreased from 0.12 +/- 0.01 sec pre-PMV to 0.09 +/- 0.02 sec at follow-up (p = 0.0001). An MVA > or = 1.7 cm2 at follow-up was the only independent predictor of a normal P-wave after PMV (p=0.02). CONCLUSION: ECG changes suggestive of LAE regress in the majority of patients with MS and sinus rhythm that undergo a successful PMV. An MVA > or = 1.7 cm2 at late follow-up was found to be an independent predictor of such normalization.

Randomized comparison between Inoue balloon and metallic commissurotome in the treatment of rheumatic mitral stenosis: immediate results and 6-month and 3-year follow-up.

The metallic commissurotome (MC) technique is a cheaper alternative to the Inoue balloon (IB) technique for percutaneous mitral valvuloplasty (PMV). There are no randomized trials comparing these techniques with longer follow-up of the patients. The objective of this study was to compare the immediate results and short- and medium-term follow-up of PMV using either the IB or the MC technique. Fifty patients with rheumatic mitral stenosis were randomly assigned to PMV using the IB (n = 27) or the MC (n = 23) technique. There were no significant differences between the groups regarding baseline clinical, echocardiographic, and hemodynamic data. Clinical and echocardiographic follow-up were done 6 months and 3 years after the procedure. The success rate was 100% in the IB group and 91.3% in the MC group (P = 0.15); two patients in the latter group developed mitral regurgitation grade 3/4, requiring elective surgery. The mean final mitral valve area was bigger in the MC group (2.17 +/- 0.13 vs. 2.00 +/- 0.36 cm2; P = 0.04), but after 6-month and 3-year follow-up, this difference was no longer significant (2.06 +/- 0.27 vs. 1.98 +/- 0.38 cm2, P = 0.22, and 1.86 +/- 0.32 vs. 1.87 +/- 0.34 cm2, P = 0.89, respectively). This finding suggests valve stretching as an important mechanism of valve dilation with the MC. Three patients in the MC group and two patients in the IB group (P = 0.65) developed mitral valve restenosis; one of them underwent repeat PMV and the other four, all asymptomatic, were clinically followed. PMV performed either with the IB or the MC technique is effective and provides excellent short- and medium-term outcomes regardless of the technique employed.

Evolução da onda P do eletrocardiograma após valvoplastia mitral em pacientes portadores de sobrecarga atrial esquerda / Changes in P-wave after percutaneous mitral valvuloplasty in patients with mitral stenosis and left atrial enlargement

OBJETIVO: Investigar potenciais preditores clínicos, ecocardiográficos e/ou hemodinâmicos de regressão de sinais eletrocardiográficos (ECG) de sobrecarga atrial esquerda (SAE) após valvoplastia mitral percutânea (VMP) com sucesso. MÉTODOS: Estudaram-se 24 pacientes (75 por cento do sexo feminino, idade média 37,1 ± 11,9 anos) com estenose mitral moderada a grave, ritmo sinusal (RS) e sinais de SAE no ECG, submetidos a VMP entre 2002 e 2004. Pelo menos seis meses após o procedimento (388,2 ± 192,9 dias), os pacientes retornaram para acompanhamento clínico, eletro e ecocardiográfico. Os pacientes foram divididos em dois grupos: Grupo 1(n = 8; 33,3 por cento), ainda com sinais ECG de SAE, e Grupo 2 (n = 16; 66,6 por cento), com onda P normal. Realizou-se análise multivariada de variáveis clínicas, ECG, ecocardiográficas e hemodinâmicas. RESULTADOS: A área valvar mitral (AVM) aumentou de 1,12 ± 0,15 para 1,9 ± 0,35cm² imediatamente após o procedimento (p< 0,0001), e diminuiu para 1,89 ± 0,41cm² no acompanhamento (p = NS). O diâmetro do átrio esquerdo variou de 4,8 ± 0,29 cm pré-procedimento para 4,28 ± 0,48cm na reavaliação (p = 0,0001). A duração da onda P diminuiu de 0,12 ± 0,01 seg pré-VMP para 0,09 ± 0,02 seg no controle (p = 0,0001). Uma AVM > 1,7 cm² no acompanhamento foi o único preditor independente de onda P normal após VMP (p = 0,02). CONCLUSÃO: Alterações ECG sugestivas de SAE regridem na maioria dos pacientes com estenose mitral e RS submetidos a VMP com sucesso. Uma AVM > 1,7 cm² no controle tardio é preditor independente para essa normalização.

OBJECTIVE: To investigate potential clinical, echocardiographic and/or hemodynamic predictors of the regression of electrocardiographic (ECG) signs of left atrial enlargement (LAE) after successful percutaneous mitral valvuloplasty (PMV). METHODS: We studied 24 patients (75 percent female, mean age =37.1 ± 11.9 years) with moderate to severe mitral stenosis (MS), sinus rhythm (SR) and ECG signs of LAE who underwent successful PMV between 2002 and 2004. At least 6 months after the procedure (388.2 ± 192.9 days), the patients returned for clinical, ECG and echocardiographic follow-up. They were then divided in 2 groups: patients of group 1 (n = 8; 33.3 percent) still had ECG signs of LAE, and patients of group 2 (n = 16; 66.6 percent), had normal P wave. A multivariate analysis of clinical, ECG, echocardiographic and hemodynamic variables was performed. RESULTS: The mitral valve area (MVA) increased from 1.12 ± 0.15 cm2 to 1.9 ± 0.35 cm² immediately after the procedure (p < 0.0001) and decreased to 1.89 ± 0.41 cm² at follow-up (p = NS). Left atrium diameter decreased from 48 ± 2.9mm pre-procedure to 43 ± 4.8mm at follow-up (p = 0.0001). P-wave duration decreased from 0.12 ± 0.01 sec pre-PMV to 0.09 ± 0.02 sec at follow-up (p = 0.0001). An MVA > 1.7 cm² at follow-up was the only independent predictor of a normal P-wave after PMV (p=0.02). CONCLUSION: ECG changes suggestive of LAE regress in the majority of patients with MS and sinus rhythm that undergo a successful PMV. An MVA>1.7 cm² at late follow-up was found to be an independent predictor of such normalization.