A Challenging Differential Diagnosis: Distinguishing between Endomyocardial Fibrosis and Apical Hypertrophic Cardiomyopathy.

Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. The disease occurs predominantly in tropical regions worldwide and in sub-Saharan Africa. This condition is not well understood, with varied manifestations, from subclinical presentations to chronic and progressive edematous syndromes. Here, we present the challenging case of a patient with an indeterminate echocardiographic image, suggesting apical hypertrophy, plus severe aortic stenosis and fibrosis of the left ventricular outflow tract. An electrocardiogram revealed symmetrical T-wave inversion, which is a characteristic manifestation of apical hypertrophy. The importance of cardiac imaging examinations such as echocardiography and cardiac magnetic resonance for differentiating between endomyocardial fibrosis and apical hypertrophy is highlighted in this patient's case.

Right Ventricular Doppler Echocardiographic Study of Indeterminate Form of Chagas Disease / Estudo do Ventrículo Direito na Forma Indeterminada da Doença de Chagas pelo Doppler Ecocardiograma

Background: Patients with indeterminate form of Chagas disease/cardiac normality (ICD/CN) exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart. Objective: To assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV) in patients with ICD/CN. Methods: This was a case–control and prevalence study. Using Doppler two-dimensional echocardiography (2D), 92 patients were assessed and divided into two groups: group I (normal, n = 31) and group II (ICD/CN, n = 61). Results: The prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%), mobility of the tricuspid annulus (0.0% versus 0.0%), and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016). The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099) and pulsed Doppler (61.3% versus 68%, p = 0.141) and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%), pseudonormal pattern (0.0% versus 0.0%), and restrictive pattern (0.0% versus 0.0%) was not statistically different between groups. Conclusion: The prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables), suggesting incipient changes in RV systolic function in the ICD/CN group. .

Fundamento: Pacientes com forma indeterminada da doença de Chagas/normalidade cardíaca (FIDC/NC) apresentam eletrocardiograma e raios X de tórax normais, porém, quando submetidos a exames mais sofisticados, são detectados alguns graus de alterações morfofuncionais do coração. Objetivo: Avaliar a prevalência de disfunção sistólica e diastólica do ventrículo direito (VD) em pacientes com FIDC/NC. Métodos: Estudo de caso-controle e prevalência. Foram avaliados 92 pacientes com Doppler ecocardiograma bidimensional (2D), divididos em dois grupos: grupo I (normal, n = 31) e grupo II (FIDC/NC, n = 61). Resultados: A prevalência da disfunção sistólica do VD em pacientes dos grupos I e II foi: mudança de área fracional (0,0% versus 0,6%), mobilidade do anel tricuspídeo (0,0% versus 0,0%) e onda S ao Doppler tecidual (6,4% versus 26,0%, com p = 0,016). As prevalências das disfunções globais – como índice de performance miocárdica direita ao Doppler tecidual (16,1% versus 27,8% com p = 0,099) e ao Doppler pulsado (61,3% versus 68% com p = 0,141) e diastólico, como alteração do relaxamento (0,0% versus 6,0%), padrão pseudonormal (0,0% versus 0,0%) e padrão restritivo (0,0% versus 0,0%) – não apresentaram significância estatística entre os grupos. Conclusão: A prevalência de disfunção sistólica do VD foi estimada em 26% (velocidade da onda S em comparação a outras variáveis), sugerindo alterações incipientes da função sistólica do VD no grupo FIDC/NC. .

Right ventricular Doppler echocardiographic study of indeterminate form of chagas disease.

BACKGROUND: Patients with indeterminate form of Chagas disease/cardiac normality (ICD/CN) exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart. OBJECTIVE: To assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV) in patients with ICD/CN. METHODS: This was a case-control and prevalence study. Using Doppler two-dimensional echocardiography (2D), 92 patients were assessed and divided into two groups: group I (normal, n = 31) and group II (ICD/CN, n = 61). RESULTS: The prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%), mobility of the tricuspid annulus (0.0% versus 0.0%), and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016). The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099) and pulsed Doppler (61.3% versus 68%, p = 0.141) and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%), pseudonormal pattern (0.0% versus 0.0%), and restrictive pattern (0.0% versus 0.0%) was not statistically different between groups. CONCLUSION: The prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables), suggesting incipient changes in RV systolic function in the ICD/CN group.

Papel do tratamento farmacológico na evolução e nas complicações das valvopatias mitrais / Pharmacological management influence on the natural history and complications of mitral disease

As valvulopatias mitrais de etiologia reumática ainda são muito prevalentes em nosso meio...

Influence of aging, tidal volume, and respiratory rate on Doppler echocardiographic indices of diastolic function in normal male subjects: a quantitative evaluation.

BACKGROUND: Although the influence of respiration on ventricular filling, as evaluated by Doppler technique, and the evaluation of diastolic velocities of mitral valve annulus (MVA), as measured by Doppler tissue imaging (DTI), can provide valuable information for the study of left ventricular (LV) diastolic function, the concomitant effects of aging, tidal volume (TV), and respiratory rate (RR) on these velocities have not been quantitatively investigated. METHODS: We evaluated 12 normal male volunteers (Group I) aged 20-26 years (mean: 22.8) and 8 normal subjects aged 41 to 54 years old (mean: 45.9) (Group II). Using DTI we measured peak early (E(a)) and late (A(a)) velocities of longitudinal axis expansion at lateral and medial MVA. Doppler mitral and tricuspid flow velocities were measured: peak early (E) and late (A) inflow velocity, early (E(i)) and late (A(i)) flow integral, and deceleration time of peak early mitral flow velocity (DT). Respiratory cycles were simultaneously recorded at RR of 9, 12, 15, and 18 cycles/min and TV of 600 and 900 mL during respiration (RESP). RESULTS AND CONCLUSIONS: (1) E, A, and A(i) in MV had negligible change during respiration, but E(i) was significantly reduced during inspiration; (2) DT reduced slightly with inspiration, but the change was significant only with TV of 900 mL; (3) an important increase of E in right ventricular flow was observed during inspiration; (4) variations of RR and TV did not significantly influence right and left ventricular inflow in normal subjects, in the conditions of this investigation; (5) a significant increase of E(a) at medial MVA was documented during inspiration only in young subjects; (6) a significant decrease of A(a) at medial MVA was observed during inspiration in both groups of volunteers; (7) RR and TV did not influence MVA velocities in young and adult subjects; (8) a consistent reduction in E(a) and a significant increase in A(a) were observed with increasing age; (9) these changes were more conspicuous and consistent than those documented in ventricular filling when young and middle-age men are compared, suggesting that the DTI is more sensitive to detect changes in diastolic function; and (10) in addition, these data suggest that, for evaluation of diastolic function, in clinical context, it is not necessary to control rigorously RR or TV.

Left ventricular global performance and diastolic function in indeterminate and cardiac forms of Chagas' disease.

The majority of patients with Chagas' disease remain for 10 to 30 years in the indeterminate form (IF) of this disease. They have no symptoms, serologic positivity, normal electrocardiogram results and heart size, and normal left ventricular global and segmental systolic function on 2-dimensional echocardiography. To investigate whether this group of patients have any impairment of left ventricular global performance (Tei index) and diastolic function, we have studied 43 individuals (age 49 +/- 12 years) including 14 healthy volunteers and 29 patients with Chagas' disease divided as IF (n = 12) and cardiac form (n = 17). Echocardiographic measurements included ejection fraction, Tei index, left atrial volume index, transmitral (peak early transmitral flow velocity, late peak mitral velocity, tissue Doppler, late peak mitral velocity duration) and pulmonary (systolic pulmonary vein velocity, diastolic pulmonary vein velocity, retrograde pulmonary vein velocity, retrograde pulmonary vein velocity duration) flow velocities, and tissue Doppler velocities at lateral mitral annulus (peak early transmitral flow velocity, late peak mitral velocity, systolic pulmonary vein velocity). Although ejection fraction and S' velocity were significantly lower for patients with cardiac form compared with control and IF groups, Tei index was not able to differentiate patients with cardiac conditions from the other groups. Diastolic dysfunction was documented for patients with cardiac form by left atrial volume index, early transmitral peak velocity, early expansion wave by tissue Doppler, late expansion wave by tissue Doppler, and peak early transmitral flow velocity/early expansion wave by tissue Doppler. Patients with the IF of Chagas' disease did not show any abnormality of diastolic function. Thus, when the IF is further characterized on the basis of absence of any echocardiographic marker of regional systolic dysfunction, no impairment of diastolic function can be detected.

Quantitative analysis of segmental left ventricular wall motion using a polar representation of color kinesis images / Avaliação quantitativa da mobilidade segmentar do ventrículo esquerdo utilizando uma representação polar das imagens de "color kinesis"

A "color kinesis (CK) é uma técnica que representa o tempo e a magnitude da mobilidade global e segmentar do ventrículo esquerdo (MSVE) em tempo real. Neste estudo descreve-se um novo método para representar estas imagens na forma "bulls-eye" em mapas polares que provêem uma avaliação integrada e objetiva da MSVE. Foram avaliados indivíduos normais e em pacientes apresentando anormalidades na MSVE no estudo ecocardiográfico bidimensional com o objetivo de verificar a capacidade desta técnica para identificar e quantificar automaticamente a disfunção ventricular. Os dados obtidos demonstram que, embora a representação polar de imagens de CK seja factível em uma elevada proporção de indivíduos e possa proporcionar uma avaliação quantitativa da MSVE mais objetiva e menos dependente do operador, essa ferramenta de processamento de imagens mostrou limitada capacidade para identificação automática de disfunção ventricular quando comparada com a análise de observadores experientes.

Papel da Doppler ecocardiografia no diagnóstico e no prognóstico da febre reumática aguda / Role of Doppler echocardiography in the evaluation of patients with acute rheumatic fever

A cardite é a única manifestação da febre reumática aguda que gera seqüelas tardias para o paciente. Esse comprometimento é responsável pelos altos índices de morbidade e de mortalidade da doença reumática do coração a longo prazo. A Doppler ecocardiografia contribui, nessa fase aguda, para a elucidação diagnóstica, a determinação da extensão do envolvimento cardíaco, a indicação de procedimentos cirúrgicos, bem como para o acompanhamento evolutivo dos pacientes. No entanto, o método, ao identificar acometimento cardíaco subclínico, oferece elementos morfológicos e funcionais cuia interpretação é alvo de controvérsia. Esta revisão procura colocar esses pontos em perspectiva e propiciar melhor compreensão do real papel do método nas avaliações diagnóstica e prognóstica dessa entidade nosológica.

Ultrasonic tissue characterization for patients with Chagas' disease.

UNLABELLED: This study was undertaken to test the hypothesis that ultrasonic tissue characterization, as evaluated by intensity and cardiac cyclic variation of integrated backscatter (IBS), could identify early myocardial involvement in Chagas' disease. We evaluated 69 participants, age 15 to 73 years (mean +/- SD: 49 +/- 12 years), who were divided as following: 19 control subjects; 13 patients with the indeterminate form of Chagas' disease; 7 patients with the digestive form; and 30 patients with the cardiac form. IBS images were obtained in parasternal short-axis (basal, papillary muscle, apical) view and analyzed in 12 left ventricular (LV) segments (anterior, lateral, posterior, and septal). The following IBS variables were evaluated: (1) the corrected coefficient (CC) of IBS, obtained by dividing IBS intensity, in each cardiac segment, by IBS intensity measured in a rubber phantom using the same equipment adjustments at the same depth; and (2) magnitude of cardiac cyclic variation (MCV) of IBS, as measured by the peak-to-peak difference between maximal and minimal values of IBS in cardiac cycle. The CC of IBS was increased (P <.05) for patients with the cardiac form who had LV segments with normal wall motion as compared with control subjects, in 4 of 12 segments evaluated (basal anterior, midposterior and midseptal, anterior apical), whereas the remaining chagasic groups were comparable with controls subjects. The CC of IBS tended to increase with worsening of LV segmental wall motion. MCV showed a large individual variability and had a large mean value (P <.05) in just 1 of 12 segments evaluated, when patients with the cardiac form were compared with control subjects. No correlation was observed between the magnitude of LV dysfunction and MCV of IBS. IN CONCLUSION: (1) the CC of IBS was able to provide early differentiation of cardiac involvement for patients with Chagas' disease who had LV segments with normal wall motion; (2) increase of CC of IBS with worsening of LV segmental wall motion suggests a relationship between the acoustic properties of myocardial tissue and grading of myocardial fibrosis; (3) MCV was not able to differentiate patients with Chagas' disease from control subjects; and (4) patients with the indeterminate form of Chagas' disease were not differentiated from control subjects by any of the IBS techniques evaluated in this study.

Doppler-ecocardiografia na hipertensão arterial sistêmica / Doppler-echocardiography in systemic arterial hypertension

A hipertensão arterial sistêmica, em função de sua elevada prevalência populacional, representa um fator de risco importante para o comprometimento cardíaco, provocando, principalmente, hipertrofia ventricular esquerda e associando-se a elevados índices de morbi-mortalidade entre os hipertensos. São discutidos aspectos diagnósticos da hipertrofia ventricular esquerda utilizando a Doppler-ecocardiografia, suas limitações técnicas e implicações clínicas. A importância do padrão geométrico da hipertrofia do ventrículo esquerdo e seu significado clínico também são analisados. A avaliação da função diastólica do ventrículo esquerdo é revisada reforçando os conceitos fisiopatológicos e as 1imitações da investigação não-invasiva, assim como a importância da correlação clínica e as dificuldades de sua interpretação. Novas técnicas como Doppler tecidual, modo M colorido e caracterização tecidual ultra-sônica são consideradas como opções de investigação não-invasiva entre os hipertensos. Também é abordada a importância da Doppler-ecocardiografia para diagnosticar e quantificar lesões valvares e principalmente doença coronariana associada entre os pacientes hipertensos, considerando também o ecocardiograma sob estresse. Concluindo, são apresentadas as indicações consensuais da Doppler-ecocardiografia na hipertensão arterial sistêmica segundo as recomendações do American College of Cardiology e da American Heart Association.

Minor segmental dyssynergy reflects extensive myocardial damage and global left ventricle dysfunction in chronic Chagas disease.

The majority of patients with Chagas disease (ChD) remain for 10 to 30 years or even for life in the indeterminate form (IF) of this disease. They have positive-specific serology tests for ChD, but no symptoms or physical signs, and normal findings for electrocardiograms (ECGs) and heart, esophagus, and colon radiographs. To investigate whether patients in this phase of disease have any impairment of left ventricular (LV) systolic performance, we assessed their contractility index by the slope of the LV end-systolic pressure-dimension (P(es)-D(es)) relation. We studied 35 patients with ChD (14 IF, 11 digestive form [DF], 10 cardiac form [CF]) and 13 healthy subjects. Patients with the CF had only minor cardiac involvement (bundle-branch block, normal LV ejection fraction). All patients had normal baseline global LV systolic function on 2-dimensional echocardiography, but minor segmental wall motion abnormalities were observed in 3 DF, 3 IF, and 2 CF patients. At rest and during intravenous phenylephrine infusion, we measured LV dimensions by echocardiography, and LV end-systolic pressure was estimated by a calibrated carotid pulse tracing. We also measured percent fractional shortening (%DeltaD) and the rate-corrected mean velocity of fiber shortening (Vcf(c)). Mean values (+/- SD) of %DeltaD and Vcf(c) were not significantly different from those exhibited by healthy control subjects in any of the ChD groups at rest (except for CF) or at peak stress using phenylephrine. The P(es)-D(es) slope was similarly and significantly reduced in all ChD patients (IF: 50.7 +/- 25; DF: 52.3 +/- 24; CF: 60.8 +/- 22 mm Hg/cm) compared with normal subjects (89 +/- 17 mm Hg/cm). The P(es)-D(es) slope was even more depressed (39.6 +/- 10 mm Hg/cm) in ChD patients who had minor segmental wall motion abnormalities (SWMAs) on the baseline 2-dimensional echocardiograph in comparison with the slightly reduced values found in patients with CF who had isolated conduction abnormalities on the ECG (71.8 +/- 10 mm Hg/cm). Although %DeltaD and Vcf(c), even at peak afterload, do not differentiate ChD patients from normal controls, the P(es)-D(es) slope is significantly impaired in IF, DF, and CF patients. The remarkably lower P(es)-D(es) slope value documented in ChD patients exhibiting only minor LVWMAs suggests a more extensive myocardial damage in this group of patients, indicating that they should be considered as exhibiting symptoms of the CF version of the disease.

Prediction of left ventricular wall motion recovery after acute myocardial infarction by Tl-201 gated SPECT: incremental value of integrated contractile reserve assessment.

BACKGROUND: This investigation tested the application of low-dose dobutamine (LDD) gated single photon emission computed tomography (SPECT) with thallium 201 for myocardial viability detection early after acute myocardial infarction (AMI). METHODS AND RESULTS: Thirty-two hemodynamically stable post-AMI patients (aged 55 +/- 5 years [mean +/- SEM]; 20 men) who were exhibiting regional left ventricular dysfunction underwent stress-redistribution Tl-201 scanning within 4 to 8 days, followed by 2 additional gated SPECT acquisitions after Tl-201 reinjection, at rest and during LDD. A visual 5-point score was computed for segmental radiotracer uptake (0, normal; 4, absent) and a 4-point score for left ventricular wall motion (1, normal; 4, dyskinesis). Predominant viable myocardium in dyssynergic regions was predicted by a mean Tl-201 uptake score of 2 or less or ischemic area of 30% or greater. These indices showed a significant association with wall motion improvement in follow-up echocardiographic studies (overall accuracy = 0.69, sensitivity = 0.93, and specificity = 0.50). Regarding the response to LDD stimulus, an increase in mean wall motion score of 30% or greater was predictive of predominant viable myocardium. Contractile reserve assessment yielded a significant increment in the predictive accuracy for function recovery (overall accuracy = 0.84, sensitivity = 0.71, and specificity = 0.94). CONCLUSIONS: Evaluation of contractile reserve by means of LDD gated SPECT with Tl-201 is safely feasible early after AMI, with incremental value over perfusion assessment alone for myocardial viability detection.

Insuficiência cardíaca na doença de Chagas / Chagas' heart disease and heart failure

A cardiopatia chagásica é condiçäo mórbida altamente prevalente no continente americano e acarreta elevadas morbidade. Além do significativo ônus socioeconômico para naçöes em desenvolvimento constitui motivaçäo essencial para seu estudo o melhor entendimento de suas marcantes particularidades fisiopatológicas, exteriorizadas também na síndrome de insuficiência cardíaca a ela vinculada. Representam, ainda, aspectos relevantes de sua fisiopatogenia, cujo entendimento tem progredido graças aos recentes avanços técnicos nos instrumentos de investigaçäo: a participaçäo do parasitismo continuado de fibras cardíacas na fase crônica da doença; a identificaçäo da isquemia miocárdica e a denervaçäo autonômica cardíaca precedendo outras manifestaçöes de cardiopatia. É bastante plausível que esses distúrbios constituam potenciais mecanisoms auxiliares e amplificadores da lesäo miocárdica; e, finalmente, o reconhecimento de que a extensa fibrose intersticial miocárdica consequente ao processo inflamatório de natureza auto-imune deve representar fator determinate da falência funcional da bomba cardíaca.

Ventricular function in Chagas' heart disease

Invasive and noninvasive methods used to evaluate ventricular function in Chagas' disease are reviewed. The traditional indices of overall ventricular performance reflect the interaction of preload, contractility, afterload and heart rate. Therefore, they are unable to distinguish changes in contractility from modifications of loading conditions. The role of ventricular function as a predictor of mortality in chronic Chagas' heart disease is discussed. Ventricular function abnormalities in patients with indeterminate and digestive forms of Chagas' disease are especially emphasized. Finally, the evidence of early impairment of diastolic performance in patients with Chagas' disease is presented.

Funçäo ventricular na moléstia de Chagas / Ventricular function in Chagas' disease

Apresentamos uma ampla revisäo dos métodos invasivos e näo-invasivos utilizdos na abordagem da funçäo ventricular em diferentes formas clínicas da moléstia de Chagas. a maior parte dos métodos empregados nesta avaliaçäo exprime o desempenho global dos ventrículos, refletindo a interaçäo dos diversos determinantes do desempenho: pré-carga, contratilidade, pós-carga e frequência cardíaca. Discute-se, ainda, o papel da funçäo ventricular como determinante de mortalidade em cardiopatas chagásicos. Uma ênfase especial é dada à abordagem da funçäo ventricular em formas näo-cardíacas da moléstia de Chagas. Finalmente, säo discutidas as evidências de comprometimento precoce da funçäo diastólica ventricular esquerda na história natural dessa doença.

Infarto agudo do miocárdio: princípios básicos do tratamento clínico / Acude myocardial infarction: current management

Procedeu-se a revisäo sistematizada das formas de tratamento atualmente aplicadas em pacientes com infarto agudo do miocárdio. As variadas intervençöes terapêuticas foram analisadas criticamente sob o enfoque dos princípios fisiopatológicos que as embasam. De fundamental relevância foram consideradas as evidências de reduçäo de morbidade e mortalidade, dependente de cada intervençäo terapêutica, resultantes de análises estatísticas coletivas de estudo globalmente focalizados, ou dos chamados mega-ensaios multicêntricos prospectivamente concebidos. A luz dessas observaçöes, säo plenamente justificadas as condutas de internaçäo em unidades coronariana, de analgesia, sedaçäo, repouso, suplementaçäo de oxigênio, como medidas gerais, aplicáveis a todos os pacientes nas primeiras 24-48 horas do infarto miocárdio. Administraçäo profilática de lidocaína e anticoagulaçäo näo devem mais ser consideradas indiscriminadamente, mas devem ser implementadas em circunstâncias específicas, com base na definiçäo do benefício/risco individualmente avaliado. O uso precoce (nas primeiras 4-6 horas) de nitratos, bloqueadores beta-adrenérgicos e de trombolíticos farmacológicos parece hoje plenamente justificado no sentido de reduzir-se a área de necrose miocárdica. angioplastia coronariana transluminal, embora bastante efetiva como agente de reperfusiao mecânica, tem emprego restrito, em virtude de limitaçöes logísticas, como intervençäo primária; pode ser necessária em condiçöes de insucesso de trombólise farmacológica, quando há extensas áres de miocárdio em risco. Revascularizaçäo cirúrgica é presentemente reservada para o tratamento de instabilizaçäo hemodinâmica consequente a insucesso com as tentativas clínicas de reperfusäo, e correçäo de complicaçöes mecânicas como insuficiência mitral, rotura septal. A identificaçäo precoce de pacientes com alto risco de acidentes isquêmicos adicionais tornou-se conduta hoje mandatória, inclusive por meio de testes ergométricos submáximos, preferencialmente com tálio-201, antes da alta hospitalar

Estudo hemodinâmico na cardiopatia periparto após compensaçäo da insuficiência cardíaca / Hemodynamic study in peripartum cardiopathy following compensation of heart failure

Objetivo: Estudo hemodinâmico de pacientes com cardiopatia periparto, em condiçäo padronizada de compensaçäo da insuficiência cardíaca, e de distanciamento temporal do período gravídico. Casuística e Métodos: Quatorze pacientes com cardiopatia periparto, mediante determinaçäo da pressöes circulatórias, medida do débito cardíaco, e da fraçäo de ejeçäo ventricular esquerda, e estudo da ciruclaçäo coronariana, em condiçäo de repouso. Resultados: Padräo hemodinâmico muito variável, 28% dos casos apresentando características hipercinéticas com perservaçäo de valores de débito cardíaco e fraçäo de ejeçäo ventricular esquerda em níveis normais ou mesmo elevados. Nessas pacientes as resistências vasculares sistêmica e pulmonar mantinham-se em níveis relativamente reduzidos. Conclusäo: Embora os mecanismos que propiciam a instalaçäo desta padräo hemodinâmico, distinto do habitualmente verificado na cardiomiopatia dilatada, sem esse fator periparto, näo sejam esclarecidos, há a possibilidade de associaçäo a prognóstico mais favorável, em tais condiçöes

Purpose: To assess hemodynamic characteristics of patients with peripartum cardiomyopathy under standartized conditions of clinical compensation of heart failure, and more than 3 months after the end of the gravidic period. Patients and Methods: Fourteen patients with peripartum cardiomyopathy underwent left and right card iac catheterization, und er rest cond ition. Cardiac output was measured by the Fick method, left ventricular ejection fraction determined by contrast ventriculography, and the coronary circulation was studied angiographically. Results: The hemodynamic pattern observed was variable, with 28% of the cases showing low right and left ventricular filling pressures, normal LV ejection fraction, and normal or even elevated cardiac output, with low pulmonary and systemic vascular resistance. Conclusion: Although the mechanisms responsible for such peculiar hemodynamic characterístics, have not been elucidated, it is likely that they are associated with more benign prognosis, as compared to other patients with peripartum cardiomyopathy, who show the low-output failure commonly seen in cases of dilated cardiomyopathy