Associação entre dispneia e o grau de disfunção diastólica ao ecocardiograma / Association among dyspnea and the degrees of diastolic dysfunction at echocardiography

RESUMO

ntrodução A disfunção diastólica do ventrículo esquerdo (DDVE) pode levar a insuficiência cardíaca com fração de ejeção preservada. O ecocardiograma, em especial o Doppler tecidual, é o principal exame utilizado. A clínica geralmente cursa com dispneia, avaliada pela escala modified Medical Research Council (mMRC). Entretanto, existem poucos estudos que investiguem qual é a associação entre o sintoma e a disfunção. Objetivo: Avaliar se a queixa de dispneia se associa com a progressão da DDVE e se há relação entre mMRC e os graus de DDVE. Métodos: Estudo caso-controle e transversal, com 60 participantes, com avaliação clínica (mMRC) e ecocardiográfica (parâmetros bidimensionais, Doppler espectral e tecidual). Dentre os participantes avaliados, 49 configuraram o grupo caso (DDVE com dispneia) e 11 o grupo controle (DDVE sem dispneia). Foram excluídos participantes com comorbidades ou outras alterações ecocardiográficas relacionadas à dispneia. Resultados: A média de idade foi de 61,7 anos (± 7,9), sendo 72% mulheres. Do total, 82% dos participantes apresentaram dispneia. Destes, 82% apresentaram DDVE grau I. Todos apresentaram função ventricular sistólica preservada. A presença de dispneia se associou com o grau de DDVE (p = 0,04), relação que não se observou com a intensidade do sintoma (p = 0,72). Conclusão: Houve associação entre a presença de dispneia e grau de DDVE, porém não houve relação entre a progressão da dispneia e a evolução da DDVE. O aumento do átrio esquerdo e a presença de doença arterial coronariana foram associadas com graus mais avançados de DDVE

ABSTRACT

Introduction: The left ventricle diastolic dysfuntion (LVDD) can lead to heart failure with preserved ejection fraction. Echocardiography, especially the tissue Doppler, is the main exam. The clinic has dyspnea as a typical symptom, which is evaluated by modified Medical Research Council (mMRC). However, there are few studies that investigate what is the association between the symptom and LVDD. Objective: Evaluate if dyspnea is associated with the advancement of LVDD and if there is a linkage between mMRC and the degrees of LVDD. Method: Case-control transversal study, with 60 participants, with clinical (mMRC) and echocardiographic (bidimensional parameters, spectral and tissue Doppler) evaluation. Among the participants, 49 constituted the case group (LVDD with dyspnea) and 11 the control group (LVDD without dyspnea). Participants with co-morbidity or other echocardiographic abnormalities related to dyspnea were excluded. Results: The average age was 61,7 (± 7,9) years and 72% were women. In overwall, 82% of the participants had dyspnea. Among them, 82% had LVDD degree I. All of the study population had preserved ventricular systolic function. The presence of dyspnea was associated with the degree of LVDD (p = 0,04), however, the symptom severity was not (p = 0,72). Conclusion: Dyspnea was associated with the degree of LVDD, but there was no association between the symptom severity and the evolution of LVDD. The aging, the increase of left atrium and coronary artery disease were associated with the advanced grades of LVDD