Delma Maria Cunha

Doppler echocardiographic study in adolescents and young adults with sickle cell anemia

OBJECTIVE Anatomical and functional assessment of the heart through Doppler and echocardiography in patients with cell anemia (SCA). METHODS Twenty-five patients with SCA and ages ranging from 14 to 45 years were prospectively studied in a comparison with 25 healthy volunteers. All of them underwent clinical and laboratory evaluation and Doppler echocardiography as well. The measurements were converted into body surface indices. RESULTS There were increases in all chamber diameters and left ventricle (LV) mass of the SCA patients. It was characterised an eccentric hypertrophy of the left ventricle. The preload was increased (left ventricle end-diastolic volume) and the afterload was decreased (diastolic blood pressure, peripheral vascular resistance and end-systolic parietal stress ESPS). The cardiac index was increased due to the stroke volume. The ejection fraction and the percentage of the systolic shortening, as well as the systolic time intervals of the LV were equivalent. The isovolumetric contraction period of the LV was increased. The mitral E-septum distance and the end-systolic volume index (ESVi) were increased. The ESPS/ESVi ratio,a loading independent parameter, was decreased in SCA, suggesting systolic dysfunction. No significant differences in the diastolic function or in the pulmonary pressure occurred. CONCLUSION Chamber dilations, eccentric hypertrophy and systolic dysfunction confirm the evidence of the literature in characterizing a sickle cell anemia cardiomyopathy.

Monitorização ambulatorial da pressão arterial e pressão casual em hiper-reatores ao esforço

BACKGROUND Developing hypertension is likely to be at least two times greater in individual with exaggerated blood pressure response on exercise testing (ET). Few reports have evaluated the parameters of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in normotensive individuals with exaggerated blood pressure response to exercise. OBJECTIVE To evaluate the relationship among the casual blood pressure with hyper-reactive response on ET and to compare Ambulatory Blood Pressure Monitoring (ABPM) data of hyper-reactive individuals with a control group in order to detect early disorders, that allows a preventive action with prognostic implication. METHODS Casual BP measurement and parameters of ABPM of 26 adult individuals, with mean age of 41.50+/-11.78 years, normotensive at rest and hyper-reactive on ET was compared to those of 16 adult individuals, with mean age of 41.38+/-11.55 years, normotensive at rest with normal BP response on exercise. The values <140 x 90 mmHg were considered normal for casual BP. The values <220 mmHg for systolic BP and/or an increase > or = 5 mmHg diastolic BP on ET for hyper-reactive response diagnosis. RESULTS Hyper-reactive individuals presented the systolic (p=0.03) and diastolic (p=0.002) casual BP and mean systolic BP (p=0.050), systolic pressure load during the day (p=0.011), and systolic (p=0.017) pressure load higher when compared to the control group. CONCLUSION Casual high normal BP had a positive correlation with exaggerated BP response. The hyper-reactive individuals showed particular characteristics in casual BP as well as in ABPM parameters, which, although within the range of reference values, differed from those of individuals with normal response to exercise.

Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients

OBJECTIVE To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.