Edmundo Arteaga Fernández

Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison betw een groups)

BACKGROUND The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.FUNDAMENTO: La resonancia magnetica es un metodo eficaz para estudio de la cardiomiopatia hipertrofica. OBJETIVO: Evaluar, por la resonancia magnetica, los parametros de funcion sistolica, perfusion y viabilidad miocardica en pacientes portadores de cardiomiopatia hipertrofica, comparando los grupos con y sin obstruccion en la via de salida del ventriculo izquierdo. METODO: Veinte y un pacientes con diagnostico de cardiomiopatia hipertrofica realizaron estudios de funcion, viabilidad y perfusion miocardica en las fases de estres y de reposo por la resonancia magnetica. RESULTADOS: Los segmentos ventriculares mas comprometidos por la hipertrofia fueron los de la region septal. El grupo obstructivo presento distribucion segmental de espesor miocardico semejante al no obstructivo, pero con mayores promedios que el primer grupo. El promedio de la fraccion de eyeccion de los pacientes del grupo obstructivo fue mayor que el grupo no obstructivo, mientras que los promedios de los volumenes sistolico y diastolico finales se hallaron menores en el grupo obstructivo. Hubo correlacion positiva entre el espesor de los segmentos del ventriculo y la masa segmental del realce tardio. La induccion de estres determino aumento del numero de segmentos con alteracion de perfusion, y esa alteracion fue mas evidente en el grupo obstructivo. CONCLUSION: Los segmentos ventriculares con mayor espesor son los septales. Las regiones hipertroficas estan asociadas a la mayor extension de realce tardio. Hubo correlacion positiva entre las areas de hipertrofia ventricular y perfusion miocardica alterada, y estos hallazgos fueron mas evidentes en el grupo obstructivo.

Cardiac pacing in hypertrophic cardiomyopathy: a cohort with 24 years of follow-up

BACKGROUND The benefits of heart stimulation in hypertrophic cardiomyopathy (HCM) patients have been questioned. Research work available in Brazil on those benefits is scarce. OBJECTIVE To describe the indication, clinical response, complications and survival time related to pacemaker implant in HCM patients. METHODS Thirty-nine hypertrophic cardiomyopathy patients were studied (41% males) and submitted to pacemaker implant from May, 1980 through November, 2003. RESULTS Twenty-seven patients presented obstructive hypertrophic cardiomyopathy, and 12, non-obstructive. Mean age was 46.4 years of age (range 14-77), with follow-up of 6.4+/-4.1 years. Major indications for implant were: spontaneous or induced atrioventricular block (54%), refractoriness to therapeutic conduct associated to high gradient (33%), support for drug therapy to treat bradychardia (8%), and atrial fibrillation prevention (5%). Functional class was shown to improve from 2.41+/-0.87 to 1.97+/-0.92 (p=0.008), and symptoms referred were reduced. No change was made in drug therapy administration. No procedure-related deaths were reported. Although shown to be safe, the procedure was not free from complications (6 patients--15.4%). Three deaths occurred in the follow-up period--the three of them were atrial fibrillation female patients, with evidence of functional deterioration. A close association was observed between clinical condition worsening and the onset of atrial fibrillation or flutter. CONCLUSION Cardiac pacing in HCM patients was successful, with evidence of symptoms relief in obstructive HCM patients. No functional improvement was observed in non-obstructive patients.

Realce tardio e perfusão miocárdica em cardiomiopatia hipertrófica (comparação entre grupos)

BACKGROUND The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.FUNDAMENTO: La resonancia magnetica es un metodo eficaz para estudio de la cardiomiopatia hipertrofica. OBJETIVO: Evaluar, por la resonancia magnetica, los parametros de funcion sistolica, perfusion y viabilidad miocardica en pacientes portadores de cardiomiopatia hipertrofica, comparando los grupos con y sin obstruccion en la via de salida del ventriculo izquierdo. METODO: Veinte y un pacientes con diagnostico de cardiomiopatia hipertrofica realizaron estudios de funcion, viabilidad y perfusion miocardica en las fases de estres y de reposo por la resonancia magnetica. RESULTADOS: Los segmentos ventriculares mas comprometidos por la hipertrofia fueron los de la region septal. El grupo obstructivo presento distribucion segmental de espesor miocardico semejante al no obstructivo, pero con mayores promedios que el primer grupo. El promedio de la fraccion de eyeccion de los pacientes del grupo obstructivo fue mayor que el grupo no obstructivo, mientras que los promedios de los volumenes sistolico y diastolico finales se hallaron menores en el grupo obstructivo. Hubo correlacion positiva entre el espesor de los segmentos del ventriculo y la masa segmental del realce tardio. La induccion de estres determino aumento del numero de segmentos con alteracion de perfusion, y esa alteracion fue mas evidente en el grupo obstructivo. CONCLUSION: Los segmentos ventriculares con mayor espesor son los septales. Las regiones hipertroficas estan asociadas a la mayor extension de realce tardio. Hubo correlacion positiva entre las areas de hipertrofia ventricular y perfusion miocardica alterada, y estos hallazgos fueron mas evidentes en el grupo obstructivo.

Realce tardío y perfusión miocárdica en cardiomiopatía hipertrófica (comparación entre grupos)

BACKGROUND The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.FUNDAMENTO: La resonancia magnetica es un metodo eficaz para estudio de la cardiomiopatia hipertrofica. OBJETIVO: Evaluar, por la resonancia magnetica, los parametros de funcion sistolica, perfusion y viabilidad miocardica en pacientes portadores de cardiomiopatia hipertrofica, comparando los grupos con y sin obstruccion en la via de salida del ventriculo izquierdo. METODO: Veinte y un pacientes con diagnostico de cardiomiopatia hipertrofica realizaron estudios de funcion, viabilidad y perfusion miocardica en las fases de estres y de reposo por la resonancia magnetica. RESULTADOS: Los segmentos ventriculares mas comprometidos por la hipertrofia fueron los de la region septal. El grupo obstructivo presento distribucion segmental de espesor miocardico semejante al no obstructivo, pero con mayores promedios que el primer grupo. El promedio de la fraccion de eyeccion de los pacientes del grupo obstructivo fue mayor que el grupo no obstructivo, mientras que los promedios de los volumenes sistolico y diastolico finales se hallaron menores en el grupo obstructivo. Hubo correlacion positiva entre el espesor de los segmentos del ventriculo y la masa segmental del realce tardio. La induccion de estres determino aumento del numero de segmentos con alteracion de perfusion, y esa alteracion fue mas evidente en el grupo obstructivo. CONCLUSION: Los segmentos ventriculares con mayor espesor son los septales. Las regiones hipertroficas estan asociadas a la mayor extension de realce tardio. Hubo correlacion positiva entre las areas de hipertrofia ventricular y perfusion miocardica alterada, y estos hallazgos fueron mas evidentes en el grupo obstructivo.