João Carlos Ferreira Braga

Ecocardiografia de pacientes talassêmicos sem insuficiência cardíaca em tratamento com transfusões sanguíneas e quelação

BACKGROUND: Patients with thalassemia major present chronic hemolysis and require regular blood transfusions which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is characterized by excessive iron accumulation in tissues, and heart involvement is the main cause of death in patients with thalassemia. OBJECTIVE: The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM and no clinical evidence of heart failure. METHODS: This is a prospective observational study including 18 patients with thalassemia major (TM) receiving regular blood transfusion. To separately evaluate anemia and blood transfusion effects, two gender, age, weight, and height-matched control groups were included: one with healthy individuals (Healthy, n=18) and one with iron deficient anemia patients (Anemia, n=18). Statistical analysis was performed using ANOVA followed by Tukeys test or Kruskal-Walliss and Dunns test. RESULTS: The following echocardiographic variables presented significantly higher values in TM than the Anemia and Healthy groups: left atrium volume index (Healthy: 16.4±6.08; Anemia: 17.9±7.02; TM: 24.1±8.30 cm3/m2); mitral septal E/Em ratio (Healthy: 6.55±1.60; Anemia: 6.74±0.74; TM: 8.10±1.31); and duration of reverse pulmonary vein flow [Healthy: 74.0 (59.0-74.0); Anemia: 70.5 (67.0-74.0); TM: 111 (87.0-120) ms]. The mitral E/A ratio was higher in TM than Anemia (Healthy: 1.80±0.40; Anemia: 1.80±0.24; TM: 2.03±0.34). No differences were found in left ventricular structures and systolic function indexes. CONCLUSION: Conventional Doppler echocardiography and tissue Doppler allow changes in left ventricular diastolic function to be identified in asymptomatic patients with thalassemia major.

Ventricular systolic reserve in asymptomatic children previously treated with low doses of anthracyclines: a longitudinal, prospective exercise echocardiography study.

The time course of mild cardiotoxicity induced by anthracycline remains unknown. The aim of this study was to evaluate the long‐term evolution of decreased myocardial reserve in children previously treated with a cumulative dose of anthracycline up to 100 mg/m2.

Diastolic dysfunction in diabetic normotensive patients, regardless of the presence of microangiopathy

OBJECTIVE To assess the Doppler-echocardiographic changes in normotensive patients with type II diabetes mellitus, in the presence or absence of signs of microangiopathy. METHODS Patients with type II diabetes mellitus were submitted to funduscopy contrasted with fluorescein and dosage of microalbuminuria for diagnose of microangiopathy and divided into two groups: DMII (patients without microangiopathy, n=19) and DM+A (patients with microangiopathy, n=13). All of them were submitted to a Doppler-echocardiography and the results were compared with normotensive patients of same sex and age (group C, n=20), by using the ANOVA, followed by the test of Tukey. In all comparisons the significance level p<0.05 was adopted. RESULTS There were no differences among the groups regarding the systolic function indicators or left ventricular mass. Differences compatible with diastolic dysfunction in the two groups of diabetic were observed, regardless of the presence of microangiopathy, which showed significantly higher values of the times of isovolumetric relaxation of the left ventricle (TIRLV, ms): (DMII= 97+/-22.2; DM+A= 107+/-28.2 and C= 80+/-10.7; p<0.05), and lower values of the maximum speeds of the wave of fast ventricular filling (E, cm/s): (DMII= 69+/-17.5; DM+A= 75+/-19.7 and C= 84+/-14.5, p<0.05 between DMII and C). There was no difference among the groups concerning the E/A rate. CONCLUSION Normotensive patients with type II diabetes mellitus and without clinical signs of cardiovascular compromising showed signs of diastolic dysfunction, non-associated to the presence of microangiopathy.