Estudo Doppler-ecocardiográfico da morfologia e função ventricular esquerda e direita de pacientes em programação de cirurgia bariátrica
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2023-07-28
Autores
Cortez, Rosana Marssaro
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Universidade Estadual Paulista (Unesp)
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Introdução: Existem indícios da relação entre obesidade e insuficiência cardíaca com ocorrência de remodelamento estrutural, bem como evidências de anormalidades pré-clínicas da função sistólica dos ventrículos esquerdo (VE) e direito (VD). Objetivo: Avaliar as alterações na morfologia e funções sistólica e diastólica do VE e função sistólica do VD por meio de ecocardiograma convencional, associado à técnica do speckle tracking, em obesos em programação de cirurgia bariátrica e em indivíduos controles com IMC normal, ambos sem comorbidades. Metodologia: Estudo transversal caso-controle em que foram incluídos 40 pacientes obesos, com índice de massa corpórea maior que 30,0 kg/m², e 40 indivíduos não obesos, pareados para sexo e idade. Foram avaliados parâmetros clínicos, laboratoriais e ecocardiográficos, com avaliação do strain longitudinal global (SLG) do VE e VD. Resultados: A avaliação das estruturas cardíacas pelo ecocardiograma mostrou que não houve diferença na fração de ejeção pelo método Teichholz entre os dois grupos. No entanto, a análise do SLG mostrou níveis reduzidos do strain no grupo obeso (p<0,001). Em relação ao VD, os valores de strain foram menores no grupo obeso (p<0,001), e houve correlação positiva entre o strain do VD e o strain do VE (r=0,507; p<0,001). Em relação aos índices que avaliam a função diastólica do VE, como a relação E/e’ média e o VAE/alt.2,7, ambos se mostraram aumentados nos indivíduos obesos, com diferença estatística significativa. A análise dos parâmetros de funções sistólica e diastólica do VE evidenciou correlação fraca entre a relação E/e’ média e o SLG, e nenhuma evidência de correlação com o VAE/alt.2,7. Não houve associação entre a função diastólica do VE e o strain do VD. Quanto aos parâmetros clínicos e laboratoriais, houve diferença estatística significativa nos valores da PAD e PAM, assim como nos níveis de glicemia e hemoglobina glicada, mais elevados nos indivíduos obesos, mas ainda dentro dos limites da normalidade. Conclusão: A obesidade está associada à elevada frequência de alteração na geometria do ventrículo esquerdo, mas com fração de ejeção normal. As técnicas contemporâneas de speckle tracking permitem evidenciar anormalidades subclínicas da função sistólica dos ventrículos esquerdo e direito, em pacientes obesos sem comorbidades associadas que possam afetar a estrutura e função cardíaca.
Introduction: There are indications of the relationship between obesity and heart failure with the occurrence of structural remodeling, as well as evidence of preclinical abnormalities of left (LV) and right (RV) ventricular systolic function. Objective: To evaluate changes in LV morphology and systolic and diastolic function and RV systolic function by conventional echocardiography, associated with the speckle tracking technique, in obese patients scheduled for bariatric surgery and in control individuals, with normal body mass index, both without comorbidities. Methodology: Cross-sectional case-control study, which included 40 obese patients with a body mass index greater than 30.0 kg/m² and 40 non-obese individuals, matched for sex and age. Clinical, laboratory, and echocardiographic parameters were evaluated with evaluation of the LV and RV global longitudinal strain (GLS). Results: The evaluation of cardiac structures by echocardiography showed that there was no difference of ejection fraction by the Teichholz method between the two groups. However, the obese group showed reduced values of LV GLS (p<0.001). The RV strain values was also lower in obese group (p<0.001), and there was a positive correlation between LV and RV strain (r=0.507; p<0.001). Regarding the indices that assess LV diastolic function, such as the E/e' mean and LAV/height2.7, they were increased in obese individuals, with a statistically significant difference. The analysis of LV systolic and diastolic function parameters showed a weak correlation between E/e' mean and GLS, and no evidence of correlation with LAV/height2.7. There was no association between LV diastolic function and RV strain. As for clinical and laboratory parameters, there was a statistically significant difference in DBP and MAP values, as well as in glycemia and glycated hemoglobin levels, which were higher in obese individuals, but still within normal limits. Conclusion: Obesity is associated with a high frequency of alteration in left ventricular geometry, but with normal ejection fraction. Contemporary speckle tracking techniques allow evidence of subclinical abnormalities of left and right ventricular systolic function in obese patients without comorbidities that may affect cardiac structure and function.
Introduction: There are indications of the relationship between obesity and heart failure with the occurrence of structural remodeling, as well as evidence of preclinical abnormalities of left (LV) and right (RV) ventricular systolic function. Objective: To evaluate changes in LV morphology and systolic and diastolic function and RV systolic function by conventional echocardiography, associated with the speckle tracking technique, in obese patients scheduled for bariatric surgery and in control individuals, with normal body mass index, both without comorbidities. Methodology: Cross-sectional case-control study, which included 40 obese patients with a body mass index greater than 30.0 kg/m² and 40 non-obese individuals, matched for sex and age. Clinical, laboratory, and echocardiographic parameters were evaluated with evaluation of the LV and RV global longitudinal strain (GLS). Results: The evaluation of cardiac structures by echocardiography showed that there was no difference of ejection fraction by the Teichholz method between the two groups. However, the obese group showed reduced values of LV GLS (p<0.001). The RV strain values was also lower in obese group (p<0.001), and there was a positive correlation between LV and RV strain (r=0.507; p<0.001). Regarding the indices that assess LV diastolic function, such as the E/e' mean and LAV/height2.7, they were increased in obese individuals, with a statistically significant difference. The analysis of LV systolic and diastolic function parameters showed a weak correlation between E/e' mean and GLS, and no evidence of correlation with LAV/height2.7. There was no association between LV diastolic function and RV strain. As for clinical and laboratory parameters, there was a statistically significant difference in DBP and MAP values, as well as in glycemia and glycated hemoglobin levels, which were higher in obese individuals, but still within normal limits. Conclusion: Obesity is associated with a high frequency of alteration in left ventricular geometry, but with normal ejection fraction. Contemporary speckle tracking techniques allow evidence of subclinical abnormalities of left and right ventricular systolic function in obese patients without comorbidities that may affect cardiac structure and function.
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Obesidade, Strain longitudinal global, Speckle tracking, Disfunção ventricular, Remodelamento cardíaco, Deformação miocárdica, Ecocardiografia, Obesity, Global longitudinal strain, Ventricular dysfunction, Cardiac remodeling, Myocardial deformation, Echocardiography