Estudo Doppler-ecocardiográfico de pacientes com talassemia major em regime de hipertransfusão sanguínea
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Data
2009-12-18
Autores
Rodrigues, Alexandre [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Os portadores de talassemia major (TM) apresentam estado de hemólise crônica, aumento na absorção intestinal de ferro e necessidade de transfusões sanguíneas freqüentes, o que pode acarretar sobrecarga de ferro no coração. A hemocromatose faz parte do grupo de doenças de depósito que se caracteriza pelo acúmulo excessivo de ferro nos tecidos, sendo o comprometimento do coração a principal causa de morte em pacientes com talassemia regularmente transfundidos. Vários exames podem ser realizados na tentativa de identificar a sobrecarga deste metal, mas a maioria apresenta baixa acurácia e só demonstram alterações em fase avançada da doença. Recentemente, a ressonância magnética com a técnica T2* passou a ser considerada o padrão ouro para este fim, porém, trata-se de um exame de custo elevado e pouco disponível. Alguns estudos, utilizando o Doppler-ecocardiograma tissular para avaliação da função ventricular, têm demonstrado ser possível identificar precocemente a disfunção ventricular sistólica e diastólica, antes do aparecimento de sintomas ou alterações cardíacas ao Doppler-ecocardiograma convencional. O objetivo do presente estudo foi avaliar a estrutura e função cardíaca pela ecocardiografia com Doppler convencional e tissular em portadores de TM sem sinais ou sintomas de insuficiência cardíaca. O presente estudo é observacional e prospectivo que incluiu 18 portadores de TM em esquema de transfusões sanguíneas freqüentes no Hemocentro de Marília, junto a Faculdade Estadual de Medicina de Marília (FAMEMA). Para avaliar separadamente os efeitos da anemia e das transfusões sanguíneas, foram incluídos dois grupos controle, um normal (n=18) e outro com anemia ferropriva (n=18), com idade, sexo e superfície corpórea semelhantes. A análise estatística foi realizada por ANOVA e teste de Tukey ou Kruskal-Wallis e teste de Dunn, de acordo...
Patients with thalassemia major (TM) present a chronic hemolysis state and a necessity for regular blood transfusions, which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is a deposition disease characterized by excessive iron accumulation in tissues, and the heart involvement is the main cause of death in patients with thalassemia regularly transfused. Although several exams have been used to identify iron overload, most of them present low accuracy and can only detect advanced disease. Recently, T2* magnetic resonance technique has been considered the gold standard for this aim; however, it is expensive and not available in most of medical centers. Few studies using tissue Doppler echocardiogram have shown that the early identification of ventricular diastolic and systolic dysfunction is possible, before signs and symptoms of heart failure or cardiac alterations by conventional Doppler echocardiogram. The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM, without clinical evidence of heart failure. This is an observational and prospective study including 18 patients with TM receiving regular blood transfusion at Marília Hemocentro - Faculdade Estadual de Medicina de Marília (FAMEMA). To separately evaluate anemia and blood transfusion effects, two sex-, age-, weight-, and height-matched control groups were included: one with normal individuals (n=18) and one with iron deficient anemic patients (n=18). Statistical analysis was performed using ANOVA complemented by Tukey’s test or Kruskal-Wallis’s and Dunn’s test, according to the probabilistic distribution of the samples. The following echocardiographic variables presented higher values in the TM group compared to the anemia (ANE) and the normal (NOR) groups: left atrium volume... (Complete abstract click electronic access below)
Patients with thalassemia major (TM) present a chronic hemolysis state and a necessity for regular blood transfusions, which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is a deposition disease characterized by excessive iron accumulation in tissues, and the heart involvement is the main cause of death in patients with thalassemia regularly transfused. Although several exams have been used to identify iron overload, most of them present low accuracy and can only detect advanced disease. Recently, T2* magnetic resonance technique has been considered the gold standard for this aim; however, it is expensive and not available in most of medical centers. Few studies using tissue Doppler echocardiogram have shown that the early identification of ventricular diastolic and systolic dysfunction is possible, before signs and symptoms of heart failure or cardiac alterations by conventional Doppler echocardiogram. The aim of this study was to evaluate cardiac structure and function by conventional Doppler echocardiography and tissue Doppler imaging in patients with TM, without clinical evidence of heart failure. This is an observational and prospective study including 18 patients with TM receiving regular blood transfusion at Marília Hemocentro - Faculdade Estadual de Medicina de Marília (FAMEMA). To separately evaluate anemia and blood transfusion effects, two sex-, age-, weight-, and height-matched control groups were included: one with normal individuals (n=18) and one with iron deficient anemic patients (n=18). Statistical analysis was performed using ANOVA complemented by Tukey’s test or Kruskal-Wallis’s and Dunn’s test, according to the probabilistic distribution of the samples. The following echocardiographic variables presented higher values in the TM group compared to the anemia (ANE) and the normal (NOR) groups: left atrium volume... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Ecocardiografia - Avaliação, Talassemia, Anemia, Ventricular function, Bood tranfusion
Como citar
RODRIGUES, Alexandre. Estudo Doppler-ecocardiográfico de pacientes com talassemia major em regime de hipertransfusão sanguínea. 2009. 107 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2009.