Características clínicas associadas à evolução desfavorável na miocardiopatia periparto
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Data
2005-02-01
Autores
Moreira, Caroline da Costa [UNESP]
Zanati, Silméia Garcia [UNESP]
Medeiros, Vera Therezinha Borges [UNESP]
Guimarães, Cláudia [UNESP]
Simões, Elaine Farah [UNESP]
Matsubara, Beatriz Bojikian [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Cardiologia (SBC)
Resumo
OBJETIVOS: Avaliar as características clínicas de mulheres com diagnóstico prévio de miocardiopatia periparto e verificar as características associadas à evolução desfavorável. MÉTODOS: Variáveis clínicas, obstétricas e ecocardiográficas foram estudadas em 12 pacientes com miocardiopatia periparto, avaliadas no momento do diagnóstico e em consulta atual, quando foram divididas em dois grupos: GF (n= 6, sem alterações cardíacas) e GD (n= 6, com cardiomegalia e disfunção ventricular persistentes). As comparações foram feitas com o teste t de Student e exato de Fisher (p<0,05). RESULTADOS: No diagnóstico, a idade média das pacientes (8 brancas e 4 negras/pardas) foi de 24±7,4 anos; todas em classe funcional IV (NYHA) e 8 relataram hipertensão gestacional ou pré-eclâmpsia. A mediana do tempo de seguimento foi de 25 meses. Dez pacientes evoluíram para classe funcional I/II. A comparação entre os grupos mostrou GD com menor fração de ejeção do ventrículo esquerdo (0,30±0,05 vs. 0,58±0,09; p<0,001) e maior diâmetro sistólico do VE (58±5mm vs. 46±3mm; p<0,001), no momento do diagnóstico. A evolução desfavorável foi mais frequente entre as pardas (p=0,01). Na avaliação atual o GD apresentou menor espessura relativa da parede (0,13±0,02 vs. 0,17±0,02; p< 0,05) e maior massa do VE (283±90g vs. 186±41g; p<0,05). CONCLUSÃO: Pacientes com miocardiopatia periparto prévia apresentam evolução desfavorável associada à raça negra e alterações cardíacas iniciais mais acentuadas e a evolução favorável está associada à redução da massa miocárdica e aumento da espessura relativa da parede ventricular.
OBJECTIVE: To assess the clinical characteristics of women with a previous diagnosis of peripartum myocardiopathy and to study the characteristics associated with unfavorable outcomes. METHODS: Clinical, obstetric, and echocardiographic variables were studied in 12 patients with peripartum myocardiopathy, assessed at diagnosis and at a current appointment, when they were divided into 2 groups: FG (n = 6, without cardiac alterations) and UG (n = 6, with cardiomegaly and persistent ventricular dysfunction). The comparisons were made using the Student t test and Fisher's exact test (P < 0.05). RESULTS: At diagnosis, mean age of the patients (8 Caucasian and 4 black/non-Caucasian) was 24±7.4 years, all in Functional Class IV (NYHA) and 8 reporting gestational hypertension or preeclampsia. Mean follow-up time was 25 months. Ten patients developed Functional Class I/II. Comparison between the groups demonstrated that UG had lower left ventricular ejection fractions (0.30±0.05 vs. 0.58±0.09; P < 0.001) and greater LV systolic diameter (58±5mm vs. 46±3mm; P < 0.001) at diagnosis. An unfavorable outcome was more frequent among non-Caucasian women (P = 0.01). In the current evaluation, UG had lower relative wall thickness (0.13±0.02 vs. 0.17±0.02; P < 0.05) and greater LV mass (283±90g vs. 186±41g; P < 0.05). CONCLUSION: Patients with previous peripartum myocardiopathy had unfavorable outcomes associated with black race, and stronger initial cardiac alterations; a favorable outcome was associated with a reduction in myocardial mass and an increase in relative ventricular wall thickness.
OBJECTIVE: To assess the clinical characteristics of women with a previous diagnosis of peripartum myocardiopathy and to study the characteristics associated with unfavorable outcomes. METHODS: Clinical, obstetric, and echocardiographic variables were studied in 12 patients with peripartum myocardiopathy, assessed at diagnosis and at a current appointment, when they were divided into 2 groups: FG (n = 6, without cardiac alterations) and UG (n = 6, with cardiomegaly and persistent ventricular dysfunction). The comparisons were made using the Student t test and Fisher's exact test (P < 0.05). RESULTS: At diagnosis, mean age of the patients (8 Caucasian and 4 black/non-Caucasian) was 24±7.4 years, all in Functional Class IV (NYHA) and 8 reporting gestational hypertension or preeclampsia. Mean follow-up time was 25 months. Ten patients developed Functional Class I/II. Comparison between the groups demonstrated that UG had lower left ventricular ejection fractions (0.30±0.05 vs. 0.58±0.09; P < 0.001) and greater LV systolic diameter (58±5mm vs. 46±3mm; P < 0.001) at diagnosis. An unfavorable outcome was more frequent among non-Caucasian women (P = 0.01). In the current evaluation, UG had lower relative wall thickness (0.13±0.02 vs. 0.17±0.02; P < 0.05) and greater LV mass (283±90g vs. 186±41g; P < 0.05). CONCLUSION: Patients with previous peripartum myocardiopathy had unfavorable outcomes associated with black race, and stronger initial cardiac alterations; a favorable outcome was associated with a reduction in myocardial mass and an increase in relative ventricular wall thickness.
Descrição
Palavras-chave
insuficiência cardíaca, ecocardiograma, gestação, heart failure, echocardiogram, gestation
Como citar
Arquivos Brasileiros de Cardiologia. Sociedade Brasileira de Cardiologia - SBC, v. 84, n. 2, p. 141-146, 2005.