Avaliação da função pulmonar e qualidade de vida em tromboembolia pulmonar após o término da terapia anticoagulante
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Data
2019-03-01
Autores
Campesato, João Marcos
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Universidade Estadual Paulista (Unesp)
Resumo
A tromboembolia pulmonar (TEP) é uma doença caracterizada pelo bloqueio da circulação pulmonar por êmbolos, que se desloca atravessando as câmaras direitas do coração e obstruindo a artéria pulmonar e/ou um de seus ramos. As alterações vasculares e seu impacto nos sintomas são bem estudadas, porém, a persistência de defeito perfusional residual (DPR), mesmo após a terapia estabelecida, pode gerar disfunções cardiovasculares e pulmonares. Em decorrência dessas complicações, os pacientes podem apresentar sintomas que alterem as atividades da vida diária. Por ser pouco explorada, hipotetizamos que, pacientes que apresentem algum grau de obstrução vascular pulmonar persistente decorrente de TEP manifestem clinicamente com piora da função pulmonar e da qualidade de vida. Objetivos: Avaliar a função pulmonar, a qualidade de vida, a capacidade de exercício e a classificação funcional dos pacientes que já finalizaram o tratamento com anticoagulante. Métodos: Foram avaliados 48 pacientes, com diagnostico confirmado de TEP e que já tinham terminado o tratamento com anticoagulante. Todos os pacientes foram submetidos a uma avaliação clínica, espirometria pré e pós broncodilatador, teste de caminhada de seis minutos (TC6M), questionário de qualidade de vida (SF-36) e classificação funcional (NYHA). Após a verificação dos resultados da cintilografia de perfusão pulmonar, os pacientes foram divididos em dois grupos de acordo com a presença (n=27) ou ausência (n=21) de DPR. Resultados: Os pacientes avaliados tinham idade média de 45 ± 12,4 anos, sendo 34 (70%) do sexo feminino. Em comparação aos grupos com e sem DPR, as comorbidades hipertensão arterial sistêmica e diabetes mellitus foram significativamente mais presentes no grupo com DPR. A espirometria não mostrou valores significantes entre os grupos. O grupo sem DPR caminhou distância significativamente maior em comparação ao grupo com DPR. Quatro dos oito domínios do Short-Form Health Survey (SF-36) mostraram um comprometimento significativamente maior nos pacientes com DPR. Em adição, o grupo com DPR foi mais presente na classe funcional III-IV. Conclusão: Os pacientes com DPR não apresentam piora da função pulmonar em relação aos sem DPR, porém, apresentam baixa capacidade de exercício, e são mais sintomáticos em comparação aos pacientes sem DPR.
Pulmonary thromboembolism (PTE) is a disease characterized by blockage of the pulmonary circulation by emboli, which travels through the right chambers of the heart and obstructs the pulmonary artery and / or one of its branches. Vascular changes, and their impact on symptoms are well studied, however, the persistence of residual perfusion defect (RPD), even after established therapy can lead to cardiovascular and pulmonary dysfunctions. As result of these complications, patients may experience symptoms that alter the activities of daily life. Since it is not well explained, we hypothesised that, patients presenting with some degree of persistent pulmonary vascular obstruction due to PTE manifest clinically with worsening pulmonary function and quality of life. Objectives: To assess lung function, quality of life, exercise capacity and functional classification of patients who have already completed anticoagulant treatment. Methods: We evaluated 48 patients, with confirmed diagnosis of PTE and who had already finished anticoagulant treatment. All patients underwent clinical evaluation, pre- and post bronchodilator spirometry, six-minute walk test (6MWT), quality of life questionnaire (SF-36) and functional classification (NYHA). After the results of the pulmonary perfusion scintigraphy, the patients were divided into two groups according to the presence (n = 27) or absence (n = 21) of RPD. Results: The patients evaluated had a mean age of 45 ± 12.4 years, of which 34 (70%) were female. Compared with the groups with and without RPD, the presence of comorbidities such as systemic arterial hypertension and diabetes mellitus was significantly more present in the RPD group. Spirometry did not show significant values between the groups. The group without RPD walked a significantly longer distance compared to the group with RPD. Four of the eight domains of the Short-Form Health Survey (SF-36) were significantly more compromised in DPR patients. In addition, the RPD group was more present in functional class III-IV. Conclusion: That patients with RPD do not present worsening of pulmonary function in relation to those without RPD, but they have a low exercise capacity and they are more symptomatic in comparison to patients without RPD.
Pulmonary thromboembolism (PTE) is a disease characterized by blockage of the pulmonary circulation by emboli, which travels through the right chambers of the heart and obstructs the pulmonary artery and / or one of its branches. Vascular changes, and their impact on symptoms are well studied, however, the persistence of residual perfusion defect (RPD), even after established therapy can lead to cardiovascular and pulmonary dysfunctions. As result of these complications, patients may experience symptoms that alter the activities of daily life. Since it is not well explained, we hypothesised that, patients presenting with some degree of persistent pulmonary vascular obstruction due to PTE manifest clinically with worsening pulmonary function and quality of life. Objectives: To assess lung function, quality of life, exercise capacity and functional classification of patients who have already completed anticoagulant treatment. Methods: We evaluated 48 patients, with confirmed diagnosis of PTE and who had already finished anticoagulant treatment. All patients underwent clinical evaluation, pre- and post bronchodilator spirometry, six-minute walk test (6MWT), quality of life questionnaire (SF-36) and functional classification (NYHA). After the results of the pulmonary perfusion scintigraphy, the patients were divided into two groups according to the presence (n = 27) or absence (n = 21) of RPD. Results: The patients evaluated had a mean age of 45 ± 12.4 years, of which 34 (70%) were female. Compared with the groups with and without RPD, the presence of comorbidities such as systemic arterial hypertension and diabetes mellitus was significantly more present in the RPD group. Spirometry did not show significant values between the groups. The group without RPD walked a significantly longer distance compared to the group with RPD. Four of the eight domains of the Short-Form Health Survey (SF-36) were significantly more compromised in DPR patients. In addition, the RPD group was more present in functional class III-IV. Conclusion: That patients with RPD do not present worsening of pulmonary function in relation to those without RPD, but they have a low exercise capacity and they are more symptomatic in comparison to patients without RPD.
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Palavras-chave
tromboembolia pulmonar, defeito perfusional residual, função pulmonar, qualidade de vida, pulmonary thromboembolism, residual perfusion defec, pulmonary function, quality of life