Objective: To determine the occurrence of hepatopulmonary syndrome (HPS) in patients with cirrhosis who are candidates for liver transplantation; to compare demographic, clinical, laboratory, and spirometric characteristics, as well as echocardiography results, arterial blood gas analysis, and severity of liver disease between the groups of patients with and without HPS; and to describe the occurrence of HPS in the subgroup of patients with cirrhosis and schistosomiasis mansoni (mixed liver disease). Methods: Between January and November of 2007, we evaluated 44 patients under treatment at the Liver Transplant Outpatient Clinic of the Federal University of Pernambuco Hospital das Clínicas, in the city of Recife, Brazil. The diagnostic criteria for HPS were intrapulmonary vascular dilatation, identified by transthoracic echocardiography, and an alveolar-arterial oxygen tension difference ≥ 15 mmHg or a PaO 2 < 80 mmHg. Results: The mean age of the patients was 52 years, and 31 patients (70%) were males. The most common cause of cirrhosis was alcohol use. Schistosomiasis was present in 28 patients (64%). Of the 44 patients, 20 (45.5%) were diagnosed with HPS. No significant differences were found between those patients and the patients without HPS in terms of any of the characteristics studied. Of the 28 patients with cirrhosis and schistosomiasis, 10 (35.7%) were diagnosed with HPS. Conclusions: In the population studied, HPS was highly prevalent and did not correlate with any of the variables analyzed.Keywords: Hepatopulmonary syndrome; Liver transplantation; Liver cirrhosis; Hypertension, portal; Schistosomiasis mansoni; Echocardiography. ResumoObjetivo: Verificar a ocorrência da síndrome hepatopulmonar (SHP) em pacientes cirróticos candidatos a transplante de fígado; comparar as características demográficas, clínicas, laboratoriais e espirométricas, resultados de ecocardiografia, análise de gases arteriais e da gravidade da doença hepática nos pacientes com e sem SHP; e descrever a ocorrência de SHP no subgrupo de pacientes com cirrose associada à esquistossomose mansônica (doença hepática mista). Métodos: Entre janeiro e novembro de 2007, foram avaliados 44 pacientes inscritos no Ambulatório de Transplante Hepático do Hospital das Clínicas da Universidade Federal de Pernambuco, em Recife (PE). Os critérios diagnósticos para SHP foram a presença de dilatações vasculares intrapulmonares, identificadas por ecocardiografia transtorácica, assim como diferença alveoloarterial de oxigênio ≥ 15 mmHg ou PaO 2 < 80 mmHg. Resultados: A idade média foi 52 anos, e 31 pacientes (70%) eram do sexo masculino. A causa mais frequente de cirrose foi uso de etanol. A esquistossomose esteve presente em 28 pacientes (64%). Dos 44 pacientes, 20 (45,5%) foram diagnosticados com SHP. Não foram observadas diferenças significativas em relação às características estudadas. No subgrupo de pacientes com cirrose associada à esquistossomose, 10/28 (35,7%) receberam o diagnóstico de SHP. Conclusões: A SHP apresentou elevada prevalênc...
Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.
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