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The normality values were slightly higher than those reported in studies from other countries. The demographic characteristics of the Brazilian population, the small number of patients or different methodologies can be the causes of such differences. (99m)Tc-MAA scintigraphy showed excellent reproducibility.

BACKGROUND Hepatopulmonary syndrome (HPS) is defined as an oxygenation defect induced by intrapulmonary vasodilation in patients with liver disease or portal hypertension. It is investigated in patients with liver cirrhosis and less frequently in those with portal hypertension without liver cirrhosis, as may occur in hepatosplenic schistosomiasis (HSS).OBJECTIVES To investigate the prevalence of HPS in patients with HSS, and to determine whether the occurrence of HPS is influenced by concomitant cirrhosis.METHODS We evaluated patients with HSS with or without concomitant liver cirrhosis. All patients underwent laboratory testing, ultrasound, endoscopy, contrast echocardiography, and arterial blood gas analysis.FINDINGS Of the 121 patients with HSS, 64 were also diagnosed with liver cirrhosis. HPS was diagnosed in 42 patients (35%) and was more frequent among patients with concomitant liver cirrhosis than in those without cirrhosis (42% vs. 26%), but the difference was not significant (p = 0.069). HPS was more common in those with spider naevi, Child-Pugh classes B or C and high model for end stage liver disease (MELD) scores (p < 0.05 each).MAIN CONCLUSIONS The prevalence of HPS was 35% in this study. The occurrence of liver cirrhosis concomitantly with HSS may have influenced the frequency of patients presenting with HPS.

BackgroundSchistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt.Methodology/Principal findingsIn this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications.Conclusions/SignificanceOur findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.

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Resumo Fundamento: Diabete Melito eleva substancialmente o risco cardiovascular dos indivíduos acometidos. Objetivo: Avaliar a importância da ecocardiografia sob estresse farmacológico (EEF) na estratificação de risco de diabéticos com suspeita de isquemia miocárdica. Métodos: Coorte prospectiva. Os pacientes foram submetidos a EEF segundo os protocolos de dipiridamol (0,84 mg/kg com até 1,0 mg de atropina) ou dobutamina (5-40 ug/Kg/min associado a até 2,0 mg/atropina). Foram seguidos por meio de consulta aos prontuários médicos, contato telefônico ou entrevista com o médico assistente. O desfecho clínico considerado foi a combinação de morte cardiovascular, infarto agudo do miocárdio, angina instável e necessidade de revascularização cirúrgica ou percutânea. Resultados: Foram avaliados 291 pacientes, 59,5% mulheres, média etária de 65 ± 9,6 anos. Os sintomas foram dor precordial atípica (60%), dor precordial típica em 12% e 24% assintomáticos. O tempo médio de seguimento foi 42 m (01-105). Ocorreram 66 eventos combinados, 51 dos quais com EEF positivo. Sensibilidade, especificidade, acurácia, Valor Preditivo Positivo (VPP) e Valor Preditivo Negativo (VPN) ante os desfechos foram: 75%, 93,3%, 89%, 77,3% e 92,4%, respectivamente. As variáveis EEF positiva para isquemia, sexo masculino, infarto agudo do miocárdio (IAM), revascularização miocárdica cirúrgica (RMC) e intervenção coronariana percutânea (ICP) prévios, hipertensão arterial sistêmica (HAS), uso de ácido acetilsalicílico (AAS) prévio e eletrocardiograma (ECG) alterado tiveram associação com a ocorrência de eventos na análise univariada. Na análise multivariada, apenas o resultado positivo do EEF foi preditor independente para os desfechos clínicos combinados (RR 25,26 IC 95% 13,62 -46,81 p < 0,001). Conclusão: O resultado positivo para isquemia miocárdica foi o único preditor independente para a ocorrência dos desfechos clínicos combinados. (Arq Bras Cardiol: Imagem cardiovasc. 2015;28(2):73-79) Palavras-chave: Ecocardiografia sob estresse; Isquemia Miocárdica; Diabetes Mellitus. Abstract Background: Diabetes Mellitus substantially increases cardiovascular risk in individuals affected.Objective: To evaluate the importance of pharmacological stress echocardiography (PSE) in risk stratification of diabetic patients with suspected myocardial ischemia.Methods: Prospective cohort study. The patients underwent PSE according to the protocols of dipyridamole (0.84 mg/kg with up to 1.0 mg of atropine) or dobutamine (5-40 ug/kg/min associated with up to 2.0 mg/atropine). They were monitored through reference to medical records, phone calls or interview with the assistant physician. The clinical outcome was the combination of cardiovascular death, acute myocardial infarction, unstable angina and need for surgical or percutaneous myocardial revascularization. Results:We evaluated 291 patients, 59.5% women, mean age of 65 ± 9.6 years. The symptoms were atypical precordial chest pain (60%), typical precordial chest pain in 12%, and 24% asymptomatic. The median follow-u...