Temas livres - 19/09/05

Abstract

TEMAS LIVRES TEMAS LIVRES TEMAS LIVRES TEMAS LIVRES TEMAS LIVRES TEMAS LIVRES -19/09/05Prevalence of malignant ventricular arrhythmias in the fibrotic form of arrhythmogenic right ventricular dysplasia/cardiomyopathy as assed by contrast-enhanced cardiovascular magnetic resonance. Hospital Barra DOR Rio de Janeiro RJ BRASIL. INTRODUCTION:Arrhythmogenic right ventricular (RV) dysplasia/cardiomyopathy (ARVD/C) is a heart muscle disease characterized by the replacement of the right ventricle by fatty and fibrous tissue, leading to malignant ventricular arrhythmias (MVA). Contrast-enhanced cardiovascular magnetic resonance (CE-CMR) can well characterize areas of myocardial fibrosis. PURPOSE:The aim was to evaluate in ARVD/C patients (pts) the prevalence of MVA and the finding of myocardial fibrosis by CE-CMR. METHODS: 30 consecutive pts under investigation of ARVD/C perform CE-CMR. Electrophysiological study (EPS) was performed in pts with suspect diagnosis of ARVD/C as defined by task force criteria (Br Heart J. 1994; 71(3):215-8).Cine MR was performed to evaluate ventricular function. CE-CMR was performed 20 minutes after IV infusion of gadolinium contrast (fast gradient-echo with an inversion-recovery preparation pulse) in a 1.5T magnet. RESULTS:The mean age of study population was 39 ± 12 and 16 were male. We detected the presence of myocardial fibrosis by CE-CRM in 3 pts (10%), with predominant involvement of RV, but concomitant presence of areas of delayed enhanced in septum, anterior wall and inferior wall. All of these pts (100%) fulfilled the diagnosis of ARVD/C and it was documented MVA in clinical setting or EPS. We did not detected myocardial fibrosis in 27 pts (90%). None of these pts (0%) fulfilled the diagnosis of ARVD/C (p<0,001) and MVA were not documented. CONCLUSION: CE-CMR could detect the presence of myocardial fibrosis with a major involvement of RV in patients with MVA and the diagnosis of ARVD/C by the international task force criteria. These findings may have implication to the potential usefulness of CE-CMR for evaluation and risk stratification of ARVC/D.Importância do sintoma de pré-síncope como manifestação clínica de intolerância ortostática. RESULTADOS: 50% dos pacientes eram homens; 62,5% em classe IV NYHA; e as etiologias mais freqüentes foram isquêmica (36,6%) e hipertensiva (34,5%). A média de idade foi de 67,5 +/-14 anos, sendo diferente entre os gêneros (64+/ -13 vs 68+/-14, p=0,001). As mulheres tinham fração de ejeção (FE) maior (37%+/-16 vs 46%+/-17, p=0,001), menores diâmetros ventriculares (DD:54mm vs 6,3mm,p<0,001;DS:41mm vs 5,1mm,p<0,001) e mais disfunção diastólica (p=0,02). Com relação às características clínicas, as mulheres tinham mais comorbidades (p=0,008 para comparação do Índice de Charlson) e mais freqüentemente apresentavam palpitação (26%vs34%, p=0,02), fadiga (50%vs58%, p=0,02) e anorexia (28%vs36%, p=0,01). A queixa dispnéia não foi diferente entre os grupos. As etiologias hipertensiva e valvular foram significativamente mais prevalentes em mulheres, e a idiop...