A fiabilidade da relação e/a no estudo da função diastólica do ventrículo esquerdo
Type
article
Publisher
Identifier
MADUREIRA, Renato ; ALCAFACHE, Carlos ; MOTA, Mauro (2020) - A fiabilidade da relação e/a no estudo da função diastólica do ventrículo esquerdo. HIGEIA : Revista Científica da Escola Superior de Saúde Dr. Lopes Dias. ISSN 2184-5565. Ano II, vol. 3, nº 1, p. 25-34.
2184-5565.
Title
A fiabilidade da relação e/a no estudo da função diastólica do ventrículo esquerdo
The reliability of the e/a ratio in the study of left ventricular diastolic function
The reliability of the e/a ratio in the study of left ventricular diastolic function
Subject
Diástole
Ventrículos do coração
Ecocardiografia
Diastole
Heart ventricles
Echocardiography
Ventrículos do coração
Ecocardiografia
Diastole
Heart ventricles
Echocardiography
Date
2020-06-09T11:03:21Z
2020-06-09T11:03:21Z
2020
2020-06-09T11:03:21Z
2020
Description
Introdução
A disfunção diastólica define-se como sendo uma
perturbação do padrão do enchimento ventricular
normal, sendo consequência do relaxamento anormal do miocárdio. Historicamente e ainda com alguma repercussão no presente, a relação E/A é um
parâmetro muito valorizado aquando da tomada de
decisão diagnóstica no que diz respeito à qualidade da função diastólica. As mais recentes guidelines
acerca do tema contrariam esta ideia, principalmente na presença de fração de ejeção normal.
Objetivo
Avaliar a validade e fiabilidade da relação E/A no
diagnóstico de disfunção diastólica do ventrículo esquerdo.
Materiais e Métodos
Estudo observacional, transversal e de abordagem
quantitativa, realizado com indivíduos admitidos,
consecutivamente, no serviço de Cardiopneumologia de um hospital da região centro de Portugal, no
período compreendido entre 1 de janeiro e 31 de
dezembro de 2017. Todos os indivíduos foram submetidos a um estudo ecocardiográfico e foram registados parâmetros de Doppler contínuo, pulsado
e tecidular relacionados com a avaliação da função
diastólica, bem como o tamanho e função das cavidades cardíacas esquerdas.
Resultados
Foram incluídos 72 indivíduos, 58 com disfunção diastólica do ventrículo esquerdo (DDVE) e os restantes
14 sem DDVE. Entre os 58 indivíduos com disfunção
diastólica, 47 apresentam Grau I, 11 Grau II e nenhum
indivíduo foi diagnosticado com Grau III. Observou-
-se que 11 indivíduos não apresentaram alterações
na relação E/A, contudo, segundo as novas guidelines, evidenciam DDVE. Por outro lado, observa-se
em 61 indivíduos alterações na relação E/A, sendo
que 14, não padecem da patologia em questão.
Conclusão
A avaliação da função diastólica do ventrículo esquerdo, com recurso à relação E/A leva a diversos
falsos positivos e diversos falsos negativos. Para um
diagnóstico mais assertivo é necessário recorrer a diferentes parâmetros, o que vem dar suporte ao mais
recente algoritmo desenvolvido para a avaliação da
função diastólica do ventrículo esquerdo.
ABSTRACT: Introduction Diastolic dysfunction is defined as a disturbance of the normal ventricular filling pattern, resulting from abnormal myocardial relaxation. Historically and still with some repercussions in the present, the E/A ratio is a highly valued parameter when making a diagnostic decision regarding the quality of diastolic function. The most recent guidelines on the subject contradict this idea, especially in the presence of normal ejection fraction. Objective To evaluate the validity and reliability of the E/A ratio in the diagnosis of left ventricular diastolic dysfunction. Materials and Methods Observational, cross-sectional study with a quantitative approach, carried out with individuals admitted consecutively to the Cardiopneumology service of a hospital in the central region of Portugal, in the period between January 1 and December 31, 2017. All individuals were submitted to an echocardiographic study and continuous, pulsed and tissue Doppler parameters related to the evaluation of diastolic function, as well as the size and function of the left cardiac cavities were recorded. Results 72 individuals were included, 58 with left ventricular diastolic dysfunction (LVDD) and the remaining 14 without LVDD. Among the 58 individuals with diastolic dysfunction, 47 had Grade I, 11 Grade II and no individual was diagnosed with Grade III. It was observed that 11 individuals did not show changes in the E/A ratio, however, according to the new guidelines, they demonstrate LVDD. On the other hand, changes in the E/A ratio are observed in 61 individuals, 14 of which do not suffer from the pathology in question. Conclusion The assessment of left ventricular diastolic function, using the E/A ratio, leads to several false positives and several false negatives. For a more assertive diagnosis it is necessary to use different parameters, which supports the most recent algorithm developed for the assessment of left ventricular diastolic function.
info:eu-repo/semantics/publishedVersion
ABSTRACT: Introduction Diastolic dysfunction is defined as a disturbance of the normal ventricular filling pattern, resulting from abnormal myocardial relaxation. Historically and still with some repercussions in the present, the E/A ratio is a highly valued parameter when making a diagnostic decision regarding the quality of diastolic function. The most recent guidelines on the subject contradict this idea, especially in the presence of normal ejection fraction. Objective To evaluate the validity and reliability of the E/A ratio in the diagnosis of left ventricular diastolic dysfunction. Materials and Methods Observational, cross-sectional study with a quantitative approach, carried out with individuals admitted consecutively to the Cardiopneumology service of a hospital in the central region of Portugal, in the period between January 1 and December 31, 2017. All individuals were submitted to an echocardiographic study and continuous, pulsed and tissue Doppler parameters related to the evaluation of diastolic function, as well as the size and function of the left cardiac cavities were recorded. Results 72 individuals were included, 58 with left ventricular diastolic dysfunction (LVDD) and the remaining 14 without LVDD. Among the 58 individuals with diastolic dysfunction, 47 had Grade I, 11 Grade II and no individual was diagnosed with Grade III. It was observed that 11 individuals did not show changes in the E/A ratio, however, according to the new guidelines, they demonstrate LVDD. On the other hand, changes in the E/A ratio are observed in 61 individuals, 14 of which do not suffer from the pathology in question. Conclusion The assessment of left ventricular diastolic function, using the E/A ratio, leads to several false positives and several false negatives. For a more assertive diagnosis it is necessary to use different parameters, which supports the most recent algorithm developed for the assessment of left ventricular diastolic function.
info:eu-repo/semantics/publishedVersion
Access restrictions
openAccess
http://creativecommons.org/licenses/by/4.0/
http://creativecommons.org/licenses/by/4.0/
Language
por
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