Pulmonology Pulmonology
Rev Port Pneumol 1995;1:59-65 - Vol. 1 Num.1 DOI: 10.1016/S0873-2159(15)31189-2
ARTIGO ORIGINAL
Diagnóstico não Invasivo de Hipertensão Pulmonar e Cor Pulmonale nos Doentes com Doença Pulmonar Crónica Obstrutiva – Importância da Ecocardiografia+
Pilar Azevedo, Nuno Cardim**, Margarida Sousa, Clara Heitor, A.T. Pereira***
* Serviço de Pneumologia-Hospital de Santa Maria
** Serviço de Cardiologia-Hospital de Pulido Valente
*** Laboratório de Ecocardiografia do Hospital Particular de Lisboa
M. Freitas E Costa
Received 21 November 1994
RESUMO

A presença de Hipertensão Pulmonar e de Cor Pulmonale é um factor de mau prognóstico no contexto da Doença Pulmonar Crónica Obstrutiva.

A Ecocardiografia modo M. bidimensional e Doppler é um método não invasivo que permite avaliar as alterações morfológicas e funcionais do coração direito e estimar a Pressão Sistólica na Artéria Pulmonar.

No entanto, condicionantes vários como a hiperinsuflação pulmonar, as alterações da parede torácica e a obesidade frequentemente presentes em doentes com patologia respiratória crónica, podem impedir a obtenção de exame com boa qualidade téscnica.

O objectivo deste trabalbo é avaliar a exeqwoilidade deste método nos doentes com Doença Pulmonar Crónica Obstrutiva e correlacionar os dados obtidos por Ecocardiografia com os aspectos clinicos sugestivos de falência cardíaca direita.

Foram estudados 35 doentes, 29 do sexo masculino e 6 do sexo feminino, com idade média de 66,2 anos, com Doença Pulmonar Crónica Obstrutiva seguidos na Consults de Oxigenioterapia de Longa Duração do Serviço de Pneumologia do Hospital de Santa Maria.

Cada doente realizou um Ecocardiograma modo M, bidimensional e Doppler para determinação da espessura da parede livre do ventrículo direito (VD), do diâmetro da cavidade ventricular direita e da Pressão Sistólica na Artéria Pulmonar (PAPs) utilizando as vias paraesternal esquerda, apical e subcostal.

Em 80% dos doentes estudados obtiveram-se registos satisfatórios que permitiram determinar a espessura da parede livre do VD, avaliar o diâmetro desta cavidade e estimar a PAPs.

Foram registados critérios de Hipertrofia Ventricular Direita em 75% dos registos validados (espessura média da parede livre do VD - 7,1±1,3mm) e critérios de dilatação ventricular direita em 25% dos casos.

Em 60% destes doentes conseguiu-se estimar a PAPs a partir do fluxo de Insuficiência Tricúspide. O valor médio da PAPs foi de 60±21,6mmHg, registando-se critérios de Hipertensão Pulmonar (HTP) em 77% dos casos estimados.

Nos doentes em que não foi possível quantificar a PAPs procedeu-se à avaliação do fluxo da câmara de saida do VD. Destes, 66% apresentavam critérios sugestivos de HTP.

Dos doentes com critérios ecocardiográficos sugestivos de Hipertrofia ventricular direita 50% apresentavam história clínica de um ou mais episódios prévios de falêncla cardíaca direita.

Dos doentes com critérios ecocardiográficos de dilataçãio do VD 83% apresentavam história clínica de um ou mais episódios prévios de falência cardíaca direita.

Os dados preliminares parecem assim sugerir que a Ecocardiografia é um método não invasivo útil na avaliaçãio dos doentes com Doença Pulmonar Crónica Obstrutiva permitindo o diagnóstico precoce de Cor Pulmonale e a quantificação da PAPs.

ABSTRACT

NON INVASIVE DIAGNOSIS OF PULMONARY HYPERTENSION AND COR PULMONALE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Pulmonary hypertension and cor pulmonale are indicators of poor prognosis in patients with Chronic Obstructive Pulmonary Disease (COPD).

M-mode, bidimensional and Doppler echocardiography is a non invasive technique usefull in the assessment of the morphological and functional characteristics of the right heart and usefull in the evaluation of the systolic pulmonary artery pressure (sPAP).

Yet, some characteristics often present in these patients such as pulmonary emphysema, obesity and deformities of the thoracic wall make difficult the obtention of adequate recordings.

The aim of this study was to analyse the feasibility of this method in patients with COPD and to compare its sensitivity to clinical methods in the assessment of Pulmonary Hipertension and Cor Pulmonale in these patients.

Thirty-five patients with COPD under long therm Oxigeniotherapy were studied by M-mode, bidimensional and Doppler Echocardiography using left paraesternal, apical and subcostal views, in order to assess the thickness of the free right ventricula wall, the dimension of the right ventricle and the Pulmonary systolic pressure.

Adequate recordings were obtained in 80% of the patients.

75% of the patients bad echocardiographic: criteria of right ventricular hypertrophy (thickness of the right ventricular wall - 7,1±1,3mm) and 25% bad echocardiograpbic criteria of right ventricular dilatation.

In 60% of the patients it was possible to estimate the sPAP through the measurement of the peak velocity of the tricuspid regurgitant jet.

The mean value of the sPAP was 60×21,6mmHg. Ecbocardiographic criteria of pulmonary hypertension were recorded in 77% of the patients.

When it was not possible to estimate de sPAP we recorded the pulmonic ejection flow. Using this approach 77% of the cases studied had echocardiographic criteria of Pulmonary Hypertension.

50% of the patients with echocardiographic criteria of right ventricular hypertrophy had clinical evidence of right heart failure while 83% of the patients with echocardiograpbic criteria of right ventricular dilatation had clinical evidence of right heart failure.

The preliminary data sugest that echocardiography is usefull as a non invasive method in the evaluation of patients with COPD allowing the early diagnosis of Cor Pulmonale and the quantification of the sPAP.

Palavras-chave
Ecocardiografia, hipertensão pulmonar, cor pulmonale, doença pulmonar crónica obstrutiva
Key-words
Echocardiography, Pulmonary Hypertension, Cor Pulmonale, Chronic Obstructive Pulmonary Disease
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Trabalho concorrente ao Prémio Thomé Villar 1993 (Secção B), da SPPR.

Copyright © 1995. Sociedade Portuguesa de Pneumologia/SPP
Rev Port Pneumol 1995;1:59-65 - Vol. 1 Num.1 DOI: 10.1016/S0873-2159(15)31189-2
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