Echocardiographic Parameters associated with Pulmonary Congestion in Chagas`s Cardiomyopathy and Non-Chagasic Cardiomyopathy

Background : In spite of significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas`s cardiomyopathy. Objectives : This study sought to identify echocardiographic parameters associated with pulmonary congestion in Chagas`s cardiomyopathy (CC) and in dilated cardiomyopathy of other etiologies (non-Chagas`s cardiomyopathy – NCC), and to compare pulmonary venous hypertension between the two entities. Method s: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed with Doppler echocardiography and chest radiography. Pulmonary venous vessels abnormalities were graded using a previously described pulmonary congestion score, and this score was compared to Doppler echocardiographic parameters. Results : NCC patients were older than CC patients (62.4±13.5 x 47.8±11.2, p=0.00), and there were more males in the CC group (66.2% x 58.5%, p=0.36). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p=0.00), the mean lung congestion score being 3.2±2.3 and 5.9±2.6 (p=0.0), respectively. On linear regression multivariate analysis, the E/e’ ratio (β=0.13; p=0.0), LV diastolic diameter (β=0.06; p=0.06), left atrial diameter (β=0.51; p=0.08) and right ventricular (RV) end-diastolic diameter (β=0.02; p=0.48) were the variables that correlated with pulmonary congestion in both groups. Conclusions: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e’ ratio was the hallmark of pulmonary congestion in both groups. Introducao : Na miocardiopatia chagasica, ocorre uma discrepância entre os achados de disfuncao ventricular e uma menor magnitude de congestao pulmonar em relacao a outras miocardiopatias. Objetivos: Foram associados parâmetros morfofuncionais ecocardiograficos com achados de congestao pulmonar a radiografia do torax em pacientes portadores de miocardiopatia chagasica e nao chagasica, sendo a intensidade dos achados radiologicos comparada nos dois grupos. Metodos : Foram recrutados 130 pacientes portadores de miocardiopatia chagasica e nao chagasica, tendo os dois grupos parâmetros ecocardiograficos semelhantes. Todos realizaram o estudo radiologico do torax, sendo atribuida uma pontuacao aos achados sugestivos de congestao pulmonar, conforme escore ja previamente estabelecido , sendo este comparado com os achados ecocardiograficos de disfuncao ventricular. Resultados :Os pacientes nao chagasicos eram mais idosos (62.4±13.5 x 47.8±11.2, p=0.00) ,havendo um predominio do sexo feminino nos chagasicos (66.2% x 58.5%, p=0.36). A hipertensao venocapilar pulmonar esteve presente em 41 chagasicos (63.1%) e 63 (96.9%) nao-chagasicos (p=0.00), com escore da congestao pulmonar de 3.2±2.3 e 5.9±2.6 (p=0.0) respectivamente. Na analise de regressao linear , a relacao E/e’ ( β =0.13; p=0.0), o diâmetro diastolico do ventriculo esquerdo ( β =0.06; p=0.06), o diâmetro do atrio esquerdo ( β =0.51; p=0.08) e o diâmetro diastolico final do ventriculo direito ( β =0.02; p=0.48) foram as variaveis que mais se associaram com a congestao pulmonar nos dois grupos. Conclusoes: Os pacientes chagasicos apresentaram um menor grau de congestao pulmonar. Os parâmetros de disfuncao sistolica e diastolica associaram com a intensidade da congestao pulmonar , sendo a relacao E/e’ a variavel que mais determinou a congestao pulmonar nos dois grupos.