Avaliação das alterações da função diastólica do ventrículo esquerdo pelo fluxograma em paciente hipertensos na faixa etária de 18 a 40 anos

Abstract

Echocardiographic study of the left ventricle has been widely used in the most varied heart pathologies, as well as in those systemic diseases having repercussion on the cardiovascular system. This study attempted to detect early alterations in diastolic function in patients with systemic hypertension aged 18 to 40 years, of both sexes. The main objectives were evaluation the repercussions homodynamic throw the echodopplercardiography study in the hypertension pacients. This was a descriptive, comparative, and prospective study in which patients were selected according to the presence of arterial hypertension, following the criteria of the IV Brazilian Guideline of arterial hypertension, and compared to healthy individuais. One hundred and thirty patients with systemic hypertension were selected, of which 68 were female and 62 were male; also chosen were 110 normotensive patients: 60 females and 50 males. Patients underwent clinicai and laboratory evaluation, electrocardiography, echodopplercardiography, and chest radiography. During echodopplercardiography, the thicknesses of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) were measured during diastole, as well as that of the left ventricular cavity during systole and diastole; the right ventricle (RV), left atrium (LA), and aorta were also measured. The geometric pattern of the left ventricle was also evaluated using the relationship between mass index and relative thickness of the posterior wall of this cavity (RTPW). Ejection fraction (EF) and left ventricular mass (M.LV) were calculated using the American Society of Echocardiography equation, and the mass index of the left ventricle (MILV) was established through use of the ratio of the left ventricular mass to the total body surface area. Mitral valve flow was analyzed using a pulsed-Doppler system, in which the widths of the E and A waves were measured and the E/A ratio determined. Electrocardiography was of very low specificity for cardiac abnormalities in hypertensive patients; only seven displayed left ventricular hypertrophy, while three normotensive patients exhibited the same alteration. Nearly all of the patients, both hypertensive and normotensive, presented with normal chest radiographs. The ejection fraction seen during echocardiography was also normal for almost all the patients. The hypertensive group and the male sex were mass and mass index significantly greater; however, in the normotensive group the left ventricular mass index was higher among the female patients. The most common left ventricular geometric pattern was that of eccentric hypertrophy for both the hypertensive and normotensive groups, with a higher prevalence in the female sex. Left ventricular relaxation (left ventricular diastolic function), as seen during mitral valve flow analysis, was abnormal in nineteen hypertensive patients and 1 normotensive patient. In conclusion, abnormal mass index of the left ventricle was the most frequent alteration among hypertensive patients, with a higher prevalence in the male sex, and eccentric hypertrophy was the predominant left ventricular geometric pattern in the hypertensive group.