Made available in DSpace on 2014-06-11T19:32:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-26Bitstream added on 2014-06-13T21:03:38Z : No. of bitstreams: 1 coleta_kd_dr_botfm.pdf: 391595 bytes, checksum: dde69b55ebd37c6d547a6c2e6321775d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam risco elevado para eventos cardiovasculares. Entretanto, existem poucos estudos sobre a função do ventrículo esquerdo (VE) nesses pacientes e os resultados são controversos. Os objetivos deste estudo foram: analisar a estrutura e função do ventrículo direito (VD) e câmaras cardíacas esquerdas, por meio de Dopplerecocardiografia, em pacientes com DPOC e avaliar a associação entre as variáveis ecocardiográficas e as variáveis clínicas relevantes. Foram avaliados 45 pacientes com DPOC (idade: 65,8 ± 10,6 anos, 64% homens): 17 pacientes com DPOC leve a moderada (grau I e II) provenientes do Serviço de Pneumologia da Faculdade de Medicina de Botucatu (FMB) e 28 pacientes com DPOC muito grave (grau IV) acompanhados no Ambulatório de Oxigenoterapia da FMB. Os critérios de inclusão foram: diagnóstico de DPOC, estabilidade clínica e, para os pacientes com DPOC IV, uso de oxigênio domiciliar por período mínimo de três meses. Para o grupo controle foram selecionados 15 indivíduos saudáveis (idade: 64,3 ± 10,1, 47% homens). Os critérios de exclusão foram: imagem ecocardiográfica inadequada, hipertensão arterial sistêmica, diabetes mellitus, doença coronariana, valvopatias, arritmias, patologias respiratórias associadas ou outras patologias cardíacas. Espirometria pré e pós-broncodilatador e oximetria de pulso foram realizadas por todos os sujeitos da pesquisa e gasometria arterial somente para os pacientes com DPOC... / Chronic obstructive pulmonary disease (COPD) is a strong risk factor for cardiovascular events. However, the status of left ventricle (LV) has been less studied and the results are controversial. The objectives were: to analyse the right ventricle (RV) and the left heart chambers structure and function in COPD patients by echocardiogram, and to analyse the association between echocardiographic variables and the relevant clinical variables. Forty-five COPD patients (age: 65,8 ± 10.6 years; 64% male) were evaluated: 17 mild to moderate COPD patients (grade I and II) and 28 very severe COPD patients (grade IV). The inclusion criteria were: COPD diagnosis, clinical stability and home oxygen therapy for at least three months (very severe COPD). The control group consisted of 15 healthy subjects (age: 64.3 ± 10.1 years; 47% male). Exclusion criteria were: poor quality echocardiographic image, history of systemic hypertension, diabetes mellitus, coronary artery disease, valvular heart disease, arrhythmias, associated lung diseases or other heart diseases. Pre and post-bronchodilator spirometry and pulse oximetry were performed in all subjects and arterial gasometry was performed in COPD patients only... (Complete abstract click electronic access below)

Resumo: Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam risco elevado para eventos cardiovasculares. Entretanto, existem poucos estudos sobre a função do ventrículo esquerdo (VE) nesses pacientes e os resultados são controversos. Os objetivos deste estudo foram: analisar a estrutura e função do ventrículo direito (VD) e câmaras cardíacas esquerdas, por meio de Dopplerecocardiografia, em pacientes com DPOC e avaliar a associação entre as variáveis ecocardiográficas e as variáveis clínicas relevantes. Foram avaliados 45 pacientes com DPOC (idade: 65,8 ± 10,6 anos, 64% homens): 17 pacientes com DPOC leve a moderada (grau I e II) provenientes do Serviço de Pneumologia da Faculdade de Medicina de Botucatu (FMB) e 28 pacientes com DPOC muito grave (grau IV) acompanhados no Ambulatório de Oxigenoterapia da FMB. Os critérios de inclusão foram: diagnóstico de DPOC, estabilidade clínica e, para os pacientes com DPOC IV, uso de oxigênio domiciliar por período mínimo de três meses. Para o grupo controle foram selecionados 15 indivíduos saudáveis (idade: 64,3 ± 10,1, 47% homens). Os critérios de exclusão foram: imagem ecocardiográfica inadequada, hipertensão arterial sistêmica, diabetes mellitus, doença coronariana, valvopatias, arritmias, patologias respiratórias associadas ou outras patologias cardíacas. Espirometria pré e pós-broncodilatador e oximetria de pulso foram realizadas por todos os sujeitos da pesquisa e gasometria arterial somente para os pacientes com DPOC... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Chronic obstructive pulmonary disease (COPD) is a strong risk factor for cardiovascular events. However, the status of left ventricle (LV) has been less studied and the results are controversial. The objectives were: to analyse the right ventricle (RV) and the left heart chambers structure and function in COPD patients by echocardiogram, and to analyse the association between echocardiographic variables and the relevant clinical variables. Forty-five COPD patients (age: 65,8 ± 10.6 years; 64% male) were evaluated: 17 mild to moderate COPD patients (grade I and II) and 28 very severe COPD patients (grade IV). The inclusion criteria were: COPD diagnosis, clinical stability and home oxygen therapy for at least three months (very severe COPD). The control group consisted of 15 healthy subjects (age: 64.3 ± 10.1 years; 47% male). Exclusion criteria were: poor quality echocardiographic image, history of systemic hypertension, diabetes mellitus, coronary artery disease, valvular heart disease, arrhythmias, associated lung diseases or other heart diseases. Pre and post-bronchodilator spirometry and pulse oximetry were performed in all subjects and arterial gasometry was performed in COPD patients only... (Complete abstract click electronic access below) / Orientador: Irma de Godoy / Coorientador: Katashi Okoshi / Banca: Beatriz Matsubara / Banca: Leonardo Zornoff / Banca: Maria Inês Zanetti Feltrim / Banca: Oliver Augusto do Nascimento / Doutor

Left ventricular (LV) volumes and ejection fraction (EF) are important predictors of cardiac morbidity and mortality. LV volumes provide valuable prognostic information which isparticularly useful in the selection of therapy or determination of the optimal time for surgery. Two-dimensional (2D) echocardiography is the most widely used non-invasive method forassessment of cardiac function, 2D echocardiography has however several limitations inmeasuring LV volumes and EF since the formulas for quantifications are based on geometricalassumptions. Three-dimensional (3D) echocardiography has been available for almost twodecades, although the use of this modality has not gained wide spread acceptance. 3D echocardiography can overcome the above mentioned limitation in LV volume and EF evaluation since it is not based on geometrical assumption. 3D echocardiography has been shownin several studies to be more accurate and reproducible with low inter- and intraobservervariability in comparison to 2D echocardiography regarding the measurements of LV volumesand EF. The overall aim of the thesis was to evaluate the feasibility and accuracy of 3D echocardiography based-methods in the clinical context. In Study I the feasibility of 3D echocardiography was investigated for determination of LV volumes and EF using parasternal, apical and subcostal approaches. The study demonstrated that the apical 3D echocardiography view offers superior visualization. Study II tested the possibility of creating flow-volume loops to differentiate patients with valvular abnormalities from normal subjects. There were significant differences in the pattern from flow-volume loops clearly separating the groups. In Study III the visual estimation, “eyeballing” of EF was evaluated with two- and tri-plane echocardiography in comparison to quantitative 3D echocardiography. The study confirmed that an experienced echocardiographer can, with a high level of agreement estimate EF both with two- and tri-plane echocardiography. Study IV exposed the high accuracy of stroke volume and cardiac output determination using a3D biplane technique by planimetrically tracing the left ventricular outflow tract and indicating that an assumption of circular left ventricular outflow tract is not reliable. In Study V, two 3D echocardiography modalities, single-beat and four-beat ECG-gated 3D echocardiography were evaluated in patients having sinus rhythm and atrial fibrillation. Thesingle-beat technique showed significantly lower inter-and intraobserver variability in LV volumes and EF measurements in patients having atrial fibrillation in comparison to four-beat ECG-gated acquisition due to absence of stitching artifact. All studies demonstrated good results suggesting 3D echocardiography to be a feasible andaccurate method in daily clinical settings. / degree of Medical DoctorQC 20100629