RESUMO
Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11 cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14 cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.
Assuntos
Doença da Artéria Coronariana , Disfunção Ventricular Esquerda , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/complicações , Deformação Longitudinal Global , Ecocardiografia , Diástole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular EsquerdaRESUMO
Dor torácica é uma queixa comum na emergência, representando 9-10% das emergências não relacionadas a trauma. Destes, a Síndrome Coronariana Aguda (SCA) conta com 13-23,6% dos casos de dor torácica. No entanto, 1,7-2,2% dos pacientes que tinham suspeita de SCA foram subsequentemente diagnosticados com Cardiomiopatia de Takotsubo. Relatamos o caso de uma paciente do sexo feminino, 78 anos, branca, sem patologias prévias, com queixa de dor torácica em sufocamento de forte intensidade associada à dispneia logo após discussão com vizinhos. A paciente foi submetida à investigação e se chegou ao diagnóstico de Cardiomiopatia de Takotsubo. A paciente foi tratada com sintomáticos e liberada em condições de alta após uma semana, não apresentando episódios de dor torácica durante a internação. A Cardiomiopatia de T akotsubo não é rara, mas sim, subdiagnosticada. Considerar a Cardiomiopatia de Takotsubo no diagnóstico diferencial especialmente em mulheres na pós-menopausa com síndrome coronariana aguda irá prevenir os perigos potenciais do tratamento com agentes trombolíticos (AU)
Chest pain is a common complaint in emergency care, representing 9-10% of non-trauma emergencies. Of these, Acute Coronary Syndrome (ACS) accounts for 13 to 23.6% of cases of chest pain. However, 1.7-2.2% of patients with suspected ACS were subsequently diagnosed with Takotsubo cardiomyopathy. Here we report the case of a white female patient, 78, without prior conditions, complaining of chest pain in suffocation of strong intensity associated with dyspnea after an argument with neighbors. After an investigation Takotsubo cardiomyopathy was diagnosed. The patient was treated symptomatically and discharged after a week, with no significant episodes of chest pain during hospitalization. Although Takotsubo cardiomyopathy is not rare, it is underdiagnosed. Considering Takotsubo cardiomyopathy in the differential diagnosis, especially in postmenopausal women with acute coronary syndrome, will prevent the potential dangers of treatment with thrombolytic agents (AU)