Uso do strain do átrio esquerdo na identificação da disfunção diastólica indeterminada em pacientes com doença renal crônica em tratamento conservador

Abstract

Introduction: Half of patients with heart failure (HF) have diastolic dysfunction (DD) and preserved left ventricular ejection fraction (LVEF). Left ventricular hypertrophy (LVH) is the cardiac abnormality in patients with chronic kidney disease (CKD). DD imaging has traditionally been performed with transthoracic echocardiography (TTE), with indexed left atrium volume (VTE) being one of the main components in the DD assessment algorithm. The methodology of speckle tracking through left ventricular global longitudinal strain (SLGVE) and left atrial strain (SAE), allows quantification of myocardial contractility and the instantaneous evaluation of left atrial function, respectively. Objective: To evaluate the use of SAE in the identification of undetermined diastolic dysfunction by VTE in patients with CKD stages 3B to 5 (in conservative treatment) and FEpVE. Methods: A control case study that evaluated patients with CKD stages 3B to 5, in conservative treatment, and who presented normal ejection fraction through transthoracic echocardiography (ETT). Patients were divided into two groups, with and without LVH. Diastolic dysfunction (DD), based on recent ASE recommendations, 2016, was initially evaluated by ETT and, later, by the SAE (reference normal value> 23%) by the speckle tracking method. In addition, the overall longitudinal strain of the left ventricle (SLGLE) was also evaluated. Results: A total of 114 patients (57 in each group) were evaluated, with a mean age of 66.3 ± 8.65, of which 52.7% were female, 94 % hypertensive and 46% diabetic. The mean glomerular filtration rate (in mL / min / 1.73 m2) in patients with and without LVH was 32.6 ± 11.9 and 40.4 ± 13.9, respectively. The presence of DD in the group with LVH (24.6%) was higher than in the group without LVH. Among the 29 patients with LVH and DD undetermined by IVAE, reduced SAE was observed in 10 cases, increasing the percentage of DD to 42%. In the group without undetermined LVH and DD (18 cases), the reduced SEA was observed in four patients, increasing the DD to 21%. Conclusion: In patients with non-dialytic CKD, the use of E / e 'in the lateral mitral annulus did not present significant alteration between the groups (10.75 ± 3.3; 10.14 ± 3.8; p> 0.05 of SAE potentially increases the identification of indeterminate cases of DD.