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    Avaliação Estrutural e Funcional do Átrio Esquerdo na Cardiomiopatia Chagásica comparada à Cardiomiopatia Dilatada Idiopática. Um estudo com Ecocardiografia Tridimensional Em Tempo Real
    (Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Mancuso, Frederico Jose Neves [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Although there is anatomopathological evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. The aim of this study was to evaluate LA volumes and function in CCM patients with real-time three-dimensional echocardiography (RT3DE) and to compare it with idiopathic dilated cardiomyopathy (DCM) patients, correlating the findings with clinical and echocardiographic variables. Methods: Thirty patients with CCM, 30 with DCM, and 20 normal subjects used as the control group (CG) were studied. With RT3DE, we measured LA maximum (maxLAV), minimum and pre-atrial contraction volumes and calculated total (TLAEF) and active (ALAEF) LA emptying fraction. Clinical variables and other echocardiographic variables were evaluated in the patients. The data were compared with statistical tests (ANOVA); significant if p . 0,05. The Pearson correlation coefficient was used between clinical and echocardiographic continuous variables. With multiple regression model we identified the determinants of increasing maxLAV e of the ALAEF worsening, in CCM patients. Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m2 was larger in CCM than in DCM (76.9 }21.9 ml vs. 59.1 }26.0 ml; p<0.01), and both were significantly larger than in the CG (p<0.01). TLAEF was lower in CCM patients than in DCM (30 } 10% vs. 40 } 12%; p<0.01), and both were lower than in the CG (p=0.01). ALAEF was also lower in CCM than in DCM (22 } 0.09% vs. 28 } 11%; p<0.01), and both were lower than in the CG (p=0.01). The E/e f ratio was higher in CCM than in DCM (21 }10 vs. 15 }6; p<0.01), and both were greater than in the CG (p<0.01). In a multiple regression model, the E/e L ratio and the mitral regurgitation were predictors of a increasing in MaxLAV, meanwhile the E/e L ratio was the only independent predictor of a worsening ALAEF. Conclusion: The MaxLAV were greater in CCM than in DCM and the LA function is more compromised in CCM than in DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy.