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Master's Dissertation
DOI
https://doi.org/10.11606/D.98.2022.tde-11072023-133159
Document
Author
Full name
Rodolfo Alves Lopes
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Barretto, Rodrigo Bellio de Mattos (President)
Daminello, Edgar
Sbano, João Cesar Nunes
Togna, Dorival Julio Della
Title in Portuguese
Determinação da taxa de fluxo transvalvar e seu impacto prognóstico sobre a área valvar na estenose aórtica
Keywords in Portuguese
Ecocardiografia
Estenose da Valva Aórtica
Prognóstico
Valvopatia Aórtica
Abstract in Portuguese
A estenose aórtica (EA) é uma doença de importância clínica, principalmente no contexto da saúde pública. Sua história natural caracteriza-se por longo período oligoassintomático. Até a manifestação de sintomas em estágio grave à crítico de acometimento. A caracterização é baseada na história clínica e uso do ecocardiograma, considerando área valvar aórtica, gradiente e velocidade máximo de fluxo transaórtico. Apesar de sua ampla aplicabilidade tem se observado, em subgrupos específicos de estenose aórtica grave, como estágios D2 e D3, a necessidade de exames e métricas adicionais, como tomografia e ecocardiograma com dobutamina, para discernir a verdadeira gravidade da lesão aórtica e sua contribuição na disfunção contrátil. Devido à limitação técnica e acessibilidade aos exames adicionais, procura-se novos determinadores de gravidade da estenose aórtica. Esta procura elucidou o método de taxa de fluxo, que seria uma relação entre volume sistólico ejetado por um orifício e o tempo de ejeção (Q). Estudos internacionais demonstraram que tal método, pode ser alcançada por avaliação ecocardiográfica convencional, apresentando impacto diagnóstico e prognóstico, em pacientes com estenose aórtica grave. Neste trabalho os autores procuraram avaliar o uso do método de taxa de fluxo, frente a uma população estritamente brasileira, considerando todo espectro de estenose aórtica. Trabalho de caráter observacional, retrospectivo, unicêntrico, com análise de consultas ambulatoriais e exames ecocardiográficos, realizado no Instituto Dante Pazzanese de Cardiologia entre o período de 2014-2020, envolvendo 196 pacientes. Análise demonstrou que o método de taxa de fluxo não apresentou poder sobre impacto prognóstico, irrespectivo da gravidade. No entanto, correlacionou-se a redução proporcional da área valvar aórtica com a diminuição da taxa de fluxo nos pacientes com estenose aórtica.
Title in English
Determination of the transvalvular flow rate and its prognostic impact on the valve area in aortic stenosis
Keywords in English
Aortic valve disease
Aortic Valve Stenosis
Echocardiography
Prognosis
Abstract in English
Aortic stenosis (AS) is a disease of clinical importance, especially in the context of public health. Natural history is characterized by a long oligosymptomatic period, until the manifestation of symptoms in a severe to critical stage of involvement. Characterization is based on the clinical history and the use of echocardiography, considering aortic valve area, gradient and maximum transaortic flow velocity. Despite its wide applicability, it has been observed, in specific subgroups of severe aortic stenosis, such as stages D2 and D3, the need for additional tests and metrics, such as tomography and echocardiography with dobutamine, to discern the true severity of the aortic lesion and its contribution to the contractile dysfunction. Due to technical limitations and accessibility to additional tests, new determinants of aortic stenosis severity are sought. This search elucidated the flow rate method, which would be a relationship between stroke volume ejected from an orifice and ejection time (Q). International studies have shown that this method can be achieved by conventional echocardiographic assessment, with diagnostic and prognostic impact in patients with severe aortic stenosis. In this study, the authors sought to evaluate the use of the flow rate method, in a strictly Brazilian population, considering the entire spectrum of aortic stenosis. This is an observational, retrospective, unicentric study, which analyzed outpatient consultations and echocardiographic exams carried out at Dante Pazzanese Institute of Cardiology between 2014-2020, involving 196 patients. The analysis demonstrated that the flow rate method showed no prognostic impact, irrespective of severity. However, a reduction in the aortic valve area was proportionally correlated with a decrease in flow rate in patients with aortic stenosis.
 
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Publishing Date
2023-10-06
 
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