Características clínicas e ultrassonográficas de pacientes com insuficiência cardíaca com fração de ejeção: preservada x deprimida

Abstract

Fundament: Current guidelines recommend that heart failure (HF) should be distinguished as heart failure with preserved ejection fraction (HFPEF) and heart failure with reduced ejection fraction (HFREF), through echocardiography. However, this differentiation is often a rather complicated task in clinical practice. Lung ultrasound (LUS) has proven to be a useful tool on demonstrating pulmonary interstitial edema (PIE) in HF patients. Objective: The aim was to compare demographic aspects, clinical features and ultrasonographic characteristics of patients who had healthcare appointments and have been diagnosed with HFPEF and HFREF in a major cardiology hospital in the state of Sergipe. Methods: This is an observational, cross-sectional and analytic study of 60 hospitalized patients, from February 2015 to October 2015, with HF diagnosis using Framingham criteria. Data were collected through a questionnaire answered by the patients, electronic medical records and from transthoracic Doppler echocardiogram and lung ultrasound (LUS) performed by a skilled cardiologist. Results: From the 60 hospitalised patients, 31 patients presented HFPEF and the other 29 presented HFREF. Both groups did not show difference regarding age, sex, blood pressure and heart rate. The average ejection fraction was 64,69% and 39,66% in the groups of patients with HFPEF and HFREF respectively. Comparing to patients with HFPEF, the group of patients with HFREF presented: higher percentage of patients with PIE (95,00% vs 64,00%; p = 0,008); greater number of B lines (56,76% vs 28,00%; p = 0,003); bigger left atrial volume index (LAVI) (45,11 ml/m2 vs 31,36 ml/m2; p = 0,05) and bigger values of E/E' ratio (13,86 vs 10,67; p = 0,002). Conclusion: Patients with HFREF exhibited higher frequency of PIE, maybe reflecting bigger left ventricular filling pressures (greater LAVI and E/E' ratio).