O valor da Ressonância Nuclea Magnética contra Ecocardiografia na avaliação pré-operatória de pacientes com distrofia muscular de Duchenne
Reino Unido – a cardiomiopatia da distrofia muscular de Duchenne aumenta a mortalidade peri-operatória e a melhro maneira de avaliar o paciente não foi ainda estabelecida. Trinta e cinco pacientes com Duchenne submetidos a cirurgia foram avaliados com o ecocardiograma e ressonância nuclear magnética. Os resultados demonstraram que a ressonância nuclear magnética acrescenta maiores informações sobre a função cardíaca do que o ecocardiograma que pode substimar ou superestimar a função cardíaca, além de freuqentemente apresentar dificuldades técnicas de visualização (janela ruim).
O resumo em inglês pode ser lido abaixo:
(European Journal of Paediatric Neurology,2015) The value of cardiac MRI versus Echocardiography in the pre-operative assessment of patients with Duchenne muscular dystrophy
A. Brunklaus, E. Parish, F. Muntoni, S. Scuplak, S.K. Tucker, M. Fenton, M.L. Hughes, A.Y. Manzur – UK
Duchenne Muscular Dystrophy (DMD) related cardiomyopathy is associated with significant perioperative mortality. Cardiac MRI (CMR) has not previously been systematically evaluated as pre-operative assessment tool for heart function in DMD. Our aim was to establish whether CMR versus echocardiography contributes to pre-operative DMD assessment. Case records were retrospectively reviewed of 35 consecutive DMD boys who underwent evaluation for surgical procedures between 2010-2013. Echocardiography revealed a median left ventricular (LV) shortening fraction (SF) of 29% (range: 7-44). 37% of boys (13/35) had abnormal SF <25%, 66% (23/35) showed hypokinesia and 26% (9/35) had LV dilatation. CMR revealed a median left ventricular ejection fraction (LVEF) of 52% (range: 27-67%). 57% of boys (20/35) had abnormal LVEF <55%, 71% (25/35) had hypokinesia, and 82% late gadolinium enhancement. Extensive versus minimal late gadolinium enhancement was associated with reduced left ventricular ejection fraction (48% vs 58%; p=0.003) suggesting more severe cardiomyopathy. Although echocardiography shortening fraction correlated with CMR ejection fraction (rs=0.67; p<0.001), three-quarter of echocardiography studies had suboptimal scanning windows and in 26% measurements significantly over- or underestimated left-ventricular function compared to CMR.
Our findings clearly demonstrate the added value of CMR versus echocardiography in assessing DMD-cardiomyopathy. Particularly when echocardiographic scanning windows are suboptimal, CMR should be considered to allow accurate pre-operative cardiac assessment.
