ABC | Volume 110, Nº3, March 2018

Original Article Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma Camilla Rayane De-Paula, 1 Giselle Santos Magalhães, 1,2 Nulma Souto Jentzsch, 1 Camila Figueredo Botelho, 1 Cleonice de Carvalho Coelho Mota, 2 Tatiane Moisés Murça, 3 Lidiana Fatima Correa Ramalho, 4 Timothy C. Tan, 6,7,8 Carolina Andrade Braganca Capuruço, 2,5 Maria da Gloria Rodrigues-Machado 1 Faculdade Ciências Médicas - Minas Gerais (FCM-MG), Belo Horizonte, MG - Brazil; 1 Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil; 2 Universidade Salgado de Oliveira, Belo Horizonte, MG - Brazil; 3 Prefeitura de Belo Horizonte - Unidade de Referência Secundária Saudade, Belo Horizonte, MG - Brazil; 4 Clínica Conrad, Belo Horizonte, MG - Brazil; 5 Westmead Hospital - Faculty of Medicine - University of Sydney, Sidney - Austrália; 6 Blacktown Hospital - Faculty of Medicine - University of Western Sydney, Sidney - Austrália; 7 School of Medical Sciences - Faculty of Medicine - University of New South Wales, Sidney - Austrália 8 Mailing Address: Maria da Gloria Rodrigues Machado • Alameda Ezequiel Dias, 275. Postal Code 30130-110, Centro, Belo Horizonte. MG – Brazil E-mail: maria.machado@cienciasmedicasmg.edu.br Manuscript received December 30, 2016, revised mansucript July 04, 2017, accepted November 16, 2017 DOI: 10.5935/abc.20180052 Abstract Background: Despite significant advances in understanding the pathophysiology and management of asthma, some of systemic effects of asthma are still not well defined. Objectives: To compare heart function, baseline physical activity level, and functional exercise capacity in young patients with mild-to-moderate asthma and healthy controls. Methods: Eighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ± 0.38 years) patients were enrolled in the study. Echocardiography parameters were evaluated using conventional and tissue Doppler imaging (TDI). Results: Although pulmonary acceleration time (PAT) and pulmonary artery systolic pressure (PASP) were within normal limits, these parameters differed significantly between the control and asthmatic groups. PAT was lower (p < 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3 ± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group (135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group had significantly lower early diastolic myocardial velocity (E’, p = 0.0047) and lower E’ to late (E’/A’, p = 0.0017) (13.75 ± 0.53 cm/s and 1.70 ± 0.09, respectively) compared with control group (15.71 ± 0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the lateral mitral valve tissue Doppler, the asthmatic group had lower E’ compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32 ± 0.25 cm/s, respectively), but there was no statistic difference in the E’/A’ ratio (p = 0.1161). Right isovolumetric relaxation time was higher (p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group (52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The right and left myocardial performance indexes were significantly higher in the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively) compared with control group (0.40 ± 0.01 and 0.34 ± 0.01, respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity level, and distance travelled on the six-minute walk test were similar in both groups. Conclusion: Changes in echocardiographic parameters, evaluated by conventional and TDI, were observed in mild‑to-moderate asthma patients even with normal functional exercise capacity and baseline physical activity level. Our results suggest that the echocardiogram may be useful for the early detection and evoluation of asthma‑induced cardiac changes. (Arq Bras Cardiol. 2018; 110(3):231-239) Keywords: Exertional Dyspnea / physiopathology; Echocardiography, Doppler; Asthma / physiopathology; Vascular Remodeling, Ventricular Dysfunction. Introduction Asthma is characterized by chronic inflammation and remodeling of the airways. 1 This remodeling leads to structural changes in the walls of the airways induced by repeated injury and repair, which can cause an irreversible loss of lung function. 2 Moreover, asthma can lead to an increase in bronchial angiogenesis 3 and remodeling of the pulmonary vessels, culminating in changes in both bronchial and pulmonary circulation. 4 The interaction between respiratory diseases and cardiovascular function is complex. Changes in the structure and function of the right ventricle are associated with pulmonary hypertension. 5 Recurring hypoxemia and hypercapnia associated with different mediators and cytokines related to chronic inflammation of the airways in patients with asthma cause pulmonary vasoconstriction and the development of pulmonary hypertension, with the consequent hypertrophy/ dilatation of the right ventricle. 6 Diastolic dysfunction of the right ventricle is the earliest hemodynamic change found in patients with asthma due to the increase in the afterload imposed on the ventricle. 7 Pulmonary disease affects the size, shape and function of the right ventricle, but altered respiratory function can also affect the left ventricle. 5 231