ABC | Volume 110, Nº3, March 2018

Original Article De-Paula et al Impact of asthma on ventricular function Arq Bras Cardiol. 2018; 110(3):231-239 Table 2 – Doppler echocardiogram parameters of right ventricle systolic and diastolic function in control and asthmatic groups Variable (normal value) Systolic function p Control (n = 18) Asthma (n = 20) TAPSE cm ( > 1.6) 1.9 ± 0.19 1.8 ± 0.11 0.184 M FAC % ( > 35) 40 ± 3.21 38 ± 2.89 0.212 M S' cm/s ( > 9.5) 12.29 ± 0.26 11.67 ± 0.34 0.3342 M MPI ( < 0.55) 0.40 ± 0.01 0.43 ± 0.01 0.0383 M Diastolic function Tricuspid E'/A' ratio ( > 0.52) 2.12 ± 0.08 1.70 ± 0.09 0.0017 T Tricuspid E' cm/s ( > 7.8) 15.71 ± 0.34 13.75 ± 0.53 0.0047 T Tricuspid E/A ratio ( > 0.8) 2.34 ± 0.09 1.71 ± 0.06 < 0.0001 T Data expressed as mean ± SEM. TAPSE: tricuspid annular plane systolic excursion; FAC %: fractional area change; S’: systolic myocardial velocity; MPI: myocardial performance index; E’: early diastolic myocardial velocity; A’: late diastolic myocardial velocity; E: peak early diastolic annular tricuspid velocity; A: peak late diastolic annular tricuspid velocity (atrial contraction). Data analysis for comparison between the two groups was made through the t-student or non-parametric statistical test Mann-Whitney test. T t-Student and M Mann-Whitney. In the tricuspid valve, the value of MPI is 0.39 (0.6) and 0.43 (0.6) for control and asthmatic groups. Discussion The present findings demonstrate for the first time that PAT was significantly lower and PSAP was significantly higher in the group with asthma compared to the controls. TDI has been used to evaluate quantitative measurements of regional velocities of the myocardium and both the systolic and diastolic intervals. 8 TDI enables the detection of right ventricular dysfunction in the early stages of respiratory disease. 9 In the current study, significant differences between groups were found regarding E' and A' evaluated in the tricuspid and mitral annuli. In addition, the MPI of the right and left ventricles was significantly higher in the group with asthma. Interestingly, respiratory muscle performance, baseline physical activity level and exercise capacity were similar in both groups. Taken together, these findings suggest that echocardiographic parameters, especially TDI parameters, can be useful as a complementary evaluation for patients with asthma, allowing the early detection of repercussions on the heart. 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 In the present study, although the conventional echocardiogram demonstrated no evidence of changes in the structure of the right ventricle, the group with asthma exhibited a reduction in PAT and an increase in PSAP in relation to control group. Recent study has demonstrated that PAT inversely correlates with right heart catheterization-measured pulmonary hemodynamics and directly correlates with pulmonary arterial compliance in children. 24 Unlike findings described in studies by Shedeed et al., 11 Ozdemir et al. 10 and Zedan et al., 12 no right ventricular hypertrophy was found in the group with asthma in the present investigation. Moreover, in the current study the conventional Doppler echocardiogram revealed statistically significant difference between the controls and the group with asthma regarding peak velocities during the early diastole and atrial contraction (E, A and E/A) evaluated Table 3 – Doppler echocardiogram parameters of left ventricle systolic and diastolic function in control and asthmatic groups Variable (normal value) Systolic function p Control (n = 18) Asthma (n = 20) Ejection fraction % (> 35) 69.0 ± 0.47 69.0 ± 0.80 0.4677 T Lateral mitral S' cm/s (> 6.7) 8.01 ± 0.20 7.30 ± 0.21 0.0170 M MPI (< 0.55) 0.34 ± 0.01 0.37 ± 0.01 0.0059 T Diastolic function Lateral mitral E'/A' ratio (> 0.82) 2.89 ± 0.09 2.52 ± 0.20 0.1161 T Lateral mitral E' cm/s (> 10.0) 14.32 ± 0.25 13.27 ± 0.43 0.0466 T Mitral E/A ratio (> 0.8) 3.42 ± 0.17 2.25 ± 0.14 < 0.0001 T Data expressed as mean ± SEM. S’: systolic myocardial velocity; MPI: myocardial performance index; E’: early diastolic myocardial velocity; A’: late diastolic myocardial velocity; E: peak early diastolic annular mitral velocity; A: peak late diastolic annular mitral velocity (atrial contraction). Data analysis for comparison between the two groups was made through the t-student or non-parametric statistical test Mann-Whitney test. T t-Student and M Mann-Whitney. In the mitral valve, the value S’ is 7.93 (1.07) and 7.12 (1.08) for control and asthmatic groups. 236