Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.010015
Jornal Vascular Brasileiro
Original Article

Avaliação da influência de alterações cardíacas na ultrassonografia vascular periférica de idosos

Assessment of cardiac influence on peripheral vascular Doppler in the elderly

Alcides José Araújo Ribeiro, Andréa Campos de Oliveira Ribeiro, Márcia Marisia Maciel Rodrigues, Sandra de Barros Cobra Negreiros, Ana Cláudia Cavalcante Nogueira, Osório Luís Rangel Almeida, José Carlos Quináglia e Silva, Ana Patrícia de Paula

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Resumo

Contexto: As cardiopatias podem causar alterações no formato das ondas da ultrassonografia vascular (UV) em vasos periféricos. Essas alterações, tipicamente bilaterais e sistêmicas, são pouco conhecidas e estudadas. Objetivo: Avaliar as ondas periféricas da UV de pacientes idosos para identificar alterações decorrentes de cardiopatias. Métodos: Foram estudados 183 pacientes idosos submetidos a UV periférica no ano de 2014. Resultados: Foram avaliados 102 mulheres (55,7%) e 81 homens (44,3%) com idade entre 60 e 91 anos (média de 70,4±7,2 anos). Encontraram-se alterações pela UV em 84 pacientes (45,9%). Foram identificadas 138 alterações de oito dos 13 tipos descritos na literatura: arritmia, onda bisferiens de pico sistólico, baixa velocidade de pico sistólico, pulsatilidade em veias femorais, bradicardia, taquicardia, onda de pulso parvus tardus e onda de pulso alternans. Houve baixa concordância entre a presença e a não presença de alterações na UV e na avaliação cardiológica. Na análise específica das alterações, os exames tiveram uma concordância variável, que foi boa para o achado de taquicardia, moderada para arritmia e baixa para bradicardia. Não houve concordância entre a UV e os exames cardiológicos para as demais alterações. Conclusões: É possível identificar determinadas alterações cardíacas em idosos por meio da análise do formato das ondas periféricas da UV. É importante reconhecer e relatar a presença dessas alterações, pela possibilidade de alertar para um diagnóstico ainda não identificado nesses pacientes. Entretanto, mais estudos são necessários para que seja definida a importância das alterações no formato das ondas Doppler periféricas no reconhecimento de cardiopatias.

Palavras-chave

ultrassonografia Doppler; cardiopatias; diagnóstico; insuficiência da valva aórtica; veia femoral; fluxo pulsátil.

Abstract

Background: Heart diseases can cause changes to vascular ultrasonography (VUS) waveforms in peripheral vessels. These changes are typically bilateral and systemic, they have been little studied, and little is known about them. Objective: To assess peripheral VUS waveforms in elderly patients in order to identify changes caused by heart diseases. Methods: During 2014, a total of 183 elderly patients were examined with peripheral VUS and the results were analyzed. Results: The sample comprised 102 women (55.7%) and 81 men (44.3%) with ages ranging from 60 to 91 years (mean of 70.4±7.2 years). Abnormalities were identified in VUS waveforms in 84 patients (45.9%). A total of 138 abnormalities were identified and classified into eight of the 13 categories described in the literature, as follows: arrhythmia, systolic pulsus bisferiens, low peak systolic velocity, pulsatile flow in femoral veins, bradycardia, tachycardia, pulsus tardus et parvus and pulsus alternans. There was low agreement between presence/absence of VUS abnormalities and cardiological assessments. Analysis of specific abnormalities revealed variable levels of agreement between VUS and cardiological assessments, ranging from good for tachycardia, moderate for arrhythmia, to low for bradycardia. There was no agreement between VUS and cardiological examinations for the remaining categories of abnormalities. Conclusions: Certain cardiac abnormalities can be identified in elderly patients by analysis of peripheral VUS waveforms. It is important to recognize and report the presence of these abnormalities because there is a possibility that they may serve to signal hitherto unidentified diagnoses in these patients. However, further studies are needed to determine the importance of changes to peripheral Doppler waveforms to recognition of heart diseases.

Keywords

Doppler ultrasonography; heart diseases; diagnosis; aortic valve insufficiency; vein femoral; pulsating flow.

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