Capitdrur24

CARDIOMIOPATIILE

D. Zdrenghea,D. Rddulesca

La oraac!ual6cardiomiopatiilc suntclAsilicatcpc criterii

dilatativareprczintdpnncipal6indicalicdctrAnsplant cardiac,
patugcnicc$i fiztuprtologicc.in dilrtativc,hipedrolicclti l bolnaviicu aceastanaladie efectuAndu+c nraiorilatcn
rcstriclivc.Indifcrcntdc rnccanismul br dc produccrc,decazurilordc transplaDt csrdiAcir intrcrgalum€.
modilicArilctiziopaldogiccsuudc ctiologicelesunt.in ge- I)in p0nctde vederefiziopdlologic clcnrcntulprincipal
ncrnl,boli cardiacc scvcrccarc,in abscnia uneisanctiun al csrdiinnioptiei dilatrlive(( MD) il reprezinta
i tera- dislunclia
pcuticeadecvate, ii adcseori ch irr in prezenlaunui sistolictr.
tratament sccundarlrcduccriimrscicontractile r VS (masei
corespunzator. auo cvolulicnefavorabilil, mbcitare).j^nconsecintise!a
conducindrelativ produccdilalarcrvcntriculului
rapid,$i uncorincaftcttrt.la dcccsulbolnnvului.De accea smng(+vcntriculului drcp,ii disfuncti.rsistolicliaacestui
accstccardiomiopaiii lrcbuicdiagnosticate precoce, llxista.de asemenea.
inainte o dislirnctiediasblici imporlantll, sc-
dcapa tir unorcomplicaliimajorcsau noraccidente cunddredisfuncfici sistolice.
fntale.
ccocardiografiasvend rclul nrimordirlir diagnostrc. Dinp!ncldc vcdcrcclinicsccanictcrizcazn printFunsin-
nxpun€rea scvr rcfc in primulrind la cardiomiopariile dromcongestiv importantiifelativ rezistenl la terapjeSiprin
idiopAtice. dartrebuie.rrntat ctrin ultimultimp temenulde asocicren sirdrunului dc dcbitcardiacscazut.cu limitar€a
cardiom iopaties-aextinssi l8 unel€cardiom severaa capacitlliide elbrtabolnavilor
iopatiis€cundare
(de ex. cardiomiprtiadilatativi ischemicr)al cnroraspect Elcmcntclc ccografice diagnostice principaleal€cardio-
coografic, ti Jiccvcntficlinic. citc cvasisup€rpozabilcu miopatieidilalativesLmlreprezenlalc
cel dcdilatarca VS.asociag
.rl cardionriopatiilor idl()paticc. cu scldcresperfonnanfei sistolice(tiactieide ejectie).
Ambelepol Ii dctcmrinrtc.t6t in modulN4cAtfi B. dar
Cardiomiopatia dilatativi dilatare.rVS estemaiusordiagnosticata h nodul M. iar FE
La oraactualh$i in zonanoasrdgeogralicd. cardiomiopa- mai acurardiagnosticatd in modullr I ll.
da dilahrivnreprezintn unadirtfe cauzele ti€c\'entealernsu- Diiaiarea VSesiedefinitoriepcntruCMDdc ladiDcDsiun i
ticienleicardiacc,dupncardiopatia ischenicl(dealllclmulli diasrolice aleVS caredepiiescI l5% din valorilenonlle,
auroriinclxdcardion1iopaiia ischemicn in sladiuldeinsulicr' .eeJce repr./'nr.165 Tm I T,xiLrl\4{frr '4.
entacardiaca severd. in categoda cardioniopalici dilatntivc). lraclia d€ ejecliepoaiefi dereminataalill r^nmodulM.
ln absenlatratanentului ii uneoriin polidaacestia,evo- pnnlbnnLrla FE:IVTDVS V]SVSiVTDVSIx100.deter-
lu(iacs|cnclalorabila.supravieluirca h cinci dni fiind mai minareaDTDVSti DTSVSIiindclcclurtl pcrycndicular pe
lnicade50%.Aceshestenoiivul pentrucarecardionbpadl VS,in sccliune parasternalaaxlung,laun nivelimediatdede-
120 E.a,rrufd .oftllnui Sitdscbr de h haza ininii

dilalotivi.
f,&?.L/. Cardionriofrrle p&aslcrrali
Sccliune axlung .ri&242 ( \4D Secliunc pdrasLdnalid hLnshco_MvM jossittd(i
EcoM DTDvs.rescut nrlenLriculor tcndinli,deegaliarca mltcirii V)l-^ ti V \'l ll Dimcn_
siunilcSlv ti I'l'sunt rcdusciar tapoful DTDVS/SIV,PPcrcscul

sublul (V I DVS: DTDVS';VTSVS

pilieriior - I) I SVS').lic
InInodLrl B.dnirJ Jnr(rl4 J,,rnJrJ.rr irrdeo\(hr 2.Jrncrcprirr
trasarca conlLrrilorVS in diastoh lii sisnti. Este deliniloric
pcnlrucardiomiopalia dilatativao FE'i 40%.
AlAti rnodulB. cnl ti l dcoscbiin nrodulM, suntprc-
/cntcti nltescnrno ctrcderi\Adindilalarea VS !iidis{unclia
sistolicitidil|slolicn snudinsciidcrc{ nmseiiniocilslc.
Aslftl, nr nx)dulM, ov61rd nr vcdcrcci dilatrrcaVS sc
rc{lizcozlipfinindcpirl0reaseptLrluidc valvaInitraln,crctlc
distanF SIV-VMA)ll rnrn.iarvul! itrahaparc j ossrlu.tti
irr vcnrricul.l)atoritirdcbi(uluiscnzutopareo tendirll dc
cgali4rc o nri$clrilor,r{lvcianterb rc ti postedoafc. tclul-
nin,lhin(rur)occ0rA rmrgin,r..iugurl J. tcrlc rli8 21.2).ln
stfldiilc v0nsate. in c rc PTDVSestcmult crescum, poltlc
JpJr( mii(rre. drr'tili,il Inlenorrl ll,ilci foslerioure.
obligandla diagrosticdiltrcnlial cu stcnozamirala (titcil
rcalizatpril1Doppler). Jii&z4J.( MD.Sccliunc 0xlunglco_B.Dcsohidcrc
narusLen)alai
I)imcnsiunile diAsbliccaleSIV 9i PPsurt reduse, atAtin prinscldctcd
0V o rcdusd
sistolica debitt,luisisiolic
valoarc bsolutAcatii, indcosebi, in ceeacc pnve$terapor-
1ulDTI)VS / SIV sauPP(fig.24.2),carecstccrcscutchiar
in cazulir cflc dinensiunilcSIV 9i PP,oa vahri absolute, Crc$lcrEamaseivcntriculare(estcirlodeaunamarnarc
rinin no nalc [2]. decellapcrsoanel€sinlioasc,darserepadtzcazapeosupra_
Amplitudinc!lni$carilor sistl]lice aleSIV$iPPcslcredush i'a!i mainrare).
Gub 8-10 mm). rcducere din carc derivd scaderca FE AspcctLrlvalveiao(icc in nodul M poaLcfi de "trunchi
Ua unnarca scaderiidebituluisistolicse poatcDolati d€ con".Dc asenenea prin cre$tereaI'fDVS. in modulM.
rcducerea deschidcriisistolice.tvilvei aortice(< l5 nln) valvamitralipoaleaveaaspcclde diamant".
(1ig.24.3). lmagincadc tronbi tn VS (dcreguiala nivclulapexulr'n)
CreitereadimcnsiunilorAS (in M sauB) estesecundlr. senoteazifrcclcntin fazeleavansate aleCMD (FE< 30%).
crcitcriiPTDVS $i. dc reguli.diredproporlionali cu scvcri iar trombozanlrialasdngaOpinn evaluatiprin ccotranse-
ratc.raMD. sauin rclaliccuaparitiaIiAsau a lM tunclionalc solagian)aparcindeosebi secundrFiA lll.
 r2l
l)ilatarcaVDpoate fi secundaridilatirii \rS fi hipcrlcnsi_ uneili.clii dc cjectic: l0% (dup,runii 259;)ulilitateaxnui
unirpulnonare secundafe Sl1u poateti preTenrn ..d emblcc...nr
evenruatrnnsplanr cardi.cL.ll
cuutalcctnrii concomitenc I VD (cardjotnll)]raliedc V1)) D. {senlcnea. la bolna\ii ctrrmnsttrrl carcliac etectuat.
ln c az ule tro k rg i e i i s c h c m iacced fd i o m i opliteidi l atari !e
eraminarca cco-Doppler serl{tnse impunepcnhr a ulmnri
cste liccvcnt uliliTati ii rcstareactc stres cu dobulrnrini. evolu!raperlbrmanlci venrriculare slingi(9idrqne)iipcnhr
cuphrn cu ecocardiogralir.reslarc care pcmite c!rluarea o€prstar$uneLe\rcntuate rcaqijderqct manitistatap ntre
miocardrlui viabil ii, in c('rsecintn.d ialsctor de succesale atlclc.iiprri depdnrarea lxnctiei sisldiceiidi$tolicc aVS.
unei cvcnlualc rcvasculrrizauimn)cafdicc. interlcntronarc
sru chirurgicalc. Cardiomiopatia hipertrofici
l)acncardiomiopatia
E x anr in a rc rI)o p p l c . a d n c c c l e m e n rc i l npofl ante rn hiperroticnpoarcfi atAridiopatica,
cntii sccundafiuneiseriide aiecliuni,dintrecarccctemar
dr agnos lic u lC MI), e !i d c n J i i n d i n s u fi c i c n l el evrrvul arc
flDclr(nraleti alterarer fnnctiei diastolicc a VS (+VI)), dc cunoscutcsunthipertensiunea arrcriahii srenozaaodica,
t1prchxare allcrati sau,in t'azctcavarsalc.de tip restrictiv cardionliopatia hipertroficn obsrructivd (CMHO/csrcceanrar
(vczi perfonnantaVS). frecvcntifonnnde cardiomiopalic hiperrroficiidiopatica.
In l)C, DP rsiindcoscbituDCo.seevidcnliazdinsuficicnq Fiziopatologic, elcmcntele principalcite CMITOsxnlrc
I nr lr J l,rlu ( ||,rrJ l a ..,l rj re r1 ra .l .,re prezcntate
c .rr p ro porfu,nr dchipertrolia
l rLr,,. septalaasjmerrici a VS.dc realizarc!
vcrilaleaCMl). JetuI rcgurfitrn I cstedc rcguti ccntrrt, sccu obslruclieidinrmiccnr caleadc iefirc I VS in sisrotaii dc
dar dilat iniin e h l u i m i tra l 0 tg .2 4 .q ). reflliAreainsuficienrcimitralcfirnctronate
i n c r^ rri l c !vansarc. cu pdn traclionarca
I ITP,sa! in cazurilcdc intercsarcconconritenliix Vl). sc inrc srsr(nicia vMA (clcctvenluri)f5l.
RcTulti,incorsccinlio disfitncticdiartoliciscver.a vcn_
gis ir c az ri jl l l a l c n rc i g | a dp o a te fid c rc n n i | alopti mi n D (i r
ticare pcnnite.in acchqirimp (tu DC).cvahrflrcaH rp(p^p$). iricululuisdng,carcrrccaqiconsecinlc .rparilia
snzerpurlno_
llarc,inilialn lnaiincursulelbrlurilor, darintr-ofyaultcriorri
dccvoh\ic,pcrnmncn$. nlaiftircuapariiiA ttTp !ii insu{icion,
lei c{fdiaccdrcpte.AccAsto csrcintAhilii 0lcsir)cazurite
in crrc hipcrtrcfiari dirirnclir diastolicl'ndi
inlcrcscazitiVI).
Dc asclncnea. cr Sico sccinll obsl rclicjlLrbortice
drn{nricc\ii ins licicnleimitrulc.dcbilulc0 iacv. ll scarTLrt.
scidcreoAccsiuiaIiind bruruhti bruscilpc pAfcL[sulcfoc
turilor. pulard rclUltri0 ischcrnic ccrcbmtlcurli(sincopi).
cvcnnralu n.!aidc (l.ccs16l.
l)e ascnreIca. hipe(11)fio \c lricut rti inrpor ntaltr_
vorizeazl Aparili.rlulburlrilordc ritrninctusiv 0 tibritalicj
lcnnicularc $i slopulnicrdiac.
Hipcrtronrscptrll po tc li elidcnliarl lit ir cco_Mcir
tiin ecoJl.noriindu-se crcilcferdilncnsiunikn diI]slr)ticea1c
SIV ii PP.dirncnsiunilc SIV6indscnrnilicatrv cr.cscure roril
.l(rel. rl..Pn (u u r.rn,,n \lV PP t < {rif '1 <, 1
Aliil in ecol\4cir ii in cco-Bdirnensjune djrsroticeirlc
Li!!.21.1.r'uD Sccliunc$rbco\Lltit.D(! tM li,rclion.li p.if VS sunlnollnalcsaurcd!r\cii cslcpreucnt,hipcrconrracrr
dll. r ir c !inc lu l uni ri tml (v e 7c io k rp t!n 4 ). lrtatea.carediminuescDrnificari! dimensiunile lclcsisrolicc
rle VS (M ri B). uneo prn, la ,.cvasidisparitia lohuDurtri
tclesislolic d VS.
I)e nrcnlioonrcirccogralidI)oppicy(tX) pcnnire,asociati Scnderex dcbinriu i sistolic arccaiiconsecinLn. jn ecoV.
cudelcmrinareadnnensiunilorcaii dc iciire a VS, oercnnrna_ reduccrea dcschiderii sistoliccr sigrlxridctof aortice.srtr]ilar
rca debilLrluicardirc, ii indcxuiLricafdiac,alc carrorscrderi cu slcnozaaonrce(sub 15 lnnt. obsrruclialinrd maxnn,
sunt dircct propo4ionalectr scvellalc.r CMD (index c.trdiac in lnczosisbh 9i rerultendnr .rpaririaLrneiincrzufrnrcro-
< 2,5 lnnrin n).
sistolice.pc sigmoidacoronarianidrcdptiti tc srgrnorda
Exanrinal€rcco-l)opplcrcsreindispensabiliin xnnnrirea noncoronadrni (fig.24.6).
evolulici bolnavi krr cu cardionliopalicdilararivir.Laccsr sens Tractionrrca anlcrioaria VMA poalcfi evidcnliatiatAtin
examniareaecoc rdiogralici esteacceacarc indice in cazul eco-B,cAt$i.indeoscbi. in ecoM. iffegjstr.^ndu secunoscutul
322 Lcograla @tduLuiti wselot de ]u hazaininit

fis.21.7. CMHO. Scclirne pamsleflnlii ax lung. Eco NL M'tclte

fi&24t ( MHO. Secliuncpdasrem.ldd l!ng. Ilco-M. Rapon . VMA(SAM).
S l V,l P ' 1, 5.

u lutg. f.co-M.SAMscvu
(:]r''lllt Scqiuncprrn($nrlndx lung.!co-M lrcizu.r ri&2dA CMHO.Sccliurel)urutleLlxrll
fit!,24,6.
- scpl ll a VM.^.
rlpozilic
pevrlvo6onicll'ousp!!orondi0nn
tr1czosistolici drcaPtI(slgeau).

aspcclde (1ig.24.7).Dis-
SAM (,.sirtolicintefiormo\rclncnt")
|anlasistolicnVMA-SIV reprezinin ii ur indjccdc evaluare
a scvcridliiobslruclici.cafcesremaximi in cazulapozitiei
scpralca VMA (fi9.24.8).
Clrci|ereadimensiunikrrAS (h M $i U)poalcll sccundarl
adl crctleriiPTI)VS(dislunclirdiastolicaia VS). cerii lM
[xaminareaeco-l)opplcroiern date escnlirlc pcnlru
cMHO [81.
diagnosricul
In Dopplercolorseevidcnliazao imaginede rip mozaic
(curycrcLurbulenti)in calcadc ictire a VS. sub valvclc
i f l )P Jri rnrrr In.Jl Jr Jr i r' r drc)r i c> rr(:rV \ (' r,rFrr ', r r t
cu I)P(sauDC) h rcrti. sc stabilcftcnivelulobst colulLriinlre
calc.rdcinlrare $i caleadcicrirc 0 VS ii abscnlagrddicnrulxi
intre calcadc ic$irea VS ir Ao rsccndentn.
Od.rlatslabilit tivelul obstacolului.ir IX sau DP, drn
pozilie apicah sau poTilie suprastcnali se poatc cvidcnlia
imaginc.rcurgcrii in caleade iciirc I VS (velocitatcnr..iaLa-
gaf')iisepo.rtc slabili gradienlullransslenotic. atit nr rcp&s
cat ii in cazul unor nanopere dinamicc (tig.2'1.9)
i nt)11& -i | JJU .cbrI D ( n..r,l adrrosri cr< ,/rl )i* r\ a
hreaz6prezenla $i sc!eritateainsuficicnlci iirale secundarc
uacl i oni fi i V MA (Ii g.24.10).

fi&2./.9.cM H( ) seclilfc lticlla 5 cdncrc.DelirliL.rex
g dlcnlului
sist)llchcdlcadcicsiEaVS.InmgnBin irhsrn"afin\uhridc!-cclie
tis.24,t0. LMll0. Sccliuncparaslernal ax lung. D(,'. IM
sccundeiituF nii sislollceanbnoar€avMA(vczi
colorplusa4).
323
In I)(. ri indeosebiin DP sc po{tc evidenlia ii evalxa
dislirnclid diastolicaa VS. dc rcguln. dc 1 p relaxarealterat:
(\.czi rcrformanta vS) L9l.
[co 1)oppleresteinrportrnln ii in elahrarearezxltatc]or
1r3t!mcntuluicll doguri- irlcncDlional sauchinrrgicrl inclu-
si! a unor inten'enliisofisticalccum arfi pacrrg-ul\cnlriculrr
drcpt sau al alcooltani coronrriane.in ioate acene siluarii
nnmaiecogmtiaDopplcr(fi dcsi!ur explorareahclnodimmi
cl invazivi. careestcinsl grcuaccesibili$i aproapeilnposibil
dc cfectuatseda(pc pcrioadc lungi de tinp) esteacccacdrc
JJrl i l l ci dl ni nudrcr, h.rnr r(. .uhJoni ced . |L. r r I ( () r . , nr .
liorareatuncticidiastdicc r ventricululxi sle g.
Cardiomiopatiarestdctivd
Dcri prcvalenlacardioniopaticircstrictiveestefari. ea
esteinrpon:rntideoarcce evohrcazlcu fcnomene de insnfi-
cicnr:rL:rJ ,hj corgesli\;rclr\tJ l.,LrIr:,r:.,eIIii..,narer.
l;ri Jri,l, gi. l)e.,,enrc(d. .:rJ lrcL,.rri J,,rJir/iJ c.rpe-
nca itr constrictiva. exarncnul ccocardiograllc contribxind
subsl{ntialla diferenlierca accs(ordounentirdfr.luc cvo-
lucazi.r,nbele cn disfunclicdirsl(ticna venlficLrluhri sreng
ti drcptiicu semne deinsulicicnlh crrdiacidfeflpli1101.
Asplctulecografic dccardi(nniopntic rcstfictivipoalcdcnv.r
tutildincrc$crcarigjditiliiplyctilor!cntdcul i(fibfozi).ciLii
dininfiltrarcaacesrora (lbstac&rdionrioprtie infiltfati!i) ll 11.
PrincipahI eleflicoldcliniloriuccoc.r|d iogrnficdcrivndin
dislirncliadiasroliciprimari rcrlizrta$i seevaftrcazi optim
nrirrccocardiogralic DopplcrinnxxlLrlI)( sau.lndcoscbi. DP
I)isfnncliadiisl(ticiicncnrt|i rrrdcriprclaxarc 0llcrfi iiinMi
Uccvcnl dc lip rcslricliv.rc\crl (\,czipcriirrlnrnlVS)
ai&?4.U. Cardiohiopatiercstriclivi
Sccliunepamtmal d lung.
ticdM. mDVS nonul o Edu6ea mphudinii @ntrd4iilorSIV $itP
.l_l,l Ecagtutd tl,dulttisi wlelofule ld bo.d ininit

Bibliografie

L.EloG. lshii Nl. Tei c er al. Assersn.nl of (il.bal Lcft \rcnri.uhr

!uncljoninNonnil Chlldtsrrnd n([iLdrcr$rdrDrhlcd(arfiom]
opalhy..,ourn!lof lhc AmcricanSocictyof Ichocard$graphy(ECHO]
1999:12(1211058-106.1.
2.ItoT. Su{a M, Otrke Y er !l Lell venrricuhrDopplcr lillnrg tal
tcnr nr drlatedcudioml.opnlh]: Relationro hc'nodynamicsard lch
rlinl hurcLionlounrl of lhe AmericanSocictvof Echocrd$gruth)
( E C H O )1 9 9 7 i 1 0 ( 5 ) : 5 l5i l2 5 .
I Nlft vi \'. Korcar C Quantlarivc Evlluatnnrol Leli venlricuhr
funct on h a TransgcficMousc Modcl ol Drhled CddionyopNlh!
{ ith 2-Dimcn$onalContust Echoclrdio.!tuphylouf,ril o I rheA mcri
can Socicit ofEchoclrdiogrthy (ECIIO) 1999:ll(3) 2l1921,1
:l.MlnolioTA. BnughndlKL. RorleheferR, l'eaFoi'|n. Bf isto{ ID.
:{ichels V\'. et il. Prevalencc and .tio o8y of idioFthic drhrcd cnF
didnyopilhy(sunnraryofaNatlora Hl. a r 1 , L u f g . a . d B l & l r ( i l u l c
F,:s.2412. (a nhiordlio rcsfictivinfi rmibidozi.secliune workshofl Am.l Cardiol 1992i69:1.158-66.
narasLemali.x hn8.EcoB.SIVirPl dedimcnsnnimultcrcscnlc5.H ldick-SnnrhDIR. Shaprc LM EchocrRliogrt'phie dilTeerLiallon
of narlxtogicaland thysologicrl lcli rerlriculd btpenrophy.Hcarl
Ill 45%(hiFocontrnclrlitatc). 2 0 0 1 i 8 56 1 5 6 i 9 .
6.Dcrune r Ci. DoilleLR, Troniou A. Jamal 1,,l,itzlcr ?Y. Ponncl
C. DindrentiaLioncnLrcl hyfcrhf[i. physo]ogiqucdu sNnil sl
in cco-M\riB dimcosiunilc dlostolice aleVS suntnomole l'hypcrtrofhic dcscardionryopndrics lrypcdrlphiquesFimili!es. lnler
sar rcdusc,iar conlraclllitatco VS, respectivanplitudinea d n I ) o n n l d c o u l c u r t l s s u l d i o . A r c h M n l ( o e o r V d1s9s9 9 i 9 : ; 2 0 1 - l l 0
niiiciirli sistolicca SIV ii PPii FE.suntnonnalesaur€duse 7 . T r b d r I o k i o , Y m d d H . A b e \ '1 . o t o s e Y . I h o n r $ I l ) . s n b c t r d o -
ll2l (llg24.1l). od{iil nlolion h lypearophieca iornlopalhya*scsnrcft flonr knr8
Dnncnsiunilc pcrctilorVS. rcspcctivalc SIV 9i nl sunt rtrd shorl dxis viclvsbt Fuhcd l)onnlcr i ag ig. J An Soc [chocnr
dbgr2lr00illlllrS-115.
nonnrlc nr cazulcaftixnniopatici rcslriclivcprin librozl \ii
11.\aiLo.1,MdNynr! l. luDo!chiJ.Mr hT.KotrdoI l,YrmdnoroK,AuI
suntcrcscu(cin cu4rl cardi niopaticircslricliveprin ir)lil- ys s oftfdiNnur{l $cnd oj n'yoo${i!liircgi(cd ulrnsoud b{cls!' -
rr ro{ pcrclik)r vcntrieul,rri (dccx.aftiloidozl). (fi9.24.12). tor ibr dillcron(iiljono I fiypc!(rql1i! .drdidnyop{Li} trndvcnlrcuh'
ir c rul c Ldio|nloplici dc lip ioliltraljveslecamcterislictr h y p 0 n r o p hdt r e | o b l p c n c n s i ( r r . . l A n( b l l ( d d o l l 9 g 4 i 2 45 l l '5 l i l .
crc\ttcrcr drmcnsiunik)r SIV$iPP(pc$lc ll unn).directpro- ,. Mricrsl-,fischcrs|,McKirlNr( i( .l lc$OM.KruycnbuoN I l-P,B(!sjger
porlionrlcu scvcrittc{ nliltririi. sociatcu o ampliludinc ll l-vr Lori{nro lcrl rcrlfcrllir *grEnfltl wrll nrliM ir1htponrlphl!
c0,didnloFrhy w $ nyeldldl tlg8itrg.( iroullli(r 1992i8( I 9 | 9.28.
nonnall sru rcdusia ifoirii sistolicca occstora. cn ii cu
l 0 l l c r c N z r c i n C S . R o i s i r b l i r J . T o r i r o A , S u r i r o z L D . M , o c r , o p tr r r i s
abscnlllVS pc ccgl3.l4l. rcsniolivds.BuonosAirls: Edinrcdrlr8? 9.
In cazurilcscvcrcfotll prczcntc scmnclcsccundurc I ITP, I l . S o h i u cNr A ,S h . r n M . C n w l o r d M , D e M r r i r A . l ) c v s r t uRx . l c g c i '
respectivinsuficicnlrpulmonrri. crc$lcrcadimcnsiunilor br!u l,chl.Rcuonnrendrrn',sotutff rLndidDfthchrivdnf iolcbynlo
\ I). {l) (J cr r.striLtru nu int(r.scr/a)i VD |'i aforiliitir- dinensioiil cchocnfdiognnhy. I Anr Socliohoc!rdiogil9ll9i2 158-i't
suficienl€itricuspidicnc f l 51. l2.l,srnod.r.(icrbaur A, vgvin I lcfdjnrtr \4. LclglqrC, DronninJ
in practica clinicl curcntlprincipalalbrmi dccardiunjo- A n p o n d c l c c h o o a r d i o g r r f h i c d u n ( l e d i u l l o s t r c d c l l b r o s e s e nd o n r y'
palierestrictivlintalnitaestcrcprczcntalldc cordulscnil. ocardiquc.Aroh Mal CoourVdi\\ 1980i1:l:13q46
ll.coldsl,ein JA. DillrenrirLion of consridlvc ps cidiris lDd rc
fiind necesara cunoasterea f.rlituluici la varstniciscmnclc srrclivc cnrdiomyopdltryJ Ao Coll Cardiol,A(rC |rlucationallligh
d€ insulicienlicardiacicongestivipot 1i prczcntcpe lingi
un cordde dimensiunicvasi-normale. in accsrccazuricstc l4.Garcli Ml. lhonas,rl). KLclnAl. Ncw DoIp lcr cchocrrdrogrrlh-
vorbape de o parl€deresriclieprinfibrozi miocardicr,daf ic ipplicationsfor rlrc srudy.fdiast.lic lirnd n J ADr Coll cltrdiol
tidereducerea numdrului demiocite.prinapoptozr.secundar 1 9 9 8 ; . 1 2 : 8765
proccsului de nnbitanire ll6l. I 5 BcrcDsrcnrCS.PincmD.MuroleguM,UvfLrlnesoflichocardiogra
ph,wdDopplerEclrocudroguphynrEndotulocardia f ibmsh..rounia of
Dc asenenea,elemeniede cardiomiopatie restrictiva :192
theAmencmSocieryof|chocNiorrtphy(l'CHO)2000:l:l(5)::185
suntinmlnilc$i in cazxlcordulxiobez,acesteelemede fiind l6 Lrtr Kl( tsinderl, ( oopcrl:l f.chocardoemfhic ttltures ofrlrirl
rclcrsibilc,in panlel cx retrocedareaobezita!i. mlocddiris rir[ ciant ccL\: A cascrc|ron Joumalol rhc ADrencm
Societyof ric[.cardiografhy(t(]lO) 200'1117(10) l07l-10?6.