DOI: 10.1111/j.1540-8175.2010.01330.x C  2011, Wiley Periodicals, Inc. Early Right Cardiac Dysfunction in Patients with Schistosomiasis Mansoni Vinicius T. Carvalho, M.D., ∗ Marcia M. Barbosa, M.D., Ph.D.,† Maria Carmo P. Nunes, M.D., Ph.D., ∗ Yuri S. Cardoso,‡ Isa´ ıas M. de S´ a Filho,‡ Fl´ avia R. Oliveira,‡ Carlos Maur´ ıcio F. Antunes, M.D., Ph.D., ∗ and Jos´ e R. Lambertucci, M.D., Ph.D. ∗ ∗ Post Graduation Course of Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; †ECOCENTER, Hospital Socor, Belo Horizonte, MG, Brazil; and ‡Medical Student, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil Background: Pulmonary hypertension (PH) is a complication of schistosomiasis mansoni (SM), mainly in the hepatosplenic form. However, its prevalence is not well established. We evaluated the usefulness of Doppler echocardiographic indexes to detect right heart dysfunction in SM. Methods: A total of 83 patients divided into two groups were studied: Group 1: 44 patients with hepatosplenic SM, and Group 2: 39 patients with hepatointestinal SM who served as controls. All patients underwent a Doppler echocardiogram. Right ventricular end-diastolic area (RVEDA), the peak systolic tricuspid annular tissue velocity (S’), right ventricular index of myocardial performance (RVIMP) and right atrial area (RAA) were measured in all patients. Tricuspid regurgitation peak velocity (TR) was measured and the pres- sure gradient (TG) was obtained. Results: The prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography was 31% in hepatosplenic patients, while no patient with the hepatointestinal form presented PH. Patients with hepatosplenic SM had larger RVEDA (10.0 ± 2.8 vs. 8.5 ± 1.8 cm 2 /m, P = 0.006) and RAA (9.39 [8.3–11.0] vs. 7.7 [6.9–8.4 cm 2 /m], P < 0.001). There was correlation between TG and RVIMP (r = 0.58; P < 0.001) and between TG and RAA (r = 0.36; P = 0.03) in Group 1. Conclusion: Larger RAA and RVEDA were found in patients with hepatosplenic SM, when compared to patients with the hepatointestinal form, which may suggest early impairment of RV function in patients with hepatosplenic SM. (Echocardiography 2011;28:261-267) Key words: right ventricular index of myocardial performance, indexed right atrial area, schistosomiasis, pulmonary hypertension, Doppler echocardiogram Schistosomiasis is one of the most prevalent parasitic diseases in the world, with significant socioeconomic impact. It is still endemic in 76 countries, mainly in places where socioeconomic conditions are inadequate. Two hundred million people are estimated to be infected in rural and suburban areas in these countries. 1,2 Because it is a chronic insidious disease, it is poorly recognized at early stages. Cardiopulmonary involvement can develop as a complication of schistosomiasis mansoni (SM) and occurs mostly in the hepatosplenic form. 3,4 Schistosome eggs trigger a granulomatous re- sponse in the pulmonary vasculature, affecting the intimal and later the medial layer of the pulmonary arteries. This may result in fibrosis, pulmonary hypertension (PH) and, subsequently, the development of cor pulmonale. 4 However, pathologic responses among the individuals are Address for correspondence: Vin´ ıcius Tostes Carvalho, Servic ¸o de Cardiologia e Cirurgia Cardiovascular – UFMG, Rua Timbi- ras, 63/1102, Funcion´ arios, 30140 060 – Belo Horizonte, MG. Fax: +55 31 34099437; E-mail: v-tostes@uol.com.br different 5 and it is still not clear whether all cases will eventually develop into right ventricular dys- function and whether such a progression is only a matter of time. 4 Therefore, noninvasive param- eters that can detect right chambers dysfunction are useful. Tricuspid regurgitation (TR) velocity has been well established in the literature as an accurate method to calculate the TG, thus allowing for the estimation of systolic pulmonary pressure. How- ever, TR velocity profile is not always suitable for a correct measurement. 6,7 Different from TR peak velocity, right ventric- ular index of myocardial performance (RVIMP), peak systolic tricuspid annular tissue velocity (S’), right ventricular end-diastolic area (RVEDA), and right atrial area (RAA) are easy to obtain and have proved their value in the study of different dis- eases associated with PH. 8–13 However, to the best of our knowledge, these parameters have not been systematically evaluated in patients with SM. Hence, the aim of this study was to inves- tigate the value of these indexes in detecting early right heart involvement in outpatients with SM. 261