RESUMO
BACKGROUND: Although dobutamine-atropine stress echocardiography (DASE) has been widely used for evaluating patients with coronary artery disease (CAD), dynamic changes that occur at microcirculatory level during each stage of stress have not been demonstrated in humans. AIM: We sought to determine variations in myocardial blood flow (MBF) during DASE using quantitative real time myocardial contrast echocardiography (RTMCE). METHODS: We studied 45 patients who underwent coronary angiography and RTMCE. Replenishment velocity of microbubbles in the myocardium (ß) and MBF reserves were obtained at baseline, intermediate stage (70% of maximal predicted heart rate), peak stress, and recovery phase. RESULTS: ß and MBF reserves were lower in patients with than without CAD at intermediate (1.65 vs. 2.10; P=0.001 and 2.44 vs. 3.23; P=0.004) and peak (1.63 vs. 3.00; P<0.001 and 2.14 vs. 3.98; P<0.001, respectively). In patients without CAD, ß, and MBF reserves increased from intermediate to peak and decreased at recovery, while in those without CAD reserves did not change significantly. Optimal cutoff values of ß reserve at intermediate, peak, and recovery were 1.78, 2.09, and 1.70, with areas under the curves of 0.80 (95%CI=0.67-0.94), 0.89 (95%CI=0.79-0.99), and 0.69 (95%CI=0.53-0.85). Sensitivity, specificity and accuracy for detecting CAD at intermediate stage were 68% (95%CI=48-89), 85% (95%CI=71-98), and 78% (95%CI=66-90), at peak stress were 79% (95%CI=61-97), 96% (95%CI=89-100), and 89% (95%CI=80-98), and at recovery were 74% (95%CI=54-93), 65% (95%CI=47-84), and 69% (95%CI=55-82), respectively. CONCLUSION: RTMCE allows for quantification of dynamic changes in microcirculatory blood flow at each stage of DASE. The best parameter for detecting CAD in all stages was ß reserve.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Ecocardiografia sob Estresse , Microcirculação , Análise de Variância , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/fisiologia , Distribuição de Qui-Quadrado , Comorbidade , Meios de Contraste , Angiografia Coronária , Doença das Coronárias/fisiopatologia , Feminino , Fluorocarbonos , Frequência Cardíaca/fisiologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Microbolhas , Microcirculação/efeitos dos fármacos , Microcirculação/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROCRESUMO
We report a case of a 60 year-old woman with von Willebrand disease type I that was submitted to a mitral valve repair. The patient needed special care due coagulopathy and needed VIII factor (VIIIf) and von Willebrand factor (vWf), before, during and after surgery. There was no complication during or after surgery. Patient is asymptomatic nine months postoperatively. The correction of VIIIf and vWf allowed the realization of a safety surgery.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Insuficiência da Valva Mitral/cirurgia , Doenças de von Willebrand/tratamento farmacológico , Fator de von Willebrand/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Assistência Perioperatória , Cuidados Pré-Operatórios , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Relatamos o caso de uma mulher de 60 anos portadora da doença de von Willebrand tipo I, submetida a cirurgia da valva mitral. A paciente necessitou de cuidados especiais em razão da coagulopatia e foi necessária a utilização de concentrado de fator VIII (VIIIf) e fator de von Willebrand (vWf) antes, durante e depois da cirurgia. Não houve complicações durante e após a cirurgia. Nove meses depois, a paciente encontra-se assintomática. A correção para valores adequados de VIIIf e vWf permitiu a realização da cirurgia com segurança.
We report a case of a 60 year-old woman with von Willebrand disease type I that was submitted to a mitral valve repair. The patient needed special care due coagulopathy and needed VIII factor (VIIIf) and von Willebrand factor (vWf), before, during and after surgery. There was no complication during or after surgery. Patient is asymptomatic nine months postoperatively. The correction of VIIIf and vWf allowed the realization of a safety surgery.