Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention.

Introduction: Classical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR. Methods: This is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups according to the median value of the mean transaortic gradient (≤25 and >25 mmHg). All-cause, intraprocedural, 30-day, and 1-year mortality rates were evaluated. Results: All of the patients had degenerative aortic stenosis, with a median age of 66 (60-73) years; most of the patients were men (83%). The median EuroSCORE II was 2.19% (1.5%-4.78%), and the median STS was 2.19% (1.6%-3.99%). On DSE, 73.2% had flow reserve (FR), i.e., an increase in stroke volume ≥20% during DSE, with no significant differences between groups. On CMR, late gadolinium enhancement mass was lower in the group with mean transaortic gradient >25 mmHg [2.0 (0.0-8.9) g vs. 8.5 (2.3-15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3-5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864-0.986, p = 0.019). A mean transaortic gradient ≤25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114). Conclusions: In patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if ≤25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.

Early Change in Area Strain Detected by 3D Speckle Tracking Is Associated With Subsequent Cardiotoxicity in Patients Treated With Low Doses of Anthracyclines.

Objective: To evaluate the prognostic impact of the parameters of myocardial deformation using three-dimensional speckle tracking echocardiography (3DSTE) in patients with breast cancer who underwent chemotherapy with low doses of anthracyclines. Background: Chemotherapy-related cardiotoxicity has an important prognostic impact on cancer survivors. Three-dimensional STE has revealed more consistent data than two-dimensional techniques and may represent a more accurate tool in the evaluation of myocardial function in patients who underwent chemotherapy. Methods: We evaluated patients with breast cancer who were treated with anthracyclines (associated or not with trastuzumab) in five stages: baseline, after cumulative doses of 120 and 240 mg/m2 of doxorubicin, and then, after 6 months and at least 1 year after anthracyclines. Ultrasensitive troponin I (US-TnI) and a standard echocardiography study were performed at each stage. We analyzed left ventricular ejection fraction (LVEF) by Simpson's method, two-dimensional speckle tracking (2DSTE) with longitudinal and radial strain values, and 3DSTE with longitudinal, radial, and circumferential strain as well as twist, torsion, rotation, and three-dimensional global area strain (3DGAS). Cardiotoxicity was defined as a decrease in LVEF by more than 10 percentage points to a value lower than 53%. Results: We evaluated 51 female patients who were aged 50.6 ± 11 years. After the cumulative dose of 240 mg/m2 of doxorubicin, US-TnI was increased (>34 pg/ml) in 21 patients (45%, p > 0.001), LVEF remained unchanged (p = 0.178), while 2DSTE longitudinal strain was decreased (from -17.8% to -17.1%, p < 0.001) and 3DSTE detected changes in longitudinal, radial, circumferential, and area strain. After a lower cumulative dose of doxorubicin (120 mg/m2), 3DGAS (p < 0.001) was the only parameter that was changed. In the follow-up, 7 (13%) patients presented a decrease in LVEF. Three-dimensional GAS early changed to abnormal values was the only variable associated with a subsequent decrease in LVEF (definitive cardiotoxicity). Conclusion: In patients with breast cancer, 3DSTE detected early changes in area strain after very low doses of doxorubicin. The 3DGAS early changed to abnormal values was associated with a subsequent decrease in LVEF, representing a promising technique to predict chemotherapy-induced cardiomyopathy.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Abstract Objectives Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). Methods Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. Results The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). Conclusion Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography. Highlights OUES analysis is useful for assessing functional capacity in refractory angina. O2 pulse curve is correlated with contractile alterations in exercise echocardiogram. Cardiopulmonary exercise test is useful toll in patients with refractory angina.

Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation.

BACKGROUND: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. METHODS: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. RESULTS: Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively. CONCLUSION: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a randomized controlled trial.

PURPOSE: Patients with chronic chagasic cardiomyopathy with preserved ventricular function present with autonomic imbalance. This study evaluated the effects of exercise training (ET) in restoring peripheral and cardiac autonomic control and skeletal muscle phenotype in patients with subclinical chronic chagasic cardiomyopathy. METHODS: This controlled trial (NCT02295215) included 24 chronic chagasic cardiomyopathy patients who were randomized www.random.org/lists/ into two groups: those who underwent exercise training (n = 12) and those who continued their usual activities (n = 12). Eight patients completed the exercise training protocol, and 10 patients were clinically followed up for 4 months. Muscular sympathetic nerve activity was measured by microneurography and muscle blood flow (MBF) using venous occlusion plethysmography. The low-frequency component of heart rate variability in normalized units (LFnuHR) reflects sympathetic activity in the heart, and the low-frequency component of systolic blood pressure variability in normalized units reflects sympathetic activity in the vessels. The infusion of vasoactive drugs (phenylephrine and sodium nitroprusside) was used to evaluate cardiac baroreflex sensitivity, and a vastus lateralis muscle biopsy was performed to evaluate atrogin-1 and MuRF-1 gene expression. RESULTS: The baroreflex sensitivity for increases (p = 0.002) and decreases (p = 0.02) in systolic blood pressure increased in the ET group. Muscle blood flow also increased only in the ET group (p = 0.004). Only the ET group had reduced resting muscular sympathetic nerve activity levels (p = 0.008) and sympathetic activity in the heart (LFnu; p = 0.004) and vessels (p = 0.04) after 4 months. Regarding skeletal muscle, after 4 months, participants in the exercise training group presented with lower atrogin-1 gene expression than participants who continued their activities as usual (p = 0.001). The reduction in muscular sympathetic nerve activity was positively associated with reduced atrogin-1 (r = 0.86; p = 0.02) and MuRF-1 gene expression (r = 0.64; p = 0.06); it was negatively associated with improved baroreflex sensitivity both for increases (r = -0.72; p = 0.020) and decreases (r = -0.82; p = 0.001) in blood pressure. CONCLUSIONS: ET improved cardiac and peripheral autonomic function in patients with subclinical chagasic cardiomyopathy. ET reduced MSNA and sympathetic activity in the heart and vessels and increased cardiac parasympathetic tone and baroreflex sensitivity. Regarding peripheral muscle, after 4 months, patients who underwent exercise training had an increased cross-sectional area of type I fibers and oxidative metabolism of muscle fibers, and decreased atrogin-1 gene expression, compared to participants who continued their activities as usual. In addition, the reduction in MSNA was associated with improved cardiac baroreflex sensitivity, reduced sympathetic cardiovascular tone, and reduced atrogin-1 and MuRF-1 gene expression. TRIAL REGISTRATION: ID: NCT02295215. Registered in June 2013.

Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study.

BACKGROUND: The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. METHODS: Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. RESULTS: There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P = .038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P < .05). CONCLUSION: Three-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MR ≥ grade II, what could suggest a potential benefit of early surgical treatment.

New equation for prediction of reverse remodeling after cardiac resynchronization therapy.

OBJECTIVES: To integrate data from two-dimensional echocardiography (2D ECHO), three-dimensional echocardiography (3D ECHO), and tissue Doppler imaging (TDI) for prediction of left ventricular (LV) reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). It was also compared the evaluation of cardiac dyssynchrony by TDI and 3D ECHO. METHODS: Twenty-four consecutive patients with heart failure, sinus rhythm, QRS ≥ 120 msec, functional class III or IV and LV ejection fraction (LVEF) ≤ 0.35 underwent CRT. 2D ECHO, 3D ECHO with systolic dyssynchrony index (SDI) analysis, and TDI were performed before, 3 and 6 months after CRT. Cardiac dyssynchrony analyses by TDI and SDI were compared with the Pearson's correlation test. Before CRT, a univariate analysis of baseline characteristics was performed for the construction of a logistic regression model to identify the best predictors of LVRR. RESULTS: After 3 months of CRT, there was a moderate correlation between TDI and SDI (r = 0.52). At other time points, there was no strong correlation. Nine of twenty-four (38%) patients presented with LVRR 6 months after CRT. After logistic regression analysis, SDI (SDI > 11%) was the only independent factor in the prediction of LVRR 6 months of CRT (sensitivity = 0.89 and specificity = 0.73). After construction of receiver operator characteristic (ROC) curves, an equation was established to predict LVRR: LVRR =-0.4LVDD (mm) + 0.5LVEF (%) + 1.1SDI (%), with responders presenting values >0 (sensitivity = 0.67 and specificity = 0.87). CONCLUSIONS: In this study, there was no strong correlation between TDI and SDI. An equation is proposed for the prediction of LVRR after CRT. Although larger trials are needed to validate these findings, this equation may be useful to candidates for CRT.

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC / Comparison between 2D and 3D echocardiography in the evaluation of reverse remodeling after CRT / Comparación entre la ecocardiografía 2D y 3D en la evaluación del remodelado reverso después de la TRC

FUNDAMENTO: A ecocardiografia consiste em método muito útil para seleção e avaliação de resposta à terapia de ressincronização cardíaca (TRC). O eco 3D já tem seu papel estabelecido na avaliação dos volumes ventriculares e fração de ejeção ventricular esquerda (FEVE) com excelente correlação de resultados quando comparado à RNM. OBJETIVO: Comparar a avaliação dos volumes ventriculares (VDVE, VSVE), FEVE e massa do VE antes e após a TRC pela ecocardiografia bi (Eco 2D) e tridimensional (Eco 3D). MÉTODOS: Foram avaliados 24 pacientes com IC CFIII ou IV (NYHA), ritmo sinusal QRS > 150 ms, em vigência de terapêutica otimizada para IC submetidos a TRC. Foram realizados eletrocardiograma (ECG), avaliação clínica, Eco 2D e 3D antes, três e seis meses após a TRC. A comparação entre as técnicas foi realizada utilizando-se a correlação de Pearson (r). RESULTADOS: No momento basal, a correlação entre os métodos foi de 0,96 para avaliação do VDVE, 0,95 para avaliação do VSVE, 0,87 para FEVE, e 0,72 para massa do VE. Após três meses da TRC, a correlação entre os métodos para análise do VDVE foi de 0,96, 0,95 para VSVE, 0,95 para FEVE, e 0,77 para massa do VE. Após seis meses da TRC, a correlação entre o Eco 2D e 3D para análise do VDVE foi de 0,98, 0,91 para VSVE, 0,96 para FEVE, e 0,85 para massa do VE. CONCLUSÃO: Neste estudo foi observada redução dos VDVE,VSVE, além de melhora da FEVE após a TRC. Houve excelente correlação entre o Eco 2D e o 3D para avaliação dos volumes ventriculares e FEVE, e boa correlação entre os métodos para avaliação da massa ventricular esquerda antes e após a TRC.

BACKGROUND: Echocardiography is a useful method for screening and assessing response to cardiac resynchronization therapy (CRT). 3D echocardiography has already established its role in the evaluation of ventricular volumes and ejection fraction (LVEF) with excellent correlation of results when compared with MRI. OBJECTIVE: To compare the evaluation of ventricular volumes (LVDV, LVSV), LVEF, and LV mass before and after CRT by 2D echocardiography and three-dimensional echocardiography. METHODS: We evaluated 24 patients with HF FCIIIouIV (NYHA), sinus rhythm QRS > 150 ms, during an optimized therapy for HF undergoing CRT. We conducted electrocardiogram (ECG), clinical evaluation, 2D and 3D echocardiography before, three and six months after CRT. The comparison between the techniques was performed using Pearson's correlation (r). Results: At baseline, the correlation between methods was 0.96 for evaluation of LVDV, 0.95 for evaluation of LVSV, 0.87 for LVEF and 0.72 for LV mass. After three months of CRT, the correlation between methods for analysis of LVDV was 0.96, 0.95 for LVSV, 0.95 for LVEF, and 0.77 for LV mass. After six months of CRT, the correlation between 2D and 3D echocardiography for analysis of LVDV was 0.98, 0.91 for LVSV, 0.96 for LVEF, and 0.85 for LV mass. CONCLUSION: This study reported was a reduction of LVDV, LVSV, besides improvement in LVEF after CRT. There was an excellent correlation between the 2D and 3D echocardiography for evaluation of ventricular volumes and LVEF, and a good correlation between methods for evaluation of left ventricular mass before and after CRT.

FUNDAMENTO: La ecocardiografía consiste en método muy útil para selección y evaluación de respuesta a la terapia de resincronización cardíaca (TRC). El ecocardiograma tridimensional ya tiene su papel establecido en la evaluación de los volúmenes ventriculares y fracción de eyección ventricular izquierda (FEVI) con excelente correlación de resultados cuando es comparado a la resonancia nuclear magnética (RNM). OBJETIVO: Comparar la evaluación de los volúmenes ventriculares (VDVI, VSVI), FEVI y masa del VI antes y después de la TRC por la ecocardiografía bi (Eco 2D) y tridimensional (Eco 3D). MÉTODOS: Fueron evaluados 24 pacientes con insuficiencia cardíaca (IC), clase funcional (CF) III o IV (NYHA), ritmo sinusal QRS > 120 ms, en vigencia de terapéutica optimizada para IC sometidos a TRC. Fueron realizados electrocardiograma (ECG), evaluación clínica, Eco 2D y 3D antes, tres y seis meses después de la TRC. La comparación entre las técnicas fue realizada utilizando la correlación de Pearson (r). RESULTADOS: En el momento basal, la correlación entre los métodos fue de 0,96 para evaluación del VDVI, 0,95 para evaluación del VSVI, 0,87 para FEVI, y 0,72 para masa del VI. Después de tres meses de la TRC, la correlación entre los métodos para análisis del VDVI fue de 0,96, 0,95 para VSVI, 0,95 para FEVI, y 0,77 para masa del VI. Después de seis meses de la TRC, la correlación entre el Eco 2D y 3D para análisis del VDVI fue de 0,98, 0,91 para VSVI, 0,96 para FEVI, y 0,85 para masa del VI. CONCLUSIÓN: En este estudio fue observada reducción de los VDVI,VSVI, además de mejora de la FEVI después de la TRC. Hubo excelente correlación entre el Eco 2D y el 3D para evaluación de los volúmenes ventriculares y FEVI, y buena correlación entre los métodos para evaluación de la masa ventricular izquierda antes y después de la TRC.

Disfunção ventricular esquerda induzida pelo estresse (takotsubo-Invertido) em pós-operatório de cirurgia abdominal / Stress-induced cardiomyopathy (Inverted Takotsubo) after abdominal surgery

Classicamente, a cardiomiopatia de Takotsubo caracteriza-se por alteração transitória da contratilidade regional envolvendo o ápex e os segmentos médios do ventrículo esquerdo, com segmentos basais hipercontráteis, na ausência de doença coronária obstrutiva. Recentemente, casos de disfunção regional do ventrículo esquerdo induzidos pelo estresse, com padrões alternativos de disfunção regional em que o ápex é geralmente poupado (Takotsubo Invertido), têm sido relatados. Neste relato é descrito um caso de miocardiopatia induzida pelo estresse, no qual alterações da contratilidade segmentar foram observadas somente nos segmentos médios dos ventrículos, formando uma região acinética em faixa em torno do coração.

Cálculo da massa ventricular ecocardiografia: análise crítica / Critical analysis of echocardiographic measurements of left ventricular mass

A determinação da massa ventricular esquerda tem um grande valor na prática clínica. Pode ser obtida pela ecocardiografia, nas suas diferentes modalidades (uni, bi ou tridimensional), por meio de várias fórmulas e algorítimos matemáticos. Os primeiros estudos utilizaram o modo M e baseavam-se na medida da espessura septal, da parede posterior e da dimensão interna do ventrículo esquerdo, para a realização do cálculo da massa ventricular. Partiam do pressuposto que o ventrículo esquerdo fosse uma esfera. Porém, estudos de necropsia demostraram que essas fórmulas superestimadas a medida da massa ventricular. Por isso, foram aplicados fatores de correção e também verificada a necessidade das medidas pelo método bidimensional, principalmente, em casos de hipertrofia, em que pode existir uma distribuição assimétrica na cavidade ventricular. Novas tecnologias, como a ecocardiografia tridimensional, demonstram uma boa correlação com a ressonância nuclear magnética (RNM), sendo uma ferramenta importante para uma medida mais acurada da massa ventricular.

Ecocardiografia transesofágica intraoperatória na cardiomiopatia hipertrófica septal / Ecocardiografía transesofágica intraoperatoria en miocardiopatía hipertrófica septal / Intraoperative transesophageal echocardiography in septal hypertrophic cardiomyopathy

Relatamos caso de paciente portador de cardiomiopatia hipertrófica septal submetido a correção cirúrgica em que o emprego da ecocardiografia transesofágica intraoperatória proporcionou o planejamento da abordagem cirúrgica e o reconhecimento imediato do resultado operatório.

We report the case of a patient with septal hypertrophic cardiomyopathy undergoing surgical correction in which the use of intraoperative transesophageal echocardiography permitted the planning of the surgical approach and an immediate knowledge of the surgical outcome.

Relatamos caso de paciente portador de cardiomiopatia hipertrófica septal submetido a correção cirúrgica em que o emprego da ecocardiografia transesofágica intraoperatória proporcionou o planejamento da abordagem cirúrgica e o reconhecimento imediato do resultado operatório.

Avaliação ecocardiográfica da sincronia cardíaca: há a necessidade de hierarquização dos métodos? / Echocardiographic evaluation of cardiac dysynchrony: is it mecessary to hierachize the methods?

A detecção e quantificação da dissincronia cardíaca têm papel central na indicação da terapia de ressincronização. O ecocardiograma é o método mais utilizado para esse fim, porém nenhum parâmetro ecocardiografico, até o momento, mostrou superioridade em relação aos demais. Esse artigo visa a enfatizar as vantagens e limitações associadas a cada método, além de propor uma abordagem sequencial na avaliação da sincronia cardíaca.

Comparação entre a aferição da fração de ejeção e dos volumes do ventrículo esquerdo, medidos com ecocardiografia tridimensional em tempo real e com tomografia computadorizada ultra-rápida / Real-time three-dimensional echocardiographic left ventricular ejection fraction and volumes asessment: comparison with cardiac computed tomography

Fundamento e objetivo: O ecocardiograma tridimensional (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) constituem 2 novos métodos de análise da fração de ejeção e dos volumes do ventrículo esquerdo (VE). Existem poucos estudos dirigidos à comparação da análise da fração de ejeção do VE aferidos por ambos os métodos. O objetivo deste estudo foi comparar as medidas da FEVE e dos volumes do VE ECO 3D em tempo real e pela CT ultra rápida. Método: Foram estudados pelo ECO 3D e pela CT ultra rápida de 64 cortes, 41 pacientes (29 homens, média etária de 58 + - 111 anos). Foram analisados com ambas as técnicas: FEVE, volumes sistólico final e diastólico final do VE. Os parâmetros aferidos com o ECO3D e com a CT foram comparados com o emprego do coeficiente de determinação (r:Pearson), do teste de Bland & Altman e do teste de regressão linear, 95 por cento IC, p<0,05. Resultados: Medidas do ECO 3D: a FEVE variou de 56,7 a 78,9 (65,3 + - 5,7) por cento; volume diastólico final variou de 49,6 a 178,2 (88+ - 27,5) mL; volume sistólico final variou de 11,4 a 78 (33,9 + - 13,7) mL. Medidas da CT: a FEVE variou de 7 a 72 (35,1 + - 13,8) mL. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7877, p>0,0001, 95 por cento IC 0,6327 a 0,8853); volume diastólico final (r:0,7671, p< 0,0001, 95 por cento IC 0,5974 a 0,8745); volume sistólico final (r: 0,8121, p< 0,0001, 95 por cento IC 0,6659 a 0,8957). Conclusão: Foi evidenciada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D em tempo real e pela CT ultra rápida de 64 cortes.

Índice de dissincronia ventricular tridimensional em tempo real: novo método de análise da função sistólica do ventrículo esquerdo. Comparação com a fração de ejeção bidimensional e tridimensional / Real - time ventricular tridimensional dyssynchrony index: new method of left ventricle systolic assessment. Comparison with bidimensional and tridimensional ejection fraction

Fundamento e Objetivo: A sincronia do ventrículo esquerdo (VE) tem importância para a performance sistólica ventricular. O objetivo desde estudo foi comparar a sincronia do VE analisada com ecocardiograma (eco) tridimensional(3D) em tempo real, com medidas de FEVE, obtidas com ECO bidimensional (2D) e 3D. Métodos: Estudo prospectivo de 82 indivíduos (46 homens, 48 + - 12 anos), sendo 50 com anatomia cardíaca (eco) e ECG normais (grupo N) e 32 pacientes portadores de cardiomiopatia dilatada (grupo CMD). Foram medidos com o ECO 3D: FEVE, volumes e o índice de dissincronia (DI) por cento para 16 segmentos do VE. Com o ECO 2D foram aferidos: FEVE (método de Simpson) e volumes. Os dados foram comprados: com a mensuração do coeficiente de correlação (Pearson), 95 por cento IC, com o teste de regressão linear e teste de Bland & Altman, p>0,05. Resultados: O DI por cento variou de 0,28 a 28,1 (5,23 + 6,72), a FEVE 3D variou de 0,17 a 0,78 (0,51 + 0,14); a FECE 2D variou de 0,3 a 0,71 (0,46 + 0,15). A correlação entre DI e FEVE 3D foi (r): -0,7272, p> 0,0001, IC: -0,8328 a -0,6257, a relação linear entre DI (x) e FEVE 3D (y) foi y 17,6163 + ( -24,9872) x, p<0,0001. A correlação entre DI e FEVE...

Ecocardiografia no laboratório de pesquisa experimental: dificuldades e aprendizado / Experimental study in echocardiography laboratory: difficulties and learning

Na biomedicina, o estudo experimental tem papel estabelecido na aquisição de novas tecnologias. Cada vez mais, o laboratório de ecocardiografia tem aplicado a experimentação animal para incorporar novos programas, analisar a segurança biológica dos meios de contraste e validar téncinas cirúrgicas cardiovasculares. O objetivo deste artigo é abordar as diversas etapas de elaboração do estudo experimental, legislação, normatização e comentar alguns experimentais envolvendo a ecocardiografia.