Septal Ablation with Radiofrequency Catheters Guided by Echocardiography for Treatment of Patients with Obstructive Hypertrophic Cardiomyopathy: Initial Experience. / Ablação Septal com Cateteres e Radiofrequência Guiada pela Ecocardiografia para Tratamento de Pacientes com Cardiomiopatia Hipertrófica Obstrutiva: Experiência Inicial.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) can cause obstruction in the left ventricular outflow tract (LVOT), and be responsible for the onset of limiting symptoms, such as tiredness. When such symptoms are refractory to pharmacological treatment, interventionist alternative therapies can be useful, such as septal ablation through the infusion of alcohol in the coronary artery or through myectomy. Recently, the use of a radiofrequency (RF) catheter for endocardial septal ablation guided by electroanatomic mapping has proven to be efficient, despite the high incidence of complete atrioventricular block. An alternative would be the application of RF at the beginning point of the septal gradient guided by the transesophageal echocardiography (TEE). The echocardiography is an imaging method with high accuracy to determine septal anatomy. OBJECTIVE: To assess the long term effect of septal ablation for the relief of ventricular-arterial gradient, using TEE to help place the catheter in the area of larger septal obstruction. Besides, to assess the effects of ablation on the functional class and echocardiographic parameters. METHODS: Twelve asymptomatic patients, with LVOT obstruction, refractory to pharmacological therapy, underwent endocardial septal ablation with 8mm-tip catheters, whose placement was oriented in the region of larger obstruction, assisted by the TEE. Temperature-controlled and staggered RF applications were performed. After each application, the gradient was reassessed and a new application was performed according to the clinical criterion. The effects of RF applications were assessed both for the gradient at rest and for that provoked by the Valsalva maneuver, and considering the gradient. The differences were significant when p-value was lower than or equal to 0.05. RESULTS: It was possible to observe that the mean reduction of the maximum gradients was from 96.8±34.7 mmHg to 62.7±25.4 mmHg three months after the procedure (p=0.0036). After one year, the mean of maximum gradient was 36.1±23.8 mmHg (p=0.0001). The procedure was well tolerated, without records of complete atrioventricular block nor severe complications. CONCLUSION: The TEE-guided septal ablation was efficient and safe, and the results were maintained during the clinical follow-up period. It is a reasonable option for the interventionist treatment of LVOT obstruction in HCM.

FUNDAMENTOS: A cardiomiopatia hipertrófica (CMH) pode causar obstrução da via de saída do ventrículo esquerdo (VSVE) e ser responsável pelo surgimento de sintomas limitantes, como cansaço físico. Quando tais sintomas são refratários ao tratamento farmacológico, os tratamentos alternativos intervencionistas podem ser úteis, como a ablação septal por meio da infusão de álcool na artéria coronária ou por meio da miectomia cirúrgica. Recentemente, o uso de cateter de radiofrequência (RF) para ablação do septo endocárdico guiado por mapeamento eletroanatômico mostrou-se eficaz apesar da elevada incidência de bloqueio atrioventricular total. Uma alternativa seria a aplicação de radiofrequência no ponto de início do gradiente septal guiada pelo ecocardiograma transesofágico (ETE). O ecocardiograma é um método de imagem com elevada acurácia para determinação da anatomia septal. OBJETIVO: Avaliar o efeito em longo prazo da ablação septal para alívio do gradiente ventrículo-arterial, utilizando o ETE para auxiliar no posicionamento do cateter na área de maior obstrução septal. Avaliar também os efeitos da ablação na classe funcional e parâmetros ecocardiográficos. MÉTODOS: Doze pacientes sintomáticos com obstrução da VSVE, refratários à terapia farmacológica, foram submetidos à ablação endocárdica septal com cateteres com ponta de 8 mm, cujo posicionamento foi orientado na região de maior obstrução com auxílio do ETE. Foram realizadas aplicações de radiofrequência (RF) termocontrolada e escalonadas sobre a área alvo. Após cada aplicação, o gradiente era reavaliado e nova aplicação era realizada de acordo com critério clínico. Foram avaliados os efeitos das aplicações de RF tanto para o gradiente em repouso como para o provocado por meio da manobra de Valsalva, e considerado o gradiente. As diferenças foram significativas quando o valor de p foi menor ou igual a 0,05. RESULTADOS: Observou-se que a redução da média dos gradientes máximos obtidos foi de 96,8±34,7 mmHg para 62,7±25,4 mmHg ao final de três meses do procedimento (p=0,0036). Após um ano, a média dos gradientes máximos obtidos foi de 36,1±23,8 mmHg (p=0,0001). O procedimento foi bem tolerado e não houve registro de bloqueio atrioventricular total e nem complicações graves. CONCLUSÃO: A ablação septal guiada pelo ETE foi eficaz e segura, com resultados mantidos durante o período de seguimento clínico. É uma opção razoável para o tratamento intervencionista da obstrução da VSVE em CMH.

Predictive role of Selvester QRS score in patients undergoing transcatheter aortic valve replacement.

INTRODUCTION: Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR. METHODS AND RESULTS: Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow-up was obtained retrospectively. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACEs). Two-hundred twenty-eight patients were included (mean age, 81.5 ± 7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6 ± 3.2 vs. 1.4 ± 1.3; p < .001). At a mean follow-up of 36.2 ± 21.2 months, the Selvester score was independently associated with all-cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48-1.84; p < .001), cardiovascular death (HR, 1.59; 95% CI, 1.38-1.74; p < .001), and MACE (HR, 1.55; 95% CI, 1.30-1.68; p < .001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk factor (HR, 0.42; 95% CI, 0.18-0.98; p = .046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 (p < .001), respectively, for 1, 2, and 3 years. CONCLUSIONS: Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis.

Inteligência artificial e diagnóstico por imagem - o futuro chegou? / Artificial intelligence and diagnostic imaging - has the future come?

Na nova era da Medicina de Precisão, a inteligência artificial (IA) - um conjunto de sistemas e programas que permitem às máquinas serem capazes de executar tarefas que habitual mente exigiriam a participação humana - emerge como ferramenta capaz de criar novas maneiras de analisar as imagens médicas além dos parâmetros morfológicos convencionais. Embora ainda não estejam completamente disponíveis para o uso clínico, essa nova abordagem tem grande potencial de aplicação na prática clínica e de pesquisa médica. A discussão dos conceitos básicos, potenciais aplicações e limitações das novas técnicas de IA no diagnóstico por imagem é importante para a interpretação adequada do potencial efeito que essa tecnologia teria na medicina, contrapondo-se à excessiva ansiedade despertada por abordagens superficiais e apressadas. Este artigo tem por objetivo apresentar uma visão equilibrada e atual sobre o tema, com especial foco no presente e no futuro da imagenologia cardíaca

In the new era of Precision Medicine, artificial intelligence (AI) - a set of systems and programs that enable machines to be able to perform cognitive tasks that would usually require human participation emerges as a tool that can create new ways of analyzing images beyond the conventional morphological parameters. Although not yet ready for clinical use, these tools have a potential effect on clinical and research practice. The discussion of the basic concepts, potential applications and limitations of new AI techniques in imaging diagnosis is important for a balanced interpretation of their results, as opposed to the excessive anxiety recently observed among professionals dealing with the subject. In this brief article, we aim to take a balanced and attentive look on this subject, with special focus on the horizon of modern cardiac imaging

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography.

BACKGROUND: In view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature. OBJECTIVE: To evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA). METHODS: This is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted. RESULTS: The frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable. CONCLUSIONS: The frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography / Placa Aterosclerótica à Angiotomografia de Coronárias em Pacientes com Escore de Cálcio Zero

Abstract Background: In view of the high mortality for cardiovascular diseases, it has become necessary to stratify the main risk factors and to choose the correct diagnostic modality. Studies have demonstrated that a zero calcium score (CS) is characteristic of a low risk for cardiovascular events. However, the prevalence of individuals with coronary atherosclerotic plaques and zero CS is conflicting in the specialized literature. Objective: To evaluate the frequency of patients with coronary atherosclerotic plaques, their degree of obstruction and associated factors in patients with zero CS and indication for coronary computed tomography angiography (CCTA). Methods: This is a cross-sectional, prospective study with 367 volunteers with zero CS at CCTA in four diagnostic imaging centers in the period from 2011 to 2016. A significance level of 5% and 95% confidence interval were adopted. Results: The frequency of atherosclerotic plaque in the coronary arteries in 367 patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant coronary obstructions (> 50%), with involvement of two or more segments in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%, p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was significantly higher in patients with atherosclerotic plaques, with an odds ratio of 3.4 for each of this variable. Conclusions: The frequency of atherosclerotic plaque with zero CS was relatively high, indicating that the absence of calcification does not exclude the presence of plaques, many of which obstructive, especially in non-obese subjects and alcohol drinkers.

Resumo Fundamento: Diante da alta mortalidade por doenças cardiovasculares, faz-se necessária a estratificação dos principais fatores de riscos e escolha correta da modalidade diagnóstica. Estudos demonstraram que escore de cálcio (EC) zero caracteriza baixo risco de eventos cardiovasculares. No entanto, a frequência de portadores de placa aterosclerótica coronária com EC zero é conflitante na literatura especializada. Objetivo: Avaliar a frequência de pacientes com placa aterosclerótica coronária, seu grau de obstrução e fatores associados em pacientes com EC zero e indicação para angiotomografia computadorizada de coronárias (ATCC). Métodos: Trata-se de estudo transversal, prospectivo, com 367 voluntários portadores de EC zero, mediante a ATCC, no período de 2011-16, em quatro centros de diagnóstico por imagem. Foi assumido nível de significância 5% e intervalo de confiança de 95%. Resultados: A frequência de placa aterosclerótica nas artérias coronárias dos 367 pacientes com EC zero foi de 9,3% (34 indivíduos); neste subgrupo, a média de idade foi 52 ± 10 anos, 18 (52,9%) eram mulheres e 16 (47%) exibiam obstruções coronarianas significativas (> 50%), dos quais 4 (25%) apresentaram placas em pelo menos dois segmentos. A frequência de não obesos (90,6% vs. 73,9%; p = 0,037) e de etilistas (55,9% vs. 34,8%; p = 0,015) foi significativamente maior nos portadores de placa, apresentando, cada variável, odds ratio de 3,4 para o desenvolvimento das referidas placas. Conclusões: A frequência de placa aterosclerótica com EC zero foi considerável, evidenciando, portanto, que a ausência de calcificação não exclui placa, muitas das quais obstrutivas, principalmente nos não obesos e etilistas.

Angiotomografia de Coronárias e Proteína C Reativa na Avaliação da Doença Arterial Coronariana / Coronary Computed Tomography Angiography and C-Reactive Protein in the Evaluation of Coronary Artery Disease

Fundamento: A doença arterial coronariana (DAC) constitui a principal causa de morte nos países desenvolvidos. No Brasil, gasta-se aproximadamente 1,74% do Produto Interno Bruto com doenças cardiovasculares. Testes de isquemia possuem baixa acurácia diagnóstica em indivíduos com risco intermediário de DAC e a angiotomografia computadorizada de múltiplos detectores (ATCMD) pode contribuir para esclarecer o diagnóstico desses pacientes, não obstante o custo deste procedimento que ainda é elevado para o nosso padrão. A proteína C reativa (PCR) eleva-se no caso de inflamação sistêmica e tem sido utilizada como marcador de DAC. Objetivo: Avaliar a correlação da PCR com a presença de placas ateroscleróticas identificadas pela angiotomografia. Métodos: Trata-se de um estudo de corte transversal, no qual foram incluídos 118 pacientes com risco intermediário para DAC, que realizaram ATCMD das artérias coronárias e dosagem de PCR de setembro de 2011 a janeiro de 2013 em um hospital de referência cardiológica. Resultados: Cerca de 55% da amostra foi representada pelo gênero masculino. A DAC, HAS e obesidade foram identificadas em 68,6%, 76,3% e 31,8% dos indivíduos, respectivamente. Observou-se que os pacientes com concentrações elevadas de PCR tiveram uma chance 2,9 maior de apresentarem DAC diagnosticada por ATCMD (p = 0,016). Conclusão: Indivíduos com PCR alterada têm maior chance de apresentarem DAC diagnosticada à ATCMD e possuem valores de PCR mais elevados que pacientes sem DAC. A PCR, junto a outros fatores de risco, pode representar um elemento preditivo relevante para o diagnóstico de DAC na ATCMD, ou em situações quando a realização da ATCMD não é possível

Background: Coronary artery disease (CAD) is the leading cause of death in developed countries. In Brazil, approximately 1.74% of the gross domestic product is spent on cardiovascular diseases. Ischemia tests have a low diagnostic accuracy for patients with intermediate CAD risk, and multidetector computed tomography angiography (MDCTA) may help establish the diagnosis of these patients, despite the cost of this procedure, which is still high for our standards. C-reactive protein (CRP) is increased in cases of systemic inflammation and has been used as a CAD marker. Objective: To evaluate the correlation of CRP with the presence of atherosclerotic plaques identified on CT angiography. Methods: Cross-sectional study including 118 patients with intermediate risk of CAD, who underwent coronary MDCTA and CRP measurement from September 2011 to January 2013 in a referral cardiology hospital. Results: Males comprised about 55% of the sample. CAD, hypertension, and obesity were identified in 68.6%, 76.3%, and 31.8% of the subjects, respectively. We observed that patients with increased CRP levels had a 2.9-fold higher chance of presenting CAD on MDCTA (p = 0.016). Conclusion: Individuals with altered CRP are more likely to present CAD diagnosed by MDCTA and have higher CRP values than patients without CAD. CRP, along with other risk factors, may represent a relevant predictive element in the diagnosis of CAD in MDCTA, or in situations in which MDCTA is not feasible

Sexo Masculino e Hipertensão Arterial São Preditores de Placa à Angiotomografia das Coronárias / Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography

Background: Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. Objective: To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. Methods: Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. Results: HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). Conclusion: Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques. .

Fundamento: Doença Arterial Coronariana (DAC) tem como um dos principais fatores de risco a Hipertensão Arterial Sistêmica (HAS), além do sexo masculino. As diferenças nas lesões de artérias coronarianas entre hipertensos e normotensos de ambos os sexos pela Angiotomografia Computadorizada Coronariana (ATC) ainda não foram claramente determinadas. Objetivo: Investigar Escore de Cálcio (EC), extensão da DAC e as características de placas coronarianas à ATC em homens e mulheres com e sem HAS. Métodos: Estudo transversal prospectivo com 509 pacientes submetidos a ATC para diagnóstico e estratificação de risco de DAC, de novembro de 2011 a dezembro de 2012, no Instituto Dante Pazzanese de Cardiologia. Foram estratificados segundo o gênero e subdivididos de acordo com a presença (HT+) ou ausência (HT-) de HAS. Resultados: As mulheres HT+ apresentaram maior idade (62,3 ± 10,2 vs 57,8 ± 12,8, p = 0,01). Quanto à avaliação de extensão da DAC, os HT+ de ambos os sexos apresentaram DAC significativa, porém a doença multiarterial é mais frequente nos homens HT+. A análise da regressão para DAC significativa mostrou que idade e sexo masculino foram fatores determinantes de doença multiarterial e EC ≥ 100. Já a análise para os tipos de placas mostrou que a HAS se comportou como fator de risco preditor para placas parcialmente calcificadas (OR = 3,9). Conclusão: Homens hipertensos apresentaram mais frequentemente doença multiarterial. O sexo masculino foi fator determinante de DAC significativa, doença multiarterial, EC ≥ 100 e placas calcificadas e parcialmente calcificadas. Enquanto a HAS foi preditora de placas parcialmente calcificadas. .

Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography.

BACKGROUND: Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. OBJECTIVE: To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. METHODS: Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. RESULTS: HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). CONCLUSION: Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques.

Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency / Diagnóstico angiotomográfico da obstrução venosa ilíaco-cava na Insuficiência Venosa Crônica avançada

Objective: Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT). Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV) for these diagnoses is under investigation. Methods: Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed. Results: A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035) (Fisher's exact test). There was a positive relationship between clinical classification (CEAP) and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011). Conclusion: Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI. .

Objetivo: A obstrução ilíaco-cava é associada a sintomas de hipertensão venosa e é um fator de risco para a trombose venosa profunda (TVP). A ultrassonografia pode falhar em seu diagnóstico. Não existe método de "sreening" bem estabelecido. A capacidade da Angiotomografia em realizar esse diagnóstico vem sendo investigada. Método: Pacientes portadores de IVC avançada e com falha no tratamento clínico foram submetidos à Angiotomografia. As imagens foram classificadas quanto ao grau de obstrução por dois investigadores independentes. Foram avaliados a prevalência e o grau de obstrução, e a sua relação com dados demográficos, fatores de risco e sintomas clínicos (CEAP). Resultados: Foram avaliados 112 membros. A idade média dos pacientes foi de 55,8 anos e 75,4% eram mulheres. A obstrução acometia o membro inferior esquerdo em 71,8% e havia história de TVP em 35,8% destes. Em 57,1% dos membros, havia obstrução > 50% e, em 10,7%, a obstrução era > 80%. A história de TVP foi o único fator demográfico com associação positiva com o grau de obstrução (p = 0,035) (teste Exato de Fisher). Houve associação positiva entre a classificação clínica (CEAP) e o grau de obstrução venosa (Teste Qui-quadrado para tendência linear; p=0,011). Conclusão: Pacientes portadores de IVC avançada são frequentemente acometidos por obstrução venosa ilíaco-cava e a Angiotomografia é capaz de identificar o grau dessa obstrução. Existe uma relação positiva entre o grau de obstrução e a classificação clínica, e a história de TVP .

Uso racional dos exames de imagem na avaliação do coração de atleta / Cardiac image in the evaluation of the athlete's heart

A intensa atividade física em treinamentos e competições, particularmente nos esportes profissionais, exige importantes adaptações por parte das câmaras cardíacas e levam o coração a trabalhos extremos, que podem gerar arritmias, além de outros sintomas cardíacos. Por outro lado, as condições intensas de funcionamento cardíaco podem fazer com que doenças cardíacas incipientes se manifestem. Estas condições fazem com que a avaliação do atleta com suspeita de cardiopatias seja cuidadosa e, muitas vezes, inclua a realização de exames de imagem. A interpretação dos resultados destes exames, porém, pode não ser muito simples, pois muitas das mudanças que se seguem à constante prática de esportes ainda não são totalmente conhecidas e elas podem variar de acordo com as características genéticas, de sexo, etnia, tipo de treino e esporte praticado. Deve-se considerar, também, que o uso indiscriminado de exames de imagem pode gerar custos elevados e também à suspensão desnecessária da prática de esportes, que, por sua vez, carregam consigo elevado impacto social e pessoal. Neste artigo, propomos o uso integrado e racional destas tecnologias, sempre consideradas após a suspeição de cardiopatias. Além do ecocardiograma, a ressonância, em especial ao se pesquisar doenças musculares e para buscar fibrose miocárdica, como a tomografia, em especial diante da suspeita de doença coronária obstrutiva ou por origem anômala destes vasos, podem auxiliar na tomada de decisão correta em cada caso individualizado.

The intense physical activity in training and competitions mainly in professional sports require important adaptations of the heart chambers and take the heart to extreme work which can cause arrhythmias and other cardiac symptoms.Therefore, intense heart work can cause heart disease. Do to this fact, it is important to be careful when assessing athletes with suspected cardiopathies and often the performance of imaging tests is required. Interpretation of the results of these tests, however, may not be so simple because many of the alterations that follow the constant practice of sports are not yet fully known, and they may vary according to the genetic characteristics of gender, ethnicity, type of training, and sports practiced. One should consider, too, that the indiscriminated use of imaging tests can generate high costs and unnecessary discontinuation of the practice of sports, which eventually will cause high social and personal impacto This article proposes integrated and rational use of these technologies, always after suspicion of heart diseases. Besides ECHO, MRI is fundamental especially when searching muscular diseases and myocardial fibrosis. Whereas, CT can assist in making the right decision particularly on the suspicion of coronary obstructive disease or for the anomalous origin of these vessels.

Atlas de diagnóstico por imagem em cardiologia / Atlas of diagnostic imaging in cardiology

O livro apresenta os principais métodos gráficos e de imagem usados atualmente na abordagem cardiológica. Contempla a prática, utilizando casos clínicos como base, reúne vivências clínicas e acadêmicas distintas e, acima de tudo, reflete o consenso entre as partes envolvidas. Aborda algumas das muitas aplicações dos testes apresentados inicialmente, sempre em situações desafiantes do ponto de vista diagnóstico.

Visceral fat and coronary artery calcification in patients with chronic kidney disease.

BACKGROUND: Abdominal fat is a metabolically active tissue which has been associated with cardiovascular events and death in chronic kidney disease (CKD) patients. We explore here the association between surrogates of abdominal fat and coronary artery calcium score (CACs). METHODS: Cross-sectional analysis of 232 non-dialysis-dependent CKD patients Stages 3-5 (median age 60 [25th-75th percentile 52-67] years; 60% men). Visceral adipose tissue (VAT) and CACs were assessed by computed tomography. Surrogates of abdominal fat included VAT and waist circumference (WC). RESULTS: VAT was positively associated with CACs in univariate analysis (ρ = 0.23). Across increasing VAT quartiles, patients were older, more often men and smokers. Although increasing VAT quartiles associated with higher glomerular filtration rate and leptin, better nutritional status (subjective global assessment) as well as larger muscle stores and strength, they were also more insulin resistant (HOMA-IR), dyslipidemic and inflamed (C-reactive protein and white blood cells). In addition, CACs were incrementally higher. Clinically evident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat (odd ratio 1.60 [95% CI 1.23-2.09] per standard deviation increase) and increased WC (1.05 [1.01-1.12] per cm increase), augmented the odds to present calcification. Such associations remained statistically significant after extensive multivariate adjustment for confounders. CONCLUSIONS: Abdominal fat is associated with coronary artery calcification in non-dialysis dependent CKD patients, supporting its potential role as a cardiovascular risk factor in uremia.