A risk score for predicting death in COVID-19 in-hospital infection: A Brazilian single-center study.

BACKGROUND: There is a paucity of information about Brazilian COVID-19 in-hospital mortality probability of death combining risk factors. OBJECTIVE: We aimed to correlate COVID-19 Brazilian in-hospital patients' mortality to demographic aspects, biomarkers, tomographic, echocardiographic findings, and clinical events. METHODS: A prospective study, single tertiary center in Brazil, consecutive patients hospitalized with COVID-19. We analyzed the data from 111 patients from March to August 2020, performed a complete transthoracic echocardiogram, chest thoracic tomographic (CT) studies, collected biomarkers and correlated to in-hospital mortality. RESULTS: Mean age of the patients: 67 ± 17 years old, 65 (58.5%) men, 29 (26%) presented with systemic arterial hypertension, 18 (16%) with diabetes, 11 (9.9%) with chronic obstructive pulmonary disease. There was need for intubation and mechanical ventilation of 48 (43%) patients, death occurred in 21/111 (18.9%) patients. Multiple logistic regression models correlated variables with mortality: age (OR: 1.07; 95% CI 1.02-1.12; p: 0.012; age >74 YO AUC ROC curve: 0.725), intubation need (OR: 23.35; 95% CI 4.39-124.36; p < 0.001), D dimer (OR: 1.39; 95% CI 1.02-1.89; p: 0.036; value >1928.5 ug/L AUC ROC curve: 0.731), C-reactive protein (OR: 1.18; 95% CI 1.05-1.32; p < 0.005; value >29.35 mg/dl AUC ROC curve: 0.836). A risk score was created to predict intrahospital probability of death, by the equation: 3.6 (age >75 YO) + 66 (intubation need) + 28 (C-reactive protein >29) + 2.2 (D dimer >1900). CONCLUSIONS: A novel and original risk score were developed to predict the probability of death in Covid 19 in-hospital patients concerning combined risk factors.

Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. / Posicionamento do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia sobre o Uso do Strain Miocárdico na Rotina do Cardiologista ­ 2023.

Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.

Figura Central : Posicionamento do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia sobre o Uso do Strain Miocárdico na Rotina do Cardiologista ­ 2023 Proposta de inclusão do strain no algoritmo integrado de avaliação da função diastólica, adaptado e traduzido de Nagueh et al. 67 AE: átrio esquerdo; Ap: duração da onda A reversa pulmonar; Am: duração da onda A mitral; DD: disfunção diastólica; FEVEr: fração de ejeção do ventrículo esquerdo reduzida; IT: insuficiência tricúspide; SAEr: strain do AE de reservatório; SLGVE: strain longitudinal global do ventrículo esquerdo. Se remodelamento concêntrico, confirmar com SLGVE. Na presença de FEVEr, tempo de desaceleração da onda E mitral (TDE) < 160 ms e onda S < D pulmonar também são parâmetros de pressão de enchimento aumentada. Esse algoritmo não se aplica a pacientes com fibrilação atrial (FA), calcificação do anel mitral ou valvopatia mitral maior que discreta, bloqueio de ramo esquerdo (BRE), ritmo de marca-passo, próteses valvares ou hipertensão pulmonar (HP) primária grave.

Evaluation of the myocardial deformation in the diagnosis of rejection after heart transplantation.

Introduction: Heart transplantation represents main therapy for end-stage heart failure. However, survival after transplantation is limited by development of graft rejection. Endomyocardial biopsy, an invasive and expensive procedure, is gold standard technique for diagnosis of rejection. Most of biopsy complications are observed using echocardiography. Novel echocardiographic techniques, such as myocardial strain and three-dimensional reconstruction, can be useful in heart transplant patients. Purpose: To evaluate ventricular strain in heart transplant patients and association with rejection, cellular or humoral, as well as two- and three-dimensional echocardiographic parameters. Methods: Cohort of patients from heart transplant program taken to echocardiography after endomyocardial biopsy, from December 2017 to January 2020. Ventricular strain and three-dimensional left ventricle parameters were studied. Rejection results were retrieved from medical record. Qualitative variables were expressed by absolute frequency and percentages, while continuous variables by means and standard deviations. Association between rejection and variables of interest was measured by odds ratio and confidence interval of 95%, with p-value < 0.05. Results: 123 post-endomyocardial biopsy echocardiographic exams were performed in 54 patients. Eighteen exams were excluded, lasting 105 exams to be evaluated for conventional and advanced echocardiographic parameters. Male patients were 60.4%. Prevalence of cellular rejection was 8.6%, humoral rejection 12.4%, and rejection of any type 20%. There was no association between right ventricular strain and rejection, whether cellular (p = 0.118 and p = 0.227 for septum and free wall, respectively), humoral (p = 0.845 and p = 0.283, respectively), or of any type (0.504 and 0.446). There was no correlation between rejection and left ventricle global longitudinal strain, three-dimensional ejection fraction or desynchrony index. Conventional parameters associated to rejection were left ventricle posterior wall thickness [OR 1.660 (1.163; 2.370), p = 0.005] and left ventricle mass index [OR 1.027 (1.011; 1.139), p = 0.001]. Left ventricle posterior wall thickness remained significant after analysis of cellular and humoral rejection separately [OR 1.825 (1.097; 3.036), p = 0.021 and OR 1.650 (1.028; 2.648), p = 0.038, respectively]. Conclusions: There was no association between ventricular strain, three-dimensional left ventricular ejection fraction and the desynchrony index and rejection, cellular or humoral. Evidence of association of graft rejection with left ventricle posterior wall thickness and left ventricle mass index was observed.

Double lumen aortic arch or persistence of fifth aortic arch?- Report of a case with no associated cardiac defects and literature review.

Different vascular abnormalities have been reported under the denomination of "persistence of the fifth aortic arch." Detailed studies on experimental embryology raised the discussion about the existence of the fifth aortic arch as an embryological structure, both in humans and mammals. In 1969 the Van Praaghs described the occurrence of double left aortic arch, denominating such anomaly as persistence of the fifth arch. We describe here a female patient showing the presence of an anomalous vessel in parallel with the aortic arch. The finding was occasional, during a preoperative evaluation for cholecystectomy.

[Erectile dysfunction: a marker for myocardial perfusion impairment?]. / Disfunção erétil: um marcador para alterações da perfusão miocárdica?

OBJECTIVE: To study the correlation between erectile dysfunction (ED) and myocardial perfusion impairment in men with suspected or diagnosed coronary artery disease (CAD). METHODS: In this prospective study a self-administered IIEF-5 questionnaire was answered by 287 patients that underwent myocardial perfusion imaging under both resting and stress condition with technetium-99m sestamibi, through gated SPECT nuclear scintigraphy technique, before and after physical or pharmacological stress. RESULTS: Some degree of erectile dysfunction (group ED+) was found in 137 (47.8%) patients and in these, age was significantly higher (60.60+/-9.84 vs 50.67+/-9.94 - p<0.001)) than in those without erectile dysfunction (group ED-). In the ED+ group, it was observed a higher prevalence of hypertension, diabetes, myocardial infarction (MI) and percutaneous coronary angioplasty (PCTA). Regardless of the age factor, ED+ patients also presented higher occurrence of myocardial perfusion impairment (necrosis and/or ischemia) and left ventricular systolic wall motion and thickening abnormalities. CONCLUSION: Patients with ED have higher estimated probability of presenting segmental myocardial perfusion and functional contraction impairment and, therefore, CAD, independent of the aging factor. The authors conclude that ED may be considered not only a marker for CAD but also a condition related to the occurrence of major coronary events such as MI and PCTA.

[Evaluation of segmentary contractility in Chagas' disease by using the integral of the myocardial velocity gradient (myocardial strain) obtained through tissue Doppler echocardiography]. / Avaliação da contratilidade segmentar na doença de Chagas utilizando a integral do gradiente intramiocárdico de velocidade (strain miocárdico) obtida pela ecocardiografia com Doppler tecidual.

OBJECTIVE: To quantify the percentage of contractility of different myocardial segments in patients with Chagas' disease by measuring myocardial strain and to assess the differences in the radial and longitudinal ventricular contractile function in the undetermined and dilated forms of chronic chagasic cardiomyopathy as compared with those in a group of healthy individuals. METHODS: The study comprised 39 individuals [20 (51.3%) of the male sex] divided into the following 4 groups: 1) Nl: 17 (43.6%) healthy individuals; 2) Und: 7 (17.9%) patients with the undetermined form of Chagas' disease; 3) C1: 7 (17.9%) patients with the chronic form of Chagas' disease with ejection fraction < 50%; and 4) C2: 8 (20.5%) patients with the chronic form of Chagas' disease with ejection fraction > 50%. After performing baseline echocardiography, Doppler tissue images were recorded to measure myocardial strain in different segments on longitudinal and transversal parasternal, and apical 2- and 4-chamber views. RESULTS AND CONCLUSION: The percentage of contractility in the different myocardial segments, both the radial and longitudinal components, is greater in healthy individuals than in patients with the chronic form of Chagas' disease, and in those with the undetermined form of the disease as compared with that of chronic chagasic patients with EF < 50%. Left ventricular radial contractility is greater than left ventricular longitudinal contractility in all groups (Nl, Und, and Chronic). The data presented allow us to propose a progressive character of myocardial impairment in patients with Chagas' disease.

Intracardiac thrombosis and mitral prosthesis dysfunction in systemic lupus erythematosus. A case report.

Systemic lupus erythematosus (SLE) is an inflammatory disease characterized by deposition of autoantibodies and pathogenic immune complexes in the cells and tissues of an organism, causing lesions. The heart is one of the most frequently involved organs, valvar involvement being common (27%) and of great clinical importance. Some studies suggest that valvar involvement is associated with the presence of a specific autoantibody, the antiphospholipid antibody (aPL). In these circumstances, major complications may occur such as arterial or venous thrombosis, thrombocytopenia, repeated spontaneous abortions and presence of lupus anticoagulant antibody. Among the semiologic methods for cardiac evaluation, echocardiography is the main instrument for investigating the anatomical and functional involvement of the heart in the great majority of systemic diseases like SLE. We report the case of a patient with SLE and aPL syndrome who underwent surgery for mitral valve replacement with a biological prosthesis and died nine months later due to massive intracardiac thrombosis and prosthesis dysfunction.

Coronary artery spasm during dobutamine stress echocardiography in a patient with angiographically normal coronary arteries.

Dobutamine stress echocardiography (DSE) has been extensively used for diagnostic and prognostic purposes in patients with suspected or known coronary artery disease. During DSE transitory alterations of myocardial wall mobility can occur in the absence of electrocardiographic alterations, or they can be associated with ST segment depression or even elevation on the electrocardiogram. ST segment elevation during DSE has been reported as an infrequent event, generally associated with previous myocardial infarction or coronary artery disease with critical lesions, since the positive inotropic and chronotropic effects of dobutamine produce an increase in myocardial oxygen demand, causing ischemia and segmental contractility abnormalities in patients with significant coronary stenosis. The present case relates to a patient referred for DSE after an ischemic treadmill exercise test. During DSE she presented ST segment elevation associated with chest pain. Subsequent coronary arteriography showed normal coronary arteries. We speculate that coronary spasm may have occurred in this patient, as a paradoxical response to the dobutamine-induced increase in coronary flow.

Study of the myocardial contraction and relaxation velocities through Doppler tissue imaging echocardiography: A new alternative in the assessment of the segmental ventricular function.

OBJECTIVE: Doppler tissue imaging (DTI) enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS: We studied 35 healthy individuals (27 were male) with ages ranging from 12 to 59 years (32.9 plus minus 10.6). Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS: The means (and standard deviation) of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls) were respectively, in cm/s, 7.35(1.64), 5.26(1.88), and 3.33(1.58) in systole and 10.56(2.34), 7.92(2.37), and 3.98(1.64) in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (+/- 19.12ms), and diastolic was 459.18ms (+/- 18.13ms) based on the peak of the R wave of the electrocardiogram. CONCLUSION: In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

3D Echo pilot study of geometric left ventricular changes after acute myocardial infarction.

BACKGROUND: Left ventricular remodeling (LVR) after AMI characterizes a factor of poor prognosis. There is little information in the literature on the LVR analyzed with three-dimensional echocardiography (3D ECHO). OBJECTIVE: To analyze, with 3D ECHO, the geometric and volumetric modifications of the left ventricle (VE) six months after AMI in patients subjected to percutaneous primary treatment. METHODS: Prospective study with 3D ECHO of 21 subjects (16 men, 56 ± 12 years-old), affected by AMI with ST segment elevation. The morphological and functional analysis (LV) with 3D ECHO (volumes, LVEF, 3D sphericity index) was carried out up to seven days and six months after the AMI. The LVR was considered for increase > 15% of the end diastolic volume of the LV (LVEDV) six months after the AMI, compared to the LVEDV up to seven days from the event. RESULTS: Eight (38%) patients have presented LVR. Echocardiographic measurements (n = 21 patients): I- up to seven days after the AMI: 1- LVEDV: 92.3 ± 22.3 mL; 2- LVEF: 0.51 ± 0.01; 3- sphericity index: 0.38 ± 0.05; II- after six months: 1- LVEDV: 107.3 ± 26.8 mL; 2- LVEF: 0.59 ± 0.01; 3- sphericity index: 0.31 ± 0.05. Correlation coefficient (r) between the sphericity index up to seven days after the AMI and the LVEDV at six months (n = 8) after the AMI: r: 0.74, p = 0.0007; (r) between the sphericity index six months after the AMI and the LVEDV at six months after the AMI: r: 0.85, p < 0.0001. CONCLUSION: In this series, LVR has been observed in 38% of the patients six months after the AMI. The three-dimensional sphericity index has been associated to the occurrence of LVR.

Assessing prognosis of pulmonary embolism using tissue-Doppler echocardiography and brain natriuretic peptide.

OBJECTIVE: To assess prognosis of pulmonary thromboembolism using tissue Doppler echocardiography and brain natriuretic peptide. METHODS: Patients aged over 18 years were evaluated within 24 hours of confirmed diagnosis (chest tomography/pulmonary scintigraphy) of pulmonary embolism using two-dimensional echocardiography and tissue Doppler for right ventricular systolic (s') velocities, strain, tissue tracking and myocardial performance index. Plasma brain natriuretic peptide was also obtained within 24 hour. The influence of echocardiographic and clinical variables on mortality was examined (up to 12 months) using Cox regression analysis. RESULTS: Out of 118 patients, 100 patients were included in the study (60 males, aged 55±17 years). Right ventricular dysfunction was observed in 28% using two-dimensional echocardiography. Tissue Doppler right ventricular variables (s' velocities, tissue tracking and strain) were decreased only for patients with right ventricular dysfunction, whereas myocardial performance index and systolic pulmonary artery pressure were increased. Mean brain natriuretic peptide value was 66±111pg/mL, also increased in patients with right ventricular dysfunction (136±146pg/mL). Mortality was 11% and related to age, malignancy and brain natriuretic peptide levels. The only echocardiographic variables capable of predicting events by univariate analysis were pulmonary pressure and right ventricular s' velocity. However, multivariate analysis showed only malignancy to predict mortality in this group. CONCLUSION: Lower tissue Doppler systolic velocities and elevated brain natriuretic peptide levels are associated with poorer prognosis in patients with pulmonary thromboembolism; but only malignancy emerged as an independent predictor of mortality.

Comparação entre Técnicas de Block-Matching e Optical Flow na análise do Strain pela Ecocardiografia / Comparison of Block-Matching and Optical Flow in Strain Echocardiography Analysis

Introdução: Diferentes tecnologias têm sido utilizadas para avaliar a função sistólica do ventrículo esquerdo. De particular interesse, está a ecocardiografia com strain bidimensional (2DSTE). Dois métodos diferentes têm sido usados para quantificar a deformação miocárdica (strain miocárdico) pela 2DSTE: block matching e optical flow. Ambos estão presentes em ecocardiógrafos comercialmente disponíveis. Entretanto, não há consenso a respeito se as medidas do strain longitudinal por estes métodos são sobreponíveis. Objetivo: Comparar os valores de pico do strain miocárdico longitudinal obtidos através da 2DSTE pelos dois diferentes métodos (block matching x optical flow). Método: Foram realizadas as medidas do strain em 16 segmentos miocárdicos do ventrículo esquerdo, conforme orientação da Sociedade Americana de Ecocardiografia pela técnica do block matching (Vivid 7, GE, Horten, Noruega) e, imediatamente após, pela técnica do optical flow (My Lab 60, Esaote, Florença, Itália) de forma randomizada e seus valores foram comparados. Resultados: Houve 28 indivíduos com idade 27,9 ± 7,7 anos, sendo 50% do sexo masculino e todos com fração de ejeção superior a 55%. A medida do strain longitudinal global foi maior pela técnica de block matching (p = 0,02). Na análise dos 16 segmentos, houve 10 segmentos com valores diferentes, em especial os segmentos apicais. Conclusão: Os valores do strain miocárdico longitudinal obtidos por métodos diferentes não são sobreponíveis e devem ser usados com cautela. Sendo assim, valores de normalidade também variam de acordo com o fabricante e o método utilizado

Introduction: Different technologies have been used to evaluate left ventricular systolic function. Of particular interest is the two-dimensional strain echocardiography (2DSTE). Two different methods have been used to quantify myocardial strain by 2DSTE: block matching and optical flow. Both are present in commercially available echocardiographs. However, there is no consensus as to whether the longitudinal strain measures using these methods are overlapping. Objective: To compare the longitudinal myocardial strain peak values obtained through 2DSTE using two different methods (block matching x optical flow). Method: Strain measurements in 16 left ventricular myocardial segments were taken as recommended by the American Society of Echocardiography using block matching (Vivid 7, GE, Horten, Norway) and, immediately after, using optical flow (My Lab 60, Esaote, Florence, Italy) in a randomized way and their values were compared. Results: There were 28 individuals aged 27.9 ± 7.7, of whom 50% were male and all with an ejection fraction greater than 55%. Global longitudinal strain was higher using block matching (p = 0.02). In the analysis of the 16 segments, 10 segments had different values, especially the apical segments. Conclusion: Longitudinal myocardial strain values obtained by different methods are not overlapping and must be used with caution. Normality values also vary according to the manufacturer and the method used

Influência do posicionamento do paciente sobre a qualidade das imagens ecocardiográficas em exames realizados no leito / Influence of patient’s positioning on the quality of bedside echocardiography images

Fundamento: O ecocardiograma é particularmente importante para a avaliação de pacientes instáveis hemodinamicamente. Apesar de sua realização à beira do leito eliminar o risco resultante do transporte, a obtenção de imagens pode ficar prejudicada; o posicionamento adequado poderia contribuir para uma melhor qualidade de imagem e consequentemente análise do exame. Objetivo: Avaliar se o posicionamento do paciente pela enfermagem poderia influenciar a qualidade das imagens ecocardiográficas obtidas no leito. Métodos: Foram estudados de maneira consecutiva os pacientes com solicitação de exame no leito. Durante a realização de ecocardiograma transtorácico foram adquiridos vídeos dos planos para esternal longitudinal (PEL) e apical 4-câmaras(Apical-4C) e a imagem estática do fluxo aórtico (FAo) em decúbito lateral esquerdo (DLE) e em decúbito dorsal (DD). As imagens digitalizadas foram analisadas cegamente por dois observadores em relação ao tipo de decúbito utilizado. A qualidade das imagens foi graduada como 1:boa/ótima; 2:inadequada/ruim; e comparadas com o teste de Kappa e correlação de Pearson. Resultados: Foram estudados 68 pacientes, com idade de 69 ± 24 anos, sendo 37 do sexo masculino e superfície corpórea 1,85 ± 0,09 m2. Em relação aos cortes, as imagens em DLE apresentam melhor qualidade (p < 0,001) quando comparadas ao DD tanto para os vídeos Apical-4C (Kappa 0,19) e PEL (Kappa 0,25) e FAo (Kappa 0,13); a concordância entre os avaliadores para a qualidade das imagens foi de 95%. Conclusão: O posicionamento adequado do paciente no leito em decúbito lateral esquerdo contribui significativamente para a aquisição de imagens de melhor qualidade.

Background: Echocardiography is particularly important for assessing hemodynamically unstable patients. Despite being carried out at the bedside to eliminate the risk resulting from patient’s transportation, the imaging maybe impaired. Proper patient’s positioning could contribute to enhancing both the image quality and analysis of the exam. Objective: To evaluate whether patient’s positioning by nurses could influence the quality of the echocardiographic images obtained at the bedside. Methods: Patients whose examinations were requested to be carried out at the bedside were studied in a consecutive manner. During transthoracic echocardiography, videos of the parasternal longitudinal view (PLV) and 4-chamber apical view (Apical-4C) were obtained, as well as the still image of the aortic flow (FAo), in the left lateral decubitus (LLD) and supine decubitus (SD). The scanned images were blindly analyzed by two observers comparing the type of decubitus used. The image quality was rated as 1: good/excellent quality; 2: inadequate/poor, and then submitted to Kappa agreement test and Pearson correlation. Results: 68 patients were studied, aged 69 ± 24 years, 37 males and body surface 1.85 ± 0.09 m2. When the distinct views were compared, LLD images showed better quality (p < 0.001) when compared to SD for both the Apical-4C videos (Kappa 0.19) and PLV (Kappa 0.25) and FAo (Kappa 0.13); interobserver agreement of the quality of the images was 95%. Conclusion: Patient’s proper positioning in bed in left lateral decubitus contributes significantly to the acquisition of better quality images.

Relation between three-dimensional and two-dimensional echocardiography and biochemical analysis in patients with ST-segment elevation myocardial infarction percutaneously treated.

OBJECTIVE: The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction, submitted to primary percutaneous treatment. METHODS: A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson's correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test. RESULTS: Pearson's correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brain natriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant. CONCLUSIONS: In this series, it was observed better correlation in regard to serum creatine kinase MB, brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.

Análise da função diastólica e função atrial em ciclistas de alto desempenho por meio da ecocardiografia tridimensional / Analysis of diastolic function and atrial function in high performance cyclists through three-dimensional echocardiography

Objetivos: Avaliar a função diastólica e a função atrial esquerda por meio do estudo com Doppler e ecocardiograma tridimensional em ciclistas de alto desempenho; comparar as variáveis estudadas a controles não esportistas. Métodos: Foram estudados 18 ciclistas profissionais (homens, idade 29, 5±4, 3 anos) e 18 indivíduos controles não esportistas (homens, idade 28, 8±5, 8 anos). Todos os indivíduos foram submetidos a ecocardiograma bidimensional e tridimensional com medidas de variáveis de função diastólica e de esvaziamento atrial como volume atrial esquerdo máximo, mínimo e antes de sua contração. Com base nestes volumes fundamentais foram calculadas a função de esvaziamento ativo, passivo e total, bem como a força de contração atrial. Resultados: Os indivíduos de ambos grupos apresentaram variáveis antropométricas semelhantes. Foi observado no grupo ciclista em relação aos controles: menor velocidade da onda A’ (5,9cm/s ± 2,2 versus 7,6 ± 2,3cm/s, com P=0,03), menor força de contração atrial (4,7 ±1,4Kdyn Vs. 6,2 ± 2,1Kdyn, com P= 0,02) e maior fração de esvaziamento passivo (43,8 ± 12,8% versus 34,8 ± 10,4% com P=0,03). Foi observada correlação linear entre a velocidade da onda A’ e a força de contração atrial no grupo dos ciclistas (r=0,80, P<0,05), entre a força de contração atrial e a fração de esvaziamento passivo (r=-0,88, P<0,05) e entre a força de contração atrial e o volume atrial antes de sua contração (r=0,65, P<0,05). Conclusão: O grupo ciclistas apresentou aumento do componente passivo em detrimento de uma redução do componente ativo no esvaziamento atrial total, o que mostrou estar correlacionado à atividade diastólica supernormal nesse grupo.

Objectives: To assess left ventricular diastolic and atrial function by means of Doppler and three-dimensional echocardiography of high-performance cyclists; To compare the variables studied for non-athlete controls. Methods: The study included 18 professional cyclists (men, age 29, 5±4, 3 years) and 18 non-athlete control individuals (men, age 28, 8±5, 8 years). All individuals underwent two-dimensional and three-dimensional echocardiography including measures of diastolic function variables and atrial emptying, such as maximum, minimum and before contraction left atrial volume. Based on these fundamental volumes, active, passive and total emptying function, and atrial contraction strength were calculated. Results: The individuals of both groups had similar anthropometric variables. The following was observed in the cyclist group as for the controls: lower A’ wave velocity (5.9 cm/s ± 2.2 versus 7.6 ± 2.3 cm/s, with P = 0.03), smaller atrial contraction force (4.7 ± 1,4Kdyn vs. 6.2 ± 2.1Kdyn, P = 0.02) and greater passive emptying fraction (43.8% ± 12.8 versus 34.8 ± 10.4% with P = 0.03). A linear correlation was found between A’ wave velocity and atrial contraction force in the cyclists group (r = 0.65, P <0.05), between atrial contraction force and passive emptying fraction (r = 0.80, P <0.05) and between atrial contraction and volume before contraction (r = 0.65, P < 0.05). Conclusion: The cyclists group showed an increase in the passive component to the detriment of a reduction in the active component in total atrial emptying, which was showed to be correlated with supernormal diastolic activity in this group.

Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function.

BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: < 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: > 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight(0.425)) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: > 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

Limitações do Doppler tecidual na avaliação da função diastólica em idosos / Tissue doppler imaging limitations for evaluating the diastolic function in elderly people / Limitaciones del doppler tisular en la evaluación de la función diastólica en añosos

Fundamento: O Doppler tecidual é uma técnica que complementa a análise da função diastólica do ventrículo esquerdo. No entanto, alguns fatores podem influenciar suas medidas, entre estes a idade, cuja contribuição não está adequadamente esclarecida.Objetivo: Comparar o comportamento dos índices de função diastólica derivados do Doppler tecidual em indivíduos idosos hipertensos e não hipertensos.Métodos: Indivíduos com idade acima de 60 anos foram divididos em um grupo controle (GC), sem comorbidades cardiovasculares, e um grupo de hipertensos (HAS). Foram avaliadas as funções sistólica e diastólica (Doppler convencional e tecidual) do ventrículo esquerdo e obtidos os volumes do átrio esquerdo e massa ventricular. Resultados: Foram analisados 56 indivíduos (idade de 70,1 ± 6,6 anos), sendo 23 (41,1%) do GC e 33 (58,9%) do HAS. Os achados ecocardiográficos estruturais foram semelhantes entre os grupos, exceto para hipertrofia ventricular esquerda, mais frequente no HAS (34,4% versus 4,8%; p=0,017). A análise do Doppler tecidual não revelou diferenças entre os grupos (e’ septal: 8,0 ± 1,5 versus 7,2 ± 1,9cm/s; p=0,08 e e’ lateral: 9,8 ± 2,2 versus 8,7 ± 2,0cm/s; p=0,07, respectivamente para o GC e HAS). No HAS observou-se tempo de desaceleração da onda E (TD) mais prolongado (253 ± 62 versus 208 ± 36 ms no GC; p=0,003). Conclusão: Na análise da função diastólica em idosos, o Doppler tecidual não foi capaz de discriminar de forma acurada, indivíduos hipertensos, com maior potencial para a ocorrência de disfunção diastólica, de indivíduos não hipertensos. O TD revelou-se um parâmetro a ser valorizado nesta população.

Background: Tissue Doppler imaging is a technique that complements the analysis of left ventricular (LV) diastolic function. Some factors may influence these parameters, however the true influence of age on Tissue Doppler velocities remains unclear. Objective: To compare the indices of diastolic function derived from tissue Doppler imaging in hypertensive and non-hypertensive elderly individuals. Methods: Subjects aged over 60 years, divided into two groups were studied: a control group (GC) without cardiovascular comorbidities and a hypertensive group (HAS). Left ventricular systolic and diastolic function (conventional and tissue Doppler) was assessed, and measurements of left atrial volumes and LV mass were obtained. Results: The group consisted of 56 subjects (70.1 ± 6.6 years), 23 (41.1%) in the GC and 33 (58.9%) in the HAS. Except for LV hypertrophy, more frequent in the HAS group compared to HG (34.4% versus 4.8% respectively; p=0.017), all structural echocardiographic findings were similar. Tissue Doppler analysis revealed no differences between the groups (septal e’: 8.0 ± 1.5 vs. 7.2 ± 1.9 cm/s; p=0.083 and lateral e’: 9.8 ± 2.2 versus 8.7 ± 2.0 cm/s; p=0.074, respectively, for GC and HAS). A longer E-wave deceleration time was observed for HAS group (253 ± 62 versus 208 ± 36 ms in GC; p=0.003).Conclusion: In the analysis of diastolic function in elderly, tissue Doppler imaging was not able to discriminate hypertensive individuals, with the greatest potential for the occurrence of diastolic dysfunction, to the non-hypertensive individuals.The E-wave deceleration time proved to be a valuable parameter in this population.

Fundamento: El Doppler tisular es una técnica que complementa el análisis de la función diastólica del ventrículo izquierdo. Mientras tanto, algunos factores pueden influenciar sus medidas, entre estos la edad, cuya contribución no está adecuadamente aclarada. Objetivo: Comparar el comportamiento de los índices de función diastólica derivados del Doppler tisular en individuos añosos hipertensos y no hipertensos. Métodos: Individuos con edad encima de 60 años fueron divididos en un grupo control (GC), sin comorbilidades cardiovasculares, y un grupo de hipertensos (HAS). Fueron evaluadas las funciones sistólica y diastólica (Doppler convencional y tisular) del ventrículo izquierdo y obtenidos los volúmenes del atrio izquierdo y de la masa ventricular. Resultados: Fueron analizados 56 individuos (edad de 70,1 ± 6,6 años), siendo 23 (41,1%) del GC y 33 (58,9%) del HAS. Los hallazgos ecocardiográficos estructurales fueron semejantes entre los grupos, excepto para hipertrofia ventricular izquierda, más frecuente en el HAS (34,4% versus 4,8%; p = 0,017). El análisis del Doppler tisular no reveló diferencias entre los grupos (e' septal: 8,0 ± 1,5 versus 7,2 ± 1,9 cm/s; p = 0,08 y e' lateral: 9,8 ± 2,2 versus 8,7 ± 2,0 cm/s; p = 0,07, respectivamente para el GC y HAS). En la HAS, se observó tiempo de desaceleración de la onda E (TD) más prolongado (253 ± 62 versus 208 ± 36 ms en el GC; p = 0,003). Conclusión: En el análisis de la función diastólica en añosos, el Doppler tisular no fue capaz de discriminar, de forma precisa, individuos hipertensos, con mayor potencial para la ocurrencia de disfunción diastólica, de individuos no hipertensos. El TD se reveló un parámetro a ser valorizado en esta población. (Arq Bras Cardiol: Imagem cardiovasc. 2014;27(3):184-190)

Origem anômala da artéria coronária esquerda do tronco pulmonar em criança de sete meses: papel do strain miocárdico após oito anos de acompanhamento / Anomalous origin of the left coronary artery from the pulmonary trunk in a seven-months baby: role of myocardial strain after eight years follow-up / Origen Anómalo de la Arteria Coronaria Izquierda del Tronco Pulmonar en Niño de Siete Meses: Papel del Strain Miocárdico tras Ocho Años de Acompañamiento

Dentre algumas doenças descritas na literatura, a origem anômala da artéria coronariana esquerda é uma das causas de insuficiência cardíaca e isquemia miocárdica nos primeiros meses de vida. Neste relato, apresentamos caso de uma criança que aos sete meses, quando em franca insuficiência cardíaca, foi submetida a um ecocardiograma que evidenciou tronco da artéria coronariana esquerda com origem na artéria pulmonar e fluxo reverso nessa artéria ao mapeamento de fluxo em cores. Submetida a cirurgia corretiva com sucesso, foi seguida por oito anos, evoluindo com fibrose do músculo papilar e consequente insuficiência mitral moderada.

Among some pathologies described in the literature, the anomalous origin of the left coronary artery is a cause of heart failure and myocardial ischemia in the early months of life. Here we report a case of a child who at seven months, when in open heart failure underwent echocardiography showed that the left main coronary artery originating from the pulmonary artery and reverse flow in this artery flow mapping in color. Underwent corrective surgery has successfully been followed for eight years, evolving with papillary muscle fibrosis and moderate mitral regurgitation.

De entre algunas enfermedades descritas en la literatura, el origen anómalo de la arteria coronaria izquierda es una de las causas de insuficiencia cardíaca e isquemia miocárdica en los primeros meses de vida. En el presente informe, presentamos el caso de un niño que a los siete meses, cuando en franca insuficiencia cardíaca, se sometió a un ecocardiograma que evidenció tronco de la arteria coronaria izquierda con origen en la arteria pulmonar y flujo inverso en esta arteria al mapeo de flujo en colores. Sometido a la cirugía correctiva con éxito, fue acompañada por ocho años, evolucionando con fibrosis del músculo papilar y consecuente insuficiencia mitral moderada.