Echocardiographic evaluation after pediatric heart transplant in Chile: initial application of a functional protocol with global longitudinal strain. / Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global.

INTRODUCTION: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. OBJECTIVE: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. PATIENTS AND METHOD: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. RESULTS: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. CONCLUSIONS: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.

Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global / Echocardiographic evaluation after pediatric heart transplant in Chile: initial application of a functional protocol with global longitudinal strain

Resumen: Introducción: La evaluación ecocardiográfica de pacientes post-trasplante cardiaco pediátrico es una herramienta útil. Sin embargo, aún es necesario definir un protocolo óptimo de seguimiento. Obje tivo: Caracterizar los resultados de la aplicación de un protocolo de evaluación ecocardiográfica fun cional en pacientes en control post-trasplante cardiaco pediátrico ortotópico. Pacientes y Método: Posterior al trasplante cardiaco pediátrico se realizó una ecocardiografía con un protocolo funcional que incluyó strain longitudinal global. Se evaluaron además los datos de la biopsia endomiocárdica y del estudio hemodinámico contemporáneos. Resultados: De un total de 9 pacientes sólo 1 presentó disfunción sistólica de ventrículo izquierdo según parámetros clásicos, pero casi la totalidad presentó un strain longitudinal global alterado. No se observaron episodios de rechazo moderado o severo en estos pacientes. Todos los pacientes presentaban disfunción sistólica ventricular derecha. No se ob servó correlación entre estos parámetros y la presión de arteria pulmonar. Conclusiones: Se observó disfunción sistólica biventricular subclínica en la mayoría de los pacientes de esta serie. No hubo aso ciación con episodios de rechazo o con hipertensión pulmonar, lo que podría estar en relación con la ausencia de episodios de rechazo moderado o severo en la biopsia contemporánea y con el reducido tamaño muestral. Sólo el seguimiento a largo plazo de estos pacientes permitirá definir la relevancia clínica de los hallazgos descritos.

Abstract: Introduction: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. Objective: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. Patients and Method: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. Results: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. Conclusions: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.

Doppler echocardiographic criteria in patency assessment of composite grafts from left internal thoracic artery.

OBJECTIVES: The purpose of our study was to establish, with an entirely noninvasive method, transthoracic Doppler echocardiography, criteria for patency of composite left internal thoracic artery grafts when placed on the left anterior descending artery and other branches of the left coronary system. METHODS: The control group comprised 20 patients with single graft and 20 patients with composite graft; all forty having their patency confirmed by coronary angiogram (CA). In this control group, two Doppler echocardiographic variables, diastolic mean velocity-time and integral diastolic peak velocity to systolic peak velocity ratio were recorded. For each variable, established cut-off points were established, using the ROC (Receiver Operator Characteristic) curves, to identify criteria which could differentiate the composite grafts. Only patients with composite grafts were included in the 159-patients study group. The criteria established by the cut-off points in the control group were then applied to detect patency using a diastolic fraction of > 0.5 as the gold standard. The sensitivity, specificity, and positive and negative predictive values of these two criteria were determined. RESULTS: In the control group, cut-off points of 0.71 and 0.09 m were established for the diastolic peak velocity/systolic peak velocity ratio and for diastolic mean velocity-time integral, respectively. In the study group phase, the sensitivity and negative predictive value of the diastolic peak velocity/systolic peak velocity > 0.71 criterion were 36% and 11%, respectively. Diastolic mean velocity-time integral > 0.09 m criterion, were 40% and 10.48%. The specificities and positive predictive values of each criterion were 100%. CONCLUSION: Values reaching the criteria established for each variable indicate high probability of composite graft patency. Lower values have a large proportion of false negatives and are not conclusive as patency criteria.

Doppler echocardiographic criteria in patency assessment of composite grafts from left internal thoracic artery / Parâmetros Dopplerfluxométricos de perviedade do enxerto composto de artéria torácica interna esquerda

OBJECTIVES: The purpose of our study was to establish, with an entirely noninvasive method, transthoracic Doppler echocardiography, criteria for patency of composite left internal thoracic artery grafts when placed on the left anterior descending artery and other branches of the left coronary system. METHODS: The control group comprised 20 patients with single graft and 20 patients with composite graft; all forty having their patency confirmed by coronary angiogram (CA). In this control group, two Doppler echocardiographic variables, diastolic mean velocity-time and integral diastolic peak velocity to systolic peak velocity ratio were recorded. For each variable, established cut-off points were established, using the ROC (Receiver Operator Characteristic) curves, to identify criteria which could differentiate the composite grafts. Only patients with composite grafts were included in the 159-patients study group. The criteria established by the cut-off points in the control group were then applied to detect patency using a diastolic fraction of > 0.5 as the gold standard. The sensitivity, specificity, and positive and negative predictive values of these two criteria were determined. RESULTS: In the control group, cut-off points of 0.71 and 0.09m were established for the diastolic peak velocity/systolic peak velocity ratio and for diastolic mean velocity-time integral, respectively. In the study group phase, the sensitivity and negative predictive value of the diastolic peak velocity/systolic peak velocity > 0.71 criterion were 36% and 11%, respectively. Diastolic mean velocity-time integral > 0.09m criterion, were 40% and 10.48%. The specificities and positive predictive values of each criterion were 100%. CONCLUSION: Values reaching the criteria established for each variable indicate high probability of composite graft patency. Lower values have a large proportion of false negatives and are not conclusive as patency criteria.

OBJETIVO: O objetivo deste estudo é estabelecer parâmetros preditores de perviedade, avaliados por Dopplerfluxometria, do enxerto composto de artéria torácica interna esquerda, quando revasculariza a artéria interventricular anterior e outro ramo do sistema esquerdo. MÉTODOS: O grupo controle foi formado por 20 pacientes com enxerto simples e 20 pacientes com enxerto, composto cuja perviedade foi confirmada por cineangiocoronariografia. No grupo controle, as variáveis de fluxo relação velocidade pico diastólico/velocidade pico sistólico e integral da velocidade média/tempo na diástole foram registradas. Para cada variável, estabeleceram-se pontos de corte para identificar enxertos compostos, usando-se curvas ROC (receiver operator characteristic). No grupo estudo, foram avaliados 159 pacientes com enxerto composto, determinando-se os dois parâmetros de fluxo. Pontos de cortes estabelecidos no grupo controle foram usados para determinar sensibilidade, especificidade, valores preditivos positivo e negativo de cada variável relacionada à perviedade dos enxertos, tomando-se como referência a fração diastólica > 0,5. RESULTADOS: No grupo controle, os pontos de corte estabelecidos para as variáveis velocidade pico diastólico/velocidade pico sistólico e integral velocidade média/tempo na diástole foram, respectivamente, 0,71 e 0,09m. No grupo estudo, a sensibilidade para a velocidade pico diastólico/velocidade pico sistólico e integral da velocidade média/tempo na diástole, considerando seus pontos de corte, foi de 36,4% e 40%, respectivamente. Os respectivos valores preditivos negativos foram 11% e 10.48%, enquanto especificidade e valor preditivo positivo foram de 100% para os dois parâmetros. CONCLUSÃO: Valores maiores ou iguais aos estabelecidos para cada variável indicam alta probabilidade de perviedade do enxerto composto. Valores inferiores apresentam grande proporção de falsos negativos, não sendo conclusivos quanto à perviedade.

Ecocardiografia-doppler e parâmetros hemodinâmicos em cardiopatias congênitas com hiperfluxo pulmonar / Doppler echocardiography and hemodynamic parameters in congenital heart disease with increased pulmonary flow

FUNDAMENTO: A predição de dados de hemodinâmica pulmonar, a partir de avaliação não invasiva, poderia isentar alguns portadores de defeitos septais cardíacos congênitos da avaliação invasiva pré-operatória (cateterismo). OBJETIVO: Verificar, em avaliação simultânea, se dados obtidos pela ecocardiografia-Doppler poderiam predizer aspectos da condição hemodinâmica pulmonar em tais pacientes. MÉTODOS: Parâmetros ecocardiográficos relacionados ao fluxo sistólico pulmonar e sistêmico e ao fluxo em veia pulmonar foram relacionados a dados hemodinâmicos em 30 pacientes consecutivos com defeitos septais cardíacos (idade entre 4 meses e 58 anos, mediana 2,2 anos; pressão arterial pulmonar média entre 16 e 93 mmHg). RESULTADOS: As variáveis integral velocidade-tempo do fluxo sistólico em via de saída de ventrículo direito (VTI VSVD > 22 cm) e do fluxo em veia pulmonar (VTI VP > 20 cm) foram preditivos de níveis RVP/RVS <; 0,1 (relação entre resistências vasculares pulmonar e sistêmica), com especificidade de 0,81 e razão de chances acima de 1,0. Para valores VTI VSVD > 27 cm e VTI VP > 24 cm, a especificidade foi superior a 0,90 e a razão de chances 2,29 e 4,47 respectivamente. A razão entre os fluxos pulmonar e sistêmico (Qp/Qs > 2,89 e > 4,0, estimativas ecocardiográficas) foi útil na predição de valores Qp/Qs > 3,0 pelo cateterismo (especificidade de 0,78 e 0,91, razão de chances 1,14 e 2,97, respectivamente). CONCLUSÃO: Em portadores de defeitos septais cardíacos, a ecocardiografia-Doppler é capaz de identificar aqueles em situação de aumento de fluxo e baixos níveis de resistência vascular pulmonar.

BACKGROUND: The prediction of pulmonary hemodynamic data from non-invasive assessment could exempt some patients with congenital cardiac septal defects from preoperative invasive assessment (catheterization). OBJECTIVE: To determine, in simultaneous assessment, whether data obtained from Doppler echocardiography could predict aspects of pulmonary hemodynamics in such patients. METHODS: Echocardiographic parameters related to systolic and systemic pulmonary flow and pulmonary venous flow were related to hemodynamic data in 30 consecutive patients with cardiac septal defects (aged 4 months to 58 years, median 2.2 years, mean pulmonary artery pressure between 16 and 93 mmHg). RESULTS: The velocity-time integrals of systolic flow in right ventricle outflow tract (VTI RVOT > 22 cm) and pulmonary venous flow (VTI VP > 20 cm) predicted PVR/SVR <; 0.1 levels (pulmonary vascular resistance and systemic vascular resistance ratio), with a specificity of 0.81 and odds ratio above 1.0. For VTI RVOT > 27 cm and VTI PV > 24 cm values, the specificity was higher than 0.90 and odds ratio 2.29 and 4.47 respectively. The ratio between pulmonary and systemic flows (Qp/Qs > 2.89 and > 4.0, echocardiographic estimates) was useful in predicting Qp/Qs > 3.0 values through catheterization (specificity of 0.78 and 0.91, odds ratio 1.14 and 2.97, respectively). CONCLUSION: In patients with cardiac septal defects, Doppler echocardiography is able to identify those at increased flow and low pulmonary vascular resistance.

[Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis]. / Alterações ecocardiográficas em pacientes com insuficiência renal crônica em programa de hemodiálise.

Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies.

[Doppler echocardiography and hemodynamic parameters in congenital heart disease with increased pulmonary flow]. / Ecocardiografia-Doppler e parâmetros hemodinâmicos em cardiopatias congênitas com hiperfluxo pulmonar.

BACKGROUND: The prediction of pulmonary hemodynamic data from non-invasive assessment could exempt some patients with congenital cardiac septal defects from preoperative invasive assessment (catheterization). OBJECTIVE: To determine, in simultaneous assessment, whether data obtained from Doppler echocardiography could predict aspects of pulmonary hemodynamics in such patients. METHODS: Echocardiographic parameters related to systolic and systemic pulmonary flow and pulmonary venous flow were related to hemodynamic data in 30 consecutive patients with cardiac septal defects (aged 4 months to 58 years, median 2.2 years, mean pulmonary artery pressure between 16 and 93 mmHg). RESULTS: The velocity-time integrals of systolic flow in right ventricle outflow tract (VTI RVOT > or = 22 cm) and pulmonary venous flow (VTI VP > or = 20 cm) predicted PVR/SVR <; 0.1 levels (pulmonary vascular resistance and systemic vascular resistance ratio), with a specificity of 0.81 and odds ratio above 1.0. For VTI RVOT > or = 27 cm and VTI PV > 24 cm values, the specificity was higher than 0.90 and odds ratio 2.29 and 4.47 respectively. The ratio between pulmonary and systemic flows (Qp/Qs > 2.89 and > or = 4.0, echocardiographic estimates) was useful in predicting Qp/Qs > 3.0 values through catheterization (specificity of 0.78 and 0.91, odds ratio 1.14 and 2.97, respectively). CONCLUSION: In patients with cardiac septal defects, Doppler echocardiography is able to identify those at increased flow and low pulmonary vascular resistance.

Alterações ecocardiográficas em pacientes com insuficiência renal crônica em programa de hemodiálise: [revisão] / Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis: [review] / Alteraciones ecocardiográficas en pacientes con insuficiencia renal crónica en programa de hemodiálisis: [revisión]

Alterações de estrutura e função cardíacas detectadas pela ecocardiografia são comuns em pacientes com doença renal crônica em hemodiálise e predizem um pior prognóstico. Esta revisão aborda recentes evidências da utilidade do método na detecção da disfunção cardíaca clínica e subclínica, estratificação do risco cardiovascular e avaliação das estratégias de intervenção terapêutica.

Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies.

Alteraciones de estructura y función cardíacas detectadas por ecocardiografía son comunes en pacientes con enfermedad renal crónica en hemodiálisis y predicen un peor pronóstico. Esta revisión aborda recientes evidencias de la utilidad del método en la detección de la disfunción cardíaca clínica y subclínica, estratificación del riesgo cardiovascular y evaluación de las estrategias de intervención terapéutica.

Internal thoracic artery graft (ITAG): patency and functional status at rest and during dobutamine-stress echocardiography.

BACKGROUND: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI). OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (> 50% and <100%) and Group III (GIII) had 7 ITAG with total occlusion. Diameters and Doppler spectrums from the ITAG at rest and during DSE were evaluated. RESULTS: Considering patency a DF >50%, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81%, 86%, 98%, 35% and 82%, and 100%, at rest and 71%, 97%, 100% and 97% in the DSE. The ITAG with DF>50% at rest were patent and the ones with DF<50% in the DSE presented total occlusion. Considering a CRI>1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79%, specificity=85.7%, PPV=94%, NPV=59% and accuracy= 80.9%. The CRI in GI was higher (p= 0.02) than in GII or GIII. CONCLUSION: In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status.

Internal thoracic artery graft (ITAG): patency and functional status at rest and during dobutamine-stress echocardiography / Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina

FUNDAMENTO: A artéria torácica interna enxertada (ATIE) patente usualmente tem fração diastólica (FD)> 50 por cento do fluxo. O estado funcional pode ser avaliado pelo índice de reserva coronariano (IRC). OBJETIVO: Avaliar, pela ecocardiografia e pelo Doppler em nível supraclavicular, a patência e o estado funcional da ATIE. MÉTODOS: Foram coletados prospectivamente e analisados os dados de 66 pacientes submetidos a ecocardiograma sob estresse com dobutamina (EED). O grupo I (GI) ocorreu com 49 ATIE sem estenose. No grupo II (GII) (10 ATIE) havia estenose significativa (> 50 por cento e <100 por cento). E no grupo III (GIII) (7 ATIE) a oclusão era de 100 por cento. Foram avaliados diâmetros e espectros do Doppler das ATIE no repouso e EED. RESULTADOS: Considerando patência uma FD>50 por cento, ocorreu em 49 ATIE (GI=40, GII=8 e GIII=1) no repouso e em 61 ATIE (GI=49, GII=10 e GIII=2) durante EED. Sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram, respectivamente, em repouso, 81 por cento, 86 por cento ,98 por cento, 35 por cento e 82 por cento; e no EED, 100 por cento, 71 por cento, 97 por cento, 100 por cento e 97 por cento. As ATIE com FD>50 por cento em repouso estavam patentes e as com FD<50 por cento no EED tinham oclusão total. Considerando para bom estado funcional um IRC>1,8, isso ocorreu em 42 ATIE (39 do GI, 2 do GII e 1 GIII), verificando-se sensibilidade = 79 por cento; especificidade = 85,7 por cento; VPP = 94 por cento; VPN = 59 por cento; e acurácia = 80,9 por cento. O IRC no GI foi maior (p=0,02) que em GII e GIII. CONCLUSÃO: Em nosso estudo, a avaliação não-invasiva da ATIE foi efetiva para verificar patência e estado funcional.

BACKGROUND: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50 percent of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI). OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (> 50 percent and <100 percent) and Group III (GIII) had 7 ITAG with total occlusion. Diameters and Doppler spectrums from the ITAG at rest and during DSE were evaluated. RESULTS: Considering patency a DF >50 percent, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81 percent, 86 percent, 98 percent, 35 percent and 82 percent, and 100 percent, at rest and 71 percent, 97 percent, 100 percent and 97 percent in the DSE. The ITAG with DF>50 percent at rest were patent and the ones with DF<50 percent in the DSE presented total occlusion. Considering a CRI>1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79 percent, specificity=85.7 percent, PPV=94 percent, NPV=59 percent and accuracy= 80.9 percent. The CRI in GI was higher (p= 0.02) than in GII or GIII. CONCLUSION: In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status.

[Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: a preliminary report]. / Determinación y análisis comparativo de gasto cardíaco en enfermos críticos mediante Doppler transesofágico y termodilución en bolos: experiencia preliminar.

BACKGROUND: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. AIM: To compare both methods of cardiac output measurement. MATERIAL AND METHODS: Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60+/-12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. RESULTS: Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. CONCLUSIONS: Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique. This preliminary experience must be confirmed in a larger series.

Determinación y análisis comparativo de gasto cardíaco en enfermos críticos mediante Doppler transesofágico y termodilución en bolos: Experiencia preliminar / Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: A preliminary report

Background: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. Aim: To compare both methods of cardiac output measurement. Material and methods: Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60±12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. Results: Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. Conclusions:Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique. This preliminary experience must be confirmed in a larger series.

[The role of echocardiography as an isolated method for indicating surgery in patients with congenital heart disease]. / O papel do ecocardiograma como método isolado na indicação cirúrgica de pacientes portadores de cardiopatia congênita.

OBJECTIVE: To determine the diagnostic accuracy of echocardiography for indicating surgery without catheterization in patients with congenital heart disease through a prospective analysis and comparison of the echocardiographic diagnosis with the intraoperative findings, or invasive study, or both. METHODS: From February 2000 to January 2001, 493 patients with congenital heart diseases indicated for surgery were followed up. They underwent echocardiography with color-flow mapping for a therapeutic decision. The results were compared with the findings of surgery or catheterization, or both, when the latter were performed for diagnostic reasons. RESULTS: Of the patients studied, 94.3% (465 cases) underwent congenital heart disease correction based only on echocardiographic findings, without a diagnostic catheterization. The invasive study was performed for diagnostic reasons in 28 (5.6%) patients, the surgical treatment was performed in more than 95% of the patients, and therapeutic catheterization was performed in 3.6%. The echocardiographic findings were confirmed in 464 (94.1%) patients, which showed the high accuracy of the method. False-positive findings occurred in 8 (1.6%) patients, and false-negative findings in 39 (7.9%). According to surgeons, no diagnostic error led to complications or adversely affected the surgical results. CONCLUSION: Echocardiography proved to be a sensitive and safe method for indicating surgery, making catheterization, often, unnecessary. The invasive study was restricted to diagnostic or therapeutic uses.

O papel do ecocardiograma como método isolado na indicação cirúrgica de pacientes portadores de cardiopatia congênita / The role of echocardiography as an isolated method for indicating surgery in patients with congenital heart disease

OBJETIVO: Determinar a acurácia diagnóstica do ecocardiograma, analisando prospectivamente, o valor do método na indicação cirúrgica sem cateterismo em portadores de cardiopatia congênita, através da comparação do diagnóstico ecocardiográfico com os achados intra-operatórios e/ou do estudo invasivo. MÉTODOS: De fevereiro/2000 a janeiro/2001, foram acompanhados 493 pacientes cardiopatas congênitos com indicação cirúrgica, submetidos a ecocardiograma com mapeamento de fluxo em cores para decisão terapêutica. Os resultados foram comparados aos achados cirúrgicos e/ou de cateterismo quando realizado para complementação diagnóstica. RESULTADOS: Dos pacientes estudados, 94,3 por cento (465 casos) foram submetidos à correção da cardiopatia congênita apenas com o ecocardiograma e sem cateterismo diagnóstico. O estudo invasivo foi realizado para complementação diagnóstica em 28 (5,6 por cento) casos, o tratamento cirúrgico realizado em mais de 95 por cento dos casos e o cateterismo terapêutico em 3,6 por cento. Os achados do ecocardiograma se confirmaram em 464 (94,1 por cento) dos casos, demonstrando uma alta acurácia do método. Ocorreram 8 (1,6 por cento) casos de falso positivos e 39 (7,9 por cento) casos de falso negativos. Segundo os cirurgiões, nenhum dos erros diagnósticos levaram a complicações ou afetaram os resultados cirúrgicos adversamente. CONCLUSAO: O ecocardiograma se mostrou método sensível e seguro para indicação cirúrgica, dispensando, muitas vezes, a realização de estudo invasivo, ficando este, restrito aos casos de complementação diagnóstica ou terapêutica.

Reference values from M-mode and Doppler echocardiography for normal Syrian hamsters.

AIMS: Echocardiography has recently been introduced to small animal research, allowing serial measurements of cardiac diseases. In addition, the hamster model has been increasingly used, as it mimics many human heart conditions. However, no reference range of echocardiographic values reflecting normal left ventricular (LV) function exists for hamsters. The purpose of this study was to provide one. METHODS AND RESULTS: The study group consisted of 118 10-week-old, female, Syrian golden hamsters, which underwent high-resolution echocardiography. LV mass was calculated using the corrected cube formula, and LV systolic and diastolic function were assessed by fractional shortening and mitral inflow pulsed-wave Doppler, respectively. The myocardial performance index (MPI) measured the time spent in isovolumic activity and reflected both systolic and diastolic function. The mean+/-SD LV mass, fractional shortening, and MPI were 0.19+/-0.04 g, 44.7+/-6.6%, and 0.39+/-0.1, respectively. E and A waves were differentiated in 52% of all animals. Logistic regression adjusted with a cutoff of 378 bpm revealed that the risk of E/A wave fusion was 35 times greater (95% CI: 12.6; 98.4) in animals with a heart rate >378 bpm. CONCLUSION: This study documents echocardiographic characteristics in normal Syrian hamsters, which can be used as control values for future studies.

Deteccion de las alteraciones de la funcion diastolica en hipertension arterial mediante ecocardiografia doppler y medicina nuclear / Detection of diastolic function alterations in arterial hypertension by doppler echocardiography and nuclear medicine

Conscientes de la importancia de las alteraciones de la relajacion y de la adaptabilidad ventriculares como componentes de la cardiopatia hipertensiva, estudiamos 12 pacientes con hipertension arterial leve y 12 hipertensos severos. Doce voluntarios sanos conformaron el grupo control. A cada uno se le realizo ecocardiograma Doppler y con base en el registro de flujo mitral se determinaron los intervalos de relajacion isometrica (RI) y de aceleracion mitral (TA) y las velocidades diastolicas temprana (E) y tardia (A). Por medicina nuclear se determino el teimpo de llenado rapido (TLLR). Encontramos los siguientes valores normales: RI=76+-26.3, TA=70+-12.2, E=63+-13.6, A=33.3+-10.7, TLLR=145.5+-29.6. El periodo de RI estaba prolongado en los hipertensos leves (96.7+-18, p<0.05) y severos (85+-30). La alteracion mas significativa fue un gran incremento en la velocidad A en los hipertensos leves (66+-16) y severos )79+-25), elevando la proporcion A/E hasta valores superiores a 1 (p<0.001). Establecemos, por primera vez en nuestro medio, valores normales de funcion diastolica. En la hipertension arterial estos se alteran precozmente, elevandose la velocidad A y la proporcion A/E y tambien se prolonga el periodo RI