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.

The use of echocardiography in type 1 diabetes. / Avaliação ecocardiográfica na diabetes mellitus tipo 1.

INTRODUCTION: Type 1 diabetes (T1D) is a chronic disease with peak incidence in adolescence; it has a major impact on morbidity and mortality, especially cardiovascular. Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure. Echocardiography has led to the identification of early cardiac lesions, despite controversial results in the literature in patients with T1D. OBJECTIVE: The objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two-dimensional Doppler and advanced speckle tracking echocardiography. METHODS: This is a case-control study with 40 asymptomatic, normotensive T1D patients aged 20 to 50 years and 40 healthy subjects. Two-dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers. Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function. RESULTS: The mean age was 33 years in both groups, with an average T1D duration of 18 years; 20% of patients with T1D had diabetic retinopathy; 12.5% kidney injury; and 10% peripheral neuropathy. There were differences in the left ventricular diastolic function parameters (lateral E', middle E' and S/D ratio) and right ventricle (tricuspid E and tricuspid E'/A' ratio). The mean value of the global longitudinal strain was -21.7% (+- 2.3) in the T1D group and -21.0% (+-2.0) in the control group (p=0.21). CONCLUSION: Echocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group, which may be the initial cardiac lesion in diabetes.

Síndrome da ativação do macrófago em paciente com artrite idiopática juvenil poliarticular / Macrophage activation syndrome in a patient with polyarticular juvenile idiopathic arthritis

A linfohistiocitose hemofagocítica caracteriza-se por ativação e proliferação excessiva de linfócitos e macrófagos. Quando associada à artrite idiopática juvenil é também conhecida por ôsíndrome de ativação do macrófagoö, sendo uma complicação potencialmente fatal desta doença. Apresentamos o caso de uma mulher de 26 anos portadora de artrite idiopática juvenil (poliartrite, fator reumatóide negativo), com diagnóstico aos 13 anos, em uso de antiinflamatórios não esteroidais (diclofenaco, nimesulide). Admitida com quadro de resposta inflamatória sistêmica, febre, linfonodomegalia, esplenomegalia, anemia, trombocitopenia, hipofibrinogenemia, hiperferritinemia, hipertrigliceridemia e achados de hematofagocitose na medula óssea. Os autores discutem aspectos relacionados com a patogênese, diagnóstico e tratamento desta doença pouco conhecida.