In-hospital COVID-19 infection echocardiographic analysis: a Brazilian, tertiary single-centre experience.

BACKGROUND: Information is lacking concerning in-hospital echocardiography analysis of COVID-19 infection in Brazil. We evaluated echocardiographic parameters to predict a composite endpoint of mortality, pulmonary thromboembolism or acute renal failure. METHODS: A prospective full echocardiographic study of consecutive patients hospitalized with COVID-19, single tertiary centre in Brazil. We correlated echocardiographic findings to biomarkers, clinical information, thoracic tomography, and in-hospital composite endpoint of mortality, pulmonary thromboembolism or renal failure. RESULTS: One hundred eleven patients from March to October 2020, 67 ± 17 years, 65 (58.5%) men, death was observed in 21/111 (18.9%) patients, 48 (43%) required mechanical ventilation, myocardial infarction occurred in 10 (9%), pulmonary thromboembolism in 7 (6.3%) patients, haemodialysis was required for 9 (9.8%). Echocardiography was normal in 51 (46%) patients, 20 (18%) presented with decreased left ventricle ejection, 18 (16.2%) had abnormal left ventricle global longitudinal strain, 35 (31%) had diastolic dysfunction, 6 (5.4%) had an E/e'ratio > 14, 19 (17.1%) presented with right ventricle dilated/dysfunction, 31 (28%) had pericardial effusion. The echocardiographic parameters did not correlate with mortality, biomarkers, clinical events. Tricuspid velocity was related to the composite endpoint of mortality, pulmonary thromboembolism or acute renal failure (p: 00.3; value: 2.65 m/s; AUC ROC curve: 0.739; sensitivity: 73.3; specificity: 66.7; CI: 0.95, inferior: 0.613; superior: 0,866). CONCLUSIONS: Among hospitalized patients with COVID-19, echocardiography was normal in 51(46%) patients, and 20 (18%) patients presented with a decreased left ventricle ejection fraction. Tricuspid velocity was related to the composite endpoint of mortality, pulmonary thromboembolism or acute renal failure.

Right Ventricular Systolic Function After the Cone Procedure for Ebstein's Anomaly: Comparison Between Echocardiography and Cardiac Magnetic Resonance.

Although the Cone procedure has improved outcomes for patients with Ebstein´s anomaly (EA), neither RV systolic function recovery in long-term follow-up nor the best echocardiographic parameters to assess RV function are well established. Thus, we evaluated RV performance after the Cone procedure comparing two-dimensional (2DEcho) and three-dimensional (3DEcho) echocardiography to cardiac magnetic resonance (CMR). We assessed 27 EA patients after the Cone procedure (53% female, median age of 20 years at the procedure, median post-operative follow-up duration of 8 years). Echocardiography was performed 4 h apart from the CMR. RV global longitudinal strain (GLS), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index and tissue Doppler S' velocity were assessed using 2DEcho, whereas 3DEcho was used to evaluate RV volumes and ejection fraction (RVEF). Echocardiographic variables were compared to CMR-RVEF. All patients were in the NYHA functional class I. Median TAPSE was 15.9 mm, FAC 30.2%, and RV-GLS -15%; median RVEF by 3DEcho was 31.9% and 43% by CMR. Among 2DEcho parameters, RV-GLS and FAC had a substantial correlation with CMR-RVEF (r = - 0.63 and r = 0.55, respectively); from 3DEcho, the indexed RV volumes and RVEF were closely correlated with CMR (RV-EDVi, r = 0.60, RV-ESVi, r = 0.72; and RVEF r = 0.60). RV systolic function is impaired years after the Cone procedure, despite a good clinical status. FAC and RV-GLS are useful 2DEcho tools to assess RV function in these patients; however, 3DEcho measurements appear to provide a better RV assessment.

Simplified single plane echocardiography is comparable to conventional biplane two-dimensional echocardiography in the evaluation of left atrial volume: a study validated by three-dimensional echocardiography in 143 individuals.

The left atrial volume index (LAVI) is a biomarker of diastolic dysfunction and a predictor of cardiovascular events. Three-dimensional echocardiography (3DE) is highly accurate for LAVI measurements but is not widely available. Furthermore, biplane two-dimensional echocardiography (B2DE) may occasionally not be feasible due to a suboptimal two-chamber apical view. Simplified single plane two-dimensional echocardiography (S2DE) could overcome these limitations. We aimed to compare the reliability of S2DE with other validated echocardiographic methods in the measurement of the LAVI. We examined 143 individuals (54 ± 13 years old; 112 with heart disease and 31 healthy volunteers; all with sinus rhythm, with a wide range of LAVI). The results for all the individuals were compared with B2DE-derived LAVIs and validated using 3DE. The LAVIs, as determined using S2DE (32.7 ± 13.1 mL/m(2)), B2DE (31.9 ± 12.7 mL/m(2)), and 3DE (33.1 ± 13.4 mL/m(2)), were not significantly different from each other (P = 0.85). The S2DE-derived LAVIs correlated significantly with those obtained using both B2DE (r = 0.98; P < 0.001) and 3DE (r = 0.93; P < 0.001). The mean difference between the S2DE and B2DE measurements was <1.0 mL/m(2). Using the American Society of Echocardiography criteria for grading LAVI enlargement (normal, mild, moderate, severe), we observed an excellent agreement between the S2DE- and B2DE-derived classifications (κ = 0.89; P < 0.001). S2DE is a simple, rapid, and reliable method for LAVI measurement that may expand the use of this important biomarker in routine echocardiographic practice.

Remodelado inverso de aurícula izquierda en pacientes con estenosis de válvula mitral tras valvuloplastia percutánea: estudio ecocardiográfico bidimensional y tridimensional / Left atrium reverse remodeling in patients with mitral valve stenosis after percutaneous valvuloplasty: A 2- and 3-dimensional echocardiographic study

Introducción y objetivos. La aurícula izquierda tiene importancia clínica en pacientes con estenosis de la válvula mitral. El objetivo de este estudio es analizar los efectos de la valvuloplastia percutánea con balón en los volúmenes auriculares izquierdos y la fracción de vaciado auricular izquierdo en pacientes con estenosis de válvula mitral sintomática, mediante el empleo de ecocardiografía transtorácica bidimensional y tridimensional en tiempo real. Métodos. Se llevó a cabo un estudio prospectivo de 28 pacientes consecutivos, 24 de ellos mujeres (85,6%), de 22-72 (media, 39 ± 11,5) años de edad, con estenosis de válvula mitral sintomática a los que se practicó una valvuloplastia percutánea con balón entre marzo de 2009 y mayo de 2011. Se realizaron exploraciones de ecocardiografía transtorácica bidimensional y tridimensional y transesofágica (fibrilación auricular) y una medición invasiva del área de válvula mitral. Se efectuó un análisis ecocardiográfico antes de la valvuloplastia percutánea con balón y a las 72 h y los 12 meses de realizada. Se analizaron los siguientes parámetros: a) área de válvula mitral (planimetría bidimensional, semitiempo de presión, ecocardiografía tridimensional, medición invasiva de parámetros hemodinámicos); b) volúmenes indexados máximo y mínimo de la aurícula izquierda, y c) fracción de vaciado auricular izquierdo. Resultados. Los parámetros tridimensionales de los pacientes con estenosis de válvula mitral antes y 72 h y 12 meses después de la valvuloplastia con balón percutánea fueron los siguientes: a) área de válvula mitral, 0,9 ± 0,1 cm2, 1,8 ± 0,2 cm2 (p < 0,001) y 1,7 ± 0,2 cm2 (p < 0,001); b) volúmenes máximos de la aurícula izquierda, 49,9 ± 12; 42 ± 11,4 (p < 0,001) y 40,3 ± 10,2 ml/m2 (p < 0,001), y c) fracción de vaciado auricular izquierdo, 30,1 ± 9,4%; 40,6 ± 7,4% (p < 0,001) y 44,1 ± 8% (p < 0,001) respectivamente. Conclusiones. En los pacientes con estenosis de válvula mitral sintomática tratados con valvuloplastia percutánea con balón, el análisis mediante ecocardiografía bidimensional y tridimensional mostró una mejora del remodelado inverso de la aurícula izquierda y de la fracción de vaciado auricular izquierdo a las 72 h y a los 12 meses de la intervención(AU)

Introduction and objectives. The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3-dimensional transthoracic echocardiography. Methods. We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 [11.5]) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemodynamic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. Results. The 3-dimensional parameters of the mitral valve stenosis patients before and 72h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm2; 1.8 (0.2) cm2 (P<.001); 1.7 (0.2) cm2 (P<.001); b) left atrium maximum volumes: 49.9 (12) mL/m2; 42 (11.4) mL/m2 (P<.001); 40.3 (10.2) mL/m2 (P<.001), and c) left atrium emptying fraction: 30.1 (9.4%); 40.6 (7.4%) (P<.001); 44.1 (8%) (P<.001), respectively. Conclusions. In symptomatic mitral valve stenosis patients who underwent percutaneous balloon valvuloplasty analysis by 2- and 3-dimensional echocardiography, improvements in left atrium reverse remodeling and left atrium emptying fraction were observed 72h and 12 months after the procedure(AU)

Left atrium reverse remodeling in patients with mitral valve stenosis after percutaneous valvuloplasty: a 2- and 3-dimensional echocardiographic study.

INTRODUCTION AND OBJECTIVES: The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3 -dimensional transthoracic echocardiography. METHODS: We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 [11.5]) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72 h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemodynamic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. RESULTS: The 3-dimensional parameters of the mitral valve stenosis patients before and 72 h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm(2); 1.8 (0.2) cm(2) (P<.001); 1.7 (0.2) cm(2) (P<.001); b) left atrium maximum volumes: 49.9 (12) mL/m(2); 42 (11.4) mL/m(2) (P<.001); 40.3 (10.2) mL/m(2) (P<.001), and c) left atrium emptying fraction: 30.1 (9.4%); 40.6 (7.4%) (P<.001); 44.1 (8%) (P<.001), respectively. CONCLUSIONS: In symptomatic mitral valve stenosis patients who underwent percutaneous balloon valvuloplasty analysis by 2- and 3-dimensional echocardiography, improvements in left atrium reverse remodeling and left atrium emptying fraction were observed 72 h and 12 months after the procedure.

Left atrial dysfunction in chagas cardiomyopathy is more severe than in idiopathic dilated cardiomyopathy: a study with real-time three-dimensional echocardiography.

BACKGROUND: Although there is anatomopathologic evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. The aim of this study was to evaluate LA function in patients with CCM with real-time three-dimensional echocardiography (RT3DE) and to compare it with patients with idiopathic dilated cardiomyopathy (DCM). METHODS: A total of 30 patients with CCM, 30 patients with DCM, and 20 normal subjects used as the control group were studied. With the use of RT3DE, we measured LA maximum (maxLAV), minimum, and pre-atrial contraction volumes and calculated total and active LA emptying fractions. RESULTS: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m(2) was larger in the CCM group than in the DCM group (76.9 ± 21.9 mL vs. 59.1 ± 26.0 mL; P < .01), and both were significantly larger than in the control group (P < .01). Total LA emptying fraction was lower in the CCM group than in the DCM group (0.30 ± 0.10 vs. 0.40 ± 0.12; P < .01), and both were lower than in the control group (P = .01). Active LA emptying fraction was also lower in the CCM group than in the DCM group (0.22 ± 0.09 vs. 0.28 ± 0.11; P < .01), and both were lower than in the control group (P = .01). The E/e' ratio was higher in the CCM group than in the DCM group (21 ± 10 vs. 15 ± 6; P < .01), and both were greater than in the control group (P < .01). In a multiple regression model, the E/e' ratio was the only independent predictor of a worsening active LA emptying fraction. CONCLUSION: LA function is more compromised in patients with CCM than in patients with DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy.

Avanços em ecocardiografia tridimensional: 2010 / New features in three-dimensional echocardiography: 2010

A ecocardiografia em tempo real representa grande avanço para a análise ecocardiográfica das estruturas cardíacas. Atualmente há a possibilidade da análise estrutural a partir de batimento cardíaco único, o que traz maior realidade anatômica à investigação ultrassonográfica e representa potencial aplicação clínica em pacientes portadores de grande irregularidade de ritmo cardíaco.

Real-time three-dimensional echocardiographic left ventricular systolic assessment: side-by-side comparison with 64-slice multi-detector cardiac computed tomography.

AIMS: To investigate by real-time 3D echocardiography (RT3DE) and cardiac computed tomography (CCT) the analysis of left ventricle ejection fraction (LVEF) and volumes. METHODS AND RESULTS: A total of 67 patients (37 males, 55 +/- 11 years) were studied prospectively by RT3DE and by 64-slice CCT. RT3DE data: LVEF ranged from 30 to 78.6% (63.1 +/- 7.33); left ventricular end-diastolic volume (LVEDV) from 44.1 to 210 (104.9 +/- 29.7) mL; left ventricular end-systolic volume (LVESV) from 11.4 to 149 ( 38.9 +/- 19.3) mL. CCT data: LVEF ranged from 28 to 86% (66 +/- 8.4); LVEDV from 51 to 212 (110.3 +/- 31.2) mL; LVESV from 7 to 152 (38.2 +/- 19.2) mL. Correlations relative to RT3DE and CCT were: LVEF (r: 0.79, P < 0.0001); LVEDV (r: 0.82, P < 0.0001); and LVESV (r: 0.91, P < 0.0001). CONCLUSION: It was observed adequate correlation between RT3DE and CCT ventricular systolic function and geometry assessment.

Left ventricular ejection fraction and volumes as measured by 3d echocardiography and ultrafast computed tomography.

BACKGROUND: Real-time three-dimensional echocardiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57+/-12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. STATISTICAL ANALYSIS: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95% CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5+/-5.58)%; end-diastolic volume ranged from 49.6 to 178.2 (87+/-27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1+/-13.6) ml. CT scan measurements: LVEF ranged from 53 to 86% (67.8+/-7.78); end-diastolic volume ranged from 51 to 186 (106.5+/-30.3) ml; end-systolic volume ranged from 7 to 72 (35.5+/-13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95% CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95% CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95% CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.

Analysis of left ventricular regional dyssynchrony: comparison between real time 3D echocardiography and tissue Doppler imaging.

BACKGROUND: There is a paucity of information concerning left ventricular (LV) dyssynchrony assessment by real time three-dimensional (3D) echocardiography (RT3DE) versus tissue Doppler imaging (TDI). AIMS: To compare RT3DE and TDI LV dyssynchrony assessment. METHODS: A prospective study of 92 individuals (56 men, age 47 +/- 10 years), 32 with dilated cardiomyopathy (CMP), and 60 healthy individuals. By RT3DE, we measured the LV% dyssynchrony index (DI) of 6, 12, and 16 segments (SDI). By pulsed-wave TDI, we measured the QS electromechanical interval in the basal segments of the mitral valve annulus of the septum, the lateral, anterior and inferior walls, and the TDI% DI. RESULTS: In the normal group, the 3D DI was 1.1 +/- 0.8%, 1.4 +/- 1.3%, 1.8 +/- 1.7%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient (Pearson's r) for the TDI DI and SDI was r = 0.2381 (P = 0.0470). In CMP group, the 3D DI was 4.6 +/- 5.4%, 7.9 +/- 7.1%, 11.1 +/- 7.1%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient for TDI DI and SDI was r = 0.7838 (P < 0.0001). CONCLUSIONS: We observed a good correlation between RT3DE and tissue Doppler LV dyssynchrony assessment in patients with advanced heart failure.

Fração de ejeção e volumes do ventrículo esquerdo medidos com eco 3D e com tomografia ultra-rápida / Fracción de eyección y volúmenes del ventrículo izquierdo medidos con eco- 3DTR y con tomografía ultrarrápida / Left ventricular ejection fraction and volumes as measured by 3d echocardiography and ultrafast computed tomography

FUNDAMENTO: O ecocardiograma tridimensional em tempo real (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) são dois novos métodos de análise da fração de ejeção e dos volumes do VE. OBJETIVO: Comparar as medidas da FEVE e dos volumes do VE aferidos pelo ECO 3D e pela CT ultra-rápida. MÉTODOS: Foram estudados pelo ECO 3D e pela CT ultra-rápida de 64 cortes, 39 pacientes consecutivos (27 homens, média etária de 57±12 anos). Foram analisados: FEVE e volumes do VE. Análise estatística: coeficiente de correlação (r: Pearson), teste de Bland & Altman, teste de regressão linear, 95 por cento IC, p<0,05. RESULTADOS: Medidas do ECO 3D: a FEVE variou de 56,1 a 78,6 (65,5±5,58) por cento; volume diastólico final variou de 49,6 a 178,2 (87±27,8)ml; volume sistólico final variou de 11,4 a 78 (33,1±13,6)ml. Medidas da CT: a FEVE variou de 53 a 86 (67,8±7,78) por cento; volume diastólico final variou de 51 a 186 (106,5±30,3) ml; volume sistólico final variou de 7 a 72 (35,5±13,4)ml. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7888, p<0,0001, 95 por cento IC 0,6301 a 0,8843); volume diastólico final (r: 0,7695, p<0,0001, 95 por cento IC 0,5995 a 0,8730); volume sistólico final (r: 0,8119, p<0,0001, 95 por cento IC 0,6673 a 0,8975). CONCLUSÃO: Nesta série, foi observada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D e pela CT ultra-rápida de 64 cortes.

BACKGROUND: Real-time three-dimensional echocargiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57±12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95 percent CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5±5.58) percent; end-diastolic volume ranged from 49.6 to 178.2 (87±27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1±13.6) ml. CT scan measurements: LVEF ranged from 53 to 86 percent (67.8±7.78); end-diastolic volume ranged from 51 to 186 (106.5±30.3) ml; end-systolic volume ranged from 7 to 72 (35.5±13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95 percent CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95 percent CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95 percent CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.

FUNDAMENTO: La ecocardiografía tridimensional en tiempo real (Eco-3DTR) y la tomografía computarizada ultrarrápida (TC ultrarrápida) son dos nuevos métodos de análisis de la fracción de eyección (FE) y de los volúmenes del ventrículo izquierdo (VI). OBJETIVO: Comparar las mediciones de la fracción de eyección del ventrículo izquierdo (FEVI) y de los volúmenes del VI apurados por la Eco-3DTR y por la TC ultrarrápida. MÉTODOS: Se estudiaron, mediante la Eco-3DTR y la TC ultrarrápida de 64 cortes, a 39 pacientes consecutivos (27 varones, promedio de edad de 57±12 años). Se analizaron: FEVI y volúmenes del VI. Análisis estadístico: coeficiente de correlación (r: Pearson), prueba de Bland & Altman, prueba de regresión lineal, 95 por ciento IC, p<0,05. RESULTADOS: Valores de la Eco-3DTR: variación de la FEVI de 56,1 a 78,6 (65,5±5,58) por ciento; variación del volumen diastólico final de 49,6 a 178,2 (87±27,8)mL; variación del volumen sistólico final de 11,4 a 78 (33,1±13,6)mL. Valores de la TC ultrarrápida: variación de la FEVI de 53 a 86 (67,8±7,78) por ciento; variación del volumen diastólico final de 51 a 186 (106,5±30,3) mL; variación del volumen sistólico final de 7 a 72 (35,5±13,4) mL. Las correlaciones entre la Eco-3DTR y la TC ultrarrápida fueron: FEVI (r: 0,7888, p<0,0001, 95 por ciento IC 0,6301 a 0,8843); volumen diastólico final (r: 0,7695, p<0,0001, 95 por ciento IC 0,5995 a 0,8730); volumen sistólico final (r: 0,8119, p<0,0001, 95 por ciento IC 0,6673 a 0,8975). CONCLUSIÓN: En esta serie, se observó una buena correlación entre las mediciones de la FEVI y entre los volúmenes ventriculares apurados por la Eco-3DTR y por la TC ultrarrápida de 64 cortes.

Ventricular dyssynchrony index: comparison with two-dimensional and three-dimensional ejection fraction.

BACKGROUND: Left ventricular (LV) electromechanical coupling (synchrony) is important in the analysis of the systolic performance, especially for the indication of cardiac resynchronization therapy in patients with advanced CHF. OBJECTIVE: To compare LV synchrony as analyzed by real-time three-dimensional (3D) echocardiography (ECHO) with LVEF measurements as obtained with 2D and 3D ECHO. METHODS: Prospective study of 92 individuals (56 men, 47 +/- 10 years of age), of which 60 had normal heart structure (ECHO) and ECG (N group), and 32 had dilated cardiomyopathy (DCM group). Using 3D ECHO, LVEF, volumes and dyssynchrony index (%DI) for 16 LV segments were measured. Using 2D ECHO, LVEF (Simpson's method), and LV systolic and diastolic volumes were measured. STATISTICAL ANALYSIS: Pearson's correlation coefficient, 95% CI, linear regression model, Bland & Altman analysis, p<0.05. RESULTS: %DI ranged from 0.2900 to 28.1000 (5.2014+/-6.3281), 3D LVEF ranged from 0.17 to 0.81 (0.52+/-0.17); and 2D LVEF ranged from 0.3 to 0.69 (0.49+/-0.11). The correlation between DI and 3D LVEF was (r): -0.7432, p<0.0001, CI: -0.8227 to -0.6350, the linear relation between DI (x) and 3D LVEF (y) was y = 19.8124 + (-27.9578) x, p<0.0001. The correlation between DI and 2D LVEF was (r): -0.7012, p<0.0001, CI: -0.7923 to -0.5797. CONCLUSION: In this case series, a good negative correlation was observed between LV electromechanical three-dimensional systolic coupling and LVEF as measured by echocardiography (3D and 2D).

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

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

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

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

Índice de dissincronia ventricular: comparação com a fração de ejeção bidimensional e tridimensional / Ventricular dyssynchrony index: comparison with two-dimensional and three-dimensional ejection fraction

FUNDAMENTO: O acoplamento eletromecânico (sincronia) do ventrículo esquerdo (VE) tem importância na análise da performance sistólica, especialmente para a indicação da terapia de ressincronização cardíaca em pacientes com ICC avançada. OBJETIVO: Comparar a sincronia do VE analisada com ecocardiograma (eco) tridimensional (3D) em tempo real com medidas de FEVE obtidas com ECO 2D e 3D. MÉTODOS: Estudo prospectivo de 92 indivíduos (56 homens, 47±10 anos), 60 com anatomia cardíaca (eco) e ECG normais (Grupo N), 32 com cardiomiopatia dilatada (Grupo CMD). Com o emprego do ECO 3D foram aferidos FEVE, volumes e índice de dissincronia (ID) por cento para 16 segmentos do VE; com o ECO 2D foram medidos FEVE (método de Simpson) e volumes sistólico e diastólico do VE. Análise estatística: coeficiente de correlação (Pearson), 95 por cento IC, teste de regressão linear, teste de Bland & Altman, p<0,05. RESULTADOS: O ID por cento variou de 0,2900 a 28,1000 (5,2014±6,3281), a FEVE 3D variou de 0,17 a 0,81 (0,52±0,17); a FEVE 2D variou de 0,3 a 0,69 (0,49±0,11). A correlação entre ID e FEVE 3D foi (r): -0,7432, p<0,0001, IC: -0,8227 a -0,6350, a relação linear entre ID (x) e FEVE 3D (y) foi y = 19,8124 + (-27,9578) x , p<0,0001. A correlação entre ID e FEVE 2D foi (r): -0,7012, p<0,0001, IC: -0,7923 a -0,5797. CONCLUSÃO: Nesta casuística foi observada boa correlação negativa entre o acoplamento sistólico tridimensional eletromecânico do VE e a FEVE medida ao ecocardiograma (3D e 2D).

BACKGORUND: Left ventricular (LV) electromechanical coupling (synchrony) is important in the analysis of the systolic performance, especially for the indication of cardiac resynchronization therapy in patients with advanced CHF. OBJECTIVE: To compare LV synchrony as analyzed by real-time three-dimensional (3D) echocardiography (ECHO) with LVEF measurements as obtained with 2D and 3D ECHO. METHODS: Prospective study of 92 individuals (56 men, 47 ± 10 years of age), of which 60 had normal heart structure (ECHO) and ECG (N group), and 32 had dilated cardiomyopathy (DCM group). Using 3D ECHO, LVEF, volumes and dyssynchrony index ( percentDI) for 16 LV segments were measured. Using 2D ECHO, LVEF (Simpson's method), and LV systolic and diastolic volumes were measured. Statistical analysis: Pearson's correlation coefficient, 95 percent CI, linear regression model, Bland & Altman analysis, p<0.05. RESULTS: percentDI ranged from 0.2900 to 28.1000 (5.2014±6.3281), 3D LVEF ranged from 0.17 to 0.81 (0.52±0.17); and 2D LVEF ranged from 0.3 to 0.69 (0.49±0.11). The correlation between DI and 3D LVEF was (r): -0.7432, p<0.0001, CI: -0.8227 to -0.6350, the linear relation between DI (x) and 3D LVEF (y) was y = 19.8124 + (-27.9578) x, p<0.0001. The correlation between DI and 2D LVEF was (r): -0.7012, p<0.0001, CI: -0.7923 to -0.5797. CONCLUSION: In this case series, a good negative correlation was observed between LV electromechanical three-dimensional systolic coupling and LVEF as measured by echocardiography (3D and 2D).

Sincronia do ventrículo esquerdo: comparação entre a análise com ecocardiografia tridimensional em tempo real e com o Doppler tecidual / Left ventricular sinchronicity: comparison between real-time tridimensional echocardiography and Tissue Doppler analysis

Objetivo: A análise da sincronia do ventrículo esquerdo pode ser realizada com o emprego da ecocardiografia tridimensional (ECO 3D) e, também, com o Doppler tecidual (DT). O objetivo deste estudo foi comparar a análise do ventrículo esquerdo observada pelos dois métodos. Métodos: Estudo prospectivo com 82 indivíduos (48 homens, média de 51 anos mais ou menos 12 anos), 50 com anatomia cardíaca e eletrocardiograma normais (grupo N), 32 com cardiomiopatia dilatada (grupo CMD) e aumento da duração do QRS. A análise ecocardiográfica foi realizada com ecocardiografia bidimensional, ecocardiografia tridimensional transtorácica, em tempo real, (ECO 3D). Foi realizada a afeição da fração de ejeção do ventrículo esquerdo, dos volumes e dos índices de dissincronia (DI) por cento para 6, 12 e 16 segmentos do ventrículo esquerdo. Com o DT, foram medidos os intervalos eletromecânicos (IQS) dos segmentos basais das paredes septal, lateral, anterior e inferior, e o índice de dissincronia tecidual (ID) por cento. A análise estatística foi feita com a determinação do coeficiênte de correlação (Pearson), IC: 95 por cento, com teste de regressão linear e teste de Bland e Altman. No grupo N, o coeficiente de correlação (r) para DT DI por cento e 3D 6 ID por cento foi de 0,4143, p igual 0,0015; para 3D 12ID por cento (r) foi de 0,2647, p igual 0,0446, e para 3D 16 ID por cento (r) foi de 0,2332, p igual 0,0430. No grupo CMD, (r) para DTI ID por cento e 3D 6 ID por cento foi de: 0,5269, p igual 0,0019; para 3D 12 ID por cento (r) foi de 0,7827, p menor 0,0001; para 3D 16 ID por cento (r) foi de r: 0,7838, p menor 0,0001. Conclusão: Foi observada boa concordância para a análise da dissincronia eletromecânica, com o emprego do Doppler tecidual e com a ecocardiografia tridimensional, em pacientes portadores de insuficiência cardíaca.

A ecocardiografia no chek-up cardiológico / Role of echocardiography in routine cardiovascular evaluation (check-up)

A versatilidade da ecocardiografia como ferramenta diagnóstica justifica seu uso na avaliação individual de pacientes assintomáticos expostos a fatores de risco para doença cardiovascular, embora não seja recomendado no rastreamento de cardiopatia na população geral. Subgrupos especiais de indivíduos assintomáticos que podem se beneficiar da avaliação ecocardiográfica incluem hipertensos, diabéticos, dislipidêmicos, obesos e os com antecedentes familiares de doença cardiovascular, na tentativa de se identificar possíveis alterações estruturais (dilatação e/ou hipertrofia ventricular/atrial) ou funcionais (disfunção sistólica global/regional, disfunção diastólica) sugestivas de comprometimento cardíaco subclínico passível de intervenções profiláticas. Outra área atual de interesse do uso da ecocardiografia em indivíduos assintomáticos é na complementação da avaliação cardiovascular para a prática de exercícios físicos, a fim de se excluir doenças miocárdicas incipientes, sobretudo naqueles com histórico de cardiopatia, aortopatia ou morte súbita na família. Por fim, este artigo avalia o papel diagnóstico e o valor prognóstico da ecocardiografia sob estresse com esforço na detecção da doença arterial coronariana latente, particularmente em mulheres e diabéticos assintomáticos.