Congestão pulmonar em insuficiência cardíaca com fração de ejeção reduzida: comparação entre o ultrassom de pulmão e o dispositivo dielétrico remoto / Pulmonary congestion in heart failure with reduced ejection fraction: comparison between lung ultrasound and remote dielectric sensing

INTRODUÇÃO: A avaliação de congestão pulmonar ambulatorial em pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFER) pode minimizar internações por descompensação e otimizar o uso de diuréticos. OBJETIVO: Comparar o dispositivo dielétrico remoto (DDR), equipamento validado para detectar líquido extravascular pulmonar, com parâmetros clínicos, medidas de ecocardiograma transtorácico (ETT) e ultrassom de pulmão (ULSP). MÉTODOS: Incluímos 38 pacientes do ambulatório de miocardiopatias (63±12 anos; 21 homens). Todos foram submetidos, num período de 24 horas, à avaliação clínica com descrição de dispneia paroxística noturna, edema de membros inferiores (EMI), presença de tonturas; avaliação laboratorial de NT-ProBNP; avaliação pelo DDR e ETT com análise de parâmetros de congestão sistêmica pela veia cava inferior, função do ventrículo direito e de congestão pulmonar, como a avaliação das pressões de enchimento por meio E/e' médio e volume indexado do átrio esquerdo. O ULSP foi realizado com o protocolo de 8 quadrantes anteriores, com contagem de linhas B em um ciclo respiratório. RESULTADOS: 22 pacientes apresentavam DDR ≥ 35% (congestão pulmonar) e 16 pacientes DDR < 35%. Parâmetros clínicos e ecocardiográficos foram comparados com o DDR ≥ 35%. Na análise multivariada, as variáveis superfície corpórea (SC), linhas B e EMI se associaram a DDR ≥ 35%. NT-ProBNP foi semelhante e elevado em ambos os grupos. CONCLUSÕES: O acompanhamento ambulatorial de ICFER para controle volêmico pode ser sensibilizado pela presença de linhas B no ULSP, que apresenta boa correlação com DDR ≥ 35%. NT-ProBNP não foi capaz de diferenciar pacientes com maior grau de congestão detectado pelo DDR.

BACKGOUND: Outpatient assessment of pulmonary congestion in patients with heart failure with reduced ejection fraction (HFREF) can minimize hospitalizations due to decompensation and optimize the use of diuretics. OBJECTIVE: To compare the remote dielectric sensor (REDS), a validated device for detecting pulmonary extravascular fluid, with clinical parameters, transthoracic echocardiogram (TTE) and lung ultrasound (ULSP). METHODS: We included 38 patients from heart failure clinic (63±12 years; 21 men). All were submitted within 24 hours to clinical evaluation with description of paroxysmal nocturnal dyspnea, leg edema (LE), presence of dizziness; laboratory evaluation of NT-ProBNP; evaluation by SDR and TTE with analysis of parameters of systemic congestion by the inferior vena cava evaluation, function of the right ventricle and of pulmonary congestion, such as evaluation of filling pressures by average of E/e' and indexed left atrial volume. The ULSP was performed using the 8 points anterior quadrants protocol, counting B lines in one respiratory cycle. RESULTS: 22 patients had REDS ≥ 35% (indicative of pulmonary congestion) and 16 patients REDS < 35%. Clinical and echocardiographic parameters were compared with REDS ≥ 35%. In the multivariate analysis, the variables body surface area, B lines and LE were associated with REDS ≥ 35%. NT-ProBNP was similar and elevated in both groups. CONCLUSIONS: Outpatient monitoring of HFREF for volume control can be sensitized by the presence of B lines on the ULSP with good correlation to REDS ≥ 35%. NT pro BNP was not able to differentiate patients with congestion detected by REDS.

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.

Relação entre o ultrassom de pulmão e o sensor dielétrico remoto na detecção de congestão pulmonar ambulatorial em pacientes com insuficiência cardíaca crônica / Relationship between lung ultrasound and remote dielectric sensor in the detection of ambulatory pulmonary congestion in patients with chronic heart failure

INTRODUÇÃO: A avaliação de congestão pulmonar ambulatorial em pacientes com insuficiência cardíaca crônica (ICC) é essencial para minimizar internações por descompensação e otimizar o uso de diuréticos, diminuindo o risco de lesões renais. OBJETIVO: Comparar o sensor dielétrico remoto (SDR), dispositivo validado para detecção de quantidade de líquido pulmonar com medidas de ecocardiograma transtorácico (ETT) e ultrassom de pulmão (ULSP). MÉTODOS: Incluímos 38 pacientes (63±12 anos; 21 homens), provenientes do ambulatório de miocardiopatias em uso de altas doses de diuréticos. Todos foram submetidos em 24 horas a avaliação clínica; laboratorial de NT pró BNP; avaliação pelo SDR (congestão pulmonar se SDR>35%); ETT com análise veia cava inferior (VCI), função do ventrículo direito (VD) pelo Doppler tecidual do anel tricúspide (S) e excursão lateral do anel tricúspide (TAPSE), fração de ejeção (FE) do ventrículo esquerdo (VE), integral das velocidades (VTI) da via de saída do VE e avaliação das pressões de enchimento por meio E/e' médio e volume indexado do átrio esquerdo (VAE). O ULSP foi realizado com o protocolo de 8 quadrantes anteriores, com contagem de linhas B em um ciclo respiratório. RESULTADOS: Dados clínicos como superfície corpórea (SC), gênero, presença de tonturas, dispneia paroxística noturna e edema de membros inferiores (EMI); NT pró BNP; dados ETT como VAE, VTI da via de saída VE, relação de E/e' médio, SVD, TAPSE, análise da VCI e contagem de linhas B foram comparados com o ajuste de modelos de Poisson com variância robusta para o resultado de SDR> 35%. Na análise multivariada as variáveis SC pela razão de prevalência ajustada (RPA): 8,7 (2,7;27,8), p=0,003; SVD RPA: 1,12 (1,00;1,04), p=0,03; linhas B RPA: 1,02 (1,00:1,04), p=0,04 e EMI RPA: 1,56 (1,00;2,57), p=0,04 se associaram a SDR> 35%. Na caracterização do grupo observamos: FEVE= 23±6%; SVD=8±2 cm/s; TAPSE= 14,5±4 mm; VAE= 65±23; E/e' médio 16,5±7, número de linhas B 8,5±5; 16 pacientes com SDR < 35% e 22 com SDR >35%. NT pro BNP foi semelhante e elevado em ambos os grupos e sem correlação com SDR (4311±3289 mg/dl para SDR 35%, p=0,97) CONCLUSÕES: O acompanhamento ambulatorial de ICC para controle volêmico pode ser sensibilizado pela utilização de parâmetros de ecocardiograma e contagem de linhas B pelo ULSP, os quais apresentaram boa correlação com o padrão observado SDR, método comprovado de detecção de congestão pulmonar, mas de menor disponibilidade.

Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease.

Background: Echocardiographic markers associated with asymptomatic acute cellular rejection (ACR) in patients with orthotopic heart transplant (HT) are still under investigation. The aim of our study was to determine clinical and myocardial strain imaging (MSI) variables evaluated by echocardiography associated with ACR in the first year of HT. A separate analysis was performed to compare variables during the first 6 months of HT, when ACR has a prevalence in 60% of patients. Another analysis evaluated an exclusive population with Chagas disease as the cause of HT. Methods: We prospectively studied 67 patients with less than 1 year of HT, 36 patients without ACR (41% men, age 49 ± 12 years, 52% Chagas disease as the cause of heart failure), and 31 patients with ACR (59% men, age 55 ± 8 years, 74% Chagas disease as the cause of heart failure). Conventional echocardiographic measurements and MSI by global longitudinal strain (GLS) from the left ventricle (LV) and right ventricle free wall (RV-FWLS) and myocardial work (MW) from the left ventricle were obtained by experienced echocardiologists. Clinical variables, such as the presence of diabetes, hypertension, and immunosuppressant drugs, were compared between groups. Results: HT patients with ACR were older and used more cyclosporine for immunosuppression. The positive ACR group had an increased relative wall thickness and LV mass index and similar LVGLS and RV-FWLS compared to the negative ACR group. Nevertheless, MW analysis observed increased global work efficiency (GWE) in positive ACR. Multivariate analysis identified older age, cyclosporine use, LV mass index, and GWE as independent predictors for detecting rejection. A separate analysis was performed for patients with less than 6 months of HT. Similar MSI was observed in both groups, with a trend for increased GWE in patients with ACR and significantly increased LV mass index in the ACR group. An exclusive group of Chagas patients as the primary cause of HT was analyzed, and similar MSI results for LVGLS, RV-FWLS, and MW were observed for both ACR and the no rejection groups. Additionally, the survival rates at 2 years were similar between the Chagas disease groups. Conclusion: LVGLS and RV-FWLS were similar between patients with or without ACR in the first year after HT. Conversely, GWE, a derivative of LVGLS, and LV mass index were increased in positive ACR and could be markers for rejection. Increased LV mass index was also found in a subgroup analysis of patients less than 6 months after HT; however, MSI was similar regardless of ACR. For chagasic patients, rejection in the first year did not increase mortality at the 2-year follow-up, and MSI parameters were similar between patients with or without ACR. In a multivariate analysis to predict ACR, the independent parameters in this study were older age, cyclosporine use, LV mass index, and GWE.

Achados ao ecocardiograma transtorácico em pacientes hospitalizados com COVID- 19: resultados do registro brasileiro de ecocardiografia durante a pandemia de COVID-19 (ECOVID) / Transthoracic echocardiography findings of hospitalized patients with COVID-19: results from the brazilian echocardiography registry during the COVID-19 Pandemic (ECOVID)

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)

Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)

Position statement on indications of echocardiography in adults ­ 2019

In accordance with the "Standards for the Elaboration of Guidelines, Positions and Normations" sanctioned by the Brazilian Society of Cardiology, this document was written to update the "Echocardiography Indication Guidelines" of 2009. The new document is not intended to be a comprehensive review of echocardiography, but rather an indispensable basic guide to support the rational clinical decision-making of the physician requesting the exam for adult patients. Although it considers the recent technological advances of echocardiography, its purpose is not to describe in detail echocardiography methods, but to summarize in a clear and concise way the main situations in which echocardiography brings benefit to the diagnosis and/or therapeutic orientation of the individual. This manuscript chose to highlight the class of recommendation, as described below: Class I: conditions for which there is conclusive evidence or, in the absence thereof, general agreement that the examination procedure is useful and safe. Class II: conditions for which there is conflicting evidence and/or divergence of opinion on the utility and/or safety of the examination. Class-IIa: evidence or opinions favorable to the examination. Most experts approve. Class IIb: utility and/or safety less well established, with divergent opinions. Class III: conditions for which there is evidence or consensus that the examination is not useful and, in some cases, may even be harmful. In addition, the level of evidence was also described, as follows: A: several concordant randomized clinical trials or robust meta-analyses; B: less robust meta-analysis data or single randomized clinical study or observational studies; C: expert opinion.(AU)

Unusual mechanism of myocardial infarction in prosthetic valve endocarditis.

A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography.

Correlação da função diastólica com a capacidade máxima de exercício ao teste ergométrico / Correlation between diastolic function and maximal exercise capacity on exercise test / Correlación de la función diastólica con la capacidad máxima de ejercicio al test ergométrico

FUNDAMENTO: O aumento da pressão de capilar pulmonar (PCP) é um dos mecanismos de intolerância ao exercício. A avaliação da função diastólica pelo ecocardiograma (ECO) é capaz de estimar a PCP. OBJETIVO: Identificar variáveis determinantes da capacidade de exercício em paciente submetidos a teste ergométrico (TE) de rotina, ECO convencional e doppler tecidual (DT). MÉTODOS: Foram estudados, retrospectivamente, 640 pacientes submetidos a TE e ao ECO e DT. Pacientes com fração de ejeção < 55 por cento foram excluídos. As velocidades de Doppler mitral convencional foram obtidas em diástole precoce (E) e diástole tardia (A), e o DT do anel mitral mediu as velocidades de diástole precoce (e’) e diástole tardia (a’). E/e’ > 10 foi considerada uma estimativa de aumento da PCP. A capacidade máxima de esforço foi avaliada pelo número de equivalentes metabólicos (MET). Para análise, os pacientes foram divididos em dois grupos: MET < 7 (n = 48) e MET > 7 (n = 572). O escore de Morise demonstrou uma população de baixo risco (60 por cento) para doença coronária (DAC). RESULTADOS: O número de pacientes com E/e’ > 10 foi significativamente maior no grupo MET < 7 em relação a MET > 7(41,7 por cento vs 9,4 por cento, p = 0,001), bem como a presença de algum grau de disfunção diastólica (76,6 por cento vs 34,1 por cento p = 0,001). Pela análise de regressão logística, as variáveis independentes de baixa capacidade de exercício (MET < 7) foram a idade, o sexo feminino e a velocidade de A (diástole tardia). CONCLUSÃO: A disfunção diastólica determinada pelo ECO, sexo feminino e idade estão associados com a menor capacidade de exercício em uma população de baixo risco de DAC.

BACKGROUND: Increased pulmonary capillary pressure (PCP) is one of the mechanisms of exercise intolerance. Assessment of the diastolic function by echocardiography (ECHO) enables estimation of PCP. OBJECTIVE: To identify variables that determine the exercise capacity in patients undergoing routine exercise test (ET), conventional ECHO, and tissue Doppler imaging (TD). METHODS: A total of 640 patients undergoing ET, ECHO, and TD were retrospectively studied. Patients with ejection fraction < 55 percent were excluded. Mitral annulus velocities by conventional Doppler imaging were obtained in early diastole (E) and late diastole (A), and TD of the mitral annulus measured early diastole (e’) and late diastole (a’) velocities. E/e’ > 10 was considered an estimate of increased PCP. Maximal exercise capacity was analyzed by the number of metabolic equivalents (MET). The patients were divided into two groups for analysis: MET<7 (n=48) and MET>7 (n=572). Morise score showed a population at low risk (60 percent) for coronary artery disease (CAD). RESULTS: The number of patients with E/e’ > 10 was significantly higher in the MET < 7 group in relation to the MET > 7 group (41.7 percent vs 9.4 percent, p=0.001), and so was the presence of any degree of diastolic dysfunction (76.6 percent vs 34.1 percent p=0.001). Using logistic regression analysis, age, female gender and A velocity (late diastole) were the independent variables related to a low exercise capacity (MET < 7). CONCLUSION: Diastolic dysfunction as determined by ECHO, female gender, and age are associated with a lower exercise capacity in a population at low risk for CAD.

FUNDAMENTO: El aumento de la presión de capilar pulmonar (PCP) es uno de los mecanismos de intolerancia al ejercicio. La evaluación de la función diastólica por el ecocardiograma (ECO) es capaz de estimar la PCP. OBJETIVO: Identificar variables determinantes de la capacidad de ejercicio en paciente sometido a test ergométrico (TE) de rutina, ECO convencional y doppler tisular (DT). MÉTODOS: Fueron estudiados, retrospectivamente, 640 pacientes sometidos a TE y al ECO y DT. Pacientes con fracción de eyección < 55 por ciento fueron excluidos. Las velocidades de Doppler mitral convencional fueron obtenidas en diástole precoz (E) y diástole tardía (A), y el DT del anillo mitral midió las velocidades de diástole precoz (e') y diástole tardía (a'). E/e' > 10 fue considerada una estimativa de aumento de la PCP. La capacidad máxima de esfuerzo fue evaluada por el número de equivalentes metabólicos (MET). Para análisis, los pacientes fueron divididos en dos grupos: MET < 7 (n = 48) y MET > 7 (n = 572). El escore de Morise demostró una población de bajo riesgo (60 por ciento) para enfermedad coronaria (EAC). RESULTADOS: EL número de pacientes con E/e' > 10 fue significativamente mayor en el grupo MET < 7 en relación a MET > 7(41,7 por ciento vs 9,4 por ciento, p = 0,001), así como la presencia de algún grado de disfunción diastólica (76,6 por ciento vs 34,1 por ciento p = 0,001). Por el análisis de regresión logística, las variables independientes de baja capacidad de ejercicio (MET < 7) fueron la edad, el sexo femenino y la velocidad de A (diástole tardía). CONCLUSIONES: La disfunción diastólica determinada por el ECO, sexo femenino y edad están asociados con la menor capacidad de ejercicio en una población de bajo riesgo de EAC.

Correlation between diastolic function and maximal exercise capacity on exercise test.

BACKGROUND: Increased pulmonary capillary pressure (PCP) is one of the mechanisms of exercise intolerance. Assessment of the diastolic function by echocardiography (ECHO) enables estimation of PCP. OBJECTIVE: To identify variables that determine the exercise capacity in patients undergoing routine exercise test (ET), conventional ECHO, and tissue Doppler imaging (TD). METHODS: A total of 640 patients undergoing ET, ECHO, and TD were retrospectively studied. Patients with ejection fraction < 55% were excluded. Mitral annulus velocities by conventional Doppler imaging were obtained in early diastole (E) and late diastole (A), and TD of the mitral annulus measured early diastole (e') and late diastole (a') velocities. E/e'> 10 was considered an estimate of increased PCP. Maximal exercise capacity was analyzed by the number of metabolic equivalents (MET). The patients were divided into two groups for analysis: MET<7 (n=48) and MET>7 (n=572). Morise score showed a population at low risk (60%) for coronary artery disease (CAD). RESULTS: The number of patients with E/e' > 10 was significantly higher in the MET < 7 group in relation to the MET > 7 group (41.7% vs 9.4%, p=0.001), and so was the presence of any degree of diastolic dysfunction (76.6% vs 34.1% p=0.001). Using logistic regression analysis, age, female gender and A velocity (late diastole) were the independent variables related to a low exercise capacity (MET < 7). CONCLUSION: Diastolic dysfunction as determined by ECHO, female gender, and age are associated with a lower exercise capacity in a population at low risk for CAD.

Avaliação de dissincronia ventricular por métodos de imagem: visão da eletrofisiologia, ecocardiografia e ressonância magnética / Imaging cardiac resynchronization therapy: the vision of eletrophisiology, echocardiogram and MRI

A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma nova estratégia de tratamento de pacientes com insuficiência cardíaca refratária ao tratamento clínico. Entretanto, cerca de 20 a 30% dos pacientes não são responsivos à TRC, o que enfatiza a necessidade de se empenhar melhores critérios para a seleção de pacientes. Diversos estudos clínicos demonstraram resultados mais favoráveis à TRC, quando os pacientes apresentavam dissincronia mecânica do VE à ecocardiografia. No entanto, o resultado do principal estudo multicêntrico prospect demonstrou somente uma modesta acurácia dos parâmetros ecocardiográficos de dissincronia do VE, na predição à TRC. Esse resultado reforça a noção de que dissincronia mecânica é somente um dos substratos da TRC, e que outros fatores, tais como a viabilidade miocárdica e a presença de cicatriz transmural, na região em que usualmente realiza-se a estimulação do VE, são fatores relevantes no sucesso desse tratamento. Nesta revisão, realizou-se, uma avaliação geral sobre a TRC e discutiu-se os principais métodos de avaliação de dissincronia ao ecocardiograma e ressonância magnética, sua aplicação na prática clínica atual e as perspectivas futuras.