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.

Linfoma cardíaco primário: o papel da multimodalidade de imagem na abordagem diagnóstica / Primary cardiac lymphoma: role of imaging multimodality in diagnosis

Massas intracardíacas constituem um desafio diagnóstico, já que os sintomas são comuns a patologias cardiovasculares ou não. Métodos ­ invasivos ou não ­ possibilitam o diagnóstico diferencial e a confirmação histológica, propiciando tratamento adequado. Para melhor compreender a importância da multimodalidade em imagem e a abordagem nos tumores cardíacos , relatamos o caso de um lifoma cardíaco primário, em que a abordagem multidisciplinar permitiu o rápido diagnóstico e seu tratamento, inclusive das intercorrências, com resposta inicial promissora, a despeito da evolução fatal durante a pandemia por SARS-CoV-2.(AU)

Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection. (AU)

Manejo a longo prazo dos sobreviventes / Long-term management of survivors

A melhora dos resultados do tratamento oncológico com consequente aumento na sobrevida dos pacientes fez surgir um grupo chamado de sobreviventes. A incidência aumentada de doença cardiovascular nessa população é responsável por morbidade e mortalidade significativas a longo prazo. Este estudo é uma abordagem multidisciplinar, com foco em prevenção, diagnóstico e tratamento da doença cardiovascular anos após o final do tratamento, que reforça a importância da cardio-oncologia

The improvement in the results of cancer treatment, with a consequent increase in patient survival, has led to the emergence of a group known as survivors. The increased incidence of cardiovascular disease in this population is responsible for significant long-term morbidity and mortality. This study is a multidisciplinary approach, with focus on the prevention, diagnosis and treatment of cardiovascular disease years after the end of treatment, which reinforces the importance of cardio-oncology

Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid.

OBJECTIVES: To assess the influence of acetyl-salicylic acid (ASA) on clinical outcomes in Staphylococcus aureus infective endocarditis (SA-IE). METHODS: The International Collaboration on Endocarditis - Prospective Cohort Study database was used in this observational study. Multivariable analysis of the SA-IE cohort compared outcomes in patients with and without ASA use, adjusting for other predictive variables, including: age, diabetes, hemodialysis, cancer, pacemaker, intracardiac defibrillator and methicillin resistance. RESULTS: Data were analysed from 670 patients, 132 of whom were taking ASA at the time of SA-IE diagnosis. On multivariable analysis, ASA usage was associated with a significantly decreased overall rate of acute valve replacement surgery (OR 0.58 [95% CI 0.35-0.97]; p<0.04), particularly where valvular regurgitation, congestive heart failure or periannular abscess was the indication for such surgery (OR 0.46 [0.25-0.86]; p<0.02). There was no reduction in the overall rates of clinically apparent embolism with prior ASA usage, and no increase in hemorrhagic strokes in ASA-treated patients. CONCLUSIONS: In this multinational prospective observational cohort, recent ASA usage was associated with a reduced occurrence of acute valve replacement surgery in SA-IE patients. Future investigations should focus on ASA's prophylactic and therapeutic use in high-risk and newly diagnosed patients with SA bacteremia and SA-IE, respectively.

Função sistólica do ventrículo esquerdo pela ecocardiografia em crianças e adolescentes com osteossarcoma tratados com doxorrubicina com e sem dexrazoxane / Left ventricular systolic function assessed by echocardiography in children and adolescents with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane

OBJETIVO: Avaliar o comportamento da função sistólica do ventrículo esquerdo (VE) pela ecocardiografia em pacientes com osteossarcoma tratados com doxorrubicina com e sem dexrazoxane. MÉTODOS: Foram estudados 55 pacientes com osteossarcoma com ou sem metástase submetidos à quimioterapia (QT) com seis ciclos de doxorrubicina, divididos em dois grupos, conforme o uso de dexrazoxane. Grupo I: 37 pacientes, os quais receberam dexrazoxane (28 do sexo masculino, com média de idade de 15,4 anos). Grupo II: 18 pacientes, que não receberam dexrazoxane (15 do sexo masculino, com média de idade de 15,1 anos). Foram realizadas quatro avaliações ecocardiográficas: 1) antes do início da QT (avaliação inicial); 2) até duas semanas após o terceiro ciclo; 3) até duas semanas após o quinto ciclo e 4) até quatro semanas após o sexto ciclo da QT (avaliação final). A função sistólica do VE foi avaliada pela porcentagem de encurtamento (PE) com o ecocardiograma. Alteração da função contrátil ou toxicidade miocárdica foi definida com valores de PE iguais ou inferiores a 29 por cento e/ou diminuição da PE, em valor absoluto, igual ou superior a 10 unidades do valor inicial de cada paciente. RESULTADOS: Não houve diferença significativa entre os grupos quanto à idade, sexo e raça. A dose cumulativa de doxorrubicina foi significantemente maior no grupo II em todas as fases do tratamento: 174 x 203 mg/m²; 292 x 338 mg/m² e 345 x 405 mg/² (p < 0,0001). A ocorrência de disfunção sistólica do VE, de acordo com os critérios previamente definidos, foi de sete indivíduos no grupo I (18,92 por cento) e de dois no grupo II (11,1 por cento), diferença não significativa (p=0,248). A análise de variância com medidas repetidas não mostrou diferença significativa nas médias da PE ao longo do período de estudo (p=0,967). Entretanto foi encontrada diferença significativa (p=0,029) entre as médias da PE dos grupos I e II nas avaliações 2 (35,67 x 37,21 por cento), 3 (34,95 x 38,47 por cento) e 4...

OBJECTIVE: To evaluate left ventricular (LV) systolic function by means of echocardiography in patients with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane. METHODS: The study analyzed 55 patients with osteosarcoma, with or without metastasis, undergoing a six-cycle chemotherapy regimen of doxorubicin, who were divided into two groups according to dexrazoxane use. Group I: Thirty-seven patients who did not receive dexrazoxane (28 males, average age 15.4 years). Group II: Eighteen patients who did receive dexrazoxane (15 males, average age 15.1 years). Four echocardiographic evaluations were performed: 1) before the beginning of the chemotherapy (initial evaluation); 2) up to two weeks after the third cycle; 3) up to two weeks after the fifth cycle; and 4) up to four weeks after the sixth cycle of chemotherapy (final evaluation). The left ventricular systolic function was assessed by the fractional percentage of systolic shortening (FS percent) on echocardiography. Alterations in the contractile function or cardiac toxicity were defined as FS percent values equal to or lower than 29 percent, and/or by a drop in FS percent by an absolute value equal to or greater than 10 units of the baseline value of each patient. RESULTS: No significant difference as to age, gender, and race was observed between the groups. The cumulative dose of doxorubicin was significantly higher in group II throughout all phases of the treatment: 174 x 203 mg/m²; 292 x 338 mg/m² and 345 x 405 mg/² (p < 0.0001). According to previously established criteria, the incidence of LV systolic dysfunction was not significantly different (p=0.248) between patients in group I (18.92 percent) and patients in group II (11.1 percent). The variance analysis with repeated measurements did not show significant differences in the means of fractional percentage of systolic percentage (FS percent) throughout the study (p=0.967). However, a significant difference (p=0.029) was...

Left ventricular systolic function assessed by echocardiography in children and adolescents with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane.

OBJECTIVE: To evaluate left ventricular (LV) systolic function by means of echocardiography in patients with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane. METHODS: The study analyzed 55 patients with osteosarcoma, with or without metastasis, undergoing a six-cycle chemotherapy regimen of doxorubicin, who were divided into two groups according to dexrazoxane use. Group I: Thirty-seven patients who did not receive dexrazoxane (28 males, average age 15.4 years). Group II: Eighteen patients who did receive dexrazoxane (15 males, average age 15.1 years). Four echocardiographic evaluations were performed: 1) before the beginning of the chemotherapy (initial evaluation); 2) up to two weeks after the third cycle; 3) up to two weeks after the fifth cycle; and 4) up to four weeks after the sixth cycle of chemotherapy (final evaluation). The left ventricular systolic function was assessed by the fractional percentage of systolic shortening (FS%) on echocardiography. Alterations in the contractile function or cardiac toxicity were defined as FS% values equal to or lower than 29%, and/or by a drop in FS% by an absolute value equal to or greater than 10 units of the baseline value of each patient. RESULTS: No significant difference as to age, gender, and race was observed between the groups. The cumulative dose of doxorubicin was significantly higher in group II throughout all phases of the treatment: 174 x 203 mg/m(2); 292 x 338 mg/m(2) and 345 x 405 mg/(2) (p < 0.0001). According to previously established criteria, the incidence of LV systolic dysfunction was not significantly different (p=0.248) between patients in group I (18.92%) and patients in group II (11.1%). The variance analysis with repeated measurements did not show significant differences in the means of fractional percentage of systolic percentage (FS%) throughout the study (p=0.967). However, a significant difference (p=0.029) was observed between the FS% means in groups I and II at evaluations 2 (35.67 x 37.21%), 3 (34.95 x 38.47%) and 4 (35.26 x 38.22%). CONCLUSION: Data in this study show that in patients with osteosarcoma treated with doxorubicin alone or combined with dexrazoxane, the LV systolic function, as assessed by the fractional percentage of systolic shortening mean, showed a better performance in the group that received dexrazoxane. On the other hand, the occurrence of systolic dysfunction was similar in both groups.

Effect of central hypothyroidism on Doppler-derived myocardial performance index.

BACKGROUND: Myocardial performance index (MPI) has been used to assess global ventricular function in different types of cardiac disease. Thyroid hormones influence cardiac performance directly and indirectly by changes in peripheral circulation. The aim of this study was to evaluate the possible effect of central hypothyroidism (CH) on MPI. METHODS: The study included 28 control subjects and 7 patients with CH without cardiac disease. MPI was defined as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time divided by ejection time. Patients were submitted to hormonal therapy with thyroxin and the study was repeated after 35 to 42 days. RESULTS: MPI was significantly higher in patients with CH (0.54 +/- 0.08) than in control subjects (0.40 +/- 0.05) (P =.002). The increase in MPI was caused by the prolongation of ICT without a significant variation of isovolumetric relaxation time and ejection time. After hormonal therapy there was a significant reduction of MPI (0.54 +/- 0.08 vs 0.42 +/- 0.07; P =.028) and ICT. CONCLUSION: MPI was increased in patients with untreated CH. The increase was related to prolongation of ICT and reverted by hormonal therapy.

Role of dobutamine-atropine stress echocardiography in prognostic evaluation of 300 women.

BACKGROUND: Dobutamine-atropine stress echocardiography (DASE) is a safe and accurate method to diagnose coronary artery disease (CAD), and can identify individuals at high risk for cardiac events such as myocardial infarction and cardiac-related death. The literature is limited regarding the prognostic value of DASE in women. OBJECTIVE: The objective was to determine the prognostic value of DASE in 300 women with known or suspected CAD. RESULTS: The 300 women underwent DASE and were followed up for 65 months (mean: 27 months). Ninety-five women had positive tests and 205 had negative tests. We demonstrated that women with negative tests had a 94% hard-event-free survival rate at follow-up (myocardial infarction and death), and in those with positive tests the event-free survival rate was 27% (P = 0.0003). The difference between women with positive and negative tests was also significant when minor events and total events were considered. Women with positive tests had 16.7 times more chance of having events than women with negative tests. Furthermore, women with positive tests but without cardiac events at follow-up (mean of peak WMSI - rest WMSI = 0.24 +/- 0.16) had less ischemic myocardium than women with positive tests and cardiac events at follow-up (mean of peak WMSI - rest WMSI = 0.34 +/- 0.26)(P < 0.04). CONCLUSION: Dobutamine-atropine stress echocardiography has good prognostic value for cardiac events in women. Women with negative tests have low probability for follow-up infarction or death. Women with positive tests and higher severity of induced ischemia have the highest incidence of cardiac events.

Pseudomixoma peritoneal associado a lúpus eritematoso sistêmico: reporte de caso / Pseudomyxoma peritonei in association with systemic lupus erythematosus: case report

Descreve-se o caso de uma paciente jovem com ascite, dor abdominal, emagrecimento e poliartralgias. Foi feito diagnóstico de pseudomixoma peritoneal de ovário. Lúpus eritematoso sistêmico foi diagnosticado como patologia associada. Os autores apresentam breve revisao da literatura.

Pseudocisto de pâncreas: apresentaçäo incomum / Pancreatic pseudocyst: unusual presentation

Pseudocisto de pâncreas (PP) constitui complicaçäo relativamente comum dos pacientes com pancreatite aguda (9 a 56 por cento) e crônica (20 a 40 por cento). Relatamos caso de PP em paciente etilista cuja manifestaçäo se deu de forma atípica, atingindo espaço perirrenal esquerdo e musculatura paravertebral esquerda (músculo psoas), que regridiu com tratamento conservador. O pseudocisto pancreático com localizaçäo no músculo psoas, embora seja apresentaçäo rara, deve fazer parte do diagnóstico diferencial de dor lombar ou em quadril, especialmente em etilistas