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1.
J Am Coll Cardiol ; 74(18): 2278-2291, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31672185

RESUMO

BACKGROUND: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). OBJECTIVES: The purpose of this study was to assess the feasibility and functional correlates of CFVR. METHODS: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. RESULTS: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. CONCLUSIONS: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

3.
Rev. argent. cardiol ; 86(6): 20-26, dic. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003233

RESUMO

RESUMEN Introducción: La fracción de eyección es un parámetro débil para evaluar la función ventricular en la hipertrofia ventricular. Es de fundamental importancia analizar aspectos de la mecánica ventricular que podrían diferenciar una amiloidosis cardiaca de una miocardiopatía hipertrófica. Objetivo: Comparar el comportamiento del strain longitudinal y otros parámetros de la mecánica ventricular entre pacientes con miocardiopatía hipertrófica y amiloidosis cardíaca ambos con fracción de eyección conservada. Material y métodos: Estudio comparativo, prospectivo realizado en 15 pacientes con amiloidosis cardíaca (Grupo G 1) y 15 pacientes con miocardiopatía hipertrófica (G 2), ambos con fracción de eyección conservada (> 50%). Fueron analizados con ecocardiografía por seguimiento de marcas (speckle tracking), parámetros de strain y rotacionales del VI. El strain longitudinal se obtuvo a partir de planos apicales de 4, 3 y 2 cámaras. El strain circunferencial y la rotación ventricular a partir de planos transversales del VI. Se calculó el giro: suma de rotación apical y basal (°), torsión (giro / distancia base-ápex del VI (°/cm)) y los nuevos parámetros: producto de deformación (multiplicación entre el strain longitudinal global y el strain circunferencial apical); índice de deformación (°/%): (giro / strain longitudinal) y el cociente fracción de eyección / strain longitudinal global Resultados: Los pacientes con amiloidosis cardíaca presentaron valores significativamente menores de fracción de eyección (58,08% ± 6,16 vs. 67,15% ± 8,09; p = 0,012) y de strain longitudinal global (-12,61% ± 4,32 vs. -17,15% ± 3,95; p = 0,008) a expensas de los segmentos basales. No se constataron diferencias significativas con el giro, la torsión, el strain circunferencial y el radial. El producto entre strain longitudinal y el circunferencial apical resultó disminuido mientras que el cociente fracción de eyección / strain longitudinal global se encontró aumentado de manera significativa en los pacientes con amiloidosis. Conclusiones: El producto strain longitudinal x strain circunferencial apical y el cociente fracción de eyección / strain longitudinal global son parámetros útiles que permiten diferenciar pacientes con amiloidosis cardíaca de pacientes con miocardiopatía hipertrófica.


ABSTRACT Background: Ejection fraction is a poor parameter to assess left ventricular function in ventricular hypertrophy. It is highly important to analyze aspectis of ventricular mechanics that could differentiate cardiac amyloidosis from hypertrophic car-diomyopathy. Objective: The aim of this study was to compare longitudinal strain and other ventricular mechanical parameters between patientis with hypertrophic cardiomyopathy and cardiac amyloidosis, both with preserved ejection fraction. Methods: A comparative, prospective study was conducted in 15 patientis with cardiac amyloidosis Group (G) 1 and 15 pa-tientis with hypertrophic cardiomyopathy (G2), both presenting preserved ejection fraction (>50%). Patientis were analyzed with speckle tracking echocardiography and strain and left ventricular (LV) rotational parameters. Longitudinal strain was obtained from apical 4-, 3- and 2-chamber planes. Circumferential strain and ventricular rotation were obtained from LV transverse planes. Twist: algebraic sum of apical and basal rotation (°), torsion [twist/LV base-apex distance (º/cm)] and the new parameters: deformation product (global longitudinal strain × apical circumferential strain); deformation index: twist/ longitudinal strain (°/%) and ejection fraction/global longitudinal strain ratio were calculated. Resultis: Patientis with cardiac amyloidosis presented significantly lower ejection fraction (58.08%±6.16 vs. 67.15%±8.09; p=0.012) and global longitudinal strain values (-12.61%±4.32 vs. -17.15%±3.95; p=0.008) at the expense of basal segmentis. No significant differences were found for twist, torsion, and circumferential and radial strain. The product between longitudinal strain and apical circumferential strain decreased, while the ejection fraction/global longitudinal strain ratio was significantly increased in patientis with cardiac amyloidosis. Conclusions: The product of longitudinal strain × apical circumferential strain and the ejection fraction/global longitudinal strain ratio are useful parameters that allow differentiating cardiac amyloidosis from hypertrophic cardiomyopathy patientis.

4.
Cardiovasc Ultrasound ; 16(1): 16, 2018 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-30223828

RESUMO

BACKGROUND: Left ventricular ejection fraction (LVEF) results from the combined action of longitudinal and circumferential contraction, radial thickening, and basal and apical rotation. The study of these parameters together may lead to an accurate assessment of the cardiac function. METHODS: Ninety healthy volunteers, categorized by gender and age (≤ 55 and >  55 years), were evaluated using two-dimensional speckle tracking echocardiography. Transversal views of the left ventricle (LV) were obtained to calculate circumferential strain and left ventricular twist, while three apical views were obtained to determine longitudinal strain (LS) and mitral annular plane systolic excursion (MAPSE). We established the integral myocardial function of the LV according to: 1. The Combined Deformation Parameter (CDP), which includes Deformation Product (DP) - Twist x LS (° x %) - and Deformation Index (DefI) -Twist / LS (° / %)-; and 2. the Torsion Index (TorI): Twist / MAPSE (° / cm). RESULTS: The mean age of our patients was 50.3 ± 11.1 years. CDP did not vary with gender or age. The average DP was - 432 ± 172 ° x %, and the average DefI was - 0.96 ± 0.36 ° / %. DP provides information about myocardial function (normal, pseudonormal, depressed), and the DefI quotient indicates which component (s) is/are affected in cases of abnormality. TorI was higher in volunteers over 55 years (16.5 ± 15.2 vs 13.1 ± 5.0 °/cm, p = 0.003), but did not vary with gender. CONCLUSIONS: The proposed parameters integrate values of twisting and longitudinal shortening. They allow a complete physiological assessment of cardiac systolic function, and could be used for the early detection and characterization of its alteration.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sístole
5.
Cardiovasc Ultrasound ; 16(1): 20, 2018 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-30249305

RESUMO

BACKGROUND: The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. PURPOSE: To provide web-based upstream quality control and harmonization of B-lines reading criteria. METHODS: 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. RESULTS: All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). CONCLUSIONS: Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.


Assuntos
Ecocardiografia sob Estresse/normas , Pulmão/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Controle de Qualidade , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade
6.
J Cardiovasc Dev Dis ; 5(3)2018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30096870

RESUMO

BACKGROUND: According to the ventricular myocardial band model, the diastolic isovolumetric period is a contraction phenomenon. Our objective was to employ speckle-tracking echocardiography (STE) to analyze myocardial deformation of the left ventricle (LV) and to confirm if it supports the myocardial band model. METHODS: This was a prospective observational study in which 90 healthy volunteers were recruited. We evaluated different types of postsystolic shortening (PSS) from an LV longitudinal strain study. Duration of latest deformation (LD) was calculated as the time from the start of the QRS complex of the ECG to the latest longitudinal deformation peak in the 18 segments of the LV. RESULTS: The mean age of our subjects was 50.3 ± 11.1 years. PSS was observed in 48.4% of the 1620 LV segments studied (19.8%, 13.5%, and 15.1% in the basal, medial, and apical regions, respectively). PSS was more frequent in the basal, medial septal, and apical anteroseptal segments (>50%). LD peaked in the interventricular septum and in the basal segments of the LV. CONCLUSIONS: The pattern of PSS and LD revealed by STE suggests there is contraction in the postsystolic phase of the cardiac cycle. The anatomical location of the segments in which this contraction is most frequently observed corresponds to the main path of the ascending component of the myocardial band. This contraction can be attributed to the protodiastolic untwisting of the LV.

7.
ABC., imagem cardiovasc ; 31(1): f:4-l:56, jan.-mar. 2018. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-878730

RESUMO

Disfunção de prótese valvar cardíaca (PVC) é rara, porém é uma potencial ameaça à vida. Estabelecer o exato mecanismo da disfunção da PVC é desafiador, no entanto é essencial para determinar a estratégia terapêutica apropriada. Na prática clinica, uma abordagem abrangente que integra vários parâmetros de morfologia e função avaliados pelo eco transtorácico 2D/3D e transesofágico são fundamentais para detectar e quantificar a disfunção da PVC. A cinefluoroscopia, a tomografia computadorizada com multidectetores, a ressonância magnética cardíaca, e em menor escala, a imagem nuclear, são ferramentas complementares para o diagnóstico e abordagem das complicações das PVC. Este documento apresenta recomendações para o uso de imagem em multimodalidade para avaliação das PVCs


Assuntos
Humanos , Masculino , Feminino , Diagnóstico por Imagem , Ecocardiografia Transesofagiana/métodos , Ecocardiografia/métodos , Próteses Valvulares Cardíacas/normas , Espectroscopia de Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Valva Aórtica , Bioprótese , Diagnóstico Diferencial , Ecocardiografia Doppler/métodos , Ecocardiografia sob Estresse/métodos , Hemodinâmica , Valva Mitral , Medicina Nuclear/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Próteses e Implantes , Análise Qualitativa , Análise Quantitativa , Stents , Volume Sistólico , Trombose , Tomografia Computadorizada por Raios X/métodos , Valva Tricúspide
8.
9.
Int J Cardiol ; 249: 479-485, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-28986062

RESUMO

BACKGROUND: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. METHODS: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). RESULTS: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p<0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt. CONCLUSIONS: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit.


Assuntos
Cardiologistas/normas , Competência Clínica/normas , Doença das Coronárias/diagnóstico por imagem , Ecocardiografia sob Estresse/normas , Controle de Qualidade , Doença das Coronárias/epidemiologia , Ecocardiografia sob Estresse/métodos , Humanos , Internacionalidade , Reprodutibilidade dos Testes
11.
Rev. argent. cardiol ; 84(4): 1-10, ago. 2016. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-957744

RESUMO

Introducción: El eco estrés evidencia la isquemia miocárdica como un trastorno regional y transitorio de la motilidad. El análisis visual es subjetivo y depende de la experiencia del operador, lo que ha motivado la búsqueda de un método semiautomático que permita minimizar esta limitación y así mejorar la confiabilidad y reproducibilidad de la prueba. Esto ha generado creciente interés en la introducción de la medición del strain longitudinal bidimensional antes del eco estrés y durante y después de él. Su determinación en las diferentes fases de apremio, en caso de que sea útil, permitiría reducir otras limitaciones, como la imposibilidad de alcanzar la frecuencia cardíaca submáxima, la dificultad de visualizar trastornos muy sutiles y el retraso en la adquisición de las imágenes, lo que incrementa los falsos negativos. Objetivos: Evaluar si el análisis del strain longitudinal realizado en reposo, cuando no hay evidencias de trastornos contráctiles visuales, es capaz de predecir el resultado del eco estrés y si el strain longitudinal basal es diferente en los pacientes con enfermedad coronaria significativa en comparación con los que no la presentan (en su evaluación previa al comienzo de la prueba). Material y métodos: Se compararon los resultados del strain longitudinal en reposo en 62 pacientes con eco estrés positivo incorporados en forma consecutiva en un período de 12 meses, a la mitad de los cuales se les realizó una cinecoronariografía (Grupo A) y a la otra mitad no se le efectuó este estudio (Grupo B) versus un grupo control (Grupo C) con prueba negativa y sin cinecoronariografía. Resultados: El strain longitudinal entre el Grupo A y el Grupo B no mostró diferencia estadística significativa (-21,8% ± 2,4% vs. -21,5% ± 2,5%), como tampoco el de los pacientes con prueba positiva (Grupo A + B) versus los controles (-21,67% ± 2,4% vs. 21,9% ± 2,8%). Conclusión: El strain longitudinal bidimensional no permitió predecir el resultado del eco estrés ni tampoco la presencia de enfermedad coronaria significativa en los pacientes que fueron sometidos a cinecoronariografía invasiva.

12.
Eur Heart J Cardiovasc Imaging ; 17(6): 589-90, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27143783

RESUMO

Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs.


Assuntos
Bioprótese , Técnicas de Imagem Cardíaca , Ecocardiografia Tridimensional/métodos , Próteses Valvulares Cardíacas , Guias de Prática Clínica como Assunto , Brasil , China , Cinerradiografia/métodos , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Internacionalidade , Imagem Cinética por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Imagem Multimodal/métodos , Falha de Prótese , Sociedades Médicas , Estados Unidos
14.
Rev. argent. cardiol ; 83(5): 420-428, oct. 2015. ilus, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-957655

RESUMO

Introducción: La hipótesis de Torrent Guasp plantea que los ventrículos están conformados por una banda muscular continua que nace a nivel de la válvula pulmonar y se extiende hasta la raíz aórtica delimitando las dos cavidades ventriculares. Esta anatomía brindaría la interpretación para dos aspectos fundamentales de la dinámica ventricular izquierda: el mecanismo de torsión y el llenado diastólico rápido por efecto de succión. Objetivos: Investigar la activación eléctrica de las bandeletas endocárdica y epicárdica para comprender la torsión ventricular, el mecanismo de succión activa en la fase isovolumétrica diastólica y el significado del volumen residual. Material y métodos: La investigación se realizó mediante un mapeo electroanatómico tridimensional en cinco pacientes. Al ser la bandeleta descendente endocárdica y la ascendente epicárdica, se utilizaron dos vías de abordaje por punción. Resultados: El mapeo tridimensional endoepicárdico demuestra una activación eléctrica de la zona de la lazada apexiana concordante con la contracción sincrónica de las bandeletas descendente y ascendente. La activación simultánea y contrapuesta de la bandeleta ascendente con punto de partida de su activación radial desde la bandeleta descendente, en la zona de entrecruzamiento de ambas, es coherente con la torsión ventricular. La activación tardía de la bandeleta ascendente se compatibiliza con la persistencia de su contracción durante el período inicial de la fase isovolumétrica diastólica (base del mecanismo de succión); se produce sin necesidad de postular activaciones eléctricas posteriores al QRS. Conclusiones: Este trabajo explica el proceso de la torsión ventricular y el mecanismo de succión. Comprueba que la activación de la bandeleta ascendente completa el QRS anulando el concepto tradicional de relajación pasiva en la fase isovolumétrica diastólica.


Background: The hypothesis of Torrent Guasp considers that the ventricular myocardium consists of a continuous muscular band that begins at the level of the pulmonary valve and ends at the level of the aortic root, limiting both ventricular chambers. This anatomy would provide the interpretation for two fundamental aspects of left ventricular dynamics: the mechanism of left ventricular twist and rapid diastolic filling due to the suction effect. Objectives: The aim of this study was to investigate the electrical activation of the endocardial and epicardial bands to understand ventricular twist, the mechanism of active suction during the diastolic isovolumic phase and the significance of the residual volume. Methods: Five patients underwent three-dimensional electroanatomic mapping. As the descending band is endocardial and the ascending band is epicardial, two sites of puncture were used. Results: Three-dimensional endo-epicardial mapping demonstrates an electrical activation sequence in the area of the apex loop in agreement with the synchronic contraction of the descending and ascending band segments. The simultaneous and opposing radial activation of the ascending band segment, starting in the descending band segment, in the area in which both band segments intertwine, is consistent with the mechanism of ventricular twist. The late activation of the ascending band segment is consistent with its persistent contraction during the initial period of the isovolumic diastolic phase (the basis of the suction mechanism), and takes place without need of postulating further electrical activations after the QRS complex. Conclusions: This study explains the process of ventricular twist and the suction mechanism, and demonstrates that the activation of the ascending band segment completes the QRS, ruling out the traditional concept of passive relaxation during the diastolic isovolumic phase.

15.
J Am Soc Echocardiogr ; 27(10): 1113-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24984585

RESUMO

BACKGROUND: Coronary flow velocity reserve (CFVR) increases the diagnostic sensitivity of stress echocardiography. The aim of this study was to evaluate the prognostic value of CFVR in patients without new wall motion abnormalities during pharmacologic stress echocardiography. METHODS: The outcomes of 651 patients with normal wall motion response during stress echocardiography with dobutamine up to 50 µg/kg/min (n = 351) or dipyridamole up to 0.84 mg/kg over 4 min (n = 300) were evaluated. CFVR was calculated simultaneously in the distal territory of the left anterior descending coronary artery. CFVR ≥ 2 was defined as normal. Major events considered during follow-up were cardiovascular death, myocardial infarction, and late myocardial revascularization. RESULTS: Normal CFVR was recorded in 523 patients and reduced CFVR in 128. During a mean follow-up period of 34.6 ± 18 months, 48 major events occurred, in 25 patients (4.8%) with normal and 23 patients (18%) with reduced CFVR; event-free survival was significantly different between patients with normal versus abnormal CFVR (P < .0001). Diabetes increased risk only in patients with abnormal CFVR (P = .05). In the multivariate analysis, CFVR and history of smoking were the only independent predictors of combined morbidity and mortality. Abnormal CFVR was associated with a higher event rate, independently of the pharmacologic stress technique used. The event hazard ratio was inversely proportional to CFVR. CONCLUSIONS: CFVR was an independent predictor of mortality after pharmacologic stress echocardiography with normal wall motion, and the degree of decrease was associated with increased risk. Diabetes worsened prognosis only with abnormal CFVR.


Assuntos
Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Complicações do Diabetes/mortalidade , Complicações do Diabetes/fisiopatologia , Dobutamina , Ecocardiografia/estatística & dados numéricos , Reserva Fracionada de Fluxo Miocárdico , Idoso , Argentina/epidemiologia , Comorbidade , Estenose Coronária/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Contração Miocárdica/efeitos dos fármacos , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Taxa de Sobrevida , Vasodilatadores
17.
Rev. argent. cardiol ; 82(2): 110-117, abr. 2014. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-734475

RESUMO

Introducción La factibilidad del análisis de la deformación longitudinal 2D en ejercicio y la contribución de su información para detectar isquemia a frecuencia cardíaca alta no están bien establecidas; si bien se han realizado estudios de eco estrés farmacológico para la evaluación de isquemia y viabilidad, no se conocen trabajos que hayan evaluado el uso de la deformación longitudinal 2D para el diagnóstico de isquemia miocárdica durante el eco estrés con ejercicio. Objetivos Se consideró de interés determinar la factibilidad del análisis de la deformación longitudinal 2D y evaluar su comportamiento durante el eco estrés con ejercicio. Material y métodos Entre febrero y marzo de 2012 se les realizó un eco estrés en camilla supina, en etapas de 150 kgm, a 93 pacientes consecutivos (59 hombres, 54,9%), edad promedio de 58,8 ± 11,8 años. Se determinó la motilidad semicuantitativa visual en condiciones basales, en el pico del ejercicio y en el posesfuerzo inmediato y se analizó la deformación longitudinal 2D de 16 segmentos en reposo y en el posejercicio inmediato mediante un algoritmo de seguimiento de marcadores acústicos (AFI: automatic functional images de GE). Simultáneamente se evaluaron los síntomas, el electrocardiograma de 12 derivaciones y la tensión arterial en cada etapa. Resultados La frecuencia cardíaca basal fue de 76 ± 18 lat/min, alcanzó 133 ± 25 lat/min en el pico del ejercicio y 117 ± 15 lat/min en el posesfuerzo inmediato. Las pruebas fueron suficientes en 64 (68,8%) de los 93 pacientes evaluados; de los 29 pacientes con pruebas insuficientes, 9 fueron positivas y 20 negativas. Desarrollaron isquemia durante la prueba 21 pacientes (22,5%), diagnosticada como asinergias regionales transitorias (7 casos en territorio anterior, septal y/o apical, en otros 7 afectó las caras inferior, posterior y/o lateral, mientras que 7 pacientes tuvieron trastornos en segmentos de ambos territorios), los cuales eran más añosos (63,5 ± 8,7 vs. 57,4 ± 12,2 años; p = 0,03), con mayor antecedente de infarto de miocardio (14,3% vs. 7%; p = 0,01) y de cirugía de revascularización miocárdica (14,3% vs. 2,77%; p = 0,04) respecto de los pacientes que no desarrollaron isquemia. No se encontraron diferencias significativas en los antecedentes de hipertensión arterial, diabetes, dislipidemia y tabaquismo. El valor de la deformación longitudinal 2D apical se incrementó en 79 (85%) de los 93 pacientes evaluados, en los que solo 3 (3,8%) presentaron trastornos contráctiles en la misma región, mientras que de los 14 pacientes en los que la deformación longitudinal 2D apical no aumentó o disminuyó, 11 (78,6%) presentaron isquemia apical visualmente confirmada (sensibilidad 79%, especificidad 96%; p = 0,0001). De los 53 pacientes en los que se incrementó el valor de la deformación longitudinal 2D inferior, posterior y/o lateral, 6 (11,3%) presentaron trastornos contráctiles homozonales, mientras que de los 40 pacientes en los que no aumentó la deformación longitudinal 2D, en 8 (20%) se constataron visualmente asinergias transitorias en la misma región (sensibilidad 43%, especificidad 41%). La deformación longitudinal 2D se pudo evaluar en 1.472 de 1.488 segmentos en el reposo (factibilidad 99%), en 1.452 en el posesfuerzo (factibilidad 97,5%) y en 1.147 de 1.488 (77%) en el pico del esfuerzo (esta etapa no se consideró para el análisis). Conclusiones El análisis de la deformación longitudinal 2D resultó factible en el posesfuerzo inmediato. La falta de aumento o la disminución en la deformación longitudinal 2D de los segmentos apicales fueron concordantes con presencia de isquemia detectada visualmente. Las frecuencias cardíacas altas fueron responsables de la obtención de resultados poco específicos en los segmentos inferoposterolaterales basales y mediales, por lo que el strain 2D longitudinal solo sería de ayuda para analizar territorio irrigado por la arteria descendente anterior.


Feasibility and Contribution of Global and Regional 2D Strain during Exercise Stress Echocardiography Introduction The feasibility of longitudinal 2D strain analysis during exercise and the contribution of the information provided to detect ischemia at elevated heart rate are not well established. Although pharmacologic stress echocardiography has been used to evaluate ischemia and viability in several studies, the use of longitudinal 2D strain for the diagnosis of myocardial ischemia during exercise stress echocardiography has not been analyzed. Objectives The goal of this study was to determine the feasibility of analyzing longitudinal 2D strain and to evaluate its performance during exercise stress echocardiography. Methods Between February and March 2012, 93 consecutive patients (59 men, 54.9%), with mean age 58.8 ±11.8 years), underwent supine exercise stress echocardiography, in 150 kgm stages. Wall motion was visually evaluated using a semiquantitative analysis at baseline, peak exercise and immediately after exercise. Longitudinal 2D deformation was analyzed in 16 segments at rest and immediately after exercise using a tracking algorithm of acoustic markers (AFI: automatic functional images, GE). Symptoms, 12-lead electrocardiogram and blood pressure were simultaneously evaluated in each stage. Results Baseline heart rate was 76 ± 18 bpm, increased to 133 ± 25 bpm during peak exercise and was 117 ± 15 bpm immediately after exercise. The target heart rate was achieved in 64 (68.8%) of the 93 patients evaluated; in the 29 patients who did not achieve target heart rate, 9 tests were positive and 20 were negative for coronary artery disease. Twenty-one patients (22.5%) developed ischemia diagnosed as transient regional assynergies during exercise stress echocardiography: 7 patients in the anterior, septal and/or apical territories, 7 in the inferior, posterior and/or lateral territories and 7 in segments corresponding to both territories. These patients were older (63.5 ± 8.7 vs. 57.4 ± 12.2 years; p = 0.03) and the prevalence of previous myocardial infarction (14.3% vs. 7%; p = 0.01) and myocardial revascularization surgery (14.3% vs. 2.77%; p = 0.04) was higher compared to those without ischemia. There were no significant differences in the history of hypertension, diabetes, dyslipidemia or smoking habits. The value of longitudinal 2D strain in the apical segments increased in 79 (85%) of the 93 patients evaluated: only 3 of these patients (3.8%) developed new wall motion abnormalities in the same region. In the 14 patients in whom longitudinal 2D strain did not increase or decreased, 11 (78.6%) presented apical ischemia in the visual analysis (sensitivity 79%, specificity 96%; p = 0.0001). Among the 53 patients presenting increased longitudinal 2D strain in the inferior, posterior and/or lateral segments, 6 (11.3%) presented wall motion abnormalities in the same sites, whereas in the 40 patients in whom longitudinal 2D strain did not increase, 8 (20%) presented transient dyssynergias which were visually detected in the same region (sensitivity 43%, specificity 41%). Longitudinal 2D strain could be evaluated in 1472 of 1488 segments at rest (feasibility 99%), in 1452 after exercise (feasibility 97.5%) and in 1147 of 1488 (77%) during peak exercise (this stage was not considered for the analysis). Conclusions The analysis of longitudinal 2D strain is feasible immediately after exercise. The lack of increase or decrease in longitudinal 2D strain in the apical segments was consistent with the presence of visually detected ischemia. Elevated heart rates were responsible of the lack of specificity in the inferior, posterior and lateral basal and mid segments. Thus, longitudinal 2D strain would only help to analyze the territory irrigated by the left anterior descending coronary artery.

18.
Rev. argent. cardiol ; 82(2): 85-86, abr. 2014.
Artigo em Espanhol | BINACIS | ID: bin-131374
19.
Rev. argent. cardiol ; 82(2): 110-117, abr. 2014. ilus, graf, tab
Artigo em Espanhol | BINACIS | ID: bin-131367

RESUMO

Introducción La factibilidad del análisis de la deformación longitudinal 2D en ejercicio y la contribución de su información para detectar isquemia a frecuencia cardíaca alta no están bien establecidas; si bien se han realizado estudios de eco estrés farmacológico para la evaluación de isquemia y viabilidad, no se conocen trabajos que hayan evaluado el uso de la deformación longitudinal 2D para el diagnóstico de isquemia miocárdica durante el eco estrés con ejercicio. Objetivos Se consideró de interés determinar la factibilidad del análisis de la deformación longitudinal 2D y evaluar su comportamiento durante el eco estrés con ejercicio. Material y métodos Entre febrero y marzo de 2012 se les realizó un eco estrés en camilla supina, en etapas de 150 kgm, a 93 pacientes consecutivos (59 hombres, 54,9%), edad promedio de 58,8 ± 11,8 años. Se determinó la motilidad semicuantitativa visual en condiciones basales, en el pico del ejercicio y en el posesfuerzo inmediato y se analizó la deformación longitudinal 2D de 16 segmentos en reposo y en el posejercicio inmediato mediante un algoritmo de seguimiento de marcadores acústicos (AFI: automatic functional images de GE). Simultáneamente se evaluaron los síntomas, el electrocardiograma de 12 derivaciones y la tensión arterial en cada etapa. Resultados La frecuencia cardíaca basal fue de 76 ± 18 lat/min, alcanzó 133 ± 25 lat/min en el pico del ejercicio y 117 ± 15 lat/min en el posesfuerzo inmediato. Las pruebas fueron suficientes en 64 (68,8%) de los 93 pacientes evaluados; de los 29 pacientes con pruebas insuficientes, 9 fueron positivas y 20 negativas. Desarrollaron isquemia durante la prueba 21 pacientes (22,5%), diagnosticada como asinergias regionales transitorias (7 casos en territorio anterior, septal y/o apical, en otros 7 afectó las caras inferior, posterior y/o lateral, mientras que 7 pacientes tuvieron trastornos en segmentos de ambos territorios), los cuales eran más añosos (63,5 ± 8,7 vs. 57,4 ± 12,2 años; p = 0,03), con mayor antecedente de infarto de miocardio (14,3% vs. 7%; p = 0,01) y de cirugía de revascularización miocárdica (14,3% vs. 2,77%; p = 0,04) respecto de los pacientes que no desarrollaron isquemia. No se encontraron diferencias significativas en los antecedentes de hipertensión arterial, diabetes, dislipidemia y tabaquismo. El valor de la deformación longitudinal 2D apical se incrementó en 79 (85%) de los 93 pacientes evaluados, en los que solo 3 (3,8%) presentaron trastornos contráctiles en la misma región, mientras que de los 14 pacientes en los que la deformación longitudinal 2D apical no aumentó o disminuyó, 11 (78,6%) presentaron isquemia apical visualmente confirmada (sensibilidad 79%, especificidad 96%; p = 0,0001). De los 53 pacientes en los que se incrementó el valor de la deformación longitudinal 2D inferior, posterior y/o lateral, 6 (11,3%) presentaron trastornos contráctiles homozonales, mientras que de los 40 pacientes en los que no aumentó la deformación longitudinal 2D, en 8 (20%) se constataron visualmente asinergias transitorias en la misma región (sensibilidad 43%, especificidad 41%). La deformación longitudinal 2D se pudo evaluar en 1.472 de 1.488 segmentos en el reposo (factibilidad 99%), en 1.452 en el posesfuerzo (factibilidad 97,5%) y en 1.147 de 1.488 (77%) en el pico del esfuerzo (esta etapa no se consideró para el análisis). Conclusiones El análisis de la deformación longitudinal 2D resultó factible en el posesfuerzo inmediato. La falta de aumento o la disminución en la deformación longitudinal 2D de los segmentos apicales fueron concordantes con presencia de isquemia detectada visualmente. Las frecuencias cardíacas altas fueron responsables de la obtención de resultados poco específicos en los segmentos inferoposterolaterales basales y mediales, por lo que el strain 2D longitudinal solo sería de ayuda para analizar territorio irrigado por la arteria descendente anterior.(AU)


Feasibility and Contribution of Global and Regional 2D Strain during Exercise Stress Echocardiography Introduction The feasibility of longitudinal 2D strain analysis during exercise and the contribution of the information provided to detect ischemia at elevated heart rate are not well established. Although pharmacologic stress echocardiography has been used to evaluate ischemia and viability in several studies, the use of longitudinal 2D strain for the diagnosis of myocardial ischemia during exercise stress echocardiography has not been analyzed. Objectives The goal of this study was to determine the feasibility of analyzing longitudinal 2D strain and to evaluate its performance during exercise stress echocardiography. Methods Between February and March 2012, 93 consecutive patients (59 men, 54.9%), with mean age 58.8 ±11.8 years), underwent supine exercise stress echocardiography, in 150 kgm stages. Wall motion was visually evaluated using a semiquantitative analysis at baseline, peak exercise and immediately after exercise. Longitudinal 2D deformation was analyzed in 16 segments at rest and immediately after exercise using a tracking algorithm of acoustic markers (AFI: automatic functional images, GE). Symptoms, 12-lead electrocardiogram and blood pressure were simultaneously evaluated in each stage. Results Baseline heart rate was 76 ± 18 bpm, increased to 133 ± 25 bpm during peak exercise and was 117 ± 15 bpm immediately after exercise. The target heart rate was achieved in 64 (68.8%) of the 93 patients evaluated; in the 29 patients who did not achieve target heart rate, 9 tests were positive and 20 were negative for coronary artery disease. Twenty-one patients (22.5%) developed ischemia diagnosed as transient regional assynergies during exercise stress echocardiography: 7 patients in the anterior, septal and/or apical territories, 7 in the inferior, posterior and/or lateral territories and 7 in segments corresponding to both territories. These patients were older (63.5 ± 8.7 vs. 57.4 ± 12.2 years; p = 0.03) and the prevalence of previous myocardial infarction (14.3% vs. 7%; p = 0.01) and myocardial revascularization surgery (14.3% vs. 2.77%; p = 0.04) was higher compared to those without ischemia. There were no significant differences in the history of hypertension, diabetes, dyslipidemia or smoking habits. The value of longitudinal 2D strain in the apical segments increased in 79 (85%) of the 93 patients evaluated: only 3 of these patients (3.8%) developed new wall motion abnormalities in the same region. In the 14 patients in whom longitudinal 2D strain did not increase or decreased, 11 (78.6%) presented apical ischemia in the visual analysis (sensitivity 79%, specificity 96%; p = 0.0001). Among the 53 patients presenting increased longitudinal 2D strain in the inferi

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