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1.
2.
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.
Int J Cardiol ; 286: 87-91, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30955880

RESUMO

BACKGROUND: Heart failure (HF) patients present with a variety of symptoms at different stages of the disease, but the underlying pathophysiology still is unclear. Left atrial (LA) function might be tightly related to changes in patients' symptoms, more than morphological and anatomic heart features, measurable by ultrasound imaging technique. This study sought to investigate the correlation between LA function, assessed by Speckle Tracking Echocardiography (STE) and Quality of Life (QoL), assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), in patients with chronic HF. METHODS: Clinically stable HF outpatients (n = 369) were enrolled from 7 different international centres and underwent echocardiographic studies. Patients >75 years old and with atrial fibrillation were excluded. LA strain during reservoir phase (LASr) by STE was measured in all subjects by averaging the 6 atrial segments. LA size was assessed using biplane volume and 4-chamber area acquisition. RESULTS: LASr strongly correlated with both MLHFQ total score (r = -0.87; p < 0.0001). Less significant correlations between MLHFQ and either LA volume or left ventricular global longitudinal strain (LV-GLS) were found (r = 0.28; p = 0.05 and r = 0.30; p = 0.01, respectively). No significant correlation was found between MLHFQ score, LVEF (r = -0.15; p = ns), E/E' ratio (r = 0.19; p = ns), and E/A ratio (r = 0.20; p = ns). Among all echocardiographic parameters analyzed, LASr presented the highest diagnostic accuracy (AUC = 0.74) in predicting a poor QoL (>45), when compared with LV-GLS (AUC = 0.61), LA volume (AUC = 0.54) and E/e' ratio (AUC = 0.51). CONCLUSIONS: In patients with HF, irrespective of etiology, LA function strongly correlates with patients' QoL.


Assuntos
Função do Átrio Esquerdo/fisiologia , Ecocardiografia Doppler/métodos , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Qualidade de Vida , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Função Ventricular Esquerda/fisiologia
4.
Eur J Prev Cardiol ; 26(9): 917-919, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30760031
5.
Curr Diabetes Rev ; 15(5): 347-348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648513

RESUMO

Problems in measuring the QT-dispersion are associated mostly with the inaccurate location of the T-wave end. The complications are: (i) In methodology due to various definition for Tend, (ii) In automatic measurements, due to low amplitude of T-wave, presence of U-wave and noise, and (iii) In manual measurements, due to lack of repeatability in the results, and involuntary subjectivism, when the QT-dispersion is measured by a person familiar with the ultimate goal of the study. New ECG repolarization parameter, 'T-Wave Area Dispersion' (TWAD), has been defined by Kenttä et al. 2018. Clustering ability of TWAD for prediction of risk for Sudden Cardiac Death (SCD) has been proven by the authors, working with a large database. We have measured TWAD in peri-, and postoperative ECG recordings of patients, undergoing coronary artery bypass grafting. Analysis of perioperative TWAD has shown an increased risk of adverse events in diabetics. Postoperative TWAD parameters have deteriorated proportionally in both diabetics/ non-diabetics groups indicating increased cardiac risk within the first ten postoperative days. The ability for diabetics/non-diabetics clustering of TWAD has been proven even in case of inaccurate location of the Tend. So far this is a reasonable advantage of TWAD vs. QT-dispersion in the study of ECG repolarization.


Assuntos
Ponte de Artéria Coronária , Diabetes Mellitus , Eletrocardiografia , Arritmias Cardíacas , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Morte Súbita Cardíaca , Complicações do Diabetes , Humanos , Medição de Risco
6.
Cardiovasc Revasc Med ; 20(1): 38-42, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29843976

RESUMO

OBJECTIVES: We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y-pattern), including the primary branches, and compared it to the standard procedure applied only within the main vessel. We also assessed the safety and practicality of a brachial access approach. METHODS AND RESULTS: Renal denervation was performed on 119 consecutive patients (60 ±â€¯13 years). In 68 of the patients, femoral arterial vascular approach was used and in 51 brachial. In 80 patients treated with the standard ablation, 12.0 ±â€¯3.0 total ablations (both sides) were applied while 20.4 ±â€¯3.9 total ablations were delivered for the group of 39 patients with Y-pattern denervation (P < 0.001). Technically successful renal denervation was achieved in all patients. Office blood-pressure levels at baseline were 170 ±â€¯17/93 ±â€¯10 mm Hg for the standard group and 169 ±â€¯13/96 ±â€¯9 mm Hg for the Y-pattern group. No major adverse events occurred during the procedure or in the postprocedural in-hospital period. Renal denervation was associated with significant decreases in both office and ambulatory systolic and diastolic blood pressure in both groups. The reduction in 24-hour mean ambulatory systolic blood pressure at 6 months was significantly greater (P = 0.002) for the Y-Pattern group (-22.1 ±â€¯15.4 mm Hg) compared to the Standard group (-11.8 ±â€¯16.2 mm Hg). Changes in diastolic office and ambulatory pressure were also significantly greater at 6 months in the Y-pattern ablation group. Indices of blood pressure variability improved in both groups. CONCLUSION: Renal denervation using a Y-pattern ablation strategy combined with a greater number of lesions is safe and resulted in significant greater decreases in mean 24-hour ambulatory systolic and diastolic blood pressure compared to the conventional approach in this single-centre matched cohort study. Brachial artery access was shown to be feasible and safe for renal denervation.


Assuntos
Artéria Braquial , Ablação por Cateter , Cateterismo Periférico/métodos , Artéria Femoral , Hipertensão/cirurgia , Rim/irrigação sanguínea , Artéria Renal/inervação , Simpatectomia/métodos , Idoso , Pressão Sanguínea , Ablação por Cateter/efeitos adversos , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Punções , Simpatectomia/efeitos adversos , Resultado do Tratamento
9.
Eur Heart J Cardiovasc Imaging ; 19(11): 1195-1221, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239635

RESUMO

The main goal of the present document is to provide a set of practical recommendations for ultrasound imagers who are interested in artery diseases or for physicians who intend to undertake vascular procedures. This is the first part of the work. It is dedicated to general principles of ultrasonography, cervicoencephalic, subclavian, aortoiliac and lower extremity arteries, abdominal aorta, and popliteal aneurysms. It also discusses miscellaneous items such as medial arterial calcinosis, arterial embolism, arteritis, arterial stents and bypasses, false aneurysms, aortic dissection, popliteal entrapment syndrome, and iliac endofibrosis.


Assuntos
Artérias/diagnóstico por imagem , Ultrassonografia/métodos , Doenças Vasculares/diagnóstico por imagem , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Guias de Prática Clínica como Assunto
10.
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
11.
Physiol Meas ; 39(9): 094005, 2018 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-30102603

RESUMO

OBJECTIVE: This study participated in the 2017 PhysioNet/CinC Challenge dedicated to the classification of atrial fibrillation (AF), normal sinus rhythm (Normal), other arrhythmia (Other) and strong noise, using single-lead electrocardiogram (ECG) recordings with a duration <60 s. The aim is to apply a linear threshold-based strategy for arrhythmia classification, ranking the most powerful time domain ECG features that could be easily reproduced on any platform. APPROACH: An algorithm for time domain ECG analysis was designed to extract 44 features with focus on the following: noise detection; heart rate variability (HRV) analysis; beat morphology analysis and delineation of P-, QRS-, and T-waves in the robust average beat; detection of atrial activity by the presence of P-waves in the average beat and atrial fibrillatory waves (f-waves) during TQ intervals. A linear discriminant analysis (LDA) classifier was optimized on the Challenge training set (8528 ECGs) by stepwise selection of a nonredundant feature set until maximization of the Challenge F1 score. Heart rate (HR) was an independent factor for the LDA classifier design, particular to bradycardia (HR ⩽ 50 bpm), normal rhythm (HR = 50-100 bpm), tachycardia (HR ⩾ 100 bpm). MAIN RESULTS: The algorithm obtained official Challenge F1 scores of 0.80 (Overall), 0.90 (Normal), 0.81 (AF), 0.70 (Other), and 0.54 (Noise) on the hidden Challenge test set (3658 ECGs). This is equivalent to a true positive rate (TPR) = 90.1% (Normal), 81.5% (AF), 67.7% (Other), and 69.5% (Noise), and a false positive rate (FPR) = 13.6% (Normal), 2.3% (AF), 7.7% (Other), and 1.5% (Noise). SIGNIFICANCE: The top five features, which together contributed to about 94% of the maximal F1 score were ranked: (1) proportion of RR intervals differing by >50 ms from the preceding RR interval; (2) Poincaré plot geometry estimated by the ratio of the minor-to-major semi-axes of the fitted ellipse; (3) P-wave presence in the average beat; (4) mean percentage of the RR interval first differences; and (5) mean correlation of all beats against the average beat. The global rank of feature extraction methods highlighted that HRV alone was able to provide 92.5% of the maximal F1 score (0.74 versus 0.8). The added value of more complex ECG morphology analysis was less significant for Normal, AF, and Other rhythms (+0.02 to 0.08 points) than for Noise (+0.19 points); however, these were indispensable for wearable ECG recording devices with frequent artefact disturbance.


Assuntos
Algoritmos , Fibrilação Atrial/diagnóstico , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Fibrilação Atrial/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Análise Discriminante , Eletrocardiografia/instrumentação , Frequência Cardíaca , Determinação da Frequência Cardíaca/métodos , Humanos , Modelos Lineares , Processamento de Sinais Assistido por Computador , Taquicardia/diagnóstico , Taquicardia/fisiopatologia
12.
Int J Cardiol ; 270: 149-153, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29980368

RESUMO

PURPOSE: Benefit of cardiac pacing in patients with vasovagal syncope (VVS) and cardioinhibitory response to head-up tilt test (HUTT) is still debated. We aimed at retrospectively assessing the long-term effect of cardiac pacing in a cohort routinely followed in our institutions. METHODS AND RESULTS: From a cohort of 1502 patients who performed HUTT between 2008 and 2014, 181 (12%) patients had VASIS 2A (40) or 2B (141) response (median age 43 [interquartile range, 25-56] years, 59% male). Fifty patients (28%) received a dual-chamber pacemaker and 131 (72%) received training on physical maneuvers and medical therapy. The so-called 'Closed Loop Stimulation' (CLS) function was activated for at least 18 months in the pacing group. The 5-year recurrence rate of syncope of paced patients was compared with non-paced patients and with a subgroup of 18 propensity-score matched patients selected among non-paced patients. The 5-year Kaplan-Meier syncope free-rate was 81% (CI, 67%-90%) in the pacing group, 57% (47%-67%; p = 0.004) in the unmatched control group, 53% (27%-74%; p = 0.005) in the 18 propensity-matched patients. The hazard ratio of pacing versus non-pacing was 0.34 (CI, 0.18-0.70) when comparing with the whole non-pacing control group, and 0.25 (CI, 0.09-0.65) including only the propensity-score matched subgroup. No deaths were observed during the follow-up. CONCLUSIONS: In the selected VVS population with HUTT-induced cardioinhibitory response, pacemaker therapy with CLS function was associated to 66% relative and 24% absolute risk reduction of 5-year syncopal recurrence rate. Benefit was confirmed after controlling variables affecting propensity for pacemaker therapy.


Assuntos
Estimulação Cardíaca Artificial/tendências , Bases de Dados Factuais , Síncope Vasovagal/fisiopatologia , Síncope Vasovagal/terapia , Teste da Mesa Inclinada/tendências , Adulto , Estimulação Cardíaca Artificial/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada/métodos , Resultado do Tratamento
14.
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
15.
Ultrasound Med Biol ; 43(11): 2558-2566, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28865726

RESUMO

Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd-5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R2 = 0.9478), 8-S (R2 = 0.9478) and 4-S scan (R2 = 0.9146) was excellent, but only good with 1-S (R2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.


Assuntos
Teste de Esforço , Água Extravascular Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Ultrassonografia/métodos , Água Extravascular Pulmonar/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descanso , Estresse Fisiológico/fisiologia
16.
Int J Cardiovasc Imaging ; 33(11): 1731-1736, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28550586

RESUMO

The diffusion of smart-phones offers access to the best remote expertise in stress echo (SE). To evaluate the reliability of SE based on smart-phone filming and reading. A set of 20 SE video-clips were read in random sequence with a multiple choice six-answer test by ten readers from five different countries (Italy, Brazil, Serbia, Bulgaria, Russia) of the "SE2020" study network. The gold standard to assess accuracy was a core-lab expert reader in agreement with angiographic verification (0 = wrong, 1 = right). The same set of 20 SE studies were read, in random order and >2 months apart, on desktop Workstation and via smartphones by ten remote readers. Image quality was graded from 1 = poor but readable, to 3 = excellent. Kappa (k) statistics was used to assess intra- and inter-observer agreement. The image quality was comparable in desktop workstation vs. smartphone (2.0 ± 0.5 vs. 2.4 ± 0.7, p = NS). The average reading time per case was similar for desktop versus smartphone (90 ± 39 vs. 82 ± 54 s, p = NS). The overall diagnostic accuracy of the ten readers was similar for desktop workstation vs. smartphone (84 vs. 91%, p = NS). Intra-observer agreement (desktop vs. smartphone) was good (k = 0.81 ± 0.14). Inter-observer agreement was good and similar via desktop or smartphone (k = 0.69 vs. k = 0.72, p = NS). The diagnostic accuracy and consistency of SE reading among certified readers was high and similar via desktop workstation or via smartphone.


Assuntos
Ecocardiografia sob Estresse/instrumentação , Aplicativos Móveis , Isquemia Miocárdica/diagnóstico por imagem , Consulta Remota/instrumentação , Smartphone , Brasil , Angiografia Coronária , Europa (Continente) , Estudos de Viabilidade , Humanos , Isquemia Miocárdica/fisiopatologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Echocardiography ; 33(1): 77-81, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26053566

RESUMO

BACKGROUND: Gold standard for pulse-wave velocity (PWV) measurement is determination of the carotid-femoral cfPWV, reflecting regional aortic PWV. Nevertheless, in several echocardiographic laboratories, PWV is measured locally, most commonly at the common carotid artery (CCA). The aim of this study was to compare regional and local PWV values in healthy volunteers. METHODS: The study population consisted of 22 prospectively enrolled healthy subjects, mean age 38.7 ± 11.1 years, 50% male. For regional PWV measurement, we evaluated cfPWV with a standard echo scanner. Regional PWV was measured at the CCA, with semiautomated dedicated software (MyLab, EsaOte, Italy). RESULTS: cfPWV and local PWV values correlated significantly with high Pearson correlation coefficient (0.62, P = 0.002). Mean regional cfPWV (9.29 ± 3.73 m/s), however, was significantly higher than mean local PWV value (5.96 ± 1.08 m/s) (P < 0.001). The difference persisted in the subgroup analysis using different cfPWV cutoff values (10, 9, 8, and 7 m/s), except for subjects with cfPWV ≤7 m/s, where regional and local PWV values were similar. CONCLUSION: In a group of healthy volunteers, regional and local PWV values showed a good correlation. However, regional PWV was significantly higher than local PWV. These findings should be carefully taken into account when using this technique in the clinical setting.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiologia , Artéria Femoral/fisiologia , Análise de Onda de Pulso/métodos , Adulto , Artérias Carótidas/fisiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Valores de Referência , Fluxo Sanguíneo Regional/fisiologia , Ultrassonografia
19.
Curr Diabetes Rev ; 11(2): 102-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25584936

RESUMO

Prevalence of diabetes mellitus (DM) is progressively increasing, contributing to a parallel increase in cardiovascular morbidity and mortality, and more than doubling the incidence of sudden cardiac death (SCD). Certain electrocardiographic (ECG) characteristics, such as alternans of the T wave (TWA), heart rate variability (HRV) and dispersion of the QT interval, have been found to be predictive of the risk of SCD. This review focuses on ECG changes that could be found in diabetics and their potential implication for SCD risk.


Assuntos
Arritmias Cardíacas/diagnóstico , Morte Súbita Cardíaca/epidemiologia , Diabetes Mellitus/fisiopatologia , Eletrocardiografia , Frequência Cardíaca , Humanos , Síndrome de Jervell-Lange Nielsen , Valor Preditivo dos Testes , Fatores de Risco
20.
Eur Cardiol ; 10(1): 12-18, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30310417

RESUMO

Coronary flow velocity reserve (CFVR) reflects global coronary atherosclerotic burden, endothelial function and state of the microvasculature. It could be measured using transthoracic Doppler echocardiography in a non-invasive, feasible, reliable and reproducible fashion, following a standardised protocol with different vasodilatory stimuli. CFVR measurement is a recommended complement to vasodilator stress echocardiography. It could serve as a diagnostic tool for coronary microvascular dysfunction and in the setting of epicardial coronary artery stenoses could help in identification and assessment of functional significance of coronary lesions and follow-up of patients after coronary interventions. CFVR has also a prognostic significance in different clinical situations.

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