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1.
Artigo em Inglês | MEDLINE | ID: mdl-32036487

RESUMO

Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. SE was recently reshaped with the ABCDE protocol: A for asynergy, B for B-lines (4-site simplified scan), C for contractile reserve based on force, D for Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending coronary artery; and E for EKG-based heart rate reserve (HRR, defined as peak/rest HR < 1.62). Aim of the study was to define the ESE response in patients with dyspnoea as the main symptom. From the initial population of patients referred in 2018 in a single center for semi-supine ESE, we selected two groups (without history of previous myocardial infarction or coronary revascularization) on the basis of the main presenting symptom: dyspnoea (Group 1, n = 100, 62 men, 63 ± 10 years) or chest pain (Group 2, n = 100, 58 men, age 61 ± 8 years). All underwent ESE with ABCDE protocol. Success rate was 100% for steps A, B, C, E, and 88% for step D. Positivity for A criterion occurred in 56 patients of Group 1 and 24 of Group 2 (p < 0.0001). B-lines positivity (stress > rest for ≥ 2 points) occurred in 40 patients of Group 1 and 28 of Group 2 (p = 0.07). LVCR positivity (< 2.0) occurred in 60 patients of Group 1 and 42 of Group 2 (p < 0.05). A reduced CFVR occurred in 56 of Group 1 and 22 of Group 2 (p < 0.0001). A blunted HRR was present in 44 patients of Group 1 and 22 of Group 2 (p < 0.001). In conclusion, in patients with unexplained dyspnoea, SE with ABCDE protocol is useful to document the cardiac origin of dyspnoea with a comprehensive assessment focused not only on ischemia (A) but also pulmonary congestion (B), myocardial scar or necrosis (C), coronary microvascular dysfunction (D) or chronotropic incompetence (E).

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.

4.
Rev. argent. cardiol ; 86(6): 14-19, dic. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003232

RESUMO

RESUMEN Introducción: Una plataforma de entrenamiento estandarizada ayuda a armonizar la lectura de la ecocardiografía de estrés (EE) más allá de las anormalidades en la motilidad parietal regional (AMPR) Objetivo: Armonizar los criterios de lectura del EE a través de diferentes laboratorios. Métodos: El laboratorio central preparó para los lectores de ecocardiografía un módulo obligatorio de 5 parámetros basado en la web de 2 horas de duración: AMPR; líneas B, reserva de la velocidad de flujo coronario (RVFC) evaluada mediante la velocidad pico del flujo diastólico en la arteria coronaria descendente anterior; reserva contráctil ventricular izquierda (RCVI, evaluada a partir de mediciones crudas del volumen de fin de sístole, VFS); y presión sistólica de la arteria pulmonar (basada en mediciones crudas de la velocidad del jet de regurgitación tricuspídea, VRT). La prueba de control de calidad consistió en 20 casos seleccionados por el centro coordinador. El umbral de aprobación determinado a priori fue de 18/20 (> 90%) con un coeficiente de correlación intraclase entre el laboratorio coordinador y el lector periférico > 0.90. Resultados: Ochenta y cuatro lectores completaron la certificación para las AMPR, 65 para las líneas B, 30 para la RVFC, 24 para el VFS y 20 para la VRT. El tiempo de lectura medio por intento fue más corto para la VRT (9 ± 4 min), la RVFC (13 ± 6 min) y las líneas B (17 ± 3 min), intermedio para el VFS (24 ± 7 min), y más prolongado para las AMPR (29 ± 12 min, p < 0.01). La tasa de acierto del primer intento fue más alta para la RVFC (85%), intermedia para la VRT (75%) y las líneas B (43%), menor para el VFS (35%) y más baja para las AMPR (28%, p < 0.01). Conclusiones: La plataforma de aprendizaje basada en la web mejora las habilidades de interpretación de imágenes sin necesidad de un equipamiento de imágenes costoso o de estudiar un paciente. El camino hacia la certificación es más largo para las AMPR, intermedio para el VFS y más corto para la VRT, la RVFC y las líneas B.


ABSTRACT Background: A standardized training platform helps to achieve reading harmonization in stress echocardiography (SE) beyond regional wall motion abnormalities (RWMA). Objective: To harmonize SE reading criteria across different laboratories. Methods: The core lab prepared for readers an obligatory 2-hour web-based learning module for 5 parameters: RWMA; B-lines; coronary flow velocity reserve (CFVR) based on peak diastolic flow velocity on the left anterior descending coronary artery; left ventricular contractile reserve (LVCR, from raw measurementis of end-systolic volume, ESV); systolic arterial pulmonary pressure (from raw measurementis of peak tricuspid regurgitant jet velocity, TRV). The quality control test consisted of 20 cases selected by the coordinating center. The a priori determined pass threshold was 18/20 (>90%) with intra-class correla-tion coefficient between the coordinating lab and the peripheral reader >0.90. Resultis: The certification was completed by 84 readers for RWMA, 65 for B-lines, 30 for CFVR, 24 for ESV and 20 for TRV The mean reading time per attempt was shorter for TRV (9±4 min), CFVR (13±6 min) and B-lines (17±3 min), intermedi-ate for ESV (24±7 min), and longer for RWMA (29±12 min, p <0.01). The success rate of the first attempt was higher for CFVR (85%), intermediate for TRV (75%) and B-lines (43 %), lower for ESV (35%) and lowest for RWMA (28 %, p <0.01). Conclusions: A web-based learning platform improves image interpretation skills without need for expensive imaging equip-ment or a patient to scan. The road to certification is longer for RWMA, intermediate for ESV, and shorter for TRV, CFVR and B-lines.

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.
Ultrasound Med Biol ; 44(7): 1402-1410, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29706411

RESUMO

There is a lack of information on the prognostic value of local high velocity in coronary arteries during echocardiography. The aim of the study described here was to define the prognostic value of local velocity >70 cm/s in the left main, anterior or circumflex artery during echocardiography. There were 412 patients in the prospective study. Death, non-fatal myocardial infarction, acute pulmonary edema, acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACEs). Over 10.5 mo, there were 207 patients with MACEs. Seventeen patients died, 10 had non-fatal acute cardiac events and 184 underwent revascularization. Deaths occurred in patients with high local velocity (6.4% vs. 0%, p <0.009). Acute cardiac events occurred in 10% versus 0% (p <0.003). MACEs were observed in 62% versus 0% (p <0.0000001). Only maximal velocity was an independent prognostic predictor of death (odds ratio = 1.02, 95% confidence interval: 1.01-1.03, p <0.02) and MACEs (odds ratio = 1.04, 95% confidence interval: 1.02-1.05, p <0.0001). The success rate of coronary artery visualization for at least one segment was 91%.


Assuntos
Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
7.
Acta Radiol ; 59(6): 664-671, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28958154

RESUMO

Background Several recent studies have reported the opportunity to diagnose significant narrowing of the coronary arteries without stress testing using local flow acceleration. Purpose To define how often patients with increased coronary flow velocities at rest (≥ 0.70 m/s) have a positive exercise echocardiography test. Material and Methods A total of 150 patients scheduled for exercise echocardiography were studied using transthoracic Doppler echocardiography in order to assess coronary artery flow velocity before exercise. Pulsed wave Doppler registered blood flow velocity placed on the color signal. The maximal diastolic velocity of coronary flow was measured. Results Of participants, 16% had a velocity of more than 0.70 m/s in the left main/proximal left anterior/proximal left circumflex arteries (LM/pLAD). A significant correlation was observed between the value of the maximal velocity in LM/pLAD and the ejection fraction at the peak of exercise ( r ≈ -0.39, P < 0.0001); between the value of the maximal velocity in LM/pLAD and index of wall motion abnormalities (IWMA) at the peak of exercise ( r ≈ 0.44, P < 0.0001); and between the value of the maximal velocity in LM/pLAD and dIWMA ( r ≈ 0.41, P < 0.0001). Afterwards, severe ischemia in stress echocardiography tests was observed in this group. The average IWMA of these tests was found to be 2.3. Sixty-two angiograms were available for comparison with Doppler data. Conclusion There is a significant correlation between the value of the maximal velocity in LM/pLAD/pLCx at rest and the severity of wall motion abnormalities during exercise tests.


Assuntos
Circulação Coronária , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Descanso , Medição de Risco
8.
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
9.
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
10.
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
11.
Eur Heart J Cardiovasc Imaging ; 18(10): 1179-1184, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27502295

RESUMO

Aims: The aim of the study was to assess the additive prognostic value of coronary flow velocity reserve (CFVR) alongside wall motion analysis during exercise echocardiography in patients with known or suspected coronary artery disease (CAD). Methods and results: In a prospective, single-centre, observational study, we evaluated 689 patients (449 males; 56 + 9 years) who underwent supine bicycle stress echo (ESE) with CFVR evaluation of the left anterior descending artery (LAD) by Doppler. ESE was positive for regional wall motion abnormalities in 359 (52%) patients. Mean CFVR was 1.9 ± 0.8. During a median follow-up of 36.6 months, there were 200 patients with major adverse cardiac events (MACE): 15 deaths, 17 non-fatal myocardial infarctions [11 of them also had percutaneous coronary intervention with stenting (PCI) or/and coronary artery bypass graft surgery (CABG)] and 179 patients underwent revascularization. The 37 months' event-free survival showed the best outcome for those patients with negative ESE by wall motion criteria and normal CFVR, and the worst outcome for patients with positive ESE by wall motion and abnormal CVFR (99 vs. 42%, P < 0.0001). At multivariable analysis, CFVR in LAD (OR 0.53, 95% CI 0.35-0.79, P < 0.0001), positivity for regional wall motion abnormalities during testing (OR 0.10, 95% CI 0.04-0.25, P < 0.000), previous PCI (OR 0.38, 95% CI 0.16-0.90, P < 0.003), male sex (OR 0.44, 95% CI 0.27-0.71, P < 0.0009), and heart rate reached during exercise (OR 0.98, 95% CI 0.96-0.99, P < 0.02) were independent prognostic predictors of MACE. Conclusion: In patients with known or suspected CAD, exercise stress tests measuring wall motion criteria and CFVR are additive and complementary for the identification of patients at risk of experiencing major adverse events.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia sob Estresse/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Idoso , Angioplastia Coronária com Balão/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Causas de Morte , Estudos de Coortes , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/terapia , Circulação Coronária/fisiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Curva ROC , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
12.
Eur J Nutr ; 55(4): 1331-43, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26932503

RESUMO

Caffeine is a most widely consumed physiological stimulant worldwide, which is consumed via natural sources, such as coffee and tea, and now marketed sources such as energy drinks and other dietary supplements. This wide use has led to concerns regarding the safety of caffeine and its proposed beneficial role in alertness, performance and energy expenditure and side effects in the cardiovascular system. The question remains "Which dose is safe?", as the population does not appear to adhere to the strict guidelines listed on caffeine consumption. Studies in humans and animal models yield controversial results, which can be explained by population, type and dose of caffeine and low statistical power. This review will focus on comprehensive and critical review of the current literature and provide an avenue for further study.


Assuntos
Cafeína/administração & dosagem , Cafeína/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Animais , Vasos Sanguíneos/efeitos dos fármacos , Vasos Sanguíneos/metabolismo , Estudos Clínicos como Assunto , Café/efeitos adversos , Café/química , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Coração/efeitos dos fármacos , Coração/fisiologia , Humanos , Metanálise como Assunto , Síndrome Metabólica/epidemiologia
13.
Acta Radiol ; 57(9): 1056-65, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26676763

RESUMO

BACKGROUND: Assessment of coronary flow is only performed during pharmacological tests. Supine bicycle tests permit the visualization of coronary flow assessments during exercise. PURPOSE: To assess the parameters of coronary flow in the left anterior descending artery (LAD) during exercise, which could be a sign of significant LAD narrowing. MATERIAL AND METHODS: A total of 253 patients were enrolled: Group 1, 186 non-selective participants before undergoing a coronary angiography; and Group 2, 67 controls without coronary artery disease (CAD). All the patients performed a supine bicycle echocardiography test. Coronary flow velocities and coronary flow velocity reserve (CFVR) were measured at the mid-segment of the LAD during exercise. Patients in Group 1 underwent a coronary angiography. RESULTS: In comparison with participants without significant LAD stenosis, patients with LAD lesions had a lower ΔV (16 ± 21 vs. 27 ± 20 cm/s, P < 0.04) and a lower CFVR (1.5 ± 0.8 vs. 2.0 ± 0.6, P < 0.004). In comparison with patients without significant proximal LAD stenosis, the patients with proximal LAD lesions had a lower flow velocity at the peak of exercise (49 ± 32 vs. 61 ± 19 cm/s, P < 0.02), a lower ΔV (13 ± 19 vs. 26 ± 22 cm/s, P < 0.004), and a lower CFVR (1.4 ± 0.6 vs. 1.9 ± 0.7, P < 0.0001). In comparison with the control group, the patients with LAD stenosis had a lower flow velocity at the peak of exercise, a lower ΔV, and a lower CFVR. CONCLUSION: Non-invasive CFVR measurement in the LAD could provide valuable additional information to a conventional echocardiography exercise test. In routine clinical practice, CFVR is sufficient for a diagnosis of severe stenosis.


Assuntos
Velocidade do Fluxo Sanguíneo , Circulação Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/fisiopatologia , Ecocardiografia Doppler de Pulso , Ecocardiografia sob Estresse , Teste de Esforço , Ciclismo/fisiologia , Estudos de Casos e Controles , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Biomarkers ; 20(1): 17-25, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25510672

RESUMO

In acute myocardial infarction patients the injured vascular wall triggers thrombus formation in the damage site. Fibrin fibers and blood cellular elements are the major components of thrombus formed in acute occlusion of coronary arteries. It has been established that the initial thrombus is primarily composed of activated platelets rapidly stabilized by fibrin fibers. This review highlights the role of platelet membrane phenotype in pathophysiology of myocardial infarction. Here, we regard platelet phenotype as quantitative and qualitative parameters of the plasma membrane outer surface, which are crucial for platelet participation in blood coagulation, development of local inflammation and tissue repair.


Assuntos
Plaquetas/metabolismo , Infarto do Miocárdio/sangue , Animais , Membrana Celular/metabolismo , Humanos , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Infarto do Miocárdio/genética , Fenótipo , Polimorfismo Genético
16.
Cardiol Res ; 4(4-5): 152-158, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28352438

RESUMO

BACKGROUND: There is conflicting data in contemporary literature concerning the best way to treat patients with stable coronary artery disease; specifically, whether medical treatment alone or invasive strategies combined with medical treatment are better. The purpose of this study was to evaluate the clinical outcomes of patients with and without revascularization after stress echocardiography and to create formulas for detecting patients with a very high risk of cardiac death/major adverse cardiac event (MACE) in their present conditions. METHODS: We assessed 323 patients (53.9 ± 8.4 years, 247 men), undergoing upright bicycle stress echocardiography in 2006 - 2007. During a median follow-up of 5.2 ± 0.2 years, 21 cardiovascular and 5 confirmed non-cardiac deaths occurred. Eighty-three patients underwent revascularization. RESULTS: Stress echocardiography was normal in 32% and abnormal in 68%. All the patients with CAD were prescribed acetylsalicylic acid, statins, beta-blockers and ACE inhibitors. Eighty-seven percents of the patients took medication regularly. The percentage taking medication didn't significantly differ in the subgroups. Two formulas were created for detecting a very high risk of cardiac death (25%) or MACE (68%) within 5 years. All the patients with abnormal stress tests were divided into two subgroups: 80 patients with revascularization and 138 subjects without revascularization. There was a significant difference in 5 year cardiac mortality if the patients had an index of wall motion abnormality (IWMA) after exercise greater than or equal to 1.3. CONCLUSION: It is possible to identify during stress echocardiography subjects with a very high risk for cardiac death/MACE. Patients with IWMA ≥ 1.3 had improved outcomes following revascularization.

17.
Coron Artery Dis ; 23(5): 337-47, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22569195

RESUMO

BACKGROUND: Knowledge of alteration in coronary artery flow during physical activity provides important and valuable information about every patient. AIM: The aim of our study was (a) to identify the possibility of assessing coronary artery flow parameters using different ultrasound systems during the exercise test and (b) to compare these parameters with angiography data. METHODS: A total of 400 consecutive nonselected patients were enrolled. Group 1 included 200 patients who underwent supine exercise echocardiography with the ultrasound system Sonoline G 60S and group 2 included 200 patients who performed the same stress test with the system Vivid 7 Dimension. Before and after exercise, Doppler velocity curves were obtained in the posterior descending coronary artery (PDA) and the left anterior descending artery (LAD). The differences between poststress and rest velocities (ΔV) and the 'poststress velocity/rest velocity' ratio were also calculated. In total, 123 patients underwent a coronary angiography. RESULTS: A total of 92% PDA and 85% LAD before the exercise and 81% PDA and 60% LAD after the exercise were feasible for the assessment of peak velocity in group 1. And a total of 95% PDA and 85% LAD before the exercise and 80% PDA and 57% LAD after the exercise were feasible for group 2. A significant correlation was observed between peak velocities after stress and the percentage of LAD stenosis severity (r ≈ -0.60, P<0.0001); between ΔV and LAD stenosis severity (r ≈ -0.65, P<0.0001); between the 'poststress velocity/rest velocity' ratio and LAD stenosis severity (r ≈ -0.61, P<0.0001); and between peak velocities and percentage of PDA stenosis (r ≈ -0.3, P<0.01). The accuracy, sensitivity, and specificity were 80, 90, and 62% for the peak of LAD; -80, 92, and 68% for ΔV of LAD; and 83, 93, and 57% for the 'poststress velocity/rest velocity' ratio, respectively. CONCLUSION: It is feasible to assess coronary artery flow by a transthoracic Doppler during supine exercise. The parameters of Doppler coronary flow velocities correlate significantly with coronary angiographic data.


Assuntos
Ciclismo , Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Posicionamento do Paciente , Decúbito Dorsal , Velocidade do Fluxo Sanguíneo , Distribuição de Qui-Quadrado , Angiografia Coronária , Estenose Coronária/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Federação Russa , Sensibilidade e Especificidade , Índice de Gravidade de Doença
18.
Cardiol Res ; 2(2): 72-78, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28348665

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is often associated with diastolic dysfunction. Theoretically, a more marked alteration of diastolic function is revealed during exercise. METHODS AND RESULTS: We studied 84 persons: 1) 25 patients with HCM, 2) 25 patients with essential arterial hypertension (AH) and 3) 34 healthy controls. Each person performed a treadmill echocardiography. Before and after work, the following parameters were measured: the time interval between the QRS complex and the onset of mitral early diastolic filling velocity (TE), the interval between the QRS complex and the onset of peak early tissue mitral annular velocity (Te'), the isovolumetric relaxation time over the difference of TE and Te' ratio (IVRT/(TE-Te')), and changes of the time parameters during the stress test. In comparison with hypertensive and control groups, HCM patients at rest showed a significantly longer TE (448 ± 55 vs. 423 ± 33 vs. 417 ± 24 ms, P < 0.04) and Te' (446 ± 48 vs. 403 ± 44 vs. 416 ± 38 ms, P < 0.003). After stress the HCM group had a longer Te' (355 ± 59 vs. 299 ± 40 vs. 292 ± 30 ms, P < 0.000004) and a higher IVRT/(TE-Te') ratio (3.1 ± 1.5 vs. 0.9 ± 2.4 vs. 1.7 ± 1.2, P < 0.002). CONCLUSIONS: HCM patients show an alteration in the time parameters not only compared to healthy persons but to hypertensive patients as well.

19.
Coron Artery Dis ; 20(8): 525-30, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19779304

RESUMO

BACKGROUND: Assessing right ventricle (RV) function is difficult primarily because of its complex shape. Worsening RV function or dilatation during stress tests in patients with coronary artery disease may indicate proximal right coronary artery (RCA) narrowing. The aim of this study was to obtain quantitative diagnostic criteria for impaired RV function by tissue Doppler imaging (TDI) during exercise echocardiography, which could detect a significant lesion of the RCA in patients with coronary artery disease. METHODS AND RESULTS: We evaluated regional systolic and diastolic function using pulsed-wave TDI in two myocardial segments of the RV free wall during exercise stress tests in 160 patients with suspected coronary artery disease. The diagnostic criteria were obtained by comparing TDI and coronary angiography data. The accuracy, sensitivity, and specificity of the TDI diagnostic model for RCA disease were 81.1, 88.0, and 72.3%, respectively. CONCLUSION: TDI is a highly accurate method for the detection of RV dysfunction and RCA disease at rest and during exercise stress echocardiography in group of patients with known or suspected coronary artery disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia Doppler de Pulso , Ecocardiografia sob Estresse , Teste de Esforço , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Diástole , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Sístole , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
20.
Eur J Echocardiogr ; 8(6): 463-9, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17030021

RESUMO

UNLABELLED: Development of optimal methods for the objective non-invasive diagnosis of coronary artery disease remains a challenge for imaging techniques in stress tests. AIM: The aim of this study was to obtain quantitative diagnostic criteria TDI which could detect significant coronary artery disease during exercise echocardiography. METHODS AND RESULTS: We evaluated regional systolic and diastolic myocardial functions of 123 patients by pulsed wave tissue Doppler imaging (TDI) in eight segments of left ventricle during exercise stress testing. Diagnostic criteria were obtained by comparing TDI and coronary angiography data. Best cut-points of velocity parameters allowed developing two diagnostic models for the detection of left anterior descending (LAD) and circumflex (LCx) artery diseases. The accuracy of the TDI diagnostic model for LAD-disease was 86.2% and for LCx-disease 78.3%. There were no criteria for the detection of RCA disease in this study. CONCLUSION: So TDI is a very accurate method for the detection of LAD- and LCx-disease during exercise stress echocardiography.


Assuntos
Ecocardiografia Doppler , Ecocardiografia sob Estresse , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Distribuição de Qui-Quadrado , Angiografia Coronária , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
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