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2.
J Interv Cardiol ; 2020: 7136802, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32140088

RESUMO

Purpose: The Occlutech Figulla occluder has been proven safe and effective at midterm follow-up after percutaneous atrial septal defect (ASD) closure. We describe the safety and efficacy at long-term follow-up in adults. Methods: All consecutive adult patients that underwent ASD closure between 2008 and 2015 were included. All complications were registered. Residual left-to-right shunt (LRS) was diagnosed using color-Doppler transthoracic echocardiography (TTE). Right-to-left shunting was diagnosed using contrast TTE. Successful closure was defined as no LRS at follow-up. Results: In total, 166 patients (mean age 56.7 ± 16.1 years; 62% female) underwent percutaneous ASD closure using the Occlutech Flex I (70%) or Flex II (30%) device (diameter 24 mm; range 10-40 mm) under general anaesthesia and transoesophageal echocardiographic guidance. Long-term follow-up data were available for 144 patients (87%) with a mean follow-up of 5.9 ± 2.6 years, a total of 814 patient-years. During hospitalization, device embolization occurred in three patients (1.8%) with successful extraction in all. During the long-term follow-up, 15 patients (9.8%) suffered new-onset atrial fibrillation and stroke occurred in 2.1%. There was no residual LRS at 12-month follow-up. No device embolization occurred during the long-term follow-up. Conclusion: Percutaneous ASD closure using the Occlutech device appears to be safe at long-term follow-up with a high successful closure rate at one year.


Assuntos
Complicações Pós-Operatórias , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/métodos , Ecocardiografia Doppler em Cores/métodos , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Dispositivo para Oclusão Septal/efeitos adversos , Dispositivo para Oclusão Septal/estatística & dados numéricos
4.
Clin Exp Med ; 20(1): 11-19, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31848778

RESUMO

Cardiovascular disease (CVD) is a major complication of systemic lupus erythematosus (SLE) and is now a leading cause of death for these patients. In this study, 23 SLE patients asymptomatic for CVD underwent a comprehensive echocardiographic examination to detect subclinical cardiac involvement. According to their SELENA-SLEDAI score, they were divided into two groups: SELENA-SLEDAI ≤ 12 (n = 13, 12 females) and SELENA-SLEDAI > 12 (n = 10, all females), indicative of mild-to-moderate and severe SLE, respectively. Patients in the latter group had significant increases in left ventricular (LV) mass, LV end-diastolic volume, left atrial volume and right heart parameters (pulmonary arterial pressure, tricuspid regurgitation velocity and diameter of the inferior cava) compared to the mild-to-moderate group. Alterations of the early to late diastolic trans-mitral flow velocity (E/A) were found in 39% of patients, equally distributed between the two groups. The Framingham score of all patients correlated directly with LV mass, interventricular septum thickness and posterior wall thickness, but did not significantly differ between patients with severe and mild-to-moderate SLE. These findings reveal the presence of early-stage, and thus clinically silent, diastolic dysfunction in patients with severe SLE. They demonstrate the poor predictive value of the Framingham score in CVD risk stratification of patients with SLE, thus highlighting the crucial role of echocardiography in the diagnostic workup of these patients.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Lúpus Eritematoso Sistêmico/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologia
5.
Cardiology ; 145(2): 80-87, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31825945

RESUMO

BACKGROUND: Diabetes mellitus type 1 (DM1) is associated with a high risk for cardiovascular disease, and early detection of myocardial dysfunction is crucial for the prevention of cardiac complications. OBJECTIVES: The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by using both conventional echocardiography as well as multi-layered speckle tracking echocardiography (STE) in young adults with DM1. METHODS: We included 50 young asymptomatic adults diagnosed with DM1 (mean interval from diagnosis 9 ± 6 years) and 80 healthy controls. STE was acquired using the GE Vivid S60 equipment. The LV longitudinal strain (LS), layer-specific strains of the endocardium, myocardium, and epicardium (global longitudinal strain [GLS]endo, GLSmyo, GLSepi) as well as RV strain were obtained using the EchoPAC BT13 workstation. RESULTS: No significant intergroup differences in LV ejection fraction were noted. GLSendo and GLSmyo were reduced in the DM1 group (-20.6 ± 2.7 vs. -22.0 ± 2.3 and -18.0 ± 2.4 vs. -19.1 ± 1.9, respectively, p < 0.05) compared to controls. Mechanical dispersion was higher in the diabetes group (34 ± 11 vs. 29 ± 7, p < 0.05). RV strain measurements showed no significant difference between the groups. CONCLUSIONS: Young adults with DM1 and without known heart disease have subclinical myocardial dysfunction with lower LV endocardium and myocardium LS and higher mechanical dispersion demonstrated by multi-layered STE.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cardiomiopatias Diabéticas/diagnóstico , Ecocardiografia Doppler em Cores/métodos , Ventrículos do Coração/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico , Adulto , Estudos de Casos e Controles , Cardiomiopatias Diabéticas/complicações , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Romênia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Direita , Adulto Jovem
6.
BMC Nephrol ; 20(1): 446, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796001

RESUMO

BACKGROUND: To investigate predictive factors related to graft failure of IgA nephropathy(IgAN) in renal allografts following living donor transplantation. METHODS: We identified a series of 102 biopsies diagnosed as IgAN in renal allografts following living donor transplantation from July 2004 to January 2017 at our center, and assess the predict value of the Lee's classification and the 2009 Oxford classification in IgAN in renal allografts, clinical, ultrasonic and pathological characteristics at biopsy and the outcomes were retrospectively analyzed. RESULTS: The 5-year graft cumulative survival rate after transplantation was 91.4%. The 4-year graft cumulative survival rate after biopsy diagnosis of IgAN in renal allografts was 59.6%. The mean time ± SD to disease was 4.7 ± 3.5 years. The color doppler ultrasound and blood flow imagine showed the echo enhancement, the reduced blood flow distribution, the reduced peak systolic velocity of main renal artery, and the increased resistance index of arcuate renal artery were valuable in evaluating the graft dysfunction. The Cox multivariate analysis revealed that the 24-h urinary protein level (HR 1.6 for 1-g increase, 95%CI 1.2-2.0), estimated glomerular filtration rate (eGFR) (HR 1.0 for 1-mL/min/1.73 m^2 decline, 95%CI 1.0-1.1), and mesangial C1q deposition (HR 3.0, 95%CI 1.2-7.4) at biopsy were independent predictive factors of graft failure of IgAN in renal allografts. CONCLUSIONS: IgAN in renal allografts occurred frequently within 5 years after transplantation. The risk of graft failure should be taken seriously in patients who exhibit heavy proteinuria and/or a declined eGFR as the initial symptoms; a high lesion grade (grade IV-V of Lee's classification) and/or mesangial C1q deposition may also indicated a poor outcome.


Assuntos
Aloenxertos , Biópsia , Glomerulonefrite por IGA/diagnóstico , Falência Renal Crônica/cirurgia , Transplante de Rim , Rim , Proteinúria , Adulto , Aloenxertos/diagnóstico por imagem , Aloenxertos/patologia , Aloenxertos/fisiopatologia , Biópsia/métodos , Biópsia/estatística & dados numéricos , Ecocardiografia Doppler em Cores/métodos , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/fisiopatologia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Doadores Vivos , Masculino , Prognóstico , Proteinúria/diagnóstico , Proteinúria/etiologia , Circulação Renal
8.
Echocardiography ; 36(11): 2118-2121, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31693216

RESUMO

Noncompaction of the ventricular myocardium (NVM), also known as spongy myocardium, is a rare type of cardiomyopathy that has a serious impact on fetuses, children, and adults. NVM mainly affects the left ventricle, as isolated right ventricular noncompaction (IRVNC) is rare. Pulmonary artery sling (PAS) is a rare condition in which the left pulmonary artery anomalously originates from a normal positioned right pulmonary artery, and only a few studies have reported PAS in fetuses. Fetal IRVNC complicated with PAS has not been reported yet. Here, we report a case of IRVNC complicated with PAS that was diagnosed prenatally at 30 weeks gestation and confirmed by postpartum anatomy and pathology.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Artéria Pulmonar/anormalidades , Ultrassonografia Pré-Natal/métodos , Malformações Vasculares/diagnóstico , Adulto , Evolução Fatal , Feminino , Idade Gestacional , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/embriologia , Humanos , Recém-Nascido , Miocárdio Ventricular não Compactado Isolado/embriologia , Gravidez , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/embriologia , Doenças Raras , Malformações Vasculares/embriologia
12.
J Am Soc Echocardiogr ; 32(12): 1526-1537.e2, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563434

RESUMO

BACKGROUND: The clinical significance of three-dimensional (3D) vena contracta area (VCA) in tricuspid regurgitation (TR) is not fully elucidated. The aim of this study was to investigate the diagnostic accuracy of 3D VCA using 3D echocardiography-derived regurgitation volume as a reference standard. METHODS: One hundred sixteen patients with at least moderate TR underwent two-dimensional transthoracic and color Doppler 3D transesophageal echocardiography. The 3D vena contracta, which was located at the narrowest neck of the TR jet just above and toward the right atrial side of the flow convergence zone, was assessed for TR location and severity. RESULTS: As for TR location, patients with severe functional TR had the highest prevalence of central jet location among TR subgroups, whereas patients with severe primary TR showed a greater spatial extent of TR jet location involved compared with the moderate TR group (P < .05 for both). As for TR severity, a 3D VCA cutoff value of 0.61 cm2 discriminated severe TR with sensitivity of 78% and specificity of 97% in the total patient population (area under the curve = 0.93, P < .001). Multivariate analysis revealed that 3D VCA, a dilated right ventricle, and hepatic vein systolic reversal were independently associated with regurgitant volume (P < .001 for all). The χ2 value for the model that incorporated clinical and two-dimensional integrative parameters and 3D VCA > 0.61 cm2 to evaluate severe TR was significantly higher than that for the model that incorporated only clinical and two-dimensional integrative parameters (P = .001). CONCLUSIONS: Three-dimensional VCA has independent and incremental diagnostic value for evaluating severe TR. Comprehensive evaluation of TR location and severity using 3D vena contracta analysis may help in treatment selection for TR.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/cirurgia
14.
Cardiovasc Ultrasound ; 17(1): 14, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31325956

RESUMO

BACKGROUND: Postnatal outcome of fetuses with isolated single umbilical artery (SUA) is determined mainly by right ventricular function. Our study examined whether there are differences in right ventricular function during the gestation period of fetuses with isolated SUA compared to healthy fetuses. METHODS: A prospective study was conducted on 77 fetuses with isolated SUA and 77 gestational age-matched controls from 22 to 39 weeks. For gestational age grouping, the isolated SUA fetuses and the control fetuses were divided into the second trimester group (22-27 weeks; 43 fetuses) and third trimester group (28-39 weeks; 34 fetuses). The fetal tricuspid annular plane systolic excursion (f-TAPSE) M-mode was applied to the tricuspid annulus, parallel to the ventricular septum, and the amplitude of the resulting wave was assessed using spatiotemporal image correlation (STIC) M-mode. We investigated the possible changes to the STIC M-mode indices during the course of pregnancy in both the isolated SUA and control groups. The relationship between f-TAPSE and gestational age was analyzed. Additionally, the correlations between f-TAPSE and birth weight was analyzed, and the birth weight differences between the isolated SUA and control groups in the third trimester were analyzed according to postpartum results. RESULTS: There was a significant difference in f-TAPSE between isolated SUA and control group in the third trimester (P < 0.05). There were significant correlations between gestational age (GA) and f-TAPSE among control fetuses (R2 = 0.9049; P < 0.01). A significant, positive correlation between GA and f-TAPSE was also found with isolated SUA fetuses (R2 = 0.8108; P < 0.01). The prevalence of small-for-gestational-age (SGA) fetuses and of discordant birth weight fetuses was significantly higher in the isolated SUA group than in the control group. In univariate analysis, the presence of an isolated SUA was associated with lower birth weight (2940 g compared with 3260 g) and with higher prevalence of SGA (13.0% compared with 3.9%; P < 0.01). The correlations between the birth weight and f-TAPSE in the two groups were analyzed in the third trimester, and the correlation in the isolated SUA group was better than that of the control group (R2 was 0.623 and 0.463 in the isolated SUA group and the control group, respectively). CONCLUSIONS: Right ventricular function in isolated SUA is altered as early as in fetal third trimester. STIC M-mode can measure the right heart function of the fetus and may predict isolated SUA with SGA.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Artéria Umbilical Única/diagnóstico , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Função Ventricular Direita/fisiologia , Adulto , Feminino , Coração Fetal/fisiopatologia , Idade Gestacional , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/embriologia , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Artéria Umbilical Única/fisiopatologia , Artérias Umbilicais/anormalidades , Artérias Umbilicais/embriologia
15.
Echocardiography ; 36(7): 1364-1371, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31169946

RESUMO

BACKGROUND: A vortex is a rotational fluid structure formed by shearing of fluid layers. It forms during diastole in the left ventricle (LV) and helps redirect flow to the LV outflow tract for ejection, optimizing energy conservation. The aim of this study was to demonstrate the feasibility of detecting and analyzing LV vortices using a new ultrasound technique known as blood speckle imaging (BSI). METHODS: Conventional and BSI parameters were acquired in preterm infants referred for echocardiography. BSI feasibility and reliability were explored using highest frequency settings and optimized Nyquist limits. Vortex area was determined by tracing the outer vortex ring at maximum area. Peak vortex formation time (PVFT) was determined at time of maximum vortex area relative to the R-wave, and vortex duration from frame-by-frame analysis of first appearance to vortex degradation. RESULTS: Left ventricle vortices were detected in 49 of the 50 preterm infants (weight 500-2020 g) with excellent intra- and inter-observer reliability. Mean vortex area indexed to LV area was 0.19 (0.08). Peak vortex formation time was at 87 (7)% of the cardiac cycle, and vortex duration lasted 13 (4)% of the cardiac cycle. Vortex area correlated positively with LV length, end-diastolic dimension, end-diastolic volume, mitral annular (R +0.42, +0.50, +0.47, +0.50, all P < 0.01), and transmitral Vti (R +0.37, P < 0.01). PVFT correlated negatively with E, EA, and Ee' (R -0.42, -0.47, -0.47, all P < 0.01). CONCLUSION: Left ventricle vortex formation can be analyzed with two-dimensional BSI and has the potential to complement existing parameters of cardiac health.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Função Ventricular Esquerda/fisiologia , Velocidade do Fluxo Sanguíneo , Estudos Transversais , Diástole , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Reprodutibilidade dos Testes
16.
J Cardiothorac Vasc Anesth ; 33(10): 2658-2662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31248799

RESUMO

OBJECTIVES: Although the most recent American Society of Echocardiography guidelines are a major step forward in echocardiographic evaluation of diastolic function, the ability to differentiate between normal and abnormal function remains challenging. The authors aimed to determine whether qualitative assessments of color M-mode flow displays could be a useful parameter in the evaluation of left ventricular (LV) diastolic dysfunction. DESIGN: Retrospective observational study. SETTING: Tertiary care level hospital. PARTICIPANTS: The study comprised echocardiographic data from 105 consecutive patients. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patients were allocated into the following 3 groups according to the LV diastolic function based on current American Society of Echocardiography recommendation guidelines for LV diastolic dysfunction classification: group I-normal function (n = 40); group II-early relaxation abnormalities (grade I) (n = 50), and group III-elevated LV pressures (grade II) (n = 15). Patients with normal diastolic function were younger (45 ± 14 y) than those with diastolic dysfunction (group II: 64 ± 10 y and group III: 56 ± 15 y) (p < 0.05). Volumetric echocardiographic parameters and mitral inflow and mitral annulus tissue Doppler imaging measures were significantly different among the 3 studied groups (p < 0.05). Interestingly, qualitative assessment of color M-mode flows displayed distinctive signals based on the left ventricle filling properties. Intraobserver and interobserver variability to determine the reliability of these signals were robust (weighted kappa 0.84 ± 0.11 and 0.65 ± 0.13, respectively). CONCLUSION: Qualitative assessment of color M-mode flow displays offers simple and reliable information of potential usefulness in the evaluation of LV diastolic function.


Assuntos
Ecocardiografia Doppler em Cores/normas , Estudo de Prova de Conceito , Pesquisa Qualitativa , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Ecocardiografia/métodos , Ecocardiografia/normas , Ecocardiografia Doppler em Cores/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologia
17.
Echocardiography ; 36(7): 1315-1321, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246345

RESUMO

OBJECTIVES: Recently, three-dimensional proximal isovelocity surface area (3D PISA) method has already been widely used in tricuspid regurgitation assessment. This study attempts to demonstrate the feasibility and accuracy of 3D PISA quantifying tricuspid regurgitation and explore the clinical value of 3D PISA in quantifying tricuspid regurgitation. METHODS: Fifty-four patients with more than mild tricuspid regurgitation (TR) were enrolled. Effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were assessed by transthoracic 3D PISA method and three-dimensional vena contracta area (3D VCA) method. The 3D VCA was used as reference method. We analyzed the correlation and differences of EROA between 3D PISA method and the reference method. RESULTS: Both EROA and Rvol assessed by the 3D PISA had good correlations with the reference method, particularly in the assessment of eccentric jets, with the correlation coefficients of r (EROA) = 0.83, P < 0.001, r (Rvol) = 0.90, P < 0.001, respectively. 3D PISA method had good agreement with 3D VCA method in grading TR. Intra-observer and inter-observer agreement were also good. CONCLUSIONS: Three-dimensional proximal isovelocity surface area method can accurately quantify the degree of tricuspid regurgitation with good repeatability and shorter time-consuming, which is worthy of further study. 3D PISA method is expected to be a new method for evaluating tricuspid regurgitation in clinic practice.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Tridimensional/métodos , Interpretação de Imagem Assistida por Computador/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Am Coll Cardiol ; 73(20): 2506-2517, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31118144

RESUMO

BACKGROUND: Diverging guideline definitions for the quantitative assessment of severe secondary mitral regurgitation (sMR) reflect the lacking link of the sMR spectrum to mortality and has introduced a source of uncertainty and continuing debate. OBJECTIVES: The current study aimed to define improved risk-thresholds specifically tailored to the complex nature of sMR that provide a unifying solution to the ongoing guideline-controversy. METHODS: This study enrolled 423 heart failure patients under guideline-directed medical therapy and assessed sMR by effective regurgitant orifice area (EROA), regurgitant volume (RegVol), and regurgitant fraction (RegFrac). RESULTS: Measures of sMR severity were consistently associated with 5-year mortality with a hazard ratio of 1.42 for a 1-SD increase (95% confidence interval [CI]: 1.25 to 1.63; p < 0.001) for EROA, 1.37 (95% CI: 1.20 to 1.56; p < 0.001) for RegVol, and 1.50 (95% CI: 1.30 to 1.73; p < 0.001) for RegFrac. Results remained statistically significant after bootstrap- or clinical confounder-based adjustment. Spline-curve analyses showed a linearly increasing risk enabling the ability to stratify into low-risk (EROA <20 mm2 and RegVol <30 ml), intermediate-risk (EROA 20 to 29 mm2 and RegVol 30 to 44 ml), and high-risk (EROA ≥30 mm2 and RegVol ≥45 ml) groups. In the intermediate-risk group, a RegFrac ≥50% as indicator for hemodynamic severe sMR was associated with poor outcome (p = 0.017). A unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac showed a significantly better discrimination compared with the currently established algorithms. CONCLUSIONS: Risk-based thresholds tailored to the pathophysiological concept of sMR provide a unifying solution to the ongoing guideline controversy. An algorithm based on the combined assessment of the unifying cutoffs for EROA, RegVol, and RegFrac improves risk prediction compared with currently established grading.


Assuntos
Algoritmos , Ecocardiografia Tridimensional/métodos , Insuficiência da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Idoso , Ecocardiografia Doppler em Cores/métodos , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico
20.
Int J Cardiovasc Imaging ; 35(9): 1627-1636, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31041633

RESUMO

Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We designed our study to compare intraventricular velocities and gradients, obtained by vector flow mapping (VFM) technology during early diastole in consecutive patients diagnosed with mild and advanced diastolic dysfunction at echocardiography and a control group with a purpose to validate the hypothesis of relationship between new parameters and severity of diastolic dysfunction and conventional markers of elevated LV filling pressure. Two-dimensional streamline fields were obtained using VFM technology in 121 subjects (57 with normal diastolic function, 38 with mild diastolic dysfunction and 26 with advanced diastolic dysfunction). We measured several velocities and calculated a gradient along the selected streamline, which we compared between groups and correlated them with conventional echocardiographic parameters. Apical intraventricular velocity gradient (GrIV) was the lowest in control group, followed by mild and advanced diastolic dysfunction groups (5.3 ± 1.9 vs. 6.8 ± 2.5 vs. 13.6 ± 5.0/s, p < 0.001) and showed good correlation with E/e' (r = 0.751, p < 000.1). GrIV/e' ratio was the strongest single predictor of severity of diastolic dysfunction. Different degrees of diastolic dysfunction affect the Intraventricular velocity behavior during early diastole obtained by VFM. GrIV could discriminate between groups with different levels of diastolic dysfunction and was closely associated with classical echocardiographic indices of elevated LV filling pressure. GrIV/e' ratio has a potential to become a single parameter needed to assess left ventricular diastolic function.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Doppler de Pulso/métodos , Interpretação de Imagem Assistida por Computador/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Dados Preliminares , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/fisiopatologia
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