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1.
Rev. cuba. med ; 59(4): e1366, oct.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144500

RESUMO

Introducción: La enfermedad arterial de miembros inferiores es un marcador de riesgo coronario, causa de invalidez y muerte en quienes la padecen, su identificación temprana puede atenuar estos efectos. Objetivo: Identificar la enfermedad arterial de miembros inferiores no diagnosticada a través de Eco-Doppler en pacientes con factores de riesgo aterogénicos. Método: Se realizó un estudio descriptivo de tipo transversal que incluyó a 100 pacientes de 40 años o más, fumadores, diabéticos y/o hipertensos, sin diagnóstico de enfermedad arterial de miembros inferiores, a quienes se le realizó Eco-Doppler de miembro inferior. Resultados: Se identificaron lesiones compatibles con EAMI en 69 por ciento de los estudiados, cuya edad media fue de 64,81 ± 10,12 años, y discreto predominio del sexo masculino. Las arterias más afectadas fueron la tibial posterior y la pedia con 43 por ciento y 39 por ciento respectivamente, las medidas de asociación mostraron OR (IC 95 por ciento) de 4,15 para la diabetes mellitus, 1,63 para el tabaquismo seguido de la hipertensión arterial con 0,27. Conclusiones: Seis de cada diez pacientes presentaron lesiones ateroscleróticas identificables por Eco-Doppler, predominaron las del sector tibial posterior y pedio en fumadores y diabéticos, estos últimos tuvieron cuatro veces más riesgo de padecer la enfermedad(AU)


Introduction: Arterial disease of the lower limbs is a marker of coronary risk, causing disability and death in those who suffer from it. Early detection can mitigate these effects. Objective: To identify undiagnosed lower limb arterial disease through Echo-Doppler in patients with atherogenic risk factors. Method: A descriptive, cross-sectional study was carried out in 100 patients aged 40 years or older, smoking habits history, and diabetic and / or hypertensive patients, with no diagnosis of arterial disease in the lower limbs, who underwent Eco-Doppler of the lower limb. Results: EAMI compatible lesions were identified in 69 percent of those studied, whose mean age was 64.81 ± 10.12 years, and a discrete male predominance. The most affected arteries were the posterior tibial and pediatric arteries in 43 percent and 39 percent respectively, the association measures showed OR (95 percent CI) of 4.15 for diabetes mellitus, 1.63 for smoking followed by arterial hypertension with 0.27. Conclusions: Six out of ten patients showed atherosclerotic lesions identifiable by Echo-Doppler, those of the posterior tibial sector and pedium predominated in smokers and diabetics, the latter had four times the risk of suffering from the disease(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ecocardiografia Doppler/métodos , Fatores de Risco , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Estudos Transversais , Estudo Observacional
2.
Am J Cardiol ; 134: 116-122, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891401

RESUMO

Assessment of right ventricular (RV) systolic function in patients with significant secondary tricuspid regurgitation (STR) remains challenging. In patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), STR and RV enlargement have been associated with poor outcomes. In these patients, speckle tracking echocardiography (STE) may detect RV systolic dysfunction better than 3-dimensional (3D) RV ejection fraction (EF). The purpose of this study was to investigate the prevalence of RV dysfunction when assessed with STE in patients with significant STR (≥3+) compared with patients without significant STR (<3+) matched for 3D RV dimensions and RVEF on dynamic computed tomography (CT). Patients with dynamic CT data before TAVI were evaluated retrospectively. To assess the performance of RV-free wall strain (RVFWS) for identifying patients with impaired RV systolic function, patients were subsequently matched 1:1 based on age, gender, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF). In a total 267 patients (80 ± 8 years, 48% male), significant STR (≥3+) was observed in 67 patients. Patients with STR≥3+ had larger RVEDVi, larger RVESVi, lower LVEF, and more impaired RVFWS compared with patients with STR<3+ (n = 200). After propensity score matching, patients with STR≥3+ (n = 53) had significantly more impaired RVFWS compared with patients with STR<3+ (n = 53): -18.2 ± 5.0% versus -21.1 ± 3.7%, p = 0.001. In conclusion, patients with significant STR have more pronounced RV systolic dysfunction as assessed with STE than the patients without significant STR despite having similar 3D RV dimensions and RVEF on dynamic CT.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ecocardiografia Doppler/métodos , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Ecocardiografia , Feminino , Humanos , Masculino , Sístole , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia
3.
Am J Cardiol ; 132: 119-125, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741538

RESUMO

It is well known that some patients present with "more than severe" tricuspid regurgitation (TR). We aimed to assess the prognosis of these very severe TR patients. We defined very severe TR using 3 simple echocardiographic parameters: a coaptation gap≥10mm, a laminar TR flow and a systolic reversal of the hepatic vein flow. We included 259 consecutive patients (76 ± 13 years; 46% men) with moderate-to-severe TR (n = 114) and severe TR (n = 145). The primary end point was the combination of hospitalisation for right heart failure (RHF) and cardiovascular mortality. Median follow-up was 24(7 to 47) months. In patients with severe TR, 52 (36%) met the definition of very severe TR. These patients were younger, had more history of RHF and were more frequently treated with loop diuretics than those with moderate-to-severe TR (all p < 0.001). Four-year event-free survival rates were 68 ± 5%, for moderate-to-severe TR, 48 ± 6% for severe TR and only 35 ± 7% for very-severe TR (p < 0.001). On multivariable analysis, after adjustment for outcome predictors including age, comorbidity, RHF, TR etiology, left and right ventricular dysfunction, and tricuspid valve surgery, patients with very severe TR had a worsened prognosis than those with moderate-to-severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.43 [1.18 to 5.53]; p = 0.002) and than those with severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.23 [1.06 to 5.56]; p = 0.015). In conclusion, very severe TR is frequent in patients with severe TR, corresponds to a more advanced stage of the disease and is associated with poor outcomes. Therefore, the use of a 5-grade classification of TR severity is justified in routine clinical practice. (ID-RCB: 2017-A03233-50).


Assuntos
Ecocardiografia Doppler/métodos , Insuficiência da Valva Tricúspide/classificação , Valva Tricúspide/diagnóstico por imagem , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico
4.
Rev. habanera cienc. méd ; 19(4): e2380, tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139176

RESUMO

RESUMEN Introducción: Las strain segmentaria y longitudinal constituyen excelentes parámetros para la cuantificación de la contractilidad miocárdica. Objetivo: Identificar los valores de strain segmentario y longitudinal de pacientes cubanos con drepanocitosis. Material y Método: Estudio descriptivo prospectivo en los 31 pacientes con drepanocitosis y 52 controles que asistieron al Instituto de Cardiología y Cirugía Cardiovascular entre junio de 2017 a enero de 2018, a los que se determinó strain segmentario y longitudinal como variables de estudio. Se compararon medias mediante la prueba t de Student y se realizó un análisis de varianza (ANOVA) con una prueba a posteriori de Tukey para p<0,05. Resultados: En los drepanocíticos las medias de strain segmentario estuvieron entre -17,7±3,4 porciento (p=0,0001*) y -28,6±4,1 por ciento(p=0,0005*) y -29,3±1,1 porciento (p=<0,0002*), fueron homogéneos todos sus segmentos y en el grupo control entre -19,3±2,9 por ciento (p=0,0001*), en general. Independientemente de que en los pacientes drepanocíticos las medias fueron más bajas estuvieron en el rango de lo normal. Los valores de las medias de strain longitudinal global oscilaron entre -19,2±3,3 y -25,2±2,7 fueron más negativos en el grupo control, respecto a los cubanos con drepanocitosis. Conclusiones: Los resultados obtenidos son los primeros de su tipo publicados en Cuba. Las strain segmentaria y longitudinal de los pacientes drepanocíticos cubanos analizados, con resultados significativamente diferentes que los individuos sanos, pero normales, coinciden con lo informado en la literatura internacional(AU)


ABSTRACT Introduction: Segmental and longitudinal strains are excellent parameters for the quantification of myocardial contractility. Objective: To identify the values ​​of segmental and longitudinal strain in Cuban patients with sickle cell disease. Material and Method: A prospective descriptive study was conducted in 31 patients with sickle cell disease and 52 controls who attended the Institute of Cardiology and Cardiovascular Surgery between June 2017 and January 2018, to which segmental longitudinal strain was determined as study variable. The means between the two groups were compared using the Student's t-test; an analysis of variance (ANOVA) was performed with a posteriori Tukey test for p <0.05. Results: In the patients with sickle cell disease, the means of segmental strain were between -17,7±3,4 percent (p=0,0001*) and -28,6±4,1 percent (p=0,0005*) and -29,3±1,1 percent (p=<0,0002*) with all segments being homogeneous; in the control group they were between -19,3±2,9 percent (p=0,0001*) in general. Despite the means were the lowest in Cuban patients with sickle cell disease, they were within the normal range. The mean values ​​of global longitudinal strain ranged between -19.2 ± 3.3 and -25.2 ± 2.7, being more negative in the control group with respect to Cuban patients with sickle cell disease. Conclusions: The results obtained are the first of its type published in Cuba. The segmental and longitudinal strain in Cuban patients with sickle cell disease analyzed, which have significantly different results from those obtained in healthy individuals, but normal, coincide with those reported in the international literature(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Volume Sistólico , Ecocardiografia Doppler/métodos , Disfunção Ventricular Esquerda/etiologia , Anemia Falciforme/complicações , Epidemiologia Descritiva , Estudos Prospectivos , Cuba , Estudo Observacional
5.
Eur Heart J Cardiovasc Imaging ; 21(7): 709-714, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391912

RESUMO

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Troponina I/sangue , Biomarcadores , Técnicas de Imagem Cardíaca/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler/estatística & dados numéricos , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Prognóstico , Medição de Risco , Papel (figurativo)
6.
Int J Cardiol ; 311: 116-121, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32291207

RESUMO

BACKGROUND: A novel coronavirus disease (COVID-19) in Wuhan has caused an outbreak and become a major public health issue in China and great concern from international community. Myocarditis and myocardial injury were suspected and may even be considered as one of the leading causes for death of COVID-19 patients. Therefore, we focused on the condition of the heart, and sought to provide firsthand evidence for whether myocarditis and myocardial injury were caused by COVID-19. METHODS: We enrolled patients with confirmed diagnosis of COVID-19 retrospectively and collected heart-related clinical data, mainly including cardiac imaging findings, laboratory results and clinical outcomes. Serial tests of cardiac markers were traced for the analysis of potential myocardial injury/myocarditis. RESULTS: 112 COVID-19 patients were enrolled in our study. There was evidence of myocardial injury in COVID-19 patients and 14 (12.5%) patients had presented abnormalities similar to myocarditis. Most of patients had normal levels of troponin at admission, that in 42 (37.5%) patients increased during hospitalization, especially in those that died. Troponin levels were significantly increased in the week preceding the death. 15 (13.4%) patients have presented signs of pulmonary hypertension. Typical signs of myocarditis were absent on echocardiography and electrocardiogram. CONCLUSIONS: The clinical evidence in our study suggested that myocardial injury is more likely related to systemic consequences rather than direct damage by the 2019 novel coronavirus. The elevation in cardiac markers was probably due to secondary and systemic consequences and can be considered as the warning sign for recent adverse clinical outcomes of the patients.


Assuntos
Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Miocardite/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Adulto , Biomarcadores/sangue , China , Estudos de Coortes , Comorbidade , Angiografia Coronária/métodos , Ecocardiografia Doppler/métodos , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Miocardite/diagnóstico , Miocardite/terapia , Pandemias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento
7.
J Interv Cardiol ; 2020: 8086796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256250

RESUMO

Percutaneous balloon aortic valvuloplasty (PBAV), which is used to treat symptomatic aortic stenosis, requires ionizing radiation and contrast agent for imaging guidance. The aim of the study is to evaluate the feasibility and effectiveness of ultrasound-guided PBAV in patients with aortic stenosis. This case series included 30 patients (14 males; mean age, 61.5 ± 4.5 years) with moderate/severe aortic stenosis treated with ultrasound-guided PBAV at the Ultrasound Department, Fuwai Hospital, Beijing, China, between January 2016 and July 2019. Cardiac function (New York Heart Association grade) was assessed before PBAV and 1 month after the procedure. Aortic peak jet velocity, aortic valve orifice area (AVA), mean transvalvular pressure gradient (MTPG), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were determined before and immediately after PBAV using Doppler echocardiography. Preprocedural cardiac function was grade I in 3 cases, grade II in 9 cases, grade III in 10 cases, and grade IV in 8 cases. Postprocedural cardiac function was grade I in 22 cases, grade II in 4 cases, and grade III in 4 cases, suggesting that cardiac function was improved by PBAV. Ultrasound-guided PBAV resulted in significant improvements (P < 0.05) in aortic peak jet velocity (3.68 ± 0.811 m/s vs. 4.79 ± 0.63 m/s), MTPG (33.77 ± 13.85 mmHg vs. 54.54 ± 13.81 mmHg), AVA (1.96 ± 0.25 cm2 vs. 0.98 ± 0.12 cm2), LVEDD (51.90 ± 3.21 mm vs. 65.60 ± 6.81 mm), LVEF (63.46 ± 11.29% vs. 56.31 ± 11.04%), and LVESD (35.50 2.62 mm vs. 45.20 ± 2.42 mm). Ultrasound-guided PBAV is feasible and achieves good short-term effects in patients with aortic stenosis.


Assuntos
Estenose da Valva Aórtica , Valvuloplastia com Balão/métodos , Ultrassonografia de Intervenção/métodos , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , China , Ecocardiografia Doppler/métodos , Estudos de Viabilidade , Feminino , Testes de Função Cardíaca/métodos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento
9.
J Vet Cardiol ; 27: 54-61, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32070937

RESUMO

OBJECTIVES: The objective of this study was to report normal echocardiographic values in healthy guinea pigs. ANIMALS, MATERIALS, AND METHODS: Twenty-two privately owned, apparently healthy, conscious guinea pigs underwent complete transthoracic echocardiography. Left ventricular (LV), right ventricular, left atrial, and aortic root dimensions were measured, as were forward flow velocities across the mitral, aortic, and pulmonic valves. The effects of age, body weight, sex, and heart rate on these variables were also investigated. RESULTS: The median age (interquartile range) was 3.0 (1.8-4.0) years with a body weight of 902 (822-998) grams. Echocardiography was feasible in all conscious animals. Early and late diastolic transmitral flow waves were summated in 17 of 22 individuals. In the remaining five animals, the two waves were reversed (E wave-to-A wave velocity less than 1.0). A positive correlation was detected between body weight and LV internal diameter at end-diastole and end-systole and left atrial diameter (P < 0.05). Heart rate was negatively correlated with LV internal diameter at end-systole (r = -0.463, P = 0.035). Age was positively correlated with LV posterior wall thickness at end-diastole and aortic diameter (P < 0.05). LV internal diameter at end-systole was larger in males than in females (P = 0.012), while fractional shortening was lower (P = 0.008). CONCLUSIONS: Descriptive echocardiography ranges in apparently healthy awake guinea pigs have been provided and can be used for cardiac assessment in these pet animals.


Assuntos
Ecocardiografia Doppler/veterinária , Ecocardiografia/veterinária , Cobaias/fisiologia , Coração/diagnóstico por imagem , Fatores Etários , Animais , Peso Corporal , Ecocardiografia/métodos , Ecocardiografia Doppler/métodos , Feminino , Frequência Cardíaca , Masculino
10.
Circ Cardiovasc Imaging ; 13(2): e009672, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32069118

RESUMO

BACKGROUND: Patients with vascular stiffening may display increased arterial afterload that is out of proportion to systolic blood pressure (SBP). Since vascular and endothelial dysfunction develop in patients with coarctation of aorta (COA), we hypothesized that for any SBP, patients with mild COA (COA peak velocity <2 m/s) will have a higher arterial afterload and increased left ventricular mass index (LVMI) compared with controls, and that Doppler-derived arterial load indices would be a better predictor of LVMI compared with SBP alone. METHODS: We studied 204 COA patients (age 35±12 y) and 204 matched controls. Doppler-derived arterial afterload was assessed using effective arterial elastance index and total arterial compliance index. RESULTS: Despite similar SBP, the mild COA group displayed higher arterial afterload as evidenced by a higher elastance index (3.3±0.9 versus 2.9±0.7 mm Hg/mL·m2; P<0.001) and lower total arterial compliance index (0.8±0.3 versus 1.2±0.5 mL/mm Hg·m2; P<0.001). This was associated with higher LVMI in COA (109±35 versus 93±32, g/m2; P<0.001). Compared with SBP (ß=0.24 [95% CI, 0.02-0.45]), elastance index (ß=20.2 [95% CI, 15.8-44.1]) and total arterial compliance index (ß=-32.5 [95% CI, -43.8 to -123.6]) were better predictors of LVMI. Elastance index (but not SBP) was predictive of longitudinal increases in LVMI (r=0.43, P<0.001). CONCLUSIONS: COA patients had higher arterial afterload compared with controls with similar SBP. In comparison to SBP, Doppler-derived arterial load indices correlate more strongly with LV hypertrophy. These data suggest that SBP may underestimate LV afterload in this population. This has important clinical implications since titration of antihypertensive therapy is currently based on SBP.


Assuntos
Coartação Aórtica/diagnóstico , Pressão Sanguínea/fisiologia , Ecocardiografia Doppler/métodos , Ventrículos do Coração/diagnóstico por imagem , Rigidez Vascular/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Coartação Aórtica/fisiopatologia , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole
11.
Mayo Clin Proc ; 95(1): 124-133, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902407

RESUMO

OBJECTIVES: To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular diseases in a community population. PATIENTS & METHODS: Cross-sectional survey of residents randomly selected through the Rochester Epidemiology Project, 45 years or older, of Olmsted County as of June 1, 1997, through September 30, 2000. Responders (2042) underwent assessment of systolic and diastolic function using echocardiography. The current analyses included all participants with DM and were compared with a group of participants without DM matched 1:2 for age, sex, hypertension, and coronary artery disease. Baseline characteristics and laboratory and echocardiography findings between groups were compared along with rates of mortality due to various cardiovascular conditions. RESULTS: We identified 116 participants with DM and 232 matched participants without DM. Those with DM had a higher body mass index and plasma insulin and serum glucose levels. Although left ventricular ejection fractions were similar, E/e' ratio (9.7 vs 8.5; P=.001) was higher in DM vs non-DM. During a follow-up of 10.8 (interquartile range, 7.8-11.7) years, participants with DM had a higher incidence of heart failure (HF); hazard ratio, 2.1; 95% confidence limits, 1.2-3.6; P=.01) and 10-year Kaplan-Meier rate of 21% (22 of 116) vs 12% (24 of 232) compared with those without DM. We also examined the subgroup of participants without diastolic dysfunction. In this subgroup, those with DM had an increased risk for HF; hazard ratio, 2.5; 95% confidence limits, 1.0-6.3; P=.04). CONCLUSION: In this cohort, participants with DM have an increased incidence of HF over a 10-year follow-up period even in the absence of underlying diastolic dysfunction. These findings suggest that DM is an independent risk factor for the development of HF and supports the concept of DM cardiomyopathy.


Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Volume Sistólico , Função Ventricular Esquerda , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Insulina/análise , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Mortalidade , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
12.
Med Sci Monit ; 26: e919247, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31971163

RESUMO

BACKGROUND The aim of this study was to assess the correlation between selective growth restriction (sGR) and co-twin utero-placental perfusion discordance by using three-dimensional power Doppler (3DPD). MATERIAL AND METHODS We prospectively recruited 60 sGR and 64 normal monochorionic-diamniotic (MCDA) twin pregnancies. Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were assessed by 3DPD, while umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed by conventional Doppler imaging. RESULTS In sGR co-twins, the VI, FI, VFI, MCA-PI, and CPR were significantly lower, while the UA-PI and MCA-PSV were significantly greater, in the smaller fetuses compared with the larger fetuses; significant differences were also observed in the VI, FI, VFI, CPR, and UA-PI in normal co-twins. Compared with the appropriately grown twins, the discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were increased in the sGR cohort. The discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were associated with birthweight discordance, and the FI discordance and CPR discordance were independently associated with sGR. The combination of the FI and CPR discordance showed a higher predictive accuracy for sGR, with an area under the ROC curve of 0.813, and a sensitivity and specificity of 68.33% and 85.94%, respectively. CONCLUSIONS MCDA twin pregnancies with birthweight discordance presented utero-placental perfusion deterioration assessed by 3DPD prior to sGR diagnosis. Co-twin utero-placental perfusion discordance was significantly correlated with growth discordance, and this correlation was more predictive of sGR when 3DPD was combined with conventional Doppler imaging.


Assuntos
Ecocardiografia Doppler/métodos , Retardo do Crescimento Fetal/diagnóstico por imagem , Placenta/irrigação sanguínea , Adulto , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Estudos Transversais , Feminino , Retardo do Crescimento Fetal/metabolismo , Retardo do Crescimento Fetal/fisiopatologia , Idade Gestacional , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Gravidez de Gêmeos , Fluxo Pulsátil , Ultrassonografia/métodos , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/irrigação sanguínea , Artérias Umbilicais/diagnóstico por imagem , Útero/irrigação sanguínea
13.
Clin Exp Hypertens ; 42(6): 527-530, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31933376

RESUMO

PURPOSE: In this study, we evaluated the electromechanical properties of atriums in patients with masked hypertension by using tissue Doppler echocardiographic technique to predict the predisposition to atrial arrhythmias. METHODS: A total of 118 subjects were included in the study. Twenty-four-hour blood pressure monitorization (ABPM) was used to determinate the masked hypertension in the study group. Tissue Doppler imaging was used to find intra-left and -right atrial electromechanical delay (AEMD) and inter-atrial electromechanical delay. The results compared between patients with masked hypertension and without. RESULTS: There were 55 (%46.6) patients with masked hypertension and 63 (%53.4) patients without masked hypertension without any difference regarding age sex heart rate. No statistically significant difference was found in intra-right AEMD between the groups. Left ventricular end-diastolic and systolic diameters (p <0.01 vs p=0.034), left ventricular posterior and septal wall thickness (p < .01 vs p < .01), left ventricular mass index (p <0.01), left atrium volume (p = 0.02), and indexed left atrial volume (p <0 .01) were high in patients with masked hypertension Inter-AEMD (48.07 ± 11.49 ms vs 43.73 ± 8.61 p=0.02) and intra-left AEMD (24.8 ± 6.35 ms vs 21.42 ± 7.99 ms p=0.013) were significantly higher in masked hypertensive patients. CONCLUSIONS: Masked hypertension shares the same clinical outcomes like overt hypertension. Any effort must be given to prevent unwanted events in masked hypertensive patients. According to our findings we suggesting that masked hypertensive patients must be evaluated for atrial arrhythmia.


Assuntos
Fibrilação Atrial , Ecocardiografia Doppler/métodos , Átrios do Coração , Hipertensão Mascarada , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Fenômenos Eletrofisiológicos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
14.
Cardiol Young ; 30(1): 1-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31910934

RESUMO

We reviewed the recent literature for echocardiographic assessment of mitral valve abnormalities in children. A literature search was performed within the National Library of Medicine using the keywords "mitral regurgitation and/or stenosis, children." The search was refined by adding the keywords "echocardiographic definition, classification, and evaluation." Thirty-one studies were finally included. Significant advances in echocardiographic imaging of mitral valve defects, mainly due to the implementation of three-dimensional technology, contribute to a better understanding of the underlying anatomy. However, heterogeneity between classification systems of mitral valve disease severity is a serious problem. For regurgitant lesions, there is only very limited evidence from small studies that support the adoption of quantitative/semi-quantitative indexes commonly employed in adults. Despite the lack of evidence base, qualitative evaluation of regurgitation severity is often employed. For stenotic lesions, no clear categorisation based on trans-valvular echocardiography-derived "gradients" has been consistently applied to define mild, moderate, or severe obstruction across different paediatric age ranges. Quantitative parameters such as valve area have also been poorly validated in children. Adult recommendations are frequently applied without validation for the paediatric age. In conclusion, significant advances in the anatomical evaluation of mitral valve diseases have been made, thanks to three-dimensional echocardiography; however, limitations remain in the quantitative/semi-quantitative estimation of disease severity, both with respect to valvular regurgitation and stenosis. Because adult echocardiographic recommendations should not be simply translated to the paediatric age, more specific paediatric guidelines and standards for the assessment of mitral valve diseases are needed.


Assuntos
Ecocardiografia Doppler/métodos , Insuficiência da Valva Mitral/diagnóstico , Estenose da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Criança , Humanos , Valva Mitral/anormalidades , Insuficiência da Valva Mitral/congênito , Estenose da Valva Mitral/congênito
15.
Clin Res Cardiol ; 109(3): 271-288, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31482241

RESUMO

According to recent recommendations on echocardiographic assessment of aortic valve stenosis direct measurement of transvalvular peak jet velocity, calculation of transvalvular mean gradient from the velocities using the Bernoulli equation and calculation of the effective aortic valve area by continuity equation are the appropriate primary key instruments for grading severity of aortic valve stenosis. It is obvious that no gold standard can be declared for grading the severity of aortic stenosis. Thus, conclusions of the exclusive evaluation of aortic stenosis by Doppler echocardiography seem to be questionable due to the susceptibility to errors caused by methodological limitations, mathematical simplifications and inappropriate documentation. The present paper will address practical issues of echocardiographic documentation to satisfy the needs to analyze different scenarios of aortic stenosis due to various flow conditions and pressure gradients. Transesophageal and multidimensional echocardiography should be implemented for reliable measurement of geometric aortic valve area and of cardiac dimensions at an early stage of the diagnostic procedure to avoid misinterpretation due to inconsistent results.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Erros Médicos/prevenção & controle , Estenose da Valva Aórtica/fisiopatologia , Documentação , Ecocardiografia Doppler/métodos , Humanos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
16.
J Cardiovasc Surg (Torino) ; 61(2): 243-249, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30303343

RESUMO

BACKGROUND: Aortic valve stenosis is the most common valvulopathy in developed countries. Transcatheter aortic valve implantation (TAVI) is a therapeutic alternative in symptomatic patients at high or prohibitive perioperative risk. Predilatation by balloon aortic valvuloplasty (BAV) under rapid ventricular pacing (RVP) has been a routine part of TAVI. However, both RVP and BAV carry substantial risks and an increasing number of interventional centers are performing TAVI without predilatation (direct TAVI). A transient decrease of left ventricular function and elevated markers of myocardial injury after TAVI with predilatation were observed in previous studies. In this study, we investigated whether direct TAVI was associated with a similar increase in cardiac biomarkers and decrease in ejection fraction in a cohort of our patients. METHODS: Consecutive patients undergoing TAVI without predilatation using a self-expanding system at a single center between April 2013 and December 2015 were followed up for one year and were retrospectively analyzed regarding mortality, safety and efficacy endpoints as well as common laboratory and echocardiographic parameters. RESULTS: A total of 164 patients (83±6 years; 56% female) were included in the analysis. According to the Valve Academic Research Consortium 2 (VARC-2) criteria the technical success rate was 96.3% and 89.1% of patients remained free of a combined safety endpoint at 30 days. Mortality rates at 30 days and 1 year were 3.0% (N.=5) and 10.4% (N.=17), respectively. TAVI without predilatation was highly effective in lowering aortic valve peak velocity from 4.4±0.6 m/s before to 1.7±0.5 m/s (P<0.01), and mean pressure gradient across the valve from 48.7±15.1 mmHg to 8.3±4.5 mmHg (<0.05). Left ventricular function remained unaltered after the intervention (51±10% prior to TAVI and 51±9% post TAVI), whereas high sensitive troponin T (hs-TnT), a well-established marker for myocardial injury, increased significantly from 26 ng/L (interquartile range=18.00-44.00) to 119 ng/L (interquartile range=73.25-166.00, P<0.001) during this time. Notably, an increase in the plasma levels of hs-TnT >15 times the upper limit of normal was associated with mortality both one month and one year after TAVI. CONCLUSIONS: TAVI without predilatation is feasible, safe and effective for aortic valve replacement in symptomatic patients with severe aortic stenosis who are at high perioperative risk. In contrast to a cohort of patients who underwent TAVI with predilatation previously published by another center, our patients did not suffer from transient impairment of left ventricular function. As a marker of myocardial injury, hs-TnT showed a less pronounced increase than reported previously. This might be a marker for a prognostic benefit as hs-TnT has been shown to be a strong predictor of outcome in patients undergoing TAVI. We conclude that direct TAVI is a less invasive option involving less myocardial stress.


Assuntos
Estenose da Valva Aórtica/cirurgia , Mortalidade Hospitalar , Segurança do Paciente/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Valvuloplastia com Balão/métodos , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Ecocardiografia Doppler/métodos , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Volume Sistólico/fisiologia , Análise de Sobrevida , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
17.
Eur Heart J Acute Cardiovasc Care ; 9(2): 102-107, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30124051

RESUMO

OBJECTIVE: Impaired vascular tone plays an important role in cardiogenic shock. Doppler echocardiography provides a non-invasive estimation of systemic vascular resistance. The aim of the present study was to compare Doppler echocardiography with the transpulmonary thermodilution method for the assessment of systemic vascular resistance in patients with cardiogenic shock. METHODS: This prospective monocentric comparison study was conducted in a single cardiology intensive care unit (Hopital Nord, Marseille, France). We assessed the systemic vascular resistance index by both echocardiography and transpulmonary thermodilution in 28 patients admitted for cardiogenic shock, on admission and after the introduction of an inotrope or vasopressor treatment. RESULTS: A total of 35 paired echocardiographic and transpulmonary thermodilution estimations of the systemic vascular resistance index were compared. Echocardiography values ranged from 1309 to 3526 dynes.s.m2/cm5 and transpulmonary thermodilution values ranged from 1320 to 3901 dynes.s.m2/cm5. A statistically significant correlation was found between echocardiography and transpulmonary thermodilution (r=0.86, 95% confidence interval (CI) 0.74, 0.93; P<0.0001). The intraclass correlation coefficient was 0.84 (95% CI 0.72, 0.92). The mean bias was -111.95 dynes.s.m2/cm5 (95% CI -230.06, 6.16). Limits of agreement were -785.86, 561.96. CONCLUSIONS: Doppler echocardiography constitutes an accurate non-invasive alternative to transpulmonary thermodilution to provide an estimation of systemic vascular resistance in patients with cardiogenic shock.


Assuntos
Ecocardiografia Doppler/métodos , Choque Cardiogênico/diagnóstico por imagem , Choque Cardiogênico/fisiopatologia , Resistência Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler/estatística & dados numéricos , Feminino , França/epidemiologia , Monitorização Hemodinâmica/métodos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Choque Cardiogênico/tratamento farmacológico , Análise de Sobrevida , Termodiluição/métodos , Termodiluição/estatística & dados numéricos , Vasoconstritores/uso terapêutico
18.
Pediatr Cardiol ; 41(2): 265-271, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707489

RESUMO

Transthoracic echocardiogram (TTE) is commonly used to screen for pulmonary hypertension (PHTN) in neonates and young infants. However, in the absence of sufficient tricuspid regurgitation (TR), a ventricular septal defect (VSD), or a patent ductus arteriosus (PDA), the estimation of systolic pulmonary artery pressure (SPAP) becomes challenging. Pulmonary artery acceleration time (PAAT) is an alternate parameter that is easy to obtain in almost all patients and does not require the presence of tricuspid valvar regurgitation or an anatomical cardiac defect. We sought to examine the correlation of PAAT with estimated SPAP by TTE and create an equation to estimate the SPAP using PAAT. We performed a retrospective review of TTEs performed on neonates and young infants (4 months of age or younger) at our institution between April 2017 and December 2018, along with the corresponding medical records. We included TTEs that provided estimation for SPAP and at least one PAAT measurement. During the study period, 138 TTEs performed on 82 patients met the inclusion criteria. Strong correlation was delineated between PAAT and SPAP estimated by the maximum velocity of tricuspid valve regurgitation Doppler, correlation coefficient (r) = - 0.83. Moderate correlation was detected between PAAT and SPAP estimated by PDA Doppler, r = - 0.66. Utilizing the following equation "SPAP = 82.6 - 0.58 × PAAT + RA mean pressure", PAAT can be used to estimate SPAP in neonates and young infants. PAAT can be used as an alternative to TR jet to assess SPAP when the latter is absent or insufficient. Further studies are needed to verify the accuracy of this equation.


Assuntos
Ecocardiografia Doppler/métodos , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/fisiopatologia
19.
Ann Thorac Surg ; 109(3): 945-949, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31756319

RESUMO

PURPOSE: Aortic insufficiency (AI) significantly affects morbidity and mortality in patients with left ventricular assist devices. Although AI may be commonly assessed by echocardiography, expert techniques are required for accurate quantification of AI severity. DESCRIPTION: In this prospective blinded study, screenshots from the HVAD (Medtronic, Framingham, MA) display and simultaneous echocardiographic measurements were obtained. Each screenshot was digitized and the early diastolic phase slope was calculated, with blinding to the echocardiographic results. The regurgitant fraction of AI was quantified by Doppler echocardiography of the outflow graft. EVALUATION: A total of 30 patients (median, 57 years old; 57% male) were enrolled. A cutoff of -17.6 L/min/s for the early diastolic phase slope had a sensitivity of 0.92 and a specificity of 0.53 to estimate significant AI with a regurgitant fraction of 30% or greater, and it significantly stratified patients into a low regurgitant faction group (0.3%) and a high regurgitant fraction group (33.0%) (P = .009). The early diastolic phase slope had a moderate correlation with the actually measured regurgitant fraction (r = .50). CONCLUSIONS: The early diastolic phase slope of the HVAD flow waveform may be a parameter that can estimate the presence of clinically significant AI.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico , Valva Aórtica/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Ecocardiografia Doppler/métodos , Coração Auxiliar/efeitos adversos , Adulto , Idoso , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/etiologia , Feminino , Humanos , Illinois/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
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