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2.
ABC., imagem cardiovasc ; 32(4): 303-308, out.-dez. 2019. tab, ilus, graf
Artigo em Português | LILACS | ID: biblio-1023931

RESUMO

A cardiomiopatia hipertrófica é uma doença de origem genética, que afeta milhares de pessoas em todo o mundo.Objetivos: Avaliar a presença de regurgitação mitral em pacientes com cardiomiopatia hipertrófica, bem como sua relação com variáveis ecodopplercardiográficas do ventrículo esquerdo. A disfunção de valva mitral encontradas nesses pacientes mostra-se um dado de extrema relevância, visto que é capaz de predizer a sobrevida e a taxa de mortalidade dos enfermos acometidos pela cardiomiopatia hipertrófica.Métodos: Foram avaliados todos os ecocardiogramas realizados no período de 2006 a 2016 no serviço de ecocardiografia do Hospital de Base de São José do Rio Preto, sendo o total de 112.930 exames. Foram selecionados aqueles com diagnóstico de cardiomiopatia hipertrófica ou espessura parietal > 15 mm, e incluídos na análise 132 pacientes.Resultados: Regurgitação valvar mitral de grau moderado e importante esteve presente em 25% e 5,3% dos pacientes, respectivamente, sendo que a regurgitação mitral esteve independentemente correlacionada com a forma obstrutiva de cardiomiopatia hipertrófica.Conclusão: A regurgitação mitral é achado frequente em pacientes com cardiomiopatia hipertrófica, no entanto, a insuficiência mitral importante é extremamente incomum e está correlacionada com a forma obstrutiva da doença


Hypertrophic Cardiomyopathy (HCM) is a genetic disease that affects thousands of people around the world.Objectives:The present study aims to evaluate the presence of mitral regurgitation in patients with HCM, as well as its relationship with left ventricular Doppler echocardiographic variables. The mitral valve failure found in these patients is an extremely important finding, since it is able to predict the survival and mortality rate of the patients affected by HCM.Materials and Methods: All echocardiograms performed from 2006 to 2016 in the echocardiographic service of Hospital de Base de São José do Rio Preto were evaluated. A total of 112,930 tests were gathered, of which those with HCM diagnosis or wall thickness >15 mm were selected and 132 patients were included in the analysis.Results: Moderate and major mitral valve regurgitation is present in 25% and 5.3% of the patients, respectively, and MRI is independently correlated with the obstructive form of HCM.Conclusion: Mitral regurgitation is a frequent finding in patients with CMP, however, significant MI is extremely uncommon and is correlated with the obstructive form of the disease


Assuntos
Humanos , Masculino , Feminino , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/genética , Ecocardiografia/métodos , Insuficiência da Valva Mitral , Volume Sistólico , Ecocardiografia Doppler/métodos , Análise Estatística , Estudos Retrospectivos , Ventrículos do Coração , Hipertensão , Valva Mitral
3.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1024061

RESUMO

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Assuntos
Humanos , Masculino , Feminino , Pediatria , Ecocardiografia/métodos , Criança , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar , Valva Tricúspide , Veia Cava Inferior , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Disfunção Ventricular Direita , Disfunção Ventricular Esquerda , Átrios do Coração , Ventrículos do Coração
4.
Pan Afr Med J ; 33: 97, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489075

RESUMO

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.


Assuntos
Anticorpos Antinucleares/imunologia , Endocardite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Ecocardiografia Doppler/métodos , Endocardite/etiologia , Endocardite/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Superinfecção/diagnóstico
5.
Int Heart J ; 60(5): 1211-1218, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484857

RESUMO

Extra- and/or intracorporeal renal replacement therapy can improve the cardiorenal hemodynamics in patients with advanced heart failure (HF) refractory to medical therapy and renal failure. Here, we report the case of a 51-year-old woman with inotrope-dependent end-stage HF and chronic renal failure due to anthracycline-induced cardiomyopathy, in whom the induction of hemodiafiltration and subsequent chronic peritoneal dialysis (PD) provided a dramatic improvement of her cardiac hemodynamics from restrictive to almost normal physiology assessed by echocardiography and cardiac catheterization. The patient returned to office work with New York Heart Association functional class I-II symptoms for at least 3 years with continuous ambulatory PD after hospital discharge.


Assuntos
Síndrome Cardiorrenal/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Antraciclinas/efeitos adversos , Antraciclinas/uso terapêutico , Biópsia por Agulha , Síndrome Cardiorrenal/diagnóstico por imagem , Doença Crônica , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Insuficiência Cardíaca/terapia , Hemodiafiltração/métodos , Hemodinâmica/fisiologia , Humanos , Imuno-Histoquímica , Falência Renal Crônica/diagnóstico , Pessoa de Meia-Idade , Prognóstico , Retorno ao Trabalho , Resultado do Tratamento
6.
Int Heart J ; 60(5): 1201-1205, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484869

RESUMO

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.


Assuntos
Feixe Acessório Atrioventricular/diagnóstico por imagem , Feixe Acessório Atrioventricular/tratamento farmacológico , Cardiomiopatia Dilatada/diagnóstico por imagem , Flecainida/uso terapêutico , Síndrome de Wolff-Parkinson-White/diagnóstico por imagem , Feixe Acessório Atrioventricular/complicações , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Lactente , Injeções Intravenosas , Masculino , Medição de Risco , Amostragem , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/fisiopatologia
7.
Int Heart J ; 60(5): 1106-1112, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484874

RESUMO

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.


Assuntos
Cardiopatias/sangue , Cardiopatias/epidemiologia , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/diagnóstico por imagem , Hospitais Universitários , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
11.
Int Heart J ; 60(4): 836-844, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257329

RESUMO

Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (PAP) ≥ 25 mmHg at rest as assessed by right heart catheterization (RHC), and Doppler-derived systolic PAP (sPAPECHO) or tricuspid regurgitation pressure gradient (TRPG) is widely used to screen for PH. However, the cutoff value of sPAPECHO or TRPG for detecting a mean PAP ≥ 25 mmHg that was determined invasively has not been well defined.We studied 189 patients who underwent RHC. Echocardiography was performed within 24 hours of invasive evaluation, and sPAPECHO was defined as the TRPG with right atrial pressure estimated on the basis of the current guideline.From the receiver operating characteristic (ROC) curve analysis, the optimal sPAPECHO, and TRPG cutoffs for detecting PH were 41 mmHg (sensitivity, 92%; specificity, 91%; area under the curve = 0.95) and 36 mmHg (sensitivity, 90%; specificity, 93%; area under the curve = 0.95), respectively. The area under the TRPG ROC curve was similar to the area under the sPAPECHO ROC curve.Given that Doppler echocardiography is required to accurately detect PH rather than to accurately estimate systolic PAP, our results provide useful information with regard to screening patients for PH and recommending further investigations on PH.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Ecocardiografia Doppler/métodos , Hipertensão Pulmonar/diagnóstico , Estudos Transversais , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão Propulsora Pulmonar/fisiologia , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole
12.
ABC., imagem cardiovasc ; 32(3): 198-208, jul.-set. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1006582

RESUMO

La ecocardiografía permite detectar y cuantificar la disfunción diastólica utilizando numerosos parámetros que parecen volver muy compleja esa tarea, particularmente en disfunciones más severas. En este artículo son revisados y actualizados los parámetros utilizados y los recursos tecnológicos disponibles. Es propuesto un algoritmo para orientar la incorporación progresiva de las variables necesarias de acuerdo con los hallazgos. La evaluación realizada, de manera metódica siguiendo un algoritmo adecuado, permite llegar al diagnóstico con elevada sensibilidad y especificidad en la casi totalidad de los casos, haciendo de la ecocardiografía el mejor método no invasivo para el diagnóstico y evaluación de esta frecuente disfunción


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ecocardiografia/métodos , Diagnóstico , Valva Aórtica , Veias Pulmonares , Volume Sistólico , Ecocardiografia Doppler/métodos , Ventrículos do Coração , Valva Mitral , Cardiomiopatias
15.
Echocardiography ; 36(6): 1118-1122, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31148213

RESUMO

INTRODUCTION: The presence of CFTR in smooth muscle and endothelial cells, systemic inflammation, and oxidative stress could explain vascular alterations in cystic fibrosis. Aortic elastic properties are determinants of left ventricular function by means of ventriculo-arterial coupling and indicators of cardiovascular risk. OBJECTIVES: The purpose of the present study was to compare clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate aortic tissue Doppler elastic properties, such as distensibility, stiffness, and strain. METHODS: A total of 22 adults affected by cystic fibrosis, and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors, secondary diabetes, neither aortic stenosis nor regurgitation. All people underwent blood pressure measurement and transthoracic echocardiography. RESULTS: Aortic diameter measured at Valsalva sinuses was significantly higher in patients with cystic fibrosis than healthy people, median 32.0 (interquartile range 29.8-35.0) vs 24.3 (22.2-30.0) mm; P < 0.001. Aortic distensibility was significantly lower among patients than controls, being 2.4 (1.3-3.3) vs 5.6 (3.4-8.3) per mm Hg (P < 0.001), while stiffness higher, 7.7 (6.0-14.8) vs 3.7 (2.9-6.7); P < 0.001. Finally, M-mode strain of ascending aorta was lower in patients, 4.1 (3.4-7.3)% than in controls, 13.4 (7.7-19.4)%; P < 0.001. CONCLUSION: For the first time in humans, we demonstrated subclinical alterations in aortic elastic properties in young adults affected by cystic fibrosis without pulmonary hypertension or secondary diabetes. This phenomenon could influence left ventricular function earlier by means of ventriculo-arterial coupling and may be a tool to identify patients who benefit from a closer follow-up.


Assuntos
Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Fibrose Cística/fisiopatologia , Ecocardiografia Doppler/métodos , Rigidez Vascular/fisiologia , Adulto , Estudos de Casos e Controles , Elasticidade , Feminino , Humanos , Masculino , Adulto Jovem
16.
Afr Health Sci ; 19(1): 1657-1664, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148995

RESUMO

Background: Mitral annular calcification (MAC) is associated with several cardiovascular disorders including coronary artery disease (CAD), atrial fibrillation, heart failure, ischemic stroke and increased mortality. Epicardial fat thickness (EFT) has strong correlation with obesity, CAD, insulin resistance, metabolic syndrome, hypertension, diabetes mellitus, and atherosclerosis. There are strong similarities between EFT and MAC from the aspect of risk factors and pathogenesis. Objective: In this study we aimed to investigate the EFT in patients with MAC. Methods: The study group consisted of 78 patients with MAC. An age, gender and body mass index matched control group consisted of 47 subjects who admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured EFT in patients with MAC and control subjects. Results: EFT was significantly higher in patients with MAC than in control subjects (5.7±0.9 vs. 4.4±0.6 mm respectively; P< 0.001). Correlation analysis indicated that EFT was positively correlated with presence of MAC (p<0.001, r=0.597). Conclusion: We showed that EFT was significantly elevated in patients with MAC and it was positively correlated with MAC.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Calcinose/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Valva Mitral/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Tecido Adiposo/patologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Casos e Controles , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Pericárdio/patologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
17.
Int J Cardiovasc Imaging ; 35(9): 1637-1649, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037473

RESUMO

Pulmonary arterial hypertension (PAH) is a serious and often fatal complication of connective tissue disease (CTD). Right atrial (RA) function is essential to maintaining adequate total right heart function in PAH. However, little is known about prognostic utility of RA function in CTD-PAH. RA longitudinal strain (LS) and strain rate (LSR) were evaluated in 53 consecutive patients (51 female, mean age 42 ± 15 years) with CTD-PAH, including systemic lupus erythematosus (SLE) (33.7%), mixed connective tissue disease (MCTD) (32.1%), primary Sjögren's syndrome (pSS) (26.4%), and systemic sclerosis (SSc) (3.8%). At a mean follow-up of 19.3 ± 10.9 months, 20 patients (37.7%) were clinically worse. The group with clinical events had worse clinical conditions and poorer RA function at baseline compared with the group that had no clinical events. RA LS independently reflected World Health Organization functional class (WHO FC) after adjusting for RA area (RAA), tricuspid regurgitation (TR) grade, right ventricular (RV) global longitudinal strain (GLS), and pulmonary vascular resistance (PVR) (P = 0.006). Receiver operator characteristic (ROC) curve analysis indicated that RA LS < 22.9% was predictive of clinical worsening during follow-up (sensitivity = 80%; specificity = 87.9%; area under the curve (AUC) = 0.858), and the Kaplan-Meier curve confirmed that RA LS ≥ 22.9% was associated with more favorable long-term outcomes compared to RA LS < 22.9% (log-rank P < 0.01). On univariate Cox proportional hazards analysis, PVR, RVGLS, RAA, and RA LS were associated with long-term outcome, while RA LS was the only independent predictor in the multivariate analysis. Our findings suggest that RA LS measurements by speckle-tracking echocardiography (STE) can independently reflect the extent of right heart failure and predict clinical outcomes in patients with CTD-PAH. RA LS < 22.9% is associated with a higher risk of clinical worsening.


Assuntos
Pressão Arterial , Função do Átrio Direito , Doenças do Tecido Conjuntivo/complicações , Ecocardiografia Doppler/métodos , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Interpretação de Imagem Assistida por Computador/métodos , Artéria Pulmonar/fisiopatologia , Adulto , Idoso , Doenças do Tecido Conjuntivo/diagnóstico , Progressão da Doença , Feminino , Átrios do Coração/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Função Ventricular Direita , Remodelação Ventricular
18.
Int J Cardiovasc Imaging ; 35(8): 1499-1508, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037475

RESUMO

Resting two-dimensional speckle tracking echocardiography (2D-STE) identified right ventricular (RV) systolic function were reported to predict exercise capacity in pulmonary hypertension (PH) patients, but little attention had been payed to 2D-STE detected RV diastolic function. Therefore, we aim to elucidate and compare the relations between 2D-STE identified RV diastolic/systolic functions and peak oxygen consumption (PVO2) determined by cardiopulmonary exercise testing (CPET) in pre-capillary PH. 2D-STE was performed in 66 pre-capillary PH patients and 28 healthy controls. Linear correlation and multivariate regression analyses were performed to evaluate and compare the relations between RV 2D-STE parameters and PVO2. Receiver operating characteristic curves were used to compare the predictive value of 2D-STE parameters in predicting the cut-off-PVO2 < 11 ml/min/kg. There were significant differences of all the 2D-STE parameters between PH patients and healthy controls. In patients, RV-peak global longitudinal strain (GLS, rs = - 0.498, P < 0.001), RV- peak systolic strain rate (GSRs, rs = - 0.537, P < 0.001) and RV- peak early diastolic strain rate (GSRe, rs = 0.527, P < 0.001) significantly correlated with PVO2, but no significant correlation was observed between RV- peak late diastolic strain rate (GSRa, rs = 0.208, P = 0.093) and PVO2. The first multivariate regression analysis of clinical data without echocardiographic parameters identified WHO functional class, NT-proBNP and BMI as independent predictors of PVO2 (Model-1, adjusted r2 = 0.421, P < 0.001); Then we added conventional echocardiographic parameters and 2D-STE parameters to the clinical data, identified S,(Model-2,adjusted r2 = 0.502, P < 0.001), RV-GLS (Model-3, adjusted r2 = 0.491, P < 0.001), RV-GSRe (Model-4, adjusted r2 = 0.500, P < 0.001) and RV-GSRs (Model-5, adjusted r2 = 0.519, P < 0.001) as independent predictors of PVO2, respectively. The predictive power was increased, and Model-5 including RV-GSRs showed the highest predictive capability. ROC curves found RV-GSRs expressed the strongest predictive value (AUC = 0.88, P < 0.001), and RV-GSRs > - 0.65/s had a 88.2% sensibility and 82.2% specificity to predict PVO2 < 11 ml/min/kg. 2D-STE assessed RV function improves the prediction of exercise capacity represented by PVO2 in pre-capillary PH.


Assuntos
Ecocardiografia Doppler/métodos , Tolerância ao Exercício , Hipertensão Pulmonar/diagnóstico por imagem , Função Ventricular Direita , Adulto , Estudos de Casos e Controles , Estudos Transversais , Teste de Esforço , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
19.
Echocardiography ; 36(6): 1103-1109, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31116460

RESUMO

OBJECTIVE: The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction (MVO) and coronary wedge pressure (CWP) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high-risk acute anterior myocardial infarction survivors. METHODS: Twenty-four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct-related artery were determined 3-5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. RESULTS: No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO. No significant correlation was identified between CWP on one side and DDT (P = 0.30) and CFR (P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow-up left ventricular remodeling was detected in patients with DDT<900 msec as compared to those with DDT≥900 msec. The medium increase in left ventricular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (P = 0.03) in patients with CWP>38 mm Hg. CONCLUSIONS: Coronary wedge pressure did not correlate with the surrogate parameters for MVO, but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow-up.


Assuntos
Circulação Coronária/fisiologia , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Microcirculação/fisiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Remodelação Ventricular/fisiologia , Trombose Coronária/complicações , Trombose Coronária/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pressão Propulsora Pulmonar , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
20.
Echocardiography ; 36(6): 1159-1164, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31116471

RESUMO

AIM: To investigate the changes of modified myocardial performance index (Mod-MPI) in early-onset and late-onset fetal growth restriction (FGR) cases, and its association with adverse perinatal outcome. METHODS: This was a prospective study on 77 early-onset and 100 late-onset FGR cases. Hundred normal fetuses were matched as control groups for early-onset and late-onset FGR groups, respectively. Mod-MPI and vessel Doppler parameters including umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA) were measured. Perinatal outcomes were followed up. Mod-MPI of FGR cases were compared in normal Doppler, abnormal Doppler, and control groups. The association of Mod-MPI and perinatal outcome was investigated, and further efficacy of Mod-MPI predicting adverse outcome was studied. RESULTS: Compared with control groups, both abnormal and normal Doppler groups showed increased Mod-MPI in early-onset and late-onset FGR, respectively. Mod-MPI had no significant difference between abnormal and normal Doppler groups. Mod-MPI was associated with adverse outcome in early-onset FGR (OR = 3.307) and late-onset FGR (OR = 3.412). The sensitivity and specificity of Mod-MPI predicting adverse outcome were 60% and 80% when cutoff value was 0.47 in early-onset FGR. And they were 65% and 70% when cutoff value was 0.50 in late-onset FGR. CONCLUSION: Fetal growth restriction fetuses had increased Mod-MPI. Mod-MPI could be used to predict adverse perinatal outcome of FGR fetuses. Mod-MPI was an effective parameter to supplement vessels' Doppler parameters in monitoring FGR.


Assuntos
Ecocardiografia Doppler/métodos , Retardo do Crescimento Fetal/fisiopatologia , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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