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BACKGROUND: There is a paucity of information about Brazilian COVID-19 in-hospital mortality probability of death combining risk factors. OBJECTIVE: We aimed to correlate COVID-19 Brazilian in-hospital patients' mortality to demographic aspects, biomarkers, tomographic, echocardiographic findings, and clinical events. METHODS: A prospective study, single tertiary center in Brazil, consecutive patients hospitalized with COVID-19. We analyzed the data from 111 patients from March to August 2020, performed a complete transthoracic echocardiogram, chest thoracic tomographic (CT) studies, collected biomarkers and correlated to in-hospital mortality. RESULTS: Mean age of the patients: 67 ± 17 years old, 65 (58.5%) men, 29 (26%) presented with systemic arterial hypertension, 18 (16%) with diabetes, 11 (9.9%) with chronic obstructive pulmonary disease. There was need for intubation and mechanical ventilation of 48 (43%) patients, death occurred in 21/111 (18.9%) patients. Multiple logistic regression models correlated variables with mortality: age (OR: 1.07; 95% CI 1.02-1.12; p: 0.012; age >74 YO AUC ROC curve: 0.725), intubation need (OR: 23.35; 95% CI 4.39-124.36; p < 0.001), D dimer (OR: 1.39; 95% CI 1.02-1.89; p: 0.036; value >1928.5 ug/L AUC ROC curve: 0.731), C-reactive protein (OR: 1.18; 95% CI 1.05-1.32; p < 0.005; value >29.35 mg/dl AUC ROC curve: 0.836). A risk score was created to predict intrahospital probability of death, by the equation: 3.6 (age >75 YO) + 66 (intubation need) + 28 (C-reactive protein >29) + 2.2 (D dimer >1900). CONCLUSIONS: A novel and original risk score were developed to predict the probability of death in Covid 19 in-hospital patients concerning combined risk factors.
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COVID-19 , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Brasil/epidemiologia , Proteína C-Reativa , COVID-19/diagnóstico , COVID-19/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Fatores de RiscoRESUMO
Rupture of tricuspid valve is unusual, occurring mainly in the setting of blunt trauma or endomyocardial biopsy. Spontaneous tricuspid valve chordal rupture is particularly rare. We report herein a case of a patient with severe pulmonary hypertension, on the lung transplantation waiting list, who presented with spontaneous chordal rupture, exacerbation of tricuspid insufficiency and worsening of clinical status. Diagnosis and treatment, along with possible mechanisms for this complication, are discussed.
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Hipertensão Pulmonar Primária Familiar/diagnóstico por imagem , Hipertensão Pulmonar Primária Familiar/terapia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Adulto , Diagnóstico Diferencial , Ecocardiografia/métodos , Hipertensão Pulmonar Primária Familiar/complicações , Evolução Fatal , Feminino , Humanos , Ruptura , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologiaRESUMO
Introduction: Heart transplantation represents main therapy for end-stage heart failure. However, survival after transplantation is limited by development of graft rejection. Endomyocardial biopsy, an invasive and expensive procedure, is gold standard technique for diagnosis of rejection. Most of biopsy complications are observed using echocardiography. Novel echocardiographic techniques, such as myocardial strain and three-dimensional reconstruction, can be useful in heart transplant patients. Purpose: To evaluate ventricular strain in heart transplant patients and association with rejection, cellular or humoral, as well as two- and three-dimensional echocardiographic parameters. Methods: Cohort of patients from heart transplant program taken to echocardiography after endomyocardial biopsy, from December 2017 to January 2020. Ventricular strain and three-dimensional left ventricle parameters were studied. Rejection results were retrieved from medical record. Qualitative variables were expressed by absolute frequency and percentages, while continuous variables by means and standard deviations. Association between rejection and variables of interest was measured by odds ratio and confidence interval of 95%, with p-value < 0.05. Results: 123 post-endomyocardial biopsy echocardiographic exams were performed in 54 patients. Eighteen exams were excluded, lasting 105 exams to be evaluated for conventional and advanced echocardiographic parameters. Male patients were 60.4%. Prevalence of cellular rejection was 8.6%, humoral rejection 12.4%, and rejection of any type 20%. There was no association between right ventricular strain and rejection, whether cellular (p = 0.118 and p = 0.227 for septum and free wall, respectively), humoral (p = 0.845 and p = 0.283, respectively), or of any type (0.504 and 0.446). There was no correlation between rejection and left ventricle global longitudinal strain, three-dimensional ejection fraction or desynchrony index. Conventional parameters associated to rejection were left ventricle posterior wall thickness [OR 1.660 (1.163; 2.370), p = 0.005] and left ventricle mass index [OR 1.027 (1.011; 1.139), p = 0.001]. Left ventricle posterior wall thickness remained significant after analysis of cellular and humoral rejection separately [OR 1.825 (1.097; 3.036), p = 0.021 and OR 1.650 (1.028; 2.648), p = 0.038, respectively]. Conclusions: There was no association between ventricular strain, three-dimensional left ventricular ejection fraction and the desynchrony index and rejection, cellular or humoral. Evidence of association of graft rejection with left ventricle posterior wall thickness and left ventricle mass index was observed.
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With the increase in the population's life expectancy and the higher frequency of risk factors such as obesity, hypertension and diabetes, an increase in the prevalence of heart failure with preserved ejection fraction (HFpEF) is expected. However, to date, the diagnosis and treatment of patients with HFpEF remain challenging. The syndromic diagnosis of HFpEF includes several etiologies and diseases with specific treatments but has points in common regarding the clinical presentation, laboratory evaluation related to biomarkers, such as BNP and NT-ProBNP, and echocardiographic evaluation of cardiac remodeling and left ventricular diastolic filling pressures. Extensive randomized clinical trials involving the treatment of this condition have failed to demonstrate benefits to the patient, making it necessary to reflect on the diagnosis, mechanisms of morbidity, mortality and reversibility in this syndrome. In this review, the current concepts, controversies and challenges, especially regarding diagnosis, will be addressed, critically analyzing the European Heart Failure Association score for the diagnosis of HFpEF.
Com o aumento da expectativa de vida da população e a maior frequência de fatores de risco como obesidade, hipertensão arterial e diabetes, espera-se um aumento na prevalência de insuficiência cardíaca com fração de ejeção preservada (ICFEp). Entretanto, no momento, o diagnóstico e o tratamento de pacientes com ICFEp permanecem desafiadores. O diagnóstico sindrômico de ICFEp inclui diversas etiologias e doenças com tratamentos específicos, mas que apresentam pontos em comum em relação à apresentação clínica e à avaliação laboratorial no que diz respeito aos biomarcadores como BNP e NT-ProBNP, à avaliação ecocardiográfica do remodelamento cardíaco e às pressões de enchimento diastólico ventricular esquerdo. Extensos ensaios clínicos randomizados envolvendo a terapia nesta síndrome falharam na demonstração de benefícios para o paciente, fazendo-se necessária uma reflexão acerca do diagnóstico, dos mecanismos de morbidade, da taxa de mortalidade e da reversibilidade. Na revisão, serão abordados os conceitos atuais, as controvérsias e, especialmente, os desafios no diagnóstico da ICFEp através de uma análise crítica do escore da European Heart Failure Association.
Assuntos
Insuficiência Cardíaca , Diástole , Ecocardiografia , Humanos , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Purpose: Semi-automated lobar segmentation tools enable an anatomical assessment of regional pulmonary perfusion with Dual-Energy CTA (DE-CTA). We aimed to quantify lobar pulmonary perfusion with DE-CTA, analyze the perfusion distribution among the pulmonary lobes in subjects without cardiopulmonary diseases and assess the correlation between lobar perfusion and regional endoluminal clots in patients with acute pulmonary embolism (PE). Methods: We evaluated 151 consecutive subjects with suspected PE and without cardiopulmonary comorbidities. DE-CTA derived perfused blood volume (PBV) of each pulmonary lobe was measured applying a semi-automated lobar segmentation technique. In patients with PE, blood clot location was assessed, and CT-based vascular obstruction index of each lobe (CTOIlobe) was calculated and classified into three groups: CTOIlobe= 0, low CTOIlobe (1-50%) and high CTOIlobe (>50%). Results: Among patients without PE (103/151, 68.2%), median lobar PBV was 13.7% (IQR 10.2-18.0%); the right middle lobe presented lower PBV when compared to all the other lobes (p < .001). In patients with PE (48/151, 31.8%), lobar PBV was 12.6% (IQR 9.6-15.7%), 13.7% (IQR 10.1-16.7%) and 6.5% (IQR 5.1-10.2%) in the lobes with CTOIlobe= 0, low CTOIlobe and high CTOIlobe scores, respectively, with a significantly decreased PBV in the lobes with high CTOIlobe score (p < .001). ROC analysis of lobar PBV for prediction of high CTOIlobe score revealed AUC of 0.847 (95%CI 0.785-0.908). Conclusion: Pulmonary perfusion was heterogeneously distributed along the pulmonary lobes in patients without cardiopulmonary diseases. In patients with PE, the lobes with high vascular obstruction score (CTOIlobe> 50%) presented a decreased lobar perfusion.
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BACKGROUND: Aortic valve replacement with a cryopreserved aortic homograft (CH) is an attractive alternative to bioprosthesis implantation. The aim of the study was to compare the hemodynamic performance of CH implanted with aortic root inclusion compared to prototype stentless (SS) bioprosthesis, standard stented (SD) bioprosthesis, and a native aortic valve. METHODS: Hemodynamics and Doppler echocardiographic measurements such as left ventricular ejection fraction, aortic valve orifice area index (AVOAI), mean and maximal transvalvular gradients, were obtained at rest and immediately after exercise in 28 patients after aortic valve replacement with CH (n = 10), SS (n = 9), or SD (n = 9), and in a control group (CG) of 15 normal volunteers. RESULTS: Rest and peak exercise heart rate and workload achieved were not different among the groups. Baseline AVOAI was larger for CH and CG compared to SS and SD groups (P < 0.05). Maximal and mean transvalvular pressure gradients at rest were lower for CH compared to SS and SD groups (P < 0.05), but higher than CG (P < 0,05). CONCLUSION: Implanted aortic CH had better hemodynamic performance than SS and SD bioprosthesis and similar to native normal aortic valves, both at rest and immediately after exercise.
Assuntos
Valva Aórtica/transplante , Bioprótese , Criopreservação/métodos , Teste de Esforço , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Stents , Adulto , Idoso , Prótese Vascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , UltrassonografiaRESUMO
INTRODUÇÃO: A avaliação e quantificação das dimensões e função das câmaras cardíacas direitas pelo ecocardiograma auxilia no diagnóstico e prognóstico de várias situações clinicas; seus valores de referência, no entanto, refletem as características antropométricas da população estudada. OBJETIVO: analisar prospectivamente exames ecocardiográficos bidimensionais de indivíduos normais das diversas regiões brasileiras para a determinação de valores de referência de câmaras direitas. MÉTODO: Ecocardiogramas de indivíduos de ambos sexos, > 18 anos, sem doença cardíaca, sistêmica ou fatores de risco cardiovascular foram obtidos em centros das 5 regiões do Brasil e analisados offline (Ultrasound Workspace- Tomtec- Phillips) para avaliação de medidas das câmaras cardíacas direitas e função ventricular direita (VD): variação fracional da área (FAC) do VD, TAPSE, s do VD e strain longitudinal (SL) do VD (global e parede livre) por speckle tracking. Foram analisadas as diferenças entre os sexos pelo teste t não pareado de Student. RESULTADOS: Foram incluídos 445 indivíduos, com idade de 42+ 15 anos, 56% do sexo feminino, sendo excluídos 40 por imagem/dados inadequados; As medidas ecocardiográficas foram realizadas em 147 indivíduos e mostraram maiores dimensões de câmaras direitas para o sexo masculino (p<0.001); para parâmetros funcionais, apenas o FAC mostrou diferença significativa entre os grupos, sendo maior para o sexo feminino (p = 0.04); os demais parâmetros funcionais ( TAPSE, S VD, e SGL e de parede livre do VD) foram similares para ambos os sexos . CONCLUSÃO: Resultados preliminares da população brasileira sugerem parâmetros estruturais com maiores dimensões de câmaras direitas para o sexo masculino, o que infere que esses dados devam ser indexados para a superfície corpórea. Parâmetros funcionais, por outro lado, parecem sofrer pouca influência do sexo.
Assuntos
EcocardiografiaRESUMO
BACKGROUND: Systemic sclerosis (SS) is a connective tissue abnormality characterized by fibrosis of the skin and internal organs. Cardiac involvement with consequent myocardial dysfunction in SS is associated with increased morbidity and mortality. OBJECTIVE: To investigate the left ventricular (LV) diastolic function in patients with SS and preserved systolic function. METHODS: Patients with SS were evaluated with two-dimensional echocardiography with tissue Doppler for analysis of chamber diameters, LV mass index (LVMI), indexed left atrial volume (iLAV), systolic function of both ventricles, and presence and degree of diastolic dysfunction (DD). RESULTS: We evaluated 50 patients, divided according to the presence of DD into Group 1 (n = 25; normal diastolic function, E/A ratio ≥ 0.8, deceleration time [DT] > 150 ms and < 200 ms, and septal e' > 8 cm/s) and Group 2 (n = 25; with DD, subdivided into type I DD [E/A < 0.8, DT > 200 ms], type II [E/A ≥ 0.8, septal e' < 8 cm/s, iLAV > 34 mL/m2], and type III [E/A > 2, DT < 150 ms, septal e' < 8 cm/s]). Type I DD was the most frequent (34%), followed by type II DD (16%). LVMI and iLAV were similar in both groups, but septal and lateral e' were reduced only in Group 2. In Group 2, we observed that patients with moderate DD had longer disease duration (p = 0.02). CONCLUSION: The prevalence of type I DD was elevated in SS and associated with aging. Disease duration emerged as an important factor in moderate DD.
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Escleroderma Sistêmico/complicações , Disfunção Ventricular Esquerda/etiologia , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnósticoRESUMO
Introdução: A esclerose sistêmica (ES) é uma doença autoimune do tecido conjuntivo que cursa com fibrose e disfunção microvascular. O envolvimento dos órgãos viscerais, incluindo os pulmões e o coração, é a principal causa de óbito na ES. Nesse contexto, analisamos a relação entre os parâmetros ventriculares direitos (VD) pela ecocardiografia com Doppler tecidual e o acometimento pulmonar em pacientes com ES. Métodos: Os pacientes que preencheram os Critérios de Classificação da ES de 2013 foram submetidos à ecocardiografia com Doppler tecidual para avaliação da função sistólica (fração de ejeção) ventricular esquerda (VE), enquanto a função sistólica do VD foi avaliada por meio da fração de variação de área do VD (fractional area change FAC), velocidade (sistólica) do Doppler tecidual, índice de desempenho miocárdico (IDM) e excursão sistólica do plano anular tricúspide (TAPSE). A pressão sistólica pulmonar foi estimada por insuficiência tricúspide. A tomografia computadorizada de alta resolução (TCAR) de tórax avaliou a presença de fibrose pulmonar. De acordo com os resultados da TCAR, os pacientes foram divididos em 2 subgrupos: Grupo I, incluindo pacientes com fibrose pulmonar (n=26), e Grupo II sem fibrose (n=17). Resultados: Entre os 43 pacientes com ES, a maioria era do sexo feminino (86%) com idade de 51±12 anos. Todos os pacientes apresentavam função ventricular sistólica normal, avaliada pela FEVE>55% e FAC VD>35%. Não houve diferença significativa em termos de idade ou duração da doença para os grupos. Exceto pela diminuição das velocidades do Doppler tecidual em pacientes com fibrose pulmonar, todos os índices de desempenho do VD foram semelhantes. Conclusão: Em pacientes com ES e fibrose pulmonar, o Doppler tecidual identifica acometimento miocárdico longitudinal precoce do VD, apesar do desempenho sistólico radial preservado do VD.(AU)
Introduction: Systemic sclerosis (SSc) is an autoimmune tissue connective disease that courses with fibrosis and microvascular dysfunction. Involvement of the visceral organs, including the lungs and heart, is the main cause of death among patients with SSc. In this context, here we analyzed the relationship between right ventricle (RV) parameters assessed by tissue Doppler echocardiography and lung involvement in patients with SSc. Methods: Patients fulfilling the 2013 SSc Classification Criteria underwent tissue Doppler echocardiography for the assessment of left ventricular (LV) systolic function (ejection fraction) and RV fractional area change (FAC), tissue Doppler s' (systolic) velocity, myocardial performance index, and tricuspid annular plane systolic excursion for the assessment of RV systolic function. Pulmonary systolic pressure was estimated using tricuspid regurgitation. Chest high-resolution computed tomography was used to evaluate the presence of pulmonary fibrosis. The patients were divided into two subgroups accordingly: Group I, patients with pulmonary fibrosis (n=26); and Group II, those without fibrosis (n=17). Results: Among the 43 patients with SSc, most were female (86%), and the mean age was 51 ± 12 years. All patients had normal systolic ventricular function as evidenced by an LV ejection fraction > 55% and an RV FAC > 35%. No significant intergroup difference was noted in age or disease duration. Except for a decreased tissue Doppler s' velocity in patients with lung fibrosis, all indexes of RV performance were similar. Conclusion: In patients with SSc and pulmonary fibrosis, tissue Doppler identified early RV longitudinal myocardial involvement despite preserved RV radial systolic performance.(AU)
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Fibrose Pulmonar/complicações , Escleroderma Sistêmico/diagnóstico , Função Ventricular Direita , Doenças Pulmonares Intersticiais/diagnóstico , Tórax/diagnóstico por imagem , Insuficiência da Valva Tricúspide/complicações , Ecocardiografia Doppler/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
Resumo Com o aumento da expectativa de vida da população e a maior frequência de fatores de risco como obesidade, hipertensão arterial e diabetes, espera-se um aumento na prevalência de insuficiência cardíaca com fração de ejeção preservada (ICFEp). Entretanto, no momento, o diagnóstico e o tratamento de pacientes com ICFEp permanecem desafiadores. O diagnóstico sindrômico de ICFEp inclui diversas etiologias e doenças com tratamentos específicos, mas que apresentam pontos em comum em relação à apresentação clínica e à avaliação laboratorial no que diz respeito aos biomarcadores como BNP e NT-ProBNP, à avaliação ecocardiográfica do remodelamento cardíaco e às pressões de enchimento diastólico ventricular esquerdo. Extensos ensaios clínicos randomizados envolvendo a terapia nesta síndrome falharam na demonstração de benefícios para o paciente, fazendo-se necessária uma reflexão acerca do diagnóstico, dos mecanismos de morbidade, da taxa de mortalidade e da reversibilidade. Na revisão, serão abordados os conceitos atuais, as controvérsias e, especialmente, os desafios no diagnóstico da ICFEp através de uma análise crítica do escore da European Heart Failure Association.
Abstract With the increase in the population's life expectancy and the higher frequency of risk factors such as obesity, hypertension and diabetes, an increase in the prevalence of heart failure with preserved ejection fraction (HFpEF) is expected. However, to date, the diagnosis and treatment of patients with HFpEF remain challenging. The syndromic diagnosis of HFpEF includes several etiologies and diseases with specific treatments but has points in common regarding the clinical presentation, laboratory evaluation related to biomarkers, such as BNP and NT-ProBNP, and echocardiographic evaluation of cardiac remodeling and left ventricular diastolic filling pressures. Extensive randomized clinical trials involving the treatment of this condition have failed to demonstrate benefits to the patient, making it necessary to reflect on the diagnosis, mechanisms of morbidity, mortality and reversibility in this syndrome. In this review, the current concepts, controversies and challenges, especially regarding diagnosis, will be addressed, critically analyzing the European Heart Failure Association score for the diagnosis of HFpEF.
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The effects of endurance training have been extensively studied in athletes, but longitudinal studies of exercise-induced cardiac changes in normal patients are limited. To assess the effects of 6 months of moderate-intensity aerobic training (1 hour/day, 3 times/week) on normal hearts, 23 sedentary men aged 31.1 +/- 3.5 years were studied by standard and tissue Doppler echocardiography. Left ventricular (LV) systolic function was assessed by the ejection fraction and Doppler-measured stroke volume, and diastolic function was assessed by transmitral and pulmonary venous flow. Tissue Doppler systolic (Sm), early (Em), and late (Am) myocardial velocities were obtained at the septal and lateral mitral annulus. After training, there was a 14.5% increase in peak oxygen consumption (p = 0.000002) and a decrease in heart rate (60 +/- 7 to 56 +/- 8 beats/min, p = 0.01). Septal and posterior wall thickness increased (8.7 +/- 1.0 to 9.4 +/- 1.3 mm, p = 0.002, and 8.2 +/- 0.7 to 8.8 +/- 1.1 mm, p = 0.0009, respectively), with a 15% increase in LV mass index (p = 0.0002). LV diameters, stroke volumes, and ejection fractions were unchanged. Mitral inflow showed a decrease in late-wave velocity (p = 0.00004), thus increasing the early (E)/A ratio. Septal and lateral Sm (p = 0.02) and Em velocities (p <0.05) increased after training. In conclusion, the physiologic increase in LV mass in response to regular exercise in healthy young men occurs in parallel with a decrease in atrial contribution to flow. LV function estimated by tissue Doppler is improved despite the lack of changes in standard echocardiographic indexes.
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Exercício Físico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Ventrículos do Coração/diagnóstico por imagem , Humanos , Estudos Longitudinais , Masculino , Contração Miocárdica/fisiologia , Resistência Física/fisiologia , Valores de Referência , Volume Sistólico/fisiologia , UltrassonografiaRESUMO
BACKGROUND: Left ventricular free wall rupture occurs in up to 10% of the in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction and its antemortem diagnosis is rarely made. Contrast echocardiography has been increasingly used for the evaluation of myocardial perfusion in patients with acute myocardial infarction, with important prognostic implications. In this case, we reported its use for the detection of a mechanical complication following myocardial infarction. CASE PRESENTATION: A 50-year-old man with acute myocardial infarction in the lateral wall underwent myocardial contrast echocardiography for the evaluation of myocardial perfusion in the third day post-infarction. A perfusion defect was detected in lateral and inferior walls as well as the presence of contrast extrusion from the left ventricular cavity into the myocardium, forming a serpiginous duct extending from the endocardium to the epicardial region of the lateral wall, without communication with the pericardial space. Magnetic resonance imaging confirmed the diagnosis of impending rupture of the left ventricular free wall. While waiting for cardiac surgery, patient presented with cardiogenic shock and died. Anatomopathological findings were consistent with acute myocardial infarction in the lateral wall and a left ventricular free wall rupture at the infarct site. CONCLUSION: This case illustrates the early diagnosis of left ventricular free wall rupture by contrast echocardiography. Due to its ability to be performed at bedside this modality of imaging has the potential to identify this catastrophic condition in patients with acute myocardial infarction and help to treat these patients with emergent surgery.
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Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Recém-Nascido Prematuro , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia/métodos , Ecocardiografia/normas , Feminino , Humanos , Recém-Nascido , Masculino , Disfunção Ventricular EsquerdaRESUMO
Involvement of the heart and pericardium by cancer is not uncommon, with metastases being more frequent than primary cardiac neoplasms. We present a case of a metastatic lung cancer for which the primary manifestation was chest pain mimicking an acute myocardial infarction.
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Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundário , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Infarto do Miocárdio/diagnóstico , Aorta/diagnóstico por imagem , Aorta/patologia , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/patologia , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologiaRESUMO
BACKGROUND: Transvascular catheter-based intracardiac echocardiography has been successfully used to help guide catheter ablation and electrophysiologic procedures. It has recently been demonstrated that catheters can be safely placed into the pericardial space to allow for epicardial cardiac mapping and ablation. We evaluated the feasibility of catheter-based intrapericardial echocardiography (IPE) during such procedures to identify cardiac structures and visualize intracardiac catheters. METHODS: IPE was performed in 7 goats by placing a phased-array ultrasound transducer contained within a 10F steerable catheter into the pericardial space using the same transthoracic subxyphoid approach as used to map and ablate epicardial ventricular tachycardia. Images were obtained of cardiac structures and of intracardiac ablation catheters. After the procedure, the hearts were harvested to assess for possible IPE-related lesions. RESULTS: The IPE catheter could be easily placed inside the pericardial space in all animals. In 7 of 7 cases, longitudinal and short-axis views of right- and left-sided chambers and valves were obtained, similar in orientation to transesophageal echocardiography. Visualization of atrial appendages (6/7), pulmonary veins (6/7), coronary arteries (6/7), and coronary sinus (3/6) was also feasible. Assessment of intracardiac transvalvar and venous blood flow was achieved by spectral and color Doppler. The ablation catheter could be clearly visualized inside cardiac chambers. No arrhythmias were induced with IPE catheter manipulation. After harvesting the hearts, no lesions resulting from the procedure were observed. CONCLUSION: In this experimental setting, IPE was able to provide detailed images of cardiac structures and establish the relative position of the ablation catheter.
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Ecocardiografia , Pericárdio/diagnóstico por imagem , Animais , Valva Aórtica/anatomia & histologia , Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Cateteres de Demora , Vasos Coronários/anatomia & histologia , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/instrumentação , Técnicas Eletrofisiológicas Cardíacas , Cabras , Átrios do Coração/anatomia & histologia , Átrios do Coração/diagnóstico por imagem , Septos Cardíacos/anatomia & histologia , Septos Cardíacos/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Aumento da Imagem , Valva Mitral/anatomia & histologia , Valva Mitral/diagnóstico por imagem , Modelos Animais , Modelos Cardiovasculares , Músculos Papilares/anatomia & histologia , Músculos Papilares/diagnóstico por imagem , Pericárdio/anatomia & histologia , Valva Pulmonar/anatomia & histologia , Valva Pulmonar/diagnóstico por imagem , Valores de ReferênciaRESUMO
Whereas the extent of wall-motion abnormality (WMA) correlates well with the area at risk (AAR) and infarction size in murine models of nonreperfused myocardial infarction, this relationship is less clear in the setting of ischemia-reperfusion injury. Echocardiography was performed in mice at baseline, after left anterior descending coronary artery ligation (30 minutes) followed by reperfusion (24 hours), and after religation of the left anterior descending coronary artery. The extent of WMA before and after religation was compared with the initial infarction size measured by triphenyltetrazolium chloride and the AAR measured by fluorescent microspheres, respectively. Echocardiography showed left ventricular dilation and dysfunction after ischemia and reperfusion. WMA after religation correlated well with AAR (r2 = 0.70, P <.0001). The correlation between WMA and infarction size was incomplete (r2 = 0.59, P <.0002) in part because of underestimation of nontransmural infarcts. Echocardiography can reliably assess AAR after ischemia-reperfusion in mice; however, it does not allow for precise quantification of the small areas of necrosis that often occur in this setting.
Assuntos
Infarto do Miocárdio/fisiopatologia , Traumatismo por Reperfusão/complicações , Sístole/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Animais , Ecocardiografia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Toracotomia , Disfunção Ventricular Esquerda/etiologiaRESUMO
OBJECTIVE: Atrial fibrillation is a common arrhythmia that increases the risk of stroke by four- to five-fold. We aimed to establish a profile of patients with atrial fibrillation from a population of patients admitted with acute ischemic stroke or transient ischemic attack using clinical and echocardiographic findings. METHODS: We evaluated patients consecutively admitted to a tertiary hospital with acute ischemic stroke or transient ischemic attack. Subjects were divided into an original set (admissions from May 2009 to October 2010) and a validation set (admissions from November 2010 to April 2013). The study was designed as a cohort, with clinical and echocardiographic findings compared between patients with and without atrial fibrillation. A multivariable model was built, and independent predictive factors were used to produce a predictive grading score for atrial fibrillation (Acute Stroke AF Score-ASAS). RESULTS: A total of 257 patients were evaluated from May 2009 to October 2010 and included in the original set. Atrial fibrillation was diagnosed in 17.5% of these patients. Significant predictors of atrial fibrillation in the multivariate analysis included age, National Institutes of Health Stroke Scores, and the presence of left atrial enlargement. These predictors were used in the final logistic model. For this model, the area under the receiver operating characteristic curve was 0.79. The score derived from the logistic regression analysis was The model developed from the original data set was then applied to the validation data set, showing the preserved discriminatory ability of the model (c statisticâ=â0.76). CONCLUSIONS: Our risk score suggests that the individual risk for atrial fibrillation in patients with acute ischemic stroke can be assessed using simple data, including age, National Institutes of Health Stroke Scores at admission, and the presence of left atrial enlargement.
Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Ataque Isquêmico Transitório/etiologia , Medição de Risco/métodos , Acidente Vascular Cerebral/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Brasil , Ecocardiografia , Feminino , Humanos , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Análise Multivariada , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Acidente Vascular Cerebral/fisiopatologia , Centros de Atenção TerciáriaRESUMO
In accordance with the "Standards for the Elaboration of Guidelines, Positions and Normations" sanctioned by the Brazilian Society of Cardiology, this document was written to update the "Echocardiography Indication Guidelines" of 2009. The new document is not intended to be a comprehensive review of echocardiography, but rather an indispensable basic guide to support the rational clinical decision-making of the physician requesting the exam for adult patients. Although it considers the recent technological advances of echocardiography, its purpose is not to describe in detail echocardiography methods, but to summarize in a clear and concise way the main situations in which echocardiography brings benefit to the diagnosis and/or therapeutic orientation of the individual. This manuscript chose to highlight the class of recommendation, as described below: Class I: conditions for which there is conclusive evidence or, in the absence thereof, general agreement that the examination procedure is useful and safe. Class II: conditions for which there is conflicting evidence and/or divergence of opinion on the utility and/or safety of the examination. Class-IIa: evidence or opinions favorable to the examination. Most experts approve. Class IIb: utility and/or safety less well established, with divergent opinions. Class III: conditions for which there is evidence or consensus that the examination is not useful and, in some cases, may even be harmful. In addition, the level of evidence was also described, as follows: A: several concordant randomized clinical trials or robust meta-analyses; B: less robust meta-analysis data or single randomized clinical study or observational studies; C: expert opinion.(AU)