Músculo Trombo Músculo ao 3D

PISA até que inventem algo melhor

Aqui, para você que não desiste do PISA!!!!
.

PHT : Defeitos e limitações

Assunto já abordado no blog mas agora como Aula internacional:


Limitations Mitral

1) LV diastolic dysfunction: Left ventricle (LV) diastolic filling rate (reflected by the deceleration slope of the E-wave) depends on MVA but also on transmitral pressure gradient in early diastole, left atrial compliance and LV diastolic function (relaxation and compliance). For example, short PHT can be observed despite severe MS in case of associated severe aortic regurgitation. Early diastolic deceleration time tends to be shortened in case of decreased LV compliance and prolonged when LV relaxation is impaired. LV diastolic dysfunction makes PHT method to assess MVA less reliable, especially in older patients with degenerative calcific MS associated with aortic valve stenosis and hypertension.
2) PHT cannot be measured in tachycardic rhythms or first degree atrioventricular block, when E and A velocities are merged or the diastolic filling period is short.
3) Immediately after balloon mitral commissurotomy: in this situation, gradient and compliance are subject to important and abrupt changes. There may be important discrepancies between the decrease in mitral gradient and the increase in net compliance, making PHT method unsuitable for evaluating MS severity.
4) Prosthetic valves: PHT method overestimates the area of normal prosthetic mitral valves. However, a large rise in PHT on serial studies or a markedly prolonged single measurement (>200ms) may be a clue to the presence of prosthetic valve obstruction, because the PHT seldom exceeds 130 ms across a normally functioning mitral valve prosthesis.[4]
.
Os residentes adoram usar o PHT no refluxo aórtico...Mas estão equivocados ao ignorarem as limitações:
Limitations

1) The PHT is influenced by chamber compliance in addition to chamber pressures. For a given severity of AR, pressure half-time is shortened with increasing left ventricular diastolic pressure, vasodilator therapy, and in patients with a dilated compliant aorta, or lengthened in chronic aortic regurgitation. Thus, this parameter serves only as a complementary finding for the assessment of AR severity.[6]
2) The assessment of PHT requires good Doppler beam alignment and an adequately dense spectral envelope of the regurgitant jet.
.
Importante saber as limitações!!!!!
.

Sobrepesos e a estatística.

.
Conclusion: In subjects at low-to-moderate cardiovascular risk, overweight is a key determinant of the reduction of global LV longitudinal function as assessed by 2D strain.
.

.
Já descrevemos aqui artigos e confusões com o uso do Doppler Tecidual para classificar obesos com "doentes ao Doppler".
Erros de angulação podem muito bem prejudicar essa análise.
.
Peak ventricular longitudinal strain (PVLS) no EchopacK também pode ser confuso???
.
De qualquer forma, a diferença estatística é significante, mas não é relevante.
.

Onda S´para avaliar reserva. Simples e fácil.

Across all subjects the strongest relationship with peak oxygen uptake (pVO2) was with peak left ventricular systolic tissue velocity (S′) during exercise (r = 0.84, P < 0.001
.

.
Conclusion
There is a very strong relationship between measurements of S′ during exercise and exercise capacity. The previously observed poor correlation with standard measures of systolic and diastolic cardiac function may be explained both by the load dependence of parameters such as ejection fraction and by reliance on resting as opposed to exercise assessment.
.
Muito simples e rápido. É só pedalar e fazer o Doppler tecidual.
.
E serve para várias patologias
.

Quanto mais eu trabalho pra valer, mais sorte eu tenho!!!

.
EchoTalk, para quem acredita em trabalhar duro.
Bons ecos!!!!
.

3D ainda aguardando padronização (assim como o Strain...)

Comparison of three-dimensional echocardiographic software packages 

for assessment of left ventricular mechanical dyssynchrony and prediction 

of response to cardiac resynchronization therapy

1. Mohamed F.A. Aly1,2,*,†, 
2. Sebastiaan A. Kleijn1,†, 
3. Karin de Boer1,
4. Yasser A. Abd El-Hady2, 

1. Khalid A. Sorour3, 
2. Hossam I. Kandil3,
3. Albert C. van Rossum1 and 
4. Otto Kamp1

Aims We directly compared TomTec and QLAB software packages for the three-dimensional echocardiographic (3DE) assessment of left ventricular (LV) dyssynchrony including their ability to predict response to cardiac resynchronization therapy (CRT) in patients with ischaemic and non-ischaemic cardiomyopathy.

Methods and results A total of 140 heart failure patients with the LVEF ≤35% and 60 healthy volunteers underwent 3DE. A subgroup of 60 patients underwent CRT and were evaluated before and 6–12 months after implantation. The systolic dyssynchrony index (SDI) was derived from the dispersion of time to minimum regional volume for all 16 LV segments and measured with both software packages and compared using Pearson's correlation and Bland–Altman analysis. Measurements of SDI were significantly higher using TomTec compared with QLAB in both patients (10.9 ± 3.8 vs. 9.7 ± 3.9, P < 0.001) and healthy volunteers (4.1 ± 0.8 vs. 2.4 ± 1, P < 0.001), with large biases and wide limits of agreement. A moderate correlation (r = 0.65, P < 0.001) was observed between both software packages in patients while their inter-observer and intra-observer reliability were good. Of the 60 patients undergoing CRT, reverse remodelling as a measure of response was observed in 41 patients (68%). The optimal SDI cut-off value to predict response to CRT was higher for TomTec than for QLAB (8.8 vs.7.3%, P < 0.001) and demonstrated better sensitivity and specificity (93 and 61%, respectively) compared with QLAB (88 and 33%, respectively). Response prediction in patients with non-ischaemic cardiomyopathy was excellent with a sensitivity and specificity of 95 and 100% for TomTec and 70 and 83% for QLAB using similar cut-off values of 9.1 and 9.2%, respectively.

Conclusion Different 3DE software packages for the assessment of mechanical dyssynchrony should not be used interchangeably until better software standardization is achieved. Dyssynchrony assessment with 3DE for the prediction of response to CRT seems particularly useful in patients with non-ischaemic cardiomyopathy.

Volume Atrial esquerdo, de novo...

Trabalho legal do pessoal de Brasília.
Gostei do valor de corte de volume atrial (32 ml/m²) e a superioridade deste (por Simpson) em relação ao diâmetro atrial na disfunção diastólica...

Recordar é preciso - doppler e angulação.

Que a angulação do doppler influencia a velocidade estimada dos fluxos todo mundo lembra.
Alguns porém se esquecem que o tecidual também é doppler e sofre essa interferência da angulação.
Aí. subestima-se a velocidade da onda e´ e superestima-se a quantidade real de disfunção diastólica...

O Valor da onda s´...

Haemodynamic response during low-dose dobutamine infusion in patients with chronic systolic heart failure: comparison of echocardiographic and invasive measurements

1. Michael Egstrup1,*, 
2. Ida Gustafsson2, 
3. Mads Jønsson Andersen3,
4. Caroline Nervil Kistorp4, 
5. Morten Schou3, 
6. Christian Ditlev Tuxen5 and
7. Jacob Eifer Møller3

+

Author Affiliations

1. ¹Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 59, Frederiksberg 2000, Denmark
2. ²Department of Cardiology, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark
3. ³Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
4. ⁴Department of Endocrinology, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark
5. ⁵Department of Cardiology, Bispebjerg University Hospital, Tuborgvej 235, Copenhagen 2400, Denmark

1. ↵*Corresponding author. Tel: +45 22 64 15 40; fax: +45 38 16 40 29, Email:michaelegstrup@dadlnet.dk

• Received June 19, 2012.
• Revision received September 21, 2012.
• Accepted October 12, 2012.

Abstract

Aims To investigate whether left ventricular (LV) systolic shortening velocity (s′), diastolic lengthening velocity (e′), and non-invasively estimated LV filling pressure (E/e′) during low-dose dobutamine echocardiography (LDDE) reflect invasive measures of cardiac output and pulmonary capillary wedge pressure (PCWP) in stable patients with chronic systolic heart failure.

Methods and results Fourteen patients with heart failure (aged 65 ± 8 years, LVEF 36 ± 8%) underwent simultaneous tissue Doppler echocardiography and invasive measurements of cardiac output and PCWP by right heart catheterization at rest and during dobutamine infusion at rates of 10 and 20 µg/kg/min. Cardiac output increased from rest to peak dobutamine (4.9 ± 1.2 to 6.6 ± 2.0 L/min, P < 0.001) and correlated with the peak systolic tissue velocity (s′) at rest (R = 0.61, P = 0.02) and during dobutamine stimulation (R = 0.79, P < 0.001). Increases in early diastolic mitral inflow (E, 74.9 ± 29.0–90.8 ± 29.5 cm/s) and LV lengthening (e′, 6.5 ± 2.4–8.2 ± 2.8 cm/s) velocities were observed during LDDE leaving the E/e′ ratio unchanged. Although a mean PCWP was also unchanged from rest to peak dobutamine (16.6 ± 8.3–14.2 ± 9.2, P = 0.25), E/e′ and PCWP only correlated at rest (R = 0.64, P = 0.014).

Conclusion The LV systolic shortening velocity is closely associated with cardiac output during LDDE in CHF patients. Dobutamine stimulation increases early diastolic mitral inflow and lengthening velocities, but theE/e′ ratio does not reflect the PCWP during LDDE, which warrants some caution in converting changes in E/e′ into changes in LV filling pressure. The sample size is, however, small and the observation need to be confirmed in a larger population.

Agora só com preservativo!

Compramos uma sonda tranesofágica para usar no Vivid I (portátil) em ambiente hospitalar, às vezes à beira do leito ou na unidade de hemodinâmica.
Desde o primeiro dia fiquei muito receoso frente à possibilidade maior de traumas e consequente quebra da sonda frente ao ambiente de manipulação de maior risco, deslocamento até o expurgo, lavagem etc...
Descobrimos então que o preservativo da foto acima já é comercializado no Brasil, foi inclusive homologado para uso, sem necessidade de desinfecção da sonda, pelo CCIH do HC da Unicamp.
Então, transesofágico agora só com camisinha! Kkkkkk!!!

Elementar meu caro ecocardiografista!

Trabalho bacana feito pelos acadêmicos do RN, mostrando mais uma vez o elementar aos que ainda vêm o sistema cardiovascular como inerte, passivo e segmentado.
O PROBLEMA É SISTÊMICO!!!
Parabéns aos alunos e seus docentes!

Volume de Átrio esquerdo, nossa nova pedra no sapato!

Juntamente com a epidemia de disfunção diastólica que assola o planeta, dilatação de átrio esquerdo vem ganhando força nos laudos dos colegas pró-patológicos.
Quem adotou a tabela européia então, dá dilatação moderada para átrios com volume indexado de 34 ml/m²!!!
Quanto aos métodos, nem se fala.
Tem gente que usa área comprimento, volume calculado por área, biplanar, uniplanar e por aí vai...
Que tal usar Simpson biplanar com corte de 32 ml/m²?

Mentirinhas que as fábricas de ultrassom nos contam.

"Aparelhos mais novos com melhor definição de bordas, melhoram a sensibilidade do Ecostress para detecção de isquemia".

A Tabela acima mostra que a sensibilidade manteve-se praticamente estável ao longo dos anos, mesmo com os velhos equipamentos do início dos anos 80.
O professor José Roberto sempre nos alertou para a teoria do espaço negativo, olhar a imagem com um todo...
Eu que comecei o Ecostress num Apogee com transdutor mecânico e captura em S-VHS, concordo plenamente com essa abordagem!

Enfim, férias!

.
Farei uma pequena pausa nas postagens por 14 dias. O Dr. Guilherme continuará postando.

Um abraço e bons ecos!!!
Beto

Oferta de emprego em SP

Prezados, boa tarde,,
Estamos contratando com urgencia médicos para realizar exames de ecocardiograma em clinica em Alphaville -Barueri,SP, ,, temos agenda cheia de segunda a sexta das 7:00 as 19:00hs, com possibilidades de atendermos também nos finais de semana , podemos ser flexíveis quanto aos períodos ,,, pagaremos valor fixo de R$ 50,00 por exame ,e mais garantia por período,, o medico é quem determina a quantidade de exames que suporta fazer..
Aguardo retorno dos interessados
Att
Carlos Montrone
Ultra Alpha Diagnósticos e Imagem
Al. Grajaú ,98 sala 1502
Te 11-43264669
11-992321831