segunda-feira, julho 02, 2007
Avante com o contraste na sala de emergência!
Myocardial Contrast Echocardiography for Distinguishing
Ischemic From Nonischemic First-Onset Acute
Insights Into the Mechanism of Acute Heart Failure
Roxy Senior, MD, DM, FRCP, FESC; Raj Janardhanan, MD, MRCP;
Paramjit Jeetley, MBBS, MRCP; Leah Burden, BSc
Background—Distinguishing ischemic from nonischemic origin in patients presenting with acute heart failure (AHF) not
resulting from acute myocardial infarction has both therapeutic and prognostic implications. The aim of the study was
to assess whether myocardial contrast echocardiography (MCE) can identify underlying coronary artery disease (CAD)
as the cause of AHF.
Methods and Results—Fifty-two consecutive patients with AHF with no prior clinical history of CAD and no clinical
evidence of acute myocardial infarction underwent resting echocardiography and MCE both at rest and after
dipyridamole stress at a mean of 92 days after admission. All patients underwent coronary arteriography before
discharge. Of the 52 patients, 22 demonstrated flow-limiting CAD (50% luminal diameter narrowing). Sensitivity,
specificity, and positive and negative predictive values of MCE for the detection of CAD were 82%, 97%, 95%, and
88%, respectively. Among clinical, ECG, biochemical, resting echocardiographic, and MCE markers of CAD, MCE was
the only independent predictor of CAD (P0.0001). Quantitative MCE demonstrated significantly (P0.0001) lower
myocardial blood flow velocity reserve in vascular territories subtended by 50% CAD (0.590.46) compared with
patients with normal coronary arteries (1.991.00). However, myocardial blood flow velocity reserve in patients with
no significant CAD was significantly (P0.03) lower compared with control (2.910.41). Myocardial blood flow
velocity reserve correlated significantly (P0.0001) with increasing severity of CAD.
Conclusions—MCE, which is a bedside technique, may be used to detect CAD in patients presenting with AHF without
a prior history of CAD or evidence of acute myocardial infarction. Quantitative MCE may further risk-stratify patients
with AHF but no CAD. (Circulation. 2005;112:1587-1593.)
Quando nós usaremos essa ferramenta no PS ?
Fiz a proposta ao fabricante de microbolhas há 1 ano e meio e naaaaaada.
Acho que vou montar uma fábrica de contraste brasileira, alguém se habilita?