domingo, junho 01, 2008
Strain Rate: ainda longe das clínicas.
No congresso, várias empresas vendiam aparelhos com Strain Rate, como se fossem essenciais para o uso de qualquer ecocardiografista.
Não é isso que está escrito, em vários artigos, inclusive no abaixo descrito, do Division of Cardiology, Johns Hopkins University, Baltimore, Md.
Leia com atenção antes de por a mão no bolso. Quer gastar? Compre um 3D.
Contemporary Reviews in Cardiovascular Medicine
Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice
Theodore P. Abraham, MD; Veronica L. Dimaano, MD; Hsin-Yueh Liang, MD
"Strain has been validated clinically with tagged CMR used as the standard. Some issues related to validation are worth noting. Most validation is performed with both a normal and a significantly abnormal population (eg, myocardial infarction), which results in 2 large, significantly separated clusters of data and consequentially high correlation between techniques. How this correlation translates into a clinically useful tool can only be addressed in large clinical trials with blinded analysis. Clinical studies yield lower correlations between ultrasound strain and CMR than those reported in experimental studies (r values of 0.40 to 0.50).103 Our (unpublished) experience in unselected patient populations has been similar."
"At the present time, tissue velocity and strain data appear to be of optimal value if the images are acquired carefully, analysis is meticulous, and the interpretation is judicious and balanced. To conclude, tissue velocity and strain echocardiography allow detailed interrogation of regional and global mechanics and offer substantial incremental information on myocardial function compared with conventional echocardiography. Both techniques characterize fundamental concepts in cardiac physiology and represent a paradigm shift in the application of echocardiography in clinical practice. Evidence is increasing that the information from these novel techniques will help with clinical decision making and the prediction of outcomes. Education in these new concepts, ample hands-on training, and improvements in imaging technology will help cardiologists gain familiarity with these techniques and better implement them in practice. Randomized and blinded studies in larger populations will help define their eventual role in clinical practice. Ongoing advances that reduce operator interaction may improve reproducibility and facilitate wider clinical use".