quinta-feira, dezembro 18, 2008
Foi mal, Doppler tecidual.
Artigo no Circulation
Leia e confira o comentário abaixo, do editorial. (use o tradutor)
The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) has been correlated
with pulmonary capillary wedge pressure in a wide variety of cardiac conditions. However, the reliability of the mitral E/Ea
ratio for predicting pulmonary capillary wedge pressure in patients admitted for advanced decompensated heart failure is
unknown. A total of 106 prospective consecutive patients with advanced decompensated heart failure (ejection fraction
30%, New Your Heart Association class III to IV symptoms) underwent simultaneous echocardiographic and
hemodynamic evaluation on admission and after 48 hours of intensive medical therapy. We found the predictive value of
baseline mitral E/Ea ratio in estimating pulmonary capillary wedge pressure to be less robust than previously reported,
which appears to be related to larger left ventricular dimensions, more impaired cardiac output, and the presence of cardiac
resynchronization therapy. In addition, no reliable direct correlation between baseline or changes in mitral E/Ea ratio and
pulmonary capillary wedge pressure was found. Taken together, our observations provide an important refinement in the
clinical interpretation of the mitral E/Ea ratio as it applies to patient populations in which important confounders such as
alterations in myocardial structure, severity of systolic dysfunction, or the presence of synchronized pacing may pose
challenges to the accurate prediction of left ventricular filling pressures.
É sempre complicado usar velocidades do Doppler sem correção do ângulo.
Como foram feitos os exames? Qual o ângulo de Doppler para cada medida?
Ao relacionar duas medidas de velocidade em locais diferentes, devemos ter o máximo rigor na técnica.