quarta-feira, julho 01, 2009

O futuro da ecocardiografia

The future of echocardiography
Thomas H. Marwick*
Department of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane QLD 4102, Australia
European Journal of Echocardiography 2009
The availability of relatively inexpensive, portable echocardiography
machines may have a major impact on the
identification and management of cardiac disease in the
developing world. The ability of high-technology echocardiography
to operate in a low-infrastructure environment
(even with battery and solar power where mains electricity
is not available) is unique among the imaging techniques.
Already, a landmark study in Mozambique and Cambodia
has documented a 10-to-15-fold increase in the identifi-
cation of rheumatic heart disease with echocardiographic
rather than clinical screening.

The eventual goal of 3D imaging will be to provide a series
of 3D data sets, minimizing imaging time or even obtained
remotely. At present, the image quality provided by 3D
data sets does not compete with 2D imaging on the basis
of either temporal or spatial resolution, with the result
that diagnoses may be missed by the interrogation of 3D
data sets alone.29 It seems likely that technological
advances will remedy these shortcomings, permitting acquisition
of a 3D data set, with offline processing to provide a
series of 2D data sets independent of the expertise of the
acquiring sonographer.

Despite data showing that myocardial contrast improves
the accuracy and prognostic value of stress echocardiography,
the use of microbubbles for the assessment of myocardial
perfusion remains an ‘off-label’ application. The
regulatory approval of two new agents has been declined
for safety and/or efficacy reasons, with the approved
agents being a decade old. Thus, despite the promise of
these agents for facilitated thrombolysis, gene delivery,
and for targeted imaging for the detection of thrombi
and inflammation, the future of this field remains


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