quarta-feira, novembro 16, 2011

Cardiopatia Hipertrófica e Ecocardiografia.

2011 ACCF/AHA Guideline for the Diagnosis and
Treatment of Hypertrophic Cardiomyopathy

A Report of the American College of Cardiology Foundation/American
Class I

1. A TTE is recommended in the initial evaluation of all patients with suspected HCM.

2. A TTE is recommended as a component of the screening algorithm for family members of patients
with HCM unless the family member is genotype negative in a family with known definitive muta-

3. Periodic (12 to 18 months) TTE screening is recomended for children of patients with HCM, starting by age 12 years or earlier if a growth spurt or signs
of puberty are evident and/or when there are plans for engaging in intense competitive sports or there is a family history of SCD.

4. Repeat TTE is recommended for the evaluation of patients with HCM with a change in clinical status or new cardiovascular event.

5. A transesophageal echocardiogram (TEE) is recommended for the intraoperative guidance of surgicalmyectomy.

6. TTE or TEE with intracoronary contrast injection of the candidate’s septal perforator(s) is recommended for the intraprocedural guidance of alcohol septal ablation.

7. TTE should be used to evaluate the effects of surgical myectomy or alcohol septal ablation for obstructive HCM.

Class IIa

1. TTE studies performed every 1 to 2 years can be useful in the serial evaluation of symptomatically stable patients with HCM to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function.

2. Exercise TTE can be useful in the detection and quantification of dynamic LVOT obstruction in the absence of resting outflow tract obstruction in patients with HCM.

3. TEE can be useful if TTE is inconclusive for clinicaldecision making about medical therapy and in situations such as planning for myectomy, exclusionof subaortic membrane or mitral regurgitation secondary to structural abnormalities of the mitral valve apparatus,or in assessment for the feasibility of alcohol septal ablation.

4. TTE combined with the injection of an intravenous contrast agent is reasonable if the diagnosis of apical HCM or apical infarction or severity of hypertrophy is in doubt, particularly when other imaging modalities such as CMR are not readily available, not
diagnostic, or are contraindicated.

5. Serial TTE studies are reasonable for clinically unaffected patients who have a first-degree relative with HCM when genetic status is unknown. Such follow-up may be considered every 12 to 18 months for children or adolescents from high-risk families.
Diretriz americana reafirma o ecocardiograma como escolha inicial e ampla na doença. Serve para diagnóstico, acompanhamento e planejamento do tratamento.


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