Escore de Cálcio ou Espessura das carótidas: Quem vê Cálcio não vê Coração 3

Carotid artery intima-media thickness, but not coronary artery calcium, predicts coronary vascular resistance in patients evaluated for coronary artery disease
.
AQUI
.
We evaluated 120 patients (mean age 56 ± 9 years, 58 men) without a documented history of CAD in whom obstructive CAD was excluded by means of invasive coronary angiography (ICA) or computed tomography coronary angiography (CTCA). All patients underwent C-IMT measurements, CAC scoring, and vasodilator stress 15O-water PET/CT, during which the coronary flow reserve (CFR) and minimal CVR were analyzed.
.
Multivariable regression analysis revealed that C-IMT (p = 0.03), male gender (p < 0.001), age (p < 0.01), and BMI (p < 0.01) were independently associated with minimal CVR. . C-IMT, but not CAC score, independently predicts minimal CVR in patients with multiple cardiovascular risk factors and suspected of CAD.
.

Ressincronização: Clínica x Eco ou Clínica + Eco?

.
Aqui
.
The clinical and echocardiographic responses to CRT were defined based on clinical improvement (≥1 NYHA class) and LV reverse remodelling (reduction in LV end-systolic volume ≥15%) at 6-month follow-up, respectively.
.
only echocardiographic response to CRT was independently associated with superior survival (hazard ratio: 0.38; 95% CI: 0.27–0.50; P < 0.001).
.
A complete two-dimensional and colour Doppler echocardiographic examination was performed. LV end-diastolic (LVEDV) and LVESV were calculated using Simpson's biplane method of discs. The LV ejection fraction was calculated and expressed as a percentage.
.
Conclusion In a large population of heart failure patients treated with CRT, the reduction in LV end-systolic volume at the mid-term follow-up demonstrated to be a better predictor of long-term survival than improvement in the clinical status.
.
Frequentemente criticamos a metodologia de Simpson para avaliar vantagens da ressincronização. Aqui usaram o volume sistólico final para encontrar benefício. Ainda aguardamos estudos com 3D e volume verdadeiro para acreditarmos.

Rodrigo, a onda a´serve para alguma coisa!!!!!

Estimation of left atrial blood stasis using diastolic late mitral annular velocity
Eur Heart J Cardiovasc Imaging (2012)
.
Diastolic late mitral annular velocity (a′) measured by transthoracic echocardiography (TTE) is reported to represent left atrial (LA) pump function and the severity of LA remodelling. The purpose of this study is to investigate the association between a′ and LA blood stasis in patients with non-valvular paroxysmal atrial fibrillation.
.
Receiver-operating characteristic curve analysis showed that the best cut-off value of a′ was 7.0 cm/s for the prediction of SEC with a sensitivity of 80%, specificity of 81%, and predictive accuracy of 80%. Multivariate analysis revealed that decreased a′ (OR = 0.61, P = 0.0026) was independently associated with SEC.
.
Conclusion Decreased a′ may be a useful parameter for the estimation of LA blood stasis in patients with paroxysmal atrial fibrillation.
.

.
Um aluno do ecocardiograma da UNICAMP fez prova prática com o Rodrigo em SP. Como sempre, foi muito bem recebido e conduzido. Durante o exame, ele perguntou ao aluno qual seria a utilidade de medir a onda a´?
.
Gostei muito da pergunta, apesar de não saber responder. O estudo acima prova que temos sim, uso racional para a medida da onda tecidual a´.
.

Ecolaudo, o melhor e mais rápido laudo em ecocardiografia está na nuvem.

.
O Ecolaudo agora é completo, com assistência técnica e fica na nuvem.
Aqui http://www.amirainfo.com.br/amira_laudos.html
.

Relação sístole e diástole no ecoestresse

.
Diastolic time – frequency relation in the stress echo lab: filling timing and flow at different heart rates
.
Tonino Bombardini1*, Vincenzo Gemignani2, Elisabetta Bianchini2, Lucia Venneri1, Christina Petersen1, Emilio Pasanisi1, Lorenza Pratali1, David Alonso-Rodriguez3, Mascia Pianelli1, Francesco Faita2, Massimo Giannoni2, Giorgio Arpesella4 and Eugenio Picano
.
The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal.

Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time.
.
Diastolic filling rate increased from 101 ± 36 (rest) to 219 ± 92 ml/m2* s-1 at peak stress (p < 0.5 vs. rest). . Conclusion Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate. Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress. . . . . . . . . . . . Muito interessante, une conhecimentos de ausculta e física para monitorar o ciclo cardíaco. Como é simples, não deve ser tão caro!

ECG em 2 braços.

.
Durante aula da EchoTalk colocamos os dois eletrodos no braço direito (Preto e Vermelho) e o amarelo no braço esquerdo.
Funcionou bem demais e poupou o desconforto da presilha no tornozelo.
Agora, ECG em todo mundo!!!

Vivid q X CX50

Os portáteis GE

The Philips CX30 video review

Siemens Acuson X300 ultrasound machine review & ratings

Siemens Acuson Freestyle wireless ultrasound transducer.

GE Vivid E9 ultrasound machine review & ratings

AORTIC FLAIL : ROLE OF 3D TEE

Alerta: Detectado uso inteligente do 3D no território nacional!!!

3D Echo pilot study of geometric Left Ventricular changes after acute myocardial infarction
.
Estudo piloto com Eco 3D das modificações geométricas do VE após infarto do miocárdio
.
FUNDAMENTO: Remodelamento ventricular esquerdo (RVE) após IAM caracteriza fator de mau prognóstico. Há pouca informação na literatura sobre o RVE analisado com ecocardiografia tridimensional (ECO 3D)
OBJETIVO: Analisar com ECO 3D as modificações geométricas e volumétricas do ventrículo esquerdo (VE) seis meses após IAM em pacientes submetidos a tratamento primário percutâneo.
.
CONCLUSÃO: Nesta série, foi observado RVE em 38% dos pacientes seis meses após IAM. O índice de esfericidade tridimensional foi associado à ocorrência de RVE.
.

Técnico em Ecocardiografia

TÉCNICO EM ECOCARDIOGRAFIA
Cada técnico em ecocardiografia deve atingir e
manter padrões mínimos em educação e
credenciamento nos dois primeiros anos de
trabalho. Isto inclui a formação inicial requerida para
ser elegível a realizar exames credenciados e a
educação continuada necessária para assegurar a
competência, manter o credenciamento, e
familiarizar-se com as mais recentes tecnologias. O
credenciamento pode ser como técnico registrado
em ecocardiografia (Registered Diagnostic Cardiac
Sonographer, RDCS) pelo Registro Americano de
Sonógrafos Médicos Diagnósticos (American
Registry of Diagnostic Medical Sonographers) ou
como técnico registrado em ecocardiografia
(Registered Cardiac Sonographer, RCS) pela
associação Internacional de Credenciamento
Cardiovascular (Cardiovascular Credencialing
International). Para técnicos que realizam
ecocardiograma pediátrico ou fetal, o padrão
mínimo inclui credenciamentos mais
especializados. Alguns técnicos podem ser
obrigados a ter um componente de experiência de
trabalho prévio à qualificação para exames
credenciados, e por isso é aceito que laboratórios
empreguem alguns técnicos que ainda não tenham
o credenciamento. Entretanto, em tais
circunstâncias, um técnico credenciado deve estar
imediatamente disponível para prover supervisão. A
maioria dos estudos ecocardiográficos em um
laboratório deve ser realizada por um técnico
credenciado, e a maioria dos técnicos deve ter os
credenciamentos apropriados. O laboratório deve
demonstrar um processo que almeje o
credenciamento de todos técnicos. Também
podem existir exigências locais ou estaduais para
os técnicos, incluindo licença, que devem ser
contempladas.
.

.
Nos EUA é assim que funciona.
.

A salvação do transesofágico virá do preservativo.

.
O CCIH vê como possível e seguro a realização do transesofágico com o preservativo e sem a desinfecção entre os exames, caso não exista a ruptura do mesmo.
.
Qual a vantagem real?
A quebra do transdutor ocorre frequentemente na desinfecção.
O produto resseca as borrachas de vedação e estraga a sonda.
O tempo para desinfecção congela a produtividade do serviço.
O custo de pessoal é maior com a desinfecção.
.
Agora sim, estamos sendo realistas com um exame fundamental e, muitas vezes, indispensável.
.

3D, quanto mais inexperiente, melhor!

Experts and Beginners Benefit from Three-Dimensional Echocardiography: A Multicenter Study on the Assessment of Mitral Valve Prolapse
Journal of the American Society of Echocardiography
Issue: Volume 26(8), August 2013, p 828–834

Hien, Maximilian Dominik MDa,b,d; Grogasteiger, Manuel Cand Meda,dß; Rauch, Helmut MDd; Weymann, Alexander MDc; Bekeredjian, Raffi Prof, MDe; Rosendal, Christian MDf,*
.
Background:: Three-dimensional (3D) transesophageal echocardiography (TEE) has been claimed to provide more information than two-dimensional (2D) TEE in the localization of mitral valve prolapse (MVP). However, most studies have been performed by experts in echocardiography, without accounting for differences in training or expertise. This multicenter study was designed to assess the differences between experts and inexperienced echocardiographers in localizing MVP and ruptured chordae tendineae using 2D and real-time 3D TEE.
.
Results:: Both study groups scored significantly higher when interpreting 3D transesophageal echocardiographic images (P <= .001). The experts were superior in 2D MVP localization (14.8%; P <= .001), a difference that diminished with 3D TEE (1.4%; P = .41). The benefit of access to 3D information for MVP localization was greater for inexperienced echocardiographers compared with experts (P < .001).
.
Conclusions:: The reported diagnostic advantage of 3D TEE over 2D TEE in MVP assessment for expert echocardiographers can be transferred to inexperienced echocardiographers. Inexperienced echocardiographers benefit from the technology to a greater extent than their expert colleagues.
.
O blog alerta que o tridimensional será uma ferramente de igualdade entre os ecocardiografistas de todas as idades.

.
Three-Dimensional Echocardiography in Mitral Valve Prolapse: Could Technology Replace Experience?
.
Beraud, Anne-Sophie MD,Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, California
.
In conclusion, should every echocardiographer buy high-end ultrasound platforms and 3D transesophageal transducers to improve his or her analysis of the mitral valve? If universal access to 3D were possible, it might improve the accuracy of mitral valve assessment at all levels of operators' expertise and facilitate the echocardiographic learning process
.

O blog EchoTalk insisti nessa afirmação há anos! Vejam aqui, e aqui e também aqui

Contraste é bom. Até melhor. Onde está a falha que o condena a uso irrisório?

.

.

Flash contrast

Get Closer to the Diagnosis in a Flash
.

Circulation: Cardiovascular Imaging
Issue: Volume 5(2), March 2012, p 280–282
.
A 15-year-old girl of Middle East origin was seen by a pediatrician because of suspected pituitary nanismus.
She had no cardiopulmonary symptoms, but the examination revealed a large nonobstructive, mobile, and apparently multicystic mass in the right ventricle.
.

.
All blood tests were normal including her infectious parameters, and she did not have serum antibodies to any Echinococcus species. An FDG PET-CT scan did not show any particular FDG activity in the mass. Cardiac magnetic resonance showed no signs of tumor infiltration into the myocardium, a feature supporting the suggestion of a benign tumor (Figure 3). It was decided to perform a flash-contrast echocardiography to elucidate the vascularity of the mass and the cyst-like structures (Figure 4). For the contrast echocardiography, a Vivid 7 (GE, Horten, Norway) ultrasound scanner was used, equipped with a 2.5-MHz probe. The echocontrast agent (Sonovue, Bracco, Inc, Milan, Italy; diluted in 10 mL isotonic sodium chloride) was administered intravenously with isotonic sodium chloride (approximately 250 mL/h) at constant rate (approximately 1 mL/min), which kept the contrast dissolved during the infusion. The scanner was adjusted to a low mechanical index to diminish contrast disruption, followed by short bursts of high mechanical index to destroy the contrast in the field of view, including the tumor (Figure 3B). During 15 consecutive heart beats, the perfusion in the tumor was semiquantitatively assessed by comparing contrast replenishment in the interventricular septum with contrast replenishment in the tumor.
.

Vejam quem está voltando...(Dê um zoom)