Ao infinito e além!

Excelente surpresa na enquete de aparelhos novos!
A maioria está interessada em aparelhos avançados.
É esse o caminho! Nós ecocardiografista não podemos nos acomodar.
Aqui na Echotalk já absorvemos o Strain na rotina de exames e cursos, temos planos de 3D para breve, inclusive transesofágico e para o que mais de novo e bom for inventado.
Podem comprar que gente ensina a usar!!!
E para quem vai gastar mais de um milhão numa Tomografia, conselho:
- Gaste também mais uns 10% disso num bom aparelho de Eco que você não vai se arrepender!

Trocar ou não trocar?

Aortic Valve Replacement in the Elderly: Determinants of Late Outcome
Ashikhmina, Elena A. MD; Schaff, Hartzell V. MD; Dearani, Joseph A. MD; Sundt, Thoralf M. III MD; Suri, Rakesh M. MD; Park, Soon J. MD; Burkhart, Harold M. MD; Li, Zhuo MS; Daly, Richard C. MD

Abstract

Background—: Few data exist on long-term outcomes of elderly patients after aortic valve replacement. We evaluated latest follow-up information for patients >=70 years of age after aortic valve replacement.

Methods and Results—: Late overall survival of 2890 consecutive patients >=70 years of age who underwent aortic valve replacement between January 1993 and December 2007 was reviewed retrospectively, analyzed, and stratified by preoperative and intraoperative variables. Observed 5-, 10-, and 15-year late postoperative survival was lower than generally expected (68%, 34%, and 8% versus 70%, 42%, and 20%, respectively; P<0.001). Independent predictors of late death included older age, renal failure, diabetes mellitus, stroke, myocardial infarction, immunosuppression, prior coronary artery bypass grafting, implanted pacemaker, lower ejection fraction, hypertension, and New York Heart Association class III or IV. After stratification by age–comorbidity risk score, 10-year survival for the lowest-risk group (n=946 [33%]) was similar to expected survival (55% versus 55%; P=0.50), but for the highest-risk group (n=564 [20%]), survival was significantly lower than expected (9% versus 26%; P<0.001). For 229 pairs of propensity-matched patients with mechanical or biological prostheses, survival was not significantly different (67%, 40%, and 19% versus 71%, 45%, and 7% at 5, 10, and 15 years, respectively; P=0.81). Structural deterioration of bioprostheses occurred in 64 patients (2.4%).

Conclusions—: Survival of elderly patients after aortic valve replacement is influenced by age and preoperative comorbidities; 33% at lowest risk had overall survival similar to that of an age- and sex-matched general population. There was no sufficient evidence that valve type affected survival. Structural deterioration of aortic bioprostheses was rare.

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Idosos de baixo risco têm taxa de sobrevida similar à população geral após troca de valva aórtica, os de alto risco morrem mais...
Situação difcícil essa!!!

Recordar é preciso 13

Na Hipertrofia septal assimétrica podemos ver um padrão de Strain com retardo de contração da região septal em relação à parede antero-lateral.
Nas hipertrofias secundárias e hipertrofia fisiológica do atleta isso não ocorre.

Gordura Epicárdica 2

Recebi vários email perguntando detalhes sobre a gordura epicárdica, valores normais etc.
Ainda não temos as respostas exatas...

Tigragem?

Knock knock knocking on: how to open stuck mitral valve prosthesis
Vihinen, Tapani; Lund, Juha; Airaksinen, K.E. Juhani
Author Information
Division of Cardiology, Department of Medicine, Turku University Hospital, Turku, Finland
Corresponding author. Tel: +358 2 3131005, Fax: +358 2 3132030, Email: juhani.airaksinen@tyks.fi
A 40-year-old man with congenital atrioventricular block and dilated cardiomyopathy presented with rapid worsening of dyspnoea and syncopal attacks during exercise. He had undergone mitral valve replacement 14 years ago and the pacemaker system was upgraded to a biventricular device 7 years ago. Echocardiography revealed severe left ventricular dysfunction (ejection fraction 25%). One disc of the prosthesis was stuck in closed position confirmed by fluoroscopy (Panel A) resulting in mean valve gradient of 8 mmHg (Panel B). Effective anticoagulation combined with aspirin was unsuccessful. New valve surgery was unacceptable and patient was referred for heart transplantation.


Severe symptoms led us to perform a percutaneous mobilization of the stuck prosthesis disc during full anticoagulation. After transseptal puncture, a deflectable ablation catheter was advanced (e.g. through a SL2 sheath) against the stuck disc which was knocked until normal disc motion could be confirmed in fluoroscopy with a decrease in pressure gradient (Panels C–E).


The symptoms ameliorated quickly and patient could be discharged. At 5 months of follow-up visit, the patient was free of syncope, but exercise tolerance had remained impaired (NYHA2–3). Echocardiography showed fully mobile discs with a mean valve gradient of 5mmHg. Later, a similar disc malfunction with a rapid deterioration of the condition was observed, but the patient could be discharged after successful disc liberation.


Our case demonstrates that stuck mitral valve prosthesis can be safely and easily mobilized by catheter manipulation through transseptal route. This quick approach may be helpful first aid in acute life-threatening situations.

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Cutucaram e prótese do cara anticoagulado, transeptalmente, com catéter de ablação, DUAS VEZES?!
Muito bacana! Adoro essas tigragens...

Genética e inflamação são tão importantes quanto colesterol e pressão.

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Aqui, cálculo online do risco levando em consideração a história familiar e o perfil inflamatório.
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A república Tcheca aceita pedalar para fazer diagnóstico de Insuficiência Cardíaca.

The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction

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Methods and results Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF.

Conclusion A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.
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Immediately after resting echocardiography, symptom-limited exercise was performed by bicycle ergometry (Kettler X7, Siemens, Germany) in a sitting position. The initial workload of 25 W was increased by 25 W every 2 min until the limited symptoms appeared (dyspnoea, leg, or general fatigue). Immediately after exercise, in the patient's position corresponding to the pre-exercise examination at rest, the following images were obtained: transmitral pulsed Doppler filling flow and Doppler tissue recordings of septal and lateral mitral annular motion and of tricuspid annular motion.

Os Radiocardiologistas são brilhantes!

Cellular adaptive response to chronic radiation exposure in interventional cardiologists
Eur Heart J (2011)
doi: 10.1093/eurheartj/ehr263
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Methods and results We enrolled 10 healthy exposed professionals (all interventional cardiologists, Group II, exposed: age = 38 ± 5 years) and 10 age- and gender-matched unexposed controls (Group I, non-exposed). Exposed subjects had a median exposure of 4 mSv/year (range 1–8) by film badge dosimetry (below lead apron). We measured reduced glutathione (GSH, a marker of antioxidant response) in erythrocytes and plasma generation of hydrogen peroxide (a marker of oxyradical stress) by ferrous oxidation-xylenol orange assay in plasma. In both groups, lymphocytes were isolated and caspase-3 activity (a marker of apoptotic response) measured at baseline and following 2 Gy in vitro irradiation. Exposed subjects showed a three-fold increase in hydrogen peroxide (Group I = 2.21 ± 1.03 vs. II = 6.51 ± 1.55 μM H2O2 equivalents) and a 1.7-fold increase in GSH (I = 12.37 ± 1.22 vs. II = 20.61 ± 2.16 mM). Exposed subjects also showed higher values of caspase-3 activity, both at baseline and—more strikingly—following high-dose radiation challenge.
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Conclusion
In interventional cardiologists, chronic exposure to low-dose radiation is associated with an altered redox balance mirrored by an increase in hydrogen peroxide and with two possibly adaptive cellular responses: (i) an enhanced antioxidant defence (increase in GSH, counteracting increased oxyradical stress) and (ii) an increased susceptibility to apoptotic induction which might efficiently remove genetically damaged cells.
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Gordura Epicárdica

Finalmente algo que sempre pareceu óbvio começa a ser estudado com mais afinco!
Gordura epicárdica deve se correlacionar com doença cardiovascular já que se correlacina com ateromatose de quem?
CARÓTIDAS!!!

O ventrículo direito após 69 anos.

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Caso eviado por Giordano Bruno com achado na valva tricúspide e alteração do VD em paciente de 69 anos.
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Dê sua opinião.
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O melhor simpósio do mundo.

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AQUI
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O simpósio acima é tão bom que se você só for a ele no ano inteiro, ficará atualizado na parte clínica da cardiologia por 365 dias.
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Tentar conquistar o mundo!

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São Paulo, 15 de agosto de 2011.
Caro colega,
No próximo ano, no período de 08 a 12 de março, o Departamento de Imagem Cardiovascular (DIC) terá a honra de sediar em São Paulo o XVII World Congress of Echocardiography and Allied Techniques, que se realizará concomitantemente ao XXIV Congresso Brasileiro de Ecocardiografia e II Congresso do Departamento de Imagem Cardiovascular. Será um evento especial, que contará com inúmeros palestrantes internacionais de grande renome.
Portanto, é com imensa satisfação que convidamos todos os sócios do DIC a participarem do nosso Congresso, enviando seus trabalhos científicos. Este ano, os trabalhos serão apresentados como temas livres, pôsteres moderados e pôsteres tradicionais. Além disso, alguns trabalhos de destaque serão inseridos entre as aulas do Congresso e teremos a grande oportunidade de publicar os sessenta melhores relatos científicos na revista Echocardiography, editada pelo Dr. Navin Nanda.
Não perca esta oportunidade de dividir o seu conhecimento com colegas de todo o mundo! A data limite de envio é 15 de setembro, impreterivelmente! Acesse a página eletrônica do DIC e a página do Congresso e veja as normas para elaboração dos resumos. Contamos com você em São Paulo!

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Procurar isquemia sem radiação, missão do Ecostress e da RM!

Stress Myocardial Perfusion Imaging by CMR Provides Strong Prognostic Value to Cardiac Events Regardless of Patient's Sex
Otavio R. Coelho-Filho, Luciana F. Seabra, MD*, François-Pierre Mongeon, Shuaib M. Abdullah, M, Sanjeev A. Francis, Ron Blankstein, , Marcelo F. Di Carli, Michael Jerosch-Herold, Raymond Y. Kwong
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Conclusions: In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
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Cardiologista da UNICAMP publicou artigo no JACC sobre as vantagens do diagnóstico de isquemia em qualquer sexo sem uso de radiação.
Usou a RM, mas o recado vale para o Ecostress.
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Mais do que placas, que todo mundo têm, interessa a isquemia provocada.
Descobri-la sem radiação, melhor ainda.
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Pára tudo!

Fico impressionado com a facilidade com que estão "batendo o martelo" em Hipertrofia Septal Assimétrica...
Precisa ter muita certeza do que se está vendo para concluir esse diagnóstico!!!

EURO 2011 : Quem e onde, nos resumos.

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Métodos de imagem são bonitos, mas não dominam um congresso geral. E isso é muito bom!
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A América Latina é irrelevante em pesquisa, do ponto de vista global.
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Mas até que o Brasil se sai bem, individualmente.
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Limitações da caixa torácica.

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Submetida a Ecocardiograma transtorácico (ETT) que sugeria MCH, porém com limitações em função da janela acústica inadequada.
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Sem comentários...
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Macrobolhas e FOP

AQUI.
No Cardiosource

Yes, nós temos biscoito!

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Agora que entregamos o Strain 2D junto com o laudo de Ecostress ficamos surpresos com a reação dos cardiologistas.
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Eles adoraram os biscoitos coloridos do Strain!
Era por isso que eles gostavam da cintilografia, eram os biscoitos coloridos!!!!
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Título de ecocardiografista 2012

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Aqui
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Após a prova de título em Cardiologia da SBC, os ecocardiografistas vão precisar estudar para a prova de título em Eco.
O bom livro acima pode ajudar.
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Em Campinas, um negócio da China.

A Longitudinal Study of Carotid Plaque and Risk of Ischemic Cardiovascular Disease in the Chinese Population.
Xie, Wuxiang MDa; Wu, Yangfeng MD, PhDa,∗; Wang, Wei MDb; Zhao, Dong MDb; Liang, Lirong PhD, MDc; Wang, Miao MDb; Yang, Ying MDd; Sun, Jiayi MDb; Shi, Ping MDe; Huo, Yong MDd

Abstract

Background: The aim of this study was to investigate the role of carotid plaque in predicting ischemic cardiovascular risk, which has been intensively reported in Western populations but not yet in the Chinese population, in which the cardiovascular disease profile is significantly different.

Methods: Cox proportional-hazards regression was used to analyze associations between the presence of carotid plaque and the number of segments of carotid arteries with plaque (total plaque score) and the risk for subsequent ischemic cardiovascular disease (ICVD) events, including ischemic stroke and coronary heart disease, in 3,258 Chinese men and women aged 38 to 79 years at baseline. During 5 years of follow-up, 137 ICVD events were identified.

Results: The person-year incidence was 10.6 per 1,000 for ICVD, 6.7 per 1,000 for ischemic stroke, and 4.4 per 1,000 for coronary heart disease. After adjustment for conventional cardiovascular risk factors, the risk for ICVD was significantly associated with the presence of carotid plaque (hazard ratio, 1.49; 95% confidence interval [CI], 1.05–2.14) and total plaque score (hazard ratio per 1-score increase, 1.25; 95% CI, 1.04–1.50). Further analysis showed that the multivariate-adjusted hazard ratio of ICVD associated with plaque in common carotid arteries was 1.90 (95% CI, 1.15–3.13) and that with plaque in bifurcations was 1.26 (95% CI, 0.86–1.85). The results of separate analyses for ischemic stroke and coronary heart disease paralleled those for ICVD. The addition of total plaque score to the risk prediction model resulted in a significant improvement in risk estimation when measured by net reclassification improvement index.

Conclusions: Carotid plaque adds significant additional information for predicting the risk for ICVD events in the Chinese population.

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Em Campinas, nossa cooperativa livrou os usuários desse risco cardiovascular aumentado previsto pelo exame de carótidas...
Negócio da China (para alguns)!!!