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)!!!

O observador dependente da imagem perfeita

The Value of 2D Strain Imaging during Stress Testing
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Artigo gratuito.
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Stress echocardiography is increasingly used but its major limitation is the subjective interpretationof wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of radial, longitudinal, and circumferential myocardial deformation. Recently, two-dimensional (2D) strain has been found to be as reliable as sonomicrometry for the assessment of left ventricular (LV) regional function. In the presence of inducible ischemia, longitudinal and circumferential abnormalities preceed the decrease in radial deformation. Optimal cutoffs have been obtained from 2D strain rate (SR) at peak dobutamine stress to predict coronary artery disease. However, 2D strain rate does not yet provide incremental accuracy to visual interpretation by experts. Speckle tracking strain could be useful to better identify contractile reverse and biphasic response of viable myocardium but there are not yet clinical studies published in this setting.
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Artigo de 2009 explora a utilidade do Strain 2D na análise ao Stress.
E a busca pela imagem perfeita e independente do observador continua...
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O Strain 2D só fica bom em imagens nítidas, ás vezes, nem assim.
E quando as imagens são nítidas, qualquer residente iniciante acerta o Ecostress!
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Quando vejo um radiologista dar laudos em uma pilha de tomografias, vejo laudos examinador-dependentes.
Quando um médico nuclear regula o ganho na tela para comparar paredes justapostas, vejo laudos examinador-dependentes.
Quando a RM demora a rodar ( 8 quadros por segundo?) ou o realce tardio não foi adequado, vejo laudos examinador-dependentes.
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Infelizmente para alguns, ainda vivemos em um mundo médico-dependente.
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Até os livros preferem as Carótidas..

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Substituir o Simpson não é tarefa fácil

Left ventricular strain and strain rate: Characterization of the effect of load
in human subjects
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European Journal of Echocardiography (2010) 11, 283–289
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Left ventricular (LV) strain and strain rate have been proposed as novel indices of systolic function; however, there are limited data about the effect of acute changes on these parameters.
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Simultaneous Millar micromanometer LV pressure and echocardiographic assessment were performed on 18
patients. Loading was altered sequentially by the administration of glyceryl trinitrate (GTN) and saline fluid
loading. Echocardiographic speckle tracking imaging was used to quantify the peak systolic strain (S) and peak systolic
strain rate (SR S) and dp/dt max was recorded from the micromanometer data. GTN administration decreased preload (LV end diastolic pressure [LVEDP]: 15.7 vs. 8.4 mmHg, P , 0.001) and afterload (end systolic wall stress:74 vs. 43  103dyn/cm2, P , 0.001). Administration of fluid increased preload (LVEDP: 11.3 vs. 18.1 mmHg, P , 0.001) and increased wall stress (53 vs. 62  103dyn/cm2, P , 0.003). Administration of GTN resulted in increased circumferential SR S (21.2 vs. 21.7s21, P , 0.01) and longitudinal SR S (20.9 vs. 21.0s21, P , 0.001). The administration of fluid resulted in decreased circumferential SR S (21.5 vs. 21.3s21, P , 0.01) and ongitudinal
SR S (21.0 vs. 20.9s21, P , 0.01). As preload and afterload increased, decrease in circumferential SR S (r ¼ 0.63, P , 0.001; r ¼ 0.56, P,0.001) and longitudinal SR S were observed (r ¼ 0.42, P , 0.003; r ¼ 0.49 P , 0.001).
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Circumferential and longitudinal peak strain and systolic strain rate are sensitive to acute changes in load, an important factor that needs to be considered in their application as indices of systolic function.
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Vários pesquisadores têm apontado o Strain como método equivalente ou superior ao Simpson.
Mas as influências da pré e pós carga no método são significativas.
Isso também ocorre no Simpson, mas já foi melhor avaliado ao longo do tempo.
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Enquanto a Fração de ejeção 3D em tempo real não se populariza, vamos de Simpson mesmo!
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DAC: Doença Arterial de Campinas 2

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Cooperativa de Campinas autoriza Escore de Cálcio a partir dos 45 anos e Espessura da Carótida só a partir dos 60 anos!
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Completando 2 meses da nova doença arterial estabelecida pelo comitê de especialistas(?) da cooperativa.
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E nenhuma organização de saúde ou revista repercutiu essa fascinante descoberta!
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Mais uma invenção maluca.

Cálcio não têm correlação com a função diastólica!

Coronary Artery Plaque Burden Does Not Affect Left Ventricular Diastolic Function in Asymptomatic Adults with Normal Ejection Fraction
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Journal of the American Society of Echocardiography
Issue: Volume 24(8), August 2011, p 909–914
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Background:: Coronary artery disease (CAD) is commonly cited as a mechanism underlying diastolic dysfunction. However, the association of CAD without ischemia and left ventricular (LV) diastolic dysfunction has not been convincingly demonstrated in asymptomatic patients. The objective of this study was to determine if such a relation exists using coronary artery calcium score (CACS) as a surrogate for coronary atherosclerosis burden.
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Conclusions:: In asymptomatic patients with normal LV ejection fraction and negative cardiac stress test results, CACS does not correlate with LV diastolic function as defined by established Doppler echocardiographic criteria. In the absence of ischemia, postinfarction LV remodeling, or previous coronary artery bypass surgery, CAD does not appear be a cause of LV diastolic dysfunction in asymptomatic patients.
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Um tubo só para o corpo inteiro.

Carotid Artery Stiffness and Diastolic Function in Subjects without Known Cardiovascular Disease
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Journal of the American Society of Echocardiography
Issue: Volume 24(8), August 2011, p 915–921
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Background:: The aim of this study was to investigate the relationship between carotid artery stiffness and diastolic function in a cohort of subjects without known cardiovascular risk factors and/or overt cardiovascular disease
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Results:: Stiffness parameter and Ep were correlated inversely with transmitral E wave (P < .01), E/A ratio, and septal Em (P < .01) and positively with A wave (P < .001). IMT was also associated with A wave, E/A ratio, Em, and Am but not with E wave. The correlation between arterial stiffness and left ventricular diastolic function remained significant after multivariate adjustment for age, sex, pulse pressure, and body mass index, but not with IMT. .

Parâmetros de elasticidade da Carótida se correlacionam com a função diastólica, sugerindo uma relação íntima da circulação central e periférica.
Mais uma evidência da doença arterial como patologia do corpo inteiro e não limitada a placas.
Conceito óbvio mas ignorado no diagnóstico e tratamento do risco cardiovascular.
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Recordar é preciso 12

Na oclusão da carótida comum (unilateralmente), vemos um fluxo retrógrado vindo pela externa, que tem comunicação com as artérias contra-laterais pelos seus ramos.

Diástole. Você precisa ler isto.

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Aqui completo e gratuito.
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Viabilidade miocárdica

Confirmando, na prática, o post do Prof. José Roberto sobre viabilidade e strain de repouso...
E, sim, ecostress de esforço também pode mostrar viabilidade!

A dança do miocárdio na insuficiência mitral.

Cardiac Resynchronization Therapy as a Therapeutic Option in Patients With Moderate-Severe Functional Mitral Regurgitation and High Operative Risk
Circulation
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we assessed the severity of MR using a multiparametric approach, which combined the following measurements: (1) vena contracta width (VCW), measured as the narrowest portion of the MR color Doppler jet in a zoomed optimized parasternal long-axis view or in the apical 4-chamber view; (2) the ratio of the jet area to the left atrium (LA) area measured by planimetry in the 4-chamber view; (3) the effective regurgitant orifice area (EROA) calculated with the proximal isove- locity surface area method.
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Conclusions—Cardiac resynchronization therapy is a potential therapeutic option in heart failure patients with moderate-severe functional MR and high risk for surgery. Improvement in MR results in superior survival after.
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Agora sim a ressincronização encontrou um uso inteligente.
Em pacientes com QRS de 160ms e refluxo mitral acentuado, a ressincronizção reduz significativamente o volume do átrio esquerdo e parâmetros de regurgitação. Pois a dissincronia atrapalha muito a função dos papilares e o fechamento da valva mitral na sístole. Esse refluxo eleva a pressão atrial e acentua os sintomas limitantes. E a avaliação do refluxo ao Eco usou parãmetros incontestáveis!
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Euro 2011 e esse tal de Strain.

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Tudo sobre Strain no Euro 2011.
Para quem ainda duvida da técnica.
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Reuniões da Cardiologia: Choque Cardiogênico.

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Essas aulas são gravadas ao vivo e sem ensaio. Eventuais erros podem ocorrer mas não comprometem a função didática.
Obrigado.

Aneurisma da aorta ascendente e dispnéia

Ascending aortic aneurysm causing orthodeoxy-platypnoe syndrome
Eur J Echocardiogr (2011) 12 ; 410.
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A 66-year old male presented to our clinic with progressive dyspnea at rest. The patient reported that the dyspnoea was worst in upright position
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The tricuspid valve annulus was slightly compressed by the aortic aneurysm with turbulent flow with colour Doppler denoting mild inflow obstruction. The inferior vena cava measured 14 mm in a supine position and 23 mm in upright position.
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Condução anômala no Ecostress

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Paciente jovem com ergométrico positivo por infra de -3 mm no pico do esforço.
Ao realizarmos o Ecostress com Strain 2D, ficou evidente a ativação assincrônica!
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Endarterectomia

A Systematic Review of Randomized Controlled Trials of
Carotid Endarterectomy for Symptomatic Carotid Stenosis
Kittipan Rerkasem, MD, PhD; Peter M. Rothwell, MD, PhD, FRCP, FMedSci
Stroke published online July 28, 2011
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Endarterectomy is of some benefit for 50% to 69% symptomatic stenosis and highly beneficial for 70% to 99%stenosis without near occlusion. Benefit in patients with carotid near occlusion is marginal in the short term and uncertain in the long term. These results are generalizable
only to surgically fit patients operated on by surgeons with low complication rates ( 7% risk of stroke and death).
Benefit from endarterectomy depends not only on the degree of carotid stenosis, but also on several other factors, including the delay to surgery after the presenting event. In particular,
in patients with only 50% to 69% stenosis, there was no evidence of benefit in women and little evidence of benefit if surgery was delayed by 2 weeks after the presenting event
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Teste Mylab 60

Notas de 1 a 5 (ruim,regular,bom,muito bom, ótimo)
Local: ECHOTALK - ESCOLA DE ECOCARDIOGRAFIA.

Preço:4
Teclado:4
Rapidez:5
Bidimensional:5
Colordoppler:4
Doppler contínuo:5
Tela:5

Média: 4,5

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COMENTÁRIOS: Imagem em modo B ótima. O teclado ficou muito melhor e o aparelho é muito rápido. Fazer o IMT é automático e a divisão de botões fica racional após alguma prática.

Stiffness

Aortic Pulse Wave Velocity Is Associated With Measures of Subclinical Target Organ Damage
J Am Coll Cardiol Img, 2011; 4:754-761
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Conclusions: Higher aPWV was independently associated with greater burden of subclinical disease in coronary, lower extremity, and cerebral arterial beds, highlighting target organ damage as a potential mechanism underlying the association of arterial stiffness with adverse cardiovascular outcomes.
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A medida do Stiffness
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A italiana se move!

Falta muito para o Strain pois falta demais no marketing das empresas.

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Metade dos leitores do blog não se interessam pelo Strain em suas máquinas no momento.
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Pesquisa anterior revelou que a maioria dos leitores têm formação plena em ecocardiografia...
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Isso acontece por um velho problema.
O gerente de marketing na área médica, em geral, vende por inércia, não precisa pensar.
Raramente você vê uma campanha inovadora ou original, na ecocardiografia então, NUNCA.
É sempre mais do mesmo. Cópia da cópia do concorrente...
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Quem têm que difundir o Strain no país são as empresas fabricantes de máquinas!
E difundir não é bancar um palestrante acadêmico em aulas com lunch box nos congressos.
Nem demonstrar em pé no stand com mais 5 pessoas em volta!
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Existem cursos bons no país, o do Prof. Castilho em Recife por exemplo, mas quem paga é o aluno.
Então fica assim:
O aluno paga para aprender uma técnica ainda inicial e paga para ter uma máquina com uma tecnologia de uso desconhecido na clínica!
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