Reserva contrátil: Quem têm, vai bem.

f5-large

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Contractile reserve as a predictor of prognosis in patients with non-ischaemic systolic heart failure and dilated cardiomyopathy: a systematic review and meta-analysis

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Conclusion Regardless of stressor and imaging modality and despite the significant methodological heterogeneity within the current data (imaging techniques and parameters), patients with non-ischaemic cardiomyopathy and reduced EF who demonstrate contractile reserve have a lower mortality, and lower events/hospitalisations. The presence of contractile reserve therefore offers a potential positive prognostic indicator when managing these patients.

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http://www.echorespract.com/content/5/1/1.full

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Artigo interessante revela a importância de conhecer a reserva contrátil.

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Revista exemplar britânica, vale a pena seguir:

1a

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Um bom exemplo a ser copiado no território do Cabral.

Ecoestresse com esforço das mãos

squeezing_balloon

NEW MODIFICATION OF ISOMETRIC HANDGRIP STRESS ECHOCARDIOGRAPHY FOR DETECTION
OF CORONARY ARTERY DISEASE: COMBINATION OF EXERCISE AND EMOTIONAL STRESS
ECHOCARDIOGRAPHY
Poster Contributions
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-350
Authors: Vadim A. Kuznetsov, Dmitriy Krinochkin, Elena Yaroslavskaya, Georgiy Pushkarev, Elena Zakharova, Tyumen Cardiology
Research Center, Tomsk National Research Medical Center, Tomsk, Russian Federation
Background: Conventional isometric stress echocardiography is not routinely used in the assessment of coronary artery disease (CAD)
because of low sensitivity in diagnosis of coronary lesions. The purpose of this study was to determine diagnostic value of new modification
of isometric handgrip stress echocardiography for detection of CAD – maximal isometric handgrip/emotional stress echocardiography
(MISE) in patients with suspected CAD compared with conventional dobutamine stress echocardiography (DSE).
Methods: 197 patients with suspected CAD were studied before coronary angiography: 87 of them underwent MISE, 110 – conventional
DSE. After baseline measurements by echocardiography at rest, MISE patients undertook a handgrip-maneuver with the balloons. The
echocardiographic image was monitored throughout the maneuver. The squeezing of the balloons was performed with the both hands and
sustained at maximal voluntary contraction for 3 min. The emotional component of stress was performed: the investigator inspired patient
to maximal effort during the stress. DSE was performed using standard protocol. Quantitative coronary angiography served as a reference
standard for anatomic disease (significant CAD defined as ≥50% reference diameter).
Results: CAD patients revealed by MISE and DSE did not differ in rate of multiple coronary stenoses: 40.4% and 45.5% (p=NS). MISE
gave virtually equal sensitivity, 84.5% (95% CL=74.1-94.8) compared to DSE, 87.3% (95% CI=78.3-96.3) in obtained data (p=NS) and
specificity – 85.7% (95% CI=71.4-99.7) and 76.6% (95% CI=62.5-90.7), respectively (p=NS). The positive predictive value of two tests was
almost similar, 92.5% (95% CI=84.9-99.8) for MISE and 83.3% (95% CI=73.3-93.4) for DSE, as well as the negative predictive value: for
MISE 72.7% (95% CI=54.5-90.9) and 81.8% (95% CI=69.0-94.7) for DSE (both p=NS). Overall accuracy for MISE did not differ from DSE –
84.9% (95% CI=76.5-93.3) and 82.7% (95% CI=74.8-90.7), p=NS.
Conclusions: MISE and DSE have a similar diagnostic value in detection of significant coronary lesions in suspected CAD patients.
However, MISE is easier to carry out, this method is less time consuming and less expensive compared to DSE.

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Outras demonstrações

http://onlinelibrary.wiley.com/doi/10.1002/ccd.1810020108/epdf

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The squeezing of the balloons was performed with the both hands and
sustained at maximal voluntary contraction for 3 min

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Vejam como é fácil fazer um ecoestresse tão bom ou melhor que a Dobutamina.

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Nós usamos a bicicleta abaixo com resultados excelentes, sempre em busca da frequência submáxima.

Muito bem tolerado por idosos com limitações em membros inferiores.

 

718l3ffz8rl-_ac_ul320_sr292320_

Fator de impacto muito baixo para uma revista de ecocardiografia muito boa

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http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1540-8175

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1540-8175

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O mundo acadêmico é movido por,fator de impacto.

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Já vi propostas de multiplicar o número de publicações por seus fatores e aí sim, checar a contribuição do autor para a pesquisa.

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Muitos pesquisadores publicam por kilo.

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Foram relevantes as pesquisas publicadas?

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Difícil saber, poucas são.

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Publicar na revista acima, com o editor genial que ela têm, deveria ser motivo de enorme orgulho.

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VVI (Vetores) é melhor?

nihms-374575-f0001

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Velocity vector imaging (VVI)

The new off-line software (syngo Velocity Vector Imaging technology [VVI], Siemens) provides angle-independent 2D velocity, strain, and SR. “Feature tracking” of the myocardium with VVI is achieved through the combination of speckle tracking, mitral annulus motion, tissue-blood border detection, and the periodicity of the cardiac cycle using R-R intervals. In order to improve the tracking results, the algorithm applies a carefully designed sequence of intermediate passages to accurately follow myocardial motion. All these passages are performed with the aid of Fourier techniques that ensure a higher accuracy using the periodicity of the heart motion. From the multiple 1-dimensional interrogations, a 2D solution is achieved and the displacement information of the tracked points is obtained. The endocardial border is visually identified by the user and manually outlined. The manual placement of an endocardial tracing over 1 frame is then automatically tracked throughout the cardiac cycle. The software allows editing of the initial trace if the resulting tracking is assessed as suboptimal. The endocardial velocity is derived as the ratio between frame-to-frame displacement and the time interval. The velocity vectors in the 2D plane are displayed throughout the cardiac cycle, representing both the magnitude of the velocity and the direction of the motion (Fig. 1). Strain and SR are obtained by comparing displacement of the speckles in relation to each other along the endocardial contour throughout the cardiac cycle.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348770/

http://www.onlinejase.com/article/S0894-7317(12)00051-X/pdf

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Ainda estamos longe de definir uma tecnologia única para a fisiologia cardíaca.

Mais ainda de entender completamente o funcionamento cardíaco.

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