Não errem na precificação do Strain

As vantagens do Strain no acompanhamento da quimioterapia jã são documentadas e concretas.

Falta o pagamento.

Veja o argumento da ASE

Value Proposition for Payers

Potential benefits to payers associated with limited coverage of this code as detailed above include the following:

−Potential to reduce hospitalizations and overall healthcare costs in patients receiving potentially cardio toxic chemotherapy

            −Opportunity to help women with advanced breast cancer (the majority of   patients receiving anthracyclines, trastuzumab)

            −Congruent with most payers core principle of innovation

            −Low risk proposition (for example V67.2 comprised just 3% of indications for  echocardiography at Saint Luke’s Mid America Heart Institute in 2014)

Americanos sempre falam em dinheiro.

E em reduções de gastos associados aos benefícios de novas tecnologias.

Além do livro. 3D economiza RM e TC.

O livro é muito bom.

Mas compara o 3D com o 2D.

Discordamos cordialmente.

O concorrente do 3D Echo é a RM e TC.

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Um aparelho 3D moderno e verdadeiro, sem atalhos ilusórios, elimina a necessidade de RM Cardíaca em 99% dos casos.

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É fato, um software completo de cardiologia para RM custa mais de 200 mil dólares e é PERFEITAMENTE dispensável se existir um aparelho 3D verdadeiro no local, comprado por menos da metade do preço.

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O valor do AE em volume

http://www.revportcardiol.org/en-left-atrial-volume-index-can-articulo-S2174204918303556

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LA volume was estimated by the area-length method. LA area and length were measured at end-systole in apical 4- and 2-chamber views, excluding the atrial appendage and pulmonary veins. LA volume was calculated using the formula (A1×A2/L)×8/3π, where A1 and A2 are the LA areas from 4- and 2-chamber views, respectively, and L is the shorter of the two long-axis lengths

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normal LA size was defined as LAVI ≤34 ml/m2, mild dilatation as 35-41 ml/m2, moderate dilatation as 42-48 ml/m2 and severe dilatation as >48 ml/m2.

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However, in this study only moderate and severe LA enlargement and age >75 years were predictors of all-cause mortality and only severe LA enlargement, moderate-to-severe LV systolic dysfunction, LV hypertrophy and moderate mitral regurgitation were independent predictors of both composite endpoints.

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Átrios acima de 28 ml/m2 e abaixo de 34 ml/m2 são normais?

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Provavelmente não.

Mas para capturar o impacto na sobrevida seria necessário um número maior de pacientes e de tempo de acompanhamento.

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Cisto de sangue

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726829/#!po=43.7500

Presentation of cardiac blood cysts in adulthood is rare. Moreover, a few of these cases occasionally develop complications, such as valvular dysfunction, embolic stroke, and ventricular outflow system obstruction.1,2 We report a case of an adult male patient who developed frequent syncope due to mitral valve blood cysts occluding the aortic orifice. This condition was detected by transthoracic and contrast echocardiography.

https://www.cureus.com/articles/23662-evaluation-of-mitral-apparatus-blood-cyst-a-case-report-and-review-of-literature

Risco e progressão da FR

Simplified Echocardiography Screening Criteria for Diagnosing and Predicting Progression of Latent Rheumatic Heart Disease

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https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.118.007928

Conclusions:

This simplified score, based on components of the World Heart Federation criteria, is highly accurate to recognize definite RHD and provides the first tool for risk stratification, assigning children with latent RHD to low, intermediate, or high risk based on echocardiographic features at diagnosis.

Um artigo muito bom e completo