Dia: 16 de julho de 2008

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Notem a placa de carótida comum esquerda, encontrada em paciente de 80 anos com episódio de síncope.
As regiões da placa tem áreas de ecodensidade diferentes.
Veja que a área 2 têm ecodensidade próxima à da luz (4), ou seja , do sangue.
O sinal da área 3 corresponde a capa fibrosa e é bem diferente das demais.
Já a área 1 corresponda a adventícia.
Seria um diagnóstico de hemorragia intra-placa com instabilização de placa outrora estável?
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Tudo isso em um vivid “e”…

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Evaluation of Left Main Coronary Artery Stenosis by Transthoracic Echocardiography
JASE Volume 21(7), July 2008, p 855–860
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Faço estudos do tronco da coronária há anos no HC, insistindo que poderia ser útil para triagem de casos.
Mas não conhecia um trabalho respeitável no tema.
Então fluxo >1,5 m/s é um forte indicativo de coronáriopatia significativa?

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E/Ea is the Major Determinant of Pulmonary Artery Pressure in Moderate to Severe Aortic Stenosis
Casaclang-Verzosa, Grace MD; Nkomo, Vuyisile T. MD; Sarano, Maurice E. MD; Malouf, Joseph F. MD; Miller, Fletcher A. Jr MD; Oh, Jae K. MD
JASE Volume 21(7), July 2008, p 824–827
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E/Ea ratio was the only independent predictor of PASP after adjusting for the other variables. AVA did not correlate with diastolic dysfunction or filling pressure. Thus, despite a critically stenosed aortic valve, PHT was not always observed.
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Hence, if PHT cannot be explained by the severity of AS, superimposed diastolic dysfunction should be considered and evaluated. If filling pressure is increased and AS is less than severe in patients with dyspnea, medical therapy to reduce diastolic filling pressure may be tried before aortic valve replacement. Therefore, evaluation of diastolic function should be an integral part of the echocardiographic examination when assessing patients with AS. The presence of PHT also should alert physicians to the possibility of superimposed diastolic dysfunction in patients with AS.
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Conclusion:: Our findings suggest that in moderate to severe AS, diastolic function, not AS severity, determines PASP. Superimposed diastolic dysfunction likely contributes to clinical symptoms of moderate to severe AS.
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Finalizada a pesquisa sobre opiniões dos leitores sobre assistência técnica.
GE com 29 votos, Phillips com 8 votos, Esaote e Toshiba com 4 votos cada e Siemens com 2 votos.
É importante destacar que pesquisas assim são apenas ilustrativas, pois vários viés podem ocorrer.
O principal é o efeito “tostines”, quando a empresa que vende mais têm mais clientes e pode aparecer como a que gera mais reclamações, o que é óbvio na pesquisa acima.
Além disso, a Toshiba não concorre de fato no mercado de ecocardiografia.

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Vejam que interessante uso do 3D!
Medir a real área da via de saída do ventrículo esquerdo na hipertrofia assimétrica.

Diagnostic Value of Left Ventricular Outflow Area in Patients with Hypertrophic Cardiomyopathy: A Real-Time Three-Dimensional Echocardiographic Study
JASE
Fukuda, Shota MD; Lever, Harry M. MD; Stewart, William J. MD; Tran, Hung RDCS; Song, Jong-Min MD; Shin, Mi-Seong MD; Greenberg, Neil L. PhD; Wada, Nozomi MD; Matsumura, Yoshiki MD; Toyono, Manatomo MD; Smedira, Nicholas G. MD; Thomas, James D. MD; Shiota, Takahiro MD
Volume 21(7), July 2008, p 789–795

CONCLUSIONS

This study demonstrated adequate cut-off value of 3DE-derived ALVOT to diagnose LVOT obstruction in a large number of patients with HCM. This finding supported that 3DE would be the diagnostic tool of choice for the assessment of LVOT obstruction in clinical practice, especially in HCM, for which pressure gradient through LVOT is difficult to determine.

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Não sei de vocês mas eu estou juntando uns trocados para comprar um Eco 3D logo que ficar mais em conta.
É inevitável a mudança, não adianta o Morcerf dizer que o 3D está na cabeça do ecocardiografista!
Veja o que os europeus pensam a respeito:
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In conclusion, going from 2D to 3D is more important for the improvement of image interpretation and quantification of certain parameters than the modality which is used and rather than considering which is better, echocardiography and CMR should learn from each other’s strengths and weaknesses. In clinical practice echocardiography is the technique of first choice for a lot of indications, but in case of suboptimal image quality one should not hesitate to move to CMR. Further developments in image processing and analysis should focus on finite element models which can be applied to different imaging modalities and which can provide the common platform for image fusion and comparative interpretation.
3D Echocardiography: Is CMR better?
Frank E. Rademakers*
Department of Cardiology, Universitaire Ziekenhuizen Leuven, 3000 Leuven, Belgium