Dia: 3 de novembro de 2008

Effect of contrast application on interpretability and diagnostic value of dobutamine stress echocardiography in patients with intermediate coronary lesions: comparison with myocardial fractional flow reserve
European Heart Journal Volume 29(20), October 2008, pp 2536-2543
Methods and results: Seventy patients with an intermediate coronary stenosis entered the study. Cineloops were recorded during DSE before and after contrast application at rest and peak stress. Two observers blinded to angiography assessed wall motion. FFR was measured in the target vessel during repeat angiography and an FFR <= 0.75 was considered pathological. Abnormal FFR findings were seen in 41% of the patients. Native DSE was abnormal in 36% and contrast-enhanced DSE in 50% of the patients. Luminal diameter narrowing measured by quantitative angiography was not significantly different between patients with normal and abnormal FFR. After contrast application, the number of non-interpretable segments [median (25–75th percentile)] decreased from 2 (1–3) to 0 (0–0) at rest and from 1 (0–3) to 0 (0–0) at stress (both P < 0.001). Compared with native imaging, sensitivity and accuracy increased with transpulmonary contrast from 48 [CI (confidence interval) 40–57%] to 83% (76–91%) and from 62 (CI 56–69%) to 77% (71–82%), respectively (both P=0.05).

Conclusion: Transpulmonary contrast application improves the interpretability and diagnostic yield of DSE in patients with intermediate coronary lesions.

Figure 6 Two-dimensional echocardiography at the parasternal long-axis view illustrating how upper septal hypertrophy distorting the left ventricular outflow tract geometry might lead to erroneous and wide variation of aortic valve area (AVA) calculation by two-dimensional continuity equation. LV, left ventricle; Ao, Aorta.
From: Poh: Eur Heart J, Volume 29(20).October 2008.2526-2535

Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography
European heart journal Volume 29(20), October 2008, pp 2526-2535
Conclusion: RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry.
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Frequentemente tenho a impressão que nem os fabricantes de Eco 3D sabem o que fazer com ele.
Não falo dos representantes, esses não fazem a menor idéia, mais preocupados com a comissão do final do mês.Não os culpo, vivem a vida que lhes foi imposta por diretores imediatistas, geralmente distantes tanto da aplicação, como da invenção.
Ainda bem que existem os cientistas de verdade na medicina, usando a cabeça para tornar o método aplicável.
O 3D veio para ficar, pois faz muito sentido.

Catherine M. Otto, MD
Series Editor, Valvular Heart Disease
In clinical practice, diagnosis and treatment of valvular heart disease are challenging for several reasons. Individual practitioners have less experience with valve disease compared with more prevalent conditions such as coronary disease, heart failure, hypertension, and atrial fibrillation. Few controlled clinical trials in patients with valvular heart disease have been published, so guidelines are largely based on clinical experience and expert opinion. In addition, our understanding of the pathophysiological responses to valve dysfunction is incomplete, and our knowledge of the basic mechanisms of disease in the valve leaflets is rudimentary.
google translate
Na prática clínica, o diagnóstico eo tratamento da doença valvular cardíaca são desafiadoras por várias razões. Praticantes individuais têm menos experiência com a doença valvar, em comparação com condições mais prevalentes, como a doença coronariana, insuficiência cardíaca, hipertensão e fibrilação atrial. Poucos ensaios clínicos controlados em pacientes com doença valvular cardíaca têm sido publicadas, pelo que as orientações são em grande parte baseadas na experiência clínica e opiniões de especialistas. Além disso, o nosso entendimento da fisiopatologia respostas à disfunção valvar é incompleta, e os nossos conhecimentos sobre os mecanismos básicos da doença nos folhetos da válvula é rudimentar
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Vale a pena ler o resto do texto, use o tradutor!