Estenose aórtica acentuada com gradiente nem tanto.


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Artigo
Paradoxical low flow, low gradient, severe aortic stenosis (AS) despite preserved ejection fraction is a recently described clinical entity whereby patients with severe AS on the basis of aortic valve area have a lower than expected gradient in relation to generally accepted values.
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Em uma ocorrência de até 35% dos casos(?), esse texto tenta explicar como reconhecer e tratar esse achado subdiagnosticado.
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Primeira pesquisa: Vitória da chapa Jorge Assef


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A chapa Jorge Assef têm motivos de sobra para comemorar, dos 90 votos válidos, 79 foram para a chapa Assef.
Mesmo quem não vota, por motivos vários, daria a vitória ao Jorge.
Pena que 11 votaram em branco…Será que não entenderam o significado dessa votação?
Ou o que está em jogo de verdade nessa eleição?
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A importância de gravar o pico do esforço


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Prognostic value of peak and post-exercise treadmill exercise echocardiography in patients with known or suspected coronary artery disease
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Jesús Peteiro1,*, Alberto Bouzas-Mosquera1, Francisco J. Broullón2, Ana Garcia-Campos1, Pablo Pazos1 and Alfonso Castro-Beiras1
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Methods and results: We studied 2947 patients who underwent EE. Wall motion score index (WMSI) was evaluated at rest, peak, and post-exercise. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Separate analyses for all-cause mortality and major cardiac events (MACE) were performed. Ischaemia developed in 544 patients (18.5%). Among them, ischaemia was detected only at peak exercise in 124 patients (23%), whereas 414 (76%) had ischaemia at peak plus post-exercise imaging and six patients (1%) had ischaemia only at post-exercise. During follow-up, 164 patients died. The 5-year mortality rate was 3.5% in patients without ischaemia, 15.3% in patients with peak ischaemia alone, and 14% in patients with post-exercise ischaemia (P < 0.001 normal vs. ischaemic groups). In the multivariate analysis, post-exercise WMSI was an independent predictor of MACE [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09–2.19, P = 0.02]. Peak exercise WMSI was an independent predictor of MACE (HR 2.19, 95% CI 1.30–3.69, P = 0.003) and mortality (HR 1.58, 95% CI 1.07–2.35, P = 0.02). The addition of peak EE results to clinical, resting echocardiography, exercise variables, and post-EE provided incremental prognostic information for MACE (P = 0.04) and mortality (P = 0.04).

Conclusion: Peak treadmill EE provides significant incremental information over post-EE for predicting outcome in patients with known or suspected CAD..
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Trabalho muito interessante do colega espanhol mostrando a importância de gravar o pico do esforço, além da gravação apenas do pós esforço.
Algo que fazemos de rotina no ecostress em bicicleta horizontal.
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