Mês: abril 2010

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Hospitalized STEMI treatment in Europe (data from national registries or surveys). 100%, all hospitalized STEMI patients in each given country; green colour, STEMI patients treated by primary PCI; red colour, STEMI patients treated by thrombolysis; black colour, STEMI patients not treated with any reperfusion. Countries abbreviations: CZ, Czech Republic; SLO, Slovenia; DE, Germany; CH, Switzerland; PL, Poland; HR, Croatia; SE, Sweden; HU, Hungary; BE, Belgium; IL, Israel; IT, Italy; FIN, Finland; AT, Austria; FR, France; SK, Slovakia; LAT, Latvia; UK, United Kingdom; BG, Bulgaria; PO, Portugal; SRB, Serbia; GR, Greece; TR, Turkey; RO, Romania.
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Aqui livre

Coronary microcirculatory vasodilator function in relation to risk factors among patients without obstructive coronary disease and low to intermediate Framingham score
Eur Heart J (2010) 31 (8): 936-942
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Multivariable analysis identified a higher Framingham risk score (P < 0.001), female sex (P < 0.001) and a positive family history of coronary disease (P = 0.043) as independent predictors of reduced CFR(coronary flow reserve).
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Conclusion In patients without obstructive coronary disease, a higher FRS was an independent predictor of reduced CFR. The current study provides insight into the relation between cardiac risk profile and coronary microcirculatory function, and suggests that impaired microcirculatory vasodilator function may be present even in patients with a low to intermediate Framingham score.
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Notem que o Escore era baixo, em torno de 5% de risco em 10 anos e na ausência de coronariopatia obstrutiva relevante. Vejam no gráfico a queda da reserva coronária com o aumento do Escore. A reserva coronária é a primeira a ser reduzida, nos estágios iniciais da Aterosclerose. Estudo muito bom, vale a pena ler e está com acesso livre.

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The colour flow area of the regurgitant jet is not recommended to quantify the severity of AR. The colour flow imaging should only be used for a visual assessment of AR. A more quantitative approach is required when more than a small central AR jet is observed.
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Eur J Echocardiogr (2010) 11 (3): 223-244.
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A Dra Ana Camarozano, elegantemente, relata seu conflito de interesse na diretriz de ecocardiografia.
Na ocasião, eu tembém participei desse trabalho para a Bristol.
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Curiosamente, outro palestrante também participou, mas “esqueceu” de relatar.
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Eur J Echocardiogr (2010) 11 (3): 223-244.
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Muito bom, mas colocaria o volume ou dimensões do ventrículo esquerdo como o primeiro da lista, na doença crônica.
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Clinical utility of strain rate imaging
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Vale a pena ler essa aula, aos poucos…
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AQUI
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Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients With Non–ST-Segment–Elevation Myocardial Infarction
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Methods and Results— Sixty-one patients with non–ST-segment–elevation myocardial infarction were examined by echocardiography immediately before revascularization, 2.1±0.6 days after hospitalization. LV systolic function was assessed by ejection fraction, wall motion score index, and circumferential, longitudinal, and radial strain in a 16-segment LV model. Global strain represents average segmental strain values. Infarct size was assessed after 9±3 months by late-enhancement MRI, as a percentage of total LV myocardial volume. A good correlation was found between infarct size and wall motion score index (r=0.74, P<0.001) and global longitudinal strain (r=0.68, P–13.8% and wall motion score index >1.30 accurately identified patients with substantial infarction (12% of myocardium, n=13; area under the receiver operator curve, 0.95 and 0.92, respectively).

Conclusions— Echocardiographic parameters of LV systolic function correlate to infarct size in patients with non–ST-segment–elevation myocardial infarction. Global longitudinal strain and wall motion score index are both excellent parameters to identify patients with substantial myocardial infarction, who may benefit from urgent reperfusion therapy.
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No infarto sem supra, o Eco convencional é limitado em sua capacidade de definir área de infarto.
Com o uso do Strain, ganha-se um marcador forte do tamanho da lesão.
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O Strain veio para ficar, antes até do 3D.
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