Dia: 18 de abril de 2011

Early Hemodynamic Changes Versus Peak Values: What Is More Useful to Predict Occurrence of Dyspnea During Stress Echocardiography in Patients with Asymptomatic Mitral Stenosis?
Journal of the American Society of Echocardiography
Issue: Volume 24(4), April 2011, p 392–398
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.DISCUSSION

The results of the present study can be summarized as follows: 1) In a group of asymptomatic patients with moderate to severe MS, occurrence of dyspnea during exercise was frequent, occurring in 46% of patients. 2) Analyses of hemodynamic pattern during exercise showed that increases in MG and relative SPAP were significantly higher and more rapid in patients who developed dyspnea than in patients who remained asymptomatic. 3) This contrasts with the lack of significant difference observed in peak SPAP values between groups. Peak SPAP >=60 mm Hg was reached in three of four cases and was not significantly associated with occurrence of dyspnea during exercise.
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Estudo com Eco de esforço demonstrou sintomas não correlacionados com pressões sistólicas mais elevadas no leito pulmonar. Parece que a adaptação ao esforço depende de elevações mais tardias no pico da pressão pulmonar e não do valor máximo atingido.
Mais uma demonstração da adaptação ao defeito cardíaco como determinante para o surgimento dos sintomas, fato que vemos repetidas vezes na insuficiência aórtica.

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Neuropsychiatric Symptoms During 24 Hours after Dobutamine-Atropine Stress Testing: A Prospective Study in 1,006 Patients
Journal of the American Society of Echocardiography
Issue: Volume 24(4), April 2011, p 367–373
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Results: A total of 1,006 patients were included (mean age, 67 ± 12 years; 462 [46%] women). Of the 750 patients who returned questionnaires, 53 patients (7.1%) reported NP symptoms. Among the 199 controls, three patients (1.5%) reported NP symptoms. Symptoms were usually mild and resolved spontaneously. Independent predictors of NP symptoms were atropine dose >= 1 mg (odds ratio [OR], 7.69; 95% confidence interval [CI], 4.13–14.81), prior NP disorder (OR, 2.11; 95% CI, 1.11–4.02), positive Delirium Observation Screening Scale result (OR, 4.89; 95% CI, 1.21–18.09), and body mass index < 24 kg/m2 (OR, 2.37; 95% CI, 1.10–4.90). Conclusions: Although usually mild, NP symptoms were nearly fivefold more common after DST (P = 1 mg atropine and those with underlying NP disease, positive Delirium Observation Screening Scale results, or lower body mass indexes are at increased risk.
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Curioso estudo aponta para outros efeitos não desejados do stress farmacológico.
Mas não são suficientes para contraindicar o método em pacientes que não podem ou não conseguem realizar a modalidade com esforço…
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