Ecocardio com contraste, opinião de quem entende:

“O estudo experimental de Camarozano et
al37 envolveu situações de grande comprometimen-
to endotelial como: diabetes, sepsis e isquemia, e
não mostrou alteração sobre a resposta inflamatória
na microcirculação com o uso das microbolhas, o
que também fortalece a informação de segurança
desse agente para uso na prática médica, em situa-
ções patológicas frequentes37.
Por fim, hoje temos como definido, que o con-
traste para ultrassom enriquece as informações
diagnósticas e prognósticas na cardiologia e na ra-
diologia e mostra-se um método seguro e eficaz.
Estudos maiores e randomizados, como o estudo
Phoenix, vêm sendo realizados para que possamos
ampliar, cada vez mais, nossos horizontes sobre os
agentes de contraste para ultrassom.”

CT de coronárias para quem?!

CT de coronárias/score de cálcio tem pouco valor para pacientes de baixo risco, é bastante controversa para os de risco intermediário e também subestima estenose significativa em pacientes de alto risco…
E tem clínico que ainda pede o exame para “confirmar” resultados positivos de Ecostress!!!

Que coisa!!!

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Ok! Ecocardio de repouso após melhora da dor tem baixa sensibiliade para detectar isquemia, mesmo com contraste (!), em pacientes de baixo risco com dor torácica no PS…
Por isso o Ecostress parece ser a melhor escolha nesses casos, com as “pequenas vantagens” do baixo custo e zero de radiação!

Ecostress: avalie contratilidade e pronto! Só isso…

Can Dobutamine Stress Echocardiography Induce Cardiac Troponin Elevation?
Blatt, Alex M.D., M.Sc.1; Moravsky, Gil M.D.1; Pilipodi, Semion M.D.2; Mor, Anat Ph.D.3; Benbeniste, Patricia Ph.D.3; Vered, Zvi M.D., F.E.S.C., A.C.C.1; Minha, Sa’ar M.D.1
Author Information
1The Department of Cardiology
2The Department of Anesthesiology
3Clinical Biochemistry Laboratory, Assaf-Harofeh Medical Center, Zerifin, Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
Abstract

Background: Elevation of cardiac troponin (cTn) is considered specific for myocardial damage. Elevated cTn and echocardiogrpahic documentation of wall motion abnormalities (WMAs) that were recorded after extreme physical effort raise the question whether dobutamine stress echo (DSE), can also induce elevation of troponin.

Methods: we prospective enrolled stable patients (age >18 years) referred to DSE. The exam was performed under standardized conditions. Blood samples for cTnI were obtained at baseline and 18–24 hours after the test. We aimed to compare between the clinical and echocardiographic features of patients with elevated cTnI and those without cTnI elevations.

Results: Fifty-seven consecutive patients were included. The average age was 64.4 ± 10.7, 73% of the patients were males, and nearly half of the patients were known to have ischemic heart disease. Two of the patients were excluded due to technical difficulty. No signs of ischemia were recorded in 25 (45.4%). Among the patients with established ischemia on DSE, 12 (22%) had mild ischemia, 13 (23.6%) had moderate and 5 (9%) had severe ischemia. Angiography was performed in 13 (26%) of the patients, of which 7 had PCI and one was referred to bypass surgery. None of the patients had elevated cTnI 18–24 hours after the DSE.

Conclusions: Our results indicate that there is no elevation of cTn despite the occurrence of significant WMAs on DSE. We conclude that cTnI cannot be used as an additional diagnostic tool during pharmacological stress test performed to evaluate the presence and severity of ischemia. (Echocardiography 2011;28:219-222)

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Muitos perguntam se não há nada para “aumentar a sensibilidade” do Ecostress.
Algum marcador laboratorial por exemplo…
NÃO! É CONTRATILIDADE E PRONTO!!!

É de pequenino que se torce o pepino

Influence of Age on Associations Between Childhood Risk Factors and Carotid Intima-Media Thickness in Adulthood
Circulation. 2010;122:2514-2520
.
Methods and Results— We used data for 4380 members of 4 prospective cohorts—Cardiovascular Risk in Young Finns Study (Finland), Childhood Determinants of Adult Health study (Australia), Bogalusa Heart Study (United States), and Muscatine Study (United States)—that have collected cardiovascular risk factor data from childhood (age 3 to 18 years) and performed intima-media thickness measurements in adulthood (age 20 to 45 years). The number of childhood risk factors (high [highest quintile] total cholesterol, triglycerides, blood pressure, and body mass index) was predictive of elevated intima-media thickness (highest decile) on the basis of risk factors measured at age 9 years (odds ratio [95% confidence interval] 1.37 [1.16 to 1.61], P=0.0003), 12 years (1.48 [1.28 to 1.72], P<0.0001), 15 years (1.56 [1.36 to 1.78], P<0.0001), and 18 years (1.57 [1.31 to 1.87], P<0.0001). The associations with risk factors measured at age 3 years (1.17 [0.80 to 1.71], P=0.42) and 6 years (1.20 [0.96 to 1.51], P=0.13) were weaker and nonsignificant. Conclusions— Our analyses from 4 longitudinal cohorts showed that the strength of the associations between childhood risk factors and carotid intima-media thickness is dependent on childhood age. On the basis of these data, risk factor measurements obtained at or after 9 years of age are predictive of subclinical atherosclerosis in adulthood. . A espessura da Carótida é um marcador poderoso de eventos cardiovasculares e pode ser feito em crianças sem riscos e de forma seriada.
Esse marcador de baixo custo mostra a importância dos fatores de risco na Aterosclerose desde os 9 anos de idade.

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