Que janela ruim, que nada!

Impact of acoustic window on accuracy of longitudinal global strain: a comparison study to cardiac magnetic resonance
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Aqui

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Methods and results Left ventricular ejection fraction (LVEF) by Simpson’s biplane method (2D-EF), global-ɛ by speckle tracking, and peak systolic mitral annulus velocity [systolic tissue Doppler imaging (S-TDI)] were compared with LVEF by cardiac magnetic resonance (EF-CMR; 45 ± 18%, range 9–76%). Speckle-tracking analysis was feasible in all segments with an optimal acoustic window and in 85% (103/121) of segments poorly visualized. Global-ɛ similarly correlated with LVEF by CMR in patients with and without optimal IQ (r = 0.81 vs. 0.82 for good vs. poor IQ). In contrast, 2D-EF (r = 0.76) and S-TDI (r = 0.64) less correlated with LVEF by CMR in patients with a suboptimal IQ. Importantly, IQ only impacted on 2D-EF inter-observer reproducibility (9 ± 5 vs. 24 ± 22% for good vs. poor IQ) but not on global-ɛ reproducibility (9 ± 1 vs. 8 ± 7% for good vs. poor IQ).

Conclusion In patients with a limited acoustic window, longitudinal strain by speckle tracking remains accurate and reproducible for assessing global and regional LV systolic function.

Recuperação pós IAM

Can strain rate imaging predict recovery of contraction after acute myocardial infarction?
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Aqui
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Methods and results In 23 patients with ACS, we measured longitudinal tissue Doppler strain and strain rate values from left ventricular basal, mid, and apical segments (n = 414). These segments were grouped according to their acute end-systolic strain values (SES) into those with normocontraction (SES≤−13%), hypocontraction (SES between −13 and −7%), and severe contraction abnormality (SES>−7%). At 8 months, we evaluated the recovery of contraction: Segments with acutely severe contraction abnormality that improved their strain values to ≤−7% were defined as viable, and those that failed to do so as non-viable. In the acute phase, SES, post-systolic strain, as well as systolic, early, and late diastolic strain rate values were significantly better in the viable than in the non-viable segments. Post-systolic strain had the best AUC 0.78, and a cut-off value of −3.8% predicted recovery from severe contraction abnormality with a sensitivity of 85% and specificity of 62%. The transmurality of the infarction, assessed by magnetic resonance imaging with delayed enhancement, was significantly larger in the non-viable than in the viable segments (P = 0.006). Acute global SES and systolic strain rate showed the best correlations with final global SES and global infarction percentage after recovery.

Conclusion SRI can serve to evaluate myocardial viability in patients with ACS, and to assess the recovery of segmental as well as global left ventricular function.
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Algo que todos gostariam de saber após um IAM:
Qual parte afetada recuperará sua função sistólica?
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Quanto mais lâminas acometidas, do endocardio para dentro, menor a chance de recuperação.
O Strain pode ajudar!
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Disfunção diastólica e/ou sistólica 1

Systolic and Diastolic Heart Failure Are Overlapping Phenotypes Within the Heart Failure Spectrum
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Aqui
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Investigators who merely perceive the ends of this spectrum, influenced by the design of clinical trials and by the relevant evidence-based clinical differences, may be unfamiliar with this spectrum view, and instead favor a binary view. However, the latter view lacks a conceptual background. In addition, it is contradicted by recent reductionist analyses, provided that the data be analyzed without selection biases. Importantly, the debate about adopting a binary or a spectrum view of HF is becoming obsolete. Integrative sciences, which complement reductionist sciences, have unveiled the existence of disease networks in which it becomes difficult, and perhaps even irrelevant, to define disease entities.
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Artigo interessante, colocando as disfunções no mesmo coração, sem divisão em sistólica e diastólica.
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Vale a pena ler nesse momento em que as novas tecnologias elevaram a diástole a “arte”.
Como um quadro, a pintura da diástole é sobre um esboço da sístole.
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