Dia: 19 de setembro de 2011

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Aqui, completo.

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Aqui, completo.
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Aqui, completo.
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Imagens bonitas de um grande aneurisma de Septo interatrial (de verdade!).
Janela subcostal um pouco limitada, aparentemente sem shunts ao doppler.

Echo Doppler Predictors of Pulmonary Artery Hypertension in Patients with Systemic Sclerosis
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Objectives: Evaluate echocardiographic predictors of pulmonary artery hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc). Methods: 38 patients with SSc who did not have PAH and significant left heart disease, with peak tricuspid regurgitant velocity (TRV) ≤ 2.8 m/sec and systolic pulmonary artery pressure (sPAP) < 40 mmHg on echo Doppler were enrolled. Patients underwent: clinical assessment, NT-proBNP, and DLco measurements. Echo Doppler evaluation included right ventricular (RV) dimensions, tricuspid annular plan systolic excursion, fractional area change, tricuspid DTI systolic velocity, Tei index, pulmonary flow acceleration time (AcT), ratio of TRV to RV outflow tract time–velocity integral (TVI) and a parameter of disturbed RV ejection (TRV/AcT). After a planned 12-month follow-up we evaluated the predictive value of these parameters for the development of PAH, as demonstrated by right heart catheterization (RHC). Criteria for RHC were TRV ≥ 3 m/sec or sPAP ≥ 40 mmHg. Results: Four patients developed PAH. Only TRV/TVI and TRV/AcT ratios significantly predicted PAH development (TRV/TVI ratio ≥ 0.16 [predefined and ROC confirmed]: OR 99, CI 95%: 4.865–2015, P = 0.004; TRV/AcT ratio ≥ 0.022 [predefined and ROC confirmed]: OR 12.68, CI 95% 1.163–379.3, P = 0.036). Both parameters showed a good diagnostic power (TRV/TVI ratio: ROC area 79%, sensitivity 75%, specificity 97% and diagnostic accuracy 94.74% for cutoff value of 0.16; TRV/AcT ratio: ROC area 75%, sensitivity 75%, specificity 71% and diagnostic accuracy 72% for cutoff value of 0.022). Conclusions: This prospective study identified increased values of the two ratios TRV/TVI and TRV/AcT as predictors of PAH in SSc.
(Echocardiography 2011;28:860-869)
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Dois bons índices para o desenvolvimento de Hipertensão pulmonar na ES.
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Todos os meses, fazemos dezenas de exames em portadores de ES para avaliação do pressão pulmonar.
Mas tínhamos pouco a dizer quando dava normal. Agora, usaremos os índices TRV/TVI e TRV/AcT.
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Effect of Food Intake on Commonly Used Pulsed Doppler and Tissue Doppler Measurements
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Objective: This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Methods: Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. Results: The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity–time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P 0.05) changes in E/A, early diastolic tissue Doppler velocities (e’), and E/e’. Most, but not all variables returned to baseline values 110 minutes after food intake. Conclusions: This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations. (Echocardiography 2011;28:843-847)
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A alimentação influencia parâmetros de disfunção endotelial e diferentes tipos de dietas influenciam de maneiras distintas a reatividade arterial.
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Faltava comprovar o mesmo em uma parte das artérias chamada coração.
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Quando fazemos pesquisas com FMD, insistimos que o jejum ou a dieta controlada é fundamental para a análise da resposta arterial. Isso dificulta a pesquisa e a obtenção de voluntários.
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Será que para estudos de Doppler tecidual e Diástole, o momento do exame em relação a alimentação não deveria ser também controlado?
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