Dia: 24 de outubro de 2011

Diastolic Echo Parameters: Meaningless Numbers or Crucial Information?
Wiegers, Susan E. MD, FACC, FASE
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Finally, we are left with the question of whether it is clinically necessary to follow PCWP invasively or noninvasively once the hemodynamics of an individual patient have been clarified. The repeated calls from the intensive care unit to “assess volume status” have, at least at our institution, in some cases replaced careful clinical assessment by physical examination and review of daily weights, I’s and O’s, A-a gradient, and so forth. The ESCAPE trial is frequently quoted as the reason to avoid Swan’s for ongoing PCWP measurement in patients hospitalized with congestive heart failure.19 A simple noninvasive measurement, such as E/e’, would be an attractive alternative. However, there is no evidence that repeated noninvasive assessment will fare any better compared with carefully applied clinical parameters in the care of patients with heart failure.
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Artigo citado
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Viva as novas tecnologias. Pequenos aparelhos, portáteis, instantâneos e telas sensíveis ao toque.
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Elas não vieram para SUBSTITUIR o exame físico detalhado. E têm que provar que servem para alguma coisa.
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Risk Stratification by Cardiac Computed Tomographic Angiography: Key Questions?
Gibbons, Raymond J. MD
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Circulation: Cardiovascular Imaging
Issue: Volume 4(5), September 2011, p 457–459
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The existing scientific evidence in support of this premise for any noninvasive modality is remarkably limited. Despite the widespread use of exercise ECG testing, exercise echocardiography, and exercise SPECT imaging for this purpose, there are no prospective studies, demonstrating that the selection of patients for revascularization on the basis of these modalities leads to improved clinical patient outcomes. In contrast, the use of fractional flow reserve during invasive angiography to select patients for percutaneous coronary intervention does lead to improved patient outcomes. A randomized trial showed that the strategy of fractional flow reserve-guided percutaneous coronary intervention led to improved survival free of major adverse events compared to angiography-guided percutaneous coronary intervention. The challenge for the imaging community is to develop similar evidence for noninvasive approaches. Two randomized trials are currently under way to test the hypothesis that CCTA will lead to improved patient outcomes compared to existing noninvasive methodologies.
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A tomografia será capaz de avaliar a perfusão miocárdica e dará uma análise funcional das lesões encontradas.
Isso acontecerá em, no máximo, 5 anos. Até para nós, da América Latina.
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Enquanto isso, surgirão estudos como o CONFIRM. Que não servem para muita coisa, só para esquentar a cadeira até a versão final da perfusão na TOMO.
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