Dia: 4 de junho de 2012

Beto Matos-Souza

Identification of Viable Myocardium in Acute Anterior Infarction Using Duration of Systolic Lengthening by Tissue Doppler Strain: A Preliminary Study

Results

Peak systolic strain fell gradually (becoming less negative) from normal segments to segments with transmural infarction (P < .0001), and the duration of systolic lengthening increased (P < .0001). Myocardial scarring was closely correlated with peak systolic strain (R = 0.76, P < .00001) and the duration of systolic lengthening (R = 0.88, P < .00001). There was a significant correlation between the degree of scarring and time to percutaneous coronary intervention (R = 0.40, P = .045). In segments with systolic lengthening, the improvement in strain after remodeling was significantly higher (5.5 ± 5.1%) than in segments with duration of systolic lengthening > 67% of systole (2.2 ± 3.7%) (P  67.3% could identify nonviable myocardium (sensitivity, 90%; specificity, 94%).

Conclusions

In patients with acute myocardial infarctions in the anterior wall, strain measurements can identify myocardium with nontransmural scarring. The duration of systolic lengthening is a novel, easily implemented variable that may identify ischemic but viable myocardium. Myocardial infarctions in other left ventricular regions should be investigated in future studies.
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A duração do Strain revela mais sobre a viabilidade do tecido do que se imaginava. 
Será capaz de dar a viabilidade já na fase aguda?
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É incrível como o Strain renovou a pesquisa em ecocardiografia e colocou o método de volta ao centro das atenções em cardiologia!
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Ventrículo direito medido e analisado

Beto Matos-Souza

Accuracy and Interobserver Concordance of Echocardiographic Assessment of Right Ventricular Size and Systolic Function: A Quality Control Exercise

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Results

Quantitative measurements increased accuracy and interreader agreement compared to qualitative assessment alone, especially in normal categories. Readers’ accuracy for diagnosing normal and severe RVS increased from 38% to 78% (P = .001) and from 70% to 97% (P = .018), and readers’ accuracy for diagnosing normal and mild RVSF increased from 52% to 84% (P < .001) and from 36% to 56% (P = .001). Interreader agreement for classification of the subjects as normal or abnormal improved from a κ value of 0.40 to 0.77 (fair to good agreement) for RVS and from 0.43 to 0.66 (moderate to good agreement) for RVSF.

Conclusions

Visual estimation of RVS(Tamanho do VD) and RVSF (Função do VD) is inaccurate and has wide interobserver variability. Quantitation improves accuracy and reliability, especially in distinction of normal and abnormal. The reliability of mild and moderate grades remains inadequate, and further guidance is needed for the classification of abnormal categories.
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Quantas vezes avaliamos o VD apenas por critérios subjetivos e mais nada?
Essa prática está em decadência nos bons serviços.
Fazer um corte perfeito ao 4 C e medir o VD é obrigatório. E a análise da onda Sm tricúspide é fundamental.
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