Cuidados a ter:
– certificar-se que a via apical está bem “apanhada” (VE em forma de cone com visualização das valvulas mitral e tricúspide e aurículas)
– conseguir a melhor definição possível do endocárdio 
– a medição do volume sistólico e do volume diastólico devem ser calculados no mesmo ciclo cardíaco.
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Enviado por Ana Feijão
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Fonte: https://www.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Left_ventricle_systolic_function
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Programa que permite interagir com os princípios de dinâmica dos fluxos no iphone.
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Agora que estudos colocam o angulo da carótida interna como fator de risco, é melhor entender o por que.
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Sustained Acceleration in Carotid Atherosclerotic Plaque Progression With Intraplaque Hemorrhage

Results  From 14 subjects who exhibited IPH at 54 months, 12 arteries were found to have developed IPH during the study period. The progression rates were –20.5 ± 13.1, 20.5 ± 13.6, and 16.5 ± 10.8 mm3/year before, during, and after IPH development, respectively. The progression rate during IPH development tended to be higher than the period before (p = 0.080) but comparable to the period after (p = 0.845). The progression rate in the combined period during/after IPH development was 18.3 ± 6.5 mm3/year, which indicated significant progression (p = 0.008 compared with a slope of 0) and was higher than the period before IPH development (p = 0.018). No coincident ischemic events were noted for new IPH.

Conclusions  The development of IPH posed an immediate and long-term promoting effect on plaque progression. IPH seems to alter the biology and natural history of carotid atherosclerosis. Early identification of patients with IPH may prove invaluable in optimizing management to minimize future sequelae.

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As placas de Carótidas são diferentes em sua composição e progressão.

O componente de hemorragia intraplaca (IPH)  é importantíssimo.

Estudo revelou até 40% do colesterol da placa proveniente das hemaceas aprisionadas nas hemorragias.

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Isso justifica, em parte,  o tratamento do colesterol circulante não ser tão eficiciente para Carótidas.

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Quando a hemorragia é detectada, por qualquer método, a chance de progressão da placa e de eventos desfavoráveis é maior.

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Agora, não se apresse em determinar a figura acima como hemorragia intraplaca ou colesterol, pode ser simplesmente elastina.

Assessment of Echocardiographic Left Atrial SizeHow Accurate Do We Need to Be?.LINK.Finally, it is pertinent to ask how much certainty is needed to conclude that the left atrium is enlarged, particularly when existing cut points are known to have predictive accuracy. Mor-Avi et al. (9) convincingly demonstrated that RT3DE more accurately measures LA volume than biplane 2DE. However, it is unclear whether the incremental benefit of RT3DE for LA volume measurement is valuable clinically. Stated another way, just how accurate do we need to be to be certain?.Sempre que o 3D acerta uma, um experiente colega desfaz o milagre..Só na ecocardiografia!.Na RM e Tomo, qualquer mudança de resolução de 0,001 mm é festejada como a cura das neoplasias!!!!.Só quando nascerem os ecocardiografistas 3D em tempo integral, essa ducha de água fria dos velhos ecocardiografistas secará..

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Real-Time 3D Echocardiographic Quantification of Left Atrial VolumeMulticenter Study for Validation.LINK.

Results  3DE-derived LAV values showed higher correlation with CMR than 2DE measurements (r = 0.93 vs. r = 0.74 for maximal LAV; r = 0.88 vs. r = 0.82 for minimal LAV). Although 2DE underestimated maximal LAV by 31 ± 25 ml and minimal LAV by 16 ± 32 ml, 3DE resulted in a minimal bias of −1 ± 14 ml for maximal LAV and 0 ± 21 ml for minimal LAV. Interobserver and intraobserver variability of 2DE and 3DE measurements of maximal LAV were similar (7% to 12%) and approximately 2 times higher than CMR (4% to 5%). 3DE classified enlarged atria more accurately than 2DE (kappa: 0.88 vs. 0.71).

Conclusions  Compared with CMR reference, 3DE-derived LAV measurements are more accurate than 2DE-based analysis, resulting in fewer patients with undetected atrial enlargement.