Dia: 28 de janeiro de 2013

Is the Inferior Vena Cava Really Superior?⁎⁎ Mark H. Drazner, MD, MSc.

The time has come to assess whether routine incorporation of hand-carried echocardiography to assess filling pressures can improve clinical outcomes of patients with heart failure as compared with therapy based upon a carefully performed history and physical examination. An evidence base for such a trial is beginning to emerge. In a study in which hand-carried echocardiography, BNP levels, and clinical evaluation were used to estimate elevated LV filling pressures (pulmonary capillary wedge pressure >15 mm Hg) in patients with chronic systolic heart failure, IVCmax had the highest AUC (0.89) followed by BNP levels (0.88), evaluation of JVP (0.82), and a clinical congestion score (0.74) (14). Importantly, the combination of these parameters had better operating characteristics (AUC 0.97) than any individual test, highlighting the potential utility of combining hand-carried echocardiography with the traditional history and physical examination. ………………………………………………………………………………………………………………. Artigo relacionado:

In a multivariable Cox regression model, including NT-proBNP, only increasing IVC diameter, urea, and the trans-tricuspid systolic gradient independently predicted a poor outcome.

Medindo no local adequado e sem erro de posicionamento, a veia cava inferior é muito precisa para a volemia, acredito.

More May Not Always Be BetterArthur E. Weyman, MD Author Information Dr. Arthur E. Weyman, Massachusetts General Hospital Cardiac Ultrasound Laboratory, 55 Fruit Street, VBK 508, Boston, Massachusetts 02114

Finally, given the complexity of this protocol one might ask whether this approach is equivalent or superior to exercise or dobutamine stress echo for routine clinical use

Não conheço esse Arthur Weyman, mas virei seu fã!!!!

Comparative Prediction of Cardiac Events by Wall Motion, Wall Motion Plus Coronary Flow Reserve, or Myocardial Perfusion Analysis A Multicenter Study of Contrast Stress Echocardiography.

Conclusions The multiparametric assessment of WM, CFR-LAD and MP during stress testing in patients with known or suspected coronary artery disease is feasible. Contrast SE allowed better prognostication, irrespective of the use of CFR-LAD or MP. The addition of either CFR-LAD or MP assessment to standard WM analysis and clinical parameters yielded progressively higher values for the prediction of cardiac events and may be required in today’s intensively treated patients undergoing SE, because their average low risk of future cardiac events requires methods with higher predictive sensitivity than that available with standalone WM assessment.

A saga da perfusão com contraste continua. O problema da perfusão é ter que desbancar a forte presença prognóstica e diagnóstica da alteração da contratilidade!

Melhor mesmo é usar o contraste para enxergar de verdade o espaço negativo e acertar 100% das alterações segmentares.