Mês: agosto 2013

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Aqui
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No serviço de ecostresse, a dúvida diagnóstica desaparece quando usamos o modo M anatômico para analisar o movimento do anel mitral, como na foto.
Em casos positivos para isquemia, esse movimento diminui ou desaparece no pico do esforço.
Dá até para medir objetivamente.
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Um Vscan passeava pelo hospital de clínicas da UNICAMP:
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Uma suspeita de tamponamento surgiu de repente:
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Derrame pequeno demais, não tampona!!!
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Diagnóstico de ICC duvidoso no PS. Pneumonia grave ou ICC desadaptada:
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ICC grave!!!
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Hipotensão e taquicardia ao lado. Aumento da área cardíaca. Será derrame agora com tamponamento?
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Nada disso. ICC!
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E por aí vai, para quem se diverte com o Eco e ajuda os pacientes.
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Nenhum ecocardiograma com Doppler  foi deixado de lado ou sofreu maus tratos durante as filmagens desse documentário.
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AQUI O ARTIGO
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Echocardiographic Image Acquisition

The cardiology fellow performed limited, indication-focused echocardiographic studies on 89 patients with standard parasternal and apical views. In each patient, a recording of single parasternal long-axis, short-axis, and apical four-chamber views was obtained. Additional loops were recorded if deemed diagnostic of an abnormality at the point of care or if the fellow was unsure of a finding, but if a view revealed clearly normal findings, a loop was not recorded, to minimize data size. PCU images were acquired using Vscan (GE Healthcare, Wauwatosa, WI), a 1.4 × 7.3 × 2.8 cm device weighing 390 g with an 8.9-cm diagonal, 240 × 320 pixel display. Vscan uses a phased-array transducer (1.7–3.8 MHz) with a fixed sector angle of 75° and maximum depth of 25 cm. Color flow Doppler is available within a 30° maneuverable sector. Spectral Doppler or M-mode imaging is not available with the device. Images are stored on the device as JPEG still captures or MPEG-4 cine loops.
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Conclusions:: Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.
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Uma ferramenta revolucionária como o Vscan não pode ficar de lado em um país como o Brasil. Várias evidências científicas da utilidade do aparelho não sensibilizam a empresa no território nacional.
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O preço elevado e a ausência de uma estratégia de mercado eficiente colocaram o produto em quarentena.
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Os números de acesso ao blog EchoTalk estão ligeiramente diferentes.
Sabemos que 2 409 pessoas acessaram o blog e que pelo menos 1 200 são leitores e retornaram para a leitura.
Quase 4 000 visitas e mais de 6 000 visualizações de páginas!
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O número de leitores fiéis dobrou em relação aos novos, hoje metade dos acessos ao blog são de origem repetida.
Também a penetração na América Latina e Península Ibérica aumentou.
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Como o assunto do blog é altamente específico, são leitores ligados ao método de alguma forma.
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Essa análises são importantes para não perdermos o foco, imprimirmos ritmo e modernização.
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Para um blog classificado pelo Nathan como “bloguinho de Eco”, até que estamos bem!!!

Aqui completo
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Aqui completo e interessante
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Muito interessante, mede o ciclo pelo movimento. Sem ECG.

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AQUI COMPLETO
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Method and results: Follow-up transthoracic echocardiography (TTE) was performed 3 years after initial TTE in 20 ‘healthy’ HTX patients (13.2 years post-transplantation at time of follow-up) with normal ejection fraction and angiographically ruled out allograft vasculopathy. Grey-scale apical views were recorded and stored for automated offline speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. Strain analysis was performed in 320 segments 34.3 ± 3.7 months after initial assessment. Automated tracking of myocardial deformation for determination of longitudinal systolic strain was not possible in 24 (7.5%) segments at baseline and in 32 (10.0%) segments at follow-up (P = ns). The left ventricular ejection fraction (LVEF) was 61.9 ± 8.1% at the initial examination vs. 62.8 ± 5.8% 3 years afterwards (P = ns). Global longitudinal peak systolic strain was -14.0 ± 4.0 vs. -14.4 ± 2.8%, respectively (P = ns)
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Apparently, deformation values remain stable over the years as long as the LVEF is preserved
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Estudo pioneiro no seguimento de transplantados com Strain. Fora os casos de rejeição, a ligação entre o Strain e a fração de ejeção se mantém confiáveis.

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AQUI >>>>>>>>>>>>>Conclusion: The assessment of longitudinal systolic and diastolic LV and RV functions is valuable during a sub-maximal exercise stress echocardiography to confirm the heart dysfunction related to the HFPEF symptoms. It might be used as a diagnostic test for difficult clinical situations.
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Reparem no protocolo simples:
Sub-maximal exercise test

Following clinical examination, arterial blood pressure measurement (Dinamap Procare Auscultatory 100), 12-lead electrocardiogram, and resting transthoracic echocardiography (Vivid 7, General Electric Healthcare, Horten, Norway), the patients underwent a standard supine exercise echocardiography on a tilting table with an electromagnetic cycle ergometer (Ergometrics). Exercise testing was started at an initial workload of 30W, the workload being increased by increments of 20 W every 2min. The pedaling rate was 60 rpm, the electrocardiogram was recorded continuously, and blood pressure was measured every 2min both on exercise and during recovery from exercise. Exercise testing was interrupted promptly in the case of typical chest pain, limiting breathlessness, dizziness, muscular exhaustion, severe hypertension (systolic blood pressure of >=250 mmHg), or significant ventricular arrhythmia. Blood pressure, ECG, and echocardiographic images were acquired at rest and for a heart rate (HR, 100–120/min) and at least five consecutive beats were recorded. The test should have been considered abnormal if the patient presented one or more of the following criteria: angina, evidence of shortness of breath at low workload level (=2 mm ST segment depression in comparison to baseline levels, rise in systolic blood during exercise <20 mmHg, or a fall in blood pressure and complex ventricular arrhythmias. The exercise duration was planned to be (8–10) min for every patient.

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Após 7 meses de absoluta gentileza e simpatia, a empresa retirou o aparelho de demonstração do HC-UNICAMP.
Caso frequente de hospital público sem facilidades financeiras ou políticas, a comunidade de cardiologia e ecocardiografia teve a oportunidade de testar longamente o aparelho Siemens.
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Hoje sabemos que o 3D Siemens é a realidade e o futuro próximo.
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Outras fábricas investem em maneiras diversas de marketing, sem beneficiar hospitais públicos ou de ensino.
Só nessa empresa vimos o famoso e raro “almoço grátis”.