As dificuldades do Strain no Estresse.

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So, deformation stress echo appears feasible, is able to identify pathology with as good if not better sensitivity than traditional wall motion analysis, and does appear to offer additional prognostic information to that gained by wall motion assessment alone. However, stress echo by any method has a steep learning curve and significant experience is needed in order to maximize its sensitivity. Unfortunately, these new tools at present may not significantly reduce this as the advanced echo techniques themselves demand a degree of expertise. There is also the time factor to overcome, but some of the newer more automated techniques may help in both these regards. In addition, appropriate cut-off values for normality vs. different types of abnormality (ischaemia, viability, etc.) need to be defined from a detailed meta-analysis of the literature, as currently there are no clear definitions and each study has used their own values according to varying endpoints.

O valor do Strain no Ecoestresse.

 

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In a study of 2D strain imaging, a peak systolic longitudinal SR of −0.83 s−1 and an early diastolic SR of 0.96 s−1 predicted significant (>70%) stenosis with a sensitivity and specificity of 85% and 64% and 77% and 93%, respectively,26 suggesting the potential for early diastolic deformation to improve diagnostic accuracy. In another study of 108 patents undergoing coronary angiography, a 2D longitudinal strain of −17.9% discriminated severe 3-vessel or left main disease from lesser coronary artery disease with a sensitivity and specificity of 79% and 79%, respectively.27 Finally, in a cohort of patients with normal ejection fraction at increased atherosclerotic risk and/or with stable chest pain, a progressive impairment of 2D global strain and SR (the former with lower variability and higher reproducibility than the latter) was directly related to increasing severity of coronary disease as determined from multislice computed tomography. A global longitudinal strain (the average of segmental longitudinal strains) ≥17.4% provided high sensitivity and specificity (83% and 77%, respectively) in identifying patients with obstructive coronary disease.

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O ponto continua sendo, por que alguém nos anos 80 e usando um aparelho primitivo  acertava os mesmos 85% no ecoestresse?

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