Patients who received pretreatment with manual thrombus aspiration before primary PCI had a more preserved microvascular integrity resulting in a better myocardial longitudinal deformation even in the absence of significant changes in traditional indices of LV function. 2DSTE imaging may have important diagnostic and therapeutic implications especially in acute clinical settings providing an easy and noninvasive risk stratification soon after acute myocardial infarction.

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O Strain Global Longitudinal parece ser o marcador mais confiável na isquemia.

Pode ser usado até para inferir a preservação da microcirculação!

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Although it is known that LV diastolic dysfunction was found in patients with CAD, in our study, there was no the relation between the severity of the disease (SS and GS) and LV diastolic function by using echocardiography (Vivid 3, General Electric, Tirat Carmel, İsrael) in patients with stable CAD and normal LV ejection fraction.

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In our study, it was seen that diastolic function did not demonstrate any impairment according to the anatomy of coronary arteries in patients which coronary angiography performed with the diagnosis of stable CAD. With this finding, it was seen that the factor that increases the diastolic dysfunction that is frequently seen in CAD is not only related to the severity of the lesion and the anatomy of CAD but also other parameters that are important for dysfunction. Especially, ischemia symptoms and heart failure symptoms can be more useful in terms of diastolic function.

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E agora?

A severidade da doença anatômica não se correlaciona com a disfunção diastólica?

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O artigo vai contra um senso comum, o valor prognóstico da diastologia no paciente assintomático.

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Veja na tabela que nem a “e´” variou na doença coronária severa.

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Sabemos que morfologia de placa  não é isquemia, sem dúvida.

Mas o eco de repouso perde seu valor com uma publicação assim.

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The report of Mobitz type II AV block occurring during a dobutamine stress test must remain questionable. True Mobitz type II AV block during a dobutamine stress echocardiography is theoretically possible based on its documented occurrence with the administration of isoproterenol. The misclassification of second-degree AV block type I and II during dobutamine stress echocardiography is important because a wrong diagnosis of Mobitz type II AV block, even if transient may cause the inappropriate implantation of a pacemaker. In this context, one should remember that the European and American guidelines for device therapy recommend pacing for Mobitz Type II second-degree AV block regardless of duration or symptoms

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Interessante abordagem dos efeitos da Dobutamina. Parece possível que a droga cause alterações na condução AV mas é de pouca relevância clínica.