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Ao receber o anúncio da PHmed me lembrei da história dos aparelhos portáteis.
O Cypress da Siemens foi um dos primeiros a apresentar a portabilidade com qualidade.
Até Ecoestresse dava para fazer!!!
Usei muito um modelo cinza e só tenho boas recordações.
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Aqui está a causa:
In the year 2012 exercise, dobutamine, dipyridamole, adenosine, and pacing SE were available in 15 (26,6%), 52 (91,2%), 5 (8,7%), 1 (1,75%) an 1 (1,75%) departments, respectively.
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Ao insistir no exame farmacológico, ao invés do esforço, os serviços enterraram o método no país.
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Aqui no Brasil um conhecido ecocardiografista tentou fazer o mesmo mas falhou!!!
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http://www.medscape.com/viewarticle/814538#1
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http://www.medscape.com/viewarticle/765017
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Finally, I wanted to describe is something that I’ve become reliant upon, and that’s this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven’t used a stethoscope for over 2 years to listen to a patient’s heart. What’s really striking about this is that it’s a real stethoscope. “Scope” means look into. “Steth” is the chest. And so now I carry this in my pocket, and it’s just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I’m sharing their image on the Vscan while I’m acquiring it and it only takes about a minute. We validated its usefulness in an Annals of Internal Medicine paper, in July 2011,[1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation. (Topol)
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As a clinician, everything about this innovation excites me. Yes, the technology is nifty, the cost-effectiveness useful, but the best part is this: if we try to make portable ultrasound do too much, it fails.(John Mandrola)
Clinical Electrophysiologist, Baptist Medical Associates, Louisville, Kentucky
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if we try to make portable ultrasound do too much, it fails.
Concordância total do blog!
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Chegou na UNICAMP nosso Vivid Q para pesquisa cardiovascular.
Completo, com 4 transdutores e todos os softwares.
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Programa de uso científico:
IMT em pacientes com lesão medular.
Ecoestresse com Ergoespirometria
Strain diastólico na Hipertensão.
E muito mais…
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Em busca de pesquisas relevantes, somos contrários a pesquisas que só engordam o currículo!
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A novel method for the non-invasive estimation of mean pulmonary artery pressure by echocardiography in comparison with right heart catheter measurements
.http://congress365.escardio.org/Cardiac-Imaging#.VBAwLPldXT8
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Methods: The study cohort comprised PHTN patients undergoing RHC and transthoracic echocardiograms (TTE) on the same day. Only cases with TTE studies containing “complete” TR spectral Doppler signals were included. Tracing the TR signal provided the TR mean gradient (TRMG). Right atrial pressure (RAP) was estimated based on the size and collapsibility of the inferior vena cava. The mPAP by TR (mPAP-TR) was then derived as TRMG + RAP.
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Results: 100 patients (65±14 years; 86% female) were included. The mPAP on RHC was 42.5±12.4mmHg and mPAP-TR was 45.9±12.2mmHg. mPAP-TR demonstrated good agreement (Intraclass correlation 0.885) and consistency (Cronbach’s alpha 0.904) with invasive RHC measurements (See attached Bland-Altman plot demonstrating a relative mean difference of 3.44±7.26mmHg). The measurement of mPAP by this technique showed excellent test-retest reproducibility (Intra-observer variability 2±4% and inter-observer variability 2±6%
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Conclusion: This novel non-invasive method for estimation of mPAP is useful in the assessment of PHTN severity. mPAP-TR is simple, reproducible, and correlates well with invasive RHC measurements.
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http://congress365.escardio.org/Presentation/slides/101606#.VBAqsfldXT8
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Impact of mitral regurgitation on clinical outcomes among patients with low-flow, low-gradient severe aortic stenosis undergoing transcathether aortic valve implantation
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Conclusions: Moderate to severe MR is associated with significantly impaired long-term clinical outcomes among patients with LFLG severe AS undergoing TAVI. Among most surviving patients, however, a significant improvement in both LVEF and MR grade was observed.
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Pelos dados apresentados, o determinante MESMO da mortalidade foi a hipertensão pulmonar, presente em 94% dos portadores de insuficiência Mitral moderada.
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Para o paciente acima, o volume atrial de 65 ml leva a 36ml/m2 no cálculo indexado.
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O mesmo paciente, após engordar 15 Kg , ficou com 33ml/m2 no cálculo indexado.
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É quase consenso mundial que o volume indexado do átrio esquerdo é o melhor marcador de Disfunção Diastólica.
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Mas o cálculo da superfície corporal permite a melhora do marcador com a piora de outro, a obesidade.
Alguém que atinge 31 de IMC não pode melhorar na Diástole!
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É uma ideia apenas, podemos pensar que em um caso real o volume atrial subiria para 70 ml com a obesidade.
Mas reforça a tese da altura como melhor indexador de volume, pois nossa altura é programada geneticamente, assim como o tamanho do coração. E em situações de alimentação adequada, definem seu coração e altura no núcleo celular.
Já o peso sofre muito mais com a interferência ambiental.
