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http://onlinelibrary.wiley.com/doi/10.1111/echo.13547/full
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O estudo da dispersão mecânica revela mais sobre a estrutura cardíaca do que esperávamos.
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Sem falar da isquemia, onde estudos iniciais revelam potencial enorme para diagnóstico ao repouso.
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Com taxa de aprovação de 23%, frente aos 15% dos não participantes do curso, o curso online da ECOR é uma boa alternativa para quem já quer começar a preparação.
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https://www.sciencedirect.com/science/article/pii/S0894731717303504?via%3Dihub
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Strain echocardiography can detect altered myocardial mechanics in patients with AS.
Pronounced mechanical dispersion is associated with worse prognosis in patients with AS.
Mechanical dispersion adds incremental prognostic value to LVEF, atrioventricular impedance, and global longitudinal strain.
Mechanical dispersion predicts mortality independently of LVEF and AVR surgery status.
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Recente descoberta do Strain, a dispersão mecânica responde perguntas anteriormente dedicadas a RM.
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Muito mais fácil e barata de realizar, a avaliação da dispersão mecânica pode virar essencial.
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http://archivestsc.com/jvi.aspx?un=TKDA-44520
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Na suspeita de tamponamento ouvi que o exame anterior mostrava uma variação do fluxo Mitral de 36%.
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Alguém ainda usa isto????
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Tamponamento é uma probabilidade levantada ao ecocardiograma e é diagnosticado clinicamente.
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O achado de colabamento diastólico do VD indica uma probabilidade de 80% e o desabamento do Átrio direito coloca a probabilidade em 40%.
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Achado de hipertensão pulmonar acentuada torna improvável o tamponamento por pressões muito elevadas na diástole ventricular direita.
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Doppler tecidual pode ajudar bastante a segurar a agulha se estiver normal.
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Fique de olho
Nas indicações
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Conclusion Regardless of stressor and imaging modality and despite the significant methodological heterogeneity within the current data (imaging techniques and parameters), patients with non-ischaemic cardiomyopathy and reduced EF who demonstrate contractile reserve have a lower mortality, and lower events/hospitalisations. The presence of contractile reserve therefore offers a potential positive prognostic indicator when managing these patients.
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http://www.echorespract.com/content/5/1/1.full
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Artigo interessante revela a importância de conhecer a reserva contrátil.
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Revista exemplar britânica, vale a pena seguir:
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Um bom exemplo a ser copiado no território do Cabral.
NEW MODIFICATION OF ISOMETRIC HANDGRIP STRESS ECHOCARDIOGRAPHY FOR DETECTION
OF CORONARY ARTERY DISEASE: COMBINATION OF EXERCISE AND EMOTIONAL STRESS
ECHOCARDIOGRAPHY
Poster Contributions
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-350
Authors: Vadim A. Kuznetsov, Dmitriy Krinochkin, Elena Yaroslavskaya, Georgiy Pushkarev, Elena Zakharova, Tyumen Cardiology
Research Center, Tomsk National Research Medical Center, Tomsk, Russian Federation
Background: Conventional isometric stress echocardiography is not routinely used in the assessment of coronary artery disease (CAD)
because of low sensitivity in diagnosis of coronary lesions. The purpose of this study was to determine diagnostic value of new modification
of isometric handgrip stress echocardiography for detection of CAD – maximal isometric handgrip/emotional stress echocardiography
(MISE) in patients with suspected CAD compared with conventional dobutamine stress echocardiography (DSE).
Methods: 197 patients with suspected CAD were studied before coronary angiography: 87 of them underwent MISE, 110 – conventional
DSE. After baseline measurements by echocardiography at rest, MISE patients undertook a handgrip-maneuver with the balloons. The
echocardiographic image was monitored throughout the maneuver. The squeezing of the balloons was performed with the both hands and
sustained at maximal voluntary contraction for 3 min. The emotional component of stress was performed: the investigator inspired patient
to maximal effort during the stress. DSE was performed using standard protocol. Quantitative coronary angiography served as a reference
standard for anatomic disease (significant CAD defined as ≥50% reference diameter).
Results: CAD patients revealed by MISE and DSE did not differ in rate of multiple coronary stenoses: 40.4% and 45.5% (p=NS). MISE
gave virtually equal sensitivity, 84.5% (95% CL=74.1-94.8) compared to DSE, 87.3% (95% CI=78.3-96.3) in obtained data (p=NS) and
specificity – 85.7% (95% CI=71.4-99.7) and 76.6% (95% CI=62.5-90.7), respectively (p=NS). The positive predictive value of two tests was
almost similar, 92.5% (95% CI=84.9-99.8) for MISE and 83.3% (95% CI=73.3-93.4) for DSE, as well as the negative predictive value: for
MISE 72.7% (95% CI=54.5-90.9) and 81.8% (95% CI=69.0-94.7) for DSE (both p=NS). Overall accuracy for MISE did not differ from DSE –
84.9% (95% CI=76.5-93.3) and 82.7% (95% CI=74.8-90.7), p=NS.
Conclusions: MISE and DSE have a similar diagnostic value in detection of significant coronary lesions in suspected CAD patients.
However, MISE is easier to carry out, this method is less time consuming and less expensive compared to DSE.
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Outras demonstrações
http://onlinelibrary.wiley.com/doi/10.1002/ccd.1810020108/epdf
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The squeezing of the balloons was performed with the both hands and
sustained at maximal voluntary contraction for 3 min
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Vejam como é fácil fazer um ecoestresse tão bom ou melhor que a Dobutamina.
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Nós usamos a bicicleta abaixo com resultados excelentes, sempre em busca da frequência submáxima.
Muito bem tolerado por idosos com limitações em membros inferiores.
