Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review

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https://academic.oup.com/europace/article/19/9/1427/3109214

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• The new 2016 ESC Guidelines on AF recommend echocardiography in all AF patients to guide management (I C).
• In this systematic review, data on the validity and reproducibility of systolic indices in AF patients were extremely limited; the best measure of systolic function and acquisition method in AF are priorities for future research.
• Diastolic parameters in AF have been validated against invasive filling pressure with adequate reproducibility. Elevated E/e’ (>15) is also associated with functional capacity, quality of life, and impaired prognosis.
• Measurement of systolic and diastolic function in AF is optimized when the two preceding cardiac cycles have similar RR-intervals and the heart rate is controlled (<100 beats/min).

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Fibrilação atrial crônica derruba qualquer ecocardiografista.

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Erros comuns:

Subestimar a fração de ejeção

Superestimar o refluxo mitral

Confundir o grau de disfunção diastólica

Superestimar a pressão pulmonar

Detectar alterações segmentares irreais

Superestimar a estenose mitral

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Só mesmo os conselhos do texto acima podem ajudar.

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Paciência ajuda, repetir as medidas por 5 vezes em 5 imagens diferentes.

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Avaliar envelopes de Doppler curtos e longos.

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Descontar as alterações superestimadas de estenose  em casos de alta resposta ventricular

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