Simpson foi bom, mas já passou.

F1.large

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Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure

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Conclusions In patients with acute HF, GLS has greater prognostic value than LVEF. Therefore, the authors suggest that GLS should be considered as the standard measurement in all patients with HF. This new concept needs validation in further studies.

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http://www.onlinejacc.org/content/71/18/1947?sso=1&sso_redirect_count=1&access_token=

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Strain gif

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GLS é facil, rápido e melhor que o Simpson.

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Só isso.

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Coronárias: Sucção diferente

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Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2544490/

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In contrast to the LMS, where coronary flow velocity was predominantly diastolic, in the proximal RCA coronary flow velocity was similar in systole and diastole. This difference was due to a smaller distal-originating suction wave in the RCA, which can be explained by differences in elastance and pressure generated between right and left ventricles.

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Vejam que mesmo conceitos de fluxo que pareciam similares na coronárias, são diferentes em territórios direito e esquerdo.

A coronária direita não têm a sucção intensa que o território esquerdo apresenta.

Tratamos da mesma forma fluxos diferentes.

O Strain também é diferente em territórios nutridos por uma ou outra coronária.

Como a sucção é gerada nas lâminas, o Strain pode apontar diferenças e mudanças do padrão ao repouso.

Passe a reparar no Strain de territórios da coronária direita.

O diagnóstico de coronariopatia ao repouso deve passar por estas diferenças!

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Escore de risco com Strain para hipertensos

1-s2-0-s1936878x16302558-gr1

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Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease

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https://www.sciencedirect.com/science/article/pii/S1936878X16302558

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Conclusions

LV longitudinal function is associated with MACE, independent of and incremental to clinical parameters and LVMI in HHD. Deterioration in strain was more strongly associated with MACE than were LVH and LV circumferential function, reflecting a higher susceptibility to chronic HTN and higher sensitivity to MACE of GLS. A multiparametric risk score including GLS may lead to better appreciation of a risk of MACE in HHD.

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Todo marcador que se firma na medicina, acaba sendo inserido em um Escore.

O Strain consegue agora esta inserção.

Mais uma evidência de uso na rotina impossível de menosprezar.

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Onde e quando no Speckle Tracking

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https://www.escardio.org/static_file/Escardio/Subspecialty/EACVI/position-papers/2d-speckle-tracking-echocardiography.pdf

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Em 2015 a sociedade européia definiu parâmetros para o speckle tracking de forma bem básica.

E só.

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Quatorze mil textos abordaram o tema desde então.

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De todos, o que mais chama a atenção é o Strain específico para cada camada miocárdica.

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O que usar, ainda é complicado responder .

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A fisiopatologia sugere que haveria um gradiente de Strain entre a camada subendocárdica, mais sujeita à isquemia, e as camadas media e subepicárdica.

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Este artigo é bem interessante:

https://www.sciencedirect.com/science/article/pii/S0167527316319830?via%3Dihub

Usefulness of layer-specific strain for identifying complex CAD and predicting the severity of coronary lesions in patients with non-ST-segment elevation acute coronary syndrome: Compared with Syntax score

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1-s2-0-s0167527316319830-gr1

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O diagnóstico de doença coronária significativa ao ecocardiograma de repouso com Strain de camadas miocárdicas caminha para o uso clínico.

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A complicação a ser resolvida é que o encurtamento longitudinal só é importante na camada subendocárdica , enquanto que a camada subepicárdica teria um componente circunferencial mais definido.

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Strain gif

Dispersão mecânica dispensa a ressonância

PowerPoint Presentation

https://www.sciencedirect.com/science/article/pii/S0894731717303504?via%3Dihub

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Highlights

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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Slide 1

VVI (Vetores) é melhor?

nihms-374575-f0001

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Velocity vector imaging (VVI)

The new off-line software (syngo Velocity Vector Imaging technology [VVI], Siemens) provides angle-independent 2D velocity, strain, and SR. “Feature tracking” of the myocardium with VVI is achieved through the combination of speckle tracking, mitral annulus motion, tissue-blood border detection, and the periodicity of the cardiac cycle using R-R intervals. In order to improve the tracking results, the algorithm applies a carefully designed sequence of intermediate passages to accurately follow myocardial motion. All these passages are performed with the aid of Fourier techniques that ensure a higher accuracy using the periodicity of the heart motion. From the multiple 1-dimensional interrogations, a 2D solution is achieved and the displacement information of the tracked points is obtained. The endocardial border is visually identified by the user and manually outlined. The manual placement of an endocardial tracing over 1 frame is then automatically tracked throughout the cardiac cycle. The software allows editing of the initial trace if the resulting tracking is assessed as suboptimal. The endocardial velocity is derived as the ratio between frame-to-frame displacement and the time interval. The velocity vectors in the 2D plane are displayed throughout the cardiac cycle, representing both the magnitude of the velocity and the direction of the motion (Fig. 1). Strain and SR are obtained by comparing displacement of the speckles in relation to each other along the endocardial contour throughout the cardiac cycle.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348770/

http://www.onlinejase.com/article/S0894-7317(12)00051-X/pdf

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Ainda estamos longe de definir uma tecnologia única para a fisiologia cardíaca.

Mais ainda de entender completamente o funcionamento cardíaco.

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