ABSTRACT
Fundamento: A avaliação da área valvar mitral por meio da reconstrução multiplano na ecocardiografia tridimensional é restrita a softwares específicos e à experiência dos ecocardiografistas. Eles precisam selecionar manualmente o frame do vídeo que contenha a área de abertura máxima da valva mitral, dimensão fundamental para a identificação de estenose mitral. Objetivo: Automatizar o processo de determinação da área de abertura máxima da valva mitral, por meio da aplicação de Processamento Digital de Imagens (PDI) em exames de ecocardiograma, desenvolvendo um algoritmo aberto com leitura de vídeo no formato avi. Método: Este estudo piloto observacional transversal foi realizado com vinte e cinco exames diferentes de ecocardiograma, sendo quinze com abertura normal e dez com estenose mitral reumática. Todos os exames foram realizados e disponibilizados por dois especialistas, com autorização do Comitê de Ética em Pesquisa, que utilizaram dois modelos de aparelhos ecocardiográficos: Vivid E95 (GE Healthcare) e Epiq 7 (Philips), com sondas multiplanares transesofágicas. Todos os vídeos em formato avi foram submetidos ao PDI através da técnica de segmentação de imagens. Resultados: As medidas obtidas manualmente por ecocardiografistas experientes e os valores calculados pelo sistema desenvolvido foram comparados utilizando o diagrama de Bland-Altman. Observou-se maior concordância entre valores no intervalo de 0,4 a 2,7 cm². Conclusão: Foi possível determinar automaticamente a área de máxima abertura das valvas mitrais, tanto para os casos advindos da GE quanto da Philips, utilizando apenas um vídeo como dado de entrada. O algoritmo demonstrou economizar tempo nas medições quando comparado com a mensuração habitual. (AU)
Background: The evaluation of mitral valve area through multiplanar reconstruction in 3-dimensional echocardiography is restricted to specific software and to the experience of echocardiographers. They need to manually select the video frame that contains the maximum mitral valve opening area, as this dimension is fundamental to identification of mitral stenosis. Objective: To automate the process of determining the maximum mitral valve opening area, through the application of digital image processing (DIP) in echocardiography tests, developing an open algorithm with video reading in avi format. Method: This cross-sectional observational pilot study was conducted with 25 different echocardiography exams, 15 with normal aperture and 10 with rheumatic mitral stenosis. With the authorization of the Research Ethics Committee, all exams were performed and made available by 2 specialists who used 2 models of echocardiographic devices: Vivid E95 (GE Healthcare) and Epiq 7 (Philips), with multiplanar transesophageal probes. All videos in avi format were submitted to DIP using the image segmentation technique. Results: The measurements obtained manually by experienced echocardiographers and the values calculated by the developed system were compared using a Bland-Altman diagram. There was greater agreement between values in the range from 0.4 to 2.7 cm². Conclusion: It was possible to automatically determine the maximum mitral valve opening area, for cases from both GE and Philips, using only 1 video as input data. The algorithm has been demonstrated to save time on measurements when compared to the usual method. (AU)
Subject(s)
Humans , Heart Valve Diseases/mortality , Mitral Valve/physiopathology , Mitral Valve/diagnostic imaging , Mitral Valve Stenosis/etiology , Image Processing, Computer-Assisted/methods , Doxorubicin/radiation effects , Echocardiography, Transesophageal/methods , Echocardiography, Three-Dimensional/methods , Transcatheter Aortic Valve Replacement/methods , Isoproterenol/radiation effects , Mitral Valve/surgeryABSTRACT
Background: Right ventricular (RV) dysfunction is a well-known predictor of mortality in patients with valvular heart disease (VHD). The assessment of RV function is often difficult due to complex geometry and hemodynamic factors. Objective: We aim to analyze RV function in patients with severe mitral and/or aortic valve disease using two-dimensional strain (2DS) imaging and conventional echocardiographic parameters, comparing it with right ventricular ejection fraction (RVEF) measured by three-dimensional echocardiography (3DE). Methods: Fifty-three patients with severe mitral and/or aortic VHD underwent complete transthoracic echocardiogram in the preoperative setting for cardiac surgery, including conventional echocardiographic parameters of RV function and speckle-tracking derived 2DS indices: RV global longitudinal strain (RVGS) and RV free wall longitudinal strain (RVFWS). Conventional echocardiographic and 2DS parameters were compared with real-time 3DE RVEF using Spearman correlation test. For comparison between two groups of patients based on the presence of RV dysfunction (normal RVEF ≥ 44% - A, abnormal RVEF < 44% - B), we used nonparametric Mann-Whitney U test. ROC (receiver operating characteristic) curve analysis was used to assess the clinical utility of all RV function variables in defining RV dysfunction. P values <0,05 were considered statistically significant.Results: We found a significant correlation between all parameters and RVEF (p<0.05), with best results for RV fractional area change (FAC), RVGS, and RVFWS. Dividing the population into two-groups based on RVEF, we found 14 patients with RV dysfunction (27.4%), and significant differences between the groups for all RV function variables. For detection of RV dysfunction defined by 3DE, ROC curve analysis showed the best area under the curve (AUC) for RVGS (0.872), RVFWS (0.851) and FAC (0.932). Conclusions: We observed significant correlation between RVGS, RVFWS and RVEF, with good accuracy in detecting RV dysfunction, comparable to FAC and better than other conventional parameters of RV function assessment. The evaluation of RV myocardial deformation with 2DS may have additional diagnostic and prognostic value in patients with severe left-sided VHD
Subject(s)
Humans , Male , Female , Echocardiography/methods , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/diagnostic imaging , Heart Valve Diseases/etiology , Aortic Valve , Atrial Fibrillation , Stroke Volume , Diagnostic Imaging/methods , Data Interpretation, Statistical , Risk Factors , Analysis of Variance , Echocardiography, Three-Dimensional/methods , Mitral ValveABSTRACT
Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement/methods , Severity of Illness Index , Brazil , Heart Valve Prosthesis/adverse effects , Echocardiography , Prospective Studies , Risk Factors , Treatment Outcome , Transcatheter Aortic Valve Replacement/adverse effectsABSTRACT
O acometimento cardíaco, nos portadores de síndrome do anticorpo antifosfoslipídio (SAAF) é relativamente comum, e pode ser detectado pela ecocardiografia transtorácica em mais de um terço dos pacientes. Frequentemente, manisfesta-se como espessamento valvular e pequenas vegetações (endocardite trombótica não bacteriana ou de Libman-Sacks), sendo rara a ocorrência de trombose intracardíca. Relata-se o caso de paciente feminima, 48 anos, com diagnóstico prévio de SAAF primária, que foi admitida na emergência de um hospital terciário com hemiparesia esquerda e redução do nível de consciência, evoluíndo rapidamente com AVC isquêmico extenso e instabilidade hemodinâmica, sendo identificada, ao ecocardiograma transtorácico, volumosa massa móvel e pedunculada aderida à mitral (>4cm), sugerindo provável etiologia cardioembólica. A paciente apresentou evolução clínica surpreendentemente favorável, com resolução completa da massa, após tratamento empírico com heparinização plena e imunoglobulina intravenosa. Recebeu alta do hospital 30 dias após a admissão, com sequelas neurológicas mínimas, sendo mantido o tratamento com cumarínico oral e AAS em dose profilática.
Subject(s)
Humans , Female , Middle Aged , Intracranial Embolism and Thrombosis , Stroke , Antiphospholipid Syndrome/diagnosis , Echocardiography/methods , EchocardiographyABSTRACT
A análise da função sistólica do ventrículo direito (VD) sempre foi um grande desafio para a ecocardiografia. A acurácia dos parâmetros quantitativos atualmente utilizados (deslocamento longitudinal e Doppler tecidual do anel tricuspídeo lateral) é influenciada por limitações técnicas e alterações de pré e póscarga do VD, fazendo com que a análise qualitativa ao bidimensional (subjetiva) tenha papel de destaque na prática clínica diária. Com o advento de técnicas quantitativas de avaliação da deformação tecidual (strain), em especial através da imagem ecocardiografica bidimensional (técnica de speckle tracking), cria-se uma nova vertente de aplicações para o estudo da função sistólica ventrícular, em particular da função sistólica do VD. Objetivo: Demonstrar a reprodutibilidade, acurácia e aplicabilidade do strain. Métodos: Estudo transversal, observacional, tendo sido encluídos 72 pacientes. Em todos, foi realizado ecocardiograma completo...
Subject(s)
Humans , Echocardiography, Doppler, Color/methods , Echocardiography, Doppler, Color , Echocardiography/methods , EchocardiographyABSTRACT
Avaliar a reproditibilidade do strain 2D (St2D) longitudinal (long) do VE, na prática diária. Método: Estudo prospectivo, transversal com 60 pacientes consecutivos, utilizando-se ecocardiógrafo Vivid7 GE, com software, para análise automática da função por imagem (AFI) do St2D. As projeções apical 3 câmaras, 4 câmaras e 2 câmaras foram digitalizadas para análise da variabilidade intra (VIaO) e interobservador (VIeO).A qualidade de imagem (QI) foi definida como muito boa (MB) ou boa (B), quando se visualizava bem todas as paredes; regular (R), quando não se visualizava 1 segmento de uma parede; fraca (F), quando não se visualizava 2 ou mais segmentos de uma ou mais paredes. Considerou-se também a necessidade (NEs) ou não de se editar (NEn) a marcação automática obtida. Analisou-se a VIeO e VIaO do St2D global (gl) e...