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1.
Arch. cardiol. Méx ; 91(2): 229-234, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1248790

ABSTRACT

Resumen Hoy una de las principales causas de mortalidad es el cáncer. La supervivencia en pacientes con cáncer ha incrementado de 1970 (25%) a la actualidad (80%). A raíz de la introducción de las antraciclinas como tratamiento de cáncer desde 1960-1970, más del 60% de los pacientes son tratados con estos agentes; sin embargo, la exposición de quimioterápicos conlleva las enfermedades cardiovasculares como la principal causa de mortalidad en enfermos supervivientes de cáncer en el s. XXI. Hay múltiples factores que incrementan la sensibilidad de cardiotoxicidad inducida por antracíclicos. En 1970 el estándar de oro para la detección de disfunción ventricular era la biopsia endomiocárdica, en forma posterior la detección y manejo de la cardiotoxicidad fue guiada por los síntomas, en 1981 la detección de cardiotoxicidad fue reportada con la determinación de la fracción de expulsión del ventrículo izquierdo (FEVI) por ecocardiografía 2D. En la actualidad el ecocardiograma 3D para FEVI y volúmenes sistólico y diastólico han presentado una alta correlación de los valores obtenidos por resonancia magnética para la evaluación de la función cardiaca. Hoy en día la ecocardiografía strain, strain-rate y speckle tracking se utilizan para determinar la función miocárdica regional y global. Para una valoración integral estos resultados se pueden complementar con biomarcadores cardiacos (troponinas y propéptido natriurético tipo B) y cambios electrocardiográficos. De esta forma se puede detectar insuficiencia cardiaca subclínica y dar un tratamiento oportuno.


Abstract Today one of the main causes of mortality is cancer. Survival in cancer patients has increased from 1970 (25%) to the present (80%). Following the introduction of anthracyclines as a cancer treatment since 1960-70, more than 60% of patients are treated with these agents, although chemotherapeutic exposure leads to cardiovascular diseases as the main cause of mortality in surviving patients. of cancer in the 21st Century. There are multiple factors that increase the sensitivity of anthracyclic-induced cardiotoxicity. In 1970 the gold standard for the detection of ventricular dysfunction was endomyocardial biopsy, subsequently the detection and management of cardiotoxicity was guided by symptoms, in 1981 the detection of cardiotoxicity was reported with the determination of the ejection fraction of the left ventricle (LVEF), by 2D echocardiography. Currently, the 3D echocardiogram for LVEF and systolic and diastolic volumes have presented a high correlation of the values obtained by magnetic resonance imaging for the evaluation of cardiac function. Today strain, strain-rate and speckle tracking echocardiography are used to determine regional and global myocardial function. For a comprehensive assessment, these results can be complemented with cardiac biomarkers (troponins) and electrocardiographic changes. In this way, subclinical heart failure can be detected and timely treatment can be given.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Echocardiography/methods , Echocardiography, Three-Dimensional/methods , Cardiotoxicity/diagnostic imaging , Heart Failure/diagnosis , Neoplasms/drug therapy , Antineoplastic Agents/toxicity , Heart Failure/etiology , Antineoplastic Agents/therapeutic use
3.
ABC., imagem cardiovasc ; 33(4): eabc98, 20200000.
Article in Portuguese | LILACS | ID: biblio-1146297

ABSTRACT

Fundamento: A fração de ejeção do ventrículo esquerdo é um dos parâmetros ecocardiográficos mais utilizados na prática clínica. Sua estimativa pelo método bidimensional manual (método de Simpson) tem reprodutibilidade e acurácia limitadas, e métodos semiautomáticos têm sido propostos. Torna-se necessário comparar o método bidimensional semiautomático com métodos mais acurados de avaliação da fração de ejeção do ventrículo esquerdo, como a medida pela ecocardiografia tridimensional automática. Objetivo: Comparar as estimativas da fração de ejeção do ventrículo esquerdo e dos volumes diastólico final e sistólico final do ventrículo esquerdo pelo método bidimensional semiautomático com as obtidas pelo método tridimensional automático. Método: Estudo observacional transversal, com pacientes em ritmo sinusal, fração de ejeção do ventrículo esquerdo >50% e sem cardiopatia estrutural significativa, submetidos ao ecocardiograma transtorácico. Teste t de Student, coeficiente de Pearson e análise de Bland-Altman foram usados na análise estatística. Resultados: Foram incluídos 40 pacientes, sendo: 53% mulheres, 35% hipertensos, 25% dislipidêmicos, 10% diabéticos, 10% tabagistas e 13% com angioplastia prévia. Os valores médios da fração de ejeção do ventrículo esquerdo aos métodos tri e bidimensionais foram 62,1 ± 5,8% e 61,7 ± 5,9% (p = 0,50), respectivamente. Houve forte correlação da fração de ejeção do ventrículo esquerdo determinada melos métodos bi e tridimensional (r = 0,74; p<0,001), assim como com o volume diastólico final (r = 0,75; p<0,001) e o sistólico final (r = 0,76; p<0,001). Houve boa concordância entre a fração de ejeção do ventrículo esquerdo bi e tridimensional (diferença média: -0,39; intervalo de confiança 95% -1,7-0,9). Conclusão: A fração de ejeção do ventrículo esquerdo estimada pelo método bidimensional semiautomático mostrou boa concordância com o método tridimensional automático. Os achados sugerem que o método bidimensional semiautomático represente uma alternativa confiável para avaliação dos volumes e fração de ejeção do ventrículo esquerdo.


Background: Left ventricular ejection fraction is one of the most used echocardiographic parameters in clinical practice. Its estimation by twodimensional manual method (Simpson method) has limited reproducibility and accuracy, and semi-automatic methods have been proposed. It becomes necessary to compare the semiautomatic two-dimensional method with more accurate methods of assessing left ventricular ejection fraction, such as measurement by automatic three-dimensional echocardiography. Objective: To compare the left ventricular ejection fraction, and left ventricular end-diastolic and end-systolic volumes estimates by the semiautomatic two-dimensional method with those obtained using the automatic three-dimensional method. Method: Observational cross-sectional study, including patients in sinus rhythm, left ventricular ejection fraction > 50% and without significant structural heart disease, submitted to transthoracic echocardiography. Student's t test, Pearson's coefficient and Bland-Altman analysis wer


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Software Design , Ventricular Function, Left/physiology , Stroke Volume , Practice Patterns, Physicians' , Echocardiography/methods , Cross-Sectional Studies/methods , Treatment Outcome , Echocardiography, Three-Dimensional/methods
5.
Arq. bras. cardiol ; 113(5): 935-945, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055037

ABSTRACT

Abstract Background: New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease. Objective: To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age. Methods: Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant. Results: Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m2) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m2) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.70 /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age. Conclusion: Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.


Resumo Fundamentos: Novas técnicas ecocardiográficas são utilizadas no diagnóstico e prognóstico de diversas cardiopatias. No entanto, muitos desses novos índices ainda carecem de valores de referência em diferentes populações. Estudamos esses novos parâmetros ecocardiográficos em um grupo de brasileiros sem doença cardiovascular conhecida. Objetivo: Estudar valores dos novos índices ecocardiográficos em brasileiros sem doença cardiovascular conhecida e sua correlação com a idade. Métodos: Estudo transversal composto por indivíduos saudáveis que realizaram ecocardiograma tridimensional (E3D) e ecocardiograma bidimensional com análise de deformação (e) por speckle tracking (EST). Foram analisadas as funções atrial esquerda (AE) e ventricular esquerda (VE) por E3D e EST, e a função ventricular direita (VD) por EST. Valores de p < 0,05 foram considerados significantes. Resultados: Foram incluídos setenta e sete indivíduos (46,7% homens; 40,4 ± 10,4 anos). Os volumes AE máximo, mínimo e pré-contração atrial (pré-A) (ml/m2) foram 21,2 ± 5,5, 7,8 ± 2,5 e 11,0 ± 3,1, respectivamente. O pico da e global positiva do AE (LAScd), pico da e global negativa do AE e e global total do AE (LASr) foram 17,4±5,2%, -13,2 ± 2,0% e 30,5 ± 5,9%, respectivamente. Os volumes diastólico final e sistólico final do VE (ml/m2) mediram 57 ± 12 e 24 ± 6 e a fração de ejeção tridimensional do VE mediu 58 ± 6%. A e longitudinal, circunferencial e radial global do VE foi de -19 ± 2%, -19 ± 3% e 46 ± 12%, respectivamente. A torção do VE mediu 1,6 ± 0,7(0)/cm. A e longitudinal global do VD (SLG-VD) e a deformação da parede livre do VD foram de -22 ± 3% e -24 ± 5%. Os volumes mínimo e pré-A do AE, rotação apical do VE, torção e SLG-VD aumentaram com a idade, enquanto as frações de esvaziamento total e passivo do LA, LAScd, LASr, volumes diastólico final e sistólico final do VE diminuíram com a idade. Conclusão: Apresentam-se os valores para os novos índices ecocardiográficos em brasileiros sem doença cardiovascular conhecida e sua correlação com a idade.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Echocardiography/standards , Atrial Function, Left , Ventricular Function, Left , Ventricular Function, Right , Echocardiography, Three-Dimensional/standards , Reference Values , Brazil , Echocardiography/methods , Sex Factors , Cross-Sectional Studies , Prospective Studies , Age Factors , Echocardiography, Three-Dimensional/methods , Healthy Volunteers
8.
Int. j. cardiovasc. sci. (Impr.) ; 31(6): 630-642, nov.- dez. 2018. ilus, tab, graf
Article in English | LILACS | ID: biblio-979931

ABSTRACT

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 , Statistical Analysis , Risk Factors , Analysis of Variance , Echocardiography, Three-Dimensional/methods , Mitral Valve
9.
Arq. bras. cardiol ; 111(3): 384-391, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973761

ABSTRACT

Abstract Background: Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis. Objectives: To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE). Methods: A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant. Results: Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients. Conclusion: Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA.


Resumo Fundamento: A amiloidose cardíaca (AC) de cadeias leves (AL) é caracterizada por depósitos fibrilares, que são compostos por cadeias leves de imunoglobulina monoclonal. O ventrículo direito é mais afetado pela AC-AL, e o comprometimento da sua função é preditor de um prognóstico pior. Objetivos: Caracterizar as propriedades volumétricas e funcionais do átrio direito (AD) na AC-AL por ecocardiografia tridimensional de speckle-tracking (3DSTE). Métodos: Um total de 16 pacientes (idade média: 64,5 ± 10,1 anos, 11 homens) com AC-AL foram examinados. Seus resultados foram comparados aos de 15 controles saudáveis pareados por idade e gênero (média de idade: 58,9 ± 6,9 anos, 8 homens). Todos os casos foram submetidos a Doppler bidimensional completo e 3DSTE. Um valor p bicaudal inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Diferenças significativas foram demonstradas em volumes do AD com respeito ao ciclo cardíaco. O total (19,2 ± 9,3% vs. 27,9 ± 10,7%, p = 0,02) e as frações ativas de esvaziamento atrial (12,1 ± 8,1 vs. 18,6 ± 9,8%, p = 0,05) foram significativamente menores nos pacientes com AC-AL. Picos de strain no AD em áreas globais (16,7 ± 10,3% vs. 31,2 ± 19,4%, p = 0,01) e segmentares médias (24,3 ± 11,1% vs. 38,6 ± 17,6%, p = 0,01), juntamente com alguns parâmetros de strain por áreas circunferenciais, longitudinais e segmentares, mostraram-se menores em pacientes com AC-AL. Strains globais longitudinais (4,0 ± 5,2% vs. 8,2 ± 5,5%, p = 0,02) e por área (7,8 ± 8,1 vs. 15,9 ± 10,3%, p = 0,03) na contração atrial e alguns parâmetros de circunferência e de strain por área na contração atrial foram menores em pacientes com AC-AL. Conclusão: Foi possível demonstrar o aumento significativo dos volumes do AD e a deterioração de suas funções na AC-AL.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Echocardiography, Three-Dimensional/methods , Heart Atria/pathology , Heart Atria/diagnostic imaging , Heart Diseases/diagnostic imaging , Amyloidosis/pathology , Amyloidosis/diagnostic imaging , Prognosis , Reference Values , Echocardiography, Doppler/methods , Case-Control Studies , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Heart Atria/physiopathology , Heart Diseases/physiopathology , Heart Diseases/pathology , Amyloidosis/physiopathology
10.
Arch. cardiol. Méx ; 88(5): 347-353, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1142141

ABSTRACT

Resumen Introducción y objetivos: La fibrilación auricular puede producir remodelado de la aurícula izquierda e inducir insuficiencia mitral funcional. El objetivo de este estudio es establecer qué características del anillo mitral están relacionadas con la regurgitación mitral funcional auricular. Método: Restrospectivamente se reclutaron 29 pacientes en fibrilación auricular persistente y 36 en ritmo sinusal. Las características del anillo mitral mediante ecocardiografía transesofágica tridimensional fueron analizadas en ambos grupos. Los parámetros ecocardiográficos 2D y 3D fueron correlacionados con el orificio regurgitante efectivo. Resultados: Los pacientes con fibrilación auricular presentaron mayor volumen de aurícula izquierda, diámetro anteroposterior al final de la diástole y disminución de su porcentaje de cambio (p: 0.015, 0.019 y < 0.001 respectivamente). En el análisis de regresión multivariante el índice de elipticidad (ˇ: −0.756, p: 0.004) y el ratio altura/diámetro anterolateral posteromedial (ˇ: −0.704, p: 0.003) fueron parámetros independientes correlacionados con el orificio regurgitante efectivo (R2: 0.699, p: 0.019) en pacientes con fibrilación auricular. Conclusiones: La fibrilación auricular produce cambios en el tamaño y dinámica del diámetro anteroposterior, lo que provoca un anillo mitral circular. Los mayores determinantes de la insuficiencia mitral funcional auricular en el grupo de fibrilación auricular resultaron el índice de elipticidad y el ratio altura/diámetro anterolateral-posteromedial.


Abstract Introduction and objectives: Atrial fibrillation can lead to left atrium remodelling and induce functional mitral regurgitation. The aim of this study is to establish those features of the mitral annulus that are related to atrial functional mitral regurgitation. Methods: A total of 29 patients with persistent atrial fibrillation and 36 controls in sinus rhythm were retrospectively enrolled. The characteristics of the mitral annulus were analysed by three-dimensional transoesophageal echocardiography in both groups. The 2D and 3D echocardiographic parameters were correlated with the effective regurgitant orifice. Results: Patients with atrial fibrillation had a larger left atrium volume, anteroposterior diameter at end-diastole, and lower percentage of change in this diameter (P = .015, P = .019 and P < .001, respectively). In the multiple regression analysis, the ellipticity index (ˇ: −0.756, P = .004) and height-anterolateral-posteromedial diameter ratio (ˇ: −0704, P = .003) were independent parameters that correlated with the effective regurgitant orifice (R2: 0.699, P = .019) in patients with atrial fibrillation. Conclusions: Atrial fibrillation leads to atrial dilation and alterations in the size and dynamics of the anteroposterior diameter, producing a circular mitral annulus. The independent determining factors of atrial functional mitral regurgitation in the atrial fibrillation group were the ellipticity index and the height-anterolateral-posteromedial diameter ratio.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/complications , Echocardiography, Transesophageal/methods , Echocardiography, Three-Dimensional/methods , Mitral Valve Insufficiency/diagnostic imaging , Regression Analysis , Retrospective Studies , Mitral Valve Insufficiency/etiology
11.
Rev. chil. cardiol ; 36(3): 232-238, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899590

ABSTRACT

Resumen: El diagnóstico ecocardiográfico (eco) de la endocarditis infecciosa ha tenido una evolución vertiginosa, destacando el desarrollo de la ecocardiografía transesofágica (ETE), la imagen armónica y la ecocardiografía tridimensional (Eco 3D), tecnologías que han incrementado su capacidad diagnóstica. Presentamos una serie de endocarditis donde el Eco 3D tuvo un rol importante. CASO 1: Hombre de 18 años, antecedente remoto de artritis séptica y deterioro de capacidad funcional asociado a soplo de insuficiencia mitral. La ecocardiografía transtorácica (ETT) objetivó leve dilatación ventricular izquierda e insuficiencia mitral severa, el Eco 3D identificó una perforación circular en el velo anterior mitral, logrando la reparación valvular con un parche de pericardio. CASO 2. Hombre de 29 años, con absceso dental reciente, se presenta en shock séptico, el ETT y ETE mostraron una válvula aórtica bicúspide (VAB) con insuficiencia severa y un absceso del velo anterior mitral. El Eco 3D identificó una perforación del velo no rafial, se realizó un doble recambio valvular. CASO 3: Hombre de 61 años, con antecedente previo de endocarditis y VAB. Consulta por estado infeccioso. El ETT y ETE informaron insuficiencia aórtica moderada asociado a insuficiencia mitral severa, el eco 3D identificó prolapso del segmento P3 de la válvula mitral, ayudando a programar su reparación. CASO 4. Mujer de 78 años, con diagnóstico de endocarditis mitral protésica, el Eco 3D objetivó un absceso periprotésico posterior de 16 mm, siendo referida a cirugía. El Eco 3D aporta información complementaria en diversos escenarios de la endocarditis, tales como: perforaciones valvulares, compromiso perianular, endocarditis protésica, optimizando su manejo.


Abstracts: The echocardiographic diagnosis of infective endocarditis has evolved in a vertiginous manner. Among its main hallmarks are; the development of transesophageal echocardiography (TEE), harmonics imaging and three-dimensional echocardiography (3D Echo), thereby enhancing its diagnosis capability. The following endocarditis cases revealed the usefulness of 3D Echo. CASE 1. 18 year-old male, past history of septic arthritis, refers decline in functional capacity associated with a mitral regurgitation murmur. Transthoracic echocardiography (TTE) pictured a mildly dilated left ventricle and severe mitral regurgitation. 3D Echo identified a circular perforation of the anterior mitral leaflet; successful mitral valve repair was accomplished. CASE 2. 29 year-old male, with recent dental abscess, presents in septic shock. TTE and TEE portrayed a bicuspid aortic valve (BAV) with severe regurgitation along with an abscess of the anterior mitral valve leaflet. 3D Echo showed a perforation of the nonfused aortic leaflet; double valve replacement was uneventfully performed. CASE 3. 61 year-old male, with remote history of endocarditis and BAV, evaluated with TTE and TEE due to sepsis, depicting moderate aortic regurgitation and P3 prolapse with rupture chordae and severe mitral regurgitation. Based on the 3D Echo data the mitral valve was repaired and the aortic valve replaced. CASE 4. 78 year-old woman with prosthetic mitral valve endocarditis, 3D Echo allowed complete visualization of a 16 mm diameter posterior abscess, being referred to surgery. Thus, 3D Echo has added value in several endocarditis scenarios such as; leaflet perforations, periannular involvement, prosthetic valve endocarditis, improving its management.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Echocardiography, Three-Dimensional/methods , Endocarditis/diagnostic imaging , Endocarditis/surgery
13.
ABC., imagem cardiovasc ; 30(3): f:92-l:97, jul.-set. 2017. tab, ilus
Article in Portuguese | LILACS | ID: biblio-848728

ABSTRACT

Introdução: A ecocardiografia é fundamental na distinção entre adaptações fisiológicas promovidas pela atividade física e alterações patológicas. O ecocardiograma tridimensional com speckle tracking (3DSTeco) poderia mostrar-se acurado para a detecção de alterações subclínicas da função cardíaca. Objetivos: Determinar o efeito do exercício nos parâmetros da deformação miocárdica em atletas, por meio do 3DSTeco. Método: Realizado ecocardiograma convencional, ecocardiograma tridimensional (3Deco) e 3DSTeco em boxeadores de elite, para análise dos volumes do ventrículo esquerdo (VE), índice de massa indexada à superfície corpórea (IMISC), fração de ejeção (FE), strain global longitudinal (GLS), strain global circunferencial (GCS), strain global radial (GRS), twist, torção e área tracking. Estes dados foram comparados com medidas efetuadas em indivíduos controle não treinados. Resultados: Analisados 16 atletas e 14 controles, com idade (23 ± 4 vs 21 ± 4 anos; p = NS) e sexo (14 vs 12 homens) similares. A FE do VE foi normal e semelhante nos 2 grupos. O IMISC foi maior nos atletas (83 ± 21 vs 65 ± 15 g/m²; p < 0,05), assim como o GRS (24,7 ± 5.2 vs 16.3 ± 7.2; p = 0.007). Não houve diferença significativa para os demais parâmetros como GCS (-26 ± 2 vs -28 ± 6), GLS (-16 ± 2 vs -17 ± 3), twist (3.1 ± 1.3 vs 3.7 ± 1.9), torção (2.0 ± 0.8 vs 1.4 ± 0.4) e área tracking (37 ± 4 vs 41 ± 6). Conclusão: Atletas e indivíduos não treinados apresentam parâmetros de deformação miocárdica comparáveis pelo 3DSTeco, contudo, um incremento do GRS foi observado apenas nos atletas. O 3DSTeco poderia auxiliar na detecção precoce de alterações cardíacas subclínicas em atletas


Introduction: Echocardiography is fundamental in the distinction between physiological adaptations promoted by physical activity and pathological abnormalities. Three-dimensional speckle tracking echocardiography (3D-STE) could prove accurate in detecting subclinical abnormalities in cardiac function. Objectives: To determine the effect of exercise on the parameters of myocardial strain in athletes through 3D STE. Method: Elite boxers underwent conventional three-dimensional echocardiography (3D-echo) and 3D-STE to analyze left ventricular (LV) volumes, left ventricular mass indexed to body surface area (LVMIBSA), ejection fraction (EF), longitudinal global strain (LGS), circumferential global strain (CGS), radial global strain (RGS), twist, torsion and tracking area. These data were compared with measurements performed on untrained control individuals. Results: The analyses included 16 athletes and 14 controls with similar age (23 ± 4 vs. 21 ± 4 years; p = NS) and gender (14 vs. 12 males). LVEF was normal and similar in the 2 groups. LVMIBSA was higher in the athletes (83 ± 21 vs. 65 ± 15 g/m², p < 0.05), as well as RGS (24.7 ± 5.2 vs. 16.3 ± 7.2; p = 0.007). There was no significant difference for the other parameters, such as CGS (-26 ± 2 vs. -28 ± 6), LGS (-16 ± 2 vs. -17 ± 3), twist (3.1 ± 1.3 vs. 3.7 ± 1.9), torsion (2.0 ± 0.8 vs. 1.4 ± 0.4) and tracking area (37 ± 4 vs. 41 ± 6). Conclusion: Athletes and untrained individuals have comparable myocardial strain parameters on 3D-STE. However, an increase in RGS was observed only in the athletes. 3D-STE could help in the early detection of subclinical cardiac issues in athletes


Subject(s)
Humans , Male , Female , Adult , Athletes , Echocardiography, Three-Dimensional/methods , Heart/diagnostic imaging , Reference Parameters/analysis , Cardiomyopathies/diagnosis , Cardiovascular Diseases/diagnosis , Cross-Sectional Studies , Diagnostic Imaging/methods , Echocardiography/methods , Exercise , Risk Factors , Statistical Analysis , Ventricular Function, Left
16.
Arq. bras. cardiol ; 108(2): 129-134, Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-838688

ABSTRACT

Abstract Background: Three-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF). Objectives: To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods: The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men). Results: Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions: Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.


Resumo Fundamento: Ecocardiografia tridimensional (3D) acoplada à técnica de speckle-tracking (3DSTE) é uma nova metodologia útil para a avaliação de volumes e propriedades funcionais do átrio esquerdo (AE). Há crescente interesse científico na análise da deformação miocárdica em adultos com tetralogia de Fallot corrigida (cTOF). Objetivos: Comparar os volumes de AE, propriedades funcionais baseadas no volume e parâmetros de strain entre pacientes com cTOF e controles saudáveis pareados por idade e sexo. Métodos: A população do estudo consistiu em 19 adultos com cTOF consecutivos, em ritmo sinusal, acompanhados na Universidade Szeged, Hungria (idade média: 37,9 ± 11,3 anos; 8 homens; com correção cirúrgica aos 4,1 ± 2,5 anos de idade). Todos foram submetidos a ecocardiografia transtorácica bidimensional com Doppler padrão e 3DSTE. Os resultados foram comparados aos de 23 controles saudáveis pareados por idade e sexo (idade média: 39,2 ± 10,6 anos; 14 homens). Resultados: Aumento dos volumes de AE e redução das frações de esvaziamento de AE em relação ao ciclo cardíaco foram demonstrados em pacientes com cTOF em comparação aos dos controles. Os volumes de ejeção de AE caracterizando todas as funções do AE não diferiram entre os dois grupos. Strains de AE global e segmentar médio uni- e multidimensional, caracterizando função de reservatório de AE, estavam diminuídos em adultos com cTOF em comparação aos de controles. À semelhança dos strains de pico, reduzidos strains de AE global e segmentar médio na contração atrial, caracterizando função de bomba atrial, foram demonstrados em pacientes com cTOF em comparação aos de controles. Conclusões: Demonstrou-se significativa deterioração das funções de AE em adultos com cTOF em fase tardia após correção.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tetralogy of Fallot/surgery , Tetralogy of Fallot/pathology , Echocardiography, Three-Dimensional/methods , Myocardium/pathology , Organ Size , Reference Values , Stroke Volume , Tetralogy of Fallot/physiopathology , Tetralogy of Fallot/diagnostic imaging , Echocardiography, Doppler/methods , Case-Control Studies , Risk Factors , Atrial Function , Heart/physiopathology , Heart Atria/pathology , Heart Atria/diagnostic imaging , Myocardial Contraction/physiology
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): 54-62, jan.-mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-836988

ABSTRACT

A Cardiologia vem enfrentando uma série de mudanças na abordagem das cardiopatias estruturais na última década. Com o avanço do tratamento por meio da Cardiologia Intervencionista, novos paradigmas têm sido estabelecidos, sobretudo com criação de comitês médicos para ampla discussão dos casos ­ os Times de Cardiologia ou "Heart Teams". Pacientes muito idosos, frágeis e com comorbidades que tornam a cirurgia convencional proibitiva ou de risco muito alto, passaram a ter novas opções além da otimização do tratamento clínico. A ecocardiografia, outrora focada no diagnóstico, tem cada vez mais participado e mesmo atuado de forma ativa nos procedimentos intervencionistas, o que fez surgir uma nova subespecialidade ­ a Ecocardiografia Intervencionista. Importante desde o momento do diagnóstico e do planejamento da intervenção, a ecocardiografia tem papel de destaque durante o procedimento, possibilitando a visualização dos cateteres e dispositivos de forma simultânea às imagens angiográficas, comprovação imediata do resultado e identificação de eventual complicação. Seu uso é praticamente imperativo em situações de implante de endoprótese valvar aórtica, fechamento de comunicação interatrial ou forame oval e oclusão de apêndice atrial esquerdo. Com a evolução tecnológica dos equipamentos e advento da tecnologia tridimensional, tem sido possível visualizar as estruturas cardíacas de forma antes impossível e muito semelhante à visão do cirurgião cardíaco e, com isso, guiar fechamento de "leaks" periprotéticos e reparos na valva mitral


In the last decade, cardiologists have faced a series of changes in the approach to structural cardiopathies. With the advances in treatment through Interventional Cardiology, new paradigms have been established, such as the creation of medical committees for wider discussion of cases, known as "Heart Teams". Very elderly or frail patients, or those with comorbidities that make conventional surgery prohibitive or high risk, now have new alternatives, as well as optimized clinical treatment. Echocardiography, which was previously focused on diagnosis, now plays a major, and even active role in interventional procedures. This has led to the emergence of a new subspecialty ­ Interventional Echocardiography. From the moment of diagnosis and planning of the intervention, echocardiography plays an important role during the procedure, enabling simultaneous visualization of catheters and devices, and angiographic images, immediate identification of the result, and the detection of any complications. Its use is practically mandatory in aortic valve endoprosthesis implantation, interatrial septal defect or foramen ovale closure, and left atrial appendage occlusion procedures. With the technological evolution of the equipment and the advent of three-dimensional technology, it has become possible to visualize the heart structures in a way that was previously impossible, giving a view that is very similar to that of the heart surgeon, guiding periprosthetic leaks and mitral valve repairs


Subject(s)
Humans , Male , Female , Diagnostic Imaging/methods , Echocardiography/methods , Echocardiography, Three-Dimensional/methods , Heart Defects, Congenital/epidemiology , Aortic Valve/surgery , Prostheses and Implants , Bioprosthesis , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methods , Stents , Morbidity , Catheters , Heart Atria , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/physiopathology
19.
Rev. bras. cir. cardiovasc ; 30(3): 325-334, July-Sept. 2015. tab, ilus
Article in English | LILACS | ID: lil-756526

ABSTRACT

AbstractIntroduction:Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.Objective:To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.Methods:Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.Results:There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.Conclusion:Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study.


ResumoIntrodução:A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém, a literatura é escassa em relação ao comportamento do anel mitral após a plástica mitral sem utilização de anéis protéticos.Objetivo:Realizar a análise morfofuncional do anel mitral de indivíduos submetidos à plastia valvar mitral pela Técnica de Duplo Teflon, sem utilização de anel protético, por meio da ecocardiografia tridimensional em tempo real.Métodos:Foram incluídos 14 pacientes com insuficiência mitral mixomatosa submetidos à plástica mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato, 6 meses e 1 ano. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante P<0,05.Resultados:Não houve óbito, reoperação por disfunção valvar, tromboembolismo ou endocardite durante o estudo. A planimetria posterior do anel mitral demostrou uma redução significativa (P<0,001) no pós-operatório imediato, que se manteve estável durante o estudo, apresentando redução média de 25,8% com 1 ano em relação ao pré-operatório. Houve uma redução significativa dos diâmetros ântero-posterior e médio-lateral no pós-operatório imediato (P<0,001), porém, houve um aumento significativo no diâmetro médio-lateral entre pós-operatório imediato e 1 ano. Não houve diferença na variação da área interna mitral ao longo do estudo.Conclusão:A anuloplastia segmentar reduziu significativamente o componente posterior do anel mitral, permanecendo estável no período de um ano. A variação da área valvar durante o ciclo cardíaco permaneceu estável durante o estudo.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Echocardiography, Three-Dimensional/methods , Mitral Valve Annuloplasty/methods , Mitral Valve Insufficiency/surgery , Mitral Valve , Analysis of Variance , Atrial Fibrillation/physiopathology , Heart Valve Prosthesis Implantation/methods , Medical Illustration , Mitral Valve/pathology , Organ Size , Perioperative Period , Reference Values , Time Factors , Treatment Outcome
20.
Rev. chil. cardiol ; 34(1): 28-35, abr. 2015. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-749425

ABSTRACT

Introducción: Para el reemplazo de válvula aórtica con catéteres (TAVR) es fundamental la adecuada medición del anillo aórtico para elegir el tamaño adecuado de la prótesis y evitar complicaciones graves como la ruptura del anillo aórtico y la insuficiencia paravalvular (IAP). La tomografía computada cardíaca (TC) es el estándar de oro en la medición del anillo aórtico, pero la ecocardiografía transesofágica 3D (ETE3D) parece ser una alternativa atractiva. Objetivo: Evaluar la correlación entre las mediciones del anillo aórtico obtenidas por ETE3D y las encontradas en la TC. Los resultados obtenidos se evaluaron en términos de la prótesis elegida y la presencia de insuficiencia aórtica post TAVR. Métodos: Se realizaron de manera retrospectiva y ciega, las mediciones del anillo aórtico por TC y ETE3D en 18 pacientes consecutivos, edad promedio 82 ± 7,06 años, sometidos a TAVR usando prótesis Sapien XT (Edwards Lifescience). Se comparó el diámetro máximo, diámetro mínimo, diámetro medio, área y perímetro del anillo. Resultados: La ETE3D subvaloró el tamaño del anillo aórtico, pero demostró tener una buena correlación con los diferentes parámetros de la TC, con mejor comportamiento para el perímetro del anillo. ETE3D y TC coincidieron en la elección de la prótesis en 17 pacientes y no hubo IAP de relevancia. Conclusión: La ETE3D tiene buena correlación comparada contra la TC en la valoración del anillo aórtico. La ETE3D parece una atractiva alternativa a la TC para medición del anillo especialmente en casos complejos o cuando la disponibilidad y acceso a la TC puede estar limitada.


In TAVR, the precise measuring of the aortic annulus is essential to determine the size of the prosthesis and to avoid complications like rupture of the annulus of aortic insufficiency. Computed tomography (CT) is the gold standard to achieve these goals. 3-D trans-esophageal echocardiography (3-D TEE) to be a useful alternative method. Aim: to evaluate the correlation of aortic annulus measurements obtained with 3-dTE and CT in the determination of annulus measurements before TAVR. Prosthesis size and presence of aortic insufficiency were related to these measurements. Methods: In a retrospective blinded protocol the measurements of the aortic annulus obtained with CT or 3D-TEE were correlated in 18 consecutive patients (mean age 82 ± 7.1) submitted to TAVR with a Sapien XT (Edwards Lifescience) prosthesis. Maximal, minimal and mean diameters as well as area and annular circumference were evaluated. Results: Compared to CT, 3D-TEE under estimated de size of the aortic annulus but correlated well with other measurements of CT, especially with the annular circumference. Measurements from both methods agreed in the determination of the prosthesis size in 17 of 18 patients. No significant per prosthetic aortic insufficiency was observed in any case. Conclusion: 3DTEE correlates well with CT in evaluating the different parameters of the aortic annulus and is a good alternative to CT in complex cases and when CT is not readily available.


Subject(s)
Humans , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/diagnostic imaging , Echocardiography, Transesophageal/methods , Echocardiography, Three-Dimensional/methods , Multidetector Computed Tomography/methods , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/therapy , Prosthesis Design , Preoperative Care , Retrospective Studies
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