Factores clínico-ecocardiográficos de terapéutica fallida en síndrome coronario agudo y fibrilación auricular paroxística

Introducción: la fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano. Su manejo requiere un abordaje holístico para que los resultados sean óptimos, por lo que se considera la epidemia cardiovascular del siglo XXI. Objetivo: establecer las variables ecocardiográficas asociadas al fracaso de la cardioversión en pacientes con diagnóstico clínico de fibrilación auricular y síndrome coronario agudo. Materiales y métodos: se realizó un estudio retrospectivo, analítico, no experimental de casos y controles en pacientes con fibrilación auricular y síndrome coronario agudo, durante el período comprendido entre los años 2017 y 2021. Resultados: la cardioversión eléctrica se observó en 55 pacientes (68,8 %) (OR = 0,24; IC 95 %: 0,08-0,7; p = 0,008). La terapia trombolítica se aplicó en 47 pacientes (58,8 %) (OR = 5,03; IC 95 %: 1,67-15,12; p = 0,0026). En cuanto a parámetros ecocardiográficos, la variable volumen de la aurícula izquierda ≥ 34 ml/sc predominó en 50 pacientes (62,5 %) (OR = 3,5; IC 95 %: 1,22-10,04; p = 0,016); la presión de la aurícula izquierda > 15 mmHg en 23 pacientes (OR = 3,61; IC 95 %: 1,23-10,54; p = 0,015), y el diámetro del ventrículo izquierdo > 57 mm en 20 pacientes (OR = 4,33; IC 95 %: 1,35-13,87; p = 0,009). Conclusiones: el volumen de la aurícula izquierda elevada, la presión de aurícula izquierda, el diámetro del ventrículo izquierdo, la terapia eléctrica y trombolítica, se asocian al fracaso de la cardioversión en pacientes con fibrilación auricular e infarto agudo de miocardio.

Introduction: atrial fibrillation is the most frequent sustained tachyarrhythmia in humans. Its management requires a holistic approach for the results to be optimal; it is considered the cardiovascular epidemics of the 21st century. Objective: to establish echo-cardiographic variables associated with cardioversion failure in patients with clinical diagnosis of atrial fibrillation and acute coronary syndrome. Materials and methods: a retrospective, analytical, non-experimental study of cases and controls was carried out in patients with atrial fibrillation and acute coronary syndrome, during the period between 2017 and 2021. Results: electrical cardioversion was observed in 55 patients (68.8%) (OR = 0.24; CI 95%: 0.08-0.7; p = 0.008). Thrombolytic therapy was applied in 47 patients (58.8%) (OR = 5.03; CI 95%: 1.67-15.12; p = 0.0026). Regarding echocardiographic parameters, the variable left atrial volume ≥ 34 ml/sc predominated in 50 patients (62.5%) (OR = 3.5; CI 95%: 1.22-10.04; p = 0.016); left atrial pressure > 15 mmHg predominated in 23 patients (OR = 3.61; CI 95%: 1.23-10.54; p = 0.015), and left ventricular diameter > 57 mm in 20 patients (OR = 4.33; CI 95%: 1.35-13.87; p = 0.009). Conclusions: elevated left atrial volume, left atrial pressure, and left ventricular diameter, electric and thrombolytic therapy, are all associated to cardioversion failure in patients with atrial fibrillation and acute myocardial infarction.

Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil / Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes.

An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = - 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.

Volumétrico ecocardiográfico de cuatro dimensiones y Evaluación Funcional de la Aurícula Izquierda en Sujetos masculinos sanos en relación con la edad / Four-Dimensional Echocardiographic Volumetric and Functional Assessment of the Left Atrium in Healthy Male Subjects in Relation to Age

Background: Four-dimensional echocardiography technique results in marked improvements in terms of quality and accuracy in assessing the size and function of heart chambers, especially the left atrium as its geometric variation has a notable impact on the results when using traditional echocardiographic techniques alone. Thus, this study aimed at investigating the probability of significant functional and morphological changes in the left atrium with advancing age using Four-dimension echocardiography. Method: Four-dimensional technique derived left atrial phasic volumes and functions were assessed in (30) healthy subjects with mean age of 73.6 (±3.6) years and (30) young subjects with mean age of 23.17 (±3.5) years. Results: Old age group showed a significant increase in maximum left atrial volume index, minimum left atrial volume index and pre-atrial contraction left atrial volume index compared to young age group (31.52±1.09 vs. 26.44±1.03, P < 0.001), (17.93±0.43 vs. 15.89±0.44, P < 0.00) and (25.73±1.003 vs. 22.34±0.77, P < 0.01), respectively. In the old age group, the passive left atrial emptying function (LAEF) significantly decreased (20.43±0.25% vs. 24.96±0.93%, p<0.00), while the active LAEF significantly increased (37.36±1.33% vs. 32.65±1.13%, P< 0.009) in comparison to the values of the young subjects. Conclusions: These results suggest that left atrial structural as well as functional changes occur with advancing age in absence of evident pathological causes and 4-dimentional echocardiography can be used to evaluate these changes

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods / Avaliação da função atrial esquerda em cães assintomáticos com degeneração mixomatosa crônica de valva mitral: métodos ecocardiográficos bidimensional feature tracking e monoplanar de Simpson

The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods / Avaliação da função atrial esquerda em cães assintomáticos com degeneração mixomatosa crônica de valva mitral: métodos ecocardiográficos bidimensional feature tracking e monoplanar de Simpson

The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods

ABSTRACT: The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpsons monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p 0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpsons monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p 0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpsons monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.

RESUMO: O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p 0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p 0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.

LEFT ATRIAL FUNCTION AND VOLUME BY MAGNETIC RESONANCE IN PATIENTS WITH HEREDITARY AMYLOIDOSIS.

BACKGROUND: Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]). METHODS: All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated. RESULTS: Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions. CONCLUSIONS: Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Left atrial function and volume by magnetic resonance in patients with hereditary amyloidosis

ABSTRACT Background Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]) Methods All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated Results Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions Conclusions Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Echocardiographic Left Ventricular Reverse Remodeling After 18 Months of Antihypertensive Treatment in Stage I Hypertension. Results From the Prever-Treatment Study.

BACKGROUND: Antihypertensive treatment improves echocardiographic parameters of hypertensive target organ damage in stage II hypertension, but less is known about the effects in stage I hypertension. METHODS: In a cohort study nested in the randomized double-blind trial PREVER-treatment, 2-dimensional echocardiograms were performed in 110 individuals, aged 54.8 ± 7.9 years-old, with stage I hypertension at baseline and after 18 months of treatment with chlorthalidone/amiloride or losartan. RESULTS: At baseline, 66 (60%) participants had concentric remodeling. After antihypertensive treatment, systolic (SBP) and diastolic blood pressure (BP) were reduced from 141/90 to 130/83 mm Hg (P = 0.009). There was a significant reduction in left ventricular (LV) mass (LVM) index (82.7 ± 17.1 to 79.2 ± 17.5 g/m2; P = 0.005) and relative wall thickness (0.45 ± 0.06 to 0.42 ± 0.05; P < 0.001), increasing the proportion of participants with normal LV geometry (31% to 49%, P = 0.006). Left atrial (LA) volume index reduced (26.8 ± 7.3 to 24.9 ± 6.5 ml/m2; P = 0.001), and mitral E-wave deceleration time increased (230 ± 46 to 247 ± 67 ms; P = 0.005), but there was no change in other parameters of diastolic function. LVM reduction was significantly higher in the 2 higher tertiles of SBP reduction compared to the lower tertile. CONCLUSIONS: Treatment of patients with stage I hypertension for 18 months promotes favorable effects in the LA and LV remodeling. This improvement in cardiac end-organ damage might be associated with reduction of long term clinical consequences of hypertensive cardiomyopathy, particularly heart failure with preserved ejection fraction.

Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography.

BACKGROUND: Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects. METHODS: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated. RESULTS: Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol-max reduction were preoperative diastolic blood pressure (coefficient = -0.004; P = 0.02), lateral mitral annular early diastolic velocity (e') (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = -0.035; P < 0.001). Furthermore, e' was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027). CONCLUSION: Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.

Simplified single plane echocardiography is comparable to conventional biplane two-dimensional echocardiography in the evaluation of left atrial volume: a study validated by three-dimensional echocardiography in 143 individuals.

The left atrial volume index (LAVI) is a biomarker of diastolic dysfunction and a predictor of cardiovascular events. Three-dimensional echocardiography (3DE) is highly accurate for LAVI measurements but is not widely available. Furthermore, biplane two-dimensional echocardiography (B2DE) may occasionally not be feasible due to a suboptimal two-chamber apical view. Simplified single plane two-dimensional echocardiography (S2DE) could overcome these limitations. We aimed to compare the reliability of S2DE with other validated echocardiographic methods in the measurement of the LAVI. We examined 143 individuals (54 ± 13 years old; 112 with heart disease and 31 healthy volunteers; all with sinus rhythm, with a wide range of LAVI). The results for all the individuals were compared with B2DE-derived LAVIs and validated using 3DE. The LAVIs, as determined using S2DE (32.7 ± 13.1 mL/m(2)), B2DE (31.9 ± 12.7 mL/m(2)), and 3DE (33.1 ± 13.4 mL/m(2)), were not significantly different from each other (P = 0.85). The S2DE-derived LAVIs correlated significantly with those obtained using both B2DE (r = 0.98; P < 0.001) and 3DE (r = 0.93; P < 0.001). The mean difference between the S2DE and B2DE measurements was <1.0 mL/m(2). Using the American Society of Echocardiography criteria for grading LAVI enlargement (normal, mild, moderate, severe), we observed an excellent agreement between the S2DE- and B2DE-derived classifications (κ = 0.89; P < 0.001). S2DE is a simple, rapid, and reliable method for LAVI measurement that may expand the use of this important biomarker in routine echocardiographic practice.

Alterações precoces da função diastólica do ventrículo esquerdo e da função do átrio esquerdo na doença de chagas detectadas ao doppler tecidual e por novos índices ecocardiográficos: Ecocardiografia tridimensional e deformação miocárdica / Early changes in diastolic function of the left ventricle and left atrium function in Chagas disease detected by tissue Doppler echocardiographic indices and new: Three-dimensional echocardiography and myocardial deformation

Fundamento: A doença de Chagas ainda é importante problema de saúde pública na América Latina onde 12 a 15 milhões de pessoas são infectadas pelo Trypanosoma cruzi. A forma crônica cardíaca apresenta alta morbimortalidade. A disfunção diastólica do ventrículo esquerdo (VE) está presente em diferentes estágios da doença de Chagas e o seu diagnóstico pode ser uma estratégia para o reconhecimento precoce do acometimento cardíaco na doença de Chagas. Objetivos: Analisar a função diastólica do VE e a função do AE em pacientes na fase crônica da doença de Chagas sem acometimento global ou segmentar da função sistólica do VE. Métodos: Pacientes com doença de Chagas entre 18 e 60 anos de idade foram consecutivamente analisados no período de março de 2010 a agosto de 2011. Ecocardiogramas de 52 pacientes sem lesão cardíaca aparente, 29 no estágio A da fase cardíaca (alterações apenas no eletrocardiograma) e 25 controles foram analisados. A função diastólica do VE foi analisada pelo fluxo mitral, fluxo de veia pulmonar, velocidade de propagação ao modo M colorido, untwist do VE e Doppler tecidual do anel mitral. A função do AE foi avaliada pela ecocardiografia tridimensional e pela análise de deformação bidimensional...

Resultados: Todos os grupos tinham idade e massa corpórea similar. Todos os grupos tinham diâmetros cavitários, massa do VE e função sistólica do VE similares. A disfunção diastólica foi mais prevalente em pacientes no estágio A que em pacientes sem envolvimento cardíaco aparente. Os parâmetros derivados do Doppler tecidual foram os melhores para discriminar o grau de disfunção diastólica entre os grupos. A razão EE foi progressivamente maior e a razão EA foi progressivamente menor de controles, para indeterminados e pacientes no estágio A. Os volumes do AE foram maiores em pacientes no estágio A, porém as frações de esvaziamento do AE foram similares entre os grupos. O pico positivo do do AE foi menor no estágio A enquanto que os outros parâmetros do do AE não diferiram entre os grupos. Conclusões: Pacientes com doença de Chagas e função sistólica do VE preservada apresentam disfunção diastólica, a qual é mais prevalente em pacientes no estágio A. O Doppler tecidual é o melhor índice para identificar a diferença na função diastólica entre os grupos estudados. Apenas a função condutiva do AE estava deprimida em pacientes no estágio A da fase cardíaca da doença de Chagas. Novos estudos são necessários para definir o valor prognóstico dos achados dessa Tese...