22nd Brazilian Congress of Echocardiography Abstracts
2010; Wiley; Volume: 27; Issue: 6 Linguagem: Inglês
10.1111/j.1540-8175.2010.01246.x
ISSN1540-8175
Tópico(s)Cardiac tumors and thrombi
ResumoO‐001 LEFT VENTRICULAR REMODELING WORSENS LEFT VENTRICULAR TORSION IN HEART FAILURE Roberto M Saraiva 1 ; Sayit Dermikol 2 ; Adisai Buakhamsri 2 ; Zoran B Popovic 2 ; Neil Greenberg 2 ; Deborah A Agler 2 ; James D Thomas 2 ; and Richard Grimm 2 1 Fundação Oswaldo Cruz, Rio de Janeiro, Brasil; 2 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Background: The development of 2‐dimensional speckle tracking imaging (STI) enabled the noninvasive measurement of LV torsion, which is considered a key element for regulating LV systolic mechanics. We sought to address the relationship between LV torsion and LV remodeling in patients with LV systolic dysfunction. Methods: We retrospectively examined data from 50 consecutive patients with LV systolic dysfunction who performed dyssynchrony studies in our echocardiographic laboratory between July 2008 and April 2009. From those, 28 individuals (62 ± 19 years old) had images suitable for LV torsion analysis. LV torsion was defined as the net‐difference of LV rotation (LVrot) between apical and basal short‐axis planes obtained from STI analysis and stated in units of degree (°). LV mass was calculated by the area‐length method. LV end‐diastolic and end‐systolic sphericity were calculated as the ratio of the minor axis to the major axis length of the LV. LV volumes and ejection fraction were calculated using Simpson's method. Results: Most patients were male (71%), had ischemic etiology (54%), and presented with class III or IV symptoms (64%). LV ejection fraction was 36.0 ± 9.6%. Basal LVrot, apical LVrot and LV torsion were −3.7 ± 3.2°, 2.4 ± 4.0°, and 6.1 ± 3.9°, respectively. Basal LVrot was clockwise in 24 patients (86%) and apical LVrot was counterclockwise in 21 patients (75%). LV torsion presented significant negative correlation with LV end‐diastolic (r =−0.53; p = 0.004) and end‐systolic (r =−0.54; p = 0.003) volumes, LV end‐diastolic (r =−0.52; p = 0.005) and end‐systolic (r =−0.47; p = 0.01) sphericity indexes, and LV mass index (r =−0.52; p = 0.009) (Figure). The correlation between LV torsion and ejection fraction was marginal (r = 0.32; p = 0.09). LV torsion also correlated negatively with the duration of the QRS of the electrocardiogram (r =−0.41; p = 0.02). Conclusions: LV torsion has the potential to become an important parameter to assess LV systolic performance and decreases proportionally to LV remodeling with increasing LV volumes and as the LV assumes a more spherical format. O‐003 DOPPLER ECHOCARDIOGRAPHIC ASSESSMENT IN PATIENTS WITH CHRONIC SUBCLINICAL RHEUMATIC VALVAR DISEASE: AN INSTRUMENT TO DISCUSS DURATION OF SECONDARY PROPHYLAXIS Fátima Derlene da Rocha Araújo; Fabiana Arantes Araújo; Lavinia Pimentel Miranda; Kelly Nascimento Brandão; Déborah de Oliveira Lauar Figueiró; Sandra Regina Tolentino Castilho; Zilda Maria Alves Meira Federal University of Minas Gerais Introduction: Rheumatic cardiopathy is still an important public health issue in developing countries. Doppler echocardiography has not been included for diagnosis in Jones criteria revision but it is considered an analysis tool to discontinue secondary prophylaxis. Objectives: To assess echocardiographic changes in rheumatic fever patients with normal cardiovascular exam and to discuss the recommended duration of prophylaxis. Methods: Seventy‐nine 79 patients with diagnosis of rheumatic fever based on Jones criteria were assessed; their cardiovascular examination was normal after at least 5 years of disease progression, regardless of the cardiac alterations in the acute phase (ARF). The criteria for mitral or aortic valvar disease were those applied at international level. Results: The age of ARF patients ranged from 4 to 15 years (39% males and 61% females). Approximately 32 (41%) exams were classified as normal – in that, 87.5% were normal and 4 (12.5%) presented mild ARF alterations. The remaining 59% of exams presented abnormalities with the following findings: thickening of the anterior mitral leaflet (91%); slight (28%)/mild (91%)/moderate (8.5%) mitral regurgitation; and slight (8.5%)/mild (21%) aortic regurgitation. Enlarged chambers were not observed. Conclusions: The current recommendation (AHA, 2007) is to continue secondary prophylaxis up to the age of 40 years, even on those that present only echocardiographic alterations. It was observed that such prophylaxis would be maintained in 59% of individuals with normal clinical examination. Only 8.5% presented some echocardiographic abnormality considered significant (moderate mitral lesion or presence of aortic lesion) and just 12.5% of altered exams in the acute phase had echocardiographic resolution. Reassessing duration of prophylaxis is suggested in these cases. O‐004 TISSUE DOPPLER EVALUATION IN PULMONARY EMBOLISM: CORRELATION WITH BRAIN NATRIURETIC PEPTIDE AND PROGNOSIS Ana Clara Tude Rodrigues; Adriana Cordovil; Claudia Monaco; Laise Guimaraes; Andrea Paula Ponchirolli; Wercules Oliveira; Edgar Lira; Marcelo Vieira; Claudio Fischer; Samira Morhy Hospital Israelita Albert Einstein While assessment of right ventricular (RV) function with echocardiography is mainly limited to qualitative analysis, tissue Doppler (TD) may be used to evaluate it. Brain natriureticpeptide (BNP) is secreted in response to ventricular strain and seems related to RV dysfunction in pulmonary thromboembolism (PE). Objective: To evaluate RV performance and prognosis with echocardiography with TD, comparing it to BNP,in patients with PE. Methods: We evaluated 80 patients (50 male, mean age 54 ± 17 years) with PE diagnosed by chest tomography (76) or scintigraphy (4), with echocardiography and BNP within24 hours of diagnosis. RV function was evaluated qualitatively with bidimensional echocardiography and quantitatively with TD (velocities, strain and tissue tracking) from the tricuspid annulus. Mortality (8 to 24 months after diagnosis) was evaluated regarding clinical and echocardiographic variables. Results: 21 patients (31%) had RV dysfunction. Patients were divided into 2 groups: GI (BNP < 50 pg/ml, n = 54) and GII (BNP ≥ 50 pg/ml, n = 26). GII was older (64 ± 19 years vs 50 ± 13 years), had more RV dysfunction (15 vs 6 pts) and lower TD velocities (S’= 10.3 ± 3.8 vs 13.4 ± 3.8 cm/s and E’= 7.3 ± 3.6 vs 9.1 ± 2.2 cm/s), strain (−23.4 ± 10 vs −17.8 ± 9.5%) and tissue tracking (14 ± 7 vs 18 ± 4 mm) and higher pulmonary pressure (49 ± 11 vs 35 ± 11 mmHg), p < 0.05 for all variables. There was an inverse correlation between S’ and BNP (r =−0.67) and positive for pulmonary pressure (r = 0.69), p < 0.05. Mortality was 13% (6 patients) and related to age, coexisting malignancy and TD E’ velocities. Conclusion: In patients with PE,TD offers an alternative means of evaluating RV performance; however only E’ velocities may be related to prognosis. O‐007 LEFT ATRIAL VOLUME: IS IT REALLY NECESSARY TO MEASURE BOTH 4 AND 2 CHAMBER VIEWS IN TWO‐DIMENSIONAL ECHOCARDIOGRAPHY? A COMPARISON WITH THREE‐DIMENSIONAL ECHOCARDIOGRAPHY Normando Gomes Vieira Filho; Orlando Campos Filho; Rudyney E. U. Azevedo; Wercules Oliveira; Manuel A. Gil. Antonio C.C. Carvalho Escola Paulista de Medicina‐UNIFESP Background: Left atrial volume (LAV) has recently emerged as a new echocardiography prognostic index. Two‐dimensional echocardiography (2DE) techniques include average 4 and 2 chambers (4 + 2c) and 4‐chambers (4c) apical views. Three‐dimensional echocardiography (3DE) is considered a more reliable method to access chamber volumes. Objectives: To compare LAV assessment by both 2DE techniques with 3DE. Methods: We studied 89 patients, all in sinus rhythm, mean age 53 years (18 to 89), 51% female, mean ejection fraction 63% (22 to 84%). The 2DE maximum LAV was performed by Simpson's method, getting two measures: 1) Average (4 + 2c) apical views; or 2) Apical 4 chamber view only (4c). These values were compared with maximum 3DE LAV, with full volume method. Student t test and Pearson's correlation test were used, with a significant level of p < 0.05. Results: The variations of LAV by 3 methods were: 2DE LAV 4 + 2c: 23 to 199 ml; 2DE LAV 4c: 20 to 199 ml; 3DE LAV: 19 to 204 ml, with equivalent mean values (p > 0.05). The correlation between 2DE LAV 4 + 2c and 2DE LAV 4c was r2 = 0.98 (p < 0.05). When compared to 3DE LAV, the correlation with 2D LAV 4 + 2c was r2 = 0.89, and with 2DE LAV 4c was r2 = 0.90. Conclusion: The LAV estimated by single plane 2DE 4c is similar to LAV estimated from 2DE mean 4 + 2c, and both have a strong correlation with 3DE LAV. The 2DE method using only a 4c apical view can be a valid way to perform a volumetric measure of LAV. O‐008 PERCUTANEOUS PROSTHESIS AORTIC IMPLANT: COMPARISON BETWEEN THE MEASURES OF THE AORTA CARRIED OUT BY COMPUTED TOMOGRAPHY AND ECHOCARDIOGRAPHY PRE PROCEDURE Andrea de Andrade Vilela; Aloyra Guedis Guimarães; Renato Costa Junior; Wesley Rodrigo de Oliveira; David Costa de Souza Le Bihan; Jorge Eduardo Assef; Ibraim Masciarelli Francisco Pinto; Auristela Isabel de Oliveira Ramos; Dimitri Mikaelis Zappi; Amanda Guerra Moraes R. Sousa Instituto Dante Pazzanese de Cardiologia Introduction: The percutaneous prosthesis aortic implant for the treatment of severe aortic stenosis is an alternative available and effective for patients with high surgical risk, especially those with advanced age and with multiple comorbidities. The selection of patients fitting for percutaneous prosthesis aortic implant is based on clinical criteria and morphological parameters of aortic complex. These parameters, from measures of angiographic tomography and echocardiography, are essential for the planning of the procedure. Objective: To compare the measures of the aorta carried out by tomography and echocardiography before percutaneous prosthesis aortic implant. Method: Studied 11 patients eligible for the percutaneous prosthesis aortic implant and evaluated by tomography and echocardiography, the diameters of the following segments of the aorta: plan of the ring, root, sinus‐tubular joint, ascendent aorta and length of Valsalva sinus. Analyzed clinical variables (age, body surface, comorbities, symptoms, physical examination, Euroscore and medications in use) and echocardiographic variables (diameters and volumes of the left chambers, systolic and diastolic function, systolic pressure of pulmonary artery, and anatomical and functional characteristics from the aortic valve. Results: Only the measure of plan of the ring presented statistically significant difference (p = 0.007) as 25 mm ± 3.9 by tomography and 20 mm ± 3.5 by echocardiography. Age was 82.4 ± 5.81; 64% was female;44% was in functional class III and Euroscore was 12 ± 4. Ejection fraction was 59%± 12; 47% presented moderate pulmonary hypertension; medium systolic gradient aortic valve was 53 mmHg ± 17 and the area of aortic valve was 0,67 cm2 ± 0.17. Conclusion: The profile of patients selected for percutaneous prosthesis aortic implant is to be in theis eights and nineties with severe aortic stenosis and high surgical risk. The measures of tomography tend to overestimate the diameter of the plan of the ring in 5 mm in relation to the measures of echocardiography. O‐010 A HYPERCHOLESTEROLEMIC DIET CAUSE AUGMENT IN THE INFARCT SIZE AND WORST THE HEMODYNAMICS PATTERNS IN RATS SUBJECTS TO AN EXPERIMENTAL MODEL OF MYOCARDIAL ISCHEMIA PMM Dourado, MBP Landim, A Casella Filho, JM Tsutsui, TFG Galvão, VD Aiello, W Mathias Jr, PL da Luz, ACP Chagas. Atherosclerosis Unity. Heart Institute (InCor); University of São Paulo Medical School; São Paulo; Brazil A better comprehension of the hypercholesterolemic diet role in the set of acute myocardial infarct is fundamental Objective: Evaluation of the role of hypercholesterolemic diet in the determination of the hemodynamics patterns by echocardiography and the infarct size in an acute infarct model in rats. Methods: Sixty three anesthetized rats were subjected to occlusion of the left anterior descending (LAD) coronary artery and divided in six groups: G1 – just normal diet (ND); G2 – ND and treatment with rosuvastatim for 30 days began after infarct and G3 – ND and 30 days previously to infarct treated with rosuvastatim until 30 days after it; G4 – just hypercholesterolemic diet (HD); G5 – HD and treatment with rosuvastatim for 30 days began after infarct and G6 – HD and 30 days previously to infarct treated with rosuvastatim until 30 days after it. Echocardiography was performed using bidimensional image in the paraesternal long axis. The planimetry of the left ventricle areas in the end of the diastole (LVEDA) and systole (LVESA) were realized before the infarct (pre) and 30 days after the infarct (post) and the% of the infarct was determined by pathology. A p value < 0.05 was considered significant. Results: see table LVEDA (cm 2 ) (pre) LDESA (cm 2 ) (post) LVESA (cm 2 ) (pre) LVESA (cm 2 ) (post) (% infarct) G1 0.48* 0.88* 0.16* 0.6* 26.29 G2 0.39* 0.8* 0.12* 0.55* 23.24 G3 0.58* 0.75* 0.21* 0.52* 21.38* G4 0.59* 1.02* 0.18* 0.78* 30.26* G5 0.67* 1.05* 0.26* 0.84* 28.15 G6 0.7* 1.06* 0.28* 0.86* 27.30 p <0.05* <0.05* <0.05* <0.05* <0.05* Conclusion: The hypercholesterolemic diet augmented the infarct size in the hypercholesterolemic group in comparison with the normocholesterolemic group treated with rosuvastatim and worst the hemodynamics parameters – LVEDA and LVESA. O‐015 TRANSCATHETER AORTIC VALVE IMPLANTATION (COREVALVE): SELECTING, MONITORING, AND ECHOCARDIOGRAPHIC FOLLOW‐UP Jairo Alves Pinheiro Junior; Alexandra Alberta dos Santos; Francine K. Araujo; Mercedes Andrade Maldonado; Vera Marcia Gimenes; Adriana Moreira; Jose Eduardo Moraes R. Souza; Adib D. Jatene Hospital do Coracao – HCOR – IEP Introduction: Percutaneous implantation of aortic valve (CoreValve) is an emerging alternative for elderly patients with severe aortic stenosis (AoS) to conventional surgical treatment. The procedure offers less morbidity and mortality. Echocardiography is the ideal tool for screening and monitoring procedure. Method: From October 2009 to February 2010, 04 pacientes (p) elderly with AS were selected and underwent the procedure at the Hospital do Coração – HCor. Sex Age (y) CFNYHA EF VMx (m/s) GMx (mmHg) GMd AV (cm 2 ) A‐m 78 III/IV 0,34 3,3 45 26 0,9 B‐m 90 III 0,61 4,9 98 66 0,7 C‐m 84 III/IV 0,44 4,1 68 35 0,8 D‐f 87 III/IV 0,67 3,3 46 29 0,9 Besides the classification of the severity of the echocardiogram provided measures: diameter of the LVOT, annulus diameter, sinotubular junction diameter, diameter and compliance of the sinus of Valsalva and ascending aortic diameter. TEE monitoring during the implant monitoring not only of liberation as well as evaluation of reflux and improvement in ventricular function still in hospital. Results: Case EF AFTER PROCEDURE Reg/Gradient LV‐Ao A 0,51 Mínimo/11 mmHg B 0,67 Mínimo/10 mmHg C 0,53 Mínimo/11 mmHg D 0,68 Minimo/13 mmHg Conclusion: Although experience is small no complications and the echocardiogram shows are exuberant from the seletion monitoring this specific group of patients. O‐016 ECOCARDIOGRAMA TRIDIMENSIONAL NO DIAGNÓSTICO DE FONTE TROMBOEMBOLICA PULMONAR Edinaldo Rodrigues Fontes Junior; Flávia Arruda Santos; Giordano Bruno Parente; Djalma Augusto Godoy Santos; Paulo Sérgio Oliveira; Claudia Braga Melo REALCOR‐REAL Hospital Portugues de Pernambuco Introduction: Authors demonstrate unusual view of thrombus in the right ventricle, diagnosed by tridimensional echocardiogram, resulting in massive pulmonary embolism. Case Description: A 31 years old, female pacient, ANBMM, with diagnosis of Schistosomiasis performed post‐operative routine transthoracic echocardiogram (TTE), which was normal. After 15 days of this TTE, she started with moderate dyspnea. New TTE showed an increase in right chambers and on the pulmonary artery (PA), and a mass (MVd) in the apex of the right ventricle (RV). A 3D echocardiogram (3DECHO) was performed and showed: the structural aspect, location, diameter, relations with the ventricle walls and the mobility of the MVd. Transesophageal echocardiogram (TEE) helped in the study. The 3DECHO showed that MVd had a variable echogenicity, was apical and adhered to moderator band, measuring 547 mm of area without relation to the RV walls neither with apex. Magnetic Resonance showed a mass in the RV apex with a delayed capture of gadolinium. A thoracic X‐ray revealed the presence of right pulmonary infection and right pulmonary effusion. At the hospital and during preoperative treatment the pacient worsens with dyspnea and hypotension, being required emergency intervention. At surgery, a large thrombus was found in the ApRV, and also occlusion of the right PA and sub‐occlusion of the left PA. Postoperatively 3DECO showed a reduction of RC and PA, and there's was no mass in RV. Comments: This case demonstrates the actual use of the ECO3D on identification and detailing intracardiac structural masses helping the surgeon during the preoperative evaluation. O‐017 CLINICAL AND ECHOCARDIOGRAPHIC PARAMETERS ASSOCIATED WITH LOW CHRONOTROPIC INDEX IN NON‐ELDERLY PATIENTS Paulo Fernando Carvalho Secundo; Bruno Fernandes de Oliveira Santos; Francis Lima de Vasconcelos; Nathalie Oliveira de Santana; Débora Consuelo Rocha Silveira; Gustavo Baptista de Almeida Faro; Rívia Siqueira Amorim; Antônio Carlos Sobral Sousa; José Augusto Soares Barreto‐Filho; Joselina Luzia Menezes Oliveira Universidade Federal de Sergipe Background: Despite all the evidence about increased morbidity and mortality, chronotropic incompetence (CI) still is not a routine and well‐defined diagnosis in clinical practice guidelines. Its pathophysiological mechanisms remain unclear, and its clinical importance and prognosis certainly continue to be underestimated in clinical practice. Objective: To evaluate the clinical and echocardiographic parameters associated with CI in non‐elderly patients undergoing exercise echocardiography (EE). Methods: After exclusion criteria, a total of 1,798 patients who underwent EE between Janeiro 2000 and August 2009 were evaluated, with a mean age of 48.4 ± 7.5 years. Patients with chronotropic index below 0.8 were considered incompetent. Groups were compared regarding clinical features (including classic cardiovascular risk factors) and echocardiographic findings. Results: The duration of treadmill test was 9.3 ± 2.4 minutes. Chronotropic incompetence was observed in 275 patients (15%) patients. In this group, the mean chronotropic index was 0.7 ± 0.1 vs . 1.0 ± 0.1. Logistic regression identified that dyspnea during EE presents one of the strongest associations with CI [odds ratio (OR) = 4.27, p < 0.0001]. Others parameters included: metabolic equivalents (METs) (OR = 0.70, p = 0.0001), ST segment depression (OR = 0.58, p = 0.0003), previous chest pain (OR = 1.51, p = 0.0111), systolic blood pressure increase (delta SBP) (OR = 0.87, p = 0.0011) and left ventricular (LV) mass index (OR = 1.16, p = 0.0001). Ischemia was not associated with CI. Conclusion: Dyspnea, previous chest pain and LV mass index are associated with CI in non‐elderly patients. METs increase, ST segment depression and delta SBP are associated with normal chronotropic response. New protocols to investigate CI may contribute to early intervention in modifiable cardiovascular risk factors in these patients. O‐018 PROGNOSIS OF PATIENTS SUBMITTED TO STRESS ECHOCARDIOGRAPHY Brivaldo Markman Filho 1 ; Maria Celita Almeida 2 ; Camila Sartechi 3 ; Manuel Markman 2 ; Silvia Marinho Martins 3 ; Clodoval Barros 2 ; Marcia Moreno 2 ; Wilberto Souza 2 ; Maria de Fátima Lôbo 2 ; Sergio Montenegro 2 1 PROCARDIO – Hospital das Clínicas da UFPE; 2 PROCARDIO; 3 PROCARDIO – REALCOR Background: Stress echocardiography (SE) is effective and highly accurate for detection of myocardial ischemia and risk stratification in patients with suspicion of coronary artery disease. Objective: To evaluate the role of SE to search myocardial ischemia and its ability to predict the composite end point of cardiovascular death, myocardial infarction, unstable angina and myocardial revascularization by percutaneous intervention or surgery. Methods: Prospective observational study. Patients were submitted to SE with Dipyridamole or Dobutamine between June/2006 to September/2009. Results: There were 221 patients with mean follow‐up of 30 months (3–38 months). The SE was positive for myocardial ischemia in 13% of patients, negative in 84% and inconclusive in 3%. Cardiac events occurred in 18 patients, 16 with a positive SE. The rest of the patients (197) was free of events with negative SE in 184 patients. Event free survival in patients with negative SE was 99% compared with 55% for positive SE (p < 0.001). The univariate analysis showed SE result, basal electrocardiogram, age, Diabetes, LV mass index, past history of percutaneous intervention and surgery of myocardial revascularization (CABG), aspirin use associated with the cardiac events. In multivariate analysis SE result and CABG were independent predictors for cardiac events (p < 0.001). Conclusion: Positive SE and past history of CABG were the only independent predictors for cardiac events in the study. O‐019 LEFT VENTRICULAR DIASTOLIC FUNCTION IN CHAGAS CARDIOMYOPATHY AFTER RENINE‐ANGIOTENSINE‐ALDOSTERONE SYSTEM INHIBITION Oliveira, BMR; Botoni, FA; Pinto, AS; Reis, A; Rocha, MOC. Faculdade de Medicina – Universidade Federal de Minas Gerais Chronic Chagas cardiomyopathy causes substantial morbidity and mortality in Latin America and its prognosis is dependent on systolic and diastolic left ventriclar (LV) function. Objective: The objective of this study was to determine the efficacy of renine‐angiotensine‐aldosterone system (RAAS) inhibitors in improving diastolic dysfunction in chronic Chagas cardiomyopathy, comparing with changes in brain natriuretic peptide (BNP) levels. Methods: All patients received enalapril (up‐titrated to 20 mg BID) and spironolactone (25 mg QD). The end points were changes in LV diastolic function parameters evaluated by transthoracic Doppler echocardiography after RAAS inhibition, and change in BNP levels, used as a surrogate marker of LV filling pressure. Results: Forty‐one patients – 29 (67,4%) males, mean age 48,05 ± 10,42 years – with Chagas cardiomyopathy were studied. Optimization of RAAS inhibition was associated with improvement in LV diastolic function parameters: isovolumic relaxation time (137.47 ± 35,96 ms vs. 151.55 ± 34,55 ms, p = 0.02), increase of inferior wall E’ velocity [6.55 (3,42) cm/s vs. 7.30 (3,51) cm/s, p = 0.03], decrease of inferior E/E’ index [9.23 (3,86) vs. 8.36(5,31), p = 0.065], and increase of antero‐lateral wall A’ (5,95 ± 2,12 cm/s vs. 6.78 ± 1,81 cm/s, p = 0.02) and inferior wall A’ velocities (7,49 ± 2,26 cm/s vs. 8,61 ± 2,20 cm/s; p = 0,006). BNP levels decreased significantly [95.90 (295,35) vs 32.55 (138,15); p = 0.026]. Conclusions: In patients wit
Referência(s)