Claudia Gianini Monaco

Study of the Myocardial Contraction and Relaxation Velocities through Doppler Tissue Imaging Echocardiography: A New Alternative in the Assessment of the Segmental Ventricular Function

OBJECTIVE Doppler tissue imaging (DTI) enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS We studied 35 healthy individuals (27 were male) with ages ranging from 12 to 59 years (32.9 plus minus 10.6). Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS The means (and standard deviation) of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls) were respectively, in cm/s, 7.35(1.64), 5.26(1.88), and 3.33(1.58) in systole and 10.56(2.34), 7.92(2.37), and 3.98(1.64) in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (+/- 19.12ms), and diastolic was 459.18ms (+/- 18.13ms) based on the peak of the R wave of the electrocardiogram. CONCLUSION In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

Disfunção erétil: um marcador para alterações da perfusão miocárdica?

OBJECTIVE To study the correlation between erectile dysfunction (ED) and myocardial perfusion impairment in men with suspected or diagnosed coronary artery disease (CAD). METHODS In this prospective study a self-administered IIEF-5 questionnaire was answered by 287 patients that underwent myocardial perfusion imaging under both resting and stress condition with technetium-99m sestamibi, through gated SPECT nuclear scintigraphy technique, before and after physical or pharmacological stress. RESULTS Some degree of erectile dysfunction (group ED+) was found in 137 (47.8%) patients and in these, age was significantly higher (60.60+/-9.84 vs 50.67+/-9.94 - p<0.001)) than in those without erectile dysfunction (group ED-). In the ED+ group, it was observed a higher prevalence of hypertension, diabetes, myocardial infarction (MI) and percutaneous coronary angioplasty (PCTA). Regardless of the age factor, ED+ patients also presented higher occurrence of myocardial perfusion impairment (necrosis and/or ischemia) and left ventricular systolic wall motion and thickening abnormalities. CONCLUSION Patients with ED have higher estimated probability of presenting segmental myocardial perfusion and functional contraction impairment and, therefore, CAD, independent of the aging factor. The authors conclude that ED may be considered not only a marker for CAD but also a condition related to the occurrence of major coronary events such as MI and PCTA.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years

UNLABELLED Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. OBJECTIVE To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism. METHOD Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to TEE. RESULTS Ten percent were aged 45 years; or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thrombus in left heart. CONCLUSION TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.

An Insignificant Flow That Intrigues Echocardiographers. Echocardiographic Pattern in 15 Cases of Coronary-Pulmonary Fistula and Literature Review

An Insignificant Flow That Intrigues Echocardiographers. Echocardiographic Pattern in 15 Cases of Coronary-Pulmonary Fistula and Literature Review Carlos Eduardo Suaide Silva,1 Vera Demarchi Aiello,2 Renata Rejane Linhares,1 Luciana Braz Peixoto,1 Mariane Daltrini Trandafilov Pimentel,3 Lucas Bercht,1 Fernanda Storti,1 Manuel Adán Gil,1 Claudia Gianini Monaco1 Diagnósticos da América SA (DASA-SP);1 Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo;2 OMNI-CCNI Medicina Diagnóstica,3 São Paulo, SP – Brazil

Comparison of Block-Matching and Optical Flow in Strain Echocardiography Analysis

Introdução: Diferentes tecnologias têm sido utilizadas para avaliar a função sistólica do ventrículo esquerdo. De particular interesse, está a ecocardiografia com strain bidimensional (2DSTE). Dois métodos diferentes têm sido usados para quantificar a deformação miocárdica (strain miocárdico) pela 2DSTE: block matching e optical flow. Ambos estão presentes em ecocardiógrafos comercialmente disponíveis. Entretanto, não há consenso a respeito se as medidas do strain longitudinal por estes métodos são sobreponíveis.

Influence of Patient’s Positioning on the Quality of Bedside Echocardiography Images

Background: Echocardiography is particularly important for assessing hemodynamically unstable patients. Despite being carried out at the bedside to eliminate the risk resulting from patient’s transportation, the imaging may be impaired. Proper patient’s positioning could contribute to enhancing both the image quality and analysis of the exam. Objective: To evaluate whether patient’s positioning by nurses could influence the quality of the echocardiographic images obtained at the bedside. Methods: Patients whose examinations were requested to be carried out at the bedside were studied in a consecutive manner. During transthoracic echocardiography, videos of the parasternal longitudinal view (PLV) and 4-chamber apical view (Apical-4C) were obtained, as well as the still image of the aortic flow (FAo), in the left lateral decubitus (LLD) and supine decubitus (SD). The scanned images were blindly analyzed by two observers comparing the type of decubitus used. The image quality was rated as 1: good/excellent quality; 2: inadequate/poor, and then submitted to Kappa agreement test and Pearson correlation. Results: 68 patients were studied, aged 69 ± 24 years, 37 males and body surface 1.85 ± 0.09 m2. When the distinct views were compared, LLD images showed better quality (p < 0.001) when compared to SD for both the Apical-4C videos (Kappa 0.19) and PLV (Kappa 0.25) and FAo (Kappa 0.13); interobserver agreement of the quality of the images was 95%. Conclusion: Patient’s proper positioning in bed in left lateral decubitus contributes significantly to the acquisition of better quality images. (Arq Bras Cardiol: Imagem cardiovasc. 2016;29(4):132-135)

Analysis of Diastolic Function and Atrial Function in High Performance Cyclists through Three-Dimensional Echocardiography

Results: The individuals of both groups had similar anthropometric variables. The following was observed in the cyclist group as for the controls: lower A’ wave velocity (5.9 cm/s ± 2.2 versus 7.6 ± 2.3 cm/s, with P = 0.03), smaller atrial contraction force (4.7 ± 1,4Kdyn vs. 6.2 ± 2.1Kdyn, P = 0.02) and greater passive emptying fraction (43.8% ± 12.8 versus 34.8 ± 10.4% with P = 0.03). A linear correlation was found between A’ wave velocity and atrial contraction force in the cyclists group (r = 0.65, P <0.05), between atrial contraction force and passive emptying fraction (r = 0.80, P <0.05) and between atrial contraction and volume before contraction (r = 0.65, P < 0.05). Conclusion: The cyclists group showed an increase in the passive component to the detriment of a reduction in the active component in total atrial emptying, which was showed to be correlated with supernormal diastolic activity in this group. (Arq Bras Cardiol: Imagem cardiovasc. 2014;27(4):235-242)

Tissue Doppler Imaging Limitations for Evaluating the Diastolic Function in Elderly People

Results: The group consisted of 56 subjects (70.1 ± 6.6 years), 23 (41.1%) in the GC and 33 (58.9%) in the HAS. Except for LV hypertrophy, more frequent in the HAS group compared to HG (34.4% versus 4.8% respectively; p=0.017), all structural echocardiographic findings were similar. Tissue Doppler analysis revealed no differences between the groups (septal e’: 8.0 ± 1.5 vs. 7.2 ± 1.9 cm/s; p=0.083 and lateral e’: 9.8 ± 2.2 versus 8.7 ± 2.0 cm/s; p=0.074, respectively, for GC and HAS). A longer E‑wave deceleration time was observed for HAS group (253 ± 62 versus 208 ± 36 ms in GC; p=0.003). Conclusion: In the analysis of diastolic function in elderly, tissue Doppler imaging was not able to discriminate hypertensive individuals, with the greatest potential for the occurrence of diastolic dysfunction, to the non‑hypertensive individuals.The E‑wave deceleration time proved to be a valuable parameter in this population. (Arq Bras Cardiol: Imagem cardiovasc. 2014;27(3):184‑190)

Pharmacological Stress Echocardiography in Patients with Anomalous Origin of Left Coronary Artery in Pulmonary Trunk

Pharmacological Stress Echocardiography in Patients with Anomalous Origin of Left Coronary Artery in Pulmonary Trunk Denise Bibiana Masselli1, Manuel Adan Gil1, Claudia Gianini Monaco1, Roberta Longo Machado1, Alfredo Jose Borges da Cunha1, Carlos Eduardo Suaide Silva1,2, Roberto Augusto Vasques Junior1, Felipe Silva Yared1, Guilherme Silva Yared1, Thaiene Martins Miranda2 OMNI-CCNI Medicina Diagnostica de Sao Paulo1; Diagnosticos da America de Sao Paulo (DASA)2, Sao Paulo, SP Brazil

Measures of Endocardial and Epicardial Longitudinal Strain by the Technique of Xstrain®: Are there Differences between their Values?

Material e métodos: Foram avaliados 32 pacientes hígidos com idade média de 31,6 ± 9,8 anos, sendo 18 masculinos (56%). Utilizamos o ecocardiógrafo modelo MyLab60® da Esaote (Firenze, Itália) com sonda multifrequencial (1,5 MHz a 2,6 MHz), e programa de computador para realização das novas técnicas ecocardiográficas (MyLab Desk, v 8.0, Esaote). Mediu-se o strain nas camadas endocárdica e epicárdica aos cortes apicais de 2, 3 e 4 câmaras.