José Luis de Castro e Silva Pretto

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

BackgroundStress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.MethodsIn a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).ResultsWe expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.ConclusionsThe study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.

Levoatriocardinal Vein Associated with Pulmonary Stenosis and Aortic Hypoplasia in Young Adult

A veia levoatriocardinal (VLAC) foi descrita pela primeira vez em 1926 por McIntosh como uma persistente conexão anormal entre o sistema venoso pulmonar e o sistêmico através do plexo esplâncnico. Está mais comumente associada com lesões obstrutivas esquerdas como atresia mitral, cor triatriatum, hipoplasia do coração esquerdo, atresia ou coarctação da aorta.1,2 Acredita-se que a persistência dessa comunicação ocorra para prover uma alternativa na drenagem venosa pulmonar em um cenário onde o coração esquerdo está mal formado e sob pressões aumentadas.3

Safety Analysis of Pharmacological Stress Echocardiography with Dipyridamole in Octogenarians

Results: The study included 262 patients with a mean age of 82.9 ± 2.9 years who underwent a pharmacological stress echocardiogram with dipyridamole 0.84 mg/kg over 4 minutes. The incidence of complications was 3.4% (nine cases), only one major complication (0.4%), which was a case of prolonged ischemia requiring urgent invasive treatment. Other complications were two cases of prolonged ischemia treated with beta blocker, three cases of transient supraventricular tachycardias, one case of sustained supraventricular tachycardia reversed with adenosine, one case of atrial fibrillation and one case of transitory atrioventricular block 2:1.

Double-chambered Left Ventricle in Adult Patient with Asymptomatic Evolution

Female Caucasian 29-year-old patient was referred to a cardiologist to reevaluate the history of echocardiographic abnormalities from birth. The patient brought nine previous echocardiography scans with inconsistent conclusions. The first survey, conducted in 1988, reports a perimembranous ventricular septal defect; the other ones with descriptions ranging from normal test to the presence of left ventricular mass and findings suggesting uncompressed left ventricle.

Fat Embolism in Differential Diagnosis of Acute Cor Pulmonale: Case Report

Embolia gordurosa (EG) e definida como a presenca de particulas de gordura na circulacao sanguinea as quais tem potencial para gerar fenomenos embolicos e lesao tecidual local, principalmente em pacientes vitimas de traumas e fraturas dos ossos longos. Sindrome de embolia gordurosa (SEG) caracteriza-se pelo surgimento de sinais e sintomas especificos secundarios ao acometimento de orgaos-alvo como pulmoes, cerebro e pele, na vigencia de EG1-10.