Navegando por Palavras-chave "Echocardiography"
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- ItemSomente MetadadadosAcute Leukemia is Associated with Cardiac Alterations before Chemotherapy(Mosby-Elsevier, 2017) Assuncao, Bruna Morhy Borges Leal [UNIFESP]; Handschumacher, Mark D.; Brunner, Andrew M.; Yucel, Evin; Bartko, Philipp E.; Cheng, Kai-Hung; Campos, Orlando [UNIFESP]; Fathi, Amir T.; Tan, Timothy C.; Scherrer-Crosbie, MarielleBackground: Patients with acute leukemia (AL) have a higher rate of congestive heart failure than patients with other cancers. AL may predispose to cardiac dysfunction before chemotherapy because of high cytokine release or direct leukemic myocardial infiltration. The aims of this study were to evaluate whether AL is associated with abnormalities of myocardial structure and function before chemotherapy and to identify possible risk factors associated with these myocardial changes. Methods: Using an echocardiographic database, 76 patients with AL and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes were retrospectively selected. Subsequently, to assess the effect of a nonhematologic malignancy, 28 women in each group were matched with women with breast cancer. Left ventricular (LV) mass, volumes, ejection fraction, and global longitudinal strain (GLS) were measured before chemotherapy. Results: The patients were predominantly male (63%), with a median age of 51 years, and had low prevalence of cardiovascular risk factors. Despite similar LV ejection fractions, patients with AL had higher LV mass and volumes and lower GLS (-19.3 +/- 2.7% vs -20.9 +/- 1.9%, P <.001) than patients without cancer. Similarly, GLS was lower in women with AL compared with women with breast cancer or without cancer. Among patients with AL, high body mass index, low LV ejection fraction, and a small number of circulating lymphocytes were all independently associated with low GLS. Conclusions: Patients with AL had higher LV volumes and lower GLS than patients without cancer and lower GLS than patients with breast cancer, suggesting that AL by itself may be associated with these cardiac alterations.
- ItemAcesso aberto (Open Access)Alterações estruturais e funcionais do ventrículo esquerdo associadas à leucemia aguda antes da quimioterapia: um estudo com speckle tracking por ecocardiografia bidimensional(Universidade Federal de São Paulo (UNIFESP), 2018-11-30) Leal, Bruna Morhy Borges [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Scherrer-Crosbie, Marielle; http://lattes.cnpq.br/9406673742771373; http://lattes.cnpq.br/5527690901008532; Universidade Federal de São Paulo (UNIFESP)Background: Patients with acute leukemia (AL) have a higher rate of congestive heart failure than patients with other cancers. AL may predispose to cardiac dysfunction before chemotherapy because of high cytokine release or direct leukemic myocardial infiltration. The aims of this study were to evaluate whether AL is associated with abnormalities of myocardial structure and function before chemotherapy and to identify possible risk factors associated with these myocardial changes. Methods: Using an echocardiographic database, 76 patients with AL and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes were retrospectively selected. Subsequently, to assess the effect of a nonhematologic malignancy, 28 women in each group were matched with women with breast cancer. Left ventricular (LV) mass, volumes, ejection fraction, and global longitudinal strain (GLS) were measured before chemotherapy. Results: The patients were predominantly male (63%), with a median age of 51 years, and had low prevalence of cardiovascular risk factors. Despite similar LV ejection fractions, patients with AL had higher LV mass and volumes and lower GLS (-19.3 ± 2.7% vs -20.9 ± 1.9%, P<0.001) than patients without cancer. Similarly, GLS was lower in women with AL compared with women with breast cancer or without cancer. Among patients with AL, high body mass index, low LV ejection fraction, and a small number of circulating lymphocytes were all independently associated with low GLS. Conclusions: Patients with AL had higher LV volumes and lower GLS than patients without cancer and lower GLS than patients with breast cancer, suggesting that AL by itself may be associated with these cardiac alterations.
- ItemAcesso aberto (Open Access)Athlete's heart in a Brazilian paralympic judo team. Case series study(Associacao Paulista Medicina, 2018) Oliveira Filho, Japy Angelini [UNIFESP]; Barros, Maria Beatriz Monteiro [UNIFESP]; Salles, Ana Fatima [UNIFESP]; Echenique, Leandro Santini [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Póvoa, Rui Manuel dos Santos [UNIFESP]BACKGROUND: Athlete's heart is a term describing the cardiovascular effects of long-term conditioning among highly trained athletes. It is a variation of normal standards. DESIGN AND SETTING: Case series study at the cardiology division of a public university hospital. METHODS: We studied 14 visually handicapped paralympic athletes (8 men) in the national judo team. They were 26.3 +/- 6.4 years old, with body mass index 25 +/- 14, and had been practicing judo for 9.2 +/- 7.9 years. Clinical evaluations, electrocardiograms, exercise testing and echocardiograms were performed by independent observers. RESULTS: Signs of athlete's heart were found in all athletes, comprising left ventricular hypertrophy (5 cases), sinus bradycardia (5), T-wave juvenile pattern (3), T wave juvenile pattern (3), left atrial hypertrophy (2) and increased left ventricular volume (9 cases
- ItemAcesso aberto (Open Access)Avaliação da função ventricular pelo strain sistólico por ecocardiograma bidimensional na amiloidose hereditária transtirretina em indivíduos sem sintomas cardíacos.(Universidade Federal de São Paulo, 2023-04-29) Capeline, Lorena Squassante [UNIFESP]; Moises, Valdir Ambrósio [UNIFESP]; http://lattes.cnpq.br/7272777672324904; http://lattes.cnpq.br/2598753229062321Introdução: A amiloidose transtirretina variante (ATTRv) é uma doença rara, de causa genética, que pode causar cardiomiopatia infiltrativa e restritiva potencialmente fatal. O gene transtirretina (TTR) está localizado no locus génico 18q12.1 com herança autossômica dominante e penetrância variável. A disponibilidade de testes genéticos permitiu identificar uma população de portadores sem manifestação de amiloidose cardíaca (AC). A ecocardiografia bidimensional com speckle tracking (2D-STE) tem sido a base do rastreamento e vigilância de diversas doenças cardíacas subclínicas. Entretanto, não há relatos da 2D-STE para a análise cardíaca em indivíduos com testes genéticos positivos sem evidências clínicas de AC. Objetivos: Avaliar se indivíduos com história familiar de amiloidose ATTRv associada a estudo genético positivo para variante TTR e sem sintomas e sinais ao exame físico de acometimento cardíaco, com FEVE preservada, podem apresentar alterações ecocardiográficas e da deformação miocárdica; e quais as variáveis clínicas e ecocardiográficas podem predizer o diagnóstico genético de amiloidose ATTRv. Métodos: Foram incluídos indivíduos com genótipo transtirretina positivo (grupo EG+) sem sintomas cardiovasculares, e pareados com indivíduos sem suspeita de amiloidose (grupo controle). Todos os indivíduos foram submetidos a um ecocardiograma completo, que incluiu análise bidimensional com medidas das cavidades, parâmetros de função sistólica e diastólica, além dos parâmetros 2D-STE. Os dados são relatados com médias e desvios-padrão (± DP) ou mediana com intervalo interquartil [IQR]. Foram utilizados testes paramétricos e não paramétricos; significantes se p<0,05. A fim de identificar variáveis que pudessem estar associadas a indivíduos com genótipo TTR positivo, foi proposta uma análise de regressão logística múltipla e da curva ROC. Resultados: Foram estudados 31 indivíduos EG+ e 34 controles, com idade média 39 anos (16; 74). As características dos parâmetros demográficos e ecocardiográficos foram semelhantes entre os grupos. Não houve diferença significativa nas dimensões internas das cavidades cardíacas e da fração de ejeção entre os grupos. Em comparação com os controles, a espessura da parede do ventrículo esquerdo e o índice de massa foram maiores no grupo EG+ (p<0,001). A relação E/e' média foi maior no grupo EG+ (7 ± 3 versus 6 ± 1; p<0,001). O strain circunferencial e o longitudinal global do VE foram significativamente menores no grupo EG+ (21 ± 4% versus 28 ± 4%; 19 ± 3% versus 25 ± 2%, respectivamente, p<0,001 para todos). O strain do VE nas regiões basal (17 ± 3% versus 22 ± 3%), média (18 ± 3% versus 24 ± 3%) e apical (23 ± 4% versus 27 ± 4%) no grupo EG+ foi menor quando comparado ao controle (p<0,001 para todos). O strain global longitudinal do VD também foi menor no grupo EG+ (18 ± 4% versus 25 ± 5%; p<0,005). Os preditores de teste genético positivo foram strain longitudinal global do VE menor ou igual a 21,5% (razão de chances ajustada [IC 95%], 2,46 [1,30 - 4,62]; p = 0,005) e E/e' médio maior ou igual a 6,5 (razão de chances ajustada [IC 95%], 2,04; [1,09 - 3,91]; p = 0,025). Conclusão: O strain sistólico global longitudinal de ambos os ventrículos e o strain sistólico global circunferencial do VE em indivíduos com história familiar positiva para amiloidose ATTRv, estudo genético positivo para amiloidose ATTRv, sem sintomas e sinais ao exame físico de acometimento cardíaco e com FEVE preservada, foram inferiores aos do grupo controle. Dentre as variáveis clínicas e ecocardiográficas avaliadas, o strain global longitudinal do VE e a relação E/e’ média foram preditores independentes de teste genético positivo para amiloidose ATTRv.
- ItemSomente MetadadadosAvaliação de programa de capacitação básica em ecocardiografia realizada pelo neonatologista(Universidade Federal de São Paulo (UNIFESP), 2021) Cabral, Nadia Canale [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Universidade Federal de São PauloIntroduction: The use of echocardiography performed by neonatologists (EchoN) to optimize the cardiovascular management of critically ill newborns is increasing. In order to guarantee a standard of excellence and protect patients from misinterpretation, structured training is necessary. However, so far, there is no standardization of training in EchoN, nor studies that prove the effectiveness of the applied models. Objective: To assess the success of a theoretical-practical course of EchoN in the training of neonatologists and neonatal fellows, and to study if some variables, such as the demographic and motivational profile of trainees, are associated with the training success. Method: From March/2019 to February/2021, a prospective cohort of 28 neonatologists, graduated or in training, who underwent a 6-month basic training in EchoN, was studied. Before starting the course, a pre-test was applied, and students with prior knowledge were excluded from the study. In addition, a demographic questionnaire and an Academic Motivation Scale were applied. An 18-hour theoretical course was applied and material for distance learning was available. A 36-hour hands-on practical training was given. Due to the Covid-19 pandemic, modifications were made to the 2020 course, and the theoretical course and evaluation were moved to online format. After completing the course, students underwent theoretical evaluation (multiple-choice test and videos) and practical test (complete exam with evaluation of image quality, identification of structures and measurements of some basic echocardiographic variables). Students who obtained at least 70% in both the theoretical and practical tests were considered qualified. Logistic regression was used to assess the association between successful training and demographic data, motivational profile and year of the course. Results: The training was effective in qualifying 53.5% of the students who attended the course. The main variable associated with the success of the training was the year: 68.8% of students who attended the training in 2019 were qualified vs. 33.3% of those who took the training in 2020. It was not possible to demonstrate an association between demographic data and motivational profile with success in training. Conclusion: The course offered the neonatologists and neonatal fellows was effective in basic training in EchoN, but the year 2020 proved to be a strong modulator of students’ performance. Analysis of the interference of the COVID-19 pandemic on the success of EchoN training may help to discuss the design and implementation of different strategies to optimize medical education.
- ItemSomente MetadadadosAvaliação ecocardiografica do movimento do septo interventricular no período pós-operatório de cirurgia cardíaca(Universidade Federal de São Paulo (UNIFESP), 1987) Moisés, Valdir Ambrósio [UNIFESP]; Pfeferman, Abraham [UNIFESP]
- ItemAcesso aberto (Open Access)Avaliação ecocardiográfica evolutiva do infarto do miocárdio em ratos jovens e adultos(Sociedade Brasileira de Cardiologia - SBC, 2008-11-01) Pabis, Francisco Cesar; Miyague, Nelson Itiro; Francisco, Julio César; Woitowicz, Vinícius; Carvalho, Katherine Athayde Teixeira de; Faria-Neto, José Rocha; Moisés, Valdir Ambrósio [UNIFESP]; Guarita-Souza, Luiz César; Pontifícia Universidade Católica do Paraná; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The regeneration of cardiomyocytes after a myocardial infarction (MI) is more evident in young animals; however, it is not known whether it is associated with functional improvement. OBJECTIVE: To perform the functional analysis by echocardiography (echo) of young adult rats submitted to MI. METHODS: Seventy-two animals were included in the study: 35 young rats (group Y) that were 28 days old and 37 adult rats (group A) that were 153 days old. The rats were subdivided in two subgroups: infarcted (YI and AI) and control (YC and AC). The animals were assessed by echocardiogram on the 7thand 30th postoperative days for the analysis of the ejection fraction (EF) and the final systolic (FSV) and diastolic volume (FDV) of the left ventricle. Only animals with EF < 40% were included in the study. RESULTS: The comparison of the FDV and FSV between infarcted and control animals showed that there was a significant increase in infarcted adult animals at the two analyzed phases. Among young animals only the FSV was significantly higher on the 7th day. The intragroup evolution analysis showed an increase in FDV and FSV in the two young subgroups, which was proportional to growth and only increase in FDV in the infarcted adult group. There was an improvement in EF in young rats, whereas EF remained decreased in adult rats when compared to controls. CONCLUSION: The infarcted young rats presented improvement in the systolic function and ventricular volumes 30 days after the infarction, whereas the adult rats presented increased FDV with no improvement in systolic function.
- ItemRestritoAvaliação tardia da função sistólica ventricular por ecocardiografia convencional e strain longitudinal em pacientes submetidos a valvoplastia pulmonar percutânea na infância(Universidade Federal de São Paulo, 2023-10-04) Nina de Azevedo, Luciana Silveria [UNIFESP]; Moises, Valdir Ambrósio [UNIFESP]; Silva, Célia Maria Camelo [UNIFESP]; http://lattes.cnpq.br/5537205929166590; http://lattes.cnpq.br/7272777672324904; http://lattes.cnpq.br/6719649092067442Objetivos: Avaliar, por meio da ecocardiografia, em uma coorte de pacientes submetidos a valvoplastia pulmonar por balão (VPB) na infância, a função sistólica de ambos os ventrículos por métodos convencionais e por strain longitudinal e verificar a possível relação da função ventricular com lesão valvar pulmonar residual. Métodos: revisão dos prontuários dos pacientes submetidos a valvoplastia pulmonar percutânea no período de janeiro de 2001 a dezembro de 2015; os pacientes que atenderam aos critérios de inclusão e aceitaram participar do estudo foram submetidos a uma avaliação ecocardiográfica atualizada. Resultados: setenta e três pacientes foram incluídos na análise retrospectiva e 18 pacientes na análise atualizada. A média da idade dos pacientes no momento da VPB foi de 4,3 anos, a taxa de sucesso foi de 94,5% e a mortalidade foi de 2,7%; houve redução significativa do gradiente transvalvar pulmonar tanto no período imediato (59,7 mmHg x 24,2 mmHg; p < 0,005) quanto no seguimento tardio (58,3 mmHg x 10,2 mmHg; p < 0,005). Não houve reestenose. Houve piora significativa do grau de insuficiência pulmonar nos pacientes da análise atualizada em relação aos registros prévios destes pacientes (p < 0,001); grau mais avançado da insuficiência pulmonar foi associado à VPB realizada em pacientes com peso < 3 kg (p < 0,03), superfície corpórea < 0,3 m2 (p < 0,04) e idade inferior a 1 ano de vida (p < 0,006). O strain sistólico longitudinal global do ventrículo direito foi alterado em 8 dos 18 pacientes enquanto os métodos convencionais foram alterados em 2 dos 18 pacientes (p = 0,001). A insuficiência pulmonar importante relacionou-se com o aumento do diâmetro médio do ventrículo direito (p = 0,02) e com o comprometimento da função ventricular direita avaliada pelo strain (p < 0,005). O ventrículo esquerdo não mostrou alterações. Conclusões: O grau da insuficiência pulmonar associou-se com pacientes tratados < 1 ano de vida, peso < 3 kg e superfície corpórea < 0,3 m2. Houve relação entre o grau da insuficiência pulmonar e o comprometimento da função sistólica do ventrículo direito avaliada pelo strain. O strain sistólico do ventrículo direito foi alterado em maior número de pacientes do que os métodos convencionais.
- ItemSomente MetadadadosComparison between respiratory changes in the inferior vena cava diameter and pulse pressure variation to predict fluid responsiveness in postoperative patients(W B Saunders Co-Elsevier Inc, 2016) de Oliveira, Olivia Haun [UNIFESP]; Rezende de Freitas, Flavio Geraldo [UNIFESP]; Ladeira, Renata Teixeira [UNIFESP]; Fischer, Claudio Henrique [UNIFESP]; Bafi, Antonio Tonete [UNIFESP]; Pontes Azevedo, Luciano Cesar [UNIFESP]; Machado, Flavia Ribeiro [UNIFESP]Purpose: The objective of our study was to assess the reliability of the distensibility index of the inferior vena cava (dIVC) as a predictor of fluid responsiveness in postoperative, mechanically ventilated patients and compare its accuracy with that of the pulse pressure variation (PPV) measurement. Materials and methods: We included postoperative mechanically ventilated and sedated patients who underwent volume expansion with 500 mL of crystalloids over 15 minutes. A response to fluid infusion was defined as a 15% increase in the left ventricular outflow tract velocity time integral according to transthoracic echocardiography. The inferior vena cava diameters were recorded by a subcostal view using the M-mode and the PPV by automatic calculation. The receiver operating characteristic (ROC) curves were generated for the baseline dIVC and PPV. Results: Twenty patients were included. The area under the ROC curve for dIVC was 0.84 (95% confidence interval, 0.63-1.0), and the best cutoff value was 16% (sensitivity, 67%
- ItemSomente MetadadadosCorrelação anatomopatológica, ecocardiográfica de cardiopatias congênitas na infância(Universidade Federal de São Paulo (UNIFESP), 1992) Ishigai, Marcia Marcelino de Souza [UNIFESP]; Patrício, Francy Reis da Silva [UNIFESP]
- ItemAcesso aberto (Open Access)Os critérios para classificação da insuficiência mitral não foram adequados na cardiomiopatia dilatada(Sociedade Brasileira de Cardiologia - SBC, 2013-11-01) Mancuso, Frederico José Neves [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Oliveira, Wercules Antonio [UNIFESP]; Poyares, Dalva [UNIFESP]; Brito, Flavio Souza [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Mitral regurgitation (MR) is common in patients with dilated cardiomyopathy (DCM). It is unknown whether the criteria for MR classification are inadequate for patients with DCM. OBJECTIVE: We aimed to evaluate the agreement among the four most common echocardiographic methods for MR classification. METHODS: Ninety patients with DCM were included. Functional MR was classified using four echocardiographic methods: color flow jet area (JA), vena contracta (VC), effective regurgitant orifice area (ERO) and regurgitant volume (RV). MR was classified as mild, moderate or important according to the American Society of Echocardiography criteria and by dividing the values into terciles. The Kappa test was used to evaluate whether the methods agreed, and the Pearson correlation coefficient was used to evaluate the correlation between the absolute values of each method. RESULTS: MR classification according to each method was as follows: JA: 26 mild, 44 moderate, 20 important; VC: 12 mild, 72 moderate, 6 important; ERO: 70 mild, 15 moderate, 5 important; RV: 70 mild, 16 moderate, 4 important. The agreement was poor among methods (kappa=0.11; p<0.001). It was observed a strong correlation between the absolute values of each method, ranging from 0.70 to 0.95 (p<0.01) and the agreement was higher when values were divided into terciles (kappa = 0.44; p < 0.01) CONCLUSION: The use of conventional echocardiographic criteria for MR classification seems inadequate in patients with DCM. It is necessary to establish new cutoff values for MR classification in these patients.
- ItemAcesso aberto (Open Access)Curvas de referência para o índice de performance miocárdica e Doppler tecidual e suas aplicabilidades em fetos de gestantes diabéticas tipo I e II.(Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Peixoto, Alberto Borges [UNIFESP]; Araujo Junior, Edward [UNIFESP]; http://lattes.cnpq.br/5590809884662013; http://lattes.cnpq.br/0754523005992469; Universidade Federal de São Paulo (UNIFESP)Objectives: to estabilish reference ranges for myocardial performance index using tissue Doppler (MPI) and spectral Doppler (MPI), peak flow velocity during the passive (E wave) and active (wave A) phases through the valves mitral and tricuspid, using spectral Doppler and annular peak velocity (APV) of the right ventricles (RV) and left ventricle (LV). To evaluate inter and intraobserver reproducibility. To evaluate the effect of type I (DM I) and type II diabetes mellitus (DM II) on the parameters of fetal heart function. Methods: A cross-sectional study was conducted evaluating 403 pregnant women divided into three groups: 360 normal (control group), 23 with type I diabetes and 20 with type II diabetes with body mass index (BMI) ≤ 35 kg / m2 and gestational age between 20 and 36 + 6 weeks. The MPI using spectral and tissue Doppler was calculated using the following formula: (isovolumetric contraction time + isovolumetric relaxation time) / ejection time. The peak velocity of the E and A waves were performed by positioning the sample volume just below the mitral and tricuspid valves. The APV during systole (S '), beginning (E') and end of diastole (A') were performed with the sample volume placed in the basal segment of the lateral wall of the right (RV) and left ventricle (LV). Polynomial regression was used to obtain the best fit for the parameters of cardiac function and gestational age (GA) with adjustments using the coefficient of determination (R2). The percentiles 5th, 50th and 95th of the cardiac function evaluation parameters were determined for each gestational age. To evaluate the effect of DM I and DM II on fetal heart function, the Kruskal-Wallis test was used. The post hoc analises using the Dunn’s test was used to comparison between pairs that presented significant difference. Results: LV MPI (p = 0.002) and isovolumetric relaxation time (IRT) (p < 0.001) significantly increased with advancing GA. Isovolumetric contraction time (ICT) and ejection time (ET) did not significantly change with GA. RV and LV E wave, A wave, and E/A ratio significantly increased with GA (p < 0.001). Only LV A wave measurements demonstrated an intra-observer CCC > 0.80. The remaining intra- and inter-observer reproducibility parameters demonstrated lower CCC. All MTD velocities (cm/s) progressively increased with advancing GA (p<0.0001). The following parameters have had significant decrease with GA: transtricuspid diastolic velocity / annular tricuspid velocity (RV E/E'), xxii transmitral diastolic velocity / annular mitral velocity (LV E/E’). LV MPI’, RV MPI’ did not significantly change with advancing GA. The CCC values for MTD were predominantly greater than 0.70, while those for MPI’ were < 0.70. In patients with DM 1, we observed an increase in the measures that evaluate the LV diastolic function (LV A, LV IRT`, LV MPI`), a decrease in the parameters that evaluate the LV systolic function (RV TE`) and increase the parameters that evaluate the diastolic function of the RV (RV IRT`). In patients with DM II, we observed an increase in the parameters that evaluate the LV diastolic function (LV A, LV MPI, LV E`, LV A`, LV IRT`), decrease in the parameters that evaluate the LV systolic function (LV ET), increase in the parameters that evaluate the RV diastolic function (RV MPI`), increase in the parameters that evaluate the RV systolic function (RV S`). Conclusion: reference ranges were determined for parameters of fetal cardiac function using conventional spectral Doppler and tissue Doppler. The vast majority of fetal cardiac function parameters tested did not demonstrate good / moderate intra and interobserver reproducibility. The results presented in our study reinforce the possibility of common coexistence of diastolic and subclinical biventricular systolic dysfunction in patients with pre-gestational diabetes, but it was not possible to determine a characteristic pattern of cardiac function-specific alteration for each of these conditions.
- ItemAcesso aberto (Open Access)Ecocardiografia à beira do leito em terapia intensiva: uma realidade ou um sonho distante?(Associação de Medicina Intensiva Brasileira - AMIB, 2009-12-01) Flato, Uri Adrian Prync; Campos, André Luis De; Trindade, Matheus Ribas; Guimarães, Hélio Penna [UNIFESP]; Vieira, Marcelo Luiz Campos; Brunori, Fernando; Instituto Dante Pazzanese de Cardiologia Unidade de Terapia Intensiva; Universidade de Marília Hospital Universitário Unidade de Terapia Intensiva; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hospital Leforte Unidade de Terapia IntensivaDuring the last few years, technological development and acquired experience advanced and the echocardiogram has become an important and useful tool in intensive care unit environment. Data obtained from semi quantitative Doppler echocardiography (transthoracic and transesophageal) evaluation has contributed to an appropriate patient monitoring and management. Echocardiography as a diagnostic, prognostic and monitoring method for fluid responsiveness assessment has become available nowadays since hand-carried ultrasound devices are portable and cheaper. Adequate training and development of appropriateness criteria for use of echocardiography in intensive care unit may lead to a standard use as a bedside tool.
- ItemSomente MetadadadosEcocardiografia realizada pelo neonatologista: impacto no manejo clínico de recém-nascidos em unidade intensiva neonatal de hospital universitário(Universidade Federal de São Paulo (UNIFESP), 2021) Figueira, Simone De Araujo Negreiros [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Universidade Federal de São PauloObjective: To assess whether the performance of neonatologist performed echocardiography (NPE) in newborns (NB) admitted to the neonatal intensive care unit (NICU) changed the previously planned hemodynamic approach, defined as the use and dosage of cardiovascular drugs and bolus of fluids. Method: Cross-sectional study, with prospective data collection, which included all NB admitted to an universitary NICU between March/2015 and September/2020, submitted to NPE according to the request of the clinical tea. The first NPE of each patient was evaluated. Before the procedure, the clinical team was questioned how the therapeutic management would be if the NPE was not available, and the answer was classified as intention to change or control of the prescribed therapy. After the NPE result, the treatment was categorized as maintained or modified in relation to the previous planning. Logistic regression was used to assess the association between changing the planned management and demographic and clinical data, the exam indication, the intention of the clinical team in relation to management, and the study period. Results: 199 NB were included in the study, with the following characteristics expressed as median (P25 – P75) or n (%): gestational age at birth -29.7 (26.6-32.6) weeks, birth weight -1180g (730 -1710), 110 (55%) were males and the SNAPPE-II was 26 (10-44). The first NPE was performed at 32 (17-54) hours of life, 129 NB (65%) were on mechanical ventilation, and 47 (24%) on vasoactive drugs. Among the exams, 40 NPE (20%) were requested for pulmonary hemodynamic assessment, 76 (38%) for ductus arteriosus (DA), and 83 (42%) for systemic flow assessment; 119 (60%) exams were request for controlling the prescribed management. NPE modified the planned pre-exam approach in 80 cases (40.2%; 95%CI: 33.3-47.4%; p<0.001). The multivariate analysis showed that the following variables were associated with an increased chance of modification of planned approach: exams to assess pulmonary hemodynamics (OR: 3.48; 95%CI: 1.99- 14.29) and to assess systemic flow (OR: 2.62; 95%CI: 1.12- 6.14) in relation to those requested for DA, pre-exam intention of changing the prescribed management (OR:5.14; 95%CI: 2.46- 10.75), the use of catecholamines at the moment of the test (OR: 5.35; 95%CI: 2.07; 13,83) and birth weight (OR:0.41; 95%CI: 0.38; 0.91). Conclusion: The NPE was an important tool to direct therapy in a different way from that previous planned for critically ill neonates.
- ItemSomente MetadadadosEcocardiografia transesofágica antes e após valvotomia mitral percutânea por cateter balão(Universidade Federal de São Paulo (UNIFESP), 1996) Tatani, Solange Bernardes [UNIFESP]; Campos Filho, Orlando [UNIFESP]
- ItemSomente MetadadadosExercise training contributes to H2O2/VEGF signaling in the lung of rats with monocrotaline-induced pulmonary hypertension(Elsevier Science Inc, 2016) Colombo, Rafael; Siqueira, Rafaela; Conzatti, Adriana; de Lima Seolin, Bruna Gazzi; Gattelli Fernandes, Tania Regina; Guerra Godoy, Alessandra Eifler; Litvin, Isnard Elman; Silva, Jairo Montemor Augusto [UNIFESP]; Tucci, Paulo José Ferreira [UNIFESP]; da Rosa Araujo, Alex Sander; Bello-Klein, AdrianePulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling and right ventricle overload. Given that angiogenesis is a key factor involved in the reduction of vascular resistance to blood flow, we tested the hypothesis that aerobic exercise exerts a positive impact on hydrogen peroxide (H2O2) and protein kinase B (Akt) levels in the lung parenchyma. To study the effects of aerobic exercise on lung angiogenesis signaling, Wistar rats were administered monocrotaline (MCT) (60 mg/kg i.p.) or the same volume of saline (0.9% NaCl i.p.). There was an increase in H2O2 (43%) in PAH-trained animals (TM) compared to control animals (SM). H2O2 showed a positive correlation (r = 0.77) with vascular endothelial growth factor (VEGF). VEGF was higher (4.7 fold) in TM animals compared to SM. VEGF and angiopoietin-1 (Ang-1) showed positive staining in the lung parenchyma of TM and SM. Glutathione peroxidase showed higher activity in the TM group (49%) compared to trained control (TC). Aerobic exercise increased the activity of peroxiredoxin (P < 0.05). The increase in VEGF was positively correlated with Akt phosphorylation (r = 0.73). p-Akt was shown to be increased in TM animals when compared to SM animals (2.5 fold). The change in fractional area, fractional shortening and systolic tricuspid annular plane excursion showed improvement after exercise training. Therefore, aerobic exercise promotes H2O2/VEGF/p-Akt signaling for pulmonary physiological angiogenesis. It is associated with an improvement in RV function, as evaluated by echocardiography. (C) 2016 Published by Elsevier Inc.
- ItemAcesso aberto (Open Access)Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room(Sociedade Brasileira de Cardiologia - SBC, 2014-12-01) Mancuso, Frederico José Neves [UNIFESP]; Siqueira, Vicente Nicoliello [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]; Góis, Aécio Flávio Teixeira de [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Campos Filho, Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.
- ItemSomente MetadadadosGeometric patterns of left ventricular hypertrophy and electrocardiography(Elsevier B.V., 2011-09-15) Costa, Francisco de Assis [UNIFESP]; Nogueira Bombig, Maria Teresa; Lima, Valter Correia de [UNIFESP]; Souza, Dilma de; Luna Filho, Braulio; Fonseca, Francisco Helfenstein [UNIFESP]; Oliveira Izar, Maria Cristina de; Costa, William da [UNIFESP]; Perez Riera, Andres Ricardo; Povoa, Rui [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemSomente MetadadadosInfluência do hipotiroidismo central no índice Doppler de performance miocárdica(Universidade Federal de São Paulo (UNIFESP), 2003) Doin, Fabio Luiz Casanova [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]Introdução: O indice de performance miocardica (IPM) obtido pela ecocardiografia Doppler, tem sido utilizado para avaliacao da funcao ventricular global em cardiopatias de diversas etiologias. O hormonio tiroidiano influencia a performance miocardica por acao direta e tambem indireta, por modificacoes na circulacao periferica. Os intervalos de tempo sistolicos podem ser alterados pelo hipotiroidismo e sao considerados marcadores da acao periferica do hormonio tiroidiano. Como o tempo de contracao isovolumetrica (TCIV) e parte do IPM, o objetivo do estudo foi avaliar o possivel efeito do hipotiroidismo central (HC) no IPM. Metodos: O estudo incluiu 28 voluntarios saudaveis (12 homens, 36 ± 8,6 anos) e sete pacientes com HC (tres homens, 35 ± 7,7 anos) sem doenca cardiaca. O IPM foi definido como a soma do TCIV e do tempo de relaxamento isovolumetrico (TRIV) dividida pelo tempo de ejecao. Os intervalos de tempo pelo Doppler pulsatil foram obtidos com amostra de volume posicionada na ponta dos folhetos da valva mitral e na via de saida do ventriculo esquerdo (VE), a partir da media de cinco batimentos consecutivos, obtida por um observador sem conhecimento do diagnostico clinico. A fracao de ejecao do VE, frequencia cardiaca e pressao arterial tambem foram medidos. Apos a avaliacao inicial, os pacientes foram submetidos a terapia de reposicao hormonal com tiroxina e o estudo foi repetido apos 35 a 42 dias. Resultados: O IPM foi significantemente maior nos pacientes com HC (0,54 ± 0,08) do que nos controles (0,40 ± 0,05) (p=0,002). A alteracao do IPM foi causada pelo prolongamento do TCIV (83 ± 22,2 ms vs. 39 ± 9,6 ms; p=0,001), sem variacao significante do TRIV e tempo de ejecao. Apos reposicao hormonal houve reducao significante do IPM (0,54 ± 0,08 vs. 0,42 ± 0,07; p=0,028) e TCIV (83 ± 22,2 ms vs. 42 ± 12,3 ms; p=0,027), associada a uma elevacao significante dos niveis de tiroxina livre (0,44 ± 0,15 ng/dL vs. 1,14 ± 0,43 ng/dL; p=0,028). A fracao de ejecao do VE, frequencia cardiaca e pressao arterial nao se alteraram significantemente. Conclusao: O IPM foi elevado nos pacientes com HC, mesmo com funcao sistolica global preservada. A elevacao do IPM se deveu ao prolongamento do TCIV e foi revertida pela reposicao hormonal. Este achado pode significar uma potencial limitacao para o uso do IPM na avaliacao da funcao do VE em doencas cardiacas em que coexista disfuncao contratil e hipotiroidismo
- ItemAcesso aberto (Open Access)Measurement of Mouse Heart Rate Variability using Echocardiographic System(Medknow Publications & Media Pvt Ltd, 2018) Stoyell-Conti, Filipe Fernandes; Santos, Fernando; Machi, Jacqueline Freire; Hernandez, Diana Rosa; Barboza, Catarina Andrade; Irigoyen, Maria-Claudia [UNIFESP]; De Angelis, Katia [UNIFESP]; Morris, MarianaAim: We employed an echocardiographic (ECHO) system as the backbone for the collection of electrocardiogram (ECG) and heart rate variability (HRV) data. The system was tested using an exercise model in which C57 male mice were exposed to sham or forced wheel running. Methods: Peak/peak (RR) interval was recorded over a 3 min period using the ECG platform of the ECHO system. Isoflurane-anesthetized male mice were divided into two groups (n = 8/group): sedentary (S) and forced wheel trained (T). HRV was analyzed in time and frequency domains (Fast Fourier Transform). Exercise training (T) was performed on a motorized wheel at low intensity 1 h/day, 5 days/week, 8 weeks duration. Cardiac morphometry and function were analyzed using ECHO while ECG was the basis to measure HRV. The sampling rate was 8000 Hz. Results show that the trained mice presented a reduction in heart rate as compared to the sedentary group. This was associated with lower cardiac sympathetic and higher parasympathetic modulation leading to an improved sympathetic/parasympathetic ratio (low-frequency band/high-frequency band). The trained group showed a reduction in isovolumetric relaxation time, reduced myocardial performance index, increased relative wall thickness, and left ventricle mass when compared to the sedentary group. Conclusion: Results document the utility of combining the ECHO and the ECG platform, allowing for the dual measurement of autonomic and cardiac function in mice.