Rodrigo Bellio de Mattos Barretto

Cardiovascular events such as myocardial infarction, sudden death, and stroke have a peak incidence in the early hours after waking. The mechanisms involved in this circadian variation are not clear. Endothelial dysfunction is associated with increased risk for cardiovascular events. We tested the hypothesis that endothelial function is reduced in the early morning, around the time of waking, compared with measurements obtained both before sleep and later in the day in healthy humans.We studied 30 subjects (19 men, 11 women; mean age, 41.6 years). All participants underwent polysomnography to exclude obstructive sleep apnea or other sleep disorders. Brachial artery flow-mediated endothelium-dependent vasodilation (FMD) and endothelium-independent dilation (non-FMD) were measured on 3 different occasions: before subjects went to sleep (9 PM), the next morning immediately after waking (6 AM), and during the late morning 5 hours after waking (11 AM). All subjects had normal sleep with good sleep efficiency of 84+/-2%. Compared with before sleep, FMD decreased markedly in the early morning after waking and recovered by late morning (9 pm, 7.5+/-1%; 6 am, 4.4+/-0.7%; 11 am, 7.7+/-1%; P=0.02). Non-FMD was similar for the 3 periods of observation (9 pm, 17.3+/-1.6%; 6 am, 17.2+/-1.3%; 11 am, 18.5+/-1.7%).FMD is blunted in the early morning in healthy subjects. Decreased endothelial function in the early morning may have implications for our understanding of the morning peak in cardiac and vascular events.

The purpose of these Guidelines is to inform.They do not substitute the clinical judgment of doctors who, in final analysis, must determine which tests and treatments are appropriate for their patients.

In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone.Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria.At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality.In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.

Sumário 1. Conceitos Básicos sobre o Estudo da Deformação do Ventrículo Esquerdo 7 1.1. Breve Introdução aos Princípios Físicos da Formação dos Speckles na Imagem Cardiovascular 7 […] Posicionamento do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia sobre o Uso do Strain Miocárdico na Rotina do Cardiologista – 2023

Background Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk. Methods Forty patients with SCA (mean age, 23.5 ± 9.3 years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed. Results There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.4 ± 1.2° vs 10.7 ± 1.8°; P < .0001). Several variables were strongly related to LV twist, including the clinical severity index (ρ = −0.97, Z score = −6.05, P < .0001), E/e′ ratio (r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure (r = 0.72, P < .0001). Conclusions LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e′ ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk. Sickle cell anemia (SCA) is associated with cardiac abnormalities and premature death. The aims of this study were to identify early markers of cardiac dysfunction through ventricular strain and ventricular twist and determine the relationships between these measures and other markers of cardiovascular risk. Forty patients with SCA (mean age, 23.5 ± 9.3 years; 24 male patients) and 40 age- and sex-matched healthy individuals were compared. All subjects participated in structured interviews, and blood samples were collected. Standard echocardiography with subsequent offline evaluations using left ventricular (LV) and right ventricular systolic strain and rotational analyses of the left ventricle using two-dimensional speckle-tracking echocardiography were performed. There were no differences in LV ejection fraction, global LV strain (longitudinal, circumferential, and radial), and global right ventricular longitudinal strain between patients and controls; however, LV twist was significantly lower in the patient group (mean, 7.4 ± 1.2° vs 10.7 ± 1.8°; P < .0001). Several variables were strongly related to LV twist, including the clinical severity index (ρ = −0.97, Z score = −6.05, P < .0001), E/e′ ratio (r = 0.78, P < .0001), LV end-diastolic volume index (r = 0.81, P < .0001), and pulmonary artery systolic pressure (r = 0.72, P < .0001). LV twist is altered in patients with SCA. There were strong correlations between left ventricular twist and clinical severity index, E/e′ ratio, LV end-diastolic volume index, and pulmonary artery systolic pressure. These data suggest that decreased LV twist may indicate a subgroup of patients with SCA at greater cardiac risk.

Background Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long‐term incidence of death and changes in life quality in a consecutive cohort submitted to ASA. Methods and Results Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan‐Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post‐ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P &lt; 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P &lt; 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow‐up, one patient had a repeated ASA, three patients underwent myectomy and other four required ICD/pacemaker. In the multivariate model only post‐ASA LVOT residual gradient and left ventricle mass were associated with worse prognosis. Conclusions In this long‐term clinical follow‐up without losses, ASA was effective in improving quality of life and NYHA functional class, with relatively low mortality and very low need for immediate permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.

To evaluate the impact of the use, prior to the procedure, of injectable diltiazem to prevent complications.Between September 2000 and July 2001, 50 patients underwent transradial coronary angiography and were randomized to receive placebo (GI) or diltiazem (GII) through a catheter inserted into the radial artery. All patients received isosorbide mononitrate. Ultrasound analyses of the radial artery were performed before examination, 30 minutes afterwards, and 7 days afterwards to evaluate the flow, the diameter, and the artery output.The radial artery diameter of GI was 2.4d +/- 0.5 mm before the procedure and 2.3 +/- 0.5 mm after 30 minutes (NS), whereas in GII the diameter was 2.2 +/- 0.3 mm before the examination and +/- 2.5 0.4 mm 30 minutes after it (P<0.001). Radial artery output in group 1 was 7.3 +/- 5.l2 mL/min before the examination and 6.1 +/- 3.5 mL/min 30 minutes after the examination (NS), and GII had an increase of 5.9 +/- 2.5 mL/min before examination to 9.05 +/- 7.78 mL/min after the examination (P=0.04). Complications (spasm, occlusion, and partial obstruction) occurred in 4 patients (17.4%) in GI and did not occur in GII (P=0.04).The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug, resulting in the significant increase in the diameter of the radial artery and radial artery output.

Abstract Background A weak correlation has been reported between left ventricular filling pressures and the traditional echocardiographic tools for the evaluation of diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). On the other hand, studies that compared invasive measurements with speckle tracking echocardiography have shown promising results, but they were not exclusively targeted on this specific population. Methods and Results Immediately before the left heart catheterization, a comprehensive two‐dimensional Doppler echocardiography and speckle tracking analysis was prospectively performed in outpatients referred for coronary angiography. Left ventricular end‐diastolic pressure (LVEDP) was measured before any contrast exposure. Eighty‐one patients with coronary artery disease were studied, and the group with high LVEDP (n = 40) showed increased left atrial volume index (22 ± 6 mL/m 2 vs 26 ± 8.26 mL/m 2 , P = 0.04), E‐wave velocity (65 ± 15 cm/s vs 78 ± 20 cm/s, P = 0.02), E/e` (average) ratio (8.14 ± 2.0 vs 11.54 ± 2.7, P = 0.03), and E/global circumferential strain rate E peak ratio (E/GCSR E ) (39 cm vs 46 cm, P &lt; 0.01). There was a positive correlation between LVEDP and E/e` (ρ = 0.56; P = 0.03), and between LVEDP and E/GCSR E ratio (ρ = 0.43; P &lt; 0.01). The area under the receiver operating characteristics (ROC) curve was 0.83 and 0.73, respectively ( P &lt; 0.05). E/e` and E/GCSR E were both independent predictors of elevated LVEDP ( P &lt; 0.05), with a higher C‐statistic for the model including E/e` (0.89 vs 0.85). Conclusion The E/e` ratio was able to identify elevated LVEDP in CAD patients with preserved LVEF with more accuracy than the E/GCSR E ratio.

Hypertrophic cardiomyopathy (HCM) is accompanied by pathophysiological changes that predispose to the development of atrial fibrillation (AF). This arrhythmia impacts negatively on the morbidity, mortality and quality of life of these patients. Our objective was to evaluate the behavior of left atrial function, by means of atrial strain (derived from speckle tracking) and volumetric analysis by three-dimensional echocardiography, in patients with HCM with paroxysmal AF. We analysed left atrial function in 53 patients with HCM, 25 of whom were paroxysmal AF carriers (mean age 61.7±9.9 years; 56% female) compared with 28 members of the control group (mean age 60.5±10 years; 53.6% female) who were matched especially for sex, age and other demographic data. It was observed that patients with HCM and a history of paroxysmal AF had lower left atrial emptying fractions than individuals in the control group; and the active atrial emptying fraction was a factor independently associated with the presence of this arrhythmia (p=0.018; odds ratio=0.93). Moreover, we found a significant reduction of the left atrial strain in all its components in the total sample of patients, with no difference between the groups. Measurements of atrial emptying fractions by three-dimensional echocardiography allowed differentiating patients with HCM with and without paroxysmal AF. A miocardiopatia hipertrófica (MCH) é acompanhada de alterações fisiopatológicas que predispõem ao desenvolvimento de fibrilhação auricular (FA). Esta arritmia impacta de forma negativa na morbimortalidade e na qualidade de vida desses doentes. Nosso objetivo foi avaliar o comportamento da função auricular esquerda, por meio do strain auricular (derivado do speckle tracking) e da análise volumétrica pelo ecocardiograma tridimensional, em doentes com MCH portadores de FA paroxística. Analisámos a função auricular esquerda em 53 doentes com MCH, sendo 25 portadores FA paroxística (idade média de 61,7±9,9 anos; 56% sexo feminino) comparados com 28 integrantes do grupo controle (idade média de 60,5±10 anos; 53,6% do sexo feminino) que foram pareados especialmente por sexo, idade e outros dados demográficos. Observou-se que doentes portadores de MCH e antecedentes de FA paroxística apresentaram frações de esvaziamento auricular menores do que indivíduos do grupo controle; sendo que a fração de esvaziamento auricular ativa foi um fator independentemente associado à presença desta arritmia (p=0,018; odds ratio=0,93). Além disso, encontramos redução importante do strain da aurícula esquerda em todos seus componentes na amostra total de pacientes, sem diferença entre os grupos. As medidas das frações de esvaziamento auricular pela ecocardiografia tridimensional permitiram diferenciar os doentes com MCH com e sem FA paroxística.

Background: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. Objective: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. Methods: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant. Results: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). Conclusion: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Individuals with resistant arterial hypertension are particularly at risk of developing target organ damage and cardiovascular events. The advanced echocardiography technique called myocardial work (MW), through the analysis of the left ventricular pressure-strain loop, is among the possibilities for evaluating these individuals. Our study was designed to describe the behavior of MW indices in individuals with resistant arterial hypertension (RH), controlled hypertension (CH), and normal arterial pressure (N).Seventy-one patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and were characterized into three groups after a medical consult: RH (subjects with hypertension on four or more antihypertensive medications despite having controlled blood pressure); CH (subjects with hypertension on up to two antihypertensive medications); and N (individuals with normal ABPM; not using any medications). Echocardiographic analysis was performed using the Vivid E95 ultrasound system and blood pressure was measured at the time of the examination and subsequently used to determine myocardial work indices. RH demonstrated lower global work efficiency (GWE, mean = .95%; p = .005) and higher global wasted work (GWW, mean = 114 mm Hg%; p = .011) compared to other groups. Left ventricular mass measured by three-dimensional echocardiography, systolic wall stress, relative wall thickness and peak systolic dispersion were inversely correlated to GWE. No difference was observed between CH and N groups regarding MW indices. On multivariate analysis, only systolic wall stress remained as an independent predictor of GWE, when controlled by 3D mass index, relative wall thickness, peak systolic dispersion, and the hypertension group.Individuals with resistant hypertension have lower global work efficiency and higher global wasted work, compared to individuals with controlled hypertension and without arterial hypertension.

The aim of this study was to test the effect of antioxidants on enzymatic abnormalities and free radicals-modified DNA adducts associated with pre-malignant changes in HP-negative chronic atrophic gastritis (CAG) patients. 60 patients with CAG and intestinal metaplasia underwent a GI endoscopy with biopsy samples for histology and for: alpha-tocopherol, malonyldialdehyde, xanthine oxidase (XO), ornithine decarboxylase (ODC) and 8-hydroxydeoxyguanosine (8-OhdG). Patients were randomly allocated into three groups supplemented for 6 months with: (A) vitamin E, 300 mg/day; (B) Multivitamin, 2 tablets/day and (C) a certified fermented papaya preparation 6 g/nocte (Immune-Age FPP, Osato Research Institute, Gifu, Japan). Ten dyspeptic patients without histological abnormalities served as control. Histological and biochemical parameters were blindly repeated at 3 and 6 months. Plasma oxidant/antioxidant status was normal in all groups. CAG patients had a significantly (p<0.05 vs. control) increased mucosal level of MDA and XO concentrations which were returned to normal by each of the three supplementations (p<0.05). All three supplements decreased ODC activity (p<0.01) but at 6-month observation FPP yielded the most significant effect (p<0.05 vs. groups A and B) and was the only one achieving a significant drop of 8-OhdG (p<0.05 vs. baseline and other groups). The present data suggest that antioxidant supplementation, and namely Immune-Age FPP, might be a potential chemopreventive agent in HP-eradicated CAG patients.

Abstract Background and Aim Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting. Methods The study included 21 patients with CoA (median age: 15 years [8–39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm‐leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested. Results Before treatment, patients with CoA had lower LV GLS than the control group (−18.4% ± 1.96 vs −21.5% ± 1.37; P &lt; .01), showing significant increase to −19.4% ± 2.1 at 6 months and −20.7% ± 2.19 at 1 year, P &lt; .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = −0.571; P = .007). Conclusion Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.

Background: Left bundle-branch block (LBBB) and the presence of systolic dysfunction are the major indications for cardiac resynchronization therapy (CRT).Mechanical ventricular dyssynchrony on echocardiography can help identify patients responsive to CRT.Left bundle-branch block can have different morphologic patterns.Objective: To compare the prevalence of mechanical dyssynchrony in different patterns of LBBB in patients with left systolic dysfunction.Methods: This study assessed 48 patients with ejection fraction (EF) < 40% and LBBB consecutively referred for dyssynchrony analysis.Conventional echocardiography and mechanical dyssynchrony analysis were performed, interventricular and intraventricular, with ten known methods, using M mode, Doppler and tissue Doppler imaging, isolated or combined.The LBBB morphology was categorized according to left electrical axis deviation in the frontal plane and QRS duration > 150 ms.Results: The patients' mean age was 60 ± 11 years, 24 were males, and mean EF was 29% ± 7%.Thirty-two had QRS > 150 ms, and 22, an electrical axis between -30° and +90°.Interventricular dyssynchrony was identified in 73% of the patients, while intraventricular dyssynchrony, in 37%-98%.Patients with QRS > 150 ms had larger left atrium and ventricle, and lower EF (p < 0.05).Left electrical axis deviation associated with worse diastolic function and greater atrial diameter.Interventricular and intraventricular mechanical dyssynchrony (ten methods) was similar in the different LBBB patterns (p = ns).Conclusion: In the two different electrocardiographic patterns of LBBB analyzed, no difference regarding the presence of mechanical dyssynchrony was observed.(

Validation of a Zero-shot Learning Natural Language Processing Tool to Facilitate Data Abstraction for Urologic Research

Introduction: Acute coronary syndromes (ACS) are among the main causes of death worldwide. Despite important advances in revascularization strategies, there are a considerable number of patients who neither have access to these therapies, or, if so, may experience the no-reflow phenomenon. In STEMI, sonothrombolysis has been shown to restore patency of coronary vessels, especially in the microcirculation, leading to better left ventricular (LV) function recovery, hence emerging as a new adjuvant treatment to reperfusion. Hypothesis: Sonothrombolysis would improve the LV function in ACS. Aim: Compare ejection fraction (EF) and global longitudinal strain (GLS) in patients with ACS randomized to receive sonothrombolysis (therapy group-TG) or conventional treatment (control group-CG). Methods: Patients were randomized from two major clinical trials (NCT04732091 and NCT02410330 - HUBBLE databank). The therapy consists of high-energy intermittent ultrasound pulses associated with ultrasound-enhancing agent infusion (Definity® - Lantheus), initiated immediately after patient admission and continued after PCI or applied only after PCI for a total of 50 minutes. EF and GLS were measured off-line (TomTec Imaging System). Images were acquired immediately post Therapy/PCI or PCI only and 48/72 hours after the patient's inclusion. Comparisons were made using Student t-test, Chi-square test, and Fisher's exact test when indicated. Results: 120 patients were included (CG=60: 51 STEMI, 1 thrombolyzed STEMI, and 8 NSTEMI; TG=60: 53 STEMI, 1 thrombolyzed STEMI e 6 NSTEMI). Demographic characteristics were similar between groups, except for a tendency of higher number of diabetic patients in TG (43% vs. 25%, p=0.054). EF and GLS were similar between TG and CG immediately post-treatment (Therapy/PCI or PCI only) (47±12 vs. 45±11, p=0.393 and 13.2±4.1 vs. 12.5±3.3, p=0.325, respectively). However, after 48/72 hours, patients who received Therapy/PCI had similar values of EF despite higher GLS (49±10 vs. 46±11, p=0.126 and 13.5±3.8 vs. 11.8±3.1, p=0.010, respectively). Conclusions: Preliminary data shows that Sonothrombolysis associated with PCI could be an effective adjuvant treatment for ACS, contributing to the early improvement of LV function.

A doença reumática, em nosso país, é ainda uma das causas mais prevalentes da regurgitação mitral.Diferentemente da regurgitação mitral ocasionada por degeneração mixomatosa ou doença isquêmica, a doença reumática pode apresentar restrição, espessamento de folhetos e anormalidades acentuadas da região subvalvar 1 , também, comumente associada à estenose valvar.A regurgitação valvar mitral reumática incide geralmente em indivíduos jovens e deve ser avaliada de modo diferenciado em suas abordagens clínica e cirúrgica.Estudos têm demonstrado a superioridade da plastia mitral (cirurgia conservadora) sobre a troca valvar (implante de prótese), quando da necessidade do tratamento cirúrgico.A primeira acompanha-se de menor incidência de endocardite infecciosa e de complicações secundárias a anticoagulação, assim como está associada a melhor preservação da função sistólica ventricular esquerda após a cirurgia 2-6 .Na atualidade, a Doppler-ecocardiografia desempenha papel importante em determinar, antecipadamente, o tipo de cirurgia que pode ser realizada para a correção da regurgitação mitral [7][8][9] .Aspectos morfológicos e funcionais obtidos pela Doppler-ecocardiografia transtorácica e transesofágica permitem, de um modo geral, estimar em 85% a possibilidade de realização e o sucesso da plastia valvar mitral nos portadores de degeneração mixomatosa, particularmente quando o folheto posterior é o mais comprometido [10][11][12] .No entanto, os estudos que tentam validar a Dopplerecocardiografia, como instrumento poderoso para predizer o tipo de cirurgia a ser realizada nos portadores de doença reumática, carecem de um número expressivo de pacientes.De fato, as características únicas da doença reumática diminuem a probabilidade de realização da plastia valvar mitral, com taxas estimadas em 50% 13 .Até o momento, as variáveis obtidas pela Doppler-ecocardiografia para predizer a cirurgia a ser realizada na regurgitação valvar mitral de diversas etiologias não são aplicáveis aos pacientes com doença de etiologia reumática.

Abstract Introduction Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR. methods and results Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow‐up was obtained retrospectively. The primary endpoint was all‐cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACEs). Two‐hundred twenty‐eight patients were included (mean age, 81.5 ± 7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6 ± 3.2 vs. 1.4 ± 1.3; p &lt; .001). At a mean follow‐up of 36.2 ± 21.2 months, the Selvester score was independently associated with all‐cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48–1.84; p &lt; .001), cardiovascular death (HR, 1.59; 95% CI, 1.38–1.74; p &lt; .001), and MACE (HR, 1.55; 95% CI, 1.30–1.68; p &lt; .001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk factor (HR, 0.42; 95% CI, 0.18–0.98; p = .046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 ( p &lt; .001), respectively, for 1, 2, and 3 years. conclusions Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis.

Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Introdução: Doppler Ecografia (DE) é largamente utilizada no diagnóstico das estenoses carotídeas.Em 2003, a Sociedade Americana de Radiologia divulgou um consenso propondo critérios para graduação das estenoses da Artéria Carótida Interna (ACI).Em 2009, um grupo do Reino Unido apresentou recomendações para realização da DE das artérias carótidas

Recent studies have demonstrated the efficacy of the transcatheter valve-in-valve implantation for the treatment of bioprosthesis dysfunction in high-risk surgical patients. This study presents the initial experience with valve-in-valve implantation. Clinical, echocardiographic, and procedural profiles were characterized, and the mid-term results of patients with surgical bioprosthesis dysfunction submitted to valve-in-valve implantation in the aortic position were reported. Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6 mmHg to 20.9 ± 5.9 mmHg, and the valve area increased from 1.2 ± 0.4 cm2 to 1.5 ± 0.5 cm2. After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period. The valve-in-valve procedure was effective in most high-risk surgical patients with bioprosthesis dysfunction. When performed in well-selected patients, it results in satisfactory clinical and hemodynamic outcomes. Estudos recentes têm demonstrado a eficácia do implante transcateter valve-in-valve para o tratamento de disfunção de biopróteses em pacientes de alto risco cirúrgico. Apresentamos nossa experiência inicial com o implante valve-in-valve. Caracterizamos o perfil clínico, ecocardiográfico e do procedimento, e reportamos os resultados de médio prazo de pacientes com disfunção de bioprótese submetidos a implante valve-in-valve em posição aórtica. Incluímos sete pacientes do sexo masculino, com idade de 72,6 ± 10,0 anos. O escore STS foi 9,6 ± 10,5%, e o EuroSCORE logístico foi 22,7 ± 14,7%. Três pacientes apresentavam dupla disfunção; dois tinham insuficiência; e dois exibiam estenose isolada. A via transfemoral foi utilizada em seis casos, e a transapical, em um caso. Os dispositivos implantados incluíram as próteses Sapien XT (n = 5) e CoreValve (n = 2). O sucesso do procedimento foi obtido em seis (85,7%) casos. Após o procedimento, o gradiente médio reduziu-se de 38,2 ± 9,6 mmHg para 20,9 ± 5,9 mmHg, e a área valvar elevou-se de 1,2 ± 0,4 cm2 para 1,5 ± 0,5 cm2. Ao final de 1 ano, não ocorreram óbitos e nem outros desfechos adversos significativos; 80% dos pacientes encontravam-se em classe funcional NYHA I/II. Os gradientes transvalvares e a área valvar permaneceram inalterados nesse período. O procedimento valve-in-valve foi eficaz na maioria dos pacientes de alto risco cirúrgico com disfunção de bioprótese. Quando realizado em pacientes bem selecionados, resulta em desfechos clínicos e hemodinâmicos satisfatórios.

Estudos recentes têm demonstrado a eficácia do implante transcateter valve‐in‐valve para o tratamento de disfunção de biopróteses em pacientes de alto risco cirúrgico. Apresentamos nossa experiência inicial com o implante valve‐in‐valve. Caracterizamos o perfil clínico, ecocardiográfico e do procedimento, e reportamos os resultados de médio prazo de pacientes com disfunção de bioprótese submetidos a implante valve‐in‐valve em posição aórtica. Incluímos sete pacientes do sexo masculino, com idade de 72,6 ± 10,0 anos. O escore STS foi 9,6 ± 10,5%, e o EuroSCORE logístico foi 22,7 ± 14,7%. Três pacientes apresentavam dupla disfunção; dois tinham insuficiência; e dois exibiam estenose isolada. A via transfemoral foi utilizada em seis casos, e a transapical, em um caso. Os dispositivos implantados incluíram as próteses Sapien XT (n = 5) e CoreValve (n = 2). O sucesso do procedimento foi obtido em seis (85,7%) casos. Após o procedimento, o gradiente médio reduziu‐se de 38,2 ± 9,6 mmHg para 20,9 ± 5,9 mmHg, e a área valvar elevou‐se de 1,2 ± 0,4 cm2 para 1,5 ± 0,5 cm2. Ao final de 1 ano, não ocorreram óbitos e nem outros desfechos adversos significativos; 80% dos pacientes encontravam‐se em classe funcional NYHA I/II. Os gradientes transvalvares e a área valvar permaneceram inalterados nesse período. O procedimento valve‐in‐valve foi eficaz na maioria dos pacientes de alto risco cirúrgico com disfunção de bioprótese. Quando realizado em pacientes bem selecionados, resulta em desfechos clínicos e hemodinâmicos satisfatórios. Recent studies have demonstrated the efficacy of the transcatheter valve‐in‐valve implantation for the treatment of bioprosthesis dysfunction in high‐risk surgical patients. This study presents the initial experience with valve‐in‐valve implantation. Clinical, echocardiographic, and procedural profiles were characterized, and the mid‐term results of patients with surgical bioprosthesis dysfunction submitted to valve‐in‐valve implantation in the aortic position were reported. Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6 mmHg to 20.9 ± 5.9 mmHg, and the valve area increased from 1.2 ± 0.4 cm2 to 1.5 ± 0.5 cm2. After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period. The valve‐in‐valve procedure was effective in most high‐risk surgical patients with bioprosthesis dysfunction. When performed in well‐selected patients, it results in satisfactory clinical and hemodynamic outcomes.

Acute kidney injury (AKI) in patients with or without pre-existing chronic kidney disease (CKD) is strongly linked to decreased survival in patients treated with cardiac surgery but this is still incompletely understood after transcatheter aortic valve replacement (TAVR). This study sought to assess

About 210,000 valve replacement surgeries are performed annually worldwide. Paraprosthetic regurgitations are a complication that can happen, especially in mechanical prostheses and reoperations, reaching a prevalence of 10 to 15% in follow-up studies1. Surgical treatment remains the first choice, especially when there are significant symptoms and hemolysis. However, due to high perioperative mortality (6-14%)2,3, percutaneous techniques for correction of paraprosthetic regurgitation have been developed, although there are not yet specific occlusion devices. Real time three-dimensional transesophageal echocardiography (3DTEECHO) plays a fundamental role in the procedure since diagnosis, quantification of regurgitation, location and measurements of the regurgitant orifice, guiding in real-time the implantation of percutaneous prostheses. The initial experience of our service is four cases of occlusion of mitral paraprosthetic regurgitation percutaneously. Although we have not achieved complete resolution of regurgitation in three cases (two remained with moderate regurgitation and one with discreet regurgitation), it is worth noting that the procedures were conducted without complications and all patients improved functional class after implantation. In order to discuss the role of echocardiography this context, we describe a case where the complete occlusion of the paraprosthetic defect was achieved after implantation of the devices.

Background: In the STICH study, adding surgical ventricular reconstruction (SVR) to coronary bypass surgery (CABG) was not associated with a reduction in the rate of death or hospitalization for cardiac causes compared to results of CABG alone. We tested the hypothesis that the absence of viable myocardium identifies patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction who have the greatest benefit with CABG + SVR compared to CABG alone. Methods: Myocardial viability was assessed by single photon computed tomography (SPECT) in 267 of the 1,000 patients randomized to CABG or CABG + SVR in STICH. All had severe regional LV dysfunction involving the anteroapical wall. A 17-segment LV model was used and segments were determined to be viable based on pre-specified criteria. A patient was deemed as having viable myocardium if 11 or more LV segments were viable. Results: Among the 267 patients, 226 (85%) were men, mean age 61±9 years. Mean LV ejection fraction was 27±5%, and 89% of patients had a previous myocardial infarction. Myocardial viability was identified in 191 (72%) of the study patients; the remaining 76 were classified as nonviable. Patients with and without viability were similar in age (61±10 vs. 62±9) and ejection fraction (27±6 vs. 28±5%). Patients without viability had larger LV end-diastolic and systolic volume indices than those with viability (143±53 vs. 115±41 and 112±48 vs. 85±38 ml/m2, respectively; p Conclusion: In patients with CAD and severe regional LV dysfunction, assessment of myocardial viability does not identify patients who will benefit in terms of survival or cardiac hospitalization from adding SVR to CABG.

Introduccion: la disincronia en pacientes con fraccion de eyeccion del ventriculo izquierdo inferior a 35% es muy comun. Los pacientes con disfuncion ventricular izquierda (DVI) y disincronia ventricular pueden beneficiarse de implantes de resincronizadores; de esta manera, es extremadamente importante la identificacion de pacientes con disincronia. Por estas razones, este trabajo tiene como objetivo evaluar la capacidad de la cintilografia miocardica en la identificacion de disincronia en pacientes con DVI y QRS ancho, en comparacion con la ecocardiografia tridimensional (ECO 3D). Metodos: a partir de octubre 2013 a octubre 2014, 23 pacientes se realizaron cintilografia de perfusion miocardica mediante la tecnica de Gated-SPECT (tomografia computarizada con emision de foton unico) y ECO 3D por indicacion clinica, en el Instituto Dante Pazzanese de Cardiologia (IDPC). Del total, 4 fueron excluidos por imposibilidad de analisis por uno de los dos metodos. Fueron incluidos solo aquellos que no se sometieron a procedimientos cardiologicos, asociados con un cuadro clinico estable entre los momentos de las tecnicas. La cintilografia miocardica se realizo mediante la tecnica estandar de gated-SPECT, y el analisis de la sincronia ventricular izquierda realizado por herramienta SyncTool. Las variables analizadas fueron el volumen diastolico final (VDFVI), el volumen telesistolico (VSFVI), fraccion de eyeccion ventricular izquierda (FEVI), y el histograma banda y su desviacion estandar obtenidos por analisis de fase. El ecocardiograma se realizo con el sistema Vivid E9 GE, con la adquisicion de imagenes en tres dimensiones. Las variables analizadas por ECO 3D fueron el VDFVI, VSFVI, el volumen sistolico (VSVI), FEVI, y el indice de disincronia (SDI). El analisis estadistico se realizo mediante la prueba de kappa. Resultados: en la tecnica gated-SPECT, 14 (82%) de 17 pacientes tenian disincronia de VI, y de estos, 11 (78,5%) tambien la presentaron en el ECO 3D. Pero hubo una baja correlacion entre los metodos con Kappa 0,105 y p 0,25. Cuando se analizo la disincronia solo por el histograma banda (histogram bandwidth - PHB) hubo una mejor concordancia, sin embargo aun con valor kappa 0.346 y p 0,263, lo que representa una concordancia regular. El valor de la sensibilidad de la cintilografia utilizando ecocardiografia como una tecnica estandar era 84% y una especificidad de 25%.

Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Abstract Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p &lt; 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Background: In atrial fibrillation (AF), the CHA 2 DS 2 -VASc score calculates the risk for stroke.Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events.Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique.Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA 2 DS 2 VASc score.Method: A total of 247 patients were divided into three groups considering the CHA 2 DS 2 -VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points.TEE produced the echocardiographic data.LAA was classified into thrombogenic and non-thrombogenic morphologies.In the analysis of statistical tests, a significance level of 5% was adopted. Results:The average age was 50 and 16.2% presented AF.In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001).In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases.Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014).A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions:The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA 2 DS 2 VASc score.Patients with higher scores had greater abnormalities in echocardiographic variables.

Abstract Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p &lt; 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Abstract Background: In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p &lt; 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p &lt; 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA &lt; 0.4 m/s in 22.7% (p &lt; 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p &lt; 0.001), stroke/TIA (77.3%, p &lt; 0.001), EF &lt; 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.

Abstract Background: In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p &lt; 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p &lt; 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA &lt; 0.4 m/s in 22.7% (p &lt; 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p &lt; 0.001), stroke/TIA (77.3%, p &lt; 0.001), EF &lt; 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.

Abstract Background: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. Objective: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. Methods: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p &lt; 0.05 was considered significant. Results: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). Conclusion: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Background:The main objective of our study was to identify, by means of global longitudinal strain (GLS), territorial strain (TS), and postsystolic shortening (PSS) of left ventricle, which patients with acute coronary syndrome without ST elevation (NSTE-ACS) had ≥ 70% coronary stenosis.Methods: One hundred patients (PTS) with diagnosis of NSTE-ACS were stratified according to GRACE risk score, and underwent coronary angiography.GLS and TS were calculated.We also evaluated the strain curves in the 18 segments to identify the presence of the PSS and to calculate the post systolic index (PSI).Results: Mean age was 60 ± 11. 4, 62% was male.The majority were low and moderate cardiovascular risk.They were divided into group A (34 PTS) with coronary stenosis<70% and group B (66 PTS) with coronary stenosis ≥ 70%.Clinical score was higher in group B (GRACE=88.7 ± 24. 18, p=0.040) and 98. 5% was in low/moderate risk by GRACE score.GLS allowed the identification of PTS with coronary stenosis ≥ 70% in this group (AUC=0.72, p=0.001, sensitivity=58%, specificity=88%, positive predictive value=75.1% and negative predictive value=74.9%).Regarding the TS, the accuracy to determine coronary stenosis ≥ 70% was 0. 70 (p=0,001).The accuracy of the PSS in detecting coronary stenosis ≥ 70% was 69.3%, with sensitivity estimated at 73. 3% and specificity at 60. 7%.Conclusion: The GLS, territorial strain, and PSS may improve the detection of severe coronary stenosis in patients with low/moderate risk by GRACE risk score.Thus, it can be an additional tool for a better stratification of such patients in the emergency unit.