RESUMEN
Introducción: La anemia es frecuentemente subdiagnosticada dada su vaga sintomatología. Estudios con evaluación subjetiva-visual por expertos describen signos tomográficos sugerentes de anemia, tales como el septo denso. Proponemos que lectores con entrenamiento básico realicen mediciones objetivas de alto poder estadístico para la detección de anemia. Material y Métodos: Se cruzaron datos de tomografía computarizada (TC) de tórax no contrastada (2021) con medición de hemoglobina plasmática (Hb) realizada 24 horas antes o después del estudio tomográfico. Dos estudiantes de Medicina, previamente entrenados, realizaron mediciones de Unidades Hounsfield (UH) en el septo interventri-cular (SIV) y cavidades ventriculares derecho (VD) e izquierdo (VI). Las relaciones SIV/VI y SIV/VD se correlacionaron con los valores de Hb. Se analizó la variabilidad interob-servador y se determinó el punto de corte óptimo para detectar anemia. Resultados: En una muestra de 112 casos, hubo alta concordancia interobservador con r de 0,85 (VD), 0,67 (SIV) y 0,87 (VI). La relación SIV/VI obtuvo el mayor AUC con 0,86 (IC 95%: 0,72 a 0,91), con una sensibilidad de 80% y especificidad de 88% utilizando un punto de corte de 1,15. Conclusiones: La razón SIV/VI con punto de corte de 1,15 es un parámetro confiable para detectar anemia mediante TC de tórax no contrastada, en observadores con entrenamiento básico.
Introduction: Anemia is frequently underdiagnosed given its vague symptomatology. Studies with subjective-visual evaluation by experts describe tomographic signs suggestive of anemia, such as a dense septum. This study aims to evaluate if readers with basic training can perform high statistical value measurements for anemia detection. Material and Methods: Data of non-contrast thoracic computed tomography (CT) (2021) with a measurement of plasma hemoglobin (Hb) performed 24 hours before or after the CT were identified. Two previously trained medical students performed measurements of Hounsfield Units (HU) on the interventricular septum (IVS) and right (RV) and left (LV) ventricular cavities. The SIV/VI and SIV/VD ratios were correlated with Hb values. Interobserver variability was analyzed and the optimal cut-off point to detect anemia was determined. Results: In a sample of 112 cases, there was a high interobserver correlation with r of 0.85 (VD), 0.67 (SIV), and 0.87 (VI). SIV/VI ratio obtained the highest AUC with 0.86 (95% CI: 0.72 to 0.91), with a sensitivity of 80% and specificity of 88% using a cut-off point of 1.15. Conclusions: The SIV/VI ratio with a cut-off point of 1.15 is a reliable parameter to detect anemia using non-contrast chest CT in observers with basic training.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Tomografía , Anemia/diagnóstico por imagen , Estudiantes de Medicina , Tórax/diagnóstico por imagen , Hemoglobinas , Chile , Tabique Interventricular/diagnóstico por imagen , Ventrículos CardíacosRESUMEN
Objectives This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation. Methods This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA). Results There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87-5.56 mm, MAPSE; 3.98-8.07 mm, TAPSE; and 2.34-4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%). Conclusions Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.
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Corazón Fetal/fisiología , Válvula Mitral/embriología , Sístole/fisiología , Válvula Tricúspide/embriología , Tabique Interventricular/embriología , Adulto , Estudios Transversales , Femenino , Corazón Fetal/diagnóstico por imagen , Feto , Edad Gestacional , Humanos , Recién Nacido , Válvula Mitral/diagnóstico por imagen , Embarazo , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Válvula Tricúspide/diagnóstico por imagen , Ultrasonografía Prenatal , Tabique Interventricular/diagnóstico por imagenRESUMEN
The use of hearts from different animals as models in the experimental pharmacology and surgical clinic has led, in recent years, to an increase on interest of research with this organ. The heart's conducting system, from the septomarginal trabecula, presents several variations, which generates numerous controversies in the literature. So, the objective of the present study is to analyse the morphology of the septomarginal trabecula of bovine hearts, identifying possible macro- and microscopic variations. Thirty-four bovine hearts were analysed. Each trabecula was analysed macroscopically to obtain an anatomical description and measurements of its length and thickness. For histological and morphometric analysis, the samples were fixed in Bouin's solution and then subjected to histological processing. In all the analysed bovine hearts, the septomarginal trabecula presented itself as a smooth, tubular meaty structure of muscular consistency, with variable length and diameter. The anatomical variations observed included a trabecula with forked marginal fixation, and single septal fixation, in addition to a trabecula with extremely reduced or excessively thick caliber. The septomarginal trabecula consists of cardiac muscle fibres, connective tissue, vascular tissue and conduction myofibrils or Purkinje fibres. In the samples of smaller thicknesses, there was a predominance of connective tissue and scarce cardiac muscle tissue, whereas in the thicker samples the predominance was of cardiac striated muscle tissue. Therefore, there are significant macro- and microscopic differences between the bovine septomarginal trabecula concerning their diameter and constituent tissue, and that can lead to possible changes in cardiac physiology.
Asunto(s)
Variación Anatómica , Bovinos/anatomía & histología , Corazón/anatomía & histología , Animales , Corazón/diagnóstico por imagen , Ventrículos Cardíacos/anatomía & histología , Ventrículos Cardíacos/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Fotomicrografía/veterinaria , Tabique Interventricular/anatomía & histología , Tabique Interventricular/diagnóstico por imagenRESUMEN
Abstract Background: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.
Resumo Fundamento: A maioria das massas adrenais descobertas incidentalmente, denominadas incidentaloma adrenal (IA), são adenomas adrenais não funcionantes. O manejo adequado da IA ainda é um tema de debate, e por isso é necessário investigar suas morbidades associadas. Entretanto, dados referentes a alterações cardíacas morfológicas e funcionais são limitados nesse grupo. Objetivo: Neste estudo, objetivamos avaliar as características estruturais e funcionais cardíacas e as propriedades de condução atrial em pacientes com IA não funcionante. Métodos: Trinta pacientes com IA não funcionante e 46 controles adequadamente pareados foram incluídos no estudo. Após análise hormonal e bioquímica, todos os participantes foram submetidos a ecocardiograma transtorácico para obtenção de parâmetros sistólicos e diastólicos de ambos os ventrículos, além dos tempos de condução atrial pelo ecocardiograma com Doppler tecidual. Os dados foram analisados com o Statistical Package for the Social Sciences (SPSS, Chicago, IL, Estados Unidos), versão 17.0 para Windows. P < 0,05 foi considerado estatisticamente significativo. Resultados: O índice de massa do ventrículo esquerdo (VE) e o índice de desempenho miocárdico do VE foram significativamente aumentados no grupo IA. Entre os tempos de condução atrial, os atrasos eletromecânicos intra- e interatriais foram significativamente prolongados em pacientes com IA não funcionante. Outros achados laboratoriais e ecocardiográficos foram semelhantes entre os grupos. Conclusão: Nosso estudo revelou que os tempos de condução intra- e interatrial estavam prolongados e o índice de massa do VE estava aumentado em pacientes com IA não funcionante. Esses achados podem ser marcadores de envolvimento cardíaco subclínico e de tendência a complicações cardiovasculares. Um acompanhamento rigoroso é necessário para indivíduos com IA não funcionante, devido ao aumento do risco cardiovascular.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Ecocardiografía Doppler/métodos , Adenoma/complicaciones , Neoplasias de las Glándulas Suprarrenales/complicaciones , Trastorno del Sistema de Conducción Cardíaco/complicaciones , Hidrocortisona/sangre , Ecocardiografía/métodos , Estudios Transversales , Función Atrial , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hormona Adrenocorticotrópica/sangre , Hallazgos Incidentales , Tabique Interventricular/fisiopatología , Tabique Interventricular/diagnóstico por imagen , Trastorno del Sistema de Conducción Cardíaco/fisiopatología , Trastorno del Sistema de Conducción Cardíaco/diagnóstico por imagenRESUMEN
BACKGROUND: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. OBJECTIVE: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. METHODS: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. RESULTS: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. CONCLUSION: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.
Asunto(s)
Adenoma/complicaciones , Neoplasias de las Glándulas Suprarrenales/complicaciones , Trastorno del Sistema de Conducción Cardíaco/complicaciones , Ecocardiografía Doppler/métodos , Hormona Adrenocorticotrópica/sangre , Adulto , Función Atrial , Trastorno del Sistema de Conducción Cardíaco/diagnóstico por imagen , Trastorno del Sistema de Conducción Cardíaco/fisiopatología , Estudios Transversales , Ecocardiografía/métodos , Femenino , Humanos , Hidrocortisona/sangre , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/fisiopatologíaRESUMEN
BACKGROUND: Interventions in patients with a left ventricular assist device (LVAD) in the intensive care unit (ICU) are typically performed based on the results of conventional monitoring, such as vital signs and Swan-Ganz catheter (SGC) and LVAD parameters. These variables might not always accurately reflect a patient's cardiac function, volume status, and interventricular septal configuration, however. To assess the accuracy of standard monitoring, we performed routine continuous hemodynamic transesophageal echocardiography (hTEE) to evaluate cardiac function, volume status, and septal position. METHODS: Between 2011 and 2015, 93 HeartMate II LVADs were implanted. The study group comprised 30 patients with an SGC in place who were monitored routinely by hTEE in the ICU every 1 to 3 hours until extubation. A total of 147 hTEE studies were analyzed retrospectively to observe differences between conventional monitoring and hTEE. RESULTS: Among the 30 patients studied, 26 (87%) had at least 1 disagreement between conventional monitoring and hTEE findings. In 22 patients (73%), at least 1 of the hTEE studies was abnormal whereas conventional parameters were normal. Abnormal hTEE findings included a shift in the interventricular septum in 19 patients (63%), abnormal ventricular volume status in 22 patients (73%), and right ventricular failure in 9 patients (30%). Based on conventional monitoring, none of the patients required an LVAD speed change, whereas hTEE showed that 14 patients (47%) needed an LVAD speed adjustment. CONCLUSIONS: Conventional monitoring in the ICU might not provide an accurate representation of cardiac function, ventricular volume status, or septal position in patients with LVAD. Continuous monitoring with hTEE in patients with an LVAD may help guide optimal intervention in the ICU setting during the early postoperative period.
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Cateterismo de Swan-Ganz , Ecocardiografía Transesofágica , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Hemodinámica , Monitoreo Ambulatorio/métodos , Función Ventricular Izquierda , Adulto , Anciano , Femenino , Estado de Salud , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Diseño de Prótesis , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/fisiopatología , Adulto JovenAsunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/cirugía , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/cirugía , Ecocardiografía/métodos , Ecocardiografía Transesofágica/métodos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Persona de Mediana Edad , Enfermedades Raras , Medición de Riesgo , Resultado del Tratamiento , Tabique Interventricular/patologíaRESUMEN
To determine reference values for fetal heart biometric parameters using the spatiotemporal image correlation (STIC) M mode and their applicability in congenital heart diseases (CHDs). A cross-sectional prospective study was conducted with 300 singleton pregnancies between 20 and 33 + 6 weeks of gestation. Right ventricular wall thickness (RVWT), interventricular septum thickness (IVST), and left ventricular wall thickness (LVWT) were measured off-line using the STIC-M mode with the cursor perpendicular to the interventricular septum. Polynomial regressions adjusted with the coefficient of determination (R 2) were performed. The curves were applied to 14 fetuses with structural CHD. For the reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean RVWT, IVST, and LVWT were 0.34 ± 0.09 cm, 0.28 ± 0.09 cm, and 0.30 ± 0.07 cm, respectively. There was correlation between RVWT, IVST, and LVWT and gestational age (GA): RVWT = -0.002 + 0.013 × GA (R 2 = 0.33), IVST = -0.011 + 0.011 × GA (R 2 = 0.25), and LVWT = 0.056 + 0.009 × GA (R 2 = 0.26). RVWT, IVST, and LVWT were altered (<5th or >95th percentile) in 5/14, 5/14, and 7/14 of the fetuses with CHD, respectively. For RVWT, IVST, and LVWT, intra-observer (CCC = 0.86, 0.85, and 0.87, respectively) and inter-observer (CCC = 0.86, 0.86, and 0.86, respectively) reproducibility were good/moderate. The reference ranges determined for fetal heart biometric parameters using STIC-M had good intra- and inter-observer reproducibility and were applicable to fetuses with CHD.
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Ecocardiografía Tridimensional , Corazón Fetal/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Valores de Referencia , Ultrasonografía Prenatal , Tabique Interventricular/diagnóstico por imagen , Adolescente , Adulto , Brasil , Estudios Transversales , Femenino , Edad Gestacional , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , Análisis de Regresión , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Pacemaker stimulation is associated with unpredictable severe cardiac events. We evaluated left ventricular mechanical dyssynchrony (LVMD) during prolonged septal right ventricular pacing. We performed 99mTc-MIBI gated-SPECT and phase analysis in 6 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Using V-Sync of Emory Cardiac Toolbox we obtained phase bandwidth (PBW) and standard deviation (PSD) from rest phase histogram. Clinical variables, QRS duration, rate and mode of pacing in septal right ventricle wall, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded. Prolonged septal endocardial pacing is associated with marked LVMD, even when systolic function was preserved. More severe dyssynchrony was found in patients with impaired LVEF, higher left ventricle diameters, extensive infarct or severe ischemia than in patients with preserved LVEF (PBW: 177.3o vs. 88.3o; PSD: 53.1o vs. 33.8o). In the patients with ischemic heart disease and pacemaker, gated-SPECT phase analysis is a valid and potentially useful technique to evaluate LMVD associated with myocardial scar and to decide the upgrading to biventricular pacing mode.
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Marcapaso Artificial/efectos adversos , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Tabique Interventricular/fisiopatología , Anciano , Anciano de 80 o más Años , Bloqueo Atrioventricular/cirugía , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Electrocardiografía , Femenino , Humanos , Masculino , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/diagnóstico por imagen , Tabique Interventricular/diagnóstico por imagenRESUMEN
La estimulación por marcapasos se asocia con eventos adversos graves. En la siguiente serie de casos se evaluó la disincronía mecánica intraventricular izquierda (DMVI) en la estimulación endocárdica prolongada del ventrículo derecho a nivel septal. Se estudiaron 6 personas con marcapasos implantados no antes de un año utilizando SPECT gatillado con 99mTc-MIBI y análisis de fase en reposo. Se registraron variables clínicas, duración del QRS, tasa y modo de estimulación ventricular, presencia y extensión de isquemia y/o infarto, volúmenes cavitarios y FEVI en reposo. Utilizando V-Sync de Emory Cardiac Toolbox se obtuvieron el ancho de banda (AB) y el desvío estándar de fase (DEF) en reposo (grados), comparándolos con una población control. La estimulación endocárdica prolongada en el septum ventricular derecho se asoció con marcada DMVI, aun cuando la función sistólica estaba conservada. Aquellos con FEVI moderada/gravemente disminuida (caracterizados por diámetros cavitarios mayores, infarto o isquemia grave) exhibieron mayor disincronía que aquellos con FEVI conservada/levemente disminuida (AB: 177.3o vs. 88.3o; DEF: 53.1o vs. 33.8o). En los casos con cardiopatía isquémica portadores de marcapasos, el AF es una herramienta válida de potencial utilidad para evaluar la disincronía asociada al infarto y, eventualmente, aportar a la decisión oportuna del pasaje al modo de estimulación biventricular.
Pacemaker stimulation is associated with unpredictable severe cardiac events. We evaluated left ventricular mechanical dyssynchrony (LVMD) during prolonged septal right ventricular pacing. We performed 99mTc-MIBI gated-SPECT and phase analysis in 6 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Using V-Sync of Emory Cardiac Toolbox we obtained phase bandwidth (PBW) and standard deviation (PSD) from rest phase histogram. Clinical variables, QRS duration, rate and mode of pacing in septal right ventricle wall, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded. Prolonged septal endocardial pacing is associated with marked LVMD, even when systolic function was preserved. More severe dyssynchrony was found in patients with impaired LVEF, higher left ventricle diameters, extensive infarct or severe ischemia than in patients with preserved LVEF (PBW: 177.3o vs. 88.3o; PSD: 53.1o vs. 33.8o). In the patients with ischemic heart disease and pacemaker, gated-SPECT phase analysis is a valid and potentially useful technique to evaluate LMVD associated with myocardial scar and to decide the upgrading to biventricular pacing mode.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Marcapaso Artificial/efectos adversos , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Tabique Interventricular/fisiopatología , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/diagnóstico por imagen , Electrocardiografía , Tabique Interventricular/diagnóstico por imagen , Bloqueo Atrioventricular/cirugía , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Infarto del Miocardio/etiología , Infarto del Miocardio/diagnóstico por imagenAsunto(s)
Defectos del Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/diagnóstico por imagen , Adulto , Angiografía Coronaria , Ecocardiografía Doppler , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/patología , Defectos del Tabique Interventricular/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Tabique Interventricular/patología , Adulto JovenRESUMEN
In children with structural congenital heart disease (CHD), the effects of chronic ventricular pacing on diastolic function are not well known. On the other hand, the beneficial effect of septal pacing over apical pacing is still controversial.The aim of this study was to evaluate the influence of different right ventricular (RV) pacing site on left ventricular (LV) diastolic function in children with cardiac defects.Twenty-nine pediatric patients with complete atrioventricular block (CAVB) and CHD undergoing permanent pacing were prospectively studied. Pacing sites were RV apex (n = 16) and RV septum (n = 13). Echocardiographic assessment was performed before pacemaker implantation and after it, during a mean followup of 4.9 years.Compared to RV septum, transmitral E-wave was significantly affected in RV apical pacing (95.38 ± 9.19 vs 83 ± 18.75, p = 0.038). Likewise, parameters at the lateral annular tissue Doppler imaging (TDI) were significantly affected in children paced at the RV apex. The E´ wave correlated inversely with TDI lateral myocardial performance index (Tei index) (R2= 0.9849, p ≤ 0.001). RV apex pacing (Odds ratio, 0.648; confidence interval, 0.067-0.652; p = 0.003) and TDI lateral Tei index (Odds ratio, 31.21; confidence interval, 54.6-177.4; p = 0.025) predicted significantly decreased LV diastolic function.Of the two sites studied, RV septum prevents pacing-induced reduction of LV diastolic function.
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Estimulación Cardíaca Artificial/métodos , Cardiopatías Congénitas/fisiopatología , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/fisiología , Tabique Interventricular/fisiopatología , Bloqueo Atrioventricular/diagnóstico por imagen , Bloqueo Atrioventricular/fisiopatología , Niño , Diástole/fisiología , Ecocardiografía Doppler , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/terapia , Humanos , Masculino , Marcapaso Artificial , Estudios Prospectivos , Estadísticas no Paramétricas , Volumen Sistólico/fisiología , Factores de Tiempo , Resultado del Tratamiento , Tabique Interventricular/diagnóstico por imagenAsunto(s)
Divertículo/patología , Ventrículos Cardíacos/patología , Tabique Interventricular/patología , Adulto , Divertículo/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Ultrasonografía , Tabique Interventricular/diagnóstico por imagenRESUMEN
OBJECTIVE: To determine reference values for fetal interventricular septum (IVS) volume by 3D/4D ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL). METHODS: A prospective cross-sectional study was conducted on 200 consecutive normal low-risk pregnant women at a gestational age ranging from 18w0d to 33w6d. The volume data sets of the fetal heart were acquired by applying STIC to a four-chamber plane. IVS volume was calculated offline using VOCAL with rotation of 30° (six planes). To assess the correlation of fetal IVS volume as a function of gestational age (GA), Pearson's correlation coefficient (r) and polynomial regression models with adjustments through the coefficient of determination (R(2)) were calculated. The intra-class coefficient (ICC) was used to evaluate intra- and inter-observer reproducibility. RESULTS: A good correlation between GA and fetal IVS volume (r = 0.827) was observed. The mean fetal IVS volume ranged from 0.13 ± 0.03 cm(3) (0.08-0.18 cm(3)) at 18wd0 of gestation to 1.33 ± 0.37 cm(3) (0.41-1.98 cm(3)) at 33w6d. The best correlation between fetal IVS volume and GA was exponential: fetal IVS volume = 0.11e(0.139×GA) (R(2 )= 0.785). A good intra- and inter-observer reliability were observed, with ICC = 0.999 and 0.991, respectively. CONCLUSIONS: Reference values for fetal IVS volume using STIC and VOCAL by 3D/4D ultrasound between 18w0d and 33w6d of gestation were determined and showed to be reliable and concordant.
Asunto(s)
Corazón Fetal/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/embriología , Estudios Transversales , Ecocardiografía Tetradimensional , Ecocardiografía Tridimensional/métodos , Femenino , Edad Gestacional , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Modelos Estadísticos , Variaciones Dependientes del Observador , Embarazo , Estudios Prospectivos , Valores de Referencia , Análisis Espacio-TemporalRESUMEN
OBJECTIVE: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. METHODS: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. RESULTS: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm² in the 18th week to 2.42 ± 1.13 cm² in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R² = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm², precision of 0.07 cm² and absolute limits of agreement of -0.14 and +0.15 cm². CONCLUSIONS: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.
Asunto(s)
Tabique Interventricular/embriología , Algoritmos , Brasil , Estudios Transversales , Ecocardiografía Tetradimensional , Femenino , Edad Gestacional , Hospitales Universitarios , Humanos , Modelos Lineales , Servicio de Ginecología y Obstetricia en Hospital , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Análisis Espacio-Temporal , Ultrasonografía Prenatal , Tabique Interventricular/diagnóstico por imagenRESUMEN
BACKGROUND: Early detection of septal changes such as septal hypertrophy commonly present in fetuses of diabetic mothers would help reduce the high rates of infant mortality. OBJECTIVE: Determine reference ranges for the fetal ventricular septal area through three-dimensional ultrasound (US3D) using the STIC method (Spatio-Temporal Image Correlation). METHODS: We conducted a cross-sectional study with 69 pregnant women between the 18th and 33rd weeks of pregnancy. We used as a reference the four-chamber plane with the ROI (Region of Interest) positioned from the ventricles; the septum area were manually marked. To assess the correlation of the interventricular septum area with gestational age (GA), we constructed scatter plots and calculated Pearson's correlation coefficient (r), and the adjustment was performed by the coefficient of determination (R²). We calculated averages, medians, standard deviations (sd), as well as maximum and minimum values. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC). The interventricular septum thickness was measured and it was correlated with gestational age and the septal area rendered in 52 patients using the ICC. RESULTS: The interventricular septum area was highly correlated with gestational age (r = 0.81), and the average increased from 0.47 cm² in the 18th week to 2.42 cm² in the 33rd of gestation. The intraobserver reproducibility was excellent with ICC = 0.994. No significant correlation was observed between the interventricular septum measurement and the GA (R² = 0.200), as well as there was no correlation with the septal area rendered with ICC = 0.150. CONCLUSION: Reference intervals for the interventricular septum area between the 18th and the 33rd pregnancy week were determined to be highly reproducible.
Asunto(s)
Corazón Fetal/diagnóstico por imagen , Edad Gestacional , Imagenología Tridimensional/métodos , Ultrasonografía Prenatal/métodos , Tabique Interventricular/diagnóstico por imagen , Adulto , Estudios Transversales , Femenino , Humanos , Variaciones Dependientes del Observador , Embarazo , Segundo Trimestre del Embarazo/fisiología , Tercer Trimestre del Embarazo/fisiología , Valores de Referencia , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To determine echocardiographic reference values for cardiac chambers, left ventricular mass, and left ventricular (LV) mass indexes in an asymptomatic adult population sample. METHODS: This was an observational study based on a randomly selected population sample from the city of Vitória, Brazil. Two hundred and ninety-five volunteers (61.7% women) with no past history of cardiovascular disease underwent transthoracic echocardiography. The following M-mode echocardiographic parameters were measured: ventricular diameters, interventricular septal thickness, LV posterior wall thickness, LV mass, left ventricular mass indexes, plus aortic and left atrial diameters. Values were expressed as mean and standard deviation and percentiles, with a 95% confidence interval. RESULTS: Echocardiographic values were slightly influenced by gender and age. Overall, cardiac measurements were higher in the male gender. LV posterior wall thickness, mass indexes corrected for height and diastolic diameter were influenced by age. The 95% percentiles of interventricular septum and LV posterior wall were 9.9 mm and 9.6 mm for men, respectively, and 9.3 mm for septum and posterior wall for women. CONCLUSION: The 95% percentile values of interventricular septum and posterior wall and, therefore, of both absolute and indexed left ventricular mass found in our study conducted in the Vitória population are lower than those reported in previous studies. In this framework, our results will be useful as a reference, since they are consistent with the new limits suggested in the literature for the echocardiographic diagnosis of left ventricular hypertrophy.