Introdução: A doença falciforme (DF) é a afecção hematológica hereditária de maior prevalência no mundo, sendo que a anemia falciforme (AF) é a forma mais grave com elevada morbidade e mortalidade. Alterações cardíacas são reconhecidamente associadas à AF, como aumento cavitário, hipertensão arterial pulmonar e disfunção diastólica do ventrículo esquerdo. No entanto, ainda não existe consenso quanto à função sistólica ventricular nesses pacientes. O objetivo deste estudo foi o de investigar a função ventricular de pacientes com anemia falciforme utilizando o strain e o twist ventricular obtidos pelo speckle tracking bidimensional, e reconhecer os indivíduos sob maior risco cardiovascular, em que a instituição precoce de tratamento específico poderá beneficiar essa população. Métodos: Foram recrutados 40 pacientes com anemia falciforme (23,5 ± 9,3 anos; 24 homens) e 40 controles saudáveis pareados por sexo e idade, submetidos à entrevista estruturada, ecocardiograma transtorácico, cintilografia pulmonar ventilação perfusão e coleta de amostras de sangue. Todos os indivíduos foram submetidos à avaliação ecocardiográfica convencional padrão e subsequente avaliação offline do strain sistólico biventricular e estudo rotacional do ventrículo esquerdo utilizando speckle-tracking ecocardiográfico. Resultados: Os pacientes com AF apresentaram volume do VE indexado, massa do VE indexado, pressão arterial pulmonar e E/E\' médio superiores aos controles. As medidas de FE do VE, excursão sistólica do plano da tricúspide (TAPSE), Strain Global do VE (longitudinal, circunferencial, radial) e Strain Global do VD (longitudinal) não evidenciaram diferenças entre os grupos. Twist VE se mostrou reduzido em comparação aos controles (7,4 ± 1,2? vs 10,7 ± 1,8? , P <0,0001 ) e Tempo de pico de rotação apical prolongado (366,7 ± 26,1ms vs 344,6 ± 11,7ms , P <0,0001 ). Algumas variáveis se mostraram fortemente relacionadas ao twist VE, como índice de gravidade clínico (Rho= - 0,97, Z value= - 6,05, P < 0,0001), relação E/E\' médio (r = 0,94, F valor= 156.9, p<0,0001), IVDFVE (índice do volume diastólico final do ventrículo esquerdo)(r = 0,81 e p<0,0001) e pressão sistólica arterial pulmonar (r = 0,72 e p<0,0001). Conclusões: Os resultados deste trabalho indicam que o twist ventricular esquerdo derivado do speckle tracking bidimensional encontra-se alterado em pacientes com anemia falciforme e função sistólica ventricular preservada, avaliada pela metodologia convencional, e existe forte correlação entre o twist ventricular esquerdo e o índice clínico de gravidade, relação E/E\', índice do volume diastólico final do ventrículo esquerdo e pressão sistólica arterial pulmonar. / Background: Sickle cell disease (SCD) is the most prevalent hematological condition in the world, with sickle cell anemia (SCA) being its most serious form, displaying a high level of morbidity and mortality. Cardiac changes are known to be associated with SCA, including an increase in cardiac chamber size, pulmonary hypertension and left ventricle diastolic dysfunction. However, there is still no consensus regarding the ventricular systolic function in these patients. The purpose of this study is to investigate the ventricular function of patients with sickle cell anemia utilizing the strain and ventricular twist, obtained by two-dimensional speckle tracking, as well as to identify individuals with higher cardiovascular risk, in which early application of specific treatment could benefit this group of people. Methods: 40 patients were recruited with sickle cell anemia (ages 23.5 ± 9.3 years; 24 males) and 40 healthy control individuals paired by gender and age, submitted to structured interviews, transthoracic echocardiogram, pulmonary scintigraphy and collection of blood samples. All individuals were submitted to a standard echocardiographic evaluation and subsequent off line evaluation of the biventricular systolic strain and rotational study of the left ventricle using echocardiographic speckle-tracking. Results: Patients with SCA presented LV volume indices, LV mass Indices, pulmonary arterial pressure and E/ E\' ratios statistically higher than the control individuals. Measurements of Ejection Fraction (EF) of the left ventricle, tricuspid annular plane systolic excursion (TAPSE), Overall LV Strain (Longitudinal, Circumferential, and Radial) and Overall RV Strain (Longitudinal) did not present differences between the groups. LV twist was significantly lower in relation to the control group (7,4 ± 1,2? vs 10,7 ± 1,8? , P <0,0001 ) and prolonged time to peak apical rotation (366.7 ± 26.1ms vs 344.6 ± 11.7ms , P <0.0001 ). In addition, some variables showed themselves to be strongly related to LV twist such as the clinical severity index ( Rho= - 0.97, Z value= - 6.05, P < 0.0001), E/E\' Ratio (r = 0.94, F value=156.9 e p<0.0001) ), left ventricle end diastolic volume index (LVEDV index) (r = 0,81, p<0,0001) and pulmonary systolic arterial pressure (r = 0.72 e p<0.0001). Conclusions: The results of this study indicate that the left ventricular twist derived from two-dimensional speckle tracking is altered in patients with sickle cell anemia and a preserved ventricular systolic function, evaluated using conventional methodology and that there is a strong correlation between left ventricular twist and the clinical severity index, E/E\' ratio, left ventricle end diastolic volume index and the pulmonary systolic arterial pressure.

A rejeição é uma das principais complicações após transplante cardíaco (TC). A biópsia endomiocárdica do ventrículo direito (BEVD) continua a ser o padrão-ouro para seu diagnóstico. Há uma necessidade de alternativas não invasivas que permitam um diagnóstico seguro e precoce de rejeição cardíaca, antes do início dos sintomas clínicos. A ecocardiografia com speckle tracking (EST) permite a análise da dinâmica de contração ventricular, possibilitando a detecção precoce de disfunção miocárdica. Os objetivos deste estudo foram comparar os parâmetros da dinâmica ventricular obtidos com a EST em pacientes transplantados e indivíduos não transplantados cardíacos e avaliar o valor da EST e da dosagem sérica de troponina I e peptídeo cerebral natriurético (BNP), como ferramentas não invasivas para a detecção precoce de rejeição celular aguda significativa (RCA) após o TC. Entre janeiro de 2014 e novembro de 2017, foram estudados, prospectivamente, 49 pacientes transplantados cardíacos com função sistólica normal, tanto do ventrículo esquerdo (VE) como do direito (VD) submetidos à BEVD para vigilância ou por suspeita clínica de rejeição. A RCA foi definida como >= 2R pelos critérios da Sociedade Internacional para Transplante de Coração e Pulmão. Quarenta e nove indivíduos saudáveis pareados por idade e sexo constituíram o grupo controle. Todos os pacientes foram submetidos à ecocardiografia convencional e à EST. Os pacientes transplantados foram submetidos, horas antes da BEVD, à dosagem de troponina I e BNP séricos. Parâmetros ecocardiográficos clássicos, strain e strain rate longitudinal global, radial e circunferencial do VE, além de strain longitudinal da parede livre do VD (SLPL-VD) foram analisados. Os 49 pacientes transplantados cardíacos (média etária 45,2 ± 11,5 anos, 28 homens) foram submetidos a 66 biópsias entre 6-12 meses após o TC. A RCA foi detectada em 17 (26%) e ausência de RCA em 49 (74%) biópsias. Strain e strain rate longitudinal, circunferencial e radial globais do VE e SL-PLVD foram significantemente menores, em valores absolutos, nos grupos dos transplantados cardíacos do que no grupo controle. O SL-PLVD apresentou valor absoluto menor no grupo com RCA do que no sem RCA (-18,28 ± 4,8% versus -22,11 ± 2,9%; p < 0,001). Um valor de SL-PLVD < 17,57% (valor absoluto) teve sensibilidade de 71%, especificidade de 90%, valor preditivo positivo de 75%, acurácia de 84% e valor preditivo negativo de 88% para detecção de RCA. A dosagem da troponina I foi significantemente mais alta em pacientes com RCA (p < 0,01). A mediana para este grupo foi 0,19 [intervalo interquartil 0,09-1,31 ng/mL], versus 0,05 [intervalo interquartil, 0,01-0,18ng/mL] para o grupo sem RCA. Na análise multivariada, o SL-PLVD foi o único preditor independente de RCA com razão de chance de 1,70 (intervalo de confiança de 95% = 1,17- 2,48); p = 0,006. Concluiu-se que o SL-PLVD derivado da EST foi marcador sensível e específico de RCA. Estes dados sugerem que esta técnica é adequada para detectar alterações na deformação ventricular direita durante um episódio de RCA / Rejection is a major complication after heart transplantation (HT). Right ventricular endomyocardial biopsy (EMB) remains the gold standard for diagnosis of rejection. There is a need for non-invasive alternatives that allow for a safe and early diagnosis of cardiac rejection prior to the onset of clinical symptoms. Speckle tracking echocardiography (STE) enables the analysis of left and right ventricular contraction dynamics, thus allowing for the early detection of myocardial dysfunction. The aims of the present study were to compare ventricular dynamics parameters obtained by STE in heart transplanted patients and control individuals. We also aimed to assess the value of STE, troponin I, and brain natriuretic peptide (BNP) serum levels as noninvasive tools for the early detection of significant acute cellular rejection (ACR) after HT. From January 2014 to November 2017, we prospectively studied 49 transplanted patients with normal left and right ventricular systolic function, who had undergone EMB for either surveillance or clinical suspicion of rejection. ACR was defined as >= 2R graded according to the revised International Society for Heart and Lung Transplantation by EMB. A total of 49 age- and sex-matched healthy individuals formed the control group. All studied patients underwent conventional echocardiography with the analysis of STE. The transplanted group also had their serum troponin I and BNP levels measured hours before undergoing EMB. Classic echocardiographic parameters left ventricular global longitudinal strain (LV-GLS), radial and circumferential strain and strain rate, and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed. The 49 heart transplanted patients (mean age 45.2 ± 11.5 years, 28 men) underwent 66 biopsies, 6-12 months after HT. ACR was detected in 17 (26%) and no ACR in 49 (74%) of biopsies. LV-GLS, circumferential and radial strain and strain rate and RVFWLS values were significantly lower in heart transplant group than in control group. RV-FWLS was lower (absolute value) in the group with ACR than in the group without ACR (-18.28 ± 4.8% versus -22.11 ± 2.9%; p < 0.001). A RVFWLS < 17.57% had 71% sensitivity, 90% specificity, 75% positive predictive value, 84% accuracy, and 88% negative predictive value for detection of ACR. The troponin I level was significantly higher in patients with ACR (p < 0.01). The median value for this group was 0.19 [interquartile interval 0.09-1.31 ng/mL] vs. 0.05 [interquartile interval 0.01-0.18 ng/mL] for the group without ACR. In the multivariate analysis, RV-FWLS was the only independent predictor of ACR, with odds ratio of 1.70 (CI 95% = 1.17-2.48); p=0.006. We concluded that STE-derived RV-FWLS was a sensitive and specific marker of ACR. Our data suggest that this is a suitable technique for noninvasive detection of changes in the right ventricular deformation during an episode of ACR

Bakgrund: Ekokardiografi har en betydande roll i diagnostisering av vänster kammare. Genom undersökning av segmentell och global longitudinell strain samt strain rate kan regional och global kinetik bedömas. Vid kontraktion och relaxation deformeras myokardiet varvid segmentell strain mäter deformationen av respektive segment uttryckt i procent medan strain rate mäter hastigheten av deformationen. Genom summering av medelvärdet från alla segment erhålls global longitudinell strain. Syfte: Syftet med studien var att jämföra ultraljudbaserade segmentell och global strain samt strain rate i vänster kammare. Jämförelse har gjorts mellan mätningar utförd av erfaren biomedicinsk analytiker samt mindre erfarna biomedicinska analytikerstudenter. Metod: Kvantitativ studie där 10 testpersoner undersökts ekokardiografiskt. Bildtagningen och mätresultaten insamlades med Siemens Acuson SC2000. Sammanställning av insamlade mätvärden gjordes på Microsoft Excel och Microsoft Word i diagram och tabeller. För jämförelse av strain segmentellt och globalt samt strain rate har analysmetoden Related-Samples Wilcoxon Signed Rank Test använts. Resultat: Resultatet visade enbart en statistisk signifikant skillnad (p &lt;0,05) vid segmentell strain i basala segmenten i apikala projektioner mellan erfaren biomedicinsk analytiker och student 1. Konklusion: Datamaterialet är inte tillräckligt för att kunna generalisera resultatet till en större population. Det behövs fortsatta studier inom området för att dra en mer säkerställd slutsats. / Background: Echocardiography has a major role for assessment of the left ventricle. By using segmental and global longitudinal strain and strain rate both regional and global kinetics can be assessed. Segmental strain measures deformation of the myocardium as strain rate measures the velocity of the deformation. By summing the average from all segments, global longitudinal strain is obtained. Purpose:  To compare heart ultrasound-based segmental and global strain and strain rate in the left ventricle. Comparisons have been made between experienced biomedical laboratory scientist and less experienced biomedical laboratory scientist’s students. Method: Quantitative study were 10 test subjects have been examined echocardiographically. Imaging and measurements were collected with Siemens Acuson SC2000. Compilation of collected measurements were made on Microsoft Excel and Microsoft Word in charts and tables. For comparison of segmental and global strain and strain rate the analysis method Related-Samples Wilcoxon Signed Rank Test were used. Result: The result shows only one statistically significant difference (p &lt;0.05) of segmental strain in the basal segments of apical projections between experienced biomedical laboratory scientist and student 1.  Conclusion: The data material is not enough to generalize the result to a larger population. Further studies are needed to draw a more secure conclusion.

Cette thèse porte sur le développement et l’évaluation de techniques d’imagerie en échocardiographie. L’objectif est de proposer des méthodes d’imagerie ultrasonore ultrarapide pour estimer le mouvement cardiaque 2-D et 3-D.Première modalité d’imagerie du cœur, l’échocardiographie conventionnelle permet la mesure des déformations myocardiques à 80 images/s. Cette cadence d’imagerie est insuffisante pour quantifier les mouvements de la totalité du myocarde lors de tests d’efforts, utiles en évaluation clinique, au cours desquels le rythme cardiaque est augmenté. De plus, la résolution temporelle actuelle en échocardiographie 3-D limite ses applications, pourtant essentielles pour une caractérisation complète du cœur.Les contributions présentées ici sont 1) le développement et l’évaluation, pour l’application cardiaque, d’une méthode originale d’estimation de mouvement 2-D par imagerie ultrarapide et marquage des images, 2) l’étude de faisabilité de la mesure globale des déformations cardiaques avec une méthode innovante d’imagerie ultrasonore ultrarapide 2-D et 3) la généralisation de cette approche en 3-D pour l’imagerie des volumes cardiaques à haute résolution temporelle. Cette technique est basée sur l’émission d’ondes divergentes, et l’intégration d’une compensation de mouvement dans le processus de formation des volumes cardiaques.La méthode proposée permet l’estimation des mouvements cardiaques 2-D et l’échocardiographie ultrarapide 3-D. L’évaluation de notre approche pour la quantification des déformations myocardiques locales 2-D et 3-D pourrait permettre de proposer des pistes innovantes pour poursuivre nos études et améliorer le diagnostic en routine clinique / This PhD work focuses on the development and the evaluation of imaging techniques in echocardiography. Our objective is to propose ultrafast ultrasound imaging methods for 2-D and 3-D cardiac motion estimations.Echocardiography is one of the most widespread modality for cardiovascular imaging. Conventional clinical scanners allow measurement of myocardial velocities and deformations at 80 images / s. In some situations, it can be recommended to increase the heart rate during a stress echocardiographic examination. Motion estimation of the whole myocardium at such heart rates is challenging with the conventional imaging systems. In addition, the low temporal resolution of the current conventional 3-D echocardiography limits quantitative applications, which would be needed for a complete characterization of the heart.The three contributions presented here are 1) the development and evaluation of an original method for 2-D cardiac motion estimation, with ultrafast imaging and image tagging, 2) the feasibility study of the global myocardial deformation measurement using an innovative 2-D ultrafast ultrasound imaging method and 3) the generalization of this approach in three dimensions for high frame-rate 3-D echocardiography. This method is based on the transmission of divergent waves and the integration of motion compensation, during the imaging process, to produce high-quality volumetric images of the heart.The proposed method allows 2-D cardiac motion estimation and 3-D echocardiography at high frame-rate. The evaluation of our approach for local 2-D and 3-D myocardial deformation measurements should permit to conduct further study in order to improve medical diagnosis

Introdução: A doença falciforme (DF) é a afecção hematológica hereditária de maior prevalência no mundo, sendo que a anemia falciforme (AF) é a forma mais grave com elevada morbidade e mortalidade. Alterações cardíacas são reconhecidamente associadas à AF, como aumento cavitário, hipertensão arterial pulmonar e disfunção diastólica do ventrículo esquerdo. No entanto, ainda não existe consenso quanto à função sistólica ventricular nesses pacientes. O objetivo deste estudo foi o de investigar a função ventricular de pacientes com anemia falciforme utilizando o strain e o twist ventricular obtidos pelo speckle tracking bidimensional, e reconhecer os indivíduos sob maior risco cardiovascular, em que a instituição precoce de tratamento específico poderá beneficiar essa população. Métodos: Foram recrutados 40 pacientes com anemia falciforme (23,5 ± 9,3 anos; 24 homens) e 40 controles saudáveis pareados por sexo e idade, submetidos à entrevista estruturada, ecocardiograma transtorácico, cintilografia pulmonar ventilação perfusão e coleta de amostras de sangue. Todos os indivíduos foram submetidos à avaliação ecocardiográfica convencional padrão e subsequente avaliação offline do strain sistólico biventricular e estudo rotacional do ventrículo esquerdo utilizando speckle-tracking ecocardiográfico. Resultados: Os pacientes com AF apresentaram volume do VE indexado, massa do VE indexado, pressão arterial pulmonar e E/E\' médio superiores aos controles. As medidas de FE do VE, excursão sistólica do plano da tricúspide (TAPSE), Strain Global do VE (longitudinal, circunferencial, radial) e Strain Global do VD (longitudinal) não evidenciaram diferenças entre os grupos. Twist VE se mostrou reduzido em comparação aos controles (7,4 ± 1,2? vs 10,7 ± 1,8? , P <0,0001 ) e Tempo de pico de rotação apical prolongado (366,7 ± 26,1ms vs 344,6 ± 11,7ms , P <0,0001 ). Algumas variáveis se mostraram fortemente relacionadas ao twist VE, como índice de gravidade clínico (Rho= - 0,97, Z value= - 6,05, P < 0,0001), relação E/E\' médio (r = 0,94, F valor= 156.9, p<0,0001), IVDFVE (índice do volume diastólico final do ventrículo esquerdo)(r = 0,81 e p<0,0001) e pressão sistólica arterial pulmonar (r = 0,72 e p<0,0001). Conclusões: Os resultados deste trabalho indicam que o twist ventricular esquerdo derivado do speckle tracking bidimensional encontra-se alterado em pacientes com anemia falciforme e função sistólica ventricular preservada, avaliada pela metodologia convencional, e existe forte correlação entre o twist ventricular esquerdo e o índice clínico de gravidade, relação E/E\', índice do volume diastólico final do ventrículo esquerdo e pressão sistólica arterial pulmonar. / Background: Sickle cell disease (SCD) is the most prevalent hematological condition in the world, with sickle cell anemia (SCA) being its most serious form, displaying a high level of morbidity and mortality. Cardiac changes are known to be associated with SCA, including an increase in cardiac chamber size, pulmonary hypertension and left ventricle diastolic dysfunction. However, there is still no consensus regarding the ventricular systolic function in these patients. The purpose of this study is to investigate the ventricular function of patients with sickle cell anemia utilizing the strain and ventricular twist, obtained by two-dimensional speckle tracking, as well as to identify individuals with higher cardiovascular risk, in which early application of specific treatment could benefit this group of people. Methods: 40 patients were recruited with sickle cell anemia (ages 23.5 ± 9.3 years; 24 males) and 40 healthy control individuals paired by gender and age, submitted to structured interviews, transthoracic echocardiogram, pulmonary scintigraphy and collection of blood samples. All individuals were submitted to a standard echocardiographic evaluation and subsequent off line evaluation of the biventricular systolic strain and rotational study of the left ventricle using echocardiographic speckle-tracking. Results: Patients with SCA presented LV volume indices, LV mass Indices, pulmonary arterial pressure and E/ E\' ratios statistically higher than the control individuals. Measurements of Ejection Fraction (EF) of the left ventricle, tricuspid annular plane systolic excursion (TAPSE), Overall LV Strain (Longitudinal, Circumferential, and Radial) and Overall RV Strain (Longitudinal) did not present differences between the groups. LV twist was significantly lower in relation to the control group (7,4 ± 1,2? vs 10,7 ± 1,8? , P <0,0001 ) and prolonged time to peak apical rotation (366.7 ± 26.1ms vs 344.6 ± 11.7ms , P <0.0001 ). In addition, some variables showed themselves to be strongly related to LV twist such as the clinical severity index ( Rho= - 0.97, Z value= - 6.05, P < 0.0001), E/E\' Ratio (r = 0.94, F value=156.9 e p<0.0001) ), left ventricle end diastolic volume index (LVEDV index) (r = 0,81, p<0,0001) and pulmonary systolic arterial pressure (r = 0.72 e p<0.0001). Conclusions: The results of this study indicate that the left ventricular twist derived from two-dimensional speckle tracking is altered in patients with sickle cell anemia and a preserved ventricular systolic function, evaluated using conventional methodology and that there is a strong correlation between left ventricular twist and the clinical severity index, E/E\' ratio, left ventricle end diastolic volume index and the pulmonary systolic arterial pressure.

No description available.

Background: Coarctation of the aorta (CoA) is a congenital heart disease which represents a narrowing of the proximal descending aorta, hence increasing pressure afterload to the left ventricle (LV). Conventional treatment of native CoA is surgical repair, however potential recurrence or other related complications e.g. aortic rupture, heart failure and cerebrovascular events are common. Thus, lifelong follow-up of these patients is required. Echocardiography is the most patient’s friendly method to evaluate CoA and in particular its effect on LV function. Moreover, the novel speckle tracking echocardiography (STE) is an important method to assess subclinical LV dysfunction, a technique that promises better evaluation of LV function in these patients. The aims of this thesis were to review the literature on LV function in children with CoA using myocardial deformation imaging technologies, hence, to better understand the current knowledge and vagueness of the scientific evidence. We also aimed to study the effect of early CoA repair on the structure and function of LV and ascending aorta. In addition, we wished to establish in a meta-analysis format normal values of speckle tracking derived strain and strain rate values. Methods: Study 1. We have systematically searched the PubMed, and studies that fulfilled the inclusion criteria were critically analyzed and presented on a narrative form. Study 2 and 3. In addition to conventional echocardiographic measures of LV and ascending aorta, we measured longitudinal strain and strain rate of the LV using a vendor independent software, TomTec. We have also measured the aorto-septal angle (AoSA). Data was compared with normal healthy controls. Study 4. Electronic databases were systematically searched and suitable studies were meta analyzed using Comprehensive meta-analysis version 3 software. Results: Study 1. In 7/4945 included articles, 123 and 76 patients with congenital aortic stenosis (CAS) and CoA were reported, respectively. Normal conventional LV function, with subclinical myocardial dysfunction were reported in all studies before intervention. After intervention, a consistent improvement of myocardial deformation parameters was documented, even though not reaching normal values. Study 2. In 21 patients with CoA, LV function significantly improved after intervention (p &lt;0.001), however normal values were not reached even at medium-term follow-up (p = 0.002). Medium-term longitudinal strain correlated with pre intervention LV ejection faction (EF) (r = 0.58, p = 0.006). Medium-term subnormal values were more frequently associated with Bicuspid aortic valve (BAV) (33.3% vs. 66.6%; p &lt;0.05). Study 3. AoSA was abnormally wide before intervention, in particular at peak ejection in the descending aorta (p &lt;0.0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters. Study 4. In a meta-analysis of 28/282 studies including 1192 subjects, strain and strain rate values were established. Longitudinal strain normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end-diastolic diameter as a significant determinant of variation of longitudinal strain. Longitudinal systolic strain rate was significantly determined by age and radial strain was influenced by the type of vendor used. Conclusion: The systematic review showed subclinical LV dysfunction in children with CoA before and after correction. However, since most of the patients were operated at an older age and had preserved LV EF, the effect of early intervention on LV function was only speculated. Our children with CoA who were operated at an earlier age showed LV subclinical dysfunction even at medium- term after intervention while the AoSA returned to normal shortly after intervention. Lower longitudinal strain values were found in patients with LV dysfunction (LV EF &lt;50%) before intervention and BAV. Finally, normal range values for strain and strain rate have been established and seem to be influenced by patients’ age, LV end-diastolic diameter and vendor used.

Background:Left ventricular function is particularly important to investigate since it has prognostic significance in some heart diseases such as aortic stenosis. One of the relatively new methods to evaluate this is deformation analysis that can produce a measure of global longitudinal strain with speckle-tracking.  Objective:The objective was to examine the possibility of measuring left ventricular longitudinal function in patients with aortic stenosis from ECG-gated computed tomography images with the new software Segment CT and investigate prevalence of its reduction. Additionally, a second objective was to evaluate the feasibility of global longitudinal strain analysis from ECG-gated computed tomography in comparison with echocardiography and ejection fraction in a subset of patients.  Material and methods:This study included 97 patients with severe aortic stenosis who underwent evaluation before planned treatment with transcatheter aortic valve implantation during 2016-2017 at Uppsala Hospital. Global strain was calculated from ECG-gated computed tomography and echocardiography with dedicated software. Results:Left ventricular function measured by global strain was impaired in all patients while ejection fraction was decreased in 31 %. Mean global longitudinal strain by ECG-gated computed tomography was -6.46±3.51 % and by echocardiography -10.69±4.23 %. The mean difference between the methods was 4.23 %, which was statistically significant (p=0.02) while the correlation was good (r=0.74). Conclusions:The strain analysis of ECG-gated computed tomography images was successful in less than a half of the patients. The results of the two methods showed good correlation but not agreement, further research is thus needed with a higher number of patients.

Submitted by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-06-12T13:51:00Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) RAIMY COSTA MARTINS.pdf: 1412873 bytes, checksum: 1a015a5d3ada01cbd7dea500b27c388a (MD5) / Approved for entry into archive by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-06-12T13:51:13Z (GMT) No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) RAIMY COSTA MARTINS.pdf: 1412873 bytes, checksum: 1a015a5d3ada01cbd7dea500b27c388a (MD5) / Made available in DSpace on 2017-06-12T13:51:13Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) RAIMY COSTA MARTINS.pdf: 1412873 bytes, checksum: 1a015a5d3ada01cbd7dea500b27c388a (MD5) Previous issue date: 2017-03-21 / O “coração atleta” é o termo designado para caracterizar as adaptações cardíacas funcionais e anatômicas secundárias ao treinamento físico intenso e prolongado em humanos e animais. O ecocardiograma desempenha papel fundamental em distinguir as adaptações fisiológicas secundárias ao exercício, outrossim, as recentes técnicas introduzidas como Speckle Tracking (Ste) têm permitido obter informações relevantes a respeito da função cardíaca em humanos atletas. Desta forma, objetivou-se avaliar por meio do ecocardiograma, a estrutura e função sistólica do ventrículo esquerdo de cães praticantes de pastoreio há no mínimo quatro meses, cinco a seis vezes por semana, de quatro a oito horas por dia. Para tanto, 31 cães foram divididos em dois grupos: grupo pastoreio (GP, n=15) e grupo sedentário (GS, n=16), avaliados em um único momento, em repouso, e posteriormente submetidas a análise de variância, multivariada (ANOVA), dois por dois, em nível de significância à 95% (p<0,05) e tendência à 90% (p<0.1). Os cães do GP apresentaram maiores valores de diâmetro interno do ventrículo esquerdo ao final da sístole (GP: 2,72 ± 0,09; GS: 2,43 ± 0,09; P<0,034) indicando predomínio isotônico desta atividade. O volume sistólico apresentou-se maior no GP (GP: 28,51 ± 2,20; GS: 22,13 ± 2,17; P<0,049), enquanto o índice de performance miocárdica do ventrículo esquerdo (GP: 0,37 ± 0,03; GS: 0,46 ± 0,03; P<0,028) e o movimento sistólico septal (GP: 0,13 ± 0,01; GS: 0,15 ± 0,01; P<0,044) foram menores em relação ao GS, indicando melhor função cardíaca sisto-diastólica nos cães de pastoreio. Por meio da técnica Ste foi possível observar diminuição dos valores de strain e ou strain rate de alguns segmentos nos cães do GP, nos sentidos radial, circunferencial, longitudinal e transversal em relação ao GS, indicando menor necessidade de deformação miocárdica para a manutenção da função sistólica. Os resultados encontrados indicam que as variáveis ecocardiográficas convencionais (estruturais e funcionais), teciduais e provenientes da técnica STe, foram complementares e fundamentais para a compreensão das adaptações cardiovasculares em cães de pastoreio. / The "athlete's heart" is the term designed to characterize functional and anatomic cardiac adaptations secondary to intense and prolonged physical training in humans and animals. The echocardiogram plays a fundamental role in distinguishing the physiological adaptations secondary to exercise, also, the recent techniques introduced as Speckle Tracking Echocardiography have allowed us to obtain relevant information regarding cardiac function in human athletes. The aim of this study was to evaluate the structure and systolic function of the left ventricle of dogs practicing herding for at least four months, five to six times a week, from four to eight hours a day using echocardiography. For this, 31 dogs were divided into two groups: herding group (GP, n=15) and sedentary group (GS, n=16), evaluated in a single moment, at rest, and then submitted the multivariate analysis of variance (ANOVA), two by two, at the level of significance at 95% (p<0,05) and tendency to 90% (p<0.1). The GP dogs showed higher values of internal diameter of the ventricle at the end of systole (GP: 2,72 ± 0,09; GS: 2,43 ± 0,09; P<0,034), indicating isotonic predominance of this activity. At respect functional adaptations variables, systolic volume was higher in GP (GP: 28,51 ± 2,20; GS: 22,13 ± 2,17; P<0,049), differently from myocardial performance index of the left ventricle (GP: 0,37 ± 0,03; GS: 0,46 ± 0,03; P<0,028) and septal systolic moviment to GS (GP: 0,13 ± 0,01; GS: 0,15 ± 0,01; P<0,044). By means of the Ste technique, it was possible to observe a decrease in the strain and or strain rate values in GP dogs, in the radial, circumferential, longitudinal and transverse directions in relation to GS, indicating a lower need for myocardial deformation to maintain systolic function. The results indicate that the conventional echocardiographic variables (structural and functional) and tissue, obtained by the STe technique, were complementary and essential for the understanding of cardiovascular adaptations in herding dogs.

Estratificar o risco de morte súbita é um grande desafio no manejo da cardiomiopatia hipertrófica (CMH). Os fatores de risco existentes atualmente apresentam baixo valor preditivo positivo e a estratégia para prevenção primária de morte súbita, que é o implante do cardiodesfibrilador implantável (CDI), baseia-se nesses fatores. Estudos que validem novos marcadores de risco são necessários, objetivando identificar pacientes com maior risco de morte súbita. A avaliação da deformação miocárdica (strain) por meio do Speckle Tracking na ecocardiografia bidimensional determina a função regional e global do ventrículo esquerdo, e, ainda, pode se correlacionar à fibrose miocárdica. Objetivo: Avaliar, em portadores de CMH e CDI, se a deformação miocárdica avaliada pelo Speckle Tracking, correlaciona-se com a ocorrência de taquiarritmias ventriculares registradas no monitor de eventos do CDI. Métodos: Foram incluídos 49 pacientes (43,5±15,8 anos; 59% mulheres) portadores de CMH e CDI acompanhados nos ambulatórios de Eletrofisiologia e Miocardiopatias do Instituto Dante Pazzanese de Cardiologia. Todos os pacientes foram submetidos à avaliação ecocardiográfica convencional padrão e análise do strain miocárdico pelo Speckle Tracking bidimensional. Foram divididos em dois grupos: grupo A, composto por aqueles que receberam terapia apropriada pelo CDI ou tiveram apenas a documentação de taquicardia ventricular não sustentada pelo CDI; e grupo B, composto por pacientes sem documentação de arritmias ventriculares no monitor de eventos. As variáveis contínuas foram comparadas utilizando-se testes t de Student pareado ou Mann-Whitney; para as categóricas o teste do x2 ou testes exatos de Fisher. Para análise dos dados, utilizou-se o programa SPSS. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Em 93,9% da população, a indicação do CDI foi por prevenção primária. Quinze pacientes (30,6%) compuseram o grupo A, 10 pacientes, por apresentarem taquicardia ventricular não sustentada (TVNS) e 5 por taquicardia ventricular sustentada (TVS). Os parâmetros ecocardiográficos convencionais não foram diferentes entre os grupos, com exceção do diâmetro da raiz aórtica, maior no grupo A (33,6 ± 4,4 e 29,4 ± 3,5, p = 0,001). Os valores do strain bidimensional longitudinal global, circunferencial global e radial global estavam reduzidos na população, porém não foram estatisticamente diferentes entre os grupos A e B. Pacientes do grupo A tiveram redução significante do strain circunferencial médio ao nível da valva mitral (SC médio VM) e do strain circunferencial no segmento ântero-septal ao nível da valva mitral (SC ântero-septal VM), em relação aos pacientes do grupo B (-12,3 ± 3,2 e -16 ± 3,9, p = 0,041 e -13,6 ± 6,6 e -18,7 ± 7,2, p = 0,039, respectivamente). O SC médio VM >= -14,2% apresentou 84,6% de sensibilidade e 70% de especificidade para predizer a ocorrência de taquicardias ventriculares em portadores de CMH com uma área sob a curva de 0,76 e nível de significância de 0,005; e O SC ântero-septal VM >= -17,9% apresentou 77% de sensibilidade e 60% de especificidade para predizer a ocorrência de taquicardias ventriculares em portadores de CMH com uma área sob a curva de 0,68 e nível de significância de 0,044. Conclusões: A presença de SC médio VM > -14,2% e SC ântero-septal VM > -17,9% correlacionaram-se com a presença de arritmias ventriculares malignas. Houve correlação positiva entre a presença de arritmias ventriculares malignas e o diâmetro da raiz da aorta. / Risk stratification for sudden cardiac death is still a challenging in the management of hypertrophic cardiomyopathy (HCM). The existing risk factors present low positive predictive value, and the strategy for primary prevention of sudden cardiac death, that is the implantable cardioverter-defibrillation (ICD), is based on these factors. Studies to validate new risk markers are necessaries to identify patients with higher sudden cardiac death risk. The evaluation of myocardial deformation (strain) through Speckle Tracking in two-dimensional echocardiography determines the regional and global function of the left ventricle, and still correlate with myocardial fibrosis. Objective: To evaluate, in patients with HCM and ICD, if the myocardial deformation evaluated through the Speckle Tracking correlates with the occurrence of ventricular tachyarrhythmias recorded in the monitor of implantable cardioverter-defribillation events. Methods: Forty-nine patients (mean age, 43,5 ± 15,8; 59% women) with hypertrophic cardiomyopathy and implantable cardioverter-defibrillation followed in Eletrophysiology and Cardiomyopathies Divisions at Dante Pazzanese Institute of Cardiology were included in the study. All patients underwent standard conventional echocardiographic evaluation and analysis of myocardial strain through two-dimensional Speckle Tracking. Patients were divided in two groups: group A, composed of those who received appropriate therapy by the ICD or had only the documentation of ventricular tachycardia not sustained by the ICD; group B, composed of patients without documented ventricular arrhythmias in the event monitor. Continuous variables were compared using paired t-Student test or Mann-Whitney. Categorical variables were analyzed using chi-square test or Fisher exact test. For data analysis, the SPSS program was used. P values < 0.05 were considered statistically significant. Results: Forty-nine patients (mean age, 43,5 ± 15,8; 59% women) were evaluated. 93.9% in the ICD was for Primary Prevention. Fifteen patients comprised the group A, ten patients for presenting Nonsustained Ventricular Tachycardia (NSVT) and five for Sustained Ventricular Tachycardia (SVT). Conventional echocardiographic parameters were not different between the groups, except for the aortic root diameter, higher in group A (33,6 ± 4,4 and 29,4 ± 3,5; p= 0,001). The values of global longitudinal, global circumferential and global radial two-dimensional strain were reduced in the population, but not statistically significant between groups A and B. Patients in group A had a significant reduction of the mean circumferential strain at the level of the mitral valve (mean SC MV) and the circumferential strain at the anteroseptal segment at the level of the mitral valve (anteroseptal MV SC), compared to the patients in group B (-12.3 ± 3.2 and -16 ± 3.9, p = 0.041 and -13.6 ± 6.6 and -18.7 ± 7.2, p = 0.039, respectively). The mean MV SC >= -14.2% presented 84.6% sensitivity and 70% specificity to predict the occurrence of ventricular tachycardias in patients with HCM with an area under the curve of 0.76 and a level of significance of 0.005 and Anteroposterior MV >= -17.9% presented 77% sensitivity and 60% specificity to predict the occurrence of ventricular tachycardias in patients with HCM with an area under the curve of 0.68 and a level of significance of 0.044. Conclusions: The presence of mean circumferential strain at the level of the mitral valve > -14,2% and anteroseptal circumferential strain at the level of the mitral valve > -17,9% correlated with the presence of malignant ventricular arrhythmias. There was a positive correlation between the presence of malignant ventricular arrhythmias and the aortic root diameter.