ABC Imagem Cardiovascular

Original Article

Correlating Invasive and Echocardiographic Hemodynamic Measures in Patients with Heart Failure with Reduced Ejection Fraction

João Pedro da Rosa Barbato et al. Fernando Luis Scolari Guilherme Pinheiro Machado André Barcellos Amon Pedro Castilhos de Freitas Crivelaro Willian R. Menegazzo Solano Vinicius Berger Gustavo Neves de Araujo Felipe Homem Valle Rodrigo Vugman Wainstein

Abstract

Background:

The management of heart failure with reduced ejection fraction (HFrEF) has advanced with the use of invasive hemodynamic markers such as cardiac power output (CPO) and pulmonary artery pulsatility index (PAPI). Simultaneously, interest has grown in noninvasive prognostic indicators, especially the left ventricular outflow tract velocity–time integral (LVOT-VTI).

Objective:

This study aimed to assess the correlation between invasive and echocardiographic parameters, particularly CPO, PAPI, and LVOT-VTI, in patients with HFrEF.

Methods:

This cross-sectional, single-center study included inpatients and outpatients with chronic stable or acutely decompensated HFrEF. Individuals with cardiogenic shock (CS) were excluded. Right heart catheterization (RHC) and echocardiography were performed on the same day. Statistical significance was defined as a two-sided p value < 0.05.

Results:

Significant correlations were observed between invasive and echocardiographic CPO (r = 0.737, p < 0.001) and PAPI (r = 0.604, p < 0.05). LVOT-VTI showed significant correlation with CPO measured via pulmonary artery catheter (PAC) (r = 0.469, p < 0.01). Echocardiographic PAPI was measurable in only 16 patients. A sensitivity analysis of those receiving inotropes showed an even stronger correlation between invasive and echocardiographic CPO (r = 0.812, p = 0.005).

Conclusion:

Echocardiographic and invasive hemodynamic parameters showed significant correlations in HFrEF, particularly CPO, supporting echocardiography as a potential alternative for hemodynamic assessment. However, the low feasibility of noninvasive PAPI measurement highlights important limitations in this population.

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Abstract

Mitral stenosis (MS) is the main clinical expression of chronic rheumatic heart disease. In symptomatic patients with severe MS and favorable anatomy, percutaneous mitral balloon valvuloplasty (PMBV) is the first-line therapeutic strategy. For the proper selection of candidates, the Wilkins-Block echocardiographic score was developed to characterize mitral valve morphology and predict eligibility for the procedure. This score includes four structural domains: leaflet mobility, valve thickening, degree of calcification, and subvalvular apparatus involvement, grading each parameter from 1 to 4 points, resulting in an overall range of 4 to 16 points, in increasing order of anatomical severity. The Wilkins score has become a widely validated tool, showing a consistent correlation with the immediate and long-term outcomes of PMBV. Among the limitations of the score, the absence of commissural anatomy assessment stands out, a variable recognized as a relevant prognostic determinant due to its strong association with the occurrence of post-procedure mitral regurgitation, considered the most frequent and clinically significant complication of PMBV. With the accumulation of clinical and technical experience, the indications for PMBV have been progressively extended to include patients with less favorable anatomical profiles. In these contexts, selection must be particularly rigorous, incorporating not only morphological criteria derived from echocardiographic evaluation, but also clinical aspects, in order to ensure satisfactory results and minimize the risk of complications.

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Original Article

Monitoring Myocardial Metabolic Changes in Lymphoma Patients Undergoing Chemotherapy Using FDG PET/CT

Diego Rafael Freitas Berenguer et al. Gustavo Freitas Alves de Arruda Monica de Moraes Chaves Becker Mayara Lais Coelho Dourado Roberto de Oliveira Buril Felipe Alves Mourato Paulo José de Almeida Filho Brivaldo Markman-Filho Simone Cristina Soares Brandão

Abstract

Background:

Cardiotoxicity is a serious adverse effect of chemotherapy, often identified only after irreversible myocardial damage has occurred. Positron emission tomography/computed tomography (PET/CT) using fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) allows for the evaluation of myocardial glucose metabolism and may help detect early metabolic changes related to chemotherapy.

Objective:

To assess changes in ¹⁸F-FDG standardized uptake values (SUVs) across different cardiac regions before and after chemotherapy in patients with lymphoma, and to identify which region exhibits the greatest increase.

Methods:

This retrospective cohort study included 62 lymphoma patients who underwent ¹⁸F-FDG PET/CT before and after chemotherapy. SUV measurements were obtained in the left ventricular (LV) free wall, interventricular septum (IVS), right ventricular (RV) free wall, and global myocardium. Control regions included the liver and aorta. Pre- and post-treatment SUV values were compared to evaluate metabolic changes related to chemotherapy.

Results:

Myocardial ¹⁸F-FDG uptake increased significantly after chemotherapy across all cardiac regions, with the most pronounced rise observed in the LV free wall (maximum SUV increase of 73%, p<0.001). The RV free wall showed a non-significant increase in SUV, and no significant changes were observed in the liver or aorta.

Conclusions:

Chemotherapy was associated with a global increase in myocardial ¹⁸F-FDG uptake, with the most pronounced elevation observed in the LV free wall. This regional predominance highlights the LV free wall as the most sensitive site for detecting early metabolic changes potentially related to cardiotoxicity.

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Abstract

Background

Dobutamine stress echocardiography (DSE) using the conventional protocol (CP-DSE) may lead to important adverse effects.

Objective

This study was aimed at assessing the safety of DSE using a modified protocol (MP-DSE).

Methods

Data were collected from our institutional database to compare MP-DSE with the CP-DSE. In the CP-DSE, atropine could be administered during the fourth stage or its extension. In the MP-DSE, atropine was initiated at the beginning of the third stage, and there was no stage extension. Upon completion of DSE or for arrhythmia control, metoprolol was administered in the CP-DSE and esmolol in the MP-DSE. In cases of typical angina, nitroglycerin was administered at the examiner’s discretion in the CP-DSE, whereas its use was predetermined in the MP-DSE. A p-value < 0.05 was considered statistically significant.

Results

Of 17,811 tests performed, 9,121 were conducted using the MP-DSE. During DSE, myocardial oxygen consumption, represented by the rate-pressure product, was significantly higher in the MP-DSE group (22,530 ± 4,575 vs 23,037 ± 4,072 bpm.mmHg; p < 0.001). Hypertensive peak (1% vs 0.4%; p = 0.0001) and nonsustained ventricular tachycardia (0.6% vs 0.1%; p = 0.0001) were more frequent in the CP-DSE, while supraventricular tachyarrhythmia (2.1% vs 3.78%; p = 0.0001) and atrial fibrillation (0.8% vs 1.3%; p = 0.003) were more common in the MP-DSE. These arrhythmias resolved spontaneously or with medication. In the CP-DSE, two patients had ventricular fibrillation and one, acute coronary syndrome.

Conclusion

In our study, the modified protocol for DSE proved to be a safe option, with no severe adverse effects observed, despite the presence of an elevated rate-pressure product.

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