2019;32(1) – ABC CARDIOL

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Primary prevention, through early diagnosis, is necessary to enable proper treatment and control disease progression, reducing mortality and public health expenditures.

Objective

Correlate carotid artery atherosclerosis (evaluated by Doppler echocardiography) and left ventricular dysfunction (evaluated by echocardiography) and to correlate the findings with the patients’ cardiovascular risk.

Method

A total of 286 medical records of patients who underwent carotid Doppler echocardiography and transthoracic echocardiography were analyzed. The data analyzed were: presence of atherosclerotic plaque and degree of stenosis, left ventricular ejection fraction and presence of diffuse or segmental left ventricular contractile disorders.

Results

Of the 238 reports of carotid Doppler echocardiography, 18 had stenosis greater than 70% in the carotid artery and 14 of those had left ventricular contractile disorders (p = 0.045). Of the patients with very high cardiovascular risk, 61 had carotid artery stenosis (p < 0.001); 51 patients with very high cardiovascular risk had contractile disorders (p < 0.001). Of the 266 echocardiography reports, 37 had reduced left ventricular ejection fraction. Of these, 25 had very high cardiovascular risk (p < 0.001).

Conclusion

There was a positive relationship between carotid artery stenosis, reduced left ventricular ejection fraction and left ventricular (diffuse or segmental) contractile disorder with very high cardiovascular risk. It was also possible to correlate carotid stenosis with contractile disorder, although this study did not demonstrate any correlation between carotid stenosis and reduced left ventricular ejection fraction. (Arq Bras Cardiol: Imagem cardiovasc. 2019;32(1):6-13)

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Image

A Complicated Mitral Prosthesis Endocarditis: An Inevitable Outcome?

Sofia Alegria et al. Ana Marques Inês Rosário Cruz Nádia Junqueira Otília Simões

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Message from the Editor

Viviane Hotta

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Review Article

Left Atrial Function Using Speckle Tracking: Beyond Volumetric Evaluation

Mardson de Araújo Medeiros et al. Rodrigo Pinto Pedrosa Carlos Antonio da Mota Silveira Jose Maria Del Castillo

Abstract

Evaluation of left atrial function is currently an emerging method that may be related to patient prognosis. Classically, the static measures of diameter, area and volume are the most used for this purpose. The technique known as speckle tracking is capable of providing dynamic information of the left atrium throughout the cardiac cycle, as well as detecting abnormalities in left atrial function in subclinical phases, before volumetric increases or diastolic dysfunctions occur. Normality values for speckle tracking are being proposed, but the methodological differences and techniques make it difficult to standardize them. This literature review aims to discuss progress in the analysis of left atrial function, especially via speckle tracking.

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Review Article

What is the Value of Perfusion Scintigraphy and Cardiac PET in Hypertrophic Cardiomyopathy?

Elry Medeiros Vieira Segundo Neto et al. Rafael Willain Lopes Simone Cristina Soares Brandão

Abstract

Hypertrophic cardiomyopathy is the most common hereditary heart disease and affects about 1:500 individuals in the general population. Diagnosis is not always simple due to phenotypic variation and concomitance with other pathologies. It is initially based on electrocardiographic and echocardiographic criteria and on the absence of other diseases occurring with ventricular hypertrophy. Having myofibrillar derangement and fibrosis as a cellular base resulting in hemodynamic abnormalities, hypertrophic cardiomyopathy may reveal myocardial ischemia (not related to atherosclerosis) and sudden death. Therefore, evaluation of functional repercussion with myocardial perfusion scintigraphy using the Single Photon Emission Computed Tomography (SPECT) has gained space, since 25% of patients with hypertrophic cardiomyopathy have fixed or ischemic perfusion defects. In this context, some perfusion disorders are not necessarily associated with the type of hypertrophic cardiomyopathy, but are able to predict morbidity and mortality in these individuals. Another recent scintigraphy technique is the positron emission tomography (PET), which stands out in the evaluation of microcirculation, coronary flow reserve and myocardial metabolism. In patients with hypertrophic cardiomyopathy, studies have shown unfavorable results when myocardial blood flow and coronary flow reserve are lower. Metabolic myocardial evaluation using PET seems to be useful in the pathophysiological understanding of this disease and in the prognostic evaluation of alcohol ablation, a procedure performed in severe obstructive forms. This review addresses the role of nuclear cardiology using SPECT and myocardial PET in the diagnostic, prognostic and therapeutic evaluation of hypertrophic cardiomyopathy.

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Review Article

Applications of the Myocardial Strain Study using Two-Dimensional Speckle Tracking in Pediatrics

Gabriela Nunes Leal

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Case Report

Cor Triatriatum Sinistrum in Symptomatic Adult: Case Report

Francilayne Moretto dos Santos et al. Laura Gomes Flores Felipe Rodrigues Dias Leandro Shigueru Ikuta Ueda Eduardo Frederico Philippi

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Viewpoint

Non-compaction cardiomyopathy: How Can Imaging Contribute?

José de Arimateia Batista Araújo Filho et al. Antonildes Nascimento Assunção-Jr José Rodrigues Parga

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Case Report

Right Ventricular Endomyocardial Fibrosis: Case Report

Stella de Souza Carneiro et al. Patrick Ventorim Costa Aline Valério de Lima Fernando Luiz Torres Gomes … Ludmilla Ventura Lirio Danielle Cristina Filgueira Alves Batista

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Original Article

Association between Insufficiency of Anterior Perforator Vein of the Knee and Great Saphenous Vein Insufficiency in Patients with Primary Varicose Veins of the Lower Limbs

Marcio Vinícius Lins Barros et al. Gabriela Silva Lauar Jéssica Monteiro Machado Maria Cláudia Freitas Silva Taynara Andrade Capanema

Abstract

Background

The accurate identification of reflux points in the study of primary varicose veins of the lower limbs is important in the therapeutic approach of these patients.

Objective

To evaluate the association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs.

Methods

The study included 886 patients, corresponding to 1,772 lower limbs, in patients older than 18, of both sexes, undergoing superficial venous mapping using vascular ultrasound.

Results

The mean age of the patients was 46.1 ± 14.5 and 81.7% were females. Great saphenous vein insufficiency was found in 38.8% of the cases. Insufficiency of the anterior perforator vein of the knee was found in 146 lower limbs (8.2%), with a mean diameter of 1.7 ± 0.15 mm, prevailing in the infrapatellar area (86.4%). The anterior tributary vein of the great saphenous vein originated leg reflux in 34%, with a direct relation of this tributary vein with the anterior perforator vein of the knee in 79.4%. An association between the presence of anterior perforator vein of the knee and great saphenous vein insufficiency (p = 0.0001) and male gender (p = 0.001).

Conclusion

There was an association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs at vascular ultrasound, and the accurate identification of this perforator vein may be important in the therapeutic approach of these patients. (Arq Bras Cardiol: Imagem cardiovasc. 2019;32(1):14-18)