2020;33(3) – ABC CARDIOL

Editorial

My Approach to Analyze Diastolic Function in Indeterminate Cases by the 2016 American Society of Echocardiography Guideline?

Renato Hortegal et al. Henry Abensur

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Case Report

A Rare Cause of Hypoxemia

Lisete Lopes et al. Patrícia Vaz Silva Dina Rodrigues António Pires

Abstract

An unroofed coronary sinus is a very rare cardiac anomaly that is commonly associated with a persistent left superior vena cava. Its diagnosis is often difficult, but clinical signs and echocardiographic findings of an interatrial shunt should raise its suspicion. The authors describe the case of a child with chronic hypoxemia whose diagnostic work-up revealed an unroofed coronary sinus and persistent superior left vena cava.

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Case Report

Giant Atrial Thrombus in a Patient with Mitral Stenosis: A Case Report

Julia Garcia Leal Elias et al. Maurício Marson Lopes Fernanda Betanho Mori Luana Monferdini … Maria Ligia Ciscon Guilherme Viana Barbosa

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Review Article

Use of Echocardiography in Infectious Endocarditis Associated with Implantable Cardiac Devices

Mauricio Vitor Machado Oliveira et al. Pedro Henrique Oliveira Murta Pinto Gustavo Brandão de Oliveira Luan Salvador Machado Barbalho … André de Oliveira Parreiras Fernanda Alves Gelape Teresa Cristina Abreu Ferrari Maria Carmo Pereira Nunes

Abstract

In recent decades, the increase in indications for cardiac implantable electronic devices (CIEDs) has been accompanied by an increased number of complications related to their use, including infectious endocarditis (IE). IE has high morbidity and mortality rates despite advances in diagnostic and therapeutic strategies. The case studies on this topic have significant limitations in terms of diagnostic criteria and methods, which affect decision-making on CIED removal and increase the risk of complications and death. Notwithstanding, echocardiography is critical for diagnosing CIED-associated IE and related potential complications. The limitations and challenges in its diagnosis demand the need for further studies on the topic. The objective of this study was to elucidate the epidemiology, microbiology, risk factors, pathogenesis, diagnosis, and treatment of IE associated with CIEDs to demonstrate the importance of imaging techniques in diagnosis of IE, especially echocardiography.

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Editorial

Therapeutic Application of Ultrasound and Microbubbles (Sonothrombolysis) in Patients with Acute Myocardial Infarction

Jeane Mike Tsutsui et al. Wilson Mathias Júnior

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Case Report

Analysis of Post-Systolic Shortening, Myocardial Strain, and Arterial Flow to Assess Myocardial Ischemia during Stress Echocardiography

Marilia Esther Benevides de Abreu et al. Renan Abreu Ponte Freire Luana Priscila G. Santos Isadora Sucupira Machado … Tereza Cristina Diógenes Pinheiro Antônio Augusto Guimarães Lima José Sebastião de Abreu

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Original Article

Fractional Flow Reserve by Tomography Diagnostic Performance in the Detection of Coronary Stenoses Hemodynamically Significant

Carlos Eduardo Elias dos Prazeres et al. Natália Boing Salvatti Hilka dos Santos Moraes de Carvalho Isaac Torquato Queiroz e Silva … Adriano Camargo de Castro Carneiro Tiago Augusto Magalhães Valéria de Melo Moreira Juliana Hiromi Silva Matsumoto Bello Carlos Eduardo Rochitte

Abstract

Background

Coronary computed tomography angiography is a noninvasive anatomic test for the diagnosis of coronary artery disease. The coronary fractional flow reserve is the gold standard method to determine if coronary stenosis is hemodynamically significant but requires an invasive procedure. Fractional flow reserve measurement by tomography is a new method to determine the hemodynamic significance of coronary luminal reduction.

Objective

To compare the accuracy of the invasive fractional flow reserve with the fractional flow reserve measurement by tomography.

Method

Patients submitted to invasive coronary computed tomography angiography and fractional flow reserve were included in the study. Flow-restricted stenosis was defined by fractional flow reserve measurement by tomography and fractional flow reserve ≤ 0.8, and anatomically significant coronary artery disease was defined as stenosis ≥ 50%. Diagnostic performance of fractional flow reserve measurement by tomography and stenosis by coronary computed tomography angiography was accessed with invasive fractional flow reserve as the gold standard.

Results

Among the patients, 33% had fractional flow reserve ≤0.8. There was no significant difference between the fractional flow reserve measurement by tomography and fractional flow reserve averages (0.87 versus 0.84; p = 0.4). The correlation between the values of the methods was r = 0.77, and concordance was moderate (k = 0.54). When fractional flow reserve ≤ 0.75 was analyzed, the concordance between the methods was absolute. The sensitivity, specificity, positive predictive value and negative predictive value of fractional flow reserve measurement by tomography were, respectively, 50%, 100%, 100% and 75%, for the threshold of 0.8. The mean difference between fractional flow reserve and fractional flow reserve measurement by tomography was -0.033 (95%CI -0.072-0.007), with concordance limits between -0.176 and -0.1111.

Conclusion

Fractional flow reserve measurement by tomography is a new method with high diagnostic performance in the detection of hemodynamically significant coronary stenoses and significantly elevates the specificity of the isolated coronary computed tomography angiography.