Heart/diagnostic imaging

ABCIC

Original Article

Evaluation of Strain Parameters by Three Dimensional Speckle Tracking Echocardiography in Competitive Athletes

Edgar Daminello et al. Ana Clara Tude Rodrigues Adriana Cordovil Wércules Antônio Oliveira … Edgar Bezerra Lira Filho Rafael Bonafim Piveta Marcelo Luiz Campos Vieira Cláudio Henrique Fischer Samira S. Morhy

Summary

Introduction

Echocardiography is fundamental in the distinction between physiological adaptations promoted by physical activity and pathological abnormalities. Three-dimensional speckle tracking echocardiography (3D-STE) could prove accurate in detecting subclinical abnormalities in cardiac function.

Objectives

To determine the effect of exercise on the parameters of myocardial strain in athletes through 3D STE.

Method

Elite boxers underwent conventional three-dimensional echocardiography (3D-echo) and 3D-STE to analyze left ventricular (LV) volumes, left ventricular mass indexed to body surface area (LVMIBSA), ejection fraction (EF), longitudinal global strain (LGS), circumferential global strain (CGS), radial global strain (RGS), twist, torsion and tracking area. These data were compared with measurements performed on untrained control individuals.

Results

The analyses included 16 athletes and 14 controls with similar age (23 ± 4 vs. 21 ± 4 years; p = NS) and gender (14 vs. 12 males). LVEF was normal and similar in the 2 groups. LVMIBSA was higher in the athletes (83 ± 21 vs. 65 ± 15 g/m², p < 0.05), as well as RGS (24.7 ± 5.2 vs. 16.3 ± 7.2; p = 0.007). There was no significant difference for the other parameters, such as CGS (-26 ± 2 vs. -28 ± 6), LGS (-16 ± 2 vs. -17 ± 3), twist (3.1 ± 1.3 vs. 3.7 ± 1.9), torsion (2.0 ± 0.8 vs. 1.4 ± 0.4) and tracking area (37 ± 4 vs. 41 ± 6).

Conclusion

Athletes and untrained individuals have comparable myocardial strain parameters on 3D-STE. However, an increase in RGS was observed only in the athletes. 3D-STE could help in the early detection of subclinical cardiac issues in athletes. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(3):92-97)

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ABC

Original Article

The Prognostic Value and Clinical Use of Myocardial Perfusion Scintigraphy in Asymptomatic Patients after Percutaneous Coronary Intervention

Larissa Franco de Andrade et al. Ana Carolina Souza Thais Peclat Caio Bartholo … Thalita Pavanelo Ronaldo de Souza Leão Lima

Abstract

Background:

The role of myocardial perfusion scintigraphy (MPS) in the follow-up of asymptomatic patients after percutaneous coronary intervention (PCI) is not established.

Objectives:

To evaluate the prognostic value and clinical use of MPS in asymptomatic patients after PCI.

Methods:

Patients who underwent MPS consecutively between 2008 and 2012 after PCI were selected. The MPS were classified as normal and abnormal, the perfusion scores, summed stress score (SSS), and summed difference score (SDS) were calculated and converted into percentage of total perfusion defect and ischemic defect. The follow-up was undertaken through telephone interviews and consultation with the Mortality Information System. Primary endpoints were death, cardiovascular death, and nonfatal acute myocardial infarction (AMI), and secondary endpoint was revascularization. Logistic regression and COX method were used to identify the predictors of events, and the value of p < 0.05 was considered statistically significant.

Results:

A total of 647 patients were followed for 5.2 ± 1.6 years. 47% of MPS were normal, 30% were abnormal with ischemia, and 23% were abnormal without ischemia. There were 61 deaths, 27 being cardiovascular, 19 non-fatal AMI, and 139 revascularizations. The annual death rate was higher in those with abnormal perfusion without ischemia compared to the groups with ischemia and normal perfusion (3.3% × 2% × 1.2%, p = 0.021). The annual revascularization rate was 10.3% in the ischemia group, 3.7% in those with normal MPS, and 3% in those with abnormal MPS without ischemia. The independent predictors of mortality and revascularization were, respectively, total perfusion defect greater than 6%, and ischemic defect greater than 3%. Forty-two percent of the patients underwent MPS less than 2 years after PCI, and no significant differences were observed in relation to those who underwent it after that period.

Conclusion:

Although this information is not contemplated in guidelines, in this study MPS was able to predict events in asymptomatic after PCI patients, regardless of when they were performed.