Arq Bras Cardiol Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia r6gs38cLGGHJ8qj5FPkKBPk S0066-782X2014002300001 00001 10.5935/abc.20140186 Editorial Cardiovascular Computed Tomography and Magnetic Resonance: History and Growing Impact in Brazil and in the World Nacif Marcelo Souto 1 2 Rochitte Carlos Eduardo 3 4 5 Hospital Universitário Antônio Pedro Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular Niterói RJ Brazil Hospital Universitário Antônio Pedro - HUAP - Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, Niterói, RJ, Brazil Universidade Federal Fluminense Pós-graduação em Ciências Cardiovasculares Niterói RJ Brazil Pós-graduação em Ciências Cardiovasculares - Universidade Federal Fluminense - UFF, Niterói, RJ - Brazil Instituto do Coração Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular São Paulo SP Brazil Instituto do Coração - InCor - Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, São Paulo, SP - Brazil Hospital do Coração Associação do Sanatório Sírio São Paulo SP Brazil Hospital do Coração – HCOR - Associação do Sanatório Sírio, São Paulo, SP - Brazil Hospital Pro-cardíaco Rio de Janeiro RJ Brazil Hospital Pro-cardíaco - Rio de Janeiro, RJ - Brazil Mailing Address: Marcelo Souto Nacif. Av. São João, 2400 – 232b. Jd Colinas, Postal Code 12242-000, São José dos Campos, SP - Brazil. E-mail – msnacif@gmail.com 11 2014 103 5 362 367 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Tomography, X-Ray Computed/history Tomography,X-Ray Computed/trends Diagnostic Imaging/trends Diagnostic Imaging/history Magnetic Resonance Spectroscopy/history Growth in Brazil and in the World

Cardiovascular computed tomography and magnetic resonance are an important topic within the area of cardiovascular imaging in Brazil and in the world. In the Arquivos Brasileiros de Cardiologia this is not different, and despite the increased focus in clinical study, these two topics have grown in impact and scientific publications in recent years.

It is notorious the expansion of the national technological park with entrance of countless devices capable of performing advanced studies using cardiovascular tomography and magnetic resonance with increasing impetus for opening more centers specialized in these methods.

When we perform a systematic review using EndNote as a search tool and select only PubMed as a database with the words "magnetic resonance" and "computed tomography", in the Arquivos Brasileiros de Cardiologia alone we observe a total of 182 studies (Figure 1).

Number of publications in the Arquivos Brasileiros de Cardiologia with exclusive focus on cardiovascular computed tomography and magnetic resonance.

In parallel, when we perform a search on PubMed using the word "cardiac" and the MeSH (Medical Subject Headings) terms "computed tomography" and "magnetic resonance imaging", we find a sum of publications close to 45 thousand articles (44,711 articles) (Figure 2).

Number of publications in PubMed with exclusive focus on cardiovascular computed tomography and magnetic resonance.

These graphics turn out to be merely illustrative, but are without doubt markers of the impact of these methods in Brazil (Figure 1) and in the world (Figure 2). It is easy to identify that after the year 2000 and in the last decade there has been a large insertion of these methods in the scientific scenario and we believe that this reflects also in the clinical scenario.

 History in the <italic>Arquivos Brasileiros de Cardiologia</italic>

The first studies published in the Arquivos Brasileiros de Cardiologia were basically clinical studies and case reports in which the methods were able to contribute to a better diagnosis 1-4. The first original articles emerged with the use of magnetic resonance imaging in the study by Kalil Filho et al 5,6 in the year of 1995. At that same year, guided by Pinto et al 7, emerged the first Brazilian consensus for the use of cardiac magnetic resonance imaging in clinical cardiology. Computed tomography had its first original study published in 1997, by Kalil et al 8. One of the pioneering studies in the path of the evaluation of the current calcium score was performed by Feldman et al 9.

 Relationship with International Societies

We currently have two international societies dedicated specifically to these methods. The SCMR (Society for Cardiovascular Magnetic Resonance) was the first society to be founded and by the year 2000, it was already organizing the process of credentialing for those dedicated to cardiovascular magnetic resonance 10. The SCCT (Society of Cardiovascular Computed Tomography) was founded shortly after, following the advances of the method, and in 2009, made available its guidelines for better practice of the method 11,12. In Brazil, the Arquivos Brasileiros de Cardiologia had a fundamental role in the publication of our first guideline 13, which was updated this year (2014) and is currently undergoing editing for future publication.

 Scientific and Educational Organization in Brazil

In the early days of the organization in Brazil, a study group of cardiovascular magnetic resonance and computed tomography called GERT was formed and played a key role in the diffusion of knowledge throughout Brazil. A group of physicians dedicated to cardiovascular computed tomography and magnetic resonance created in Brazil the National Meeting of Cardiac Radiology (Encontro Nacional de Radiologia Cardíaca, ENRC), which will be on its eighth consecutive year in 2015. This group is composed of radiologists and cardiologists supported by SCMR and SCCT, along with national societies, to enhance the methods in Brazil and discuss the experiences in national territory. Similarly, SBC's Department of Cardiovascular Imaging (DIC), bringing together specialists in nuclear medicine, echocardiography, vascular ultrasound, and cardiovascular magnetic resonance and computed tomography, gathers annually in a meeting with almost 2 thousand participants and maintains the role of diffusing knowledge in the areas of cardiovascular magnetic resonance and computed tomography started with GERT.

We still have only a few training centers of experts in the field, mostly in the Rio-São Paulo hub, but in the last 5 years an increasing number of private institutions and university hospitals are strengthening teaching and research in the area. Many who are currently in charge of the specialized centers in Brazil sought their expertises in international centers and we believe that in the near future this reality will no longer be true, since we will have large groups throughout the country.

 Worldwide Impact of the Latest Publications by Brazilians

The increasing group of people involved in cardiovascular imaging in Brazil and in the world culminated in an explosion of publications dedicated to standardization and proper use of the method over the last years 14-31.

Some pioneering work of great international impact has been elaborated by Brazilians and we managed, through this editorial, to draw attention to each one in their area.

- Computed Tomography

Assessment of the coronaries – The study conducted by Miller et al 32 had one of the highest scientific impact and collaboration of three Brazilians, one of which was the principal investigator, and also had the largest number of patients included in the study by a Brazilian center. Published in The New England Journal of Medicine , the authors concluded that computed tomography can identify the presence and severity of coronary artery disease with good accuracy, but when positive, could not replace conventional coronary angiography. Recently, tomography showed its value in patients with acute coronary syndrome 33.

Assessment of myocardial perfusion – The studies by Cury et al34, first published in Radiology, brought a new proposal for the use of computed tomography in the evaluation of myocardial ischemia. With simple protocols and easy clinical applicability, it managed to demonstrate that myocardial perfusion on computed tomography has good correlation with SPECT and with conventional coronary angiography in identifying stenosis of native vessels35 or with stent36. The first multicenter study validating this new technique to detect myocardial ischemia was recently published by Rochitte et al37. This study reported high accuracy for detecting meaningful stenoses associated with perfusion defects in the same territory evaluated by tomography when compared with the combination of invasive catheterization with SPECT scintigraphy, and with a lower cost of radiation dose. Thus, this new method is able to diagnose hemodynamically meaningful stenoses or those associate with a reduction of myocardial blood flow.

Evaluation of volumes and function – The quantification of ventricular volumes and function has been validated against other methods of great clinical applicability38,39, but recently the use of these measurements demonstrated a great potential for detection of cardiovascular risk and mortality40.

Evaluation of focal fibrosis – In studies by Shiozaki et al41,42 we can observe that, in addition to the ability to detect focal fibrosis, tomography can be used to predict ventricular arrhythmias. This field is of great importance because some patients are unable to undergo magnetic resonance and can benefit with this new technique.

Evaluation of interstitial fibrosis – In quantifying interstitial fibrosis by computed tomography, the studies by Nacif et al43,44 were pioneers and open a potential for evaluating subclinical myocardial damage not previously possible in the context of cardiomyopathies.

Epidemiological impact – The studies by Bittencourt et al45,46 demonstrated the prognostic potential of computed tomography in symptomatic patients with nonobstructive and obstructive coronary disease. However, Prazeres et al47 were able to summarize in an unique way the potential of the technique for use in the emergency room, with potential of cost reduction for low-probability patients.

 - Magnetic Resonance

Assessment of the coronaries – Evaluation of the coronary arteries by magnetic resonance is currently limited to the characterization of the origin or evaluation of the proximal thirds of the main vessels. Recently, new techniques and use of specific vascular contrast created a new horizon for implementation of this method which is free of ionizing radiation. Nacif et al 48 demonstrated that the intravenous contrast medium Gadofosveset trisodium had a slightly better performance than the contrast media routinely used.

Assessment of myocardial perfusion – Since the initial studies on the characterization of microvascular obstruction by Rochitte et al49 in 1998, until the clinical applicability of the evaluation of myocardial ischemia by Cury et al50 in 2006, and the use of multimodal (combined) resonance techniques for characterization of coronary artery disease by de Mello et al51 in 2012, we are able to observe the current maturity of the method in the country.

Evaluation of volumes and function – After years using indexing and morphological, volumetric and functional values ​​of international studies, we can say that in a pioneer way, Macedo et al52 were able to demonstrate in a Brazilian population different morphological and volumetric standards for men and women. Nacif et al53 demonstrated that there are several ways to quantify atrial volume and that all correlate with one another.

Evaluation of iron deposits – The studies by Fernandes et al54-56 are of great importance for standardization and evaluation of patients with hepatic and myocardial iron storage.

Evaluation of focal fibrosis – In this topic of publications, there are countless contributions by Brazilians in the impact of the method worldwide, but without a doubt one of the most discussed was the study by Azevedo et al57 who were able to demonstrate the importance of detection and quantification of delayed myocardial enhancement in patients who underwent aortic valve replacement with great implication in left ventricular functional improvement and evaluation of mortality.

Evaluation of interstitial fibrosis – The studies by Mongeon et al58, Coelho-Filho et al59, Nacif et al44, Sibley et al60 and Liu et al61 were pioneers in the evaluation of interstitial fibrosis by techniques of T1 map and quantification of extracellular volume.

Epidemiological impact – Without a doubt, magnetic resonance is one of the best methods for quantification of myocardial fibrosis. When present, myocardial fibrosis is associated with increased mortality and worse prognosis62. In Brazil, in addition to the diseases commonly evaluated in the world, we have Chagas disease that was very well studied by Rochitte et al63,64. Now, one of the studies with a major impact on clinical decision using the method was in the risk reclassification using stressor agents65.

 Impact of the Latest Publications in the<italic> Arquivos Brasileiros de Cardiologia</italic>

The Arquivos Brasileiros de Cardiologia function as a national thermometer and a main scientific channel reflecting this explosion of publications. The article by Duarte66, published in 2010, clearly demonstrates the growth of computed tomography and its impact on the detection of coronary artery disease. Over the past decade, we observed an increasing number of review articles67-75 and original articles47,52,76-90, which reinforces the impact of tomography and magnetic resonance in current cardiovascular imaging.

Finally, it is not possible to include all studies by Brazilian authors due to the increasing number of publications in the area, but we are sure that we are entering a new era of cardiovascular imaging. The great development of technology applied to medicine causes computed tomography and magnetic resonance to grow increasingly, changing day-to-day the impact on clinical practice.

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Rabelo DR Barros MV Nunes Mdo C Oliveira CC Siqueira MH Multislice coronary angiotomography in the assessment of coronary artery anomalous origin Arq Bras Cardiol 2012 98 3 266 272 Tomografia Computadorizada e Ressonância Magnética Cardiovascular: Histórico e Impacto Crescente no Brasil e no Mundo Nacif Marcelo Souto 1 2 Rochitte Carlos Eduardo 3 4 5 Hospital Universitário Antônio Pedro Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular Niterói RJ Brasil Hospital Universitário Antônio Pedro - HUAP - Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, Niterói, RJ, Brasil Universidade Federal Fluminense Pós-graduação em Ciências Cardiovasculares Niterói RJ Brasil Pós-graduação em Ciências Cardiovasculares - Universidade Federal Fluminense - UFF, Niterói, RJ - Brasil Instituto do Coração Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular São Paulo SP Brasil Instituto do Coração - InCor - Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular, São Paulo, SP - Brasil Hospital do Coração Associação do Sanatório Sírio São Paulo SP Brasil Hospital do Coração – HCOR - Associação do Sanatório Sírio, São Paulo, SP - Brasil Hospital Pro-cardíaco Rio de Janeiro RJ Brasil Hospital Pro-cardíaco - Rio de Janeiro, RJ - Brasil Correspondência: Marcelo Souto Nacif. Av. São João, 2400 – 232b. Jd Colinas, CEP 12242-000, São José dos Campos, SP - Brasil. E-mail – msnacif@gmail.com Tomografia Computadorizada por Raios X/história Tomografia Computadorizada por Raios X/tendências Diagnóstico por Imagem/tendências Diagnóstico por Imagem/história Espectroscopia de Ressonância Magnética/história Crescimento no Brasil e no Mundo

A tomografia computadorizada e a ressonância magnética cardiovascular são um importante tópico dentro da área de imagem cardiovascular no Brasil e no mundo. Nos Arquivos Brasileiros de Cardiologia não é diferente, e apesar do maior enfoque nos estudo clínicos, estes dois tópicos cresceram em impacto e publicações científicas nos últimos anos.

É notória a ampliação do parque tecnológico nacional com entrada de inúmeros aparelhos capazes de realizar estudos avançados utilizando a tomografia e ressonância magnética cardiovascular com um impulso cada vez maior para abertura de mais centros especializados nestes métodos.

Quando realizamos uma revisão sistemática utilizando o EndNote como ferramenta de busca e selecionamos apenas o PubMed como banco de dados com as palavras “magnetic resonance” e “computed tomography” apenas no jornal “Arquivos Brasileiros de Cardiologia” observamos um total de 182 trabalhos (Figura 1).

Número de publicações nos Arquivos Brasileiros de Cardiologia com foco exclusivo em tomografia computadorizada e ressonância magnética cardiovascular.

Paralelamente quando fazemos uma busca no PubMed utilizando a palavra “cardiac” e os MeSH (Medical Subject Headings) terms “computed tomography” e “magnetic resonance imaging” encontramos uma somatória de publicações próxima a 45 mil artigos (44.711 artigos) (Figura 2).

Número de publicações no PubMed com foco exclusivo em tomografia computadorizada e ressonância magnética cardiovascular.

Estes gráficos acabam sendo meramente ilustrativos mas são, sem dúvida, marcadores do impacto destes métodos no Brasil (Figura 1) e no mundo (Figura 2). É fácil identificar que após o ano 2000 e na última década houve uma grande inserção destes métodos no cenário científico e acreditamos refletir também no cenário clínico.

 Histórico nos Arquivos Brasileiros de Cardiologia

Os primeiros trabalhos publicados nos Arquivos Brasileiros de Cardiologia foram basicamente estudos de contexto clínico e relatos de caso, onde os métodos conseguiram contribuir para um melhor diagnóstico 1-4. Os primeiros artigos originais vieram com a utilização da ressonância magnética nos trabalhos de Kalil Filho e cols. 5,6 no ano de 1995. Neste mesmo ano, guiado por Pinto e cols. 7, surgiu o primeiro consenso brasileiro para a utilização da ressonância magnética cardíaca na prática cardiológica. A tomografia computadorizada teve o seu primeiro artigo original publicado em 1997, por Kalil e cols. 8. Um dos trabalhos pioneiros no caminho da avaliação do atual escore de cálcio foi realizado por Feldman e cols. 9.

 Relação com Sociedades Internacionais

Temos atualmente duas sociedades internacionais dedicadas especificamente aos métodos. A SCMR ( Society for Cardiovascular Magnetic Resonance ) foi a primeira a ser fundada, e no ano 2000 já organizava o processo de credenciamento para os que se dedicavam à ressonância magnética cardiovascular 10. A SCCT ( Society of Cardiovascular Computed Tomography ) foi fundada um pouco depois, seguindo os avanços do método, e em 2009 já colocava à disposição as suas diretrizes para melhor prática do método 11,12. No Brasil, os Arquivos Brasileiros de Cardiologia tiveram papel fundamental na publicação da nossa primeira diretriz 13 que, neste ano (2014), foi atualizada e está passando pelo processo de editoração para futura publicação.

 Organização Científica e Educacional no Brasil

Nos primórdios da organização no Brasil, ocorreu a formação de um grupo de estudos de ressonância e tomografia cardiovascular, chamado de GERT, e que teve papel fundamental na difusão do conhecimento por todo o Brasil. Um grupo de médicos dedicados à tomografia computadorizada e à ressonância magnética cardiovascular criaram no Brasil o Encontro Nacional de Radiologia Cardíaca (ENRC) que irá para o oitavo ano consecutivo em 2015. Este grupo é formado por radiologistas e cardiologistas que aproveitam o suporte da SCMR e da SCCT, em conjunto com as sociedades nacionais, para aprimorar os métodos no Brasil e discutir as experiências no território nacional. Da mesma forma, o Departamento de Imagem Cardiovascular (DIC) da SBC, reunindo especialistas em ecocardiografia, medicina nuclear, ultrassom vascular, ressonância e tomografia cardiovascular, reúne-se anualmente em um congresso com quase 2 mil participantes e mantém o papel difusor do conhecimento nas áreas de ressonância magnética e tomografia cardiovascular iniciado com o GERT.

Ainda temos poucos centros formadores de especialistas na área, a maioria no eixo Rio-São Paulo, mas nos últimos 5 anos um maior número de instituições privadas e hospitais universitários estão fortalecendo o ensino e a pesquisa na área. Muitos que atualmente estão chefiando os centros especializados no Brasil buscaram sua especialização em centros internacionais e acreditamos que em um futuro próximo esta realidade não será mais verdadeira, pois teremos grandes grupos em todo o território nacional.

 Impacto das Últimas Publicações de Brasileiros no Mundo

O crescente aumento do grupo de pessoas envolvidas em imagem cardiovascular no Brasil e no mundo culminou em uma explosão de publicações dedicadas à padronização e correta utilização do método nos últimos anos 14-31.

Alguns trabalhos pioneiros e de grande impacto internacional foram elaborados por brasileiros e conseguimos, através deste editorial, chamar a atenção para cada um em sua área.

- Tomografia Computadorizada

Avaliação de coronárias – O trabalho realizado por Miller e cols.32 teve um dos maiores impactos científicos e colaboração de 3 brasileiros, sendo um deles o investigador principal, e teve ainda o maior número de pacientes do estudo incluídos por um centro brasileiro. Publicado no The New England Journal of Medicine, os autores concluíram que a tomografia computadorizada pode identificar a presença e a severidade da doença arterial coronariana com boa acurácia mas que quando positiva não poderia substituir a angiografia coronariana convencional. Recentemente, a tomografia mostrou seu valor nos pacientes com síndrome coronariana aguda33.

Avaliação de perfusão miocárdica – Os trabalhos de Cury e cols.34, primeiramente publicados na Radiology, trouxeram uma nova proposta para a utilização da tomografia computadorizada na avaliação de isquemia miocárdica. Com protocolos simples e de fácil aplicabilidade clinica, conseguiu demonstrar que a perfusão miocárdica por tomografia computadorizada tem boa correlação com o SPECT e com a angiografia coronariana convencional na identificação de estenose de vasos nativos35 ou com stent36. O primeiro trabalho multicêntrico validando esta nova técnica de detecção de isquemia miocárdica foi recentemente publicada por Rochitte e cols.37. Neste estudo observou-se alta acurácia para detecção de estenoses significativas associadas a defeitos perfusionais no mesmo território na avaliação pela tomografia quando comparada à combinação do cateterismo invasivo com a cintilografia por SPECT, e com um custo menor de dose de radiação. Assim, este novo método é capaz de diagnosticar estenoses hemodinamicamente significativas ou que se associam à redução do fluxo sanguíneo miocárdico.

Avaliação de volumes e função – A quantificação de volumes e função ventricular já foi validada frente a outros métodos de grande aplicabilidade clínica38,39, mas recentemente o uso destas mensurações demonstrou um grande potencial de detecção do risco cardiovascular e mortalidade40.

Avaliação de fibrose focal – Nos trabalhos de Shiozaki e cols.41,42, conseguimos observar que além da capacidade de detectar fibrose focal, a tomografia pode ser utilizada para predizer arritmias ventriculares. Este campo é de grande importância pois alguns pacientes não conseguem realizar a ressonância magnética e podem se beneficiar com esta nova técnica.

Avaliação de fibrose intersticial – Na quantificação de fibrose intersticial pela tomografia computadorizada, os trabalhos de Nacif e cols.43,44 foram pioneiros e abrem um potencial de avaliação de comprometimento miocárdico subclínico anteriormente não possível no contexto das miocardiopatias.

Impacto epidemiológico – Os trabalhos de Bittencourt e cols.45 e Hulten e cols.46, demonstraram o potencial prognóstico da tomografia computadorizada em pacientes sintomáticos e com doença coronariana não obstrutiva e obstrutiva. Já Prazeres e cols.47 conseguiram de forma ímpar resumir o potencial da técnica para uso na sala de emergência, com potencial de redução de custos para os doentes de baixa probabilidade.

 - Ressonância Magnética

Avaliação de coronárias – A avaliação das coronárias pela ressonância magnética esta limitada atualmente à caracterização da origem ou avaliação dos terços proximais dos vasos principais. Recentemente, novas técnicas e utilização de contraste vasculares específicos criaram um novo horizonte para a realização deste método que é livre de radiação ionizante. Raman e cols.48 demonstraram que o meio de contraste endovenoso Gadofosveset trisodium teve uma performance pouco melhor do que os meios de contraste rotineiramente utilizados.

Avaliação de perfusão miocárdica – Desde os trabalhos iniciais de caracterização da obstrução microvascular por Rochitte e cols.49 em 1998, até a aplicabilidade clínica da avaliação da isquemia miocárdica por Cury e cols.50 em 2006, e a utilização da multimodalidade (combinada) das técnicas de ressonância para caracterização da doença arterial coronariana por de Mello e cols.51 em 2012, conseguimos constatar a atual maturidade do método em território nacional.

Avaliação de volumes e função – Após anos utilizando indexação e valores morfológicos, volumétricos e funcionais de estudos internacionais podemos dizer que de forma pioneira Macedo e cols.52 conseguiram demonstrar em uma população brasileira padrões morfológicos e volumétricos diferentes para homens e mulheres. Nacif e cols.53 demostraram que existem várias formas de quantificação do volume atrial e que todas possuem correlação entre si.

Avaliação de depósito de ferro – Os trabalhos de Fernandes e cols.54-56 são de grande importância para padronização e avaliação dos pacientes com depósito de ferro hepático e miocárdico.

Avaliação de fibrose focal – Neste tópico de publicações são inúmeras as contribuições de brasileiros no impacto do método no cenário mundial, mas sem sombra de dúvidas, um dos trabalhos mais discutidos foi o de Azevedo e cols.57 que conseguiu demonstrar a importância da detecção e quantificação do realce miocárdico tardio nos pacientes que se submeteram à troca valvar aórtica, tendo grande implicação na melhora funcional do ventrículo esquerdo e na avaliação de mortalidade.

Avaliação de fibrose intersticial – Os trabalhos de Nacif e cols.44, Mongeon e cols.58, Coelho-Filho e cols.59, Sibley e cols.60 e Liu e cols.61, foram pioneiros na avaliação da fibrose intersticial pelas técnicas do mapa T1 e quantificação do volume extracelular.

Impacto epidemiológico – Sem sombra de dúvidas, a ressonância magnética é um dos melhores métodos para quantificação de fibrose miocárdica. A fibrose miocárdica quando presente está relacionada a maior mortalidade e pior prognóstico62. No Brasil, além das doenças comumente avaliadas no mundo, temos a doença de Chagas que foi muito bem estudada por Rochitte e cols.63,64. Agora, um dos trabalhos com grande impacto na decisão clínica utilizando o método foi na reclassificação de risco utilizando agentes estressores65.

 Impacto das Últimas Publicações nos Arquivos Brasileiros de Cardiologia

Os Arquivos Brasileiros de Cardiologia funcionam como termômetro nacional e principal canal científico refletindo esta explosão de publicações. O artigo de Duarte 66, publicado em 2010, demonstra claramente o crescimento da tomografia computadorizada e seu impacto na detecção da doença arterial coronariana. Nos últimos dez anos observamos um número crescente de artigos do tipo revisão 67-75 e artigos originais 47,52,76-90 o que reforça o impacto da tomografia e da ressonância na imagem cardiovascular atual.

Finalmente, não é possível incluir todos os trabalhos de autores brasileiros devido ao número crescente de publicações na área, mas temos certeza que estamos entrando em uma nova era da imagem cardiovascular. O grande desenvolvimento da tecnologia aplicada à medicina faz com que a tomografia computadorizada e a ressonância magnética cresçam cada vez mais modificando dia-a-dia o impacto na prática clínica.