abc Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia - SBC São Paulo, SP, Brazil KJNfK7nb6GPxQtK7YZLms6r S0066-782X2012000500013 S0066-782X(12)09800513 10.1590/S0066-782X2012000500013 Carta ao Editor Avaliação de cardiomiopatia não compactada por métodos ecocardiográficos modernos Nemes Attila Forster Tamás Szeged University of Szeged Medical Faculty Cardiology Centre Hungary 05 2012 98 5 467 467 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. 31 07 2012

CARTA AO EDITOR

Avaliação de cardiomiopatia não compactada por métodos ecocardiográficos modernos

Attila Nemes; Tamás Forster

2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary

Endereço para correspondência

Palavras-chave: Cardiomiopatias, diagnóstico, ecocardiografia, tomografia, espectroscopia e ressonância magnética.

O artigo de Rosa e cols1. intitulado "Noncompaction cardiomyopathy - a current view" [Cardiomiopatia não compactada - uma visão atual] foi lido com muito interesse. A análise buscou demonstrar que a ressonância magnética, a tomografia computadorizada e a ventriculografia esquerda surgiram como métodos diagnósticos suplantando o ecocardiograma convencional na avaliação da cardiomiopatia não compactada (CMNC). Este quadro impressiona, porém sentimos falta de comentários adicionais sobre métodos ecocardiográficos modernos.

Verificou-se que a ECO 3D em tempo real é útil na avaliação da CMNC. Mostrou-se que a disfunção sistólica não se limita aos segmentos não compactados do VE na CMNC2. Verificou-se anel mitral (AM) aumentado e funcionalmente prejudicado com maior incidência e gravidade da insuficiência mitral3. A força de ejeção atrial esquerda (FEAE) com base na velocidade da onda A do fluxo de entrada mitral de pico e o AM derivado da ECO 3D em tempo real encontravam-se aumentados nos pacientes com CMNC comparados a indivíduos normais, sugerindo o trabalho compensador do átrio esquerdo contra a disfunção do VE4 .

Existe outro método ecocardiográfico novo e promissor, cujos parâmetros de rotação, tensão e torção do VE podem ser avaliados: a ecocardiografia com speckle tracking (EST). Van Dalen e cols.5 foram os primeiros a demonstrarem que a "rotação do corpo sólido/rígido do VE", com torção do VE praticamente ausente, pode ser um novo critério diagnóstico funcional sensível e específico, objetivo e quantitativo, parra a CMNC5.

A ECO 3D em tempo real e a EST podem ajudar a compreender a fisiopatologia da CMNC e talvez o posicionamento exato dessas metodologias seja esclarecido na avaliação dos pacientes com CMNC.

Endereço para correspondência:

Attila Nemes

Koranyi Fasor, 6

6720 - Szeged, Hungria

E-mail:

nemes@in2nd.szote.u-szeged.hu,

attila.nemes.md@gmail.com

Artigo recebido em 18/09/11

Revisado recebido em 23/09/11

Aceito em 05/03/12

1. Rosa LV, Salemi VM, Alexandre LM, Mady C. Noncompaction cardiomyopathy: a current view. Arq Bras Cardiol 2011; 97(1): e13-9. Noncompaction cardiomyopathy: a current view Arq Bras Cardiol 2011 e13 9 1 97 Rosa LV Salemi VM Alexandre LM Mady C 2. Nemes A, Caliskan K, Geleijnse ML, Soliman OI, Vletter WB, ten Cate FJ. Reduced regional systolic function is not confined to the noncompacted segments in noncompaction cardiomyopathy. Int J Cardiol. 2009; 134(3): 366 - 70. Reduced regional systolic function is not confined to the noncompacted segments in noncompaction cardiomyopathy Int J Cardiol 2009 366 70 3 134 Nemes A Caliskan K Geleijnse ML Soliman OI Vletter WB ten Cate FJ 3. Nemes A, Anwar AM, Caliskan K, Soliman OI, van Dalen BM, Geleijnse ML, et al. Non-compaction cardiomyopathy is associated with mitral annulus enlargement and functional impairment: a real-time three-dimensional echocardiographic study. J Heart Valve Dis. 2008; 17(1): 31 - 5. Non-compaction cardiomyopathy is associated with mitral annulus enlargement and functional impairment: a real-time three-dimensional echocardiographic study J Heart Valve Dis 2008 31 5 1 17 Nemes A Anwar AM Caliskan K Soliman OI van Dalen BM Geleijnse ML 4. Nemes A, Anwar AM, Caliskan K, Soliman OI, van Dalen BM, Geleijnse ML, et al. Evaluation of left atrial systolic function in noncompaction cardiomyopathy by real-time three-dimensional echocardiography. Int J Cardiovasc Imaging 2008; 24(3): 237 - 42. Evaluation of left atrial systolic function in noncompaction cardiomyopathy by real-time three-dimensional echocardiography Int J Cardiovasc Imaging 2008 237 42 3 24 Nemes A Anwar AM Caliskan K Soliman OI van Dalen BM Geleijnse ML 5. van Dalen BM, Caliskan K, Soliman OI, Kauer F, van der Zwaan HB, Vletter WB, et al. Diagnostic value of rigid body rotation in noncompaction cardiomyopathy. J Am Soc Echocardiogr. 2011; 24(5): 548-55. Diagnostic value of rigid body rotation in noncompaction cardiomyopathy J Am Soc Echocardiogr 2011 548 55 5 24 van Dalen BM Caliskan K Soliman OI Kauer F van der Zwaan HB Vletter WB Letter to the Editor Evaluation of noncompaction cardiomyopathy by modern echocardiographic methods

LETTER TO THE EDITOR

Evaluation of noncompaction cardiomyopathy by modern echocardiographic methods

Attila Nemes; Tamás Forster

2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary

Correspondence

Keywords: Cardiomyopathies; diagnosis; echocardiography; tomography; magnetic resonance spectroscopy.

The paper by Rosa et al1 entitled "Noncompaction cardiomyopathy - a current view" was read with great interest. This review was aimed to demonstrate that MRI, CT and left ventriculography have emerged as diagnostic methods over conventional echocardiography in the evaluation of noncompaction cardiomyopathy (NCCM). This summary is impressive, but we feel that a few additional comments on new modern echocardiographic methods are necessary.

Real-time three-dimensional (3D) echocardiography (RT3DE) was found to be useful to assess NCCM. It was shown that systolic LV dysfunction is not confined to noncompacted LV segments in NCCM2. Mitral annulus (MA) was found to be enlarged and functionally impaired with a higher incidence and severity of mitral regurgitation3. Left atrial (LA) ejection force (LAEF) based on peak mitral inflow A wave velocity and RT3DE-derived MA was increased in NCCM patients compared to normal individuals suggesting compensating LA work against the dysfunctional LV4.

There is another promising new echocardiographic method, with which LV strain, rotation and twist parameters can be assessed: speckle-tracking echocardiography (STE). Van Dalen et al5 were the first to demonstrate that "LV solid/rigid body rotation", with nearly absent LV twist, may be a new sensitive and specific, objective and quantitative, functional diagnostic criterion for NCCM5.

RT3DE and STE can help us understand the pathophysiology of NCCM and hopefully the exact place of these methodologies will be clarified in the evaluation of NCCM patients.

References