Reproducibilidad del strain longitudinal global del ventrículo izquierdo por ecocardiografía bidimensional speckle tracking: Estudio Longitudinal de Salud del Adulto (ELSA-Brasil)

Resumen: Introducción: Se han propuesto técnicas ecocardiográficas avanzadas como el strain longitudinal global por ecocardiografía bidimensional speckle tracking para la detección de alteraciones precoces de la función sistólica del ventrículo izquierdo. La evaluación de la reproducibilidad del strain longitudinal global es fundamental para su aplicación clínica en diferentes escenarios. Objetivo: Estimar la reproducibilidad del strain longitudinal global del ventrículo izquierdo en individuos de un estudio de cohorte del Brasil. Métodos: La reproducibilidad del strain longitudinal global del ventrículo izquierdo fue evaluada mediante lectura y análisis de imágenes de ecocardiografía de una muestra aleatoria de 50 participantes de la línea de base del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil). Resultados: Los participantes tenían una edad promedio de 49,7 ± 7,3 años, 54% eran mujeres y la media del strain longitudinal global fue â19,5% ± 1,9%. La reproducibilidad interobservador de la medida del strain longitudinal global mostró un coeficiente de variación de 7,4% y un coeficiente de correlación intraclase de 0,76 (IC 95%: 0,61, 0,86). El análisis del acuerdo interobservador de las medidas del strain longitudinal global mediante el método de Bland & Altman evidenció un promedio de diferencias de 0,1% ± 1,4% y unos límites de acuerdo superior de 2,9 e inferior de â2,7. Conclusiones: Hubo una reproducibilidad adecuada de las medidas del strain longitudinal global del ventrículo izquierdo en participantes del ELSA-Brasil y los valores fueron similares a los reportados en otros estudios epidemiológicos longitudinales. Los hallazgos refuerzan la utilidad del strain longitudinal global como un índice clínico de deformación miocárdica, capaz de detectar alteraciones subclínicas de la contractilidad miocárdica. Abstract: Introduction: Advanced echocardiography techniques, such as the global longitudinal strain using two-dimensional ultrasound speckle tracking, have been proposed for the detection of early changes in the left ventricular systolic function. The evaluation of the reproducibility of left ventricular global longitudinal strain is essential for its clinical application in different scenarios. Objective: To determine the reproducibility of left ventricular global longitudinal strain in individuals from a Brazil cohort study. Methods: The reproducibility of left ventricular global longitudinal strain was evaluated by the reading and analysis of echocardiograph images of a random sample of 50 participants of the baseline Longitudinal Study of Adult Health (ELSA-Brasil). Results: The mean age of the participants was 49.7 ± 7.3 years, of whom 54% were women, and the mean global longitudinal strain was â19.5% ± 1.9%. The inter-observer reproducibility of the mean global longitudinal strain, had a coefficient of variation of 7.4%, and an intra-class correlation of 0.76 (95% CI: 0.61 â 0.86). The analysis of the inter-observer agreement of the global longitudinal strain measurements using the Bland and Altman method showed a mean differences of 0.1% ± 1.4%, and upper and lower limits of agreement of 2.9 and â2.7, respectively. Conclusions: There was adequate reproducibility of the left ventricular global longitudinal strain measurements in participants of the ELSA-Brasil study, and the values were similar to those reported in other longitudinal epidemiological studies. The findings reinforce the use of the global longitudinal strain as a clinical marker of myocardial deformation, capable of detecting subclinical changes in myocardial contractility. Palabras clave: Reproducibilidad de resultados, Strain longitudinal, Contracción miocárdica, Ecocardiografía, Keywords: Reproducibility of results, Longitudinal strain, Myocardial contraction, Echocardiograph

Regional contributions to impaired myocardial mechanical function in heart failure with preserved ejection fraction

Aims: Hypertensive heart disease (HHD) is recognized as a key clinical precursor to heart failure with preserved ejection fraction (HFPEF). However, pathophysiological transition from HHD to HFPEF is not well understood. We sought determine whether regional differences in impaired myocardial function may underlie the greater mechanical dysfunction seen in HFPEF compared to HHD. Methods and results: We used standardized echocardiography to assess regional myocardial deformation in a cohort of n = 327 adults with preserved left ventricular (LV) ejection fraction (≥45%), including: n = 129 with HFPEF, n = 158 with HHD and no heart failure, and n = 40 normotensive controls. From detailed measurements of LV systolic strain performed in multiple views, we derived and then compared regional measures of basal, mid-ventricular, and apical longitudinal strains. In models adjusting for clinical covariates, basal and mid-ventricular LV myocardial deformation was more impaired in HHD than in controls (P ≤ 0.003), whereas apical deformation was more impaired in HFPEF than in HHD (P = 0.005). In multivariable-adjusted analyses, only apical strain remained independently associated with HFPEF vs. HHD status [odds ratio 1.18 (1.02–1.37), P = 0.030 per 1% decrease in apical strain]. Compared to other regional strains, apical longitudinal strain optimally differentiated HFPEF from HHD (area under the receiver operating curve: apical longitudinal strain = 0.67; mid-ventricular longitudinal strain = 0.59; basal longitudinal strain = 0.60). Conclusion: We found that while apical mechanical function is preserved in HHD, it was impaired in HFPEF and may contribute to the transition from an asymptomatic heart disease to a symptomatic heart disease

Association of Weight and Body Composition on Cardiac Structure and Function in the ARIC Study (Atherosclerosis Risk in Communities)CLINICAL PERSPECTIVE

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Diretrizes curriculares do curso de pedagogia no Brasil: disputas de projetos no campo da formação do profissional da educação Curriculum guidelines of the pedagogy course in Brazil: project disputes in the field of the training of education professionals

Neste artigo, os autores analisam as novas diretrizes curriculares do curso de pedagogia, objeto de normatização do Conselho Nacional de Educação (CNE), em 2005, a partir do debate feito à luz do acervo de conhecimentos teórico-práticos sistematizados pelas principais entidades do campo educacional (ANFOPE, ANPED, CEDES, FORUMDIR, ANPAE).<A NAME="tx01"></A><A HREF="#nt01">1</A> Evidenciam, criticamente, alguns dos problemas e das tensões que marcam a trajetória desse curso ao longo da história da educação brasileira. Focalizam, no âmbito das políticas educacionais, em especial, o movimento dos educadores pela definição das diretrizes curriculares para a formação dos profissionais da Educação Básica, que reflete posições de ordem epistemológica, pedagógica e política atinentes às visões e aos projetos educacionais em disputa, no Brasil, nas últimas décadas. A problematização das diretrizes curriculares concorre para ampliar a compreensão da complexidade do campo da pedagogia e dos desafios teórico-práticos com que as instituições de ensino superior, em particular as universidades, deparam-se para materializar a reforma do curso de pedagogia, na esteira das novas regulamentações legais e na perspectiva de uma formação cidadã.<br>Based on the debate conducted in the light of the theoretical-practical knowledge acquired by the main organisms of the educational field (ANFOPE, ANPED, CEDES, FORUMDIR, ANPAE), the authors analyze the new curriculum guidelines of the pedagogy course, which was regulated by the Conselho Nacional de Educação (CNE - Brazilian Council for Education) in 2005. They critically highlight some of the problems and tensions that have marked the trajectory of this course along the history of Brazilian education. Within the educational policies, they more particularly focus on the educator movement for the definition of curriculum guidelines for the training of basic education professionals, which reflects some epistemological, pedagogical and political positions related to the educational visions and project in dispute, in Brazil, these last decades. Problematizing the curriculum guidelines helps understanding better how complex the field of pedagogy is and what theoretical-practical challenges face the higher education institutions, more particularly universities, in order to concretize the reform of the pedagogy course to comply with the new legal regulations but also from the point of view of a citizen training

Report of the Topical Group on Cosmic Probes of Fundamental Physics for for Snowmass 2021

International audienceCosmic Probes of Fundamental Physics take two primary forms: Very high energy particles (cosmic rays, neutrinos, and gamma rays) and gravitational waves. Already today, these probes give access to fundamental physics not available by any other means, helping elucidate the underlying theory that completes the Standard Model. The last decade has witnessed a revolution of exciting discoveries such as the detection of high-energy neutrinos and gravitational waves. The scope for major developments in the next decades is dramatic, as we detail in this report

Report of the Topical Group on Cosmic Probes of Fundamental Physics for for Snowmass 2021

International audienceCosmic Probes of Fundamental Physics take two primary forms: Very high energy particles (cosmic rays, neutrinos, and gamma rays) and gravitational waves. Already today, these probes give access to fundamental physics not available by any other means, helping elucidate the underlying theory that completes the Standard Model. The last decade has witnessed a revolution of exciting discoveries such as the detection of high-energy neutrinos and gravitational waves. The scope for major developments in the next decades is dramatic, as we detail in this report