Ecografía pulmonar: un nuevo abordaje para cardiólogos

Lung ultrasound is a new diagnostic technique that has impacted various medical and surgical specialties, and especially Cardiology. In this review we describe the technical aspects, the five basic ultrasound patterns that should be recognized and the main applications in the cardiac area, referred to four clinical scenarios, namely: the differential diagnosis of dyspnea; diagnosis, monitoring and quantification of lung extravascular fluid; heart failure, and acute coronary syndromes. Finally, the concept of integrated cardiopulmonary ultrasound is introduced as a new approach to cardiac pathology.La ecografía pulmonar es una nueva técnica diagnóstica que ha impactado en diversas especialidades médicas y quirúrgicas, y en especial en Cardiología. En esta revisión se describen los principales aspectos técnicos, los cinco patrones ecográficos básicos que deben reconocerse y las aplicaciones en el área cardiovascular en referencia a cuatro escenarios clínicos: en el diagnóstico diferencial de disnea, en el diagnóstico, monitorización y cuantificación del líquido extravascular pulmonar, en la insuficiencia cardíaca y en los síndromes coronarios agudos. Finalmente, se introduce el concepto de ecografía cardiopulmonar integral como un nuevo abordaje de la patología cardíaca

Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis

BACKGROUND: Cardiac involvement is a relevant clinical finding in systemic sclerosis (SSc) and is associated with poor prognosis. Left atrial (LA) remodeling and/or dysfunction can be an early sign of diastolic dysfunction. Two-dimensional speckle tracking echocardiography (STE) is a novel and promising tool for detecting very early changes in LA myocardial performance. AIM: To assess whether STE strain parameters may detect early alterations in LA function in SSc patients. METHODS: Forty-two SSc patients (Group 1, age 50 +/- 14 years, 95% females) without clinical evidence for cardiac involvement and 42 age- and gender-matched control subjects (Group 2, age 49 +/- 13 years, 95% females) were evaluated with comprehensive 2D and Doppler echocardiography, including tissue Doppler imaging analysis. Positive peak left atrial longitudinal strain ( pos peak), second positive left atrial longitudinal strain (sec pos peak), and negative left atrial longitudinal strain ( neg peak) were measured using a 12-segment model for the LA, by commercially available semi-automated 2D speckle-tracking software (EchoPac PC version 108.1.4, GE Healthcare, Horten, Norway). RESULTS: All SSc patients had a normal left ventricular ejection fraction (63.1 +/- 4%). SSc patients did not differ from controls in E/A (Group 1 = 1.1 +/- 0.4 vs Group 2 = 1.3 +/- 0.4, p = .14) or pulmonary arterial systolic pressure (Group 1 = 24.1 +/- 8 mmHg vs Group 2 = 21 +/- 7 mmHg, p = .17). SSc patients did not show significantly different indexed LA volumes (Group 1 = 24.9 +/- 5.3 ml/m2 vs Group 2 = 24.7 +/- 4.4 ml/m2, p = .8), whereas E/e' ratio was significantly higher in SSc (Group 1 = 7.6 +/- 2.4 vs Group 2 = 6.5 +/- 1.7, p<0.05), although still within normal values. LA strain values were significantly different between the two groups ( pos peak Group 1 = 31.3 +/- 4.2% vs Group 2 = 35.0 +/- 7.6%, p < .01, sec pos peak Group 1 = 18.4 +/- 4 vs Group 2 = 21.4 +/- 7.6, p < 0.05). CONCLUSION: 2D speckle-tracking echocardiography is a sensitive tool to assess impairment of LA mechanics, which is detectable in absence of changes in LA size and volume, and may represent an early sign of cardiac involvement in patients with SSc

Lung Ultrasound for the Evaluation of Pulmonary Congestion in Outpatients

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Peptídeo natriurético cerebral (BNP) e troponinas como biomarcadores de estresse do miocárdio em ciclistas: uma revisão narrativa

Cycling is an old sport that has attracted many fans around the world. Cycling requires major neuroimmunoendocrine and cardiovascular adaptations, in such a way that the body maintains homeostasis. In this context, myocardial stress biomarkers may change secondary to the cyclist's physical effort. The objective of this study was to evaluate, in cyclists, the values of BNP, NT-proBNP and ultrasensitive Troponin, relating the changes in these biomarkers to the presence of myocardial lesions in long-term exercise. A narrative review was carried out, which executed an active search in the Bireme, Pubmed, MedLine, SciELO and LILACS databases. Seven articles that meet the study methodological criteria were published. Studies demonstrate that cycling athletes are predisposed to higher values of BNP, NT-proBNP and ultrasensitive troponin during exercise than individuals who do not practice resistance exercise, however, there is no evidence of short-term changes in the cardiac muscle.El ciclismo es un deporte que ha atraído a muchos aficionados en todo el mundo. La práctica del ciclismo requiere importantes adaptaciones neuroinmunoendocrinas y cardiovasculares, para que el organismo mantenga la homeostasis. En este contexto, los biomarcadores de estrés miocárdico parecen sufrir alteraciones secundarias al esfuerzo físico del ciclista. El objetivo de este estudio fue evaluar, en ciclistas, los valores de BNP, NT-proBNP y troponina ultrasensible, relacionando cambios en estos biomarcadores con la presencia de daño miocárdico en ejercicio de larga duración. Se realizó una revisión narrativa, mediante una búsqueda activa en las bases de datos Bireme, Pubmed, MedLine, SciELO y LILACS. Se analizaron siete artículos que cumplieron con los criterios metodológicos del estudio. Los estudios demuestran que los ciclistas están predispuestos a valores más altos de BNP, NT-proBNP y troponina ultrasensible durante el ejercicio que los que hacen ejercicio sin resistencia; sin embargo, no hay evidencia de cambios a corto plazo en el músculo cardíaco.O ciclismo é um esporte que tem atraído vários adeptos pelo mundo. A prática do ciclismo exige grandes adaptações neuroimunoendócrinas e cardiovasculares, de tal modo que o corpo mantenha a homeostase. Nesse contexto, biomarcadores de estresse miocárdico parecem sofrer alterações secundárias ao esforço físico do ciclista. O objetivo desse trabalho foi avaliar, em ciclistas, os valores de BNP, NT-proBNP e Troponina ultrassensível, relacionando alterações nesses biomarcadores à presença de lesões miocárdicas em exercícios de longa duração. Realizou-se uma revisão narrativa, que realizou busca ativa nas bases de dados Bireme, Pubmed, MedLine, SciELO e LILACS. Foram analisados 7 artigos que atenderam aos critérios metodológicos do estudo. Os estudos demonstram que os atletas de ciclismo estão predispostos a valores mais elevados de BNP, NT-proBNP e Troponina ultrassensível durante o exercício que os indivíduos não praticantes de exercícios de resistência; contudo, não se evidenciam alterações no músculo cardíaco em curto prazo

Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study

Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio