Orthostatic stress echocardiography as a useful test to measure variability of transvalvular pressure gradients in aortic stenosis

The aim of the study was to assess the influence of the orthostatic stress test on changes in aortic pressure gradients in patients with aortic stenosis (AS). METHODS: The orthostatic stress test was performed in 56 AS patients. The maximum aortic gradient was compared between the supine and the upright position (using Doppler echocardiography from the apical window). The left hand of each patient was kept on top of their head for both readings. 21 patients were excluded from the study for three reasons: 1) atrial fibrillation (significant beat-to-beat variability of measured gradient), 2) suboptimal Doppler signal during the orthostatic test, and 3) aortic gradient significantly higher in suprasternal or right parasternal windows than in apical window (different direction of stenosed blood jets) in the supine examination. The last limitation (#3) is methodologically important because during the orthostatic examination, only the transapical measurement was used. We were able to analyze 35 AS patients (20 males, 15 females, mean age 74.8 ± 9.2 years). RESULTS: The wide range of severity of AS was examined (maximal aortic gradient in the supine position from 30 to 146 mmHg). With regard to statistical trends, the mean value of the maximum aortic gradient significantly decreased after orthostatic stress (from 87.5 ± 28.6 to 75.8 ± 23.7 mmHg), p > 0.01). In 7 patients (increasing responders) the peak aortic gradient slightly increased during the stress test. Five of the seven only increased by a few percent. The other two patients increased by nearly 10%. In contrast, the remaining 28 AS patients’ gradient decreased by as much as 40% (decreasing responders). CONCLUSIONS: The orthostatic position test frequently generated a decrease of “theoretically fixed at rest” valvular gradient in AS. The combination of the stiffened stenotic valve apparatus and a reduced LV preload may be responsible for this decreasing response

Mudança organizacional : um estudo sobre a Universidade do Oeste de Santa Catarina-UNOESC

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Socio-EconomicoEsta pesquisa, de caráter descritivo, teve como objetivo verificar as mudanças que estão ocorrendo nos subsistema social, gerencial e técnico pela formação da FUNDESTE, em UNOESC, segundo a perceção de seus administradores e docentes. Pretendeu-se, também, observar a diferença de percepção entre os administradores e docentes das mudanças que estão ocorrendo nos subsistemas. Constatou-se que dentre os três subsistemas analisados, o subsistema social apresenta um número maior de mudanças

Imaging of all three coronary arteries by transthoracic echocardiography. an illustrated guide

BACKGROUND: Improvements in ultrasound technology has enabled direct, transthoracic visualization of long portions of coronary arteries : the left anterior descending (LAD), circumflex (Cx) and right coronary artery (RCA). Transthoracic measurements of coronary flow velocity were proved to be highly reproducible and correlated with invasive measurements. While clinical applications of transthoracic echocardiography (TTE) of principal coronary arteries are still very limited they will likely grow. The echocardiographers may therefore be interested to know the ultrasonic views, technique of examination and be aware where to look for coronary arteries and how to optimize the images. METHODS: A step-by-step approach to direct, transthoracic visualization of the LAD, Cx and RCA is presented. The technique of examination is discussed, correlations with basic coronary angiography views and heart anatomy are shown and extensively illustrated with photographs and movie-pictures. Hints concerning optimization of ultrasound images are presented and artifacts of imaging are discussed. CONCLUSIONS: Direct, transthoracic examination of the LAD, Cx and RCA in adults is possible and may become a useful adjunct to other methods of coronary artery examination but studies are needed to establish its role

The non-invasive documentation of coronary microcirculation impairment: role of transthoracic echocardiography

Transthoracic Doppler echocardiographic-derived coronary flow reserve is an useful hemodynamic index to assess dysfunction of coronary microcirculation. Isolated coronary microvascular abnormalities are overt by reduced coronary flow reserve despite normal epicardial coronary arteries. These abnormalities may occur in several diseases (arterial hypertension, diabetes mellitus, hypercholesterolemia, syndrome X, aortic valve disease, hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy). The prognostic role of impaired microvascular coronary flow reserve has been shown unfavourable especially in hypertrophic or idiopathic dilated cardiomyopathies. Coronary flow reserve reduction may be reversible, for instance after regression of left ventricular hypertrophy subsequent to valve replacement in patients with aortic stenosis, after anti-hypertensive treatment or using cholesterol lowering drugs. Coronary flow reserve may increase by 30% or more after pharmacological therapy and achieve normal level >3.0. In contrast to other non invasive tools as positron emission tomography, very expensive and associated with radiation exposure, transthoracic Doppler-derived coronary flow reserve is equally non invasive but cheaper, very accessible and prone to a reliable exploration of coronary microvascular territories, otherwise not detectable by invasive coronary angiography, able to visualize only large epicardial arteries

Reversed septal curvature is associated with elevated troponin level in hypertrophic cardiomyopathy

The aim of study was to compare patients with hypertrophic cardiomyopathy divided according to septal configuration assessed in a 4-chamber apical window. The study group consisted of 56 consecutive patients. Reversed septal curvature (RSC) and non-RSC were diagnosed in 17 (30.4%) and 39 (69.6%) patients, respectively. Both RSC and non-RSC groups were compared in terms of the level of high-sensitivity troponin I (hs-TnI), NT-proBNP (absolute value), NT-proBNP/ULN (value normalized for sex and age), and echocardiographic parameters, including left ventricular outflow tract gradient (LVOTG). A higher level of hs-TnI was observed in RSC patients as compared to the non-RSC group (102 (29.2-214.7) vs. 8.7 (5.3-18) (ng/l), p=0.001). A trend toward increased NT-proBNP value was reported in RSC patients (1279 (367.3-1186) vs. 551.7 (273-969) (pg/ml), p=0.056). However, no difference in the NT-proBNP/ULN level between both groups was observed. Provocable LVOTG was higher in RSC as compared to non-RSC patients (51 (9.5-105) vs. 13.6 (7.5-31) (mmHg), p=0.04). Furthermore, more patients with RSC had prognostically unfavourable increased septal thickness to left LV diameter at the end diastole ratio. Patients with RSC were associated with an increased level of hs-TnI, and the only trend observed in this group was for the higher NT-proBNP levels. RSC seems to be an alerting factor for the risk of ischemic events. Not resting but only provocable LVOTG was higher in RSC as compared to non-RSC patients

Troponin as ischemic biomarker is related with all three echocardiographic risk factors for sudden death in hypertrophic cardiomyopathy (ESC Guidelines 2014)

Abstract Background Sudden cardiac death (SCD) risk stratification is the most important preventive action in patients with hypertrophic cardiomyopathy (HCM). The identification of the ischemia biomarker high sensitive troponin I (hs-TnI) role for this arrhythmic disease may provide additional information for SCD risk stratification. The aim of the study was to compare echocardiographic parameters (prognostic for risk stratification of SCD in HCM) among two subgroups of HCM patients: with elevated hs-TnI versus non-elevated hs-TnI level. Methods In 51 HCM patients (mean age 39 ± 8 years, 31 males and 20 females) an echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, was performed. The hs-TnI was measured 24 h later. Results By comparing two subgroups of patients, 26 members with hs-TnI positive versus 25 with hs-TnI negative, the study showed that the values of all three parameters were greater: provocable left ventricular outflow tract gradient (LVOTG) – 49.1 ± 45.9 vs 25.5 ± 24.8 mmHg, p = 0.019; left atrial diameter – 50.1 ± 9.6 vs 43.9 ± 9.8 mmHg, p = 0.041; maximal LV thickness – 22.1 ± 5.3 vs 19.9 ± 34 mm, p = 0.029. Conclusion The increased value of all three echocardiographic parameters used as risk factors for SCD (ESC Guidelines) is related to the elevated level of hs-TnI in HCM. Due to the high LVOTG – great hs-TnI relationship, exercise stress, both diagnostic and even rehabilitation/training, should be monitored by biomarker control

Sistema ambiental Ilha de Santa Catarina: ecossistemas dominantes, componentes e processos

TCC(graduação) - Universidade Federal de Santa Catarina. Centro de Ciências Biológicas. Biologia.A ausência de uma visão sistêmica e integrada da Ilha de Santa Catarina compromete esforços em direção ao gerenciamento costeiro integrado e inserção de práticas de manejo eficazes nas políticas públicas. A fragmentação dos processos que sustentam o SISC, assim como o não reconhecimento das interações energéticas presentes nesse sistema, estimulam o uso desordenado e comprometem sua capacidade de alto organização e manutenção dos serviços ecossistêmicos. O presente trabalho teve como objetivo fazer descrição integrada do Sistema Ambiental Ilha de Santa Catarina – SISC – identificando seus ecossistemas dominantes, além de seus componentes e processos. A identificação e distribuição dos ecossistemas do SISC e a sua representação através de modelos energéticos, pode ser um passo em direção à gestão com base ecossistêmica. A análise aprofundada dos processos que mantêm o SISC e o estudo detalhado de cada ecossistema, poderão apontar espaços de intervenção a serem utilizados pela gestão costeira integrada.The absence of a systemic and integrated view of the Island of Santa Catarina undermines the efforts towards an integrated coastal management as well as the application of effective management practices in public policy. The fragmentation of the processes that sustain SISC, as well as the nonacknowledgment of energy interactions present in this system, stimulates its uncontrolled use and compromise its ability to self-organization and maintenance of ecosystem services. This study aimed at describing the Environmental System of the Island of Santa Catarina - SISC - in an integrated manner, identifying its dominant ecosystems, components and processes. The identification and distribution of SISC's ecosystems and its representation through energy models can be a step toward an ecosystem-based management model. In-depth analysis of the processes that preserve SISC and the detailed study of each ecosystem may point to intervention spots to be taken advantage for an integrated coastal management