Deformação miocárdica em atletas de diferentes modalidades – Um estudo por 2D Speckle Tracking: projecto de investigação

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de Especialização: Ultrassonografia Cardiovascular

Deformação miocárdica analisada por Speckle Tracking, em doentes hipertensos com fracção de ejecção preservada

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Ultrassonografia Cardiovascular.

Strain global longitudinal avaliado por VVI-Speckle Tracking numa população de indivíduos normais

O VVI-Speckle Tracking é um método visual e quantitativo de avaliação dos parâmetros de deformação miocárdica utilizando a imagem bidimensional. Tem com principal vantagem em relação a outras metodologias a sua facilidade de execução. O SGL apresenta-se como o parâmetro de deformação miocárdica que mais precocemente deteta a alteração da função contrátil. Objectivo do estudo: determinar os valores do Strain Global Longitudinal (SGL), numa população de indivíduos normais utilizando a mais recente versão desta tecnologia e compará-los com outos valores já publicados, assim como a sua eventual variação com alguns parâmetros demográficos, como seja o género, idade e IMC.

Deformação miocárdica pelo speckle tracking na cardiomiopatia dilatada grave

FUNDAMENTO: A alta e crescente prevalência de Cardiomiopatia Dilatada (CMD) representa sério problema de saúde pública. Novas tecnologias vêm sendo utilizadas objetivando diagnósticos mais sofisticados, que melhorem a abordagem terapêutica. Nesse cenário, o Speckle Tracking (STE) utiliza marcadores miocárdicos naturais para analisar a deformação sistólica do Ventrículo Esquerdo (VE). OBJETIVO: Mensurar o strain transmural longitudinal global (SG) do VE através do STE em pacientes com CMD grave, comparando os resultados com indivíduos normais e com parâmetros ecocardiográficos consagrados para análise da função sistólica do VE, validando o método nessa população. MÉTODOS: Foram estudados 71 pacientes com CMD grave, (53 ± 12a, 72% homens) e 20 controles (30 ± 8a, 45% homens). Foram obtidos os volumes e a FEVE pela ecocardiografia bi e tridimensional, parâmetros do Doppler, Doppler tecidual e o SG pelo STE. RESULTADOS: Comparados ao grupo controle, os volumes do VE foram maiores no grupo CMD; entretanto, a FEVE e velocidade de pico da onda E foram menores neste último. O índice de performance miocárdica foi maior entre os pacientes. As velocidades do miocárdio pelo Doppler tecidual (S', e', a') foram consideravelmente menores e a relação E/e' foi maior no grupo CMD. O SG apresentou-se diminuído no grupo CMD (-5,5% ± 2,3%), em relação aos controles (-14,0% ± 1,8%). CONCLUSÃO: No presente estudo, o SG foi significativamente menor nos pacientes com CMD grave, abrindo novas perspectivas para abordagens terapêuticas nessa população específica.

Estudo da Mecânica Cardíaca pelo Speckle Tracking

Speckles, ou marcadores naturais do miocárdio, originam se da interferência construtiva e destrutiva do feixe de ultrassom que incide sobre os tecidos, podem fornecer um diagnóstico precoce das alterações miocárdicas e atuar na predição de certos eventos cardíacos. Devido à sua relativa estabilidade temporal, os speckles podem ser rastreados durante o ciclo cardíaco por software dedicados, promovendo a análise da função sistólica e diastólica. São identificados tanto pela escala de cinza da ecocardiografia 2D convencional quanto pela ecocardiografia 3D, sendo independentes do ângulo de incidência do ultrassom, permitindo assim a avaliação da mecânica cardíaca nos três planos espaciais: longitudinal, circunferencial e radial. O objetivo do presente artigo é discutir o papel e o significado da deformação cardíaca obtida por meio do speckle tracking durante a avaliação da fisiologia cardíaca, e discutir as aplicações clínicas desta tecnologia ecocardiográfica inovadora.

Subclinical Ventricular Dysfunction Detected by Speckle Tracking Two Years after Use of Anthracycline

Background: Heart failure is a severe complication associated with doxorubicin (DOX) use. Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown to be useful in identifying subclinical ventricular dysfunction. Objectives: a) To investigate the role of strain in the identification of subclinical ventricular dysfunction in patients who used DOX; b) to investigate determinants of strain response in these patients. Methods: Cross-sectional study with 81 participants: 40 patients who used DOX ±2 years before the study and 41 controls. All participants had left ventricular ejection fraction (LVEF) ≥55%. Total dose of DOX was 396mg (242mg/ms2). The systolic function of the LV was evaluated by LVEF (Simpson), as well as by longitudinal (εLL), circumferential (εCC), and radial (εRR) strains. Multivariate linear regression (MLR) analysis was performed using εLL (model 1) and εCC (model 2) as dependent variables. Results: Systolic and diastolic blood pressure values were higher in the control group (p < 0.05). εLL was lower in the DOX group (-12.4 ±2.6%) versus controls (-13.4 ± 1.7%; p = 0.044). The same occurred with εCC: -12.1 ± 2.7% (DOX) versus -16.7 ± 3.6% (controls; p < 0.001). The S’ wave was shorter in the DOX group (p = 0.035). On MLR, DOX was an independent predictor of reduced εCC (B = -4.429, p < 0.001). DOX (B = -1.289, p = 0.012) and age (B = -0.057, p = 0.029) were independent markers of reduced εLL. Conclusion: a) εLL, εCC and the S’ wave are reduced in patients who used DOX ±2 years prior to the study despite normal LVEF, suggesting the presence of subclinical ventricular dysfunction; b) DOX was an independent predictor of reduced εCC; c) prior use of DOX and age were independent markers of reduced εLL.

Methodological Gaps in Left Atrial Function Assessment by 2D Speckle Tracking Echocardiography

Abstract The assessment of left atrial (LA) function is used in various cardiovascular diseases. LA plays a complementary role in cardiac performance by modulating left ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non‑invasively. However, evaluation of LA deformation derived from 2D speckle tracking echocardiography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition. Normal ranges for LA deformation and cut-off values to diagnose LA dysfunction with different diseases have been reported, but data are still conflicting, probably because of some methodological and technical issues. This review highlights the importance of an unique standardized technique to assess the LA phasic functions by STE, and discusses recent studies on the most important clinical applications of this technique.

Fine speckle contrast in InGaAs/InP systems: Influence of layer thickness, missmatch, and growing temperature

This work is focused on the study of the fine speckle contrast present in planar view observations of matched and mismatched InGaAs layers grown by molecular beam epitaxy on InP substrates. Our results provide experimental evidence of the evolution of this fine structure with the mismatch, layer thickness, and growth temperature. The correlation of the influence of all these parameters on the appearance of the contrast modulation points to the development of the fine structure during the growth. Moreover, as growth proceeds, this structure shows a dynamic behavior which depends on the intrinsic layer substrate stress.

Strain and strain rate by two-dimensional speckle tracking echocardiography in a maned wolf

The measurement of cardiovascular features of wild animals is important, as is the measurement in pets, for the assessment of myocardial function and the early detection of cardiac abnormalities, which could progress to heart failure. Speckle tracking echocardiography (2D STE) is a new tool that has been used in veterinary medicine, which demonstrates several advantages, such as angle independence and the possibility to provide the early diagnosis of myocardial alterations. The aim of this study was to evaluate the left myocardial function in a maned wolf by 2D STE. Thus, the longitudinal, circumferential and radial strain and strain rate were obtained, as well as, the radial and longitudinal velocity and displacement values, from the right parasternal long axis four-chamber view, the left parasternal apical four chamber view and the parasternal short axis at the level of the papillary muscles. The results of the longitudinal variables were -13.52±7.88, -1.60±1.05, 4.34±2.52 and 3.86±3.04 for strain (%), strain rate (1/s), displacement (mm) and velocity (cm/s), respectively. In addition, the radial and circumferential Strain and Strain rate were 24.39±14.23, 1.86±0.95 and -13.69±6.53, -1.01±0.48, respectively. Thus, the present study provides the first data regarding the use of this tool in maned wolves, allowing a more complete quantification of myocardial function in this species.

Evaluación de la mecánica ventricular izquierda mediante speckle tracking en pacientes sanos en la Clínica Shaio

Introducción: La ecocardiografía es actualmente la técnica de imagen diagnóstica más utilizada para la evaluación de la anatomía y la función cardiovascular. En la actualidad se está utilizando la ecocardiografía por speckle tracking la cual permite una evaluación mas objetiva y confiable de la función ventricular, sin embargo se requieren valores de referencia que hagan que los valores obtenidos sean válidos y útiles para determinar en forma mas oportuna conductas previas al deterioro de su función. Objetivo general: Determinar los valores de referencia para mecánica ventricular izquierda mediante ecocardiografía bidimensional por speckle tracking con equipo Toshiba Artida con transductor multifrecuencia de 3 megahertzios en pacientes sin patología cardiaca conocida en la Fundación Clínica Shaio en el año 2014. Metodología: Análisis de una cohorte prospectiva de todos los pacientes que ingresaron a la Fundación Clínica Shaio para evaluación ecocardiográfica sin patología cardiaca conocida entre los meses Agosto y Diciembre del 2014. Resultados: Se presenta este estudio de la evaluación de la mecánica ventricular izquierda en adultos sanos, los resultados son similares a los obtenidos en estudios de referencia, sin embargo se consideran de gran importancia ya que de acuerdo a la guía actual de evaluación de la mecánica ventricular por strain rate es importante que cada equipo se encuentre estandarizado con el fin de tener resultados válidos de acuerdo a las diferentes patologías en las que se puede aplicar y a nuestra población.

Measurement of shrinkage of composite resin by laser speckle contrast analysis

The aim of this study was to evaluate the shrinkage of a microhybrid dental composite resin photo-activated by one LED with different power densities by means of speckle technique. The dental composite resin Filtek (TM) Z-250 (3M/ESPE) at color A(2) was used for the samples preparation. Uncured composite was packed in a metallic mold and irradiated during 20 s from 100 to 1000 mW cm(-2). For the photo-activation of the samples, it was used a LED prototype (Light Emission Diode) with wavelength centered at 470 nm and adjustable power density until 1 W cm(-2). The speckle patterns obtained from the bottom composite surfaces were monitored using a CCD camera without lens. The speckle field is recorded in a digital picture and stored by CCD camera as the carrier of information on the displacement of the tested surface. The calculated values were obtained for each pair of adjacent patterns and the changes in speckle contrast as a function of time were obtained from six repeated measurements. The speckle contrasts obtained from the bottom surface with 100 mW cm(-1) were smaller than those than the other power densities. The higher power densities provided the higher shrinkage.

Analysis of mechanical behavior of implant-supported prostheses in the anterior maxilla: analysis by speckle pattern interferometry

The use of implants to rehabilitation of total edentulous, partial edentulous or single tooth is increasing, it is due to the high rate of success that this type of treatment present. The objective of this study was to analyze the mechanical behavior of different positions of two dental implants in a rehabilitation of 4 teeth in the region of maxilla anterior. The groups studied were divided according the positioning of the implants. The Group 1: Internal Hexagonal implant in position of lateral incisors and pontic in region of central incisors; Group 2: Internal Hexagonal implant in position of central incisors and cantilever of the lateral incisors and Group3 - : Internal Hexagonal implants alternate with suspended elements. The Electronic Speckle Pattern Interferometry (ESPI) technique was selected for the mechanical evaluation of the 3 groups performance. The results are shown in interferometric phase maps representing the displacement field of the prosthetic structure.

Measurement of shrinkage of composite resin by laser speckle contrast analysis

The aim of this study was to evaluate the shrinkage of a microhybrid dental composite resin photo-activated by one LED with different power densities by means of speckle technique. The dental composite resin Filtek (TM) Z-250 (3M/ESPE) at color A(2) was used for the samples preparation. Uncured composite was packed in a metallic mold and irradiated during 20 s from 100 to 1000 mW cm(-2). For the photo-activation of the samples, it was used a LED prototype (Light Emission Diode) with wavelength centered at 470 nm and adjustable power density until 1 W cm(-2). The speckle patterns obtained from the bottom composite surfaces were monitored using a CCD camera without lens. The speckle field is recorded in a digital picture and stored by CCD camera as the carrier of information on the displacement of the tested surface. The calculated values were obtained for each pair of adjacent patterns and the changes in speckle contrast as a function of time were obtained from six repeated measurements. The speckle contrasts obtained from the bottom surface with 100 mW cm(-1) were smaller than those than the other power densities. The higher power densities provided the higher shrinkage.