sured with both PE and SE.Pearson correlations varied lrom 0.223 (posterior wall thickness) to 0884 (LVEF).PE did not miss any significant valvular regurgitation (_>grade 2) or stenosis.The overall concordance lor the main echocardiographic diagnosis was 86% (Kappa coelficient 0.764, p < 0.001) and lor an associated echocardiographic diagnosis (Kappa coelficienl 0.460, p < 0.001 ) Overall concordance in measurements ParametersPearson correlation P-value Left atrial area (4e) 0651 < 0.001 Biplane LVEF 0884 < 0.

10.1016/s1525-2167(05)80688-2

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3151The prognostic meaning of a reduced reserve of left ventricular force during exercise in hypertrophic cardiomyopathy

European Heart Journal (2019)

M G D'Alfonso Jesús Peteiro Clarissa Carmona de Azevedo Bellagamba Marco Antônio Rodrigues Torres Federica Re

Abstract Background Hypertrophic cardiomyopathy (HCM) patients with blunted force-frequency relationship assessed with pacing during cardiac catheterization are at greater risk of adverse events. Left ventricular contractile reserve (LVCR) based on force can be obtained noninvasively during exercise stress echocardiography (ESE). Purpose To evaluate the prognostic correlates of force-based LVCR during ESE in HCM. Methods We enrolled 332 HCM patients (age 51±15 years, 193 males, New York Heart Association, NYHA, Class I-III, EF 68±9%, maximal wall thickness 20±5 mm, left ventricular outflow tract gradient, LVOTG, present at rest in 34 pts, 10%) referred for ESE in 7 quality-controlled labs. SE assessment included LVOTG (mm Hg), LV Force (systolic blood pressure by cuff sphygmomanometer + LVOTG/LV end-systolic volume assessed with 2-D, mmHg/ml) and LVCR (peak/rest ratio of LV Force). LV volumes were measured from apical biplane (4- and 2-chamber) views with Simpson method when feasible (n=290) or with linear Teichholz (T) method from parasternal (long- or short-axis) view (n=42). All patients were followed-up. Results Force values were 8.5±6.7 at rest and 15.0±13.7 mmHg/mL at peak stress (P<0.001). During a median follow-up time of 58 months, 50 patients experienced at least one event: 19 deaths (10 cardiac), 9 hospitalizations for acute heart failure, 16 myotomy/myectomy and 22 atrial fibrillations. The event-free survival was lower in the 195 patients with LVCR <1.77 (identified with Receiver-Operator Characteristic analysis) compared to the 137 with LVCR ≥1.77: see figure. Multivariate analysis identified LVCR (Hazard ratio, HR, 2.032, 95% confidence intervals, CI, 1.042–3.964, P=0.037), age (HR, 1.033, 95% CI 1.009–1.058, P=0.007) and NYHA class (HR 2.204, 95% CI 1.161–4.185, P<0.016) as independent predictors of events. Figure 1. HCM-LVCR Conclusion A non-invasive evaluation of LVOTG, systolic blood pressure and LV end-systolic volume during ESE allows to assess force-based LVCR in HCM. Lower LVCR is associated with greater risk of events at follow-up.

Parasternal line

Ventricular outflow tract

Interventricular septum

10.1093/eurheartj/ehz745.0039

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Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension

Revista Portuguesa de Cardiologia (English Edition) (2014)

Ana Rita Almeida Maria Jose Ze Loureiro Liliana Lopes Carlos Cotrim Luís Felipe Dias Lopes

Right ventricular function is a major determinant of prognosis in pulmonary hypertension. The aim of this study was to assess and compare right ventricular contractile reserve in healthy subjects (controls) and in subjects with pulmonary hypertension (cases). In this prospective study of seven cases and seven controls undergoing treadmill stress echocardiography, right ventricular S-wave velocity, tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and stroke volume index were assessed at rest and with exercise. The increase in each parameter between rest and exercise for cases and controls was analyzed and the magnitude of change in each parameter with exercise between cases and controls was compared. A significant increase in S-wave velocity was observed in cases (rest: 9.4±3.1; exercise: 13.7±4.8 cm/s [p<0.05]). In controls there was a statistically significant increase in S-wave velocity (12.9±2.3 to 23.0±7.2 cm/s [p<0.005]), TAPSE (25.7±2.4 to 31.0±3.5 mm [p<0.05]) and RVFAC (53.8±14.7% to 64.4±9.9% [p<0.005]). The magnitude of change in S-wave velocity (cases: 4.3±3.3; controls: 10.1±5.5 cm/s [p<0.05]), TAPSE (cases: 0.6±2.5; controls: 5.3±3.8 mm [p<0.05]) and RVFAC (cases: −0.4±11.8; controls: 10.6±5.9% [p<0.05]) was significantly different between cases and controls. S-wave velocity, TAPSE and RVFAC increased significantly with exercise in controls. S-wave velocity was the only parameter that showed a significant increase in cases, although the magnitude of this increase was significantly less than in controls. A função ventricular direita é um determinante major do prognóstico na hipertensão pulmonar. Caracterização e comparação da reserva contrátil do ventrículo direito em indivíduos saudáveis (controlos) e doentes com hipertensão pulmonar (casos). Estudo prospetivo de sete casos e sete controlos submetidos a ecocardiograma de esforço. Avaliámos, em repouso e no esforço, a velocidade da onda S ventricular direita, a excursão sistólica do plano anular tricúspide, a área de encurtamento fracional do ventrículo direito e o volume sistólico indexado. Analisámos o aumento de cada parâmetro entre repouso e esforço para casos e controlos e comparámos a magnitude de variação com o exercício de cada parâmetro entre casos e controlos. Nos casos observámos aumento significativo da onda S (repouso 9,4 ± 3,1; esforço 13,7 ± 4,8 cm/seg [p < 0,05]). Nos controlos ocorreu aumento significativo da onda S (repouso 12,9 ± 2,3; esforço 23,0 ± 7,2 cm/seg [p < 0,005]), da excursão sistólica do plano anular tricúspide (repouso 25,7 ± 2,4; esforço 31,0 ± 3,5 mm [p < 0,05]) e da área de encurtamento fracional (repouso 53,8 ± 14,7%; esforço 64,4 ± 9,9% [p < 0,005]). A magnitude de variação da onda S (casos 4,3 ± 3,3; controlos 10,1 ± 5,5 cm/seg [p < 0,05]), da excursão sistólica do plano anular tricúspide (casos 0,6 ± 2,5; controlos 5,3 ± 3,8 mm [p < 0,05]) e da a área de encurtamento fraccional (casos 0,4 ± 11,8; controlos 10,6 ± 5,9% [p < 0,05]) foi significativamente diferente entre casos e controlos. A onda S, a excursão sistólica do plano anular tricúspide e a área de encurtamento fracional aumentaram significativamente com o esforço nos controlos. A onda S foi o único parâmetro que aumentou significativamente nos casos, embora a magnitude desse aumento seja significativamente menor do que nos controlos.

Ventricular Function

Right heart

10.1016/j.repce.2013.09.017

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Citations (1)

[Changes in regional wall contractility induced by effort in women with normal coronary angiography --report of a clinical case].

PubMed (2001)

I João Carlos Cotrim Paula Fazendas Carmen C.S. Martins P Osório

Contractility

Transthoracic echocardiogram

Source

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Citations (1)

Left ventricular thrombus in repaired Tetralogy of Fallot

International Journal of Cardiology (2015)

Daniel Caldeira Carlos Cotrim Rita Calé Inês Cruz Bruno Stuart

Ventricular Function

Pulmonary Valve Insufficiency

10.1016/j.ijcard.2015.03.185

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Acute type A aortic dissection involving the left main coronary artery and the aortic valve--a case report.

PubMed (2001)

I João Duarte Ja Carlos Cotrim Manuel Carrageta

Transesophageal echocardiogram

Aortography

Aortic valve regurgitation

Transthoracic echocardiogram

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Citations (2)

What Is Really a Nonobstructive Hypertrophic Cardiomyopathy? The Importance of Orthostatic Factor in Exercise Echocardiography

ISRN Cardiology (2011)

Carlos Cotrim Ana Rita Almeida Luís R. Lopes Paula Fazendas Isabel João

The authors report the case of a 23-year-old girl with nonobstructive hypertrophic cardiomyopathy evaluated by resting echocardiography. The patient complained of syncope after playing basketball. The patient was submitted to treadmill exercise echocardiogram, and she exercised for 9 minutes in standard Bruce protocol. The left ventricular outflow gradient did not occur at peak workload; however she developed intraventricular gradient greater than 100 mmHg after exercise in orthostatic position. There was fall in arterial pressure, and the patient was then put in supine position. The authors suggest the possible role of exercise stress echo in symptomatic patients with no significant gradient at baseline, as well as maintenance in orthostatic position after exercise, as an important stress factor. This can disclose the occurrence of left ventricular outflow tract obstruction that should not be detected in other way and has potential relevance in the patient's symptoms understanding.

Supine position

Ventricular outflow tract

Bruce protocol

Stress Echocardiography

Treadmill

10.5402/2011/346797

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Citations (3)

[Recovery of respiratory parameters and oxygen consumption during the recovery phase of cardiopulmonary exercise test in patients with dilated cardiomyopathy].

PubMed (1998)

C Silveira Soares Rm Marisa A. S. V. Ferreira Ferreira Rc Carlos Cotrim

Treadmill

Respiratory exchange ratio

Dilated Cardiomyopathy

Respiratory minute volume

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Clinical significance of intraventricular gradient during effort in an adolescent karate player

Cardiovascular Ultrasound (2007)

Carlos Cotrim Ana G. Almeida Manuel Carrageta

The authors report the case of a 16-year-old boy who practices karate, who underwent medical evaluation because of atypical chest discomfort, related to strenuous effort. The ECG and echocardiogram findings were normal. The young boy did a treadmill stress test which was positive for myocardial ischemia. Late during the investigation, he underwent treadmill stress echocardiography, during which he developed intraventricular gradient of over 130 mmHg with end-systolic peak and systolic anterior movement (SAM) of the mitral valve. These echocardiographic findings were not present at rest and disappeared shortly after termination of exercise. The authors discuss the significance of this event. This leads us to advise withdrawal from participation in competitive sport according to the recomendations of the European Society of Cardiology. A possible role of exercise stress echo for intraventricular pressure gradient assessment in symptomatic athletes with structurally normal hearts is suggested.

Angiology

Treadmill

Stress Echocardiography

10.1186/1476-7120-5-39

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Citations (13)