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S Salomão

Publications and source records attributed to S Salomão.

At least 19 recordsLinked to original sources
PubMed2001

Non-invasive monitoring of pulmonary capillary wedge pressure in heart failure.

OBJECTIVE: To evaluate the usefulness of pulsed Doppler (PD) mitral flow E wave deceleration time (EDcT) to detect and quantify changes of pulmonary capillary wedge pressure (PCWP) in patients (pt) with dilated chronic heart failure (CHF) submitted to tailored therapy. METHODS: In 14 pt with dilated cardiomyopathy (DCM) (59.4+/-10.0 years, 11 males, sinus rhythm), admitted to the ICU because of worsening CHF, serial simultaneous hemodynamic and echocardiographic studies were performed (3-5/pt; overall 49 evaluations). PD mitral flow register was used to measure EDcT and correlated with PCWP at each study. RESULTS: PCWP ranged from 36 to 3 mmHg (17.6+/-8.8) and EDcT from 271 to 52 ms (104.9+/-42.4). The correlation between EDcT and PCWP was -0.65 (PCWP=31.7-0.134EDcT). Using this equation to calculate PCWP, individual absolute values difference (identity error - IE) was 5.6+/-3.5 mmHg (0.4-14.6). In 29 cases (59.2%) IE was >5 mmHg, defined as major error. Considering EDcT percent change (delta%EDcT) and PCWP variation (deltaPCWP) in serial evaluations, we found a correlation of -0.87 (deltaPCWP=-2.83-0.19 delta%EDcT). Using this equation, the IE was 2.3+/-1.6 mmHg (0-5.2) and there were only two (6%) major errors (P<0.0001). CONCLUSIONS: In pt with DCM and advanced CHF, EDcT shows a reasonable correlation with PCWP, but when it is used to calculate PCWP the IE to hemodynamic values is often large. However, our results with EDcT percent change in serial evaluations using a first simultaneous invasive determination, suggest that this technique is reliable for monitoring PCWP and can be particularly useful for pt submitted to tailored therapy.

Adult↗
PubMed2000

Cardiac output quantification by Doppler echocardiography in intensive care--limitations and validation.

UNLABELLED: Cardiac output (CO) quantification is primordial to the evaluation of patients with heart failure who are on tailored therapy and under invasive hemodynamic monitoring. Doppler echocardiography can be used to access CO noninvasively, but the concordance between its results and those obtained by invasive methods in paired measurements is still controversial. To our knowledge, no previous studies have assessed the clinical relevance of Doppler echocardiography for CO serial evaluation in patients submitted to tailored therapy. AIM: To evaluate the usefulness of echo-Doppler in the assessment of CO and quantification of changes in CO, compared to thermodilution, in patients with advanced heart failure under hemodynamic monitoring to guide tailored therapy. METHODS: In 20 patients (14 male, 62 +/- 14 years old, all in sinus rhythm), with dilated cardiomyopathy and NYHA IV, admitted to the intensive care unit (ICU), CO was simultaneously determined by Doppler echocardiography (dpCO) and thermodilution (tdCO) in three serial evaluations (overall 60). The dpCO was calculated by multiplying the aortic orifice area by the velocity-time integral of aortic continuous wave Doppler flow and by the heart rate. A difference between tdCO and dpCO of more than 20% was considered a major error. RESULTS: In the overall evaluations, dpCO systematically overestimates tdCO (p = 0.026). The correlation between tdCO and dpCO was 0.81, the mean difference between measurements was 0.40 +/- 0.61 l/min (mean -2SD = -1.62 mean +2SD = 0.81) and 19 (32%) major errors occurred. No significant difference was found between CO percentual variation values assessed by both methods, with a stronger correlation (r = 0.92-p = 0.014) compared to that found for absolute values. On using the dpCO/tdCO ratio in the first evaluation to correct subsequent dpCO, the correlation was fairly good (r = 0.96-p = 0.0002 versus corrected dpCO). The mean difference between paired measurements was significantly lower (0.12 +/- 0.28 l/min-mean 2SD = -0.44 mean +2SD = 0.67), and there were no errors. CONCLUSIONS: CO estimated by Doppler echocardiography has a good correlation with thermodilution although with a weak concordance between paired results in patients with dilated cardiomyopathy and advanced heart failure admitted to the ICU for tailored therapy. Our results with dpCO percentual change in repeated evaluations and with corrected dpCO value after a single simultaneous invasive determination suggest that Doppler echocardiography is a valid method for clinical purposes, allowing us to propose a reduction in the time period of invasive hemodynamic monitoring.

Adult↗
PubMed1999

[The semiquantitative evaluation of systemic vascular resistances in heart failure via an analysis of Doppler aortic flow].

UNLABELLED: In patients with advanced heart failure (HF) submitted to tailored therapy, monitoring of systemic vascular resistance (SVR) is essential to establish an adequate hemodynamic response, being one of the end-points to achieve SVR < 18 Wood U (WU). PURPOSE: To correlate SVR value with parameters derived from the analysis of echo-Doppler aortic flow in patients with HF on tailored therapy, in order to allow a non-invasive semiquantitative evaluation of this hemodynamic end-point. METHODS: In 13 patients with dilated cardiomyopathy (eight idiopathic, five ischemic) and advanced HF (mean age 60 +/- 10 years, 10 male, all in sinus rhythm, NYHA class IV), admitted in the ICU and submitted to tailored therapy, serial simultaneous hemodynamic and echocardiographic studies were performed (2 to 5 per patient, overall 43 evaluations). The following parameters derived from the analysis of continuous wave aortic Doppler flow were analysed: peak velocity, acceleration, deacceleration and ejection times, systolic time intervals ratio, mean acceleration, mean deacceleration, acceleration, deacceleration and overall systolic flow velocity time integrals. RESULTS: SVR ranged from 10.4 to 41.9 WU (mean = 21.7, SD = 6.9). A significant correlation was found only with mean deacceleration (MnDc)-r = -0.60. MnDc ranged from 362 to 1162 cm/s2 (mean = 667, SD = 188) and proved to be independent from heart rate, systolic, diastolic and mean blood pressure, capillary wedge pressure, cardiac output, cardiac index and ejection volume. MnDc < 700 cm.s2 occurred in 25/28 evaluations with SVR > 18 WU and only in 3/15 evaluations with SVR < 18 WU-p = 0.00003. A MnDc value < 700 cm.s2 showed sensitivity = 89%, specificity = 80%, and predictive value = 89% for SVR > 18 WU (Kappa index = 0.693). CONCLUSION: Mean deacceleration of aortic continuous wave flow is reliable for semiquantitative evaluation of systemic vascular resistance and can be particularly useful for patients with advanced heart failure submitted to tailored therapy.

Adult↗
PubMed1999

[The sinus venosus type of interatrial communication: its diagnosis by transesophageal echocardiography].

Transthoracic echocardiography has important limitations in the diagnosis of sinus venosus atrial septal defects in adults because of the posterior location of the defect. We review the role of transesophageal echocardiography in the diagnosis of this congenital heart disease in nine patients, as well as in the identification of associated abnormal pulmonary venous connections.

Adult↗
PubMed1999

[A pseudoaneurysm of the mitral-aortic intervalvular fibrosis after aortic valve replacement].

A 58-year-old male underwent a transesophageal echocardiogram for suspected aortic valve infective endocarditis, four years after surgery. The examination, performed with a multiplane probe, showed a pulsatile (systolic expansion) echo-free cavity in the intervalvular mitral-aortic region, communicating with the left ventricle outflow tract, with no signs of rupture to the left atrium or the aorta. These findings meet the criteria for the diagnosis of pseudoaneurysm of the mitral-aortic intervalvular fibrosa.

Aneurysm, False↗
PubMed1997

[Mitral valve insufficiency caused by tendinous cord rupture and mitral valve aneurysm. Significance of the echocardiographic study].

Mitral valve aneurysm is a rare complication that may occur in a myxomatous valve. We report the case of a 73 year old male patient with severe mitral regurgitation and heart failure-class IV NYHA. Echocardiography showed perforation of an aneurysm of the anterior leaflet of the mitral valve associated with rupture of tendinous cords of the posterior mitral leaflet. Diagnosis was made by transthoracic echocardiography and confirmed by transesophageal echocardiography. The patient was urgently operated with success and a mitral valve prosthesis was implanted.

Aged↗
PubMed1996

[Endocarditis in patients with endocardial catheters; role of transesophageal echocardiography for its detection (report of 4 clinical cases)].

UNLABELLED: To evaluate the usefulness of transesophageal echocardiography in the diagnosis of patients with non-prosthetic intracardiac material and clinical suspicion of endocarditis. A brief review of the literature was also made. PATIENTS: All the clinical cases of patients with febril syndrome, clinical suspicion of endocarditis and non-prosthetic intracardiac material who were referred to our Department of Echocardiography for an echocardiographic examination - transthoracic and transesophageal approach. RESULTS: Four patients were found from our revision, three of them had a permanent endocavitary pacing catheter and one had a central venous catheter. Transthoracic echocardiography confirmed the diagnosis in three patients, but did not provide accurate information in two cases due to deficient acoustic window. Transesophageal echocardiography confirmed the clinical suspicion of endocarditis in all four patients and gave more information about the size and site of vegetations, involvement of cardiac valves and existence or absence of abcesses. CONCLUSIONS: Transesophageal echocardiography improves the diagnosis of right heart endocarditis in patients with non-prosthetic intracardiac material providing more accurate information, sometimes with prognostic and therapeutic importance.

Adult↗
PubMed1995

[The QTc interval and its dispersion in hypertrophic myocardiopathy--its relation to complex ventricular arrhythmias and the effect of anti-arrhythmia agents].

UNLABELLED: The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HCM): 1. The relation of rate corrected QT interval (QTc) and of QTc interlead variability (QTc dispersion) to complex ventricular arrhythmias (CVA); 2. The effects of amiodarone (Am), beta-blockers (beta B) and calcium antagonists (CA) on QTc and on QTc dispersion. Surface 12 leads ECG was analysed in 55 patients with HCM (39 +/- 12 years, 32 males). All patients were in sinus rhythm, without bundle branch block. Maximum (max), minimum (min) and mean QTc values were considered. QTc dispersion was calculated as: a) max QTc - min QTc (max-min); b) dispersion index (DI) = standard deviation of QTc/mean QTcx100. Patients groups were defined accordingly to: 1--the absence (group A1-35 patients) or the presence (group A2-20 patients) of CVA on 24 hours Holter monitoring; II--absence of cardioactive medication (group B1-20 patients) versus monotherapy with Am (group B3-10 patients), or beta B (group B4-15 patients), or CA (group B5-10 patients). Age, gender, type of HCM (asymmetric versus concentric) and echocardiographic fractional shortening were not different in the studied groups. RESULTS: [table: see text] CONCLUSIONS: 1. Maximum QTc interlead QTc dispersion are increased in patients with HCM that show CVA on Holter monitoring; 2. Amiodarone prolongs QTc but reduces QTc dispersion, while beta-blockers and calcium antagonists do not significantly change neither the duration nor the dispersion of ventricular repolarization.

Adrenergic beta-Antagonists↗
PubMed1995

[Diagnosis of coronary disease using echocardiography with inotropic dobutamine stimulation].

PURPOSE: To evaluate dobutamine echocardiography capacity to diagnose coronary artery disease. STUDY DESIGN: Prospective clinical study. SETTING: Cardiology Department of Hospital Santa Marta. PATIENTS: 32 patients with suspected coronary artery disease, without myocardial infarction, have been studied. METHODS: An intravenous perfusion of dobutamine with gradual doses, from 5 to 40 micrograms/kg/min, and increments of 5 to 10 micrograms/kg/min, in 3 minute stages, except the last stage which lasted only 1 minute with 40 micrograms/kg, was performed. Twelve-lead ECG were registered to detect ST changes and symptoms, namely chest pain. Basal and dobutamine bidimensional echocardiograms, in the end of each stage and during recovery, were registered in video. The segmental analysis was performed considering the left ventricle divided in 16 segments. It was considered positive the occurrence or aggravation of the contractility asynergy of the left ventricle with inotropic stress. All the patients were submitted to coronary arteriography. RESULTS: Due to the bad quality of the echocardiographic images 2 patients were excluded. The stress dobutamine echocardiograms were positive in 14 P and negative in 16 P. The coronary arteriography showed coronary disease in 18 cases and absence of significant lesions in 12 cases. The values for sensitivity, specificity positive predictive value and negative predictive value obtained with dobutamine echocardiography were, 78% and 100% and 75% respectively. In Dobutamine-ECG, 7P had ST segment changes, 2 of them with chest pain values for sensitivity, specificity, positive and negative predictive value with dobutamine-ECG were, 39%, 100% and 52%, respectively. The occurrence of side-effects was observed in 8 P (27%): ventricular tachycardia (2 P-7%), complex ventricular ectopy (4 P-13%), chest pain (2 P-7%), headache (1 P-3%), nausea (1 P-3%) and palpitations (2 P-7%). There was no significant difference in the occurrence of side-effects in the two groups of patients, with and without coronary artery disease (33% vs 17%, respectively; p = ns). The reasons for early discontinuation of dobutamine infusion were: ventricular tachycardia (2 P), complex ventricular ectopy (2 P) and chest pain (1 P). Heart rate, systolic blood pressure and double-product did not differ significantly in patients with and without coronary artery disease. In dobutamine electrocardiography 7 P had ST segment changes, 2 of them with chest pain. CONCLUSION: Dobutamine echocardiography showed in this study elevated values for sensitivity and specificity, however sensitivity can be increased with better technical conditions.

Aged↗
PubMed1994

Use of sleep questionnaires in assessing the effect of moclobemide on the sleep profiles of depressive patients.

The sleep profiles of healthy adult volunteers (group 1) were compared with the sleep profiles of depressive patients (group 2), using the method suggested by Görtelmeyer. This method uses a questionnaire to evaluate the various aspects of sleep profiles that may be different in depressive patients compared with healthy subjects. Thirty patients in group 2 were tested before and during exposure to moclobemide (450 mg/day) for 8 weeks. The group of healthy adults did not receive moclobemide and showed stable sleep profiles throughout the study period. After approximately 2 weeks of administration of moclobemide, the sleep profiles of depressive patients that had been aberrant at baseline became more normal. Around this same time, the antidepressant effects of moclobemide became apparent. The sleep questionnaire used in this study appears to be a valuable and practical method for evaluating sleep architecture.

Adult↗
PubMed1994

[Non-invasive evaluation of ventricular ejection force by Doppler echocardiography].

UNLABELLED: Left ventricular ejection force as been purpose as a new Doppler ejection phase index, to assess left ventricular performance. In order to evaluate its usefulness, 33 patients undergoing cardiac catheterization were prospectively study. We considered three groups based on angiographic ejection fraction: group A-- > or = 55% (11 patients), group B--35 to 55% (10 patients), and group C-- < or = 35% (10 patients). All patients were in sinus rhythm and mitral regurgitation > I/IV or aortic valve disease were exclusion criterion. The following parameters, derived from Pulsed Doppler aortic velocities curves, were analyzed: peak velocity (cm/s), acceleration time (s), velocity time integral over the acceleration time (VTI Ac-cm), mean acceleration (cm/s2) and ejection force (g.cm/s2). Ejection force as calculated using the mass-acceleration concept, ad: ejection force = mean acceleration x VTI Ac x CsA x 1.06 (CsA - 2D cross sectional area of the aortic annulus; 1.06 - mass density of blood, g/cm3). [table: see text] CONCLUSIONS: The present study confirms that Doppler echocardiography can be used for the assessment of left ventricular performance based on noninvasive measurements and that Doppler derived ejection force is an accurate index for this purpose. However, ejection force evaluation, taking in account the results obtained for mean acceleration, a much less time consuming Doppler derived parameter, appears not to show any clinical advantage.

Adult↗
PubMed1993

[The recurrence of an atrial myxoma in a patient with a mechanical mitral prosthesis--apropos a case].

Recurrence of cardiac myxoma after surgery is an uncommon situation, particularly if a wide excision of the tissue under the tumour has been done. The authors report a case of a 54-year-old male presenting with a left atrial myxoma near the mitral valve, which had to be replaced by a mechanical prosthetic valve during the removal of the tumour. One year later, he was admitted to hospital with persistent fever, weight loss, and congestive heart failure. After a positive hemoculture, intravenous antibiotherapy was initiated, and twice modified because of relapsing fever. Six weeks later, he was transferred to our institution, after an episode of severe acute pulmonary edema. 2D-Doppler echocardiography suggested the possibility of prosthesis dysfunction, revealing a transprothetic diastolic flow with a high peak velocity and moderately elevated pressure half-time. No intra-atrial masses were visualized. Computed tomography was also inconclusive, because of multiple artifacts produced by the prosthesis. These results led to the performance of a cardiac catheterization with contrast ventriculography, which revealed the presence of a transprothetic gradient, and mild mitral regurgitation. The patient was submitted to cardiac surgery, which revealed a recurrent pedunculated left atrial myxoma, with mechanical obstruction of the mitral prosthetic valve. No signs of endocarditis were found. Recurrent cardiac myxomas are reviewed and discussed, as well as the specific problems of the present case, namely the presence of a mechanical prosthetic mitral valve and the initial hemoculture results, with consequent diagnostic delay.

Heart Atria↗