ANA CLARA TUDE RODRIGUES
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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- Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study(2022) KARAGODIN, Ilya; SINGULANE, Cristiane Carvalho; DESCAMPS, Tine; WOODWARD, Gary M.; XIE, Mingxing; TUCAY, Edwin S.; SARWAR, Rizwan; VASQUEZ-ORTIZ, Zuilma Y.; ALIZADEHASL, Azin; MONAGHAN, Mark J.; SALAZAR, Bayardo A. Ordonez; SOULAT-DUFOUR, Laurie; MOSTAFAVI, Atoosa; MOREO, Antonella; CITRO, Rodolfo; NARANG, Akhil; WU, Chun; ADDETIA, Karima; RODRIGUES, Ana C. Tude; LANG, Roberto M.; ASCH, Federico M.Background: COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection. Methods: Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyz-able, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardio-graphic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function. Results: For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not signif-icantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a signif-icant reduction of LVEF at follow-up (74.3% +/- 3.1% vs 64.4% +/- 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% +/- 5.9% vs 49.3% +/- 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<-18%) at baseline had a significant reduction of LVLS at follow-up (-21.6% +/- 2.6% vs-20.3% +/- 4.0%, P = .006), while patients with impaired LVLS at base-line had a significant improvement at follow-up (-14.5% +/- 2.9% vs-16.7% +/- 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>-20%) at baseline had significant improvement at follow-up (-15.2% +/- 3.4% vs -17.4% +/- 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 +/- 0.7 cm vs 4.6 +/- 0.6 cm, P = .019). Conclusions: Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.
- Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study(2021) KARAGODIN, Ilya; SINGULANE, Cristiane Carvalho; WOODWARD, Gary M.; XIE, Mingxing; TUCAY, Edwin S.; RODRIGUES, Ana C. Tude; VASQUEZ-ORTIZ, Zuilma Y.; ALIZADEHASL, Azin; MONAGHAN, Mark J.; SALAZAR, Bayardo A. Ordonez; SOULAT-DUFOUR, Laurie; MOSTAFAVI, Atoosa; MOREO, Antonella; CITRO, Rodolfo; NARANG, Akhil; WU, Chun; DESCAMPS, Tine; ADDETIA, Karima; LANG, Roberto M.; ASCH, Federico M.Background: The novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality. Methods: We studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning-derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality. Results: Significant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007). Conclusions: Left ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echo cardiographic utilization in different parts of the world. (J Am Soc Echocardiogr 2021;34:819-30.)
- Importance of Adequately Performed Valsalva Maneuver to Detect Patent Foramen Ovale during Transesophageal Echocardiography(2013) RODRIGUES, Ana Clara; PICARD, Michael H.; CARBONE, Aime; ARRUDA, Ana Lucia; FLORES, Thais; KLOHN, Juliana; FURTADO, Meive; LIRA-FILHO, Edgar B.; CERRI, Giovanni G.; ANDRADE, Jose L.Background: Transesophageal echocardiography (TEE) plays an important role in evaluating cardioembolic sources of emboli. The identification of a patent foramen ovale (PFO) is reportedly improved with TEE compared with transthoracic echocardiography (TTE), but the Valsalva maneuver during TEE may be difficult or suboptimal. The aim of this study was to assess the efficacy of the Valsalva maneuver for PFO diagnosis using TEE compared with TTE by evaluating patients with ischemic stroke referred for echocardiography. Methods: Only patients able to perform the Valsalva maneuver during TTE were included; efficacy was defined by a 20 cm/sec decrease in transmitral E velocity. A PFO was judged present when microbubbles of agitated intravenous saline were seen in the left chambers within three cycles after right atrial opacification. Results: Of 108 patients (mean age, 55615 years; 61 men), 48 (44%) were judged to have PFOs by TEE and/or TTE. In 36 patients (33% of the total, 75% of those with PFOs), microbubbles were observed both by TEE and TTE, in seven patients only during TTE, and in five patients only during TEE. In patients able to satisfactorily perform the Valsalva maneuver during TEE, 22 PFOs were found, and two shunts (9%) were missed, whereas in patients unable to perform this maneuver, 26 PFOs were observed, with five shunts missed (19%) (P <.05). When a PFO was missed by TTE, either the echocardiographic window was suboptimal or the shunt was small. Conclusions: An adequate Valsalva maneuver is crucial for diagnosis of PFO; most patients with stroke may be screened using TTE with contrast and the Valsalva maneuver, with TEE indicated in case of suboptimal transthoracic images.