FUNDAMENTO: A sedação com midazolam e meperidina é amplamente utilizada em ecocardiografia transesofágica, entretanto, não existe dose média estabelecida para cada caso. OBJETIVO: Correlacionar as doses médias de midazolam e meperidina para sedação adequada em ecocardiografia transesofágica com faixa etária, área de superfície corpórea e fração de ejeção do ventrículo esquerdo. MÉTODOS: Estudo retrospectivo envolvendo 1.841 pacientes submetidos à sedação baseada na escala de Ramsay, com solução contendo midazolam 1,5 mg (1,5 ml), meperidina 1 mg (1 ml) e água destilada (7,5 ml). Analisamos quatro grupos etários: G1: < 24 anos; G2: 25 a 44 anos; G3: 45 a 64 anos; e G4: > 65 anos. Obtivemos a área de superfície corpórea pela fórmula: {[(altura x 100)0,725] x (peso0,425) x 0,0071}. Com relação à fração de ejeção do ventrículo esquerdo, estudamos dois grupos: GA: < 55%; e GB: > 55%. Na análise estatística utilizamos o teste de Kruskal-Wallis para correlação com idade e fração de ejeção do ventrículo esquerdo, e correlação linear simples para área de superfície corpórea. RESULTADOS: No estudo da idade, as doses médias de sedação necessárias foram significativamente menores no G3 e G4 (p < 0,01). Na análise da fração de ejeção do ventrículo esquerdo, esta foi significativamente menor no GA (p < 0,01). O coeficiente de correlação linear entre dose de sedação e área de superfície corpórea foi 0,09 (nulo). CONCLUSÃO: Houve menor dose média necessária de sedativos nos indivíduos com maior idade e em portadores de disfunção sistólica do ventrículo esquerdo, e não houve correlação com área de superfície corpórea.

BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: < 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: > 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight0.425) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: > 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

FUNDAMENTO: La sedación con midazolam y meperidina es ampliamente utilizada en ecografía transesofágica, no obstante, no existe dosis media establecida para cada caso. OBJETIVO: Correlacionar la dosis media de midazolam y meperidina para sedación adecuada en ecografía transesofágica con intervalo de edades, área de superficie corporal y fracción de eyección del ventrículo izquierdo. MÉTODOS: Estudio retrospectivo involucrando 1.841 pacientes sometidos a sedación basada en la escala de Ramsay, con solución conteniendo midazolam 1,5 mg (1,5 ml), meperidina 1 mg (1 ml) y agua destilada (7,5 ml). Analizamos cuatro grupos etarios: G1: < 24 años; G2: 25 a 44 años; G3: 45 a 64 años; y G4: > 65 años. Obtuvimos el área de superficie corporal mediante la fórmula: {[(altura x 100)0,725] x (peso0,425) x 0,0071}. Con relación a la fracción de eyección del ventrículo izquierdo, estudiamos dos grupos: GA: < 55%; y GB: > 55%. En el análisis estadístico utilizamos el test de Kruskal-Wallis para correlación con edad y fracción de eyección del ventrículo izquierdo, y correlación lineal simple para área de superficie corporal. RESULTADOS: En el estudio de la edad, las dosis medias de sedación necesarias fueron significativamente menores en el G3 y G4 (p < 0,01). En el análisis de la fracción de eyección del ventrículo izquierdo, ésta fue significativamente menor en el GA (p < 0,01). El coeficiente de correlación lineal entre dosis de sedación y área de superficie corporal fue 0,09 (nulo). CONCLUSIÓN: Hubo menor dosis media necesaria de sedantes en los individuos con mayor edad y en portadores de disfunción sistólica del ventrículo izquierdo, y no hubo correlación con el área de superficie corporal.

OBJETIVO: Quantificar o percentual de contratilidade dos diversos segmentos miocárdicos, em portadores de doença de Chagas, através da medida do strain miocárdico e verificar diferenças na função contrátil radial e longitudinal ventricular entre as formas indeterminada e dilatada da miocardiopatia chagásica crônica quando comparadas a um grupo de indivíduos normais. MÉTODOS: Foram estudados 39 indivíduos, 20 (51,3%) do sexo masculino divididos em quatro grupos: Nl: 17 (43,6%) indivíduos normais; Ind: 7 (17,9%) portadores de doença de Chagas forma indeterminada; C1, 7 (17,9%) portadores de doença de Chagas forma crônica com fração de ejeção < 50% e C2: 8 (20,5%) portadores de doença de Chagas forma crônica com fração de ejeção > 50%. Após realização de ecocardiograma basal foram registradas as imagem em Doppler tecidual para a medida do strain miocárdico nos diversos segmentos aos cortes paraesternais, longitudinal e transversal, e apicais, de duas e quatro câmaras. RESULTADOS E CONCLUSÃO: O percentual de contração dos diversos segmentos miocárdicos, tanto em seu componente radial quanto longitudinal é maior nos indivíduos normais do que em portadores da forma crônica da doença de Chagas e naqueles com a forma indeterminada da doença quando comparado com chagásicos crônicos com FE < 50%. A contratilidade radial do ventrículo esquerdo é maior que a longitudinal nos três grupos (Nl, Ind e Crônico). Os dados apresentados nos permitem propor um caráter progressivo do acometimento miocárdico em portadores da doença de Chagas.

OBJECTIVE: To quantify the percentage of contractility of different myocardial segments in patients with Chagas' disease by measuring myocardial strain and to assess the differences in the radial and longitudinal ventricular contractile function in the undetermined and dilated forms of chronic chagasic cardiomyopathy as compared with those in a group of healthy individuals. METHODS: The study comprised 39 individuals [20 (51.3%) of the male sex] divided into the following 4 groups: 1) Nl: 17 (43.6%) healthy individuals; 2) Und: 7 (17.9%) patients with the undetermined form of Chagas' disease; 3) C1: 7 (17.9%) patients with the chronic form of Chagas' disease with ejection fraction < 50%; and 4) C2: 8 (20.5%) patients with the chronic form of Chagas' disease with ejection fraction > 50%. After performing baseline echocardiography, Doppler tissue images were recorded to measure myocardial strain in different segments on longitudinal and transversal parasternal, and apical 2- and 4-chamber views. RESULTS AND CONCLUSION: The percentage of contractility in the different myocardial segments, both the radial and longitudinal components, is greater in healthy individuals than in patients with the chronic form of Chagas' disease, and in those with the undetermined form of the disease as compared with that of chronic chagasic patients with EF < 50%. Left ventricular radial contractility is greater than left ventricular longitudinal contractility in all groups (Nl, Und, and Chronic). The data presented allow us to propose a progressive character of myocardial impairment in patients with Chagas' disease.

OBJECTIVE: Doppler tissue imaging (DTI) enables the study of the velocity of contraction and relaxation of myocardial segments. We established standards for the peak velocity of the different myocardial segments of the left ventricle in systole and diastole, and correlated them with the electrocardiogram. METHODS: We studied 35 healthy individuals (27 were male) with ages ranging from 12 to 59 years (32.9 ± 10.6). Systolic and diastolic peak velocities were assessed by Doppler tissue imaging in 12 segments of the left ventricle, establishing their mean values and the temporal correlation with the cardiac cycle. RESULTS: The means (and standard deviation) of the peak velocities in the basal, medial, and apical regions (of the septal, anterior, lateral, and posterior left ventricle walls) were respectively, in cm/s, 7.35(1.64), 5.26(1.88), and 3.33(1.58) in systole and 10.56(2.34), 7.92(2.37), and 3.98(1.64) in diastole. The mean time in which systolic peak velocity was recorded was 131.59ms (±19.12ms), and diastolic was 459.18ms (±18.13ms) based on the peak of the R wave of the electrocardiogram. CONCLUSION: In healthy individuals, maximum left ventricle segment velocities decreased from the bases to the ventricular apex, with certain proportionality between contraction and relaxation (P<0.05). The use of Doppler tissue imaging may be very helpful in detecting early alterations in ventricular contraction and relaxation.

OBJECTIVE: The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli. METHODS: We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. Transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid. RESULTS: Transeophageal echocardiography detected at least one abnormality in 40 cases (58%). Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9%); anticoagulation was added in 10 cases and surgical correction in one patient. CONCLUSION: Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism.