BackgroundDiagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization.MethodsWe prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE.ResultsLogistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1–7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s−1 (0.01–0.14), 2.00 dB/s−1 (1–6), and 1.18 dB/s−1 (0.52–3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s−1 (1.42–4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT.ConclusionRTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.

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Recibido el 18 de noviembre de 2013; aceptado el 7 de julio de 2014 Disponible en Internet el 10 de diciembre de 2014 PALABRAS CLAVE Endomiocardiofibrosis; Miocardiopatía restrictiva; EcocardiografíaResumen La endomiocardiofibrosis es una miocardiopatía restrictiva causada por formación de tejido fibroso en el subendocardio. Es una enfermedad de etiología desconocida, que puede afectar uno o ambos ventrículos, comprometer músculos papilares y causar insuficiencia valvular auriculoventricular del ventrículo correspondiente. Es endémica de los países tropicales de África y puede hallarse en Europa y en países de clima templado como Brasil, Colombia e India. El diagnóstico se hace mediante hallazgos clínicos, ecocardiográficos y angiográficos típicos. El tratamiento, después de la aparición de los síntomas, es eminentemente quirúrgico. Se describe un caso de endomiocardiofibrosis biventricular en una paciente desnutrida y en fase avanzada de la enfermedad. A case report of endomyocardial fibrosis in ColombiaAbstract Endomyocardial fibrosis is a restrictive cardiomyopathy caused by the deposit of fibrotic tissue in the subendocardium. The etiology remains unknown. It can affect one or both ventricles, alter the papillary muscles and produce insufficiency of the auriculoventricular valve of the corresponding ventricle. It is endemic in the tropical countries of Africa, but can also be found in Europe and countries with mild temperatures such as Brazil, Colombia and India. Diagnosis is made by typical clinical, echocardiographic and angiographic findings. Once * Autor para correspondencia. Correo electrónico: ezkaori@yahoo.com.br (E.K. Uenishi).

Primary tumors of the heart are rare, most of them benign. However the differential diagnosis between benign and malignant tumors is very difficult. Quantitative Real-time Contrast Echocardiography(QRTCE) can evaluate the vascularity of cardiac masses and therefore help in characterizing the nature of cardiac masses. To evaluate the perfusion of cardiac masses and to compare the quantitative perfusion parameters of malignant and benign cardiac tumors by QRTCE. We studied 42 patients with cardiac masses, 23(54.8%) women, mean age 47.2±17.9 years old, 23(54.8%) with malignant tumor and 19 (45.2%) with benign tumors. Contrast-enhanced images were obtained after intravenous administration of PESDA(perfluorocarbon-exposed sonicated dextrose and albumin) or Definity®(lipid-encapsulated microbubbles) contrast. Q-lab software was applied to quantitative the perfusion of mass and adjacent cavity. The CE-derived rate of microbubble velocity(β), blood volume(A), blood flow(A × β) and relative blood flow(A/Acavity × β) were obtained by curve fitting of videointensity versus time plots, after the transient destruction of microbubbles by high-energy ultrasound. All malignant cardiac and 16 benign masses were confirmed by pathology. Blood velocity (β) was greater in the malignant than benign mass (1.4±2.04 × 0.71±0.48 dB, p=0.001). Malignant and benign mass A, A×B and A/Acavity × β values were 4.11±3.99 × 3.4±2.53, p=0.095; 3.69±3.95 × 2.85±3.36, p=0.113; 0.18±0.24 × 0.13±0.17, p=0.442; respectively. The malignant tumors were primary cardiac lymphoma (n=2), mediastinal lymphoma (n=5), pericardial mesothelioma(n=1) and metastatic tumors(n=15). Myxoma (n=15), lypoma(n=1), paraganglioma(1) and rabdomyoma(n=2) constituted the benign masses. QRTCE provides important information to differentiate the nature of cardiac masses by the demonstration of higher values of resting myocardial blood flow.

Esta tese está de acordo com as seguintes normas, em vigor no momento desta publicação: Referências: adaptado de International Committee of Medical Journals Editors (Vancouver).