I. Terol

Prevalencia de un índice tobillo-brazo patológico según el riesgo cardiovascular calculado mediante la función de Framingham

Fundamento y objetivo La medicion del indice tobillo-brazo (ITB) es un metodo sencillo para detectar la presencia de arteriosclerosis en miembros inferiores. Un valor inferior a 0,9 o superior a 1,4 se asocia con un riesgo elevado de enfermedad cardiovascular, cerebrovascular y/o muerte por cualquier causa. A pesar de ello, su implantacion en la practica clinica es escasa. El objetivo del presente estudio fue determinar la prevalencia de un ITB patologico en una poblacion en prevencion primaria clasificada segun su riesgo vascular calculado por la funcion de Framingham recomendada por el National Cholesterol Education Program en su documento Adult Treatment Panel III. Pacientes y metodo Participaron en el estudio 1.001 sujetos sin enfermedad vascular conocida atendidos en atencion primaria. A todos ellos se les estimo el riesgo vascular y se les midio el ITB. Resultados El ITB fue bajo (menor de 0,9) en un 3,8% de los participantes (un 3,9% de las mujeres y un 3,6% de los varones). Se considero patologico (inferior a 0,9 o mayor de 1,4) en un 6,4% (un 5,2% de las mujeres y un 8,8% de los varones). En el analisis multivariante los factores que se asociaron con un ITB patologico fueron la edad odds ratio (OR) = 1,09 por cada ano de edad; intervalo de confianza (IC) del 95%, 1,03-1,15), el tabaquismo (OR = 2,96; IC del 95%, 1,51-5,80), la concentracion de colesterol unido a lipoproteinas de alta densidad (OR = 0,98 por cada mg/dl; IC del 95%, 0,95-0,99) y la presencia de hipertension arterial (OR = 1,80; IC del 95%, 1,05-3,06). Al ser clasificados segun su riesgo vascular, el porcentaje de sujetos de riesgo bajo, intermedio y alto con un ITB patologico fue del 2,6, el 8,7 y el 14,9%, respectivamente. Conclusiones En prevencion primaria, uno de cada 10 sujetos con riesgo intermedio y uno de cada 6 con riesgo elevado presentan un ITB patologico. En estos sujetos estan indicadas las medidas preventivas energicas y la antiagregacion.

Valor pronóstico de los estudios de perfusión miocárdica con Tl-201 normal en pacientes con ergometría positiva

El objetivo de este trabajo ha sido determinar el valor pronostico a medio plazo de los estudios de perfusion miocardica con Tl-201 normal en los pacientes con ergo-metria positiva. Se seleccionaron 85 pacientes consecutivos que desde enero de 1996 a diciembre de 2000 habian presentado gammagrafias normales con ergometrias electricamente positivas. La probabilidad pretest de enfermedad coronaria era intermedia o alta. Se efectuo seguimiento a 78 pacientes (89%) durante una media de 2,03 anos. Un total de 40 pacientes (51%) eran varones. La edad media fue de 56 anos. Se analizaron las siguientes variables: angina, revascularizacion, infarto no mortal y muerte cardiaca. Durante el periodo de seguimiento no se produjeron acontecimientos coronarios mayores; solo 8 enfermos refirieron episodios de dolor anginoso y uno de ellos angina inestable que requirio revascularizacion. En pacientes con probabilidad pretest de enfermedad coronaria intermedia que presentan una gammagrafia de perfusion miocardica normal, el pronostico a medio plazo es excelente, aunque la ergometria haya sido electricamente positiva.

Autoinmunidad y miocardiopatía dilatada: situación actual y perspectivas

El diagnostico de miocardiopatia dilatada idiopatica se asigna, por exclusion, a pacientes en los que se ha descartado la presencia de etiologias conocidas que justifiquen la disfuncion ventricular. Se le supone un origen multifactorial, en el que se incluye la posibilidad de una reaccion autoinmunitaria. Se revisa el estado actual de las investigaciones etiologicas y las hipotesis fisiopatologicas que se relacionan: reaccion autoinmunitaria-hiperactividad simpatica y disfuncion-dilatacion del ventriculo izquierdo. Sobre la base de estas hipotesis etiologicas y fisiopatologicas, se han postulado diversas terapeuticas que se han ensayado con mayor o menor exito en otras enfermedades. Se revisan sus resultados hasta el momento actual, asi como sus perspectivas de desarrollo futuro.

Cuantificación del estudio de perfusión miocárdica en pacientes con baja probabilidad de cardiopatía isquémica. Valores normales de gated-SPECT con 201Tl

INTRODUCTION This study has aimed to establish quantitative normality parameters in the thallium-201 GATED SPECT and to assess the changes related to age, gender, risk factors and stress testing. METHODS A total of 427 patients with low pre-test likelihood of coronary artery disease were selected (45.5% men). The examinations were performed, by obtaining 32 25-second images on a 180% arc. The isotope used was thallium-201 and the SU SEGAMI software was using for the examination procedure. RESULTS Myocardial tracer uptake in each one of the vascular territories was: left descending artery 77%+/-4; circumflex artery 76%+/-5 and right coronary artery 70%+/-4 (P=.000). Uptake in the right coronary artery territory was lower in men (68.7% vs 70.5% in women, P=.000) and in the left descending artery territory in the obese. There were no gender-related differences in the post-stress ejection fraction for both genders (65.7% in men vs 66.8% in women). However, ventricular volumes were higher in men (end-diastolic volume 80ml+/-27 vs 61ml+/-22; P=0.000 and end-systolic volume 27.2ml+/-25 vs 19ml+/-8; P=0.000). There is an inverse relationship between age and end-diastolic volume. Smokers have higher end-diastolic volumes than non-smokers. CONCLUSIONS Quantification of T1201 uptake in patients having low pre-test probability of coronary artery disease and normal thallium GATED-SPECT in the RCA territory is lower in men. The ventricular function study shows that there are no differences in post-stress EF based on gender but that the end-diastolic and end-systolic volumes are higher in men.

Myocardial perfusion study in patients who do not reach submaximal frequency on ergometry

UNLABELLED The aim of the study was to evaluate the sensitivity and specificity of TI-201 myocardial perfusion SPECT for the diagnosis of ischaemic cardiopathy in a group of patients with chronotropic insufficiency. MATERIALS AND METHODS The examinations of 750 patients who had attended for the diagnosis of ischaemic cardiopathy during 2005-2006 were selected. 28 % (n = 209) did not reach submaximal frequency. Data on the diagnosis was collected in 112 by telephone interview. Ergometry and SPECT were carried out following the usual techniques. RESULTS Patients who reached submaximal frequency and patients with chronotropic insufficiency did not show differences in age and exercise time. The proportion of patients on beta-blocker treatment, with clinically positive ergometries and pathological SPECT was higher in the patient group which had not reached 85 % of their maximum frequency. The data obtained in the patient group which did not reach submaximal frequency and followed-up by telephone interview showed a SPECT sensitivity of 84 % and specificity of 96 %. The sensitivity of the ergometry was 25 % and its specificity was 96 %. CONCLUSIONS Ergometry with myocardial perfusion SPECT has adequate sensitivity and specificity for the diagnosis of ischaemic cardiopathy, even in patients with chronotropic incompetence. The proportion of pathological examinations is higher in those patients in whom tachycardia could not be sufficiently induced, which seems to indicate that the inability to reach submaximal frequency is related with a higher probability of having ischaemic cardiopathy.

La gammagrafía de reactividad hiperémica en el estudio de la función endotelial

Objective. The aim of this study was to compare a recently described method to evaluate endothelial function; the hyperemic reactivity scintigraphy (HRS) with the ultrasono- graphic flow-mediated dilatation (FMD) in brachial artery and its relationship with myocardial SPECT. Methods. 42 consecutive patients that underwent myocardial scintigraphy were included. Thirty-six patients had simultane- ous measurement of FMD. Both studies were obtained after 5 minutes occlusion of the upper arm with a blood pressure cuff inflated at 250 mmHg. HRS was performed dynamically at rate 1 frame/sec during 3 minutes after intravenous injection of 740 MBq of Tc-99 sestamibi. Time-activity curves allowed ob- taining the following indexes: medium hyperemic activity/medi- um contrallateral activity (MHA/MCA) and maximum hyperemic activity/maximum contrallateral activity (MxHA/CxHA). Results. In 13 patients SPECT was normal. Twenty-nine pa- tients had perfusion defects in scintigraphy. There was relation- ship between the FMD and the MHA/MCA (r = 0.23; p = 0.018) and the FMD and the MxHA/CxHA (r = 0.18; p = 0.05). Patients with alterations in the SPECT had an index MxHA/CxHA lower than patients with normal SPECT (1.8 ± 0.2 vs 1.5 ± 0.4; p = 0.04). We did not find relationship between FMD and alter- ations in SPECT. Conclusions. There is relationship between FMD and HRS. HRS is lower in patients with perfusion defects in the SPECT. HRS could provide additional value to myocardial scintigraphy.

Isquemia silente versus angina en la tomogammagrafía con Tl-201

Resumen —Introduccion El proposito del presente estudio fue describir las variables que se asocian a la isquemia silente en los pacientes a los que se les realiza ergometria con gammagrafia de perfusion miocardica y presentan defectos reversibles de la perfusion. Metodos Se analizan retrospectivamente de forma cuantitativa las gammagrafias con Tl201-SPECT de 522 pacientes que presentaban defectos de perfusion total o parcialmente reversibles durante la prueba de esfuerzo maxima. Se relaciono la aparicion de angina con el tamano del defecto de perfusion y la presencia de diferentes factores de riesgo. Resultados En 412 (73 %) pacientes la isquemia fue silente. En 176 (33 %) pacientes la ergometria fue electricamente positiva. No hubo diferencias en el tamano del defecto de perfusion entre los pacientes con y sin angina (27 ± 12 vs 27 ± 14), pero en los pacientes que presentaron angina durante la ergometria el grado de reversibilidad fue mayor sobre todo en el territorio de la arteria descendente anterior (ADA) (56 ± 40 vs 45 ± 40 p Conclusiones Una elevada proporcion de los pacientes con defectos de la perfusion reversibles en la gammagrafia tuvieron isquemia silente. En los pacientes con angina el grado de reversibilidad en el territorio de la ADA fue mayor. La isquemia silente es mas frecuente en los pacientes con IAM previo.

[Quantification of myocardial scintigraphy in patients with low probability of coronary artery disease. Normal values of thallium-201 gated SPECT].

Abstract Introduction This study has aimed to establish quantitative normality parameters in the thallium-201 GATED SPECT and to assess the changes related to age, gender, risk factors and stress testing. Methods A total of 427 patients with low pre-test likelihood of coronary artery disease were selected (45.5% men). The examinations were performed, by obtaining 32 25-second images on a 180% arc. The isotope used was thallium-201 and the SU SEGAMI software was using for the examination procedure. Results Myocardial tracer uptake in each one of the vascular territories was: left descending artery 77% ± 4; circumflex artery 76% ± 5 and right coronary artery 70% ± 4 (P = .000). Uptake in the right coronary artery territory was lower in men (68.7% vs 70.5% in women, P = .000) and in the left descending artery territory in the obese. There were no gender-related differences in the post-stress ejection fraction for both genders (65.7% in men vs 66.8% in women). However, ventricular volumes were higher in men (enddiastolic volume 80 ml ± 27 vs 61 ml ± 22; P = 0.000 and end-systolic volume 27.2 ml ± 25 vs 19 ml ± 8; P = 0.000). There is an inverse relationship between age and end-diastolic volume. Smokers have higher enddiastolic volumes than non-smokers. Conclusions Quantification of T1201 uptake in patients having low pre-test probability of coronary artery disease and normal thallium GATED-SPECT in the RCA territory is lower in men. The ventricular function study shows that there are no differences in post-stress EF based on gender but that the end-diastolic and end-systolic volumes are higher in men.