José Casco Raudales

Left ventricular function and endomyocardial biopsy in early and advanced dilated cardiomyopathy

We evaluated left ventricular function and endomyocardial biopsy in 20 patients with early and advanced dilated cardiomyopathy, with the purpose of assessing the correlation between histologic variables and systolic and diastolic filling indexes. Group 1 included 10 patients with no clinical history of heart failure and left ventricular ejection fraction > or = 45% and group 2, 10 patients with a clinical history of heart failure and left ventricular ejection fraction <45%. Group 1 showed lower left ventricular end-systolic and end-diastolic volumes indexes (49+/-14 versus 86+/-23 ml/m2, P<0.001; 98+/-25 versus 127+/-35 ml/m2, P=0.049), higher left ventricular ejection fraction (50+/-4 versus 32+/-4%, P<0.001) and lower coefficient of variation of percentage shortening of left ventricular transverse hemiaxes (0.3+/-0.1 versus 0.5+/-0.1, P=0.001) compared with group 2. Group 1 had higher A wave peak velocity (78+/-18 versus 60+/-20 cm/s, P=0.048), lower E/A ratio (0.9+/-0.3 versus 1.5+/-0.6, P=0.02) and slower E wave deceleration time (204+/-51 versus 155+/-50 ms, P=0.047) compared with group 2. Semiquantitative histologic scores did not differ significantly between groups. There was no significant correlation between histologic variables and left ventricular systolic and diastolic indexes. Thus, dilated cardiomyopathy shows borderline to severe left ventricular systolic impairment and distinct left ventricular diastolic filling abnormalities, according to the clinical stage. This study suggests a marked dissociation between histologic findings and functional abnormalities in early and advanced dilated cardiomyopathy.

Avaliação das propriedades físicas e funcionais dos dispositivos de insuflação de cateteres de angioplastia submetidos a processo para reutilização

BACKGROUND: Reuse of dental and medical devices is a worldwide common practice, and our country is not an exception; its aim is to reduce procedural costs. PTCA insufflation devices (or manometers) are frequently re-sterilized for clinical reuse purposes. Evaluations of their physical and mechanical properties are not described in current literature. OBJECTIVE: Determine if the physical and functional characteristics of insufflation devices are maintained after reuse processing, as well as establish their life span. Methods: This was a prospective longitudinal study, carried out at university hospital in Porto Alegre, RS, Brazil. From November 2007 to March 2008, all new insufflation devices were included and separated in two different groups: Group A devices were evaluated immediately after their first use and Group B devices were evaluated after subsequent uses. RESULTS: Of the 36 devices, 11 (30.6%) were discarded after the first use due to severe mechanical or functional problems. Of the remaining devices, only 8 (32%) in Group A and 6 (24%) in Group B kept totally preserved functionality. These devices presented significant changes, even though they were mild, in measurements after 12 atm. Mean reuse rate was 1.7 ± 1.2 times. CONCLUSIONS: Results showed that about 30% of PTCA insufflation devices were not in working conditions after the first use. Only a quarter of the remaining devices maintained intact functional characteristics to the end of their life span.