Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial.

BACKGROUND: Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions. PURPOSE: To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm2 International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery). RESULTS: Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm2 (range, 1-4 cm2) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment. CONCLUSION: Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up. REGISTRATION: NCT01947374 (ClinicalTrials.gov identifier).

Meniscal repair using the inside-out technique with cross stitch.

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

Effect of angiogenesis-related cytokines on rotator cuff disease: the search for sensitive biomarkers of early tendon degeneration.

BACKGROUND: Hallmarks of the pathogenesis of rotator cuff disease (RCD) include an abnormal immune response, angiogenesis, and altered variables of vascularity. Degenerative changes enhance production of pro-inflammatory, anti-inflammatory, and vascular angiogenesis-related cytokines (ARC) that play a pivotal role in the immune response to arthroscopic surgery and participate in the pathogenesis of RCD. The purpose of this study was to evaluate the ARC profile, ie, interleukin (IL): IL-1ß, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and angiogenin (ANG), in human peripheral blood serum and correlate this with early degenerative changes in patients with RCD. METHODS: Blood specimens were obtained from 200 patients with RCD and 200 patients seen in the orthopedic clinic for nonrotator cuff disorders. Angiogenesis imaging assays was performed using power Doppler ultrasound to evaluate variables of vascularity in the rotator cuff tendons. Expression of ARC was measured by commercial Bio-Plex Precision Pro Human Cytokine Assays. RESULTS: Baseline concentrations of IL-1ß, IL-8, and VEGF was significantly higher in RCD patients than in controls. Significantly higher serum VEGF levels were found in 85% of patients with RCD, and correlated with advanced stage of disease (r = 0.75; P < 0.0005), average microvascular density (r = 0.68, P < 0.005), and visual analog score (r = 0.75, P < 0.0002) in RCD patients. ANG and IL-10 levels were significantly lower in RCD patients versus controls. IL-1ß and ANG levels were significantly correlated with degenerative tendon grade in RCD patients. No difference in IL-6 and bFGF levels was observed between RCD patients and controls. Patients with degenerative changes had markedly lower ANG levels compared with controls. Power Doppler ultrasound showed high blood vessel density in patients with tendon rupture. CONCLUSION: The pathogenesis of RCD is associated with an imbalance between pro-inflammatory, anti-inflammatory, and vascular ARC.

A complication of soft tissue graft tibial fixation with the IntraFix device.

BACKGROUND: One potential complication of interference devices to fix anterior cruciate ligament (ACL) grafts is divergence between the implant and the graft-tunnel. Tunnel-screw divergence >15-30 degrees significantly reduces graft-tunnel fixation and may compromise the stability of the knee. CASE REPORT: A complication of the IntraFix device is presented. A 43-year-old male sustained a primary ACL reconstruction. The autologous hamstring graft was fixed in the tibia with the IntraFix device. The procedure went without apparent incidents or complications. During postoperative follow-up he developed pain and crepitus over the anteromedial aspect of the operated knee. A flexion contracture slowly developed up to 10 degrees and did not improve with aggressive physiotherapy. At eight postoperative weeks, second-look arthroscopy was performed. The intraoperative findings were a healthy-looking ACL graft and a grade III chondral injury in the medial femoral condyle (MFC) caused by the tip of the IntraFix device, which protruded through the medial tibial plateau. During flexion-extension motion of the knee, the tip eroded the chondral surface of the MFC. This was treated with mechanical and thermal chondroplasty and the tip of the IntraFix device was burred flat to match the surface of the medial tibial plateau. The patient's symptoms improved. CONCLUSIONS: Divergence of the interference screws in the femur is not uncommon, but on the tibia it is rare. Although this technical error did not affect stability, it did produce intrarticular injury. Strict adherence to the surgical technique is recommended and several hints on how to avoid complications with this implant are suggested.

[Arthroscopic treatment for osteoarthritis: knee and shoulder]. / Tratamiento artroscópico de la osteoartritis: rodilla y hombro.

We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though arthroscopic techniques are only useful for a specific group of patients and that the procedure does not modify disease's natural history, it is an accessible therapeutic option.

Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: To analyze intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) and quadruple hamstring semitendinosus and gracilis (STG) grafts. METHODS: From January 1999 to June 2004, we performed 330 BPTB and 96 STG procedures. Intraoperative incidents and complications were recorded for each case. RESULTS: Our overall intraoperative incident and complication rate was 9.6% and was higher in the STG group (13.5%) than in the BPTB group (8.7%). In the BPTB group, combined incidents and complications according to stage of the procedure consisted of graft harvesting, 4 cases (1.21%); tunnel placement, 9 cases (2.7%); and graft fixation, 15 cases (4.5%). In the STG group, combined incidents and complications included graft harvesting, 8 cases (8.3%); tunnel placement, 1 case (1%); graft fixation, 3 cases (3.1%); and others, 1 case (1%). In 4 patients (0.9%), we had to change the technique from BPTB to STG and vice versa. In 2 STG cases, conversion of the technique was required because of graft-related problems; in the third case, it was necessary because of fixation. One BPTB was converted to STG because the graft was completely transected as a result of improper screw fixation technique. CONCLUSIONS: None of the encountered incidents and complications had an adverse effect on final stability or on range of motion in operated knees. All incidents and complications were due to technical errors that occurred during graft harvesting, tunnel placement, or graft fixation. It is known that technical errors are preventable if careful surgical technique is followed. The surgeon must be well versed in various reconstruction techniques to be able to detect and resolve forthcoming incidents or complications. Backup implants are mandatory. LEVEL OF EVIDENCE: IV, therapeutic case series.

Engaging needles: a simple technique for arthroscopic side-to-side rotator cuff repair.

We present a simplified technique for the side-to-side arthroscopic rotator cuff repair. The instruments required for this technique are a 45 degrees Suture Lasso (SL; Arthrex, Naples, FL) and a 17F spinal needle (SN). With the arthroscope in the lateral portal, the SL is inserted through the posterior cannulas to grab healthy tissue at the posterior margin of the cuff. Through the anterior cannulas or through a skin puncture, the SN is inserted to catch healthy tissue at the anterior margin. Once both instruments are through the tissues, we manipulate them to make their tips converge. Because the SN diameter is small, it is very easy to engage its tip into the SL tip. Once engaged, a No. 1 PDS monofilament suture is easily passed through both instruments. When the suture comes out of the SL handle, both instruments can be pulled out, leaving the suture in place. Using a suture retriever clamp, the sutures are retrieved through a cannula for knot tying. This technique can be repeated as many times as necessary to place enough sutures in a side-to-side fashion to achieve the repair.

Engaging needles: a simple technique for arthroscopic side-to-side rotator cuff repair.

We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using a tendon stripper. Once satisfactory placement of 2 guide pins convergently is done, create a closed-end socket in the lateral femoral condyle with an adequate sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples using a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement from intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage.

Simple arthroscopic technique for rotator interval closure.

The rotator interval is a recognized source of pathology; there are several different techniques described for its closure but all require special instruments and skills. We present a technique that is simple in terms of skills and instrumentation. Two spinal needles are used. One needle is used as a suture retriever and the other as a suture passer. Each needle is passed through the margins of the rotator interval and, under arthroscopic vision, the needles are approximated to pass and retrieve the suture. Several sutures can be used as required. The knots are finally tied in an outside-inside fashion. This technique allows the surgeon to efficiently close the rotator interval under direct arthroscopic visualization in a few steps. The technique of arthroscopic rotator interval closure is simple, inexpensive, and easily reproducible.

[Mycotic femoral pseudoaneurysm after 11 years of catheterism]. / Pseudo-aneurisma femoral micótico após onze anos de cateterismo.

The authors report the unusual case of a 52-year-old mountain climber that presented with pain and swelling in his right thigh which revealed to be a ruptured mycotic pseudoaneurysm with no history of recent trauma or other apparent cause. The patient reported a past history of myocardial infarction 11 years before, with the performing of two femoral catheterisms for coronary angiography. He denied any episode of fever or diagnosis of bacteraemia at that time or later, nor any other complaint during these 11 years. The rarity of the case, the appearance of this extremely late complication together with the patient's kind of sportive activity prompted us to publish the case.

Pseudo-aneurisma femoral micótico após onze anos de cateterismo / Mycotic femoral pseudoaneurysm after 11 years of catheterism

Relatamos o caso incomum de um alpinista de 52 anos que apresentava dor e edema em sua coxa direita, o que revelou ser um pseudoaneurisma micótico roto, sem histórico de trauma recente ou outra causa aparente. O paciente relatou uma história de infarto do miocárdio onze anos antes, com a realizacão de dois cateterismos femorais para cineangiocoronariografia. Ele negou qualquer episódio de febre ou diagnóstico de bacteremia naquele momento ou mais tarde, como também outra queixa durante esses onze anos. A raridade do caso, a aparência dessa complicacão extremamente tardia, juntamente com o tipo de atividade esportiva do paciente sugeriram-nos publicar o caso.

Angio-Behçet with vertebral erosion: an exceptional Behçet's complication and literature review.

Behçet's disease is a multisystem disorder commonly seen in Japan and in Mediterranean countries characterized by a vasculitis of unknown origin. In this work, we describe a case of a 47-year-old man with Behçet's disease of 28 years evolution who presented with a common lumbago and revealed to have a rare case of destruction of the third lumbar vertebra due to a giant pseudoaneurysm of the right iliac artery. In the discussion, we make a brief review of the literature on the subject and analyze the existence of three similar cases.

Low-molecular-weight heparin versus saphenofemoral disconnection for the treatment of above-knee greater saphenous thrombophlebitis: a prospective study.

The objective of this study was to assess the efficacy, safety, and cost of low-molecular-weight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n = 45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n = 39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the low-molecular-weight heparin group had socioeconomic advantages.

Heparina de bajo peso molecular y embarazo. Tres pacientes con estenosis mitral pura / Low molecular weight heparin in pregnancy. Report of three cases with pure mitral stenosis

Se presentan 3 casos de mujeres portadoras de estenosis mitral pura con área valvular < 1 cm², que por falta de respuesta a tratamiento médico, se sometieron a valvuloplastía mitral percutánea (VMP) con técnica de Inoue antes de la semana 30 del embarazo. Desde su ingreso recibieron heparina de bajo peso molecular (HBPM; Enoxaparina) como profiláctico de formación de trombos intracavitarios y enfermedad embolígena sistémica secundaria, se realizó ecocardiogramas transtorácico y transesofágico (ETT y ETE) para demostrar efecividad del fármaco en evitar formación de trombos, sin causar efectos colaterales en la madre ni teratogénicos en el producto. La dosis utilizada fue de 40 mg. Subcutáneo cada 24 hs. durante 16 semanas en las tres pacientes, se repitió el ETT y ETE durante la VMP y se demostró ausencia de trombos intracavitarios. Ninguna paciente presentó alteraciones en la biometría hemática, ni en los tiempos de coagulación. Se obtuvieron productos sin malformaciones. En conclusión, aunque la serie de pacientes es pequeña, se demostró que la HBPM puede utilizarse como alternativa del uso de anticoagulante oral así como de la heparina convencional, como profiláctico durante el primer trimestre del embarazo sin provocar efectos secundarios indeseables

Isquemia asintomática en la ectasia arterial coronaria efecto de la anticoagulación / Silent myocardial ischemia in coronary ectasis. Efects of anticoagulation

Estudiamos 23 enfermos (22 hombres y 1 mujer), con edades comprendidas entre 31 y 71 años (55.9 ñ 9.7 años) y ectasia arterial coronaria aislada. Diecisiete pacientes padecían angina de pecho, 19 infarto del miocardio, 5 presentaron imágenes angiográficas de trombos intracoronarios. Antes del tratamiento con anticoagulantes (warfarina oral) 16 enfermos presentaron angina de pecho inestable, el electrocardiograma en ejercicio fue positivo en 9 enfermos y 16 presentaron isquemia asintomática (mostrada en el ECG-Holter), cuya duración fue 35.21 ñ 29.27 min por día. Después del tratamiento con anticoagulantes, sólo 5 pacientes presentaron angina de pecho inestable, el electrocardiograma en ejercicio resultó positivo en 7 casos y disminuyó a 7 el número de enfermos con isquemia asintomática, cuya duración decreció significativamente (P< 0.001) a 12.47 ñ 22.5 min por día

Hiperinsulinemia in patients with coronary heart disease in absence of overt risk factors

The objetive of the study was to determine if male subjectes with coronary atherosclerotic heart disease (CHD) without major CHD risk factor have hyperinsulinemia and related metabolic changes. Previoys studies suggestested that hyperinsulinemia is a CHD risk factor, but they did not entirely exclude concurrent metabolic abnormalities. A prospective, comparative, cross-sectional study in a tertiary care teaching hospital in Mexico City was conducted in 15 men who had suffered myocardial infarction 6 to 24 months before and had significant coronary occlusion on angiography. Control group was formed by 15 age-matched healthy men. None had hypertension, obesity, diabetes, gout, glucose intolerance or hyperlipidemia. Body mass index (BMI), waist/hip ratio (WHR), blood pressure (BP); oral glucose tolerance test (OGTT) with measurement of serum glucose, insulin and C-peptide every 30 min for 2 h, fasting serum cholesterol, triglycerides and uric acid, areas under curve (AUC) of glucose and insulin, insuli/glucose ratio and insulin sensitivity indez were calculated. BMI, WHR and BP were similar in both groups. Fasting and post-load serum glucose and insulin concentrations were significantly higher in CHD than in control group (p<0.01); fasting glucose 5.9 ñ 0.6 vs. 4.8 ñ 0.7 nmol/l, 2-h glucose 8.3 ñ 0.6 vs. 7.3 ñ 0.9 mmol/l, fasting insulin 17.5 ñ 1.2 vs. 15.3 ñ 1.7 pmol/l, 2 h insulin 448 ñ 108 vs. 282 ñ 87 pmol/l in CHD and control group, respectively. AUC of glucose, AUC of insulin, insulin/glucose ratio, pos load C-peptide, serum cholesterol, triglycerides and uric acid levels were also significantly higher in CHD than in healthy controls. Insulin sensitivity index was significantly lower in patients with CHD (27.7 ñ 8.3) than in healthy control subjects (73.9 ñ 18) (p<0.001). Patients with CHD have hyperinsulinemia and subtle metabolic abnormalities realted with insulin resistance even in absence of overt risk factors

Comisurotomía mitral percutánea con balón de Inoue durante el embarazo / percuteneous mitral valvuloplasty during pregnancy

Los autores presentan tres casos de mujeres embarazadas con estenosis mitral severa sintomática, con edad media de 28.6 ñ 2.3 años y con embarazo de 27.6 ñ 1.52 semanas, sometidas a comisurotomía mitral percutánea (CMP). A pesar del tratamiento médico, dos pacientes estaban en clase funcional III y una en clase IV de la New York Heart Association (NYHA). Las tres pacientes tenían área valvular mitral igual o menor de 1cm², con "Score" de Wilkins de 7 a 9 puntos e insuficiencia mitral grado I en dos casos. Dos tenían hipertensión arterial pulmonar severa (presión media de arteria pulmonar > 50 mm Hg). Tras la CMP el área valvular mitral determinada por ecocardiografía bidimensional aumentó de 0.83 ñ 0.2 cm² a 1.8 ñ 0.15 cm²; el gradiente medio transmitral se redujo de 13 ñ 3.4 mm Hg a 3.6 ñ 1.15 mm Hg; el grado de insuficiencia mitral no se modificó en ningún caso. Los resultados hemodinámicos mostraron un incremento del área valvular mitral de 0.83 ñ 0.18 cm² a 2.23 ñ 0.3 cm²; el gradiente medio transmitral disminuyó de 21.6 ñ 9 a 4.3 ñ 0.5 mm Hg; la presión media de aurícula izquierda de 30 ñ 12 a 12.3 ñ mm Hg; la presión media de arteria pulmonar disminuyó inmediatamente de 44.3 ñ 16 a 25.6 ñ 11 mm Hg. El tiempo promedio de fluoroscopía fue 15.3 minutos. No hubo complicaciones. Las pacientes fueron egresadas 48 horas después del procedimiento y continuaron el resto del embarazo en clase I NYHA, resolviéndose éste por vía vaginal sin complicaciones, con productos sanos. Se concluye que la CMP es una alternativa terapéutica segura y eficaz para obtener mejoría clínica y hemodinámica en pacientes embarazadas con estenosis mitral severa sintomátia, refractaria a tratamiento médico

Coronary fistula associated with double mitral valve disease. A case report

The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure ot he fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease

Prueba de estres farmacológica eco-dobutamina en cardiopatía isquémica / Echo-Dobutamine pharmacologic stress test in ischemic heart disease

Se reporta la experiencia de la División de Cardiología del Hospital de Especialidades del Centro Médico "La Raza", IMSS con la prueba de estrés farmacológica eco-dobutamina. Para evaluar la sensibilidad, especificidad y seguridad de la prueba de estrés farmacológica edo-dobutamina, estudiamos 30 pacientes con cardiopatía isquémica en base a historia clínica, ecocardiograma 2D, prueba de esfuerzo y cateterismo cardiaco. La prueba se inició teniendo videograbación de las vistas convensionales de la movilidad segmentaria ventricular izquierda. Administramos dobutamina endovenosa a razón de 2.5, 5, 10, 20, 30 y con un máximo de 40 µg/kg/min; los incrementos fueron cada 3 minutos y la dosis promedio fue de 19 ñ14.3 µg/kg/min, teniendo monitorización electrocardiográfica continua de la frecuencia cardiaca y de la tensión arterial. Las imágenes de la movilidad miocárdica se grabaron con cada cambio de dosis. Veintidós de los casos correspondieron a varones y 8 a mujeres. La edad promedio fue de 55 ñ 9 años. Veintidós pacientes tuvieron antecedente de infarto miocárdico antiguo, quienes se encontraban asintomáticos al momento de la prueba y 8 con angina de pecho en clase funcional I y II de la CCS. La fracción de explusión promedio basal fue de 62.6 ñ 11.7 por ciento por ecocardiografía vs 64.4 ñ 16.8 por ciento obtenida por cateterismo cardiaco con p no significativa. Ningún sujeto presentó trastornos del ritmo. La TA sistólica se incrementó de un promedio de 124 ñ 14.5 a 138.3 ñ 14.4 mmHg (p<0.0005) mientras que la TA sistólica se incrementó de 82.3 ñ 8.2 a 90.8 ñ 9.6 mmHg (p<0.001). La FC se incrementó de 68.7 ñ 10.1 a 85.5 ñ 15.7 latidos por minuto (p<0.001). No hubo complicaciones graves. Dieciocho pacientes tuvieron alteraciones en la movilidad segmentaria, las que se consideraron como pruebas positivas y estuvieron asociadas a lesiones obstructivas > 50 por ciento; 9 fueron negativas, de las cuales, sólo 1 caso estuvo asociado a lesión significativa, tres pruebas fueron positivas en ausencia de lesión coronaria, teniendo así: 94, 72 y 85 por ciento de sensibilidad, especificidad y valor predictivo respectivamente (p<0.005). La prueba eco-dobutamina es altamente sensible, con buena especificidad y valor predictivo. Se puede realizar con seguridad y facilidad en pacientes isquémicos.