Normal Myocardial Perfusion Gated SPECT and Positive Stress Test: Different Prognoses in Women and Men.

BACKGROUND: The aim of this study was to analyze different prognoses in women and men with normal myocardial perfusion gated SPECT, according to stress test results. METHODS: Differences between women and men in terms of hard events (HE) (non-fatal acute myocardial infarction or cardiac death) and HE plus coronary revascularization (HE + CR) were analyzed in 2,414 consecutive patients (mean age 62.8 ± 13.5 years, 1,438 women) with a normal stress-rest gated SPECT, taking into account their stress test results. RESULTS: Four hundred and seven patients (16.9%) (15.9% women and 17.5% men) had a positive stress test (ST-segment depression ≥1 mm and/or angina). During a follow-up of 5.1 ± 3.4 years, there were more significant HE (6.5% vs 2.3%; P = .005) and HE + CR (11.6% vs 4.8%, P = .001) in men with a positive stress test than in men with a negative stress test. These differences were not observed in women. In multivariate regression models, HE and HE + CR were also more frequent in men with a positive stress test (HR:3.3 [95% CI 1.1% to 9.5%]; HR:4.2 [95% CI 1.8% to 9.9%]; respectively) vs women with a positive stress test. CONCLUSIONS: Although patients with normal gated SPECT studies have a favorable outcome, men with an abnormal stress test have a more adverse prognosis than women.

Warranty periods for normal myocardial perfusion stress SPECT.

BACKGROUND: To assess different warranty periods following a normal myocardial perfusion SPECT based on patients' clinical characteristics and the type of stress performed. METHODS AND RESULTS: A study was done of 2,922 consecutive patients (62.9 ± 13 years; 53.4% women) with a normal stress-rest SPECT. The warranty period was defined as the period during which patients remained at a low risk (<1% events/year) of total mortality (TM), or hard events (HE) (cardiac death or non-fatal myocardial infarction). Of these patients, 2,051 were given an exercise myocardial perfusion imaging (Ex-MPI); 461 submaximal exercise plus dipyridamole (Ex+Dipy-MPI); and 410 dipyridamole (Dipy-MPI). During a mean follow-up of 5 ± 3.3 years, a significant reduction (P < .05) of the warranty period for TM (13.5, 9.6 and 8 months) and HE (34.8, 20.5 and 8.2 months) was observed, for Ex-MPI, Ex+Dipy-MPI and Dipy-MPI, respectively. Other warranty period determinants were the clinical variables of age, sex, diabetes and known coronary artery disease. An abnormal left ventricular ejection fraction on gated-SPECT also significantly shortened the warranty period for HE in patients undergoing Ex+Dipy-MPI (P = .001) or Dipy-MPI alone (P = .007). CONCLUSIONS: The warranty period for a normal stress-rest SPECT is highly variable since it is primarily determined by the type of stress, the patient's clinical characteristics and LVEF.

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institution’s protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.

Categorización del síndrome metabólico de acuerdo con las variables que lo constituyen y su relación con la insulino-resistencia / Consensus definition of the metabolic syndrome and diagnostic criteria for identification and its relationshipo with the insulin-resistance syndrome

In recent years, the cardiovascular prevention has found a new clinical tool: the metabolic syndrome (MS). Arised in the observation of associations between risk factors, it is recognized as the clinical manifestation of insulin resistance. In the course of time, it was demonstrated that the presence of MS possess a prognostic value to predict death, nonfatal acute myocardial infarction, vascular stroke and the development of diabetes... The relationshipo to insulin resistance and diagnostic criteria for identification of the metabolic syndrome are given in the article.