Noninvasive assessment of endothelial function and ST segment changes during exercise testing in coronary artery disease

Endothelial function (EF) plays an important role in the onset and clinical course of atherosclerosis, although its relationship with the presence and extent of coronary artery disease (CAD) has not been well defined. We evaluated EF and the ST segment response to an exercise test in patients with a broad spectrum of CAD defined by coronary angiography. Sixty-two patients submitted to diagnostic catheterization for the evaluation of chest pain or ischemia in a provocative test were divided into three groups according to the presence and severity of atherosclerotic lesions (AL): group 1: normal coronaries (N = 19); group 2: CAD with AL <70 percent (N = 17); group 3: CAD with AL ¡Ý70 percent (N = 26). EF was evaluated by the percentage of flow-mediated dilatation ( percentFMD) in the brachial artery during reactive hyperemia induced by occlusion of the forearm with a pneumatic cuff for 5 min. Fifty-four patients were subjected to an exercise test. Gender and age were not significantly correlated with percentFMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1 percent vs 31.6 percent in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8 percent) was observed in the group with obstructive CAD with AL ¡Ý70 percent during the exercise test. Endothelial dysfunction was observed in patients with CAD, irrespective of the severity of injury. A significantly higher frequency of ischemic alterations in the ST segment was observed in the group with obstructive CAD. EF and exercise ECG differed among the three groups and may provide complementary information for the assessment of CAD.

Valvuloplastia aórtica por baläo como ponte para o tratamento definitivo na estenose aórtica grave / Aortic balloon valvuloplasty as a bridge to definitive theraphy od severe aortic stenosis

Homem de 36 anos, com quadro de estenose aórtica crítica e choque cardiogênico refratário, foi submetido avalvuloplastia aórtica por baläo como procedimento desalvamento, seguindoÄse compensaçäo clínica, o que possiblitou a realizaçäo de cirurgia de troca valvar aórtica no 48§ dia após esse procedimento. O acompanhamento clínico e ecocardiográfico demonstrou melhora funcional significativa até o presente, oito meses apósa cirurgia. A valvuloplastia aórtica por baläo constitui opçäo terapêutica de salvamento em pacientes com estenose aórtica grave e elevado risco cirúrgico, servindo como ponte para a cirurgia de troca aórtica ou transplante cardíaco. A cirurgia de troca aórtica deve ser considerada, mesmo em pacientes com disfunçäo ventricular grave, reservandoÄse transplante cardíaco aos pacientes em que se supöe depressäo muito acentuada e irreversível da contratilidade miocárdica.