[Percutaneous extraction of pacemaker and defibrillator leads]. / Extracción de electrodos de marcapasos y desfibrilador mediante técnicas percutáneas.

INTRODUCTION AND OBJECTIVES: There is an increasing need for endocardial pacing and defibrillators leads to be removed. However, the procedure can be complex and it is not risk-free. We reviewed our experience between April 1989 and June 2006 with the percutaneous extraction of leads. METHODS: In total, 314 electrodes were extracted from 187 patients. The leads had been implanted over an average period of 69.16 months (range 0.11-234.6 months, median 60.25 months). Some 115 were atrial leads, 196 were ventricular, and three were in the coronary veins; of these, 78 had been abandoned in the vascular bed. RESULTS: Indications for removal were infection (26.1%), dysfunction (22.9%), erosion (25%), endocarditis (20.7%), and bacteremia (2.7%). Overall, 58.8% of patients were referred from other departments. In 96.8%, the electrodes were completely removed. Simple traction was used in 23.4%, and countertraction techniques (with and without radiofrequency current support) were used in 60.7%. For abandoned leads, a biopsy clamp was used in combination with countertraction (4.3%) or a femoral approach with a snare (10.1%). A sternotomy was required in three of the 10 patients with remaining electrode fragments. The complication rate was 4.6% (with major complications in 2.5%). Complications were associated with age < 60 years (odds ratio [OR]=5.38, 95% confidence interval [CI] 1.07-27.23), the presence of endocarditis (OR=4.97: 95%CI, 1.04-23.70), and right side implantation (OR=17.09; 95% CI, 2.15-135.70). CONCLUSIONS: In the majority of cases, pacing and defibrillator leads can be removed without difficulty using modern extraction techniques. However, because there is a risk of complications during extraction, even though it is low, the procedure should be carried out in specialized centers with surgical facilities.

Extracción de electrodos de marcapasos y desfibrilador mediante técnicas percutáneas / Percutaneous extraction of pacemaker and defibrillator leads

Introducción y objetivos. La necesidad de retirar los electrodos endocavitarios del marcapasos o el desfibrilador es cada vez más frecuente, aunque no está exenta de riesgos y complejidad. Revisamos nuestra experiencia en la retirada de electrodos por vía percutánea desde abril de 1989 hasta junio de 2006. Métodos. Se retiraron 314 electrodos en 187 pacientes, implantados durante un período medio de 69,16 meses (intervalo, 0,11-234,6 meses; mediana 60,25 meses). En total, 115 fueron auriculares, 196 ventriculares y 3 de seno coronario, encontrándose 78 de ellos abandonados en el lecho vascular. Resultados. Las indicaciones fueron: infección (26,1%), disfunción (22,9%), decúbito (25%), endocarditis (20,7%) y bacteriemia (2,7%). El 58,8% de los pacientes fue remitido desde otros servicios. El 96,8% de los electrodos se retiró completamente. Se utilizó la tracción simple en el 23,4% de los pacientes y técnicas de contratracción (con y sin radiofrecuencia) en el 60,7%. En caso de que hubiera electrodos abandonados, se utilizó una pinza de biopsia (4,3%) combinada con sistemas de contratracción o lazos femorales (10,1%). Se necesitó una esternotomía media en 3 pacientes de los 10 en los que quedaron restos de electrodos. El porcentaje de complicaciones fue del 4,6% (un 2,5% de complicaciones mayores). Éstas se relacionaron con la edad menor de 60 años (odds ratio [OR] = 5,38; intervalo de confianza [IC] del 95%, 1,07-27,23), la presencia de endocarditis (OR = 4,97; IC del 95%, 1,04-23,70) y la implantación por el lado derecho (OR = 17,09; IC del 95%, 2,15-135,70). Conclusiones. La retirada de electrodos endocavitarios con los modernos sistemas de extracción soluciona el problema en la mayoría de los casos. Debido a la posibilidad, aunque baja, de complicaciones durante la retirada, se aconseja realizar el procedimiento en centros especializados con capacidad quirúrgica (AU)

Introduction and objectives. There is an increasing need for endocardial pacing and defibrillators leads to be removed. However, the procedure can be complex and it is not risk-free. We reviewed our experience between April 1989 and June 2006 with the percutaneous extraction of leads. Methods. In total, 314 electrodes were extracted from 187 patients. The leads had been implanted over an average period of 69.16 months (range 0.11-234.6 months, median 60.25 months). Some 115 were atrial leads, 196 were ventricular, and three were in the coronary veins; of these, 78 had been abandoned in the vascular bed. Results. Indications for removal were infection (26.1%), dysfunction (22.9%), erosion (25%), endocarditis (20.7%), and bacteremia (2.7%). Overall, 58.8% of patients were referred from other departments. In 96.8%, the electrodes were completely removed. Simple traction was used in 23.4%, and countertraction techniques (with and without radiofrequency current support) were used in 60.7%. For abandoned leads, a biopsy clamp was used in combination with countertraction (4.3%) or a femoral approach with a snare (10.1%). A sternotomy was required in three of the 10 patients with remaining electrode fragments. The complication rate was 4.6% (with major complications in 2.5%). Complications were associated with age < 60 years (odds ratio [OR]=5.38, 95% confidence interval [CI] 1.07-27.23), the presence of endocarditis (OR=4.97: 95%CI, 1.04-23.70), and right side implantation (OR=17.09; 95% CI, 2.15-135.70). Conclusions. In the majority of cases, pacing and defibrillator leads can be removed without difficulty using modern extraction techniques. However, because there is a risk of complications during extraction, even though it is low, the procedure should be carried out in specialized centers with surgical facilities (AU)

[Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence]. / Estimación de la severidad de la insuficiencia mitral según un método simplificado basado en el flujo de convergencia proximal.

INTRODUCTION AND OBJECTIVES: Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies. METHODS: In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies. RESULTS: We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P< .001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11. CONCLUSIONS: Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use.

Estimación de la severidad de la insuficiencia mitral según un método simplificado basado en el flujo de convergencia proximal / Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence

Introducción y objetivos. El cálculo del orificio regurgitante efectivo (ORE) se considera el método más fiable para estimar la severidad de la insuficiencia mitral (IM), pero es poco usado por su complejidad. El objetivo fue modificar y validar un método semicuantitativo basado en la proximal isovelocity surface area (PISA), previamente publicado, para adaptarlo a las recientes recomendaciones de las sociedades americana y europea de cardiología. Métodos. Cuando usamos el método PISA, el flujo regurgitante máximo (FRM) es una función del radio y la velocidad de aliasing (Va). Esta relación permite la creación de un normograma formado por líneas de diferentes valores de FRM que se pueden obtener con facilidad al buscar en el gráfico los valores del radio y su cruce con los de Va. Los límites de severidad en esa tabla se han adaptado para que reflejen los grados y los límites de severidad recomendados por las sociedades americana y europea de cardiología según el valor de ORE. Resultados. Estudiamos a 76 pacientes con IM mediante eco-Doppler. Se encontró una correlación excelente entre FRM y ORE (r = 0,98; p < 0,001). La estimación de severidad mediante el nuevo normograma mostró una concordancia excelente con la determinada mediante el ORE, con un valor de kappa de 0,951 y un error estándar de 0,11 para una escala en 3 grados, y un valor de kappa de 0,969 y error estándar de 0,11 para la escala en 4 grados. Conclusiones. La estimación semicuantitativa de la severidad de la IM mediante el FRM mediante el normograma propuesto tiene un acuerdo excelente con la estimación cuantitativa por ORE, pero es mucho más simple y rápida

Introduction and objectives. Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies. Methods. In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies. Results. We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P<.001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11. Conclusions. Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use

Endothelial dysfunction, intima-media thickness and coronary reserve in relation to risk factors and Framingham score in patients without clinical atherosclerosis.

BACKGROUND: Endothelial dysfunction, decreased coronary flow reserve (CFR) and increased intima-media thickness (IMT) are related to atherosclerosis and can be assessed non-invasively by echography. OBJECTIVES: In order to describe the relationship between these parameters and with cardiovascular risk, this study investigated them simultaneously in patients without clinical atherosclerosis. METHODS: A total of 106 subjects were studied, 91 with and 15 without cardiovascular risk factors. Cardiovascular disease was excluded in all cases. Doppler ultrasound was used to analyse endothelium-dependent vascular dilation in the brachial artery, IMT in the common carotid artery and CFR in the left anterior artery. RESULTS: Patients with cardiovascular risk factors had impaired flow-mediated dilation (FMD; 3.7 +/- 3.2 versus 11.6 +/- 4.4%, P = 0.000); greater IMT (0.89 +/- 0.3 versus 0.56 +/- 0.14 mm, P = 0.000) and lower CFR (2.7 +/- 0.9 versus 4 +/- 1.2, P = 0.000). Correlation was found between IMT and FMD r = -0.240, (P = 0.013), IMT and CFR, r = -0.384 (P = 0.000), and between FMD and CFR of r = 0.289 (P = 0.007). All patients with IMT greater than 1 mm showed depressed FMD, most of them with low values of CFR, but patients with reduced FMD or CFR did not necessarily show increased IMT. There was a significant correlation between the three parameters and the Framingham risk score. Multiple linear regression analysis showed that IMT was the only factor related to the Framingham score. CONCLUSION: In patients without clinical atherosclerotic disease, cardiovascular risk factors are associated with impaired FMD, CFR and increased IMT. Even though a correlation between these changes was found, they showed different dependence on cardiovascular risk factors and with global risk, IMT being the best correlated with the Framingham score.

[Prognostic value of Valsalva maneuver-induced change in Doppler-detected ventricular filling in patients with systolic dysfunction]. / Valor pronóstico de los cambios inducidos por la maniobra de Valsalva en el llenado ventricular registrado con Doppler en pacientes con disfunción sistólica.

INTRODUCTION AND OBJECTIVES: In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. MATERIAL AND METHOD: The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers. RESULTS: The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]=0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43). CONCLUSIONS: Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure.

Valor pronóstico de los cambios inducidos por la maniobra de Valsalva en el llenado ventricular registrado con Doppler en pacientes con disfunción sistólica / Prognostic value of Valsalva Maneuver-Induced change in Doppler-detected ventricular filling in patients with systolic dysfunction

Introducción y objetivos. Los patrones de llenado ventricular registrados con Doppler tienen valor pronóstico en la disfunción sistólica y también los cambios que sufren al modificar la carga mediante tratamiento crónico o nitroprusiato. Nuestro propósito fue investigar el valor pronóstico de los cambios inducidos por la maniobra de Valsalva sobre los patrones restrictivo y seudonormal del llenado ventricular, registrados con Doppler en pacientes con disfunción sistólica. Material y método. Se estudió a 36 pacientes en ritmo sinusal, disfunción sistólica y cociente entre las ondas E y A > 1, en situación clínicamente estable. Las velocidades de llenado se registraron antes y después de tres maniobras de Valsalva parcialmente estandarizadas. Resultados. El cociente E/A se mantuvo mayor de 1 en 12 pacientes (grupo irreversible) y se transformó en uno de relajación anormal (E/A menor de 1) en 24 (grupo reversible). Durante un seguimiento medio de 18 meses fallecieron 8 pacientes, 6 en el grupo irreversible (50%) y 2 en el grupo reversible (8,3%; p = 0,005). Doce murieron o presentaron insuficiencia cardíaca severa, 8 en el grupo irreversible (67%) y 4 en el grupo reversible (17%; p = 0,003). La reversibilidad se asoció a un menor riesgo tanto de defunción como de defunción y hospitalización por insuficiencia cardíaca (hazard ratio [HR] = 0,11; intervalo de confianza [IC] del 95%, 0,03-0,43, y HR = 0,06; IC del 95%, 0,01-0,48, respectivamente). Conclusiones. La transformación de un patrón de llenado seudonormal o restrictivo en otro de relajación anormal tras la maniobra de Valsalva predice un mejor pronóstico en la disfunción sistólica (AU)

Introduction and objectives. In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. Matherial and method. The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers.Results. The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P>=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]= 0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43).Conclusions. Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure (AU)

Predictors of lack of response to resynchronization therapy.

About 30% of patients treated with cardiac resynchronization therapy (CRT) do not respond to treatment. The aim of this study was to identify clinical predictors of lack of improvement in patients receiving CRT. From 197 consecutive patients scheduled to receive CRT, 143 fulfilled the inclusion criteria. Mean age was 68 +/- 7 years and 79% were men. Heart failure was due to ischemic heart disease in 49 patients (34%). Mean QRS duration was 165 +/- 26 ms, and left ventricular ejection fraction was 27 +/- 7%. Nonresponder patients were defined as those who died of heart failure, underwent heart transplantation, or did not increase the distance walked in 6 minutes >10%. At 6-month follow-up, there were 28 nonresponders (20%). Among nonresponders, 2 patients received a heart transplantation and 9 patients died of heart failure. In logistic regression analysis, independent predictors of lack of response to CRT were ischemic heart disease (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.2 to 7; p = 0.023), severe mitral regurgitation (OR 3.5, 95% CI 1.3 to 9; p = 0.014), and left ventricular end-diastolic diameter > or =75 mm (OR 3.1, 95% CI 1.1 to 8; p = 0.026). Patients with these 3 predictors had a probability response of 27%.

Consenso sobre la terapia de Resincronización Cardíaca / Spanish Society of Cardiology Cardiac Resynchronization Working Group Consensus on Indications for, Programing of and Follow-Up Resynchronization Devices

Dentro del arsenal terapéutico de la insuficiencia cardíaca, la resincronización cardíaca cada vez está adquiriendo un papel más importante como coadyuvante del tratamiento médico. Se ha demostrado ampliamente que en los pacientes con insuficiencia cardíaca avanzada y bloqueo de rama izquierda, la estimulación biventricular produce una mejoría hemodinámica y clínica, así como un remodelado inverso del ventrículo izquierdo. Algunos estudios sugieren también una disminución de la mortalidad. Sin embargo, es una terapia costosa y compleja que no está libre de complicaciones y con un porcentaje de pacientes que no mejoran. Por ello, para su correcta aplicación es necesaria una colaboración multidisciplinaria. El Grupo de Trabajo de Resincronización Cardíaca de la Sociedad Española de Cardiología ha redactado el presente documento de consenso con especial interés por exponer las indicaciones de esta terapia, así como la correcta selección de los dispositivos y su adecuada técnica de implante y seguimiento (AU)

Cardiac resynchronization is an increasingly important therapeutic option for a subgroup of patients with heart failure. It has been shown that biventricular pacing produces significant hemodynamic and clinical improvements and results in left ventricular remodeling in patients with severe heart failure and left bundle branch block. Some studies also indicate that cardiovascular mortality is decreased. However, this form of treatment is expensive and complex, it is not free of complications, and there are a significant number of non-responders. Therefore, multidisciplinary collaboration is necessary if it is to be used correctly. The Spanish Society of Cardiology Cardiac Resynchronization Working Group has produced this consensus document with the aim of establishing current indications for therapy, and ensuring that device selection is appropriate and that implantation and follow-up are carried out correctly (AU)

[Noninvasive assessment of the effect of atorvastatin on coronary microvasculature and endothelial function in patients with dyslipidemia]. / Determinación no invasiva del efecto de atorvastatina en la microvasculatura coronaria y la función endotelial periférica de pacientes dislipémicos.

INTRODUCTION AND OBJECTIVES: The effect of statins has been monitored mainly in peripheral arteries. It is now possible to study coronary microcirculation by analyzing coronary reserve with transthoracic echocardiography. The aim of this study was to use this noninvasive technique to evaluate the effect of atorvastatin on peripheral endothelial function and on the coronary microvasculature in patients with dyslipidemia. PATIENTS AND METHOD: We included 21 patients with dyslipidemia but no clinical antecedents of atherosclerosis. Mean (SD) age was 64.9 (11) years, and women made up 61.9% of the group. All patients were treated with 20 mg atorvastatin during 3 months. Lipid profile, carotid intima-media thickness, endothelium-dependent vasodilation and coronary flow reserve were determined at baseline and at the end of treatment. All studies were performed with echocardiographic techniques. RESULTS: Together with improvements in the lipid profile, we found a 43% increase in endothelium-dependent vasodilation (4.3 [4.4] to 6.2 [3.8]; P=.07) and a 25% increase in coronary flow reserve (2.5 [0.6] vs 3.1 [0.8]; P=.002). The increase in endothelium-dependent vasodilatation correlated with age (r=-0.60; P=.004), intima-media thickness (r=-0.47; P=.029), low-density lipoprotein level before treatment (r=-0.43; P=.05), and baseline endothelium-dependent vasodilatation (r=-0.63; P=.002). The increase in coronary flow reserve correlated with low-density lipoprotein level after treatment (r=-0.51; P=.04). CONCLUSIONS: Short-term treatment with atorvastatin improved the lipid profile, coronary microvascular function and endothelium-dependent vasodilation in the peripheral circulation. The noninvasive assessment of coronary reserve is feasible with transthoracic echocardiography.

[Endothelial dysfunction and intima-media thickness in relation to cardiovascular risk factors in patients without clinical manifestations of atherosclerosis]. / Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis.

INTRODUCTION: Endothelial dysfunction and increased intima-media thickness are early findings in the development of atherosclerosis that can be assessed non-invasively by echography. The aim of this study was to investigate endothelial function and intima-media thickness, and the relation between these processes and cardiovascular risk factors in patients without clinical atherosclerosis. PATIENTS AND METHOD: Fifty-two subjects were studied, 39 with one or more cardiovascular risk factors and 13 with none. Vascular echography was performed to analyze endothelium-dependent vascular dilatation in the brachial artery and intima-media thickness in the common carotid artery. RESULTS: Compared to patients without risk factors, patients with cardiovascular risk factors more frequently had impaired vascular dilatation after ischemia, 11.98 4.61% vs 2.77 2.57%, (P<.0.001; mean difference = 9.21%, 95% CI of the difference 6.33-12.07%) and a greater intima-media thickness, 0.085 0.024% vs 0.057 0.014 cm (P < 0.0001; mean difference = 0.028 cm, 95% CI of the difference, 0.017-0.04 cm). There was a significant negative correlation between intimal-media thickness and endothelial dysfunction (r = -0.357; P<0.01). Linear regression analysis showed that intima-media thickness was independently related to age and the presence of hypertension, while endothelial function was related only with the presence of hypertension, smoking, and hyperlipoproteinemia. CONCLUSIONS: In patients without clinical atherosclerotic disease, cardiovascular risk factors were associated with impaired endothelial function and increased intima-media thickness. There was a negative correlation between endothelial-dependent vascular dilatation and intima-media thickness.

Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis / Endothelial dysfunction and intima-media thickness in relation to cardiovascular risk factors in patients without clinical manifestations of atherosclerosis

Introducción y objetivos. La disfunción endotelial y el aumento del grosor mediointimal carotídeo son fenómenos tempranos en el desarrollo de la aterosclerosis, que pueden estudiarse de forma incruenta por ecocardiografía. Se pretende analizar la función endotelial, el grosor mediointimal carotídeo y la correlación entre ambos parámetros con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis. Pacientes y método. Se incluyeron 52 sujetos, 13 sin ningún factor de riesgo coronario y 39 con al menos un factor de riesgo coronario. Se les realizó una medición ecocardiográfica de la vasodilatación dependiente del endotelio en la arteria braquial y del grosor mediointimal en la carótida común. Resultados. En comparación con los sujetos sin factores de riesgo coronario, los pacientes con factores de riesgo presentaron una disminución de la vasodilatación dependiente del endotelio: 11,98 ñ 4,61 por ciento frente a 2,77 ñ 2,57 por ciento, (p < 0,0001; diferencia de medias del 9,21 por ciento con un IC del 95 por ciento de 6,33-12,07), y un aumento del grosor mediointimal carotídeo de 0,085 ñ 0,024 cm frente a 0,057 ñ 0,014 cm (p = 0,0002; diferencia de medias de 0,028 cm con un IC del 95 por ciento de 0,017-0,04). Se obtuvo una correlación estadísticamente significativa entre el grosor mediointimal carotídeo y la vasodilatación dependiente del endotelio (r = -0,357; p < 0,01). En el análisis de regresión lineal múltiple, el grosor mediointimal carotídeo dependía de la edad y de la presencia de hipertensión arterial, mientras que la vasodilatación dependiente del endotelio lo hacía de la presencia de hipertensión, tabaquismo y dislipemia. Conclusiones. En pacientes sin evidencia clínica o complicaciones ateroscleróticas pero con factores de riesgo coronario, la función endotelial es peor y el grosor mediointimal carotídeo es mayor que en pacientes sin ellos. Además, existe una asociación lineal negativa entre la vasodilatación dependiente del endotelio y el grosor mediointimal (AU)