RESUMEN
We evaluated the clinical usefulness of assessing the ankle-brachial index (ABI) and carotid stenosis (CS) in a type 2 diabetic population. Patients with type 2 diabetes and coronary artery disease (n = 265) were enrolled in a prospective 3-year cohort study. The cardiovascular mortality rate was 8.7% (23 of 265) during the 36-month study and the all-cause mortality rate was 9.5% (25 of 265). Multivariate logistic regression analysis revealed that age (odds ratio [OR] 2.09), hypertension (OR 7.99), obesity (OR 4.86), internal CS (OR 262.17), and Gensini score (OR 1.15) were independent predictors of cardiovascular mortality. Mean ABI value (OR 0.15) was the only predictor of all-cause mortality in this population. The ABI and carotid artery ultrasound have independent prognostic value in a type 2 diabetic population.
Asunto(s)
Índice Tobillo Braquial , Estenosis Carotídea/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Anciano , Estenosis Carotídea/etiología , Estenosis Carotídea/fisiopatología , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/patología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Ultrasonografía DopplerRESUMEN
A high proportion of diabetic subjects are referred with atherosclerotic disease and higher risk for cardiovascular events. Rapid expansion of the use of non-invasive coronary and peripheral arteries imaging, facilitated by technological advances, have found diagnostic and prognostic roles in this population. This review, which includes important and actual works, guidelines, and algorithms on cardiovascular disease in the diabetic population, indicates mandatory screening for arterial disease in these patients in light of their appropriate management.
Asunto(s)
Angiopatías Diabéticas/diagnóstico , Diagnóstico por Imagen/métodos , Calcio/metabolismo , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/metabolismo , Angiopatías Diabéticas/metabolismo , Angiopatías Diabéticas/fisiopatología , Humanos , Cintigrafía , Estrés Fisiológico , UltrasonografíaRESUMEN
The study was aimed to define the predictors for peripheral and carotid revascularization in type 2 diabetic population. In all, 279 patients with type 2 diabetes and peripheral arterial disease were enrolled in a cohort longitudinal study. Study population was followed up for 24 months for the need and performance of peripheral or carotid revascularization. Logistic regression analysis was conducted to identify variables predictive of revascularization, when lipid plasma levels, glycemia, arterial hypertension, blood pressures, ankle-brachial index, intima-media thickness, body mass index, waist circumference, and hip distances were put in a model. Total cholesterol and maximal value of carotid intima-media thickness were presented as factors that independently influenced the performed peripheral revascularization. Waist circumference is defined as independent factor associated with carotid endarterectomy. Measurement of carotid intima-media thickness, waist circumference, and plasma lipid levels in type 2 diabetes with manifested peripheral and carotid arterial disease should be recommended in a manner of proper risk stratification of this population.
Asunto(s)
Enfermedades de las Arterias Carótidas/cirugía , Diabetes Mellitus Tipo 2/complicaciones , Enfermedades Vasculares Periféricas/cirugía , Procedimientos Quirúrgicos Vasculares , Anciano , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/etiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/cirugía , Progresión de la Enfermedad , Endarterectomía Carotidea , Femenino , Humanos , Lípidos/sangre , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/sangre , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/etiología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , Ultrasonografía , Circunferencia de la CinturaRESUMEN
Acute myocardial infarction is a rare condition in young athletes. One of the causes could be a hypercoagulable state due to congenital antithrombin III deficiency, together with a prothrombotic state soon after strenuous physical training. We present the case of myocardial reinfarction in young football player with antithrombin III deficiency, treated with primary percutaneous coronary intervention and drug eluting stent, as well as the functional repercussions of continuous intensive physical activity.
Asunto(s)
Deficiencia de Antitrombina III/complicaciones , Fútbol Americano , Infarto del Miocardio/etiología , Angioplastia Coronaria con Balón , Deficiencia de Antitrombina III/sangre , Deficiencia de Antitrombina III/tratamiento farmacológico , Clopidogrel , Angiografía Coronaria , Stents Liberadores de Fármacos , Humanos , Masculino , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Imagen de Perfusión Miocárdica , Aptitud Física , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recurrencia , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Adulto JovenRESUMEN
High-sensitivity C-reactive protein (CRP) has been extensively used in recent years to assess cardiovascular risk more thoroughly. A significant association between elevated CRP, a prevalence of coronary artery disease (CAD) and adverse cardiac events has been found. Stress myocardial SPECT perfusion imaging (MPI) is an accurate noninvasive technique for detecting CAD. The aim of our study was to find out if there are any differences in the CRP levels between patients with normal myocardial perfusion and mild to moderate perfusion defects, detected with 99m-Tc sestamibi gated SPECT MPI. We prospectively studied 127 patients (79 men, 48 women) suspected of having CAD or with previously confirmed CAD, who were referred for MPI. According to the findings of the stress study, they were divided into two groups: with normal/ near normal myocardial perfusion (n = 85) and with a mild to moderate perfusion defect (n = 42). Levels of CRP in the former group were significantly lower (2.7 mg/L vs. 4.2 mg/L, p = 0.01). There were significantly more men (78.6% vs. 54%, p = 0.000*) and smokers (26% vs. 15%, p = 0.003), also the rates of PCI were significantly higher (36% vs. 15%, p = 0.006) in patients with mild to moderate perfusion defects. The two groups did not differ significantly in age, type of stress, presence of most risk factors for CAD, previous myocardial infarction and CABG. The results of our study have shown that patients with mild to moderate perfusion defects on stress myocardial perfusion SPECT imaging have significantly higher levels of C-reactive protein, compared to those with normal/near normal myocardial perfusion.
Asunto(s)
Proteína C-Reactiva/análisis , Enfermedad de la Arteria Coronaria/diagnóstico , Circulación Coronaria , Imagen de Perfusión Miocárdica , Radiofármacos , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Myocardial viability is an important parameter, predictive of improvement in left ventricular function after coronary artery bypass surgery (CABG). We wanted to define the relationship between the extent of hibernated myocardium and improvement in ejection fraction function and quality of life after CABG. METHODS: Sixty-five consecutive patients with ischaemic cardiomyopathy (mean LVEF <40%) undergoing surgical revascularization were studied with (99m)Tc-sestamibi myocardial perfusion Gated SPECT imaging (MPI) to assess preoperative myocardial viability. Patients were divided into two groups, based on the extent of viable myocardium before CABG: group 1, 39 patients with more than four viable segments; and group 2, 26 patients with fewer than four viable segments. Regional and global ejection fraction function, heart failure symptoms and quality of life were measured before and 14+/-4 months after revascularization. We used bull's eye quantitative analysis of MPI scans and a 17-segment model of ejection fraction function and perfusion evaluation. RESULTS: The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r=0.79, P<0.01). Patients with more than four viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79%, respectively, for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms and quality of life after revascularization. CONCLUSION: The presence of more than four viable segments (24% of the left ventricle) on MPI in patients with ischaemic heart failure before CABG surgery is significantly correlated with the improvement in LVEF, heart failure symptoms and quality of life post-operatively.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Puente de Arteria Coronaria , Insuficiencia Cardíaca/diagnóstico , Aturdimiento Miocárdico/diagnóstico por imagen , Calidad de Vida , Tecnecio Tc 99m Sestamibi , Disfunción Ventricular Izquierda/diagnóstico por imagen , Cardiomiopatías/complicaciones , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Aturdimiento Miocárdico/complicaciones , Cintigrafía , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicacionesRESUMEN
There are some specifics in the presentation of coronary artery disease (CAD) in women compared with men that may cause diagnostic pitfalls. The accuracy of noninvasive diagnostic testing in women tends to be lower than that in men. Stress myocardial perfusion imaging with 99m-Tc sestamibi gated SPECT is an accurate technique for detecting CAD. Only a few studies have compared dipyridamole stress imaging according to gender. The aim of the study was to compare the diagnostic value of dipyridamole myocardial perfusion imaging with 99m-Tc sestamibi gated SPECT in detecting CAD among patients of both sexes. We studied 62 consecutive patients (38 men, 24 women) using 99m-Tc sestamibi gated SPECT and dipyridamole stress to detect CAD. All the patients also underwent coronary angiography. Overall regional sensitivity was significantly lower in women compared with men (71.4% vs. 92.7%, p=0.039). There were no significant differences for detecting CAD in individual coronary arteries, although regional sensitivity in all three vascular territories was higher in men compared to women. The lowest sensitivity in women was found in the LAD territory (66.6%). Overall regional specificity in men and women was similar and did not reach statistical significance (88.7% vs. 94.7%). Significantly lower specificity in men was found only in the RCA territory (79.1%), compared with that in women (100%). Our results confirmed that there are certain gender differences in the diagnostic performance of dipyridamole stress myocardial perfusion imaging with 99-Tc sestamibi gated SPECT which are assigned to the characteristics of the female population. However, the diagnostic accuracy is also quite high in women, which makes this technique efficient enough in detecting CAD among this population.