Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Angina de Pecho/diagnóstico , Angina de Pecho/terapia , Enfermedad de la Arteria Coronaria/diagnóstico , Pruebas de Función Cardíaca/métodos , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Revascularización Miocárdica/métodosRESUMEN
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.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Braquial , Enfermedad de la Arteria Coronaria/fisiopatología , Prueba de Esfuerzo , Endotelio Vascular/fisiopatología , Estudios de Casos y Controles , Estudios Transversales , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
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% (N = 17); group 3: CAD with AL > or = 70% (N = 26). EF was evaluated by the percentage of flow-mediated dilatation (%FMD) 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 %FMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1% vs 31.6% in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8%) was observed in the group with obstructive CAD with AL > or = 70% 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.
Asunto(s)
Arteria Braquial/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Endotelio Vascular/fisiopatología , Prueba de Esfuerzo , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
BACKGROUND: The primary objective of the research was to determine whether sigmoidoscopy training during family practice residency is associated with subsequent performance of sigmoidoscopy in practice. METHODS: We surveyed 292 family physicians who graduated from the University of Minnesota Department of Family Practice and Community Health residency program between 1983 and 1989. The survey instrument collected information on the number of physicians who were currently performing flexible sigmoidoscopy in their practices and what factors were associated with performance of this procedure. RESULTS: Physicians with flexible sigmoidoscopy training during residency were performing flexible sigmoidoscopies at a significantly higher rate than those without training during residency (P = .001). A significantly higher proportion of males were performing flexible sigmoidoscopy in their practices than females (P = .0002). The mean number of flexible sigmoidoscopies recommended by residency-trained physicians to be performed during residency for adequate training was 16. CONCLUSIONS: Training in flexible sigmoidoscopy during a family practice residency is associated with a higher rate of flexible sigmoidoscopy performance later in practice. Female physicians perform flexible sigmoidoscopy at a significantly lower rate than their male colleagues; this could be due to a less-adequate training during residency. We recommend that residents perform a minimum of 16 flexible sigmoidoscopies during residency training.