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Deterioro agudo de la función renal en una Unidad Coronaria en España / Acute renal function deterioration in a coronary unit in Spain

Objetivo. Valorar la incidencia y el valor pronóstico del deterioro agudo de la función renal (DAFR) en pacientes cardiológicos agudos. Ámbito. Unidad Coronaria de un hospital universitario terciario. Diseño. Estudio retrospectivo. Pacientes. Cien pacientes consecutivos ingresados durante 2004. Intervenciones. No hubo intervenciones aleatorizadas. Los procedimientos diagnósticos y terapéuticos se realizaron de acuerdo con protocolos locales y las Guías de Práctica Clínica en uso. Variables principales. El objetivo primario del estudio fue analizar la incidencia de DAFR y su relación con la mortalidad por cualquier causa durante el ingreso. Se definió DAFR como el aumento de la creatinina sérica respecto a la basal mayor de 0,5 mg/dl y/o mayor del 50%. Resultados. La incidencia de DAFR fue del 26%, con un incremento medio de la creatinina sérica de 1,5 ± 0,9 mg/dl. El DAFR se asoció de forma significativa con la edad y los antecedentes de hipertensión e insuficiencia renal crónica. Los pacientes con DAFR tuvieron un curso más complicado, mayores estancias hospitalarias y recibieron menos cateterismos. El empeoramiento agudo de la función renal se asoció con mayor mortalidad hospitalaria (33% frente a 6%, p = 0,002). Conclusiones. El DAFR es frecuente en el paciente cardiópata agudo y su presencia se asocia con alta mortalidad (AU)

Objective. To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. Setting. Coronary Care Unit in a tertiary university hospital. Design. Retrospective study. Participants. One hundred consecutive patients admitted during 2004. Interventions. No randomized interventions were done. Diagnostic and therapeutic procedures were performed according to local protocols and current Clinical Practice Guidelines. Primary variables. The primary aim of the study was to analyze the incidence of acute renal function deterioration and its effect in mortality during hospitalization. ARFD was defined as the increase of serum creatinine by 0.5 mg/dl and/or by 50% over baseline. Results. Incidence of ARFD was 26%, with a mean increase of serum creatinine of 1.5 ± 0.9 mg/dl. ARFD was significantly associated with age, background of hypertension and chronic kidney disease. Patients with ARFD had a more complicated course, longer hospitalizations, and received fewer catheterisms. Acute renal function deterioration was associated with higher mortality during hospitalization (33% versus 6%, p = 0.002). Conclusions. Acute renal function deterioration is frequent in patients with acute heart disease and its presence is linked with higher mortality (AU)

[Acute renal function deterioration in a Coronary Unit in Spain]. / Deterioro agudo de la función renalen una Unidad Coronaria en España.

OBJECTIVE: To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. SETTING: Coronary Care Unit in a tertiary university hospital. DESIGN: Retrospective study. PARTICIPANTS: One hundred consecutive patients admitted during 2004. INTERVENTIONS: No randomized interventions were done. Diagnostic and therapeutic procedures were performed according to local protocols and current Clinical Practice Guidelines. PRIMARY VARIABLES: The primary aim of the study was to analyze the incidence of acute renal function deterioration and its effect in mortality during hospitalization. ARFD was defined as the increase of serum creatinine by 0.5 mg/dl and/or by 50% over baseline. RESULTS: Incidence of ARFD was 26%, with a mean increase of serum creatinine of 1.5 +/- 0.9 mg/dl. ARFD was significantly associated with age, background of hypertension and chronic kidney disease. Patients with ARFD had a more complicated course, longer hospitalizations, and received fewer catheterisms. Acute renal function deterioration was associated with higher mortality during hospitalization (33% versus 6%, p = 0.002). CONCLUSIONS: Acute renal function deterioration is frequent in patients with acute heart disease and its presence is linked with higher mortality.

[Diagnostic value of gated-SPECT for each coronary artery in patients clinically diagnosed of coronary heart disease]. / Valor diagnóstico del gated-SPECT para cada arteria coronaria en pacientes con el diagnóstico clínico de cardiopatía isquémica.

UNLABELLED: This study aimed to evaluate the diagnostic value of gated-SPECT for each coronary artery in patients with clinical diagnosis or suspicion of coronary heart disease. PATIENTS AND METHODS: The study population is made up of 43 patients (64 9 years, 88% male gender) with prior clinical diagnosis or suspicion of coronary heart disease who had undergone gated-SPECT (99mTc-tetrofosmin) and cardiac catheterization. Scintigraphic study after exercise treadmill test and rest study were performed on the same day. RESULTS: Gated-SPECT showed perfusion defects in 86% of patients, the mean number of territories with perfusion defects being 1.58 +/- 0.79. A total of 39 (91%) of the 43 patients had significant coronary heart disease. Single, two- and three-vessel disease was demonstrated in 12 (28%), 15 (35%) and 12 (28%) patients, respectively. Sensitivity and specificity were 81% and 91%, respectively, for left anterior descending artery, 88% and 65% for right coronary artery, and 55% and 81% for circumflex one. CONCLUSIONS: Myocardial scintigraphy with gated-SPECT offers high sensitivity and specificity for the diagnosis of left anterior descending artery disease. However, sensitivity for circumflex artery and specificity for right coronary artery were low in our series.

[Clinical predictors of the presence of perfusion defects in more than than one territory in myocardial scintigraphy with GATED-SPECT]. / Predictores clínicos de la existencia de defectos de perfusión de más de un territorio en la gammagrafía de perfusión miocárdica con GATED-SPECT.

BACKGROUND AND OBJECTIVE: Extension of perfusion defects is associated with outcome in patients undergoing myocardial scintigraphy. The study aimed to identify the clinical characteristics that can predict the existence of perfusion defects in more than one territory in patients referred for myocardial scintigraphy with GATED-SPECT. PATIENTS AND METHODS: A total of 193 patients undergoing myocardial scintigraphy with GATED-SPECT (99mTc-tetrofosmine) were studied. Clinical variables and scintigraphy results were studied to determine what clinical variables are associated with perfusion defects in more than one territory. RESULTS: The number of territories with perfusion defects per patient was 1.1 0.8 and 29% had perfusion defects in > 1 territory. Patients with greater probability of having perfusion defects in > 1 territory were those with previous myocardial infarction (44% vs 21%, p = 0.030) and males (33% vs 10%, p = 0.006). In addition, patients with > 2 coronary risk factors had a statistical tendency to have defects in > 1 territory (47% vs 20%, p = 0.057). Only 15% of the patients with one of these three characteristics had perfusion defects in > 1 territory in comparison with 45% and 83% in those with 2 or 3 factors, respectively. CONCLUSION: Considering 3 simple clinical characteristics (male gender, previous infarction and existence of > 2 coronary risk factors), it is possible to predict which patients are more likely to show perfusion defects in > 1 territory during GATED-SPECT myocardial scintigraphy.

Predictores clínicos de la existencia de defectos de perfusión de más de un territorio en la gammagrafía de perfusión miocárdica con GATED-SPECT / Clinical predictors of the presence of perfusion defects in more than one territory in myocardial scintigraphy with gated spect

Introducción y objetivo: La extensión de los defectos de perfusión es un marcador pronóstico en los pacientes a los que se realiza gammagrafía de perfusión miocárdica. El objetivo fue determinar qué variables clínicas pueden predecir la existencia de defectos de perfusión en más de un territorio en pacientes a los que se realiza gammagrafía de perfusión miocárdica mediante GATED-SPECT. Pacientes y métodos: Se estudiaron 193 pacientes a los que se realizó estudio de perfusión miocárdica mediante GATEDSPECT con 99mTc-tetrofosmina. Se analizaron las variables clínicas y el resultado del estudio isotópico, con objeto de determinar las características asociadas a la existencia de defectos de perfusión en > 1 territorio. Resultados: El número de territorios con defectos de perfusión por paciente fue 1,1 ñ 0,8 y el 29 per cent presentaron defectos de perfusión en > 1 territorio. Los pacientes con mayor probabilidad de tener defectos de perfusión en > 1 territorio fueron aquellos con infarto de miocardio previo (44 per cent vs 21 per cent, p = 0,030) y los varones (33 per cent vs 10 per cent, p = 0,006). Además, los pacientes con > 2 factores de riesgo coronario presentaron una tendencia estadística a tener más frecuentemente defectos de perfusión en > 1 territorio (47 per cent vs 20 per cent, p = 0,057).Sólo el 15 per cent de los pacientes con una de estas tres características tuvieron defectos de perfusión en > 1 territorio, en comparación con el 45 per cent y el 83 per cent de los que presentaron dos o tres factores, respectivamente. Conclusiones: Teniendo en cuenta tres variables clínicas sencillas (sexo masculino, infarto previo y existencia de > 2 factores de riesgo), podemos conocer qué pacientes tienen mayor probabilidad de presentar defectos de perfusión en más de un territorio en el estudio mediante GATED-SPECT (AU)

Valor diagnóstico del GATED-SPECT para cada arteria coronaria en pacientes con el diagnóstico clínico de cardiopatía isquémica / Diagnostic value of gated-spect for each coronary artery in patients clinically diagnosed of coronary heart disease

El objetivo de este estudio fue evaluar el valor diagnóstico del gated-SPECT para cada una de las arterias coronarias en pacientes con diagnóstico previo o sospecha de enfermedad coronaria. Pacientes y métodos: La población de estudio esta formada por 43 pacientes (64 ñ 9 años, 88 per cent varones) con diagnóstico previo o sospecha de cardiopatía isquémica a los que se les había realizado estudio gated-SPECT y coronariografía. El radiofármaco empleado fue 99mTc-tetrofosmina, realizándose en el mismo día el estudio tras ejercicio físico en tapiz rodante y el estudio de reposo. Resultados: El estudio gated-SPECT mostró defectos de perfusión en el 86 per cent de los pacientes, siendo el número de territorios con defecto de perfusión por paciente 1,58 ñ 0,79.De los 43 pacientes, 39 (91 per cent) tenían enfermedad coronaria significativa. La enfermedad fue de 1, 2 y 3 vasos en 12 (28 per cent), 15 (35 per cent) y 12 (28 per cent) pacientes, respectivamente. La sensibilidad y especificidad fueron, respectivamente, 81 per cent y 91 per cent para la descendente anterior, 88 per cent y 65 per cent para la coronaria derecha y 55 per cent y 81 per cent para la circunfleja. Conclusiones: En pacientes con diagnóstico previo o sospecha de cardiopatía isquémica, la gammagrafía mediante gated-SPECT posee una elevada sensibilidad y especificidad en el diagnóstico de enfermedad de la arteria descendente anterior. Sin embargo, la sensibilidad para la circunfleja y la especificidad para la coronaria derecha fueron bajas en nuestra serie. (AU)

A semiquantitative method based on proximal convergence zone to estimate the severity of the mitral regurgitation: design and clinical application.

AIMS: The analysis of the mitral regurgitation using the proximal isovelocity surface area method has not been extended to clinical practice because of its complexity. Our objective was to design and validate a simplified semi-quantitative method based on proximal isovelocity surface area to assess the severity of mitral regurgitation. METHODS AND RESULTS: We studied 58 patients with mitral regurgitation. We found a good correlation between the angiographic grade of mitral regurgitation and the parameters derived from proximal isovelocity surface area: maximal regurgitant flow, regurgitant orifice and volume (r: 0.90 to 0.92, P<0.05). The values of maximal regurgitant flow that best predicted the grades of angiographic severity (I--IV) were estimated by regurgitant orifice curves, with cut points of 16, 56 and 160ml.s(-1)kappa(p)=0.92). Considering that maximal regurgitant flow only depends on the radius of proximal isovelocity surface area and the velocity of aliasing used, we constructed a nomogram with the previously described limits. Twenty-four new patients were studied using this nomogram and angiography. An excellent degree of agreement was found (kappa(p)=0.93). The inter- and intraobserver variability showed a kappa(p)=0.89 and 0.91, respectively. CONCLUSION: This nomogram allows a fast semi-quantitative estimation of the grade of MR, feasible and highly correlative with the invasive methods.

[Left ventricular pseudoaneurysm with a fistula to right ventricle following previous repair of septal defect after acute myocardial infarction]. / Seudoaneurisma de ventrículo izquierdo con fístula a ventrículo derecho tras la corrección de una comunicación interventricular postinfarto.

A case of left ventricular pseudoaneurysm with a fistula to right ventricle is presented. It appeared following the repair of a ventricular septal defect after acute myocardial infarction. The left ventricular pseudoaneurysm is associated, in most cases, with acute myocardial infarction. However, we should not forget surgery as aetiology of this pathology. The most frequent post-surgery pseudoaneurysms appear after aneurysmectomy and after mitral valve replacement. They tend to develop fistulas which differ from post acute myocardial infarction pseudoaneurysms. Few cases have been described following the repair of septal defect and none of them complicated with a fistula to right ventricle, as in our case.

[The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics]. / Guías de práctica clínica de la Sociedad Española de Cardiología en cardiología intervencionista: angioplastia coronaria y otras técnicas.

Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

Sensitivity of the Doppler rate of pressure rise to changes in the inotropic state: an experimental comparison with invasively obtained dP/dt.

AIMS: To investigate the sensitivity of the rate of pressure rise obtained by Doppler to changes in the inotropic state by comparing it to simultaneous invasive measurements of dP/dt under different conditions of contractility. METHODS AND RESULTS: Mitral regurgitation was provoked in five pigs, and simultaneous measurements of dP/dt and the Doppler-estimated rate of pressure rise were made with a micro-manometer and with continuous-wave Doppler. Changes in the inotropic state were induced by drug infusion and by ischaemia. One hundred and twenty-seven simultaneous measurements were made with a correlation coefficient between the Doppler-estimated rate of pressure rise and dP/dt of 0.85 (P<0.001). Sensitivity to inotropic changes was estimated as the percentage change of each parameter in each condition of contractility, and showed that the Doppler-estimated rate of pressure rise had better sensitivity than dP/dt. CONCLUSION: The sensitivity of Doppler-estimated rate of pressure rise to changes in the inotropic state is greater than that of dP/dt. The correlation between the rate of pressure rise obtained by Doppler and dP/dt is maintained even in extreme conditions of contractility. Therefore, the rate of pressure rise can be considered a good parameter to assess linear changes of contractility.

Prevalence of angina pectoris in Spain. PANES Study group.

The frequency of coronary heart disease in a community is usually measured by myocardial infarction incidence and mortality rates. The measurement of the prevalence of angina pectoris may, however, become a convenient way of assessing coronary heart disease morbidity in the future. The aim of this study was to determine the prevalence of angina and validity of the Rose questionnaire in the Spanish population aged from 45 to 74 years. A cross-sectional study was conducted in 10,248 subjects (45-74 years), representative of the Spanish population. The WHO Rose questionnaire was used and a construct validation against regional mortality rates and cardiovascular risk factor prevalence was devised. The overall angina prevalence increased with age both in men and women, but was higher in the latter (7.3% and 7.7%, respectively). Angina prevalence also increased with the number of cardiovascular risk factors present and correlated with regional CHD mortality rates (r = 0.66). Sensitivity and specificity results of the Rose questionnaire were low when tested against exercise test (52.9% and 52.1%, respectively). As conclusions, Rose questionnaire is a reliable tool for assessing angina prevalence in the Spanish population which is similar to that of other industrialized countries with higher myocardial infarction morbidity and mortality.

[The prevalence of angina and cardiovascular risk factors in the different autonomous communities of Spain: the PANES Study. Prevalencia de Angina en España]. / Prevalencia de angina y factores de riesgo cardiovascular en las diferentes comunidades autónomas de España: estudio PANES.

INTRODUCTION AND OBJECTIVE: The study of angina prevalence has received little attention in the analysis of the dimension of coronary heart disease. The aim of this study was to determine the prevalence of angina and cardiovascular risk factors in the 45- to 74-year-old population of the different autonomous regions of Spain. METHODS: A sample of 10,248 subjects was recruited. Sampling was stratified by gender and age groups (45-54, 55-64 and 65 to 74 years), and proportional to the population distribution of the different autonomous regions. A multistage sampling was performed, firstly 200 villages were randomly selected, secondly three different socio-economic household were chosen. Sample unit was neighbouring households. Rose questionnaire of angina and a structured questionnaire to collect socio-demographic and risk factor variables were administered. RESULTS: Angina prevalence in the 45- to 74-year-old Spanish population was 7.5%. The autonomous regions with the higher and lower prevalence were Baleares (11.4%) and Basque Country (3.1%), respectively. The Pearson correlation coefficient between angina prevalence and ischemic heart disease or cardiovascular disease mortality in men and women was 0.52 and 0.55, and 0.31 and 0.44, respectively. The self reported prevalence of hypertension, dyslipemia, diabetes and smoking was 31.1%, 24.2%, 14.3% and 34.6% respectively. CONCLUSIONS: Angina prevalence in Spain is similar to that of developed countries although significant differences were observed among the autonomous regions of Spain. These differences correlate with those observed in ischemic heart disease or cardiovascular mortality among them and are associated with the cardiovascular risk factors prevalence which also varies among communities.

[Improvement in diastolic function in hypertensive patients with left ventricular hypertrophy with inhibitors of the angiotensin converting enzyme]. / Mejoría de la función diastólica en pacientes hipertensos con hipertrofia ventricular izquierda mediante inhibidores de la enzima de conversión de la angiotensina.

An open and multicentric study was conducted with 66 patients with mild to severe diastolic arterial hypertension and echocardiographic left ventricular hypertrophy, the evolution of diastolic function, by means of doppler transmitral flow echocardiography, under treatment with ramipril, an angiotensin converting enzyme inhibitor, at a dose of 2.5 and 5 mg/day, or combined with a diuretic, after three and six months of treatment. Despite not obtaining the tensional control in all patients, a decrease in the mass, both in absolute values and mass index, was obtained. This decrease was observed both in male and female patients from the first three months, which went on until the sixth month, thus suggesting an independent action of the hemodynamic load decrease for the obtention of this effect. There was also a change in the ventricular geometry with a displacement of patients from concentric enlargement to normal, remodelling and eccentric enlargement. The diastolic function improved both for the early and for the late maximal filling velocity, relationship between both, and deceleration time, although the time during which this improvement occurred was different for each parameter, thus indicating the different influence of the dynamic and structural factors on these parameters. No correlation was found between the improvement in diastolic function and hypertrophy regression. We can conclude that ramipril is useful for the control of the left ventricular hypertrophy and diastolic function, irrespective of arterial tension values.

[A simplified method for estimating mitral valve area by Doppler]. / Método simplificado para la estimación del área valvular mitral por Doppler.

Based upon geometrical considerations we have developed a new method for estimation of valve area in patients with mitral stenosis. A special ruler enables us to read the valve area from the Doppler record. We prove that our new method is more precise and rapid than original Hatle's procedure. In 35 patients, we found a good correlation between the result of our method and the valve area obtained by 2D-Echo. Thus the new method is very useful for Doppler evaluation of mitral stenosis patients.

Carcinoid heart disease: a Doppler echocardiographic report.

This paper describes the two-dimensional echocardiographic and pulsed Doppler findings in a 25-year-old man with tricuspid insufficiency due to carcinoid heart involvement. A hypothesis explaining the time sequence of the carcinoid valve involvement is suggested.