Significance of the treadmill scores and high-risk criteria for exercise testing in non-high-risk patients with unstable angina and an intermediate Duke treadmill score.

BACKGROUND: The appropriate management of patients with an intermediate Duke treadmill score (DTS) is not well established.The aim of this study is to compare several treadmill indexes (American College of Cardiology/American Heart Association (ACC/AHA) High-Risk Criteria for exercise testing,Veterans Affairs and West Virginia Prognostic Score, ST/Heart Rate Index, Failure to attain 85% of age-predicted maximum Heart Rate) with ST-segment depression in detecting significant or severe coronary artery disease as determined by coronary angiography in patients with an intermediate DTS. METHODS: 144 consecutive patients admitted to the hospital for unstable angina were studied. RESULTS: The sensitivities of the ACC/AHA High-Risk Criteria and West Virginia Prognostic Score were greater than 95% for the detection of significant coronary artery disease and 96.67% for the detection of severe coronary artery disease. The sensitivity of I mm ST depression for the detection of significant and severe coronary disease was 74.74% and 86.67%, respectively. The combined evaluation of ST-segment depression > or =1 mm and exercise-induced angina could efficiently identify a population with a high prevalence of significant coronary artery disease (specificity of 95.92%, positive predictive value of 94.29%). CONCLUSIONS: The ACC/AHA High-Risk Criteria was West Virginia Prognostic Score provided relevant diagnostic information in patients with an intermediate DTS. A coronary angiography is to be recommended in patients with an intermediate DTS who also present ST-segment depression > or =1 mm and exercise-induced angina.

Angiographic correlates of the treadmill scores in non-high-risk patients with unstable angina.

BACKGROUND: There has been no clear consensus regarding the optimum definition of a high-risk exercise ECG test. The aim of this study is to compare the diagnostic accuracy of several treadmill scores [American College of Cardiology/American Heart Association (ACC/AHA) High-Risk Criteria for exercise testing, Duke Treadmill Score, Veterans Affairs and West Virginia Prognostic Score, ST/Heart Rate Index] with the ST-segment depression analysis in the detection of significant and severe coronary disease as determined by coronary angiography. METHODS: The study included a cohort of 248 consecutive patients admitted to hospital for unstable angina. RESULTS: The sensitivities of the ACC/AHA High-Risk Criteria and the ST depression > or =1 mm were 89.02 and 76.83%, respectively, for the detection of significant coronary artery disease, and 96.15 and 86.54% for the detection of severe coronary artery disease. The specificities of the Duke Treadmill Score and the ST depression > or=1 mm were 96.43 and 73.81%, respectively, for the detection of significant coronary artery disease, and 81.63 and 47.45% for the detection of severe coronary artery disease. CONCLUSIONS: The ACC/AHA High-Risk Criteria and Duke Treadmill Score provided relevant diagnostic information not available from the ST segment analysis alone.

[Angiographic evaluation of high-risk treadmill scores in patients with unstable angina according to sex, age, or use of drugs with a negative chronotropic effect]. / Comparación angiográfica de los criterios e índices de alto riesgo para ergometría convencional en pacientes diagnosticados de angina inestable en función del sexo, la edad o el uso de fármacos bradicardizantes.

INTRODUCTION AND OBJECTIVES: The aim of the study is to determine whether age, sex, or the use of drugs with a negative chronotropic effect modifies the sensitivity, specificity, positive or negative predictive value, or positive or negative likelihood ratio of the high-risk criteria used in exercise testing as defined by the Spanish Society of Cardiology (SEC) and the American College of Cardiology/American Heart Association (ACC/AHA), the Duke treadmill score, the Veterans Affairs and West Virginia prognostic score, or the ST/Heart Rate Index at the time when left main coronary artery disease, three-vessel disease or two-vessel disease involving the proximal left anterior descending artery is detected by coronary angiography. METHODS: The study included a cohort of 469 consecutive patients aged 75 years who were admitted to hospital for unstable angina. All patients underwent exercise stress testing and coronary angiography. RESULTS: In all situations, the ACC/AHA high-risk criteria had the highest sensitivity, negative predictive value, and negative likelihood ratio, and the Duke Treadmill Score had the highest specificity and positive predictive value. The diagnostic accuracy of the other treadmill scores was affected by sex, age or the use of drugs with a negative chronotropic effect. CONCLUSIONS: The ACC/AHA high-risk criteria and Duke Treadmill Score provided useful additional information during the assessment of ST-segment depression. These measures could help improve the diagnostic accuracy of conventional ECG exercise testing in women, older individuals, and patients taking beta-blockers or non-dihydropyridine calcium antagonists.

Comparación angiográfica de los criterios e índices de alto riesgo para ergometría convencional en pacientes diagnosticados de angina inestable en función del sexo, la edad o el uso de fármacos bradicardizantes / Angiographic evaluation of high-risk treadmill scores in patients with unstable angina according to sex, age, or use of drugs with a negative chronotropic effect

Introducción y objetivos. El objetivo del estudio es evaluar si la edad, el sexo o la toma de fármacos bradicardizantes modifican la sensibilidad, la especificidad, el valor predictivo positivo y negativo y la razón de verosimilitud positiva y negativa del descenso del segmento ST, de los criterios de alto riesgo para ergometría convencional de la Sociedad Española de Cardiología (SEC) y del American College of Cardiology/American Heart Association (ACC/AHA), del índice de Duke, del índice pronóstico del Veterans Affairs y de West Virginia y del índice segmento ST/frecuencia cardiaca a la hora de detectar en la coronariografía: enfermedad del tronco común izquierdo, de 3 vasos o de 2 vasos con afección de la arteria descendente anterior proximal. Métodos. Se estudió a 469 pacientes con una edad ≤ 75 años, que ingresaron consecutivamente con el diagnóstico de angina inestable primaria, a los que se les practicó ergometría convencional pronóstica y cateterismo cardiaco. Resultados. Los criterios del ACC/AHA ofrecieron la mayor sensibilidad, valor predictivo negativo y razón de verosimilitud negativa en todos los casos. El índice de Duke presentó una mejor especificidad y valor predictivo positivo en todas las situaciones. El resto de escalas de riesgo vio afectado su rendimiento diagnóstico por el sexo, la edad o la toma de fármacos bradicardizantes. Conclusiones. Los criterios del ACC/AHA y el índice de Duke añadieron información relevante a la valoración aislada del descenso del segmento ST. Estas escalas podrían ser una herramienta útil a la hora de mejorar la rentabilidad diagnóstica de la prueba de esfuerzo convencional en mujeres, personas de más edad y pacientes con tratamiento con bloqueadores beta o antagonistas del cacio tipo no dihidropiridina (AU)

Introduction and objectives. The aim of the study is to determine whether age, sex, or the use of drugs with a negative chronotropic effect modifies the sensitivity, specificity, positive or negative predictive value, or positive or negative likelihood ratio of the high-risk criteria used in exercise testing as defined by the Spanish Society of Cardiology (SEC) and the American College of Cardiology/American Heart Association (ACC/AHA), the Duke treadmill score, the Veterans Affairs and West Virginia prognostic score, or the ST/Heart Rate Index at the time when left main coronary artery disease, three-vessel disease or two-vessel disease involving the proximal left anterior descending artery is detected by coronary angiography. Methods. The study included a cohort of 469 consecutive patients aged › 75 years who were admitted to hospital for unstable angina. All patients underwent exercise stress testing and coronary angiography. Results. In all situations, the ACC/AHA high-risk criteria had the highest sensitivity, negative predictive value, and negative likelihood ratio, and the Duke Treadmill Score had the highest specificity and positive predictive value. The diagnostic accuracy of the other treadmill scores was affected by sex, age or the use of drugs with a negative chronotropic effect. Conclusions. The ACC/AHA high-risk criteria and Duke Treadmill Score provided useful additional information during the assessment of ST-segment depression. These measures could help improve the diagnostic accuracy of conventional ECG exercise testing in women, older individuals, and patients taking beta-blockers or non-dihydropyridine calcium antagonists (AU)

[Myocardial Infarction Registry in Asturias: the RIMAS project]. / Registro del Infarto de Miocardio en Asturias: proyecto RIMAS.

BACKGROUND AND OBJECTIVE: Spanish hospital registers of myocardial infarction (MI) are not uniform. The RIMAS project is trying to know the real situation of myocardial infarction in Asturias and to observe possible differences among hospitals and with other registers. PATIENTS AND METHOD: It was a cohorts study using a hospital registry of patients with MI. All cases arriving alive to all public and private-public Asturian hospitals during 1998 were included. Demographic data, cardiovascular risk factors, delays, evolution, treatments and techniques used, were all registered. RESULTS: 875 cases were registered with a coverage rate of 77%. The average age was 66.5 years (45.6% older than 70 years) and women represented 29.1%. Sixty three per cent of the patients had tobacco consumption, 43% had arterial hypertension, and 22.3% were diabetics. The extrahospital delay was 135 min and thrombolysis delay was 180 min. Thrombolytic therapy was administered to 34.1% of patients and 4% were treated with primary angioplasty. Intrahospital mortality was 14.4%. At discharge, antiagregant therapy was administrated to 94%, betablockers to 43.2%, ACE inhibitors to 33.3% and hypolipemiants to 25% of treated patients. CONCLUSIONS: People attended in Asturias with a MI are older and there is a higher percentage of women. There are delays which include the start of thrombolytic therapy. However, there are significant differences with regard to the adhesion to clinical practice guidelines between different hospitals.

Delayed myocardial perforation following pacemaker implantation.

Myocardial perforation is a rare complication following pacemaker implantation that may cause cardiac tamponade. If it does occur, it is usually at the time of lead insertion. This condition requires urgent recognition since the prompt drainage of the pericardial fluid may be lifesaving. We present a case report of myocardial perforation complicated by cardiac tamponade 4 days after pacemaker lead insertion that was repaired surgically.

Displasia arritmogénica del ventrículo derecho en una mujer de edad avanzada: manifestación inicial como una tormenta arrítmica / Arrythmogenic right ventricular dysplasia in an old woman: electrical storm as initial presentation

No disponible

Taponamiento cardíaco secundario a pericarditis hemorrágica tras la trombólisis de un infarto agudo de miocardio / Cardiac tamponade secondary to hemorrhagic pericarditis following thrombolysis for acute myocardial infarction

No disponible

Trombo flotante sobre la válvula de Eustaquio como complicación de la enfermedad tromboembólica venosa / Floating thrombi on the Eustachian valve as complication of venous thromboembolic disease

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Correlación angiográfica de los criterios de alto riesgo para ergometría convencional y el índice de Duke / Angiographic Correlates of the High-Risk Criteria for Exercise Testing and the Duke Treadmill Score

Introducción y objetivos. Comparar la sensibilidad, especificidad, valor predictivo positivo y negativo y precisión de la predicción del índice de Duke y de los criterios de alto riesgo para ergometría convencional de la Sociedad Española de Cardiología (SEC) y del American College of Cardiology/American Heart Association (ACC/AHA) a la hora de detectar, en la coronariografía, enfermedad del tronco común izquierdo, de 3 vasos o de 2 vasos con afectación de la arteria descendente anterior proximal. Pacientes y método. Se estudiaron 199 pacientes con una edad 75 años, que ingresaron consecutivamente con el diagnóstico de angina inestable primaria y a los cuales se les practicó ergometría convencional pronóstica y cateterismo cardíaco. Resultados. Los criterios de la SEC demostraron una sensibilidad del 69,2 por ciento y una especificidad del 49,0 por ciento. Los criterios del ACC/AHA ofrecieron una sensibilidad del 98,1 por ciento y una especificidad del 23,8 por ciento. El índice de Duke tuvo una sensibilidad del 30,8 por ciento y una especificidad del 90,5 por ciento. En los pacientes con un índice de Duke de riesgo moderado encontramos una sensibilidad del 62,9 por ciento y una especificidad del 39,8 por ciento para los criterios de la SEC, en tanto que los criterios del ACC/AHA presentaron una sensibilidad del 100,0 por ciento y una especificidad del 5,8 por ciento. Conclusiones. Los criterios del ACC/AHA aportaron una mayor sensibilidad. El índice de Duke demostró una mayor especificidad. Los criterios de la SEC y del ACC/AHA podrían ser de gran utilidad en el manejo de pacientes con índice de Duke de riesgo moderado (AU)