Teste ergométrico precoce após infarto do miocárdio: comparação com ecocardiograma, monitorização eletrocardiográfica e arteriografia coronariana / Exercise testing early after myocardial infarction: comparison with echocardiography, electrocardiographic monitoring and coronary arteriography

FUNDAMENTO: O teste ergométrico precoce após infarto do miocárdio, realizado antes da alta hospitalar, é útil na estratificação de risco, na prescrição de exercício e na avaliação do prognóstico e do tratamento. OBJETIVO: O objetivo deste estudo foi comparar os achados do teste ergométrico precoce pós-infarto aos resultados do ecocardiograma, da monitorização eletrocardiográfica pelo sistema holter (24 horas) e da cinecoronariografia. MÉTODOS: Avaliaram-se 60 casos (51,42 ± 9,34 anos), 46 do sexo masculino (77 por cento). O teste ergométrico foi máximo sintoma limitante, realizado pelo protocolo de Naughton, entre o sexto dia de internação e a alta hospitalar, realizado em uso de medicação. Durante a internação, os pacientes foram submetidos a ecocardiograma, eletrocardiografia dinâmica e cinecoronariografia. Adotou-se o nível de significância de 0,05 (a=5 por cento). RESULTADOS: O desempenho do teste ergométrico na detecção de doença coronária multiarterial foi reduzido (sensibilidade, 42 por cento; especificidade, 69 por cento). Não houve diferenças significativas quando se comparou a presença de isquemia no teste ergométrico com doença coronária de múltiplos vasos, arritmias ventriculares complexas na eletrocardiografia dinâmica e ocorrência de fração de ejeção inferior a 60 por cento no ecocardiograma (p = 0,56), bem como com a presença de lesões multiarteriais, arritmias ventriculares complexas na eletrocardiografia dinâmica e fração de ejeção anormal no ecocardiograma (p = 0,36). CONCLUSÃO: Durante o teste, a presença de isquemia se associou à ocorrência de arritmias ventriculares na eletrocardiografia dinâmica, à redução da fração de ejeção no ecocardiograma e à presença de lesões coronárias multiarteriais, o que representou um indicador de elevado risco coronário.

BACKGROUND: Predischarge exercise testing early after myocardial infarction is useful for risk stratification, exercise prescription, and assessment of prognosis and treatment. OBJECTIVE: The objective of this study was to compare the findings of exercise testing early after myocardial infarction with those of echocardiography, electrocardiographic monitoring (24-hour Holter monitoring) and coronary angiography. METHODS: We evaluated 60 cases (mean age of 51.42 ± 9.34 years), of which 46 were males (77 percent). The symptom-limited maximal exercise test according to the Naughton protocol12 was performed between the sixth day of hospitalization and hospital discharge, with the patients on medication. During hospitalization, the patients underwent echocardiography, electrocardiographic monitoring and coronary angiography. The significance level was set at 0.05 (a = 5 percent). RESULTS: Exercise testing had a poor performance in the detection of multivessel coronary artery disease (sensitivity, 42 percent; specificity, 69 percent). No significant differences were found when the presence of ischemia on exercise test was compared with multivessel coronary disease, complex ventricular arrhythmias on electrocardiographic monitoring, and the finding of an ejection fraction lower than 60 percent on echocardiography (p = 0.56), as well as with the presence of multivessel lesions, complex ventricular arrhythmias on electrocardiographic monitoring and abnormal ejection fraction on echocardiography (p = 0.36). CONCLUSION: The presence of ischemia during exercise testing was associated with the occurrence of ventricular arrhythmias on electrocardiographic monitoring, with reduced ejection fraction on echocardiography, as well as with the presence of multivessel coronary lesions, which constitutes an indicator of a high coronary risk.

Angiografía coronaria: indicación, resultados y complicaciones en 5.000 pacientes consecutivos / Coronary angiography: indications, results and complications in 5.000 consecutive patients

Background: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere. Aim: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines. Material and methods: Prospective registry of 5.000 patients aged 60±11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications. Results: The indications for 80 percent of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62 percent, mainly one vessel disease. These were two deaths due to the procedure (0.04 percent), three patients (0.06 percent) had an acute myocardial infarction or a stroke. These figures are lower than referential values. Conclusions: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values.

Noninvasive detection and evaluation of coronary atherosclerotic plaques with multi-slice spiral CT:a comparative study with intravascular ultrasonograhy / 中华放射学杂志

Objective To evaluate the capability and accuracy of multi-shce spiral computed tomography(MSCT)in detecting atherosclerotic plaques in nonstenotic coronary arteries with reference to the findings of intravascular ultrasound(IVUS)in a segment analysis.Methods Both IVUS exams and 16-row MSCT scans were performed on 35 consecutive patients among whom 30 patients had successful MSCT scans.A total of 94 coronary segments without significant coronary stenoses were paired-analyzed both on IVUS and MSCT segment by segment.The plaques were classified as calcified,fibrotic and soft types according to the echogeneity on IVUS.Plaque attenuation on MSCT was measured and expressed by Hounsfield units(HU).Results When referred to IVUS,MSCT had a sensitivity of 82.1%(46/56)and specificity of 89.5% (34/38),respectively in detectiong any plaques.For the detection of calcified plaques,the sensitivity and specificity were 92.1%(35/38)and 96.4%(54/56),respectively.For the detection of mixed and noncalcified plaques,MSCT had sensitivity of 73.2%(30/41)and specificity of 88.7%(47/53).But for the detection of the noncalcified plaque,the sensitivity was 66.7%(12/18). According to the findings On IVUS,the plaques were classified as calcified(n=19),fibrotic(n=19)and soft(n=16).The CT attenuation of calcified plaques was(489?169)HU(196 to 817 HU),fibrotic plaques(69?21)HU(25 to 117 HU)and soft plaques(23?18)HU(-12 to 47 HU).Nonparametric Kruskal-Wallis test revealed a significant difference of plaque attenuation among the three groups(P