Identificación no invasiva de ateroesclerosis subclínica en individuos con psoriasis / Non-invasive identification of subclinical atheroesclerosis

Antecedentes. La psoriasis es una enfermedad inflamatoria crónica multisistémica que implica un riesgo cardiovascular aumentado, incluidos enfermedad coronaria, infarto de miocardio y muerte de causa cardiovascular, sobre todo en pacientes jóvenes y con psoriasis más graves. Esto se debe a una aterogénesis precoz y en ocasiones subclínica, que podría ser identificada de manera no invasiva mediante estudios vasculares de vasos periféricos. Objetivos. a) identificar la presencia de ateroesclerosis subclínica en pacientes con psoriasis; b) establecer su valor predictivo independientemente de otros factores de riesgo cardiovascular. Diseño. Estudio de cohorte, prospectivo, controlado. Métodos. Se incluyeron 175 pacientes consecutivos, un grupo con psoriasis (GP, n:35) y un grupo control (GC, n:140), a quienes se les efectuó estudios de identificación de placas de ateroesclerosis y de elasticidad arterial en vasos carotídeos extracraneales y femorales. Resultados. El score de Framingham en los pacientes de ambos grupos fue bajo (7 ± 2,3% vs. 5,7 ± 1,8%; GP vs. GC respectivamente; p = .003), mientras que el score de riesgo vascular determinado según la alteración de parámetros de ateroesclerosis subclínica evaluados fue mayor en el GP (2,9 ± 1,2 vs. 2,2 ± 0.08; p = .002). La rigidez de la pared arterial se halló significativamente incrementada en el GP (EIM 0,7 ± 0,2 vs. 0,63 ± 0,1 mm, p< 0.001), donde se observó una prevalencia mayor de placas ateroescleróticas (94% vs. 62,5%, p = .001) la mayoría de alta vulnerabilidad. Conclusiones. El uso de técnicas no invasivas que faciliten la detección precoz de pacientes psoriásicos con enfermedad subclínica de la pared arterial, permitiría evaluar correctamente el riesgo, que puede ser subestimado si sólo se realizan estudios clínicos de los factores de riesgoconvencionales.

Background. Psoriasis is a chronic multisystem inflammatory disease that involves an increasedcardiovascular risk as heart disease, myocardial infarction and cardiovascular death, especially inyounger patients and severe psoriasis. This is due to early atherogenesis, and sometimes to a subclinicalcourse, which could be identified by non invasive vascular studies of peripheral vessels.Objectives. a) Identify the presence of subclinical atherosclerosis in patients with psoriasis; b)Determine its predictive value independently of other cardiovascular risk factors.Design. Cohort, prospective, controlled trial. Methods. 175 consecutive patients were included, a Psoriatic Group (PG, n:35) and a Control Group(CG, n:140) where identified, and submited to studies for identification of atherosclerotic plaquesand arterial elasticity in extracranial carotids and femoral vessels.Results. The Framingham scores in patients of both groups was low (7 ± 2.3% vs. 5.7 ± 1.8%;GP vs. GC respectively, p = .003) while the vascular risk score, determined by the alteration ofsubclinical atherosclerosis parameters, was higher in the GP (2.9 ± 1.2 vs. 2.2 ± 0.08, p = .002).The arterial wall stiffness was found significantly increased in the GP (EIM 0.7 ± 0.2 vs 0.63 ± 0.1mm, p< 0.001), where a higher prevalence of atherosclerotic plaques (94% vs. 62.5%, p = .001),mostly of high vulnerability, was also observed.Conclusions. The use of non invasive techniques that facilitate early detection of psoriaticindividuals with subclinical arterial wall disease, would allow a proper assessment of risk whichmay be underestimates by only clinical assessment of conventional risk factors.

Propedêutica cardiológica para avaliação dacardiopatia chagásica na atenção primária / Cardiologic investigation for the evaluation of Chagas' heart disease inthe primary health assistance

Objetivos: Controlando-se a transmissão da doença de Chagas, faz-se necessário investir na prevenção dos agravos de sua cardiopatia crônica. Procurou-se comparar a propedêutica cardiológica acessível na Atenção Primária, com exames mais complexos, na avaliação dos cardiopatas chagásicos. Métodos: Foram analisados os prontuários de 515 pacientes acompanhados no ambulatório do Grupo de Estudos em Doença de Chagas (GEDoCh) - HC / UNICAMP, Campinas,SP, sendo selecionados 52 com registro completo dos exames básicos - avaliação clínica, ECG convencional (ECG) e RX detórax (RX), e ao menos um dos exames complementares: teste de esforço (TE), ecocardiograma (ECO) e eletrocardiografia dinâmica (Holter). Excluíram-se os prontuários com dados incompletos ou de portadores de outras cardiopatias, incluindos edoença arterial coronariana e doença reumática, hipertensão arterial e alcoolismo. Comparamos-se os resultados desses dois tipos de investigação. Resultados: A avaliação clínica, associada ao ECG e RX,mostrou significância quando confrontada com aptidão cardiorrespiratória(ACR) e classe funcional (CF) obtidas no TE(p=0,0062; p=0,0409). Os cardiopatas mais graves apresentaram comprometimento maior da ACR e CF mais baixa, comparando-se aos menos graves. Os demais exames complexos não mostraram associação significativa com a propedêutica cardiológica disponível em nível de Atenção Primária.Conclusão: A propedêutica cardiológica básica permite classificar a cardiopatia chagásica em formas leve ou grave. Entretanto, apenas dois parâmetros obtidos no TE (ACR e CF) mostraram correlação significativa com o exame clínico. De qualquer modo, a propedêutica cardiológica básica é relevantena consideração do nível em que devem ser assistidos os portadores crônicos dessa afecção.(AU)

Objective: The next step after the control of Chagas' diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas' heart disease.Methods: The study evaluated 52 medical records among515 of the chagasic patients from the Ambulatory of the Chagas'Disease Study Group (State University of Campinas, SP). These patients showed complete registration of Clinical Evaluation, ECG, Chest Radiography, and, at least one of the morecomplex exams: Ergometric Test, Echocardiography Evaluation,and Holter. It was excluded those with incomplete data, other cardiac diseases, arterial hypertension, and alcoholism.The results obtained from the two kinds of cardiologic evaluationwere compared. Results: The clinical evaluation plus the ECG and chestradiography showed statistical significance compared withthe cardio - respiratory aptitude (CRA) and the functional class (FC) obtained from the Ergometric Test (p = 0.0062; p= 0.0409). The patients classified in the severe stages of the Chagas' heart disease presented lesser levels of CRA and FC compared with those in the benign stages. The other complexexams didn't show significant association with the availableexams usually found in the Primary Health Units. Objective: The next step after the control of Chagas' diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas' heart disease. Methods: The study evaluated 52 medical records among 515 of the chagasic patients from the Ambulatory of the Chagas'Disease Study Group.(AU)