The exercise test that indicates a low risk of events. Differences in prognostic significance between patients with chronic stable angina and patients with unstable angina.

OBJECTIVES: The objective of this prospective study was to determine the differences in the prognostic significance of an exercise test (ET) that indicates a low risk of events (low-risk exercise test [LRET]) between patients with unstable angina (UA) and those with chronic stable angina (CSA). BACKGROUND: It is not known whether the prognostic significance of an LRET is influenced by the disease; that is the reason for performing exercise testing. METHODS: All patients not presenting with high-risk criteria were submitted to a prognostic ET. The ET was performed by patients with CSA and patients with primary UA stabilized with medical therapy. Medical therapy was planned for all patients. A combined end point was defined as cardiac death, nonfatal acute myocardial infarction or hospital admission for UA. Multivariate analysis was performed to determine the independent predictors of events. RESULTS: Low-risk criteria were fulfilled by 105 patients with UA and 86 patients with CSA. The mean follow-up time was 347 +/- 229 days. The event rate was higher in the UA group than in the CSA group (28% vs. 9%, p = 0.001). The CSA group showed worse ET results. Performance of ET by patients with UA was the principal predictor of events (odds ratio 4.2, p = 0.0005). CONCLUSIONS: Among patients who underwent an LRET, those with UA had a rate of events significantly higher than that of patients with CSA, despite the worse results of ET in patients with CSA.

[Diagnosis of apical hypertrophic cardiomyopathy using contrast echocardiography]. / Diagnóstico de miocardiopatía hipertrófica apical con ecocardiografía de contraste.

Apical hypertrophic cardiomyopathy is a disease with clear electrocardiographic and echocardiographic characteristics. However, poor visualization of apical endocardial border is a limiting factor to diagnose apical hypertrophic cardiomyopathy by echocardiography. We present a case report of a patient with a characteristic electrocardiogram but poor apical endocardial border delineation. A contrast-enhanced echocardiography was performed to confirm the diagnosis of apical hypertrophic cardiomyopathy. We discuss the role of echocardiographic image enhancement with contrast to diagnose apical hypertrophic cardiomyopathy.

[Ellis-van Creveld syndrome: an easy early diagnosis?]. / Síndrome de Ellis-Van Creveld: un fácil diagnóstico precoz?

Ellis-Van Creveld syndrome is a rare chondroectodermal dysplasia. Congenital heart disease is present in more than one-half of cases. The majority are partial atrioventricular septal defects and affect the atrial septum. Although isolated cases of the syndrome are uncommon, an early diagnosis is made in most of the patients because of their cardinal manifestations. The cases of two gypsy brothers with Ellis-Van Creveld syndrome and congenital heart disease (ostium primum atrial septal defect and single atrium), diagnosed during adulthood, are presented.

[Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women]. / Influencia del tratamiento hormonal sustitutivo en el perfil aterogénico de la mujer postmenopáusica.

OBJECTIVE: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women. METHOD: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters. RESULTS: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83 +/- 78.47 versus 10 +/- 3.99; 12 +/- 4.56 mg/l, p < 0.0001). Levels of serum cholesterol (198 +/- 30.2 versus 236 +/- 33.7; 228 +/- 32.8 mg/dl; p < 0.002), LDL-cholesterol (120 +/- 25 versus 151 +/- 34.2; 144 +/- 31.5 mg/dl, p < 0.02), uric acid (3.98 +/- 0.5 versus 4.6 +/- 1; 4.8 +/- 1 mg/dl, p < 0.004) and homocysteine (9.8 +/- 3.3 versus 13 +/- 3.1; 11 +/- 1.7 mmol/l, p < 0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49 +/- 34.43 versus 10 +/- 3.99, p < 0.0001) and CRP (0.11 +/- 0.06 vs. 0.24 +/- 0.12 mg/l, p < 0.05), lower waist/hip ratio (0.82 +/- 0.06 versus 0.83 +/- 0.05, p < 0.03), glucose (78 +/- 15.4 versus 85 +/- 14.3 mg/dl, p < 0.03), cholesterol (215 +/- 33.2 versus 236 +/- 33.7 mg/dl, p < 0.03), triglycerides (90 +/- 30.1 versus 106 +/- 47 mg/dl, p < 0.003) and calcium (9.4 +/- 0.4 versus 9.5 +/- 0.4 mg/dl, p < 0.0005) than postmenopausal women without hormone replacement. CONCLUSION: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women.

[Infectious Brucella endocarditis in a case of corrected transposition of the great arteries]. / Endocarditis infecciosa por brucella en un caso de transposición corregida de las grandes arterias.

We describe a case of a 14 year old male who developed infections endocarditis due to Brucella sp. He had a corrected transposition of great vessels with valvular pulmonary stenosis and mitral insufficiency. Vegetations were demonstrated by echocardiogram on the pulmonary valve as well as on left atrioventricular valve. He had also proliferative nephritis. Prolonged antimicrobial treatment results in complete healing. Because the rarity of this association we inform this observation.

[Importance of color-coded Doppler in a case of interventricular communication associated with fixed subaortic stenosis]. / Valor del Doppler codificado en color en un caso de comunicación interventricular asociado a estenosis subaórtica fija.

We describe a 10 year old girl with ventricular septal defect in whom bidimensional echocardiogram disclosed a membrane in the outflow tract of the left ventricle. Color Doppler found the presence of fixed subaortic stenosis.

Influencia del tratamiento hormonal sustitutivo en el perfil aterogénico de la mujer postmenopáusica / Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women

Objetivo: El riesgo cardiovascular se eleva en la mujer tras la menopausia. Este estudio pretende comparar el perfil aterogénico de las mujeres postmenopáusicas respecto a las premenopáusicas y valorar la influencia que el tratamiento hormonal sustitutivo ejerce sobre dicho perfil aterogénico. Método: Se seleccionan 76 mujeres climatéricas de 45 a 59 años y 15 mujeres con ciclos menstruales regulares de 40 a 45 años. Concluyen el estudio 63 mujeres con menopausia natural, normotensas, no diabéticas que no habían recibido previamente tratamiento hormonal sustitutivo ni fármacos con efecto sobre el sistema cardiovascular. El grupo control lo forman 15 mujeres sanas con ciclos menstruales regulares, de 40 a 45 años. Reciben durante 6 meses tratamiento hormonal 27 mujeres (50 microgramos de estradiol transdérmico y 100 milígramos de progesterona oral) y no lo reciben 36 de ellas. Se realiza al inicio del estudio y a los 6 meses exploración física (peso, talla, índice cintura/cadera) y determinaciones analíticas (bioquímica general, estrógenos, homocisteína, cobre, fibrinógeno y proteína C reactiva). Al grupo control sólo se le realizan las exploraciones iniciales. Resultados: Los subgrupos de mujeres postmenopáusicas según reciban o no tratamiento hormonal, presentan al inicio del estudio niveles de estradiol inferiores al grupo control (10 ± 3,99; 12 ± 4,56 vs. 83 ± 78,47 mg/l, p<0,0001) mientras que los niveles de colesterol total (236 ± 33,7; 228 ± 32,8 vs. 198 ± 30,2 mg/dl, p<0,002), LDL-colesterol (151 ± 34,2; 144 ± 31,5 vs. 120 ± 25 mg/dl, p<0,02), ácido úrico (4,6 ± 1; 4,8 ± 1 vs. 3,98 ± 0,5mg/dl, p<0,04) y homocisteína (13 ± 3,1; 11 ± 1,7 vs. 9,8 ± 3,3 mmol/l; p<0,02) son más elevados. En el subgrupo que recibe tratamiento hormonal, a los 6 meses del mismo, disminuye significativamente el índice cintura/cadera (0,83 ± 0,05 vs. 0,82 ± 0,06; p<0,03), los niveles de glucemia (85 ± 14,3 vs. 78 ± 15,4 mg/dl, p<0,03), colesterol total (236 ± 33,7 vs. 215 ± 33,2 mg/dl, p<0,03), triglicéridos (106 ± 47 vs. 90 ± 30,1mg/dl, p<0,003) y calcio (9,5 ± 0,4 vs. 9,4 ± 0,4 mg/dl, p<0,0005), y aumentan los de estrógenos (10 ± 3,99 vs. 49 ± 34,43 mg/l, p<0,0001) y de PCR (0,11 ± 0,06 vs. 0,24 ± 0,12 mg/l, p<0,05). Conclusión: El tratamiento hormonal sustitutivo parece mejorar el perfil aterogénico de la mujer postmenopáusica (AU)

Objective: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women. Method: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters. Results: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83±78.47 versus 10±3.99; 12±4.56 mg/l, p<0.0001). Levels of serum cholesterol (198±30.2 versus 236±33.7; 228±32.8 mg/dl; p<0.002), LDL-cholesterol (120±25 versus 151±34.2; 144±31.5 mg/dl, p<0.02), uric acid (3.98±0.5 versus 4.6±1; 4.8±1 mg/dl, p<0.004) and homocysteine (9.8±3.3 versus 13±3.1; 11±1.7 mmol/l, p<0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49±34.43 versus 10±3.99, p<0.0001) and CRP (0.11±0.06 vs. 0.24±0.12 mg/l, p<0.05), lower waist/hip ratio (0.82±0.06 versus 0.83±0.05, p<0.03), glucose (78±15.4 versus 85±14.3 mg/dl, p<0.03), cholesterol (215±33.2 versus 236±33.7 mg/dl, p<0.03), triglicerides (90±30.1 versus 106±47 mg/dl, p<0.003) and calcium (9.4±0.4 versus 9.5±0.4 mg/dl, p<0.0005) than postmenopausal women without hormone replacement. Conclusion: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women (AU)