El método más eficaz para detectar el fenómeno de «no reflujo» tras el infarto de miocardio revascularizado es el estudio del flujo mediante guías de Doppler intracoronario. La incorporación de ...sondas Doppler de alta frecuencia permite evaluar el flujo coronario de forma no invasiva. El objetivo es describir diferentes patrones de flujo coronario mediante Doppler transtorácico y estudiar sus asociaciones con la recuperación funcional del tejido infartado.
Estudiamos a 57 pacientes de 60 años de edad (rango, 30-85). Describimos un flujo coronario anómalo al caracterizado por onda diastólica de elevada velocidad con tiempo de deceleración rápido (≤ 500
ms). Comparamos la contractilidad regional, los volúmenes ventriculares y la fracción de eyección del ventrículo izquierdo (FEVI) de los pacientes a las 72 h y al mes del episodio agudo.
En total, 31 pacientes (54%) presentaban un flujo normal (grupo 1) y 26 (46%), un flujo anómalo (grupo 2). Al mes de seguimiento, en los pacientes del grupo 1 mejoró tanto la contractilidad regional como la FEVI (el 46,8
±
8,6 frente al 52,6
±
8,8%; p
=
0,002), sin aumento en los volúmenes ventriculares. Por el contrario, los pacientes del grupo 2 no experimentaron mejoría en la contractilidad regional ni en la FEVI aumentando sus volúmenes ventriculares de 55,8
±
12,9 a 62,9
±
16,8
ml/m
2 (p
=
0,05) y de 32,2
±
9,5 a 37,1
±
14,9
ml/m
2 (p
<
0,05). El análisis multivariable mostró que el patrón de flujo era el predictor más importante para el remodelado ventricular (
odds ratio
=
6,14; intervalo de confianza del 95%, 1,56-24,17).
El estudio del flujo coronario mediante Doppler transtorácico permite identificar a los pacientes con daño microvascular que tras un infarto anterior evolucionarán hacia la dilatación ventricular sin recuperación de la función regional de la zona infartada.
Coronary blood flow measurement using a Doppler guidewire is the most sensitive way of detecting the no-reflow phenomenon following reperfusion of a myocardial infarction (MI). New high-frequency Doppler probes enable coronary blood flow velocity to be measured noninvasively. Our aims were to study the different patterns of left anterior coronary artery blood flow observed by transthoracic Doppler echocardiography, and to describe their association with functional recovery following reperfusion of an anterior MI.
The study included 57 patients with a mean age of 60 years (range 30-85 years). An abnormal coronary blood flow pattern was defined as one in which there was a high peak diastolic velocity and a short deceleration time (i.e., ≤ 500 ms). We compared the regional contractility, ventricular volumes, and left ventricular ejection fraction (LVEF) measured after 72 hours with those measured 1 month after MI.
Overall, 31 patients (54%) had a normal coronary blood flow pattern (Group 1) and 26 (46%), an abnormal pattern (Group 2). After one month, regional contractility improved in Group-1 patients, as did LVEF, from 46.8 (8.6) to 52.6 (8.8)% (
P
=
002). In these patients, left ventricular volumes were unchanged. In contrast, regional contractility and LVEF remained unchanged in Group-2 patients whereas ventricular volumes increased, from 55.8 (12.9) to 62.9 (16.8) ml/m
2 (
P
=
05), and from 32.2 (9.5) to 37.1 (14.9) ml/m
2 (P
<
05). Coronary blood flow pattern was the most important independent predictor of left ventricular remodeling, odds ratio
=
6.14 (95% CI, 1.56-24.17).
Transthoracic Doppler echocardiographic assessment of coronary blood flow following reperfusion of an anterior myocardial infarction can be used to identify patients with microvascular damage who are progressing towards ventricular dilatation without recovery of myocardial function.
Coronary blood flow measurement using a Doppler guidewire is the most sensitive way of detecting the no-reflow phenomenon following reperfusion of a myocardial infarction (MI). New high-frequency ...Doppler probes enable coronary blood flow velocity to be measured noninvasively. Our aims were to study the different patterns of left anterior coronary artery blood flow observed by transthoracic Doppler echocardiography, and to describe their association with functional recovery following reperfusion of an anterior MI.
The study included 57 patients with a mean age of 60 years (range 30-85 years). An abnormal coronary blo:d flow pattern was defined as one in which there was a high peak diastolic velocity and a short deceleration time (i.e., < or = 500 ms). We compared the regional contractility, ventricular volumes, and left ventricular ejection fraction (LVEF) measured after 72 hours with those measured 1 month after MI.
Overall, 31 patients (54%) had a normal coronary blood flow pattern (Group 1) and 26 (46%), an abnormal pattern (Group 2). After one month, regional contractility improved in Group-1 patients, as did LVEF, from 46.8 (8.6) to 52.6 (8.8)% (P=.002). In these patients, left ventricular volumes were unchanged. In contrast, regional contractility and LVEF remained unchanged in Group-2 patients whereas ventricular volumes increased, from 55.8 (12.9) to 62.9 (16.8) ml/m2 (P=.05), and from 32.2 (9.5) to 37.1 (14.9) ml/m2 (P< .05). Coronary blood flow pattern was the most important independent predictor of left ventricular remodeling, odds ratio =6.14 (95% CI, 1.56-24.17).
Transthoracic Doppler echocardiographic assessment of coronary blood flow following reperfusion of an anterior myocardial infarction can be used to identify patients with microvascular damage who are progressing towards ventricular dilatation without recovery of myocardial function.
Last developments on hypertension Bertomeu Martínez, Vicente; Morillas Blasco, Pedro; Soria Arcos, Federico ...
Revista española de cardiologia,
2006, Volume:
59 Suppl 1
Journal Article
Peer reviewed
The following article reviews some of the most recent data that have come to light in the field of hypertension during the last year, including the long lasting controversy USA/Europe on the ...definition and treatment of hypertension, the importance of the interrelationship hypertension/sleep apnea syndrome, to conclude by discussing some of the most compelling implications of the main trials that have been published during the last few months.
Coronary blood flow measurement using a Doppler guidewire is the most sensitive way of detecting the no-reflow phenomenon following reperfusion of a myocardial infarction (MI). New high-frequency ...Doppler probes enable coronary blood flow velocity to be measured noninvasively. Our aims were to study the different patterns of left anterior coronary artery blood flow observed by transthoracic Doppler echocardiography, and to describe their association with functional recovery following reperfusion of an anterior MI.
The study included 57 patients with a mean age of 60 years (range, 30–85 years). An abnormal coronary blood flow pattern was defined as one in which there was a high peak diastolic velocity and a short deceleration time (i.e., ≤500 ms). We compared the regional contractility, ventricular volumes, and left ventricular ejection fraction (LVEF) measured after 72 hours with those measured 1 month after MI.
Overall, 31 patients (54%) had a normal coronary blood flow pattern (Group 1) and 26 (46%), an abnormal pattern (Group 2). After one month, regional contractility improved in Group-1 patients, as did LVEF, from 46.8 (8.6) to 52.6 (8.8)% (
P=.002). In these patients, left ventricular volumes were unchanged. In contrast, regional contractility and LVEF remained unchanged in Group-2 patients whereas ventricular volumes increased, from 55.8 (12.9) to 62.9 (16.8) mL/m
2 (
P=.05), and from 32.2 (9.5) to 37.1 (14.9) mL/m
2 (
P<.05). Coronary blood flow pattern was the most important independent predictor of left ventricular remodeling, odds ratio =6.14 (95% CI, 1.56–24.17).
Transthoracic Doppler echocardiographic assessment of coronary blood flow following reperfusion of an anterior myocardial infarction can be used to identify patients with microvascular damage who are progressing towards ventricular dilatation without recovery of myocardial function.
El método más eficaz para detectar el fenómeno de «no reflujo» tras el infarto de miocardio revascularizado es el estudio del flujo mediante guías de Doppler intracoronario. La incorporación de sondas Doppler de alta frecuencia permite evaluar el flujo coronario de forma no invasiva. El objetivo es describir diferentes patrones de flujo coronario mediante Doppler transtorácico y estudiar sus asociaciones con la recuperación funcional del tejido infartado.
Estudiamos a 57 pacientes de 60 años de edad (rango, 30–85). Describimos un flujo coronario anó-malo al caracterizado por onda diastólica de elevada ve-locidad con tiempo de deceleración rápido (< 500 ms). Comparamos la contractilidad regional, los volúmenes ventriculares y la fracción de eyección del ventrículo izquierdo (FEVI) de los pacientes a las 72 h y al mes del episodio agudo.
En total, 31 pacientes (54%) presentaban un flujo normal (grupo 1) y 26 (46%), un flujo anómalo (grupo 2). Al mes de seguimiento, en los pacientes del grupo 1 mejoró tanto la contractilidad regional como la FEVI (el 46,8 ± 8,6 frente al 52,6 ± 8,8%; p = 0,002), sin aumento en los volúmenes ventriculares. Por el contrario, los pacientes del grupo 2 no experimentaron mejoría en la contractilidad regional ni en la FEVI aumentando sus volúmenes ventriculares de 55,8 ± 12,9 a 62,9 ± 16,8 ml/m
2 (p = 0,05) y de 32,2 ± 9,5 a 37,1 ± 14,9 ml/m
2 (p < 0,05). El análisis multivariable mostró que el patrón de flujo era el predictor más importante para el remodelado ventricular (
odds ratio = 6,14; intervalo de confianza del 95%, 1,56–24,17).
El estudio del flujo coronario mediante Doppler transtorácico permite identificar a los pacientes con daño microvascular que tras un infarto anterior evolucionarán hacia la dilatación ventricular sin recuperación de la función regional de la zona infartada.
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Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Desde la elaboración de las guías de práctica clínica en hipertensión arterial en enero del año 2000 se han producido nuevas evidencias científicas que hay que tener en cuenta en el ámbito de la ...práctica clínica. Es necesario realizar la evaluación clínica del hipertenso mediante la estratificación de su riesgo cardiovascular global, en la que los datos aportados por el electrocardiograma (ECG) y el análisis de orina (detección de excreción urinaria de albúmina) son de especial relevancia. Hasta la actualidad, los resultados de múltiples estudios disponibles indican que en la hipertensión arterial lo más importante es normalizar los valores de la presión arterial, con un control más estricto en los hipertensos de mayor riesgo (diabéticos, lesión de órgano diana y enfermedad cardiovascular asociada). La individualización del tratamiento constituye la base de la elección de fármacos antihipertensivos. Sin embargo, debe tenerse en cuenta que los hipertensos con ciertas enfermedades asociadas obtienen un mayor beneficio de determinados grupos farmacológicos. Los hipertensos diabéticos o con hipertrofia ventricular izquierda parecen beneficiarse del bloqueo farmacológico del sistema renina-angiotensina y los pacientes con insuficiencia cardíaca deben recibir tratamiento combinado con inhibidores de la enzima de conversión de la angiotensina (IECA) y bloqueadores beta.
Since publication of the Spanish Society of Cardiology Clinical Practice Guidelines on High Blood Pressure in January 2000, a new body of scientific evidence has been obtained that needs to be taken into account in clinical practice. A complete clinical evaluation by assessment of the global cardiovascular risk score should be done in patients with hypertension. In this connection, ECG findings and urine albumin excretion are of particular value. Up to now, the results of most important clinical trials indicate that the aim should be to normalize blood pressure, with stricter control in patients at higher risk (diabetes, target organ damage or left ventricular hypertrophy). Antihypertensive therapy should be selected on an individual basis, taking in account that patients with certain associated pathologies will benefit more from particular groups of drugs. Those with diabetes or left ventricular hypertrophy seem to benefit from pharmacological block of the renin-angiotensin system, and patients with heart failure from combined therapy with ACE inhibitors plus beta-blockers.
Differences between anatomical severity and clinical manifestations are frequent in patients with hypertrophic cardiomyopathy. Our objective was to assess functional capacity in a consecutive group ...of patients with hypertrophic cardiomyopathy measuring exercise aerobic parameters, as well as clinical and echocardiographic variables.
We studied 98 consecutive patients with hypertrophic cardiomyopathy. All patients underwent both echocardiographic and cardiopulmonary exercise testing. The control group consisted of 22 untrained persons. We studied exercise capacity by analyzing maximal oxygen consumption and aerobic functional capacity, among other variables.
Patients with hypertrophic cardiomyopathy attained significantly lower maximal oxygen consumption values than controls (24.1 5.9 vs 36.4 5.9 ml/kg/min; p = 0.0001). Maximal aerobic capacity was significantly different among patients with NYHA functional capacity class I, II or III (78.9 13.5%; 71.9 14.7%; 63.9 15.7%; p = 0.009). However, considerable overlap was found between groups in maximal aerobic capacity. Functional impairment was greater in patients with left ventricular thickness > 20 mm, ejection fraction < 50%, left atrial dimension > 45 mm and pseudonormal or restrictive transmitral flow pattern.
Patients with hypertrophic cardiomyopathy show significant functional impairment, which is difficult to detect from their clinical manifestations. Optimal assessment requires cardiopulmonary exercise testing.
El proposito de este estudio fue evaluar la capacidad de deteccion de flujo en la arteria descendente anterior y la utilidad de la medicion de la reserva de flujo coronario para diagnosticar ...enfermedad coronaria significativa, empleando ecocardiografia Doppler transtoracica con transductor de alta frecuencia y eco-contraste.
Estudiamos a 107 pacientes ingresados por cardiopatia isquemica conocida o sospechada, en los que se indico una coronariografia. Se obtuvo un registro de Doppler pulsado de la descendente anterior distal en condiciones basales y tras infusion de dipiridamol. En todos los pacientes se administro un agente de eco-contraste. Consideramos que la reserva del flujo coronario era normal si su valor era ≥ 1,7.
Se obtuvieron registros Doppler adecuados de la descendente anterior en 83 pacientes (78%). Encontramos estenosis significativas de la descendente anterior en 24 de 83 pacientes (29%). En los pacientes en los que no se obtuvo el registro Doppler, la prevalencia de estenosis en la descendente anterior fue significativamente mayor (62 frente a 29%; p = 0,006). La sensibilidad, especificidad y eficacia diagnostica de una reserva de flujo coronario menor de 1,7 para detectar estenosis significativa de la descendente anterior fueron, respectivamente, del 87, 74 y 78%.
La medicion de la reserva de flujo coronario por medio de ecocardiografia Doppler transtoracica empleando transductor de alta frecuencia y eco-contraste es un metodo factible, accesible y con una buena capacidad para detectar estenosis significativas en la descendente anterior.
We evaluated the feasibility of detecting blood flow in the left anterior descending coronary artery and the usefulness of measuring coronary flow reserve to diagnose significant coronary artery disease, both by means of transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent.
We studied 107 patients who were scheduled for coronary arteriography for known or suspected ischemic heart disease. A Doppler signal was recorded by a pulsed wave in the distal left anterior descending artery at baseline and after dipyridamole infusion. An echo-contrast agent was administered to all patients. A coronary flow reserve equal to or higher than 1.7 was considered normal.
We recorded Doppler signals in the left anterior descending coronary artery of 83 patients (78%). Significant stenosis of the left anterior descending coronary artery was observed in 24 out of 83 patients (29%). The prevalence of significant stenosis was higher (62 vs 29%; p = 0.006) in patients in which no Doppler signal was detected. The sensitivity, specificity, and accuracy of abnormal coronary flow reserve in detecting significant stenosis of the left anterior descending coronary artery were 87, 74 and 78%, respectively.
The measurement of coronary flow reserve by transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent is a feasible, widely available, and accurate method for detecting significant stenosis of the left anterior descending coronary artery.
We evaluated the feasibility of detecting blood flow in the left anterior descending coronary artery and the usefulness of measuring coronary flow reserve to diagnose significant coronary artery ...disease, both by means of transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent.
We studied 107 patients who were scheduled for coronary arteriography for known or suspected ischemic heart disease. A Doppler signal was recorded by a pulsed wave in the distal left anterior descending artery at baseline and after dipyridamole infusion. An echo-contrast agent was administered to all patients. A coronary flow reserve equal to or higher than 1.7 was considered normal.
We recorded Doppler signals in the left anterior descending coronary artery of 83 patients (78%). Significant stenosis of the left anterior descending coronary artery was observed in 24 out of 83 patients (29%). The prevalence of significant stenosis was higher (62 vs 29%; p = 0.006) in patients in which no Doppler signal was detected. The sensitivity, specificity, and accuracy of abnormal coronary flow reserve in detecting significant stenosis of the left anterior descending coronary artery were 87, 74 and 78%, respectively.
The measurement of coronary flow reserve by transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent is a feasible, widely available, and accurate method for detecting significant stenosis of the left anterior descending coronary artery.
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