ABSTRACT
BACKGROUND AND OBJECTIVES: Non-invasive evaluation of endothelial function with high resolution ultrasound has become a widely accepted tool in determination of high risk subjects for early atherosclerosis. Despite its simple appearance, ultrasonographic assessment of brachial artery changes, is technically challenging and has a significant learning curve. In the present study, we evaluate the intra and inter-observer variability in assessing peripheral endothelial function with high resolution ultrasound at a tertiary referral center. METHODS: Assessment of endothelial function was performed by 2 physicians in 20 volunteers without evidence of coronary artery disease. Endothelial function is evaluated with a high frequency bidimensional ultrasound with a 10.0-MHz linear-array transducer used for the study. Each volunteer was examined by both observers using an identical protocol, measuring brachial artery diameter on three occasions. RESULTS: Excellent correlation was observed for all brachial artery measures with a Spearman's correlation coefficient > 0.9 (p < 0.0001). Flow-mediated dilation (FMD) in the study population was of 10.45+/-6.9%. Flow independent dilation (FID) was of 24.35+/-7.63%. Intra-observer variability was of 2.1% for observer A and 1.1 % for observer B. CONCLUSIONS: Non-invasive assessment of endothelial function using brachial artery ultrasound is reproducible and can be performed with low intra and inter-observer variability.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Brachial Artery , Endothelium, Vascular/physiology , Endothelium, Vascular , Data Interpretation, Statistical , Observer Variation , TransducersABSTRACT
The importance of atrial fibrillation has always motivated the search of new treatment alternatives. Internal cardioversion has been proposed as a choice in the treatment of atrial fibrillation, giving rise to the development of atrial defibrillator. We present the case of a 68 years old patient without structural heart disease and with diagnosis of chronic atrial fibrillation of 10 months of evolution. He received treatment with antiarrhythmic drugs and successful electrical external cardioversion, but he relapsed a week later. For this reason, we decided to perform internal cardioversion with an electrocatheter (DAIG) placed in the coronary sinus through the right jugular vein and under light sedation with propofol (2 mg/kg weight). We applied three shocks of 1, 3, and 5 joules, being able to convert to sinus rhythm without complications. The patient continues under treatment with antiarrhythmic agents. Internal cardioversion has shown to be an effective way for the treatment of chronic atrial fibrillation, using a light sedation and low energy level to reestablish the sinus rhythm.