Radiación ionizante secundaria generada en equipos de cineangiografía coronaria digital y analógica: influencia de los sistemas externos de protección radiológica / Secondary ionizing radiation generated by analog and digital coronary cineangiographic equipment: influence of external protection devices

Background: Exposure to ionizing radiation is a known hazard of radiological procedures. Aim: To compare the emission of secondary ionizing radiation from two coronary angiographic equipments, one with digital and the other with analog image generation. To evaluate the effectiveness of external radiological protection devices. Material and methods: Environmental and fluoroscopy generated radiation in the cephalic region of the patient was measured during diagnostic coronary angiographies. Ionizing radiation generated in anterior left oblique projection (ALO) and in anterior right oblique projection (ARO) were measured with and without leaded protections. In 19 patients (group 1), a digital equipment was used and in 21 (group 2), an analog equipment. Results: Header radiation for groups 1 and 2 was 1194 ñ 337 and 364 ñ 222 µGray/h respectively (p<0.001). During fluoroscopy and with leaded protection generated radiation for groups 1 and 2 was 612 ñ 947 and 70 ñ 61 µGray/h respectively (p<0.001). For ALO projection, generated radiation for groups 1 and 2 was 105 ñ 47 and 71 ñ 192 µGray/h respectively (p<0.001). During filming the radiation for ALO projection for groups 1 and 2 was 7252 ñ 9569 and 1671 ñ 2038 µGray/h respectively (p = 0.03). Out of the protection zone, registered radiation during fluoroscopy for groups 1 and 2 was 2800 ñ 1741 and 1318 ñ 954 µGray/h respectively (p < 0.001); during filming, the figures were 15500 ñ 5840 and 18961 ñ 10599 µGray/h respectively (NS). Conclusions: Digital radiological equipment has a lower level of ionizing radiation emission than the analog equipment

Validación de un método para realizar angiografía cuantitativa a bajo costo / Validation of a low cost method for quantitative angiography

La angiografía cuantitativa es el método de elección para la medición de la severidad de las lesiones coronarias en cardiología intervencional. Sin embargo, su aplicabilidad está restringida por los elevados costos de los programas comerciales que permiten realizar estas mediciones. En el presente trabajo hemos estudiado la posibilidad de desarrollar un sistema de angiografía cuantitativa a un costo más razonable, abordable por distintos laboratorios en el país. Diversos moldes de polietileno (PE,n=14) de diámetro interno conocido (entre 0, 58 y 1,67 mm) fueron llenados con medio de contraste y filmados con un cineangiógrafo General Electric a 25 cuadros por segundo. Los films fueron escaneados (Microteck) y las imágenes digitales fueron transferidas a un programa computacional de libre distribución (Image-NIH), con el cual se realizaron las mediciones en un computador Quadra, con una relación de 14 bit/pixel. También se realizaron aortografías de ratas Sprague Dawley anestesiadas (n=5), y los films fueron procesados de idéntica manera. Inmediatamente después de la aortografía, las ratas fueron perfundidas in vivo con formalina a 100 mm Hg, para mediciones histológicas posteriores. Se encontró una correlación de 0,95 (p<0,001) al comparar los valores reales de los diámetros de los moldes de PE versus los medidos digitalmente, y de 0,91 (p<0, 0001) para las áreas. La exactitud de la medición fue de 0,046 mm. Al comparar los diámetros de la aotiografía versus los diámetros histológicos, se encontró una correlación de 0,92 (p<0,02). Los díámetros reales fueron 1,06 ñ 0,1 mm y los medidos 1,09 ñ 0,07mm, lo cual representa una diferencia de 3,5 por ciento (NS). En conclusión, se logró validar un método de angiografía cuantitativa que requiere de elementos tecnológicos mínimos y de bajo costo. Este método puede ser de utilidad en laboratorios de hemodinamia que estén interesados en comenzar a realizar anaioarafía cuantitativa

Um método para análise de movimentaçäo segmentar do ventrículo esquerdo em cineangiocardiografia com correçäo da obliteraçäo apical / Method for left ventricular wall motion analysis in cineangiocardiography with correction of the apical obliteration

Apresentamos um método para análise de movimentação segmentar do ventrículo esquerdo em cineangiografia que corrige a obliteração apical (OA) observada durante a sístole. A análise de movimentação é efetuada nas direções transversal e longitudinal segundo um sistema de referência baseado nos pontos de referência simétricos da silhueta diastólica final. A correção da OA mostrou ser necesssária especialmente para pacientes hipertróficos, caso contrário, levaria a uma avaliação incorreta da movimentação da região próxima ao ápice.

Perfil lipídico e doença arterial coronária / The lipid profile and coronary artery disease

PURPOSE--To correlate lipid profile with coronary artery disease (CAD). METHODS--One hyndred patients with symptomn of CAD were studied by coronariography: 62 males (55.6ñ9.26 years) and females (56.3ñ9.72 years). Blood glucose, total cholesterol (TC), triglycerides (TG), and HDL-C (n=96) levels were determined; LDL-C was calculated by the Friedewald formula. Coronary artery stenotic and normal proximal lumen were measured with a paquimeter, and the percent degree of obstruction calculated. The proximal, medial and distal segments of left anterior descending (LAD), circumflex (CX), right coronary artery (RCA) and the coronary trunk, 1st LAD diagonal branch and 1st marginal branch were analysed. RESULTS--Coronariography: CAD was documented in 74 patients, (56-75,6 por cento men), with >=50 por cento stenosis in 67 (90.5 por cento ), 54 (79.1 por cento ) men. The lesions were univessel in 24 (33.4 por cento ), bivessel in 29 (39,7 por cento ), and trivessel in 20 (27.4 por cento ). Seventy patients had TC>=200mg/dl, 29 (41.4 por cento )>=240mg/dl; 69 (71.9 por cento ) LDL-C>=130mg/dl, 37 (38.5 por cento )>=160mg/dl; 35 (36.5 por cento ) HDL-C<35mg/dl and 10 TG>=200mg/dl. Lipid profile vs CAD - 1)CAD patients had lower HDL-C values (38.8ñ10mg/dl vs 48.2ñ13.6mg/dl,p=0.01) and higher Castelli risk indexes (CRI) (TC/HDL-C=5.9ñ1.7 vs 5.1ñ1.4 and LDL-C/HDL-C=4.1ñ1.5 vs 3.4ñ1.2,p=0.04); 2)>=50 por cento stenosis and multivessel disease showed higher CRI (p=0.01 and p=0.04 for TC/HDL-C, and p=0.01 and p=0.02 for LDL-C/HDL, respectively). Twenty one (70 por cento ) of the patients with TC<200mg/dl had CAD (28 por cento of the patients with CAD), in whom there was a high frequency of patients with a low HDL-C level (11/21, 52.4 por cento vs 3/9, 33 por cento , p=0.06). CONCLUSION--Lower HDL-C and higher CRI values were associated with more severe and intensive CAD; TC<200mg/dl is compatible with CAD, specially if there is a low HDL-C level. These findings strengthen the need of HDL-C measurement for CAD risk assessment