¿Podría ser útil la resonancia magnética de estrés en pacientes con baja probabilidad de cardiopatía isquémica? / Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease?

Objetivo: Evaluar la utilidad de la resonancia magnética cardiaca de estrés (RMCE) con adenosina en la detección de cardiopatía isquémica en pacientes con baja probabilidad preprueba. Material y Métodos: Se evaluó la utilidad de la RMCE en una selección de pacientes con baja probabilidad preprueba (riesgo cardiovascular bajo o moderado, dolor torácico atípico o ausencia de cardiopatía isquémica previa) mediante el uso del cociente de probabilidad. Resultados: Se incluyeron 295 pacientes, con un seguimiento de 28 (19-36) meses. Un total de 60 pacientes presentaron un evento. Se observó una mayor utilidad de la RMCE en los pacientes con una probabilidad preprueba baja: dolor torácico atípico (cociente de probabilidad [CP] positivo 8,56), ausencia de cardiopatía isquémica previa (CP positivo 4,85) y riesgo cardiovascular bajo o moderado (CP positivo 3,87). Conclusiones: La RMCE puede ser una técnica útil en el diagnóstico de cardiopatía isquémica en pacientes con baja probabilidad preprueba

Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). Results: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). Conclusions: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability

Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease? / ¿Podría ser útil la resonancia magnética de estrés en pacientes con baja probabilidad de cardiopatía isquémica?

OBJECTIVE: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. MATERIAL AND METHODS: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). RESULTS: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). CONCLUSIONS: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability.

La presión arterial domiciliaria se asocia con la hipertrofia concéntrica del ventrículo izquierdo / Home blood pressure is associated with concentric hypertrophy of the letf ventricle

Introducción. La hipertrofia del ventrículo se relaciona con el grado de hipertensión arterial e incrementa el riesgo de sufrir eventos cardiovasculares. Hay controversia acerca de la asociación entre las cifras de presión arterial medida por los distintos métodos clínicos y domiciliarios y la morfología ecográfica del ventrículo izquierdo. El objetivo ha sido investigar posibles asociaciones entre los parámetros ecocardiográficos de hipertrofia y las presiones clínicas y por automedida domiciliaria. Material y métodos. Se realizó determinación de presión arterial clínica y ambulatoria mediante automedida domiciliaria de presión arterial y ecocardiograma a 122 pacientes hipertensos (61,5% hombres). Se dividió a los pacientes según el patrón ecográfico del ventrículo izquierdo: normal, remodelado concéntrico, hipertrofia excéntrica y concéntrica. Resultados. Solamente 51 pacientes (41,8 %) mostraron un patrón ecográfico ventricular izquierdo normal. El 25,4 % tenía remodelado concéntrico y el 32,8 % hipertrofia ventricular izquierda. Existió asociación estadísticamente significativa entre la presión arterial sistólica clínica y el índice de masa de ventrículo izquierdo ajustando por edad, sexo e índice de masa corporal (ß = 0,004; intervalo de confianza del 95% [IC 95 %]: 0,001 a 0,007 [p = 0,022]), y entre la presión de pulso de automedida y el grosor relativo de pared (ß = 0,006; IC 95 %: 0,001 a 0,010 [p = 0,013]). La presión de pulso domiciliaria fue estadísticamente superior en los pacientes con grosor relativo de la pared mayor de 0,44. Discusión. Se han encontrado evidencias que sugieren la asociación de las mediciones de presión arterial de automedida con los patrones de remodelado e hipertrofia concéntrica que predicen mayor riesgo cardiovascular, las cuales no se relacionan con las mediciones clínicas. Estos resultados apoyan la utilización de automedida domiciliaria en la evaluación de los pacientes hipertensos

Introduction. Ventricle hypertrophy is related with the degree of arterial hypertension and increases risk of suffering cardiovascular events. There is a debate on the association between the blood pressure values measured by different clinical and home methods and ultrasonographic morphology of the left ventricle. The objective has been to investigate possible associations between echocardiographic parameters of hypertrophy and clinical pressures and by home self-measurement. Material and methods. Clinical and out-patient blood pressure was measured by home blood pressure monitoring and echocardiogram in 122 hypertensive patients (61.5 % men). Patients were divided according to the ultrasonographic pattern of the left ventricle: normal, concentric remodeling, eccentric and concentric hypertrophy. Results. Only 51 patients (41.8 %) had a normal left ventricular ultrasonographic pattern. A total of 25.4 % had concentric remodeling and 32.8 % left ventricular hypertrophy. There was a statistically significant association between the clinical systolic blood pressure and the left ventricle mass index, adjusting by age, gender and body mass index [ß = 0.004; 95 % confidence interval (95 % CI): 0.001 to 0.007 (p = 0.022)], and between self-measured pulse pressure and relative wall thickness [ß = 0.006; 95 % CI: 0.001 to 0.010; (p = 0.013)]. Home pulse pressure was statistically greater in patients with relative wall thickness greater than 0.44. Discussion. Evidence has been found that suggests the association of the self-measurement blood pressure measurement with remodeling patterns and concentric hypertrophy, that predict greater cardiovascular risk, these not being related with clinical measurements. These results support the use of home self-measurement in the evaluation of hypertensive patients

El ciclo cardíaco: una cuestión inacabada / Cardiac cycle: an unfinished question

No disponible

[Rehabilitation in the heart transplant patient]. / Rehabilitación en el paciente trasplantado de corazón.

Cardiac transplantation should not only enlarge life time but additionally should provide the patient with good quality of life and a satisfactory rehabilitation level. An integrated rehabilitation program can help to the process of recovery. In spite of the multiple factors which modify the physiological response during exercise, an appropriate training can be reached by many patients. Nevertheless the physiological rehabilitation is one of the components of the patients global restitution in order to reach satisfactory life style after transplantation.

[Fever of unknown origin and tuberculous aortitis]. / Fiebr de origen desconocido y aortitis tuberculosa.

We present the case of a silicotic patient, with recurrent febrile episodes during the past three years, who was hospitalized for the study of prolonged fever. In addition to compliance with the criteria of fever from unknown origin (FUO), the patient presented semiology and echocardiogram compatible with infectious endocarditis. Later on, he developed a severe aortic failure refractary to medical treatment and hence, he underwent surgery. The surgical intervention showed an abscess in the aortic root, which resulted to be of a tuberculous origin and an intact aortic valve. The review of the echocardiographic study allowed the detection of an image compatible with aortic abscess. We comment on the characteristic of this rare entity and the peculiarities of this case, which fulfill the criteria of what has been recently named recurrent or episodic FUO and among whose causes Mycobacterium tuberculosis had not been detected up to now.