Correlación entre glucemia capilar y venosa en urgencias: un apunte metodológico / Capillary and venous blood glucose readings in emergency care: correlation and methodological considerations

Objetivos: Comprobar la fiabilidad de la glucemia capilar y su correlación con la glucemiavenosa según las condiciones en las que se realice. Método: Se determinó la glucemia capilar en 100 en voluntarios sanos (glucómetro Optium Xceed) en cinco condiciones diferentes: A, previo al contacto con uvas; B, trastocar durante 10 segundos uvas enteras; C, tras contacto breve con el jugo de uva y posterior secado; D, después de limpieza superficial y E, después de limpieza profunda. Resultados: La edad media de los participantes fue de 35,4 años (DE 10,2) y el 72%eran mujeres. Los valores medios de glucemia capilar (mg/dl) en las cinco condiciones descritas fueron 90 para A, 115 para B (p < 0,001), 401 para C (p < 0,001), 198 paraD (p < 0,001) y 124 para E (p < 0,001). La especificidad para detectar glucemias alteradas(> 140 mg/dl) osciló entre el 99% en la situación A y el 7% en la situación C. En esta última situación, el 83% de los voluntarios serían considerados diabéticos mediante la determinación de la glucemia capilar. Conclusiones: Existe una buena correlación entre glucemia capilar y venosa cuando la primera se realiza en las condiciones adecuadas, aunque puede verse alterada por distintos factores si existe mala aplicación de la técnica, por lo que debe insistirse en su correcta realización en urgencias (AU)

Objectives: To ascertain the reliability of capillary blood glucose readings and their correlation with venous blood glucose levels according to the conditions under which capillary blood is tested. Method: Capillary blood glucose was measured in 100 healthy volunteers (Optium Xceed blood glucose meter) under 5conditions: A, before the subject had contact with grapes; B, after touching whole grapes for 10 seconds; C, after brief contact with grape juice and after drying the skin; D, after superficial cleaning; and E, after thorough cleaning. Results: The mean (SD) age of the participants was 35.4 (10.2) years and 72% were women. The mean capillary blood glucose levels were 90 mg/dL in condition A, 115 mg/dL in condition B, 401 mg/dL in C, 198 mg/dL in D, and 124mg/dL in E (P <.001, all comparisons). The specificity of the test for detecting abnormal glucose levels (> 140 mg/dL)ranged from 99% under condition A to 7% under condition C. Under condition E, 83% of the volunteers would have been considered diabetics according to the capillary blood glucose reading. Conclusions: The correlation between capillary and venous blood glucose levels is good if the capillary blood reading is taken under the proper conditions. The results of the test may change according to various factors if the technique is not applied correctly. Emergency staff should take care to carry out the test properly (AU)

Usefulness of clinical, electrocardiographic, and echocardiographic parameters to detect cardiac asynchrony in patients with left ventricular dysfunction secondary to ischemic or nonischemic heart disease.

OBJECTIVES: Specific evaluation using echocardiographic Doppler is superior to the measurement of the QRS complex to detect cardiac asynchrony. Nevertheless, no clinical, electrocardiographic, or echocardiographic parameters have been evaluated to obtain an accurate and easy-to-use marker of cardiac asynchrony in patients with depressed left ventricular (LV) ejection fraction. Our aim was to determine whether there is any marker of cardiac asynchrony in patients with LV systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy. METHODS: In all, 316 consecutive patients with LV ejection fraction less than 40% were enrolled. Interventricular asynchrony was defined as an interventricular mechanical delay longer than 40 milliseconds. Intraventricular asynchrony was defined as the difference between time from Q wave to LV ejection end and the time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging greater than 50 milliseconds. RESULTS: In all, 177 (56%) had ischemic and 139 (44%) had nonischemic heart disease. The logistic regression analysis showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease (odds ratio and 95% confidence interval 7.2 [3.9-13.4], P < .001; 5.99 [2.7-13.2], P < .001; and 8.75 [3.2-23.8], P < .001 for the total population, ischemic and nonischemic groups, respectively). Nevertheless, none of the studied parameters was found as a predictor of intraventricular asynchrony. CONCLUSIONS: The presence of left bundle branch block is a marker of interventricular asynchrony in patients with ventricular dysfunction despite the cause of the underlying cardiac disease. Nevertheless, intraventricular cardiac asynchrony cannot be detected using conventional parameters. A specific echocardiographic evaluation before cardiac resynchronization therapy must be performed in all these patients. Our aim was to determine whether there is any marker of cardiac asynchrony in patients with left ventricular systolic dysfunction that allows us to obviate the performance of a specific echocardiographic study before cardiac resynchronization therapy. Our results showed that only the presence of left bundle branch block was an independent predictor of interventricular asynchrony despite the cause of the underlying disease but none of the studied parameters was found as a predictor of intraventricular asynchrony.

Prevalence of echocardiographically detected ventricular asynchrony in patients with left ventricular systolic dysfunction.

OBJECTIVES: QRS complex width is not an accurate marker of cardiac asynchrony. Our aims were to determine the prevalence of cardiac asynchrony by Doppler echocardiography for patients with left ventricular (LV) dysfunction and to evaluate whether QRS width is a reliable method for detecting asynchrony. METHODS: In all, 316 consecutive patients with a LV ejection fraction less than 40% from 13 hospitals comprised the study group. Interventricular asynchrony was defined by the interventricular mechanical delay. Intraventricular asynchrony was evaluated using the calculation of the septal-to-posterior wall motion delay, the difference between time from Q wave to LV ejection end, and time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging, the SD of the time from the Q wave to the end of the systolic wave of 4 basal segments, and the maximum difference in the time from the Q wave to the end of the systolic wave of all 4 basal segments. RESULTS: Mean age was 62.14 +/- 13.5 years (234 men; 74.1%). Interventricular asynchrony was present in 50 (26.2%) patients in the narrow QRS group and in 57 (55.3%) patients in the prolonged QRS group (P < .001). Intraventricular asynchrony was present in 40 (20.8%) to 136 (72.8%) patients in the narrow QRS group and in 27 (26.2%) to 82 (79.6%) in the prolonged QRS group, depending on the method used. CONCLUSIONS: Cardiac asynchrony is highly prevalent for patients with LV dysfunction but there is a very poor agreement among the different methods used to detect it. Interventricular asynchrony is more prevalent for patients with prolonged QRS but intraventricular asynchrony is irrespective of the QRS duration. Further studies are needed to evaluate which method is the best to detect cardiac resynchronization therapy responders.

[Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients]. / Utilidad de la ecocardiografía de contraste miocárdico con cuantificación basada en imagen paramétrica para la predicción de la recuperación funcional de segmentos acinéticos en pacientes con infarto agudo de miocardio sometidos a angioplastia primaria.

INTRODUCTION AND OBJECTIVES: Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments. PATIENTS AND METHOD: The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. RESULTS: The patients' mean age was 62.3+/-14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (beta): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. CONCLUSIONS: Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods.

Utilidad de la ecocardiografía de contraste miocárdico con cuantificación basada en imagen paramétrica para la predicción de la recuperación funcional de segmentos acinéticos en pacientes con infarto agudo de miocardio sometidos a angioplastia primaria / Usefulness of parametric imaging-based quantitative myocardial contrast echocardiography in predicting the functional recovery of akinetic segments following primary angioplasty in acute myocardial infarction patients

Introducción y objetivos. La ecocardiografía de contraste miocárdico (ECM) es útil para predecir la recuperación funcional de los segmentos acinéticos en pacientes que reciben una angioplastia coronaria transluminal percutánea primaria. Se ha desarrollado recientemente la imagen paramétrica para la cuantificación de la perfusión. Los objetivos son: a) valorar de forma cuantitativa la perfusión de los segmentos acinéticos en pacientes que reciben angioplastia primaria, y b) evaluar la utilidad de la cuantificación con imagen paramétrica para predecir la recuperación funcional de los segmentos acinéticos.Pacientes y método. Se analizó a 49 pacientes con infarto agudo de miocardio (IAM) que recibieron angioplastia primaria. Se realizó ecocardiograma estándar y ECM entre los 2 y 5 días posteriores al IAM. Se realizaron ecocardiograma estándar y cateterismo a los 6 meses. La evaluación cualitativa y cuantitativa fue realizada off-line por 2 investigadores independientes. Resultados. La edad media fue de 62,3 ± 14,5 años (39 varones). En el estudio basal se detectaron 170 segmentos acinéticos. La recuperación funcional fue observada en 105 segmentos. El mejor parámetro cuantitativo para predecir la recuperación funcional fue la velocidad del flujo sanguíneo (β): el área bajo la curva ROC fue 0,96 (intervalo de confianza del 95%, 0,92-0,99). Para un punto de corte de 31dB/s, la sensibilidad fue del 87,62%, la especificidad del 95,31%, el valor predictivo positivo del 96,8% y el valor predictivo negativo del 82,43%. Estos resultados son mejores que los obtenidos con el método cualitativo. Conclusiones. La cuantificación de la perfusión con imagen paramétrica es una herramienta útil para predecir la recuperación funcional de los segmentos acinéticos en pacientes que reciben angioplastia coronaria transluminal percutánea primaria y es mejor que la valoración cualitativa

Introduction and objectives. Myocardial contrast echocardiography (MCE) is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after acute myocardial infraction (AMI). Recently, parametric imaging-based quantitative MCE has been developed for measuring perfusion. Our aims were: a) to measure perfusion in akinetic myocardial segments in patients undergoing primary angioplasty using parametric imaging-based quantitative MCE; and b) to assess the usefulness of these measurements in predicting functional recovery of these segments. Patients and method. The study group comprised 49 consecutive patients undergoing primary angioplasty. Both MCE and standard echocardiography were performed between 2 and 5 days after AMI. Six months later, additional standard echocardiography and coronary angiography were performed. Perfusion was quantified independently off-line from parametric images. Results. The patients' mean age was 62.3±14.5 years (39 men; 79.2%). Some 170 akinetic segments were detected. Of these, 105 (62.1%) recovered function. The quantitative MCE parameter that best predicted functional recovery was myocardial blood flow velocity (β): the area under the receiver operating characteristic (ROC) curve was 0.96 (95% CI, 0.92-0.99). For a cut-off point of 31 dB/s, the sensitivity was 87.62%, the specificity was 95.31%, the positive predictive value was 96.8%, and the negative predictive value was 82.43%. These results were better than those obtained using qualitative methods for assessing myocardial perfusion. Conclusions. Perfusion measurement by parametric imaging-based quantitative MCE is useful for predicting the functional recovery of akinetic segments in patients undergoing primary angioplasty after AMI. The technique provides superior information to older qualitative methods

Long-term prognostic importance of transient left ventricular dilation during pharmacologic stress echocardiography.

OBJECTIVES: We sought to evaluate the prognostic significance of left ventricular (LV) transient ischemic dilation (TID) for patients with a positive stress echocardiogram (SE). BACKGROUND: TID during SE has been related to the presence of extensive coronary artery disease, but its long-term prognostic implications have not been reported. METHODS: In all, 99 consecutive patients with a positive SE comprised the study group. LV volumes were evaluated according to the modified Simpson's rule. TID during SE was defined as the presence of an increase in LV end-diastolic volume during the stress test. A clinical history was fulfilled for each patient and all of them were followed up. RESULTS: Of 99 patients, 32 (32.3%) showed TID. Mean age was 65.8 +/- 9.8 years for non-TID group and 70.2 +/- 8.4 for TID group (P = .048). Baseline characteristics and subsequent treatment were similar in both groups. Mean follow-up was 21.4 +/- 15.8 months. In non-TID group the mean survival free of acute myocardial infarction was 47.28 months and 39.7 months in TID group (log rank = 0.012). In the univariate and multivariate analysis only TID and the wall motion score index were found as independent predictors related to long-term prognosis (risk ratio = 6.9; 95% confidence interval = 0.8-59.6; P = .042; and risk ratio = 0.4; 95% confidence interval = 0.18-0.89; P = .047, respectively). CONCLUSIONS: LV TID during SE is an easy and independent prognostic marker. It helps to select patients with increased risk.