Student survey after ten years of continuous blended teaching of echocardiography.

OBJECTIVE: To analyse the impact of 10 years of blended echocardiography teaching. METHODS AND RESULTS: A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. CONCLUSIONS: Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.

Effect of carvedilol and nebivolol on oxidative stress-related parameters and endothelial function in patients with essential hypertension.

Oxidative stress and endothelial dysfunction have been associated with essential hypertension (EH) mechanisms. The purpose of this study was to evaluate the effect of carvedilol and nebivolol on the oxidative stress-related parameters and endothelial function in patients with EH. The studied population included 57 patients, either sex, between 30 and 75 years of age, with mild-to-moderate EH complications. Participants were randomized to receive either carvedilol (12.5 mg) (n = 23) or nebivolol (5 mg) (n = 21) for 12 weeks. Measurements included; 24-hr ambulatory blood pressure (BP), flow-mediated dilatation, levels of nitric oxide estimated as nitrite - a nitric oxide metabolite ( NO2) - in plasma, and oxidative stress-related parameters in plasma and erythrocyte. EH patients who were treated with nebivolol or carvedilol showed systolic BP reductions of 17.4 and 19.9 mmHg, respectively, compared with baseline values (p < 0.01). Diastolic BP was reduced by 13.7 and 12.8 mmHg after the treatment with ebivolol and carvedilol, respectively (p < 0.01) (fig. 2B). Nebivolol and carvedilol showed 7.3% and 8.1% higher endothelium-dependent dilatation in relation to baseline values (p < 0.05). Ferric-reducing ability of plasma (FRAP) and reduced glutathione/oxidized glutathione (GSSH) ratio showed 31.5% and 29.6% higher levels in the carvedilol group compared with basal values; however, nebivolol-treated patients did not show significant differences after treatment. On the other hand, the NO2 plasma concentration was not modified by the administration of carvedilol. However, nebivolol enhanced these levels in 62.1% after the treatment. In conclusion, this study demonstrated the antihypertensive effect of both beta-blockers. However, carvedilol could mediate these effects by an increase in antioxidant capacity and nebivolol through the raise in NO2 concentration. Further studies are needed to determine the molecular mechanism of these effects.

Doppler Tisular: velocidad de desplazamiento miocárdico en sístole en pacientes con hipertensión arterial con fracción de eyección conservada / Tissue Dopler: myocardial systolic velocity in patients with arterial hypertension and preserved ejection fraction

Background: Tissue Doppler imaging (TDI) could improve the prognostic evaluation of patients with arterial hypertension in whom systolic function is normal as well as in those with diasto-lic dysfunction. Low values of peak systolic myo-cardial velocity (Sm) are associated with systolic function impairment, hypertensive cardiomyopathy and mortality from cardiac causes. Nevertheless, the association of Sm wave with increased end-diastolic pressure is not clear yet. Aim: to estimate the correlation between Sm wave and several echocardiography morphologic and functional parameters in patients with arterial hypertension and preserved ejection fraction. Methods: in a retrospective analysis (2007-2010) of 1198 hypertensive patients with preserved ejection fraction, Sm wave was evaluated and correlated with ejection fraction, left ventricular mass index (VMI), left atrium indexed volume (LAIV), pulmonary artery systolic pressure (PAPs) and E/e' ratio. Results: a decrease Sm was observed as VMI increased (p<0.01). Among patients with Sm <6cm/s, 76.6% had E/e' >13 (p<0.01). Normal Sm values were observed in 93% of patients with E/e' ratio <13, 92% of patients with LAID < 32ml/m2 and 71% of patients with PAPs <35mmHg (p<0.01). Conclusion: Sm wave measurement gives valuable information about systolic function as well as end-diastolic pressure in hypertensive patients with left ventricular hypertrophy.

Antecedentes: El doppler tisular podría mejorar la evaluación pronostica en pacientes hipertensos con función sistólica normal o aparentemente normal como en la disfunción diastólica Valores bajos de velocidad de desplazamiento miocárdico en sístole (Sm) están asociados con deterioro de la función sistólica, cardiopatía hiper-tensiva y mortalidad de causa cardíaca. No obstante, la asociación de la onda Sm con parámetros de aumento de presión de fin de diástole aún no es clara. Objetivos: Estimar la asociación entre la onda Sm y diferentes parámetros ecocardiográficos morfológicos, de función sistólica y diastólica en pacientes con hipertensión arterial que poseen fracción de eyección conservada. Métodos: En un análisis retrospectivo de 1198 pacientes hipertensos (con fracción de eyección preservada) entre los años 2007 y 2010, se evaluó onda Sm y su asociación con la fracción de eyección, índice de masa ventricular (IMV), volumen de aurícula izquierda indexado (VAI), presión de arteria pulmonar en sístole (PAPS) y la relación E/e'. Resultados: Se observó una tendencia al descenso de la onda Sm a medida que aumenta el IMV (p<0,01). De los pacientes con Sm <6 cm/s, el 76,6% de presentó E/e' >13 cm/s (p<0,01). Además, Sm normal se asoció con E/e' <13 cm/s, VAI <32 ml/m2 y PAPS <35 mmHg en un 93%, 71% y 92% respectivamente (p<0,01). Conclusiones: La medición de la onda Sm aporta valiosa información, no sólo de función sistólica, sino también de función diastólica, en pacientes hipertensos con hipertrofia ventricular izquierda.