[Evaluation of the safety of stress echocardiography in Spain and Portugal]. / Evaluación de la seguridad de la ecocardiografía de estrés en España y Portugal.

UNLABELLED: INTRODUCTION. There are few studies that evaluate the safety of stress echocardiography with discordant results. They are done in well-trained centers with highly selected populations leading to selection bias. OBJECTIVE: To assess the safety of the different modalities of stress echocardiography in Spain and Portugal. METHOD: Severe complications were retrospectively analyzed during the stress echocardiography performed in 29 hospitals in Portugal and Spain, from the beginning of their activity to September, 1999. In this period 22,105 stress echocardiograms were performed: 10,975 exercise echos, 2,969 low dose dobutamine echos, 6,832 high dose dobutamine echocardiograms, 1,276 dypiridamole echocardiograms, 41 paced echocardiograms and 12 with adenosine. A complication was defined as severe when it was life-threatening or led to hospital admission. RESULTS: We registered 26 complications, one death, 3 ventricular fibrillations, 10 sustained ventricular tachycardias, 2 complete atrioventricular blocks, 6 acute myocardial infarctions, 2 ruptures of the free wall or ventricular septal defects, 1 transient ischemic attack and 1 severe symptomatic hypotension. We had one severe complication for every 2,743 exercise stress, 1 every 1,231 dypiridamole, 1 every 325 high dose dobutamine without any complications with low dose dobutamine stress. We found a relationship between experience in dobutamine stress echocardiography and the frequency of complications. Three complications appeared once the test was finished. CONCLUSIONS: The stress echocardiography is a safe technique, but not harmless. The exercise stress echo is the safest of all the modalties of stress echocardiography. There is a relation between experience and the number of complications.

Pre-infarction angina elicits greater myocardial viability on reperfusion after myocardial infarction: a dobutamine stress echocardiographic study.

OBJECTIVES: We sought to evaluate myocardial viability (inotropic reserve) after myocardial infarction (MI) and its relationship with the presence of unstable pre-infarction angina (PIA). BACKGROUND: Several studies have suggested that PIA can limit infarct size, but it is not known whether PIA can elicit myocardial viability after an acute MI, with left ventricular function improvement. METHODS: Before discharge from the hospital, 91 patients with a reperfused MI (either fibrinolysis or primary coronary angioplasty) had low-dose dobutamine echocardiography performed to assess the myocardial inotropic reserve of the infarct-related area. RESULTS: Twenty-nine patients (31.9%) had PIA in the 24-h period before the onset of MI. Nine patients were treated with primary coronary angioplasty: five (8.1%) in the group with PIA and four (13.8%) in the group without PIA. There were no other significant differences in the baseline characteristics of the patients. There were more viable segments in patients with PIA (44.9% vs. 30.7%, p = 0.007), and the number of patients with significant viability was higher in the PIA group (73.9% vs. 46.3%, p = 0.026). This occurred despite a similar number of segments with segmental wall abnormalities at baseline in both groups (46.1% vs. 46.9%, p = NS). CONCLUSIONS: The presence of previous unstable PIA induces greater myocardial viability of the infarct-related area upon reperfusion and, as such, could have considerable therapeutic and clinical implications.

[Influence of pre-infarction angina on mid-term mortality after acute myocardial infarction]. / Influencia de la angina preinfarto en la mortalidad a medio plazo tras infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: Pre-infarction angina may reduce the extent of myocardial cell necrosis and improves the prognosis after myocardial infarction. The aim of this study was to analyze the total mortality six-month after acute myocardial infarction according to the presence or absence of pre-infarction angina. METHODS: One hundred seventy-five consecutive patients with acute myocardial infarction were prospectively included, 72 (41.4%) with pre-infarction angina. They were followed for 6 months. There were 16 deaths (15.5%) in the group of patients without pre-infarction angina and 7 (9.7%) in the group with pre-infarction angina (log-rank = 1.03; p = 0.311). The hazard-risk function curves showed a higher risk of death during the entire follow-up in the group without pre-infarction angina. In the multivariate logistic regression model, the presence of pre-infarction angina does not significantly reduce the risk of death (OR = 0.43; CI 95% = 0.09-2. 22; p = 0.303). We detected a significant interaction between treatment with sulfonylureas before the infarction and the presence of pre-infarction angina (p = 0.017). CONCLUSIONS: In this study no significant differences were observed in total mortality six months after acute myocardial infarction according to the presence of pre-infarction angina. However, the risk of death seemed to be higher in the group of patients without pre-infarction angina during the entire follow-up. A significant interaction was found between the treatment with sulfonylurea drugs before infarction and the presence of pre-infarction angina.

[Doppler tissue imaging of the mitral annulus in patients with left ventricular systolic dysfunction. Assessment of diastolic function]. / Doppler tisular del anillo mitral en pacientes con disfunción sistólica ventricular izquierda. Análisis de la función diastólica.

INTRODUCTION AND OBJECTIVES: We assessed the Doppler tissue imaging technique in the left mitral annulus of patients with left ventricular systolic dysfunction since the technique has been used to evaluate diastolic function of the left ventricle and the values obtained have been considered to be relatively independent of the preload. PATIENTS AND METHODS: Patients (n = 46) with an ejection fraction < 40% in sinus rhythm without mitral regurgitation underwent pulsed wave Doppler analyses of mitral inflow (E and A waves), pulmonary venous flow (S, D and Ar waves) and Doppler tissue imaging of the mitral annulus (Ea and Aa waves). RESULTS: Overall, the linear correlations between the different Doppler measurements were poor. When sub-grouped with respect to E/A < 1 and E/A >= 1 (Groups 1 and 2, respectively), the Ea value did not significantly differ between the two groups: 5.0 cm/s (4.2/6.0) vs 6.2 cm/s (5.5/8. 2) respectively; p = 0.129 and neither did the E/Ea quotient: 10.2 (8.2/14.5) vs 12.9 (9.1/17.4) respectively; p = 0.160. Atrial size was significantly greater in Group 2: 20.0 cm2 (18.0/22.0) vs 25.0 cm2 (20.0/29.0) respectively; p = 0.000. The Ea/Aa quotient was pseudo-normalized in Group 2: 0.65 (0.48/0.83) vs 1.15 (0.75/1.71) respectively; p = 0.001. CONCLUSIONS: In patients with left ventricular systolic dysfunction the Ea/Aa value tends towards pseudo-normalization when the preload is increased. This does not apply to the values of Ea, E/Ea or to size of the left atrium. Therefore, Doppler tissue imaging of the left mitral annulus is valuable in the assessment of left ventricular dysfunction and the problem of pseudo-normalization due to preloading.

[The effect of pre-infarction unstable angina on the size of myocardial necrosis]. / Efecto de la angina inestable preinfarto en el tamaño de la necrosis miocárdica.

INTRODUCTION AND OBJECTIVES: Recent studies suggest that preinfarction angina (PA) might induce less myocardial necrosis. The objective of this study is to evaluate whether patients with PA have smaller myocardial infarctions. METHODS: Patients with acute myocardial infarction of less than 12 hours since the onset symptoms were included. PA was defined as unstable angina at rest during the 7 days before the infarction. Infarct size was assessed with the area under the curve of CK-MB levels in the 24 hours following the onset of the infarct. RESULTS: One hundred-seventy nine patients were included, 75 (41.9%) with PA. There were more men in the group with PA (89.3% vs 70.2%, p = 0.004) and a higher prevalence of ex-smokers (38.7% vs 19.2%, p = 0.006). We did not find significant differences in myocardial infarction size between both groups, but a statistically significant interaction between PA and pre-treatment with sulfonylurea drugs was noted (p = 0.050). CONCLUSIONS: Preinfarction angina does not seem to induce less myocardial necrosis in this study. There is a significant interaction between preinfarction angina and pre-treatment with sulfonylurea drugs.