Utilidad de las alteraciones especulares en el diagnóstico del infarto con elevación mínima del segmento ST / Usefulness of reciprocal changes in the diagnosis of myocardial infarction with minimal ST-segment elevation

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Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction.

BACKGROUND: Borderline electrocardiograms represent a challenge in ST-segment elevation myocardial infarction (STEMI) management and are associated with inappropriate discharges and delays to intervention. OBJECTIVES: To assess angiographic characteristics and outcomes of patients presenting with subtle ST-elevation (STE) myocardial infarction. METHODS: A total of 504 consecutive patients with suspected STEMI treated by systematic primary percutaneous coronary intervention were prospectively included. Subtle STE was defined as a maximal preinterventional STE of 0.1 to 1 mm. Angiograms were interpreted by investigators unaware of the electrocardiographic data. RESULTS: The proportion of patients with subtle STE was 18.3%, 86% of them presented with Thrombolysis In Myocardial Infarction flow grade 0/1 and 91% underwent percutaneous coronary intervention. Despite having smaller infarcts, subtle STE patients associated more frequent multivessel disease (57% vs 44%, P = .02) and larger delays to reperfusion. During a follow-up of 19.0 ± 4.9 months, the rates of death or reinfarction were similar among groups (10.0% vs 12.6%, P = .467). Subtle STE was not associated with better outcomes neither in univariate nor after adjustment in a multivariate analysis (adjusted hazard ratio 0.79, 95% CI 0.37-1.69, P = .546). CONCLUSIONS: Subtle STEMI is frequent in clinical practice and is usually associated with acute total coronary occlusion. Therefore, it should be diagnosed and treated in the same expeditiously manner as marked STEMI.

Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation.

BACKGROUND: Maternal hypothyroxinemia, due to gestational iodine deficiency, causes neurological dysfunctions in the progeny. Our aim was to determine the effects of delayed iodine supplementation (200 microg KI per day) to mildly hypothyroxinemic pregnant women at the beginning of gestation (i.e., having circulating free thyroxine [FT(4)] within the 0th-10th percentile interval and normal thyrotropin [TSH]) on the neurobehavioral development of their children. METHODS: Using the Brunet-Lézine scale, we evaluated the neurocognitive performance at 18 months of age in three groups of children. Group 1 included children of women with FT(4) above the 20th percentile at 4-6 gestational weeks and at full-term. Group 2 included children of mildly hypothyroxinemic women diagnosed during the first 12-14 gestational weeks and with FT(4) above the 20th percentile at full-term. Group 3 included children born to mildly hypothyroxinemic women at full-term, without iodine supplementation during gestation. Women of all groups were iodine supplemented from the day of enrollment until the end of lactation. RESULTS: Before iodine supplementation, 33.0% of the women (114 out of 345) were hypothyroxinemic, with FT(4) below normal in 28 of them (8.1%). None were found to be hypothyroxinemic at full-term after supplementation. The mean (+/-SD) developmental quotient of children was 101.8 +/- 9.7 in group 1 (n = 13) vs. 87.5 +/- 8.9 in group 3 (n = 19; p < 0.001) and 92.2 +/- 5.4 in group 2 (n = 12; p < 0.05). The difference between groups 2 and 3 was not statistically significant. Delayed neurobehavioral performance was observed in 36.8% and 25.0% of children in groups 3 and 2, respectively, compared with no children in group 1. Differences (p < 0.001) were found on gross and fine motor coordination and socialization quotients. No statistically significant differences were found on language quotients. CONCLUSIONS: A delay of 6-10 weeks in iodine supplementation of hypothyroxinemic mothers at the beginning of gestation increases the risk of neurodevelopmental delay in the progeny. Public health programs should address the growing problem of iodine deficiency among women of gestational age in developing and industrialized nations.

[Analysis of mortality in myocardial infarction patients treated with primary angioplasty]. / Análisis de mortalidad en el infarto de miocardio tratado con angioplastia primaria.

BACKGROUND AND OBJECTIVE: Primary angioplasty is an effective method to achieve myocardial reperfusion in ST-elevated myocardial infarction (MI). The objective of this study was to determine the independent factors that could predict mortality in MI patients treated with primary angioplasty and to analyze the prognostic value of tissue reperfusion parameters in those patients. PATIENTS AND METHOD: A prospective observational study was performed in 380 consecutive patients with ST-elevated MI treated with primary angioplasty at a single hospital. RESULTS: Early mortality was 8.9%. Upon univariate analysis, the following variables were associated with significantly higher mortality: age, ejection fraction (EF), multivascular disease, anterior location of MI, lack of resolution of ST segment, flow 0-1 of TIMI, grade 0-1 of blush index and delay time above 4 hours. Multivariate analysis yielded the following independent variables as predictors of mortality: age, degree of heart failure (Killip index) and degree of myocardial perfusion (blush index). CONCLUSIONS: The independent predictive factors of mortality in patients with ST-elevated MI and treated with primary angioplasty are: age, degree of heart failure (Killip index) and degree of myocardial reperfusion (blush index). The resolution of ST segment and blush index represent additional prognostic variables in patients with good epicardial reperfusion.

Análisis de mortalidad en el infarto de miocardio tratado con angioplastia primaria / Analysis of mortality in myocardial infarction patients treated with primary angioplasty

FUNDAMENTO Y OBJETIVO: La angioplastia primaria es el método de reperfusión de elección en el infarto con elevación del segmento ST. El objetivo de nuestro estudio ha sido determinar cuálesson los factores independientes predictores de mortalidad en los pacientes con infarto de miocardio(IM) sometidos a angioplastia primaria y, por otro lado, analizar la implicación pronósticadel estudio de la perfusión tisular en estos pacientes. PACIENTES Y MÉTODO: Se ha realizado un estudio observacional y prospectivo de 380 pacientes tratados con angioplastia primaria, en el contexto de un IM con elevación del segmento ST, en un único centro. RESULTADOS: La mortalidad intrahospitalaria fue del 8,9%. En el estudio univariante, las variables asociadas a una mayor mortalidad fueron: la edad, la fracción de eyección, la enfermedad multivaso, la localización anterior del IM, la falta de resolución del segmento ST, el flujo TIMI0 o 1 en la arteria causante del IM, los grados 0 o 1 del índice de blush y un tiempo de demor superior a 4 h. En el análisis multivariante las variables independientes predictoras de mortalidad fueron la edad, el grado de insuficiencia cardíaca, valorada con la escala Killip, y elgrado de perfusión tisular, valorada con el índice de blush. CONCLUSIONES: Los factores independientes predictores de mortalidad en los pacientes con IM con elevación del segmento ST tratados con angioplastia primaria son la edad, el grado de insuficiencia cardíaca según la escala Killip y el grado de reperfusión miocárdica según el índicede blush. La resolución del segmento ST y el índice de blush poseen un valor pronóstico adicionalen los pacientes con buena reperfusión epicárdica (AU)

BACKGROUND AND OBJECTIVE. Primary angioplasty is an effective method to achieve myocardial reperfusion in ST-elevated myocardial infarction (MI). The objective of this study was to determine the independent factors that could predict mortality in MI patients treated with primary angioplasty and to analyze the prognostic value of tissue reperfusion parameters inthose patients. PATIENTS AND METHOD. A prospective observational study was performed in 380 consecutive patients with ST-elevated MI treated with primary angioplasty at a single hospital. RESULTS. Early mortality was 8,9%. Upon univariate analysis, the following variables were associated with significantly higher mortality: age, ejection fraction (EF), multivascular disease, anterior location of MI, lack of resolution of ST segment, flow 0-1 of TIMI, grade 0-1 of blush indexand delay time above 4 hours. Multivariate analysis yielded the following independent variables as predictors of mortality: age, degree of heart failure (Killip index) and egree of myocardial perfusion (blush index). CONCLUSIONS. The independent predictive factors of mortality in patients with ST-elevated MI and treated with primary angioplasty are: age, degree of heart failure (Killip index) and degreeof myocardial reperfusion (blush index). The resolution of ST segment and blush index represent additional prognostic variables in patients with good epicardial reperfusion (AU)

Análise de potenciais tardios em pacientes com arritmias ventriculares malignas / Late potentials analysis in patients with malignant ventricular arrhythmia

PURPOSE--To assess the relationship between late potentials and spontaneous ventricular arrhythmias, organic heart disease, inducibility of arrhythmias at electrophysiological study and ejection fraction. METHODS--The population is comprised by 52 patients (41 men, 11 women with mean age 50 +/- 16 years) with spontaneous clinically documented ventricular tachycardia or ventricular fibrillation. An electrophysiological study was performed with conventional programmed stimulation. Within a week of the test a study of late potentials was also performed. RESULTS--Late potentials were documented in 73 per cent of the patients with ventricular tachycardia and only in 17 per cent of the patients with ventricular fibrillation. Sixty-eight percent of the patients with ischemic cardiopathy presented late potentials and in these, ventricular tachycardia was inducible in 93 per cent . Only one from a group of 7 patients with ventricular arrhythmias and no organic heart disease, presented late potentials. In patients with late potentials, 84 per cent have inducible ventricular tachycardia, but only 26 per cent of patients without late potentials have inducible ventricular tachycardia. The incidence of late potentials was inversely correlated with left ventricular ejection fraction. CONCLUSION--The presence of late potentials was more frequent in patients with ventricular tachycardia than in patients with ventricular fibrillation. The presence of late potentials has a sensibility of 81.5 per cent and a specificity of 78 per cent to detect patients with inducible ventricular tachycardia