Utilidad de la ecografía portátil en el cribado del aneurisma de aorta abdominal y de la ateromatosis de aorta abdominal / Feasibility of hand-held-ultrasonography in the screening of abdominal aortic aneurysms and abdominal aortic atherosclerosis

Fundamento y objetivo: La diabetes mellitus tipo 2 (DM2) se asocia con un elevado riesgo cardiovascular (RCV), siendo de gran importancia tratar intensivamente los distintos factores de RCV, como la dislipemia. El tratamiento hipocolesterolemiante es necesario para conseguir reducir el RCV asociado a la DM2, siendo el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) el principal objetivo terapéutico. En este trabajo se analiza el perfil lipídico de pacientes diabéticos en tratamiento con estatinas. Pacientes y método: El estudio DYSIS (Dyslipidemia International Study) es un estudio observacional, internacional, en el que se analiza el perfil lipídico de pacientes tratados con estatinas, en prevención primaria o secundaria. Resultados: De los 3703 pacientes analizados, el 39% eran diabéticos. El 59,2% de los diabéticos presentaban el colesterol LDL fuera de control. En conjunto, el 43,6% de diabéticos presentaba triglicéridos elevados y el 36,4% tenían el colesterol unido a lipoproteínas de alta densidad (colesterol HDL) bajo. De los pacientes con cardiopatía isquémica y diabetes, el 31% tenían colesterol LDL, colesterol HDL y triglicéridos fuera de control. De los pacientes diabéticos con síndrome metabólico el 60% tiene el colesterol LDL fuera de objetivos, el 39,8% tienen el colesterol HDL bajo y el 46,6% triglicéridos elevados. El 57% de los pacientes diabéticos obesos presentaba falta de control del colesterol LDL, aún en tratamiento con estatinas. Conclusiones: Las enfermedades cardiovasculares son la primera causa de morbimortalidad en pacientes con DM2. El estudio DYSIS muestra que la mayoría de los pacientes tratados con estatinas no alcanzan los objetivos lipídicos recomendados por las guías. En el presente estudio se constata que más de la mitad de los diabéticos tratados con estatinas tiene el colesterol LDL fuera de control, el grado de control de la dislipemia es muy limitado a pesar del tratamiento con estatinas, lo que puede determinar la necesidad de una terapia combinada para el tratamiento eficaz de la dislipemia (AU)

Background and objective: To determine the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic atheromatosis (AA-At) using a hand-held ultrasound by a general practitioner in the public Primary Health Care system. Patients and method: Pilot study that prospectively studied a cohort of men over 50 years with cardiovascular risk factors: active smokers, former smokers, or hypertensive patients, attended in primary health care center. The general practitioner completed an ultrasonography training in an Ultrasound Unit under supervision of experienced radiologists using an standard ultrasound equipment and hand-held ultrasound (VScan1, General Electric, USA). One hundred and six patients participated in the study and all imaging data recorded were blindly evaluated by a radiologist in order to establish the concordance in the interpretation of images between general practitioner and radiologist. The kappa index was calculated to study the agreement on the presence or absence of AAA and AA-At. Results: We observed a prevalence of 5.88% of AAA. Kappa index for concordance in AAA diagnosis was absolute (k = 1.0), with a sensitivity and specificity of 100%. Otherwise, the general practitioner identified 59 patients (58.4%) with AA-At, while radiologist identified 39 (38.6%) in the image review, with moderate concordance (k = .435), sensitivity 89.74% and specificity 57.14%. Hypercholesterolemia (odds ratio [OR] 2.61; 95% confidence interval [95% CI] 0.92-7.39) and diabetes mellitus (OR 3.35; 95%CI 0.89-12.55) were independent risk factors for AA-At development in logistic regression. Conclusions: After an adequate training in ultrasonography, hand-held ultrasound is a useful tool for AAA screening in Primary Care. Its simplicity, security, validity, cost-effectiveness and acceptance by the general population, makes it a feasible tool for cardiovascular risk assessment (AU)

[Feasibility of hand-held-ultrasonography in the screening of abdominal aortic aneurysms and abdominal aortic atherosclerosis]. / Utilidad de la ecografía portátil en el cribado del aneurisma de aorta abdominal y de la ateromatosis de aorta abdominal.

BACKGROUND AND OBJECTIVE: To determine the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic atheromatosis (AA-At) using a hand-held ultrasound by a general practitioner in the public Primary Health Care system. PATIENTS AND METHOD: Pilot study that prospectively studied a cohort of men over 50 years with cardiovascular risk factors: active smokers, former smokers, or hypertensive patients, attended in primary health care center. The general practitioner completed an ultrasonography training in an Ultrasound Unit under supervision of experienced radiologists using an standard ultrasound equipment and hand-held ultrasound (VScan(®), General Electric, USA). One hundred and six patients participated in the study and all imaging data recorded were blindly evaluated by a radiologist in order to establish the concordance in the interpretation of images between general practitioner and radiologist. The kappa index was calculated to study the agreement on the presence or absence of AAA and AA-At. RESULTS: We observed a prevalence of 5.88% of AAA. Kappa index for concordance in AAA diagnosis was absolute (κ = 1.0), with a sensitivity and specificity of 100%. Otherwise, the general practitioner identified 59 patients (58.4%) with AA-At, while radiologist identified 39 (38.6%) in the image review, with moderate concordance (κ = .435), sensitivity 89.74% and specificity 57.14%. Hypercholesterolemia (odds ratio [OR] 2.61; 95% confidence interval [95% CI] 0.92-7.39) and diabetes mellitus (OR 3.35; 95%CI 0.89-12.55) were independent risk factors for AA-At development in logistic regression. CONCLUSIONS: After an adequate training in ultrasonography, hand-held ultrasound is a useful tool for AAA screening in Primary Care. Its simplicity, security, validity, cost-effectiveness and acceptance by the general population, makes it a feasible tool for cardiovascular risk assessment.