Prevalencia de la miocardiopatía hipertrófica en una amplia muestra de la población laboral española / Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population

Antecedentes y objetivo En España no existen estudios que hayan evaluado la prevalencia de la miocardiopatía hipertrófica en la población general. El objetivo de este trabajo fue evaluar la prevalencia de la miocardiopatía hipertrófica en una muestra amplia de la población laboral española. Materiales y métodos Se incluyó a 13.179 trabajadores (73% varones, con una edad media de 40 años) de 5 regiones españolas a los que, entre mayo de 2008 y noviembre de 2010, se les realizó un reconocimiento médico con un electrocardiograma. Se derivó a los trabajadores con alteraciones sugestivas en el electrocardiograma o con antecedentes médicos predisponentes (síncope de esfuerzo o muerte súbita en familiar menor de 50 años) para una evaluación ecocardiográfica. Se definió miocardiopatía hipertrófica a la presencia de un grosor parietal igual o mayor a 13mm en cualquier segmento del ventrículo izquierdo. Se estimó la prevalencia de la miocardiopatía hipertrófica en toda la muestra y en los trabajadores no hipertensos. Resultados Se seleccionó a 1.008 trabajadores para el ecocardiograma, aunque solo 496 (49,2% de los seleccionados) acudieron a la prueba. Tras el ecocardiograma se detectaron 16 casos de miocardiopatía hipertrófica y se estimó una prevalencia del 0,24% en el total de la muestra. En el subgrupo de trabajadores no hipertensos se objetivaron 10 casos de miocardiopatía hipertrófica, que se corresponden con una prevalencia estimada del 0,19%. Conclusiones En nuestra muestra de la población laboral española la prevalencia estimada de miocardiopatía hipertrófica fue del 0,24%. En el subgrupo de pacientes no hipertensos la prevalencia estimada fue del 0,19% (AU)

Background and objectives To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. Materials and methods The study included 13,179 workers (73% men; mean age, 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. Results A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. Conclusions In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19% (AU)

Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population.

BACKGROUND AND OBJECTIVES: To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS: The study included 13,179 workers (73% men; mean age: 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS: A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS: In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.

Prevalence of hypertrophic cardiomyopathy in a large sample of the Spanish working population. / Prevalencia de la miocardiopatía hipertrófica en una amplia muestra de la población laboral española.

BACKGROUND AND OBJECTIVES: To date, in Spain, there are no studies that have evaluated the prevalence of hypertrophic cardiomyopathy in the general population. The aim of this study was to assess the prevalence of hypertrophic cardiomyopathy in a large sample of the working population of Spain. MATERIALS AND METHODS: The study included 13,179 workers (73% men; mean age, 40 years) from 5 regions of Spain who, between May 2008 and November 2010, had a medical examination with an electrocardiogram. The workers with suggestive abnormalities in the electrocardiogram or a predisposing medical history (exertional syncope or sudden death of a family member younger than 50 years) were referred for an echocardiographic evaluation. We defined hypertrophic cardiomyopathy as a parietal thickness ≥13mm in any segment of the left ventricle. We estimated the prevalence of hypertrophic cardiomyopathy in the entire sample and in the workers without hypertension. RESULTS: A total of 1008 workers were selected for the echocardiogram, although only 496 (49.2% of those selected) of these attended the appointment. After the echocardiogram, we detected 16 cases of hypertrophic cardiomyopathy, estimating a prevalence of 0.24% for the entire sample. In the subgroup of workers with no hypertension, we observed 10 cases of hypertrophic cardiomyopathy, which corresponds to an estimated prevalence of 0.19%. CONCLUSIONS: In our sample of the working population in Spain, the estimated prevalence of hypertrophic cardiomyopathy was 0.24%. In the subgroup of patients with no hypertension, the estimated prevalence was 0.19%.

Clinical outcomes after tricuspid surgery : The role of previous cardiac surgery.

BACKGROUND: The aim of our study was to assess the outcomes of surgical treatment for severe tricuspid regurgitation according to whether cardiac surgery had been performed before the tricuspid valve intervention. METHODS: Between 1996 and 2013, 201 consecutive patients with severe tricuspid regurgitation underwent tricuspid surgery at our center. Patients were classified according to whether or not they had undergone previous cardiac surgery, which 33% of the sample had. Perioperative as well as long-term morbidity and mortality were analyzed. RESULTS: Mean patient age was 62.3 years. 32.8% underwent suture annuloplasty, 41.3% underwent ring annuloplasty, 15.4% received a bioprosthesis, and 10.4% received a mechanical prosthesis. There were no significant differences in perioperative mortality between the group that had not undergone previous cardiac surgery and the group that had (12.7% vs. 17.9%, respectively; p = 0.32). The long-term mortality rate (median follow-up time: 53 months) was 43.3%. Long-term survival curves showed no significant differences between the two groups (p = 0.884), and previous cardiac surgery was not a predictive factor for long-term mortality (hazard ratio = 1.211; p = 0.521). CONCLUSION: In a series of patients who underwent tricuspid valve surgery, no significant differences were observed in perioperative mortality or in long-term survival according to whether or not subjects had undergone previous cardiac surgery.

Prevalencia de pluripatología y valor pronóstico del índice PROFUND en una unidad de hospitalización de Cardiología / Prevalence of comorbidities and the prognostic value of the PROFUND index in a hospital cardiology unit

Introducción. El objetivo del estudio fue conocer la prevalencia de pluripatología y la utilidad del índice PROFUND para la estratificación pronóstica de los pacientes pluripatológicos en una unidad de hospitalización de Cardiología. Pacientes y métodos. Se analizaron de forma consecutiva todos los pacientes ingresados en 2012 en el servicio de Cardiología. Se registraron las comorbilidades, estancia y mortalidad intrahospitalarias, y los índices de Charlson y PROFUND. En los pacientes pluripatológicos, se registraron además los reingresos y la mortalidad durante un año de seguimiento. Resultados. Se incluyeron 1.033 pacientes (67±13,1 años, 35% mujeres); 381 (36,9%) fueron pluripatológicos, con un índice de Charlson de 6,4±1,7 y PROFUND de 2,5±2,5. Comparados con el resto, los pluripatológicos fueron mayores (72 vs. 64 años, p<0,001), tuvieron más mortalidad (2,9% vs. 1,1%, p=0,046) y estancia intrahospitalarias (8±5,5 vs. 6±5,7 días, p<0,001) e ingresaron más por insuficiencia cardiaca (42,3% vs. 15,8%, p<0,001). El índice PROFUND se asoció de manera independiente con la mortalidad global (hazard ratio[HR]=1,13, intervalo de confianza [IC] del 95%: 1,01-1,27, p=0,034) y con la existencia de eventos adversos mayores en el seguimiento a 12 meses (HR=1,09, IC del 95%: 1,01-1,18, p=0,026). Conclusiones. Un alto porcentaje de los pacientes ingresados en Cardiología fueron pluripatológicos. Estos presentaron mayor prevalencia de factores de riesgo cardiovascular, mayor estancia y mortalidad intrahospitalarias. El índice PROFUND predijo de forma independiente la mortalidad y los acontecimientos adversos durante el seguimiento (AU)

Introduction. The aim of this study was to understand the prevalence of comorbidities and the usefulness of the PROFUND index for the prognostic stratification of patients with comorbidities in a hospital cardiology unit. Patients and methods. We consecutively analysed all patients hospitalized in 2012 in the department of cardiology. We recorded the comorbidities, length of stay, hospital mortality, Charlson indices and PROFUND indices. In the patients with comorbidities, we also recorded the readmissions and mortality during a 1-year follow-up. Results. The study included 1,033 patients (mean age, 67±13.1 years; 35% women), 381 (36.9%) of whom had comorbidities, with a mean Charlson index of 6.4±1.7 and a mean PROFUND index of 2.5±2.5. Compared with the other patients, the patients with comorbidities were older (72 vs. 64 years, p<.001), had a higher mortality rate (2.9% vs. 1.1%, p=.046) and longer hospital stays (8±5.5 vs. 6±5.7 days, p<.001) and were more often admitted for heart failure (42.3% vs. 15.8%, p<.001). The PROFUND index was independently associated with overall mortality (hazard ratio [HR], 1.13; 95% CI: 1.01-1.27; p=.034) and with the presence of major adverse events during the 12-month follow-up (HR, 1.09; 95% CI: 1.01-1.18; p=.026). Conclusions. A high percentage of patients hospitalized in the department of cardiology had comorbidities. These patients had a higher prevalence of cardiovascular risk factors, longer stays and greater hospital mortality. The PROFUND index independently predicted mortality and adverse events during the follow-up (AU)

Prevalence of comorbidities and the prognostic value of the PROFUND index in a hospital cardiology unit. / Prevalencia de pluripatología y valor pronóstico del índice PROFUND en una unidad de hospitalización de Cardiología.

INTRODUCTION: The aim of this study was to understand the prevalence of comorbidities and the usefulness of the PROFUND index for the prognostic stratification of patients with comorbidities in a hospital cardiology unit. PATIENTS AND METHODS: We consecutively analysed all patients hospitalized in 2012 in the department of cardiology. We recorded the comorbidities, length of stay, hospital mortality, Charlson indices and PROFUND indices. In the patients with comorbidities, we also recorded the readmissions and mortality during a 1-year follow-up. RESULTS: The study included 1,033 patients (mean age, 67±13.1 years; 35% women), 381 (36.9%) of whom had comorbidities, with a mean Charlson index of 6.4±1.7 and a mean PROFUND index of 2.5±2.5. Compared with the other patients, the patients with comorbidities were older (72 vs. 64 years, p<.001), had a higher mortality rate (2.9% vs. 1.1%, p=.046) and longer hospital stays (8±5.5 vs. 6±5.7 days, p<.001) and were more often admitted for heart failure (42.3% vs. 15.8%, p<.001). The PROFUND index was independently associated with overall mortality (hazard ratio [HR], 1.13; 95% CI: 1.01-1.27; p=.034) and with the presence of major adverse events during the 12-month follow-up (HR, 1.09; 95% CI: 1.01-1.18; p=.026). CONCLUSIONS: A high percentage of patients hospitalized in the department of cardiology had comorbidities. These patients had a higher prevalence of cardiovascular risk factors, longer stays and greater hospital mortality. The PROFUND index independently predicted mortality and adverse events during the follow-up.

Remote ischemic postconditioning: does it protect against ischemic damage in percutaneous coronary revascularization? justification and design of a randomized placebo-controlled clinical trial.

OBJECTIVE: Myocardial damage that is associated with percutaneous coronary intervention (PCI) partially affects the results of the procedure, and is related to medium-term cardiovascular death. Remote postischemic conditioning might reduce the myocardial lesions that are associated with PCI, but perhaps less so in diabetics. The aim of this study was to evaluate the protective effect of remote postischemic conditioning in patients undergoing elective PCI for stable angina or non-ST elevation acute coronary syndrome with troponin <1 ng/ml at the time of randomization. METHODS: This randomized single-blinded single-center clinical trial involved 320 patients undergoing elective PCI who were randomized to either receive three 5-min cycles of ischemia by inflation of a cuff on the non-dominant arm to 200 mm Hg (remote postischemic conditioning) or to placebo (uninflated cuff). The primary outcome variable was the maximum increase in troponin in the first 24 h. The secondary outcome variable was readmission due to heart failure or cardiovascular mortality after 1 year of follow-up. In addition, a diabetic population was studied. CONCLUSIONS: This clinical trial evaluated the possible reduction in intervention-related myocardial damage that was attributable to remote postischemic conditioning.

Insuficiencia cardiaca en Andalucía / No disponible

No disponible

[Trends of hospitalizations for chronic heart failure in Andalusia in the last decade]. / Evolución de las hospitalizaciones por insuficiencia cardíaca en Andalucía en la última década.

BACKGROUND AND OBJECTIVES: The cost of hospitalization represents the greatest proportion of total expenditure due to heart failure. Our objective was to analyze the trends of morbidity of chronic heart failure in Andalusia between 1990-2000. MATERIAL AND METHODS: The data on hospitalizations in Andalusia (title 428 of the ninth revision of the International Disease Classification) were obtained from the National Survey of Hospital Morbidity of the National Institute of Statistics. The rates, standardized by age and gender, of admission due to heart failure were calculated by the direct standardization method. RESULTS: The absolute number of hospitalizations due to hear failure in people over 45 years was 4,345 in 1990 and 10,153 in 2000 (a relative increase of 230%) and it represents 14.2% hospitalizations in Spain. The increase was focused on those over 65 years and the standardized rates were slightly greater in women than in men. CONCLUSIONS: Hospitalization discharge rates increased mostly in the population older than 65 and women showed hospitalization rates slightly greater than men.

Evolución de las hospitalizaciones por insuficiencia cardíaca en Andalucía en la última década / Trends of morbidity of chronic heart failure in Andalusia in the last decade

Fundamento y objetivos. Las hospitalizaciones ocasionan la mayor parte del gasto sanitario por insuficiencia cardíaca. Nuestro objetivo es analizar las tendencias de estas hospitalizaciones en Andalucía en el período 1990-2000. Material y método. Los datos sobre hospitalizaciones en Andalucía (rúbrica 428 de la novena revisión de la Clasificación Internacional de Enfermedades) se tomaron de la Encuesta Nacional de Morbilidad Hospitalaria del Instituto Nacional de Estadística. Mediante el método de estandarización directa se calcularon las tasas, estandarizadas por edad y sexo, de ingreso por insuficiencia cardíaca. Resultados. El número absoluto de hospitalizaciones por insuficiencia cardíaca en mayores de 45 años pasó de 4.345 en 1990 a 10.153 en el año 2000, lo que representa un crecimiento relativo de un 230% y correspondió al 14,2% de los ingresos en España en el año 2000. El aumento se centró en mayores de 65 años y las tasas estandarizadas fueron ligeramente superiores en mujeres que en hombres. Conclusiones. El número de hospitalizaciones por insuficiencia cardíaca en Andalucía en la década de los noventa creció de forma importante, y esto se produjo fundamentalmente en mayores de 65 años, tanto en mujeres como en hombres

Background and objectives. The cost of hospitalization represents the greatest proportion of total expenditure due to heart failure. Our objective was to analyze the trends of morbidity of chronic heart failure in Andalusia between 1990-2000. Material and methods. The data on hospitalizations in Andalusia (title 428 of the ninth revision of the International Disease Classification) were obtained from the National Survey of Hospital Morbidity of the National Institute of Statistics. The rates, standardized by age and gender, of admission due to heart failure were calculated by the direct standardization method. Results. The absolute number of hospitalizations due to hear failure in people over 45 years was 4,345 in 1990 and 10,153 in 2000 (a relative increase of 230%) and it represents 14.2% hospitalizations in Spain. The increase was focused on those over 65 years and the standardized rates were slightly greater in women than in men. Conclusions. Hospitalization discharge rates increased mostly in the population older than 65 and women showed hospitalization rates slightly greater than men

Mortalidad por insuficiencia cardíaca en España: ¿existe una paradoja andaluza? / Heart failure mortality in spain: is there an andalusian paradox?

La mortalidad actual por insuficiencia cardíaca es alta como demuestran los resultados de los ensayos clínicos y estudios observacionales. Andalucía constituye uno de los paradigmas de la cultura mediterránea; sin embargo, presenta una prevalencia de enfermedad coronaria y una tasa ajustada de mortalidad por insuficiencia cardíaca mayor que otras Comunidades de España. Así, la tasa de mortalidad por insuficiencia cardíaca en España en el año 2000 por 100.000 habitantes fue de 27,3 en hombres y 28,88 en mujeres, mientras que Andalucía presentó una tasa media de 38,19 en hombres y 41,13 en mujeres, y cada una de las 8 provincias andaluzas presentaron mayores tasas que la media nacional, tanto en hombres como en mujeres. Por tanto, incluso en países con baja prevalencia de enfermedad coronaria como España la mortalidad por insuficiencia cardíaca es mayor en las Comunidades como Andalucía, con tasas mayores de enfermedad coronaria

Congestive heart failure has a high mortality, as reflected in different clinical trials and observational studies. Spain, as other countries around the Mediterranean basin, have a relatively low rate of coronary deaths, attributed to the so-called Mediterranean lifestyle. Andalusia, in the southernmost part of Spain, constitutes the paradigm of Mediterranean lifestyle. However, different reports show that the prevalence of ischemic heart disease is higher in Andalusia than in other zones of Spain. Thus the mortality rate due to heart failure in Spain in the year 2000 per 100,000 inhabitants was 27.3 in men and 28.88 in women and each one of the eight Andalusia provinces had greater rates than the national mean in both men and woman. Even in countries with a relatively low prevalence of coronary heart disease as is the case in Spain, heart failure mortality seems to be parallel to local differences in IHD prevalence

Actitud terapéutica tras la coronariografía en pacientes ancianos con cardiopatía isquémica / Therapeutic attitude after coronariography in elderly patients with ischemic heart disease

Introducción. La incidencia de cardiopatía isquémica en ancianos es elevada. De forma creciente estos pacientes son derivados para coronariografía. Objetivos. Identificar factores asociados con la revascularización coronaria en pacientes ancianos. Material y métodos. Estudio retrospectivo de 473 pacientes ≥ 75 años a los que se realizó coronariografía en relación con cardiopatía isquémica. Se analizaron sus características clinicoepidemiológicas y el tratamiento adoptado. Se utilizó un modelo de análisis multivariante para identificar factores asociados con la revascularización. Resultados. La edad media fue 77,6 ± 2,8 años; el 70,4% fueron varones. El 36% eran fumadores, el 53% hipertensos, el 33% diabéticos y el 30% dislipidémicos. El 31% presentaron enfermedad multivaso y el 11% afectación de tronco coronario izquierdo. En el 68% se evidenció afectación de la descendente anterior. Se realizó tratamiento médico en el 48,4%, revascularización percutánea en 41,5% y quirúrgica en 10,1 %. Los enfermos con lesiones de la descendente anterior fueron revascularizados en mayor proporción: 67,7% frente al 32,3%; p < 0,001. Se utilizó un modelo de regresión logística para identificar predictores de revascularización, obteniendo una relación directa con la afectación de la descendente anterior (OR 4,87; IC al 95%: 2,98-7,94; p < 0,001) e inversa con la revascularización previa (OR: 0,47; IC al 95%: 0,26-0,85; p < 0,02), la disfunción ventricular izquierda (OR: 0,58; IC al 95%: 0,39-0,88; p = 0,01) y la presencia de enfermedad multivaso (OR: 0,51; IC al 95%: 0,31-0,84; p < 0,01).Conclusiones. Los ancianos con cardiopatía isquémica a los que se les realizó coronariografía recibieron tratamiento revascularizador en algo más del 50% de los casos. Se encontró una relación directa entre la afectación de la descendente anterior y la realización de tratamiento revascularizador e inversa entre la revascularización previa, la disfunción ventricular izquierda y la presencia de enfermedad multivaso

Introduction. The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography. Objectives. Identify factors associated with coronary revascularization in elderly patients. Material and methods. Retrospective study of 473 patients ≥ 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization. Results. Mean age was 77.6 ± 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion: 67.7% vs 32.3%; p < 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR: 4.87; 95% CI: 2.98-7.94; p < 0.001) and inverse one with the previous revascularization (OR: 0.47; 95% CI: 0.26-0.85; p < 0.02), left ventricular dysfunction (OR: 0.58; 95% CI: 0.39-0.88; p = 0.01) and presence of multivessel disease (OR: 0.51; 95% CI: 0.31-0.84; p < 0.01). Conclusions. The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse one between previous revascularization, left ventricular dysfunction and presence of multivessel disease

[Therapeutic attitude after coronariography in elderly patients with ischemic heart disease]. / Actitud terapéutica tras la coronariografía en pacientes ancianos con cardiopatía isquémica.

INTRODUCTION: The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography. OBJECTIVES: Identify factors associated with coronary revascularization in elderly patients. MATERIAL AND METHODS: Retrospective study of 473 patients > or = 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization. RESULTS: Mean age was 77.6 +/- 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion: 67.7% vs 32.3%; p. 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR: 4.87; 95% CI: 2.98-7.94; (p < 0.001) and inverse on with the previous revascularization (OR: 0.47; 95% CI: 0.26-0.85; p < 0.02), left ventricular dysfunction (OR: 0.58; 95% CI: 0.39-0.88; p = 0.01) and presence of multivessel disease (OR: 0.51; 95% CI: 0.31-0.84; p < 0.01). CONCLUSIONS: The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse on between previous revascularization, left ventricular dysfunction and presence of multivessel disease.

¿Desigualdades en el tratamiento de la angina inestable en las mujeres? / Disparities in the treatment of unstable angina among women?

No disponible

Seguridad cardiovascular de los inhibidores de la ciclooxigenasa 2 / Cardiovascular safety of ciclooxigenase 2 inhibitors

Los inhibidores de la ciclooxigenasa 2 (celecoxib y rofecoxib) son fármacos antiinflamatorios no esteroideos potentes y con un excelente perfil de seguridad cardiovascular. Sin embargo, en un artículo reciente se sugiere que estos fármacos podrían presentar un incremento del riesgo de complicaciones cardiovasculares tromboembólicas. En el presente artículo analizamos los datos disponibles hasta la fecha sobre la seguridad cardiovascular de los inhibidores de la ciclooxigenasa 2 (AU)

[The influence of angina the week before a first myocardial infarction on short and medium-term prognosis]. / Influencia de la angina en la semana previa al primer infarto agudo de miocardio sobre su pronóstico intrahospitalario y a medio plazo.

INTRODUCTION AND OBJECTIVES: The implications of early angina on the prognosis of myocardial infarction are controversial. The aim of this study was to assess the effect of angina one week before the first myocardial infarction on short and medium-term prognosis. PATIENTS AND METHOD: A total of 290 consecutive patients (107 with previous angina and 183 without it) with the first myocardial infarction were studied to determine the effect of preceding angina on short and medium-term prognosis. Further criteria for inclusion were no previous history of angina > 1 week before the first myocardial infarction, and no evidence of prior structural cardiopathy. The end points studied were death and congestive heart failure in the acute phase of myocardial infarction and during the follow-up. RESULTS: Patients with a history of prodromal angina were less likely to experience in-hospital death, heart failure or combined end-point (3.7 vs 11.5%; 4.6 vs 15.8%; 7.5 vs 21.3%) (p = 0.002). There was also a difference between groups in the follow-up (4.1 vs 13.2%; p = 0.03). Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of death and heart failure in the acute phase of myocardial infarction as well as in the follow-up. CONCLUSIONS: The occurrence of angina one week before the first myocardial infarction protects against death and heart failure in the acute phase of myocardial infarction as well as in the medium follow-up.

Both alleles of the M235T polymorphism of the angiotensinogen gene can be a risk factor for myocardial infarction.

We have studied the role of three polymorphic genes of the renin-angiotensin system (RAS) as independent risk factors for myocardial infarction (MI) and their correlation with three of the major coronary risk factors: serum cholesterol (CH), hypertension (HT) and smoking (SM). A population of 392 men was genotyped for the M235T polymorphism of the angiotensinogen (AGT) gene, the insertion/deletion of the angiotensin-converting enzyme (ACE) and the all66c of the angiotensin-II type 1 receptor (AT1R), by means of polymerase chain reaction (PCR) and restriction enzyme analysis. It was observed that the T allele frequency increased significantly in the MI with HT, CH, and SM subgroup (0.58 vs 0.31) (p<0.01). In contrast, the M allele frequency was higher in the MI without HT, CH, and SM (0.69 vs 0.42) (p<0.01). A strong association between the MM genotype and MI (p<0.001, odds ratio=4.29, confidence interval=1.95-9.42) was found when age-matched MM control subjects were compared to MI individuals with none of the other known major coronary risk factors. Futhermore, subjects with the MM genotype showed a significantly higher plasma renin activity (PRA) profile than those with the TT genotype (p<0.001). It can be concluded that the M allele is an independent risk factor for MI and the T allele modified the risk when other major risk factors are present.

Measurement of fractional flow reserve to assess moderately severe coronary lesions: correlation with dobutamine stress echocardiography.

BACKGROUND: New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems. METHODS AND RESULTS: We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (> or = 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%, respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [kappa] = 0.51). CONCLUSIONS: FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory.