RESUMEN
BACKGROUND: The prognostic impact of left ventricular (LV) geometry on cardiovascular risk for patients with a first, uncomplicated acute myocardial infarction (AMI), and echocardiographic ejection fraction > or =50% has not been well described. METHODS AND RESULTS: Accordingly, 111 AMI consecutive patients (mean age 59.3+/-10 years) performed echocardiographic examination at predischarge. LV mass was calculated by means of Devereux's formula and subsequently indexed by body surface area. Fifty-three patients had LV hypertrophy and 58 patients had normal LV mass. The two groups were homogeneous for demographic, clinical and angiographic variables as well as for the incidence of residual ischemia on predischarge stress testing. During follow-up period there were 24 cardiac events (cardiac death, unstable angina and non-fatal reinfarction) in the 53 patients with LV hypertrophy and only four events in the remaining 58 patients without LV hypertrophy (RR=2.45; CI=1.76-3.41; P<0.0001). The patients with concentric LV hypertrophy showed a higher incidence of events (64%) than patients with eccentric LV hypertrophy (32%, P<0. 05) and patients with normal geometry and mass (6%, P<0.0001). Multivariate Cox regression model identified concentric geometry as the most powerful predictor of combined end-points (chi(2)=32.7, P<0. 0001). CONCLUSIONS: An increased LV mass and concentric geometry resulted important independent markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction and good LV function.
Asunto(s)
Ecocardiografía Doppler , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etiología , Infarto del Miocardio/complicaciones , Anciano , Análisis de Varianza , Cateterismo Cardíaco , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Probabilidad , Pronóstico , Modelos de Riesgos Proporcionales , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Volumen SistólicoRESUMEN
The prognostic value of wall motion score index (WMSI), assessed at predischarge after a first acute myocardial infarction (AMI) in the thrombolytic era, is still not well known. One-hundred forty-four consecutive patients with a first AMI treated with thrombolytic therapy underwent exercise testing and echocardiography at rest before discharge and were followed-up for a mean period of 18 months. During follow-up, there were 32 cardiac events (12 patients had cardiac deaths, 8 had unstable angina pectoris, 1 had nonfatal reinfarction, and 11 patients had congestive heart failure). The patients who experienced any cardiac event had a higher WMSI (1.67+/-0.15 vs. 1.30+/-0.16, p<0.0001), a higher end-systolic volume (75.1+/-34 vs. 59.5+/-22 ml, p<0.01), and a lower ejection fraction (47+/-16% vs. 55+/-10%, p<0.001) at predischarge than patients without events. The incidence of a positive predischarge exercise testing did not differ between patients with and without cardiac events (22% vs. 24%, p = NS). Multivariate Cox regression analysis, including clinical, exercise results, and echocardiographic parameters, showed that the most powerful predictor of a subsequent event was a resting WMSI > or =1.50 before discharge (chi-square 17.8, p<0.0001). Thus, in patients with a first AMI who underwent thrombolysis, the severity and extent of echocardiographically detected wall motion abnormalities are important independent predictors of cardiac events.
Asunto(s)
Fibrinolíticos/uso terapéutico , Contracción Miocárdica/fisiología , Infarto del Miocardio/fisiopatología , Terapia Trombolítica , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/tratamiento farmacológico , Alta del Paciente , Pronóstico , Modelos de Riesgos Proporcionales , Índice de Severidad de la Enfermedad , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
The prognostic role of C-reactive protein levels in patients with a first acute myocardial infarction, an uncomplicated in-hospital course, and the absence of residual ischemia on a predischarge ergometer test and with an echocardiographic ejection fraction > or = 50% has not been described. C-reactive protein was determined during hospitalization in 64 patients (55 men, mean age 64.6 +/- 10.4 years). The patients were followed up for 13 +/- 4 months and the following cardiac events were recorded: cardiac death, new-onset angina pectoris, and recurrent myocardial infarction. Patients who developed cardiac events during the follow-up period had significantly higher C-reactive protein values than patients without events (3.61 +/- 2.83 vs 1.48 +/- 2.07 mg/dl, p <0.001). The probability of cumulative end points was: 6%, 12%, 31%, and 56% (p = 0.006; RR 3.55; confidence interval 1.56 to 8.04), respectively, in patients stratified by quartiles of C-reactive protein (< 0.45, 0.45 to 0.93, 0.93 to 2.55 and > 2.55 mg/dl). In the Cox regression model, only increased C-reactive protein levels were independently related to the incidence of subsequent cardiac events (chi-square 9.8, p = 0.001). Thus, increased C-reactive protein levels are associated with a worse outcome among patients with a first acute myocardial infarction, an uncomplicated in-hospital course without residual ischemia on the ergometer test, and with normal left ventricular function.
Asunto(s)
Proteína C-Reactiva/metabolismo , Infarto del Miocardio/sangre , Isquemia Miocárdica/sangre , Anciano , Biomarcadores/sangre , Supervivencia sin Enfermedad , Electrocardiografía , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Pronóstico , Modelos de Riesgos ProporcionalesRESUMEN
Computerized stabilometry is an useful test to monitor postural effects of anticonvulsant therapy in adults. Our study was carried out on 65 epileptic children: 51 were treated with CBZ or PHT or VPA or PB in monotherapy, and 14 were not on therapy, in the aim to observe abnormalities of postural control in pediatric population. Computerized stabilometry has to be considered auxiliary monitoring to evaluate toxic effect of anticonvulsant therapy in children.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Equilibrio Postural/efectos de los fármacos , Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Carbamazepina/uso terapéutico , Niño , Diagnóstico por Computador , Monitoreo de Drogas , Epilepsias Parciales/tratamiento farmacológico , Epilepsia Generalizada/tratamiento farmacológico , Humanos , Fenobarbital/efectos adversos , Fenobarbital/uso terapéutico , Fenitoína/efectos adversos , Fenitoína/uso terapéutico , Postura , Ácido Valproico/efectos adversos , Ácido Valproico/uso terapéuticoRESUMEN
The behaviour of bone conduction audiograms in the operated and non-operated ears of 200 otosclerotic patients was analysed. The majority (84%) of both operated and unoperated ears showed virtually unchanged bone conduction thresholds throughout the follow-up period (mean follow-up period = 13.4 +/- 5.3 years). Slight but statistically significant bone conduction deterioration was observed in the remaining 16% of cases, most frequently in the non-operated ears. However, this deterioration was generally within the usually accepted limits of the Carhart effect, and does not demonstrate the presence of any causative factor other than evolution of the ostosclerotic disease. Our findings do not support the hypothesis that total stapedectomy per se may be responsible for sensorineural deterioration.
Asunto(s)
Pérdida Auditiva Sensorineural/fisiopatología , Otosclerosis/cirugía , Adulto , Audiometría , Umbral Auditivo , Conducción Ósea , Estudios de Seguimiento , Pérdida Auditiva Sensorineural/etiología , Humanos , Persona de Mediana Edad , Otosclerosis/complicaciones , Complicaciones Posoperatorias , Cirugía del EstriboRESUMEN
A multicenter open prospective comparative study was carried out during two years enrolling 60 patients with upper respiratory infections. Thirty were treated with single daily 500 mg doses of azithromycin for three days, and 30 received two daily doses of roxithromycin of 150 mg each for seven days. Both treatments were equally well tolerated, and there was no substantial difference concerning clinical recovery. However, azithromycin treatment was more practical and of shorter duration.