Influencia del riesgo cardiovascular en la predicción y el momento de aparición de eventos cardiacos tras ecocardiograma de esfuerzo sin isquemia / Influence of cardiovascular risk in the prediction and timing of cardiac events after exercise echocardiogram testing without ischemia

Introducción y objetivos: La influencia del riesgo cardiovascular en el pronóstico de pacientes con ecocardiograma de esfuerzo (EE) sin isquemia inducible no se ha evaluado. El objetivo es determinar predictores de eventos, con especial atención al riesgo cardiovascular. Métodos: Se incluyó a 1.640 pacientes con EE sin isquemia: 1.206 sin cardiopatía isquémica (CI), cuyo riesgo de muerte cardiovascular se estimó según el SCORE (Systematic COronary Risk Evaluation) europeo, y 434 con CI. El objetivo primario fue la supervivencia libre de eventos (SLEv) (muerte cardiaca, síndrome coronario agudo no fatal y revascularización en el seguimiento). Resultados: Tras una mediana de seguimiento de 35 [23-54] meses, no hubo diferencias significativas entre la SLEv de los pacientes con SCORE ? 10 o diabetes y pacientes con CI (el 89,8 frente al 87,1%). Al año la SLEv era alta en todos los grupos (el 99,4% si SCORE < 5; el 100% si SCORE 5-9; el 98% si SCORE ? 10 o diabetes y el 97% si CI), con un descenso a los 3 años si SCORE ? 10 o diabetes (94,5%), similar al de los pacientes con CI (91,1%, diferencias no significativas). Las tasas de eventos anualizadas fueron del 2,8 y el 2,55% respectivamente, significativamente superiores a las de los grupos con SCORE < 5 (0,6%) y 5-9 (0,12%). Los eventos más frecuentes fueron el síndrome coronario agudo sin elevación del segmento ST no fatal y la revascularización. Fueron predictores de eventos cardiacos: la CI conocida, un SCORE ? 10 o diabetes, el aclaramiento de creatinina, la fracción eyección del ventrículo izquierdo y el dolor durante la EE. Conclusiones: Un EE sin isquemia implica buen pronóstico inicial, posteriormente modulado por el riesgo cardiovascular (AU)

Introduction and objectives: There have been no analyses of the influence of cardiovascular risk as a predictor of events in patients with exercise echocardiography (EE) without ischemia. Our objective was to determine the predictors of cardiac events, paying special attention to cardiovascular risk. Methods: This study included 1640 patients with EE without ischemia. Of these,there were 1206 with no previously known coronary artery disease (CAD), whose risk of a fatal cardiovascular disease event was estimated according to the European SCORE (Systematic COronary Risk Evaluation) risk assessment system, and 434 with known CAD. The primary endpoint was cardiac event-free survival (EFS) (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization). Results: After a median follow-up of 35 [23-54] months, no differences were found in cardiac EFS between patients with a SCORE 10 or diabetes and patients with previous CAD (89.8% vs 87.1%). In the first year, cardiac EFS was high in all groups (99.4% if SCORE < 5; 100% if 5-9; 98% if 10 or diabetes and 97% in patients with CAD). In the third year, cardiac EFS was similar in the group with SCORE 10 or diabetes (94.5%) and patients with CAD (91.1%, P = NS). In these patients, the annualized event rate was 2.8% and 2.55%, respectively, and was significantly higher than in groups with SCORE < 5 (0.6%) and SCORE 5-9 (0.12%). The most frequent events were non—ST-segment elevation acute coronary syndrome and late revascularization. Predictors of cardiac events were previous CAD, SCORE 10 or diabetes mellitus, creatinine clearance, left ventricular ejection fraction, and chest pain during EE. Conclusions: Initial outcome after an EE without ischemia is favorable but is subsequently modulated by cardiovascular risk (AU)

Influence of Cardiovascular Risk in the Prediction and Timing of Cardiac Events After Exercise Echocardiogram Testing Without Ischemia.

INTRODUCTION AND OBJECTIVES: There have been no analyses of the influence of cardiovascular risk as a predictor of events in patients with exercise echocardiography (EE) without ischemia. Our objective was to determine the predictors of cardiac events, paying special attention to cardiovascular risk. METHODS: This study included 1640 patients with EE without ischemia. Of these, there were 1206 with no previously known coronary artery disease (CAD), whose risk of a fatal cardiovascular disease event was estimated according to the European SCORE (Systematic COronary Risk Evaluation) risk assessment system, and 434 with known CAD. The primary endpoint was cardiac event-free survival (EFS) (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization). RESULTS: After a median follow-up of 35 [23-54] months, no differences were found in cardiac EFS between patients with a SCORE ≥ 10 or diabetes and patients with previous CAD (89.8% vs 87.1%). In the first year, cardiac EFS was high in all groups (99.4% if SCORE < 5; 100% if 5-9; 98% if ≥ 10 or diabetes and 97% in patients with CAD). In the third year, cardiac EFS was similar in the group with SCORE ≥ 10 or diabetes (94.5%) and patients with CAD (91.1%, P = NS). In these patients, the annualized event rate was 2.8% and 2.55%, respectively, and was significantly higher than in groups with SCORE < 5 (0.6%) and SCORE 5-9 (0.12%). The most frequent events were non-ST-segment elevation acute coronary syndrome and late revascularization. Predictors of cardiac events were previous CAD, SCORE ≥ 10 or diabetes mellitus, creatinine clearance, left ventricular ejection fraction, and chest pain during EE. CONCLUSIONS: Initial outcome after an EE without ischemia is favorable but is subsequently modulated by cardiovascular risk.

Evolución y repercusión científica de las becas de investigación de la Sociedad Española de Cardiología y la Fundación Española del Corazón (2000-2006) / Evolution and scientific impact of research grants from the spanish Society of Cardiology and Spanish Heart Foundation (2000-2006)

Introducción y objetivos. La Sociedad Española de Cardiología convoca anualmente becas para financiar proyectos de investigación en el campo de las enfermedades cardiovasculares. Nuestro objetivo es identificar la repercusión de estas inversiones durante el periodo 2000-2006 a partir de los artículos derivados de las becas y publicados en revistas científicas. Métodos. Utilizando los datos de identificación de cada proyecto como términos de búsqueda, se recuperaron todos los artículos derivados de estas becas en las bases de datos del Índice Médico Español, el Índice Bibliográfico Español en Ciencias de la Salud, el Science Citation Index-Expanded y Scopus. Los artículos se sometieron a un análisis estadístico descriptivo en relación con la tipología de las becas, la evolución anual de su número y de su importe, el sexo y las instituciones de los becados. Resultados. Se concedieron 207 becas con un importe total de 3.270.877 € y una dotación media anual de 467.268 €. De ellas, 123 (59,42%) aportaron publicaciones derivadas. El promedio de artículos publicados por beca concedida ha sido de 1,12, y de 1,9 si se tiene en cuenta únicamente las becas que dieron lugar a publicaciones. Conclusiones. Durante el periodo 2000-2006, la Sociedad Española de Cardiología/Fundación Española del Corazón destinó casi 500.000 € anuales a financiar becas de investigación y así contribuir a luchar contra las enfermedades cardiovasculares. Casi el 60% de las becas han aportado publicaciones derivadas, 231 artículos. El 73% de los artículos se publicaron en revistas extranjeras y el 91,34%, en revistas españolas o extranjeras con factor de impacto en el Journal Citation Report (AU)

Introduction and objectives. The Sociedad Española de Cardiología (Spanish Society of Cardiology) every year awards grants to finance research in the field of cardiovascular diseases. The aim of this study is to identify the impact of these investments during the period 2000-2006 from the subsequently published articles in scientific journals. Methods. Using the identifying data of each project as search terms, all articles that resulted from these grants were located in the Spanish Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud databases, and in Science Citation Index-Expanded and Scopus. Descriptive statistical analysis of these articles included type of grant, number and amount awarded per year, and the recipient's sex and institutional affiliation. Results. The Sociedad Española de Cardiología awarded €3 270 877 to 207 recipients, an average annual total of €467 268, We identified 231 publications that resulted from 123 (59.42%) of these grants. The average number of articles per grant awarded was 1.12, and 1.9 when taking into account only the awards that led to publication. Conclusions. During the period 2000 to 2006, the Sociedad Española de Cardiología/ Fundación Española del Corazón (Spanish Heart Foundation) provided about €500 000 per year to fund research grants, thereby contributing to the fight against cardiovascular diseases. Almost 60% of grants have led to publications, 73% of which were published in international journals, and 91.34% in national or international journals with an impact factor in the Journal Citation Reports (AU)

[Evolution and scientific impact of research grants from the spanish society of cardiology and spanish heart foundation (2000-2006)]. / Evolución y repercusión científica de las becas de investigación de la Sociedad Española de Cardiología y la Fundación Española del Corazón (2000-2006).

INTRODUCTION AND OBJECTIVES: The Sociedad Española de Cardiología (Spanish Society of Cardiology) every year awards grants to finance research in the field of cardiovascular diseases. The aim of this study is to identify the impact of these investments during the period 2000-2006 from the subsequently published articles in scientific journals. METHODS: Using the identifying data of each project as search terms, all articles that resulted from these grants were located in the Spanish Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud databases, and in Science Citation Index-Expanded and Scopus. Descriptive statistical analysis of these articles included type of grant, number and amount awarded per year, and the recipient's sex and institutional affiliation. RESULTS: The Sociedad Española de Cardiología awarded €3,270,877 to 207 recipients, an average annual total of €467,268. We identified 231 publications that resulted from 123 (59.42%) of these grants. The average number of articles per grant awarded was 1.12, and 1.9 when taking into account only the awards that led to publication. CONCLUSIONS: During the period 2000 to 2006, the Sociedad Española de Cardiología/ Fundación Española del Corazón (Spanish Heart Foundation) provided about €500,000 per year to fund research grants, thereby contributing to the fight against cardiovascular diseases. Almost 60% of grants have led to publications, 73% of which were published in international journals, and 91.34% in national or international journals with an impact factor in the Journal Citation Reports.

Utilidad de la resonancia magnética cardiaca en el diagnóstico de los pacientes con síndrome coronario agudo y coronarias normales / The value of cardiac magnetic resonance in patients with acute coronary syndrome and normal coronary arteries

Introducción y objetivos. Diferentes enfermedades pueden presentar síntomas similares a los del síndrome coronario agudo (SCA): dolor torácico, cambios en el ECG y elevación de marcadores de daño miocárdico. Incluso después de realizar una coronariografía, a veces es difícil establecer el diagnóstico. El objetivo del estudio fue valorar la utilidad de la resonancia magnética cardiaca (RMC) en el diagnóstico de los procesos que se presentan como un SCA y tienen coronarias normales. Métodos. Estudiamos a 80 pacientes con sospecha de SCA y coronarias normales. La media de edad fue 48 ± 15 años. La troponina T media fue 1,8 ± 0,9 ng/ml. Realizamos un estudio de RMC incluyendo secuencias potenciadas en T2 para detectar edema y secuencia I-R de realce tardío (RT) a los 10 min de la administración de gadolinio. Resultados. El diagnóstico final fue miocarditis aguda en 51 pacientes (63%). En todos estos casos observamos RT localizado en el subepicardio y las porciones medias de miocardio. En 12 pacientes (15%) el diagnóstico final fue infarto agudo de miocardio, todos ellos con RT subendocárdico o transmural. En 9 pacientes (11%) con alteraciones de la contractilidad en el ecocardiograma basal y normalización posterior, el estudio con RMC no mostró RT de contraste y se les diagnosticó síndromes de tako-tsubo. En 4 pacientes el diagnóstico final fue pericarditis aguda y en 4 no se pudo establecer un diagnóstico. Conclusiones. La miocarditis aguda y el síndrome de tako-tsubo pueden presentarse en la clínica de forma similar al SCA. La presencia y el patrón de RT de contraste en el estudio de RMC nos ayudan de forma importante a establecer el diagnóstico (AU)

Introduction and objectives. A number of different conditions can present with symptoms similar to acute coronary syndrome (ACS): chest pain, electrocardiographic changes, and elevated levels of markers of myocardial damage. Even after coronary angiography has been performed, differential diagnosis can be challenging. The aim of this study was to evaluate the usefulness of cardiac magnetic resonance (CMR) for diagnosing conditions that present like ACS but in which the coronary arteries are normal. Methods. The study involved 80 patients with suspected ACS and normal coronary arteries. Their mean age was 48 (15) years and their mean troponin-T (TnT) level was 1.8 (0.9) ng/mL. A CMR study, which involved T2 weighted imaging to detect edema and delayed contrast-enhancement (DCE) imaging 10 minutes after gadolinium administration, was performed. Results. In 51 patients (63%), the final diagnosis was acute myocarditis. In all these cases, DCE was observed in subepicardial and middle segments of the myocardium. The final diagnosis was acute myocardial infarction in 12 patients (15%), all of whom exhibited subendocardial or transmural DCE. In the 9 (11%) who exhibited abnormal contractility on baseline echocardiography with subsequent normalization, CMR did not show DCE, a finding that is characteristic of Takotsubo cardiomyopathy. In addition, 4 patients had a final diagnosis of pericarditis, while no diagnosis could be established in another 4. Conclusions. The clinical presentation of acute myocarditis and Takotsubo syndrome can be similar to that of ACS. The presence and distribution of DCE on CMR are of great help in establishing a diagnosis (AU)

The value of cardiac magnetic resonance in patients with acute coronary syndrome and normal coronary arteries.

INTRODUCTION AND OBJECTIVES: A number of different conditions can present with symptoms similar to acute coronary syndrome (ACS): chest pain, electrocardiographic changes and elevated levels of markers of myocardial damage. Even after coronary angiography has been performed, differential diagnosis can be challenging. The aim of this study was to evaluate the usefulness of cardiac magnetic resonance (CMR) for diagnosing conditions that present like ACS but in which the coronary arteries are normal. METHODS: The study involved 80 patients with suspected ACS and normal coronary arteries. Their mean age was 48+/-15 years and their mean troponin-T (TnT) level was 1.8+/-0.9 ng/ml. A CMR study, which involved T2-weighted imaging to detect edema and delayed contrast-enhancement (DCE) imaging 10 minutes after gadolinium administration, was performed. RESULTS: In 51 patients (63%), the final diagnosis was acute myocarditis. In all these cases, DCE was observed in subepicardial and middle segments of the myocardium. The final diagnosis was acute myocardial infarction in 12 patients (15%), all of whom exhibited subendocardial or transmural DCE. In the 9 (11%) who exhibited abnormal contractility on baseline echocardiography with subsequent normalization, CMR did not show DCE, a finding that is characteristic of Takotsubo cardiomyopathy. In addition, 4 patients had a final diagnosis of pericarditis, while no diagnosis could be established in another 4. CONCLUSIONS: The clinical presentation of acute myocarditis and Takotsubo syndrome can be similar to that of ACS. The presence and distribution of DCE on CMR are of great help in establishing a diagnosis.

Electrocardiografía e infarto «posterior»: ¿está resuelto el enigma? / No disponible

No disponible

Documentación clínica. Aspectos legales y fuente de información para las bases de datos hospitalarias / Clinical documentation. Legal status and as a source of information for hospital databases

La legislación sanitaria relacionada con la información, la documentación clínica y los derechos y obligaciones de los pacientes ha evolucionado en sintonía con la sociedad española en los últimos 25 años. Hay 2 leyes fundamentales que afectan a todo el estado: la Ley orgánica de protección de datos de carácter personal y la Ley básica reguladora de la autonomía del paciente y de los derechos y obligaciones en materia de información y documentación clínica. Se describen los detalles más importantes que un médico debe conocer, pues influyen en su práctica clínica. Por otro lado, la documentación clínica es la fuente de información para las bases de datos hospitalarias y mucha información de las historias clínicas se almacena en bases de datos informatizadas. Un médico debe saber que cualquier base de datos clínicos debe ser dada de alta en un registro oficial de bases de datos, que debe tener un responsable y que las transferencias de datos están limitadas por la propia ley. Se describen las bases de datos hospitalarias más relevantes, como el conjunto mínimo básico de datos, los grupos relacionados por el diagnóstico, el fichero de pacientes y el registro de tumores (AU)

Healthcare legislation on patient information and clinical documentation and on the rights and obligations of patients has evolved during the last 25 years in tune with changes in Spanish society. There are two fundamental laws that frame the overall context: constitutional law on the protection of personal data, and statute law regulating patients’ autonomy and their rights and obligations with regard to information and clinical documentation. Here, we describe the most important points that physicians should be aware of because they could have an influence on clinical practice. From another perspective, clinical documentation provides the main source of information for hospital databases, and a substantial amount of information from medical records is stored in computerized databases. The physician should be aware that any clinical database must be entered on an official register of databases, that someone must be designated as being responsible for the database, and that any transfer of data is limited by the appropriate law. This article also contains descriptions of the most important hospital databases: the Minimum Basic Data Set, Diagnosis-Related Groups, patients’ files, and cancer registers (AU)

[Update in cardiac imaging techniques. Echocardiography and magnetic resonance imaging]. / Actualización en técnicas de imagen cardíaca. Ecocardiografía y cardiorresonancia magnética.

This article is a review of the main developments in cardiac imaging techniques reported in publications during 2005. Recent advances in digital technology have led to steadily increasing reliance on imaging techniques in the management of cardiovascular disease. We discuss advances in two techniques that fall under the remit of the echocardiography working group: echocardiography and magnetic resonance imaging.

Actualización en técnicas de imagen cardíaca. Ecocardiografía y cardiorresonancia magnética / Update in Cardiac Imaging Techniques. Echocardiography and Magnetic Resonance Imaging

En este artículo se revisan los principales avances publicados en diferentes técnicas de imagen cardíaca durante el año 2004. Los recientes avances en la tecnología digital han hecho que el clínico se apoye cada vez más en las técnicas de imagen no invasiva para el diagnóstico de las enfermedades cardíacas. Comentamos algunas novedades en ecocardiografía y cardiorresonancia magnética (AU)

This article is a review of the main developments in cardiac imaging techniques reported in publications during 2005. Recent advances in digital technology have led to steadily increasing reliance on imaging techniques in the management of cardiovascular disease. We discuss advances in two techniques that fall under the remit of the echocardiography working group: echocardiography and magnetic resonance imaging (AU)

Ecocardiografía. Impacto de las nuevas tecnologías / Echocardiography. Impact of New Technologies

Los recientes avances en el campo de la tecnología digital han dado lugar a un enorme progreso en las diferentes modalidades de imagen cardíaca. Estos grandes avances han hecho que el clínico confíe y se apoye cada vez más en las técnicas de imagen para el diagnóstico de las enfermedades cardíacas. La ecocardiografía se ha convertido en la modalidad de imagen cardíaca más utilizada en todo el mundo. Los equipos de ultrasonidos de alta gama que tenemos en la actualidad tienen integradas numerosas funciones que los hacen verdaderamente complejos. Un importante reto de los cardiólogos es conseguir llegar a entender las características de las nuevas modalidades de imagen y conocer su impacto clínico. Debido a la sofisticación de los sistemas, el incremento en el número de las indicaciones y las complejas cuestiones clínicas que se plantean, serán necesarios programas de entrenamiento específico y probablemente obtener acreditaciones en los diferentes desarrollos tecnológicos. En este artículo revisamos el impacto que ha tenido el desarrollo de algunas de estas técnicas, como la imagen armónica, la ecocardiografía de contraste miocárdico para estudios de perfusión, la ecocardiografía intracardíaca y la ecografía tridimensional (AU)

Recent advances in digital techniques have resulted in an enormous progress in complex cardiac imaging modalities. These advances will accelerate our reliance on imaging techniques for management of cardiovascular disease. With the increasing number of functions and the availability of Doppler assessment, ultrasound has become the most widely disseminated cardiac imaging technology. Currently available cutting edge technology ultrasound systems have integrated many functions that make them very complex. An important challenge for clinicians is to understand the characteristics of new ultrasound imaging modalities. Because of the sophistication of the systems, the increasing number of indications and the complexity of the clinical questions, the need for specific training programs and certification will grow. In this article the impact of some of the recent technical developments: harmonic imaging, myocardial contrast, intracardiac echocardiography and real-time 3-D echocardiography, is reviewed (AU)