Prevalencia total de una seriede anomalías congénitas enla isla de Mallorca durante ladécada de los noventa / Total prevalence of a series of birth defects in Majorca (Spain) in the ninetils

Objetivos: Cálculo de tasas de prevalencia total para ciertas anomalías congénitas en Mallorca durante la última década. Material y método: Recopilación de información sobre nacidos desde las 20 semanas de gestación e interrupciones voluntarias de embarazo con historia clínica abierta en nuestros hospitales públicos. Nos valemos de la centralización asistencial existente en nuestra comunidad autónoma para obtener cifras de ámbito poblacional. Resultados: Respecto a los registros poblacionales españoles de malformaciones durante 1990-1996, nuestra prevalencia total (por 10.000) para los defectos del tubo neural es superior a la de Barcelona (12,9 frente a 7,1; p = 0,003), y para la gastrosquisis es más alta que en el País Vasco (2,7 frente a 0,7; p = 0,002), Asturias (0,8; p = 0,028) y Barcelona (0,6; p = 0,007). Por el contrario, para la agenesia renal bilateral es inferior a la del País Vasco (0,7 frente a 2,2; p = 0,035), y para las cromosomopatías es más baja que en el País Vasco (23,7 frente a 31,9; p = 0,006) y el Vallès (33,7; p = 0,012). Si comparamos los quinquenios 1990-1994 y 1995-1999 en Mallorca, aumentan significativamente las prevalencias totales de las cardiopatías septales (30,4 frente a 42,3; p = 0,01), las hidronefrosis (13,1 frente a 19,3; p = 0,048) y las cromosomopatías (19,8 frente a 34,0; p < 0,001).Conclusiones: Las diferencias con los registros poblacionales considerados pueden ser reales u obedecer a discrepancias metodológicas. El aumento evolutivo de la prevalencia total de defectos septales, hidronefrosis y cromosomopatías refleja principalmente una mayor disponibilidad del diagnóstico prenatal (AU)

Truly silent ischemia and the relationship of chest pain and ST segment changes to the amount of ischemic myocardium: evaluation by supine bicycle stress echocardiography.

OBJECTIVES: The objectives of this study were 1) to determine the relationship between the amount of exercise-induced ischemic myocardium and the presence or absence of chest pain and ST segment depression, and 2) to define the incidence and characteristics of "truly silent ischemia," that is, ischemia that is not manifested by symptoms or electrocardiographic (ECG) findings. BACKGROUND: There are no prior data relating ischemia to chest pain and ST depression. Thallium-201 imaging studies have evaluated perfusion but not ischemia. In contrast, supine bicycle stress echocardiography demonstrates exercise-induced ischemic dysfunction. METHODS: Supine bicycle stress echocardiography and arteriography were performed in 130 patients and the severity and geographic extent of ischemic myocardium were compared in three groups. On exercise, Group I patients had both chest pain and ST segment depression (symptomatic ischemia), Group II patients ST depression without chest pain (asymptomatic ischemia) and Group III patients had neither chest pain nor ST depression (truly silent ischemia). RESULTS: There were no differences among groups in arteriographic characteristics. The incidence of "truly silent ischemia" was 43%. The number of abnormally contracting ischemic segments, average score per segment and sum of scores were virtually identical in Groups I and II and significantly greater than in Group III for the patients (p < 0.01 to < 0.0001), for the vessels as a group (p < 0.01 to < 0.0001) and for the left anterior descending (p < 0.01 to < 0.0001) and right (p < 0.05) coronary arteries. By multivariate analysis, positive findings on the stress ECG was the single most significant variable in relation to the amount of ischemia (p < 0.001); exercise chest pain had no significant relationship. CONCLUSIONS: Exercise-induced ST segment depression is the single most significant variable in relation to the amount of ischemic myocardium; exercise-induced chest pain is not related to the amount of ischemia. Patients with "truly silent ischemia" constitute almost 50% of patients with coronary artery disease and have less ischemia than do patients with ECG indications of ischemia, with or without chest pain.

Supine bicycle stress echocardiography: peak exercise imaging is superior to postexercise imaging.

The abilities of peak exercise (PEAK) stress echocardiography versus postexercise (POST) stress echocardiography to detect coronary artery disease were evaluated in 136 consecutive patients undergoing supine bicycle stress echocardiography and coronary arteriography: 42 (31%) had normal coronary vessels, 38 (28%) had single-vessel disease, 34 (25%) had double-vessel disease, and 22 (16%) had triple-vessel disease. The results were as follows: (1) For detection of disease in the group of patients, sensitivity of PEAK versus POST was 94% versus 83% (p < 0.01) and specificity was 88% versus 90%. (2) For detection of disease in specific vessels, sensitivity of PEAK versus POST was 90% versus 72% (p < 0.0001) and specificity was 89% versus 92%. (3) For evaluation of the three major coronary arteries, sensitivity of PEAK versus POST was 96% versus 85% (p < 0.05) for the left anterior descending artery, 90% versus 65% (p < 0.01) for the right coronary artery, and 79% versus 60% (p < 0.05) for the left circumflex coronary artery. There were no differences in specificity. (4) The percent diameter stenosis of vessels normalizing from PEAK to POST versus vessels abnormal at PEAK and POST was 80.6% +/- 16% versus 85.9% +/- 14%, p = 0.07. There were no differences in exercise parameters between patients with and without resolution from PEAK to POST. (5) PEAK versus POST accuracy for identification of patients with multivessel disease was 93% versus 68% (p < 0.001). We conclude that stress echocardiography performed during peak exercise is superior to postexercise stress echocardiography.