[A clinical screening can predict coronary artery disease in women]. / Un cribado clínico puede pronosticar la enfermedad arterial coronaria en la mujer.

INTRODUCTION AND OBJECTIVE: Cardiovascular disease is the leading cause of death in women. Approximately one of every two women will die of some cardiovascular event, such as myocardial infarction. Thereby, the significance of discarding or confirming coronary artery disease in women presenting with chest pain. The objective of this trial was to demonstrate that on the bases of the Douglas and Ginsburg's clinic screening, it is possible to predict the existence of coronary artery disease in the angiography. MATERIAL AND METHODS: For this research only women with angina pectoris were included. These were 189 patients (cineangiographies) whose clinical determinants and angiographic findings were related. RESULTS: Taking in to account the estimated likelihood, there was a low-risk group A with 29 patients, a moderate-risk group B with 55 patients and a high-risk group C with 105 patients. There was no significant coronary artery disease in the first group, there was a significant coronary artery disease in 13 patients in the second group and 72 patients in the third group. Group A had 0%, 72%, 0% and 47%, group B 15.2%, 59.6%, 23.6% and 46.3%, and group C had 84.7%, 68.3%, 68.5% and 84.5%, of sensibility, specificity, positive and negative predictive value, respectively. CONCLUSION: The usage of the Douglas and Ginsburg's clinic Screening is very effective at the time of deciding whether to perform a coronary angiograpy or not, and it has very good correlation between the probability degree and the presence of coronary artery disease in the coronary angiography.

Percutaneous balloon mitral valvuloplasty: early and late results according to surgical risk and echocardiographic score.

OBJECTIVE AND DESIGN: Early results, complications and follow-up of 70 patients undergoing percutaneous balloon mitral valvuloplasty (BMV) were retrospectively analyzed to establish whether an increased surgical risk or an unfavourable echocardiographic score influenced the results. PATIENTS: The patients were divided into two groups according to the presence (group A, n = 31) or absence (group B, n = 38) of high surgical risk factors. The patients were also divided into two other groups according to the presence (group C, n = 46) or absence (group D, n = 20) of favourable mitral valve anatomy. Group A (high surgical risk) included patients fulfilling at least one of the following criteria: 65 years of age or older; previous surgical commissurotomy; depressed left ventricular function; respiratory or hepatic insufficiency; or previous aortic valve replacement. Mitral valve anatomy was classified as 4 to 16, according to the echocardiographic score established by Abascal et al. Group C patients had echocardiographic score below 8 and group D had echocardiographic scores of 8 or greater. INTERVENTIONS: Mean mitral valve gradient (MVG) and area (MVA) were Doppler-estimated immediately before and 48 h after the BMV. MAIN RESULTS: There were no differences in the early results and complications between groups A and B (MVA 1.8 +/- 0.5 versus 1.9 +/- 0.4 cm2). Final MVA was significantly greater in group C than in group D (MVA 1.9 +/- 0.4 versus 1.6 +/- 0.4 cm2; P = 0.03). There was no difference in the incidence of complications. Over a follow-up period averaging 19.1 months (range 1 to 55), 90.7% of the patients were in New York Heart Association functional class I or II. Four patients had a mitral valve replacement, one had a surgical commissurotomy and one had a second BMV. Two unrelated deaths occurred. There were no differences in the characteristics of the study population and the incidence of events in the follow-up period between groups. CONCLUSIONS: The results and outcome of BMV were unrelated to the general surgical risk, suggesting that this procedure may be used with particular benefit in this group of patients. In contrast, mitral valve anatomy must be considered as an important determinant of the results.