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Alfonso Castro-Beiras

Publications and source records attributed to Alfonso Castro-Beiras.

30 records · Page 2Linked to original sources
PubMed2004

Comparison of peak and postexercise treadmill echocardiography with the use of continuous harmonic imaging acquisition.

OBJECTIVES: We sought to compare the feasibility and accuracy of peak and postexercise treadmill echocardiography with the use of continuous harmonic imaging capture. BACKGROUND: Previous work has demonstrated the superiority of peak exercise echocardiography (EE) as compared with post-EE for the diagnosis of coronary artery disease (CAD). However, most of these studies used fundamental imaging and view-per-view acquisition systems. Technical advantages in stress echocardiography include harmonic imaging and continuous imaging capture. METHODS: The study group included 650 patients (423 men; 60 +/- 12 years) who were submitted to peak and postexercise treadmill echocardiography. RESULTS: Postexercise images were acquired within 55 seconds after exercise (28 +/- 10). The number of segments visualized in each view were similar at peak and post-EE except for the parasternal short-axis view, which was better qualified at postexercise. For analysis of diagnostic capability we included 312 patients: 195 were included on the basis of having had an EE and a coronary angiography, whereas 117 patients with pretest probability of CAD < 10% who had atypical chest pain or were asymptomatic were also included and considered as having no CAD. CAD (>/=50% stenosis) was confirmed in 159 patients. Positive EE was defined as ischemia or necrosis. Sensitivity for CAD was higher with peak imaging (92% vs 77%, P <.001), with similar specificity (78% vs 87%, P = not significant) and accuracy (85% vs 82%, P = not significant). CONCLUSION: Peak treadmill EE is technically feasible and has higher sensitivity for CAD than posttreadmill EE. Therefore, in the clinical setting, peak EE should be performed for diagnostic purposes.

Aged↗
PubMed2004

[Real time myocardial contrast echocardiography to predict left ventricular wall motion recovery after reperfused acute myocardial infarction].

INTRODUCTION AND OBJECTIVES: Real time myocardial contrast echocardiography (RTMCE) is a recently developed method. We sought to determine: a) whether RTMCE predicts recovery of left ventricular function after acute myocardial infarction (AMI), and b) whether data obtained with this method are comparable to those obtained with 99mTc-sestamibi single photon emission computed tomography (SPECT) and magnetic resonance. PATIENTS AND METHOD: We studied 85 patients with AMI who underwent angioplasty. RTMCE was performed 7 (4) days after AMI. Two-dimensional echocardiography was performed at the time of the RTMCE study and at follow-up (10 [4] weeks). SPECT and magnetic resonance were performed after AMI in 18 and 32 patients, respectively. RESULTS: Follow-up two-dimensional echocardiography results were available for 82 patients, who were subdivided into 2 groups: recovery (n=49) and no recovery (n=33). Regional (AMI-related) wall motion score index improved from 1.75 (0.49) to 1.32 (0.36) (P< .001) in the recovery group, and worsened from 1.85 (0.39) to 1.95 (0.36) in the no recovery group (P< .001). RTMCE perfusion score was 0.8 (0.3) in the recovery group, and 0.6 (0.4) in the no recovery group (P< .001). Concordance between RTMCE and SPECT in a segmental analysis was 78% (P< .001; kappa=0.49), whereas concordance between RTMCE and hyperenhancement with delayed contrast magnetic resonance findings was 70% (P< .001; kappa =0.35). Independent predictors of recovery were peak creatine kinase (OR=1.4 per 1000 UI; 95% CI, 1.0-1.9; P< .05) and RTMCE score (OR=8.8; 95% CI, 1.9-39.3; P< .01). A RTMCE score > or = 0.60 had a positive predictive value of 73% and a negative predictive value of 69% (P< .001; area under the curve 0.70). CONCLUSION: RTMCE showed a modest predictive value for recovery of left ventricular function after reperfused AMI.

Angioplasty, Balloon, Coronary↗
PubMed2003

Comparison of exercise echocardiography to exercise electrocardiographic testing added to echocardiography at rest for risk stratification after uncomplicated acute myocardial infarction.

Recommendations for risk assessment after acute myocardial infarction (AMI) include electrocardiographic (ECG) exercise testing. We hypothesized that a more sensitive technique, exercise echocardiography (EE), would refer a greater number of patients to invasive procedures. Therefore, we compared a strategy based on EE with a strategy based on ECG exercise testing for patients with uncomplicated AMI. A series of 164 patients referred for exercise testing after AMI were randomized to treadmill EE (strategy 2) or baseline echocardiography and ECG treadmill exercise testing (strategy 1). Ischemic response was more frequently detected with strategy 2 (59% vs 27%, p <0.001), and consequently angiography and revascularization procedures were more commonly performed (59 vs 32 procedures, p <0.01 and 46 vs 19 procedures, p <0.001, respectively). Fourteen percent and 15% of patients experienced soft events (unstable angina, heart failure, or late revascularization) after strategy 1 and strategy 2, respectively (p = NS); 6% and 9% of patients had hard events (nonfatal AMI or cardiovascular death) at follow-up (p = NS). In conclusion, a strategy based on EE detected more patients with ischemia; therefore, more patients were submitted to coronary angiography and revascularization procedures. No differences were detected in cardiac events when we compared this strategy with the less expensive ECG exercise testing after uncomplicated AMI.

Coronary Angiography↗
PubMed2003

Myocardin mRNA is augmented in the failing myocardium: expression profiling in the porcine model and human dilated cardiomyopathy.

The implication of myocardin and homeodomain only protein (HOP) in combinatorial molecular pathways that guide heart development and cardio-specific gene expression has recently been reported. However, expression of these genes in the failing heart has not yet been investigated. This study was designed to elaborate a molecular profile of myocardin and HOP expression in the failing ventricular myocardium through the use of both explanted human heart samples and heart biopsies from neonatal piglets with doxorubicin-induced cardiomyopathy (Dox-CM). Myocardin and HOP mRNA levels were estimated by both northern blot hybridization and semiquantitative RT-PCR in human ventricular preparations in end-stage failure due to dilated cardiomyopathy (DCM), as well as in nonfailing donor hearts. Similar experiments were performed with ventricular samples from normal and Dox-treated neonatal piglets. The gene expression of brain natriuretic peptide (BNP) was used as a molecular marker of myocardial damage and failure. The study revealed the following novel findings: (1) myocardin transcripts are detected in neonatal human and pig hearts at lower levels than in mature cardiac tissues, (2) the myocardin transcript pool is significantly augmented in the failing human and porcine myocardium as compared to that in nonfailing heart samples, (3) in the failing human myocardium, increased levels of myocardin mRNA are associated with a diminished HOP transcript content, and (4) the inverse proportion in cardiac myocardin/HOP mRNA pools observed in explanted human hearts is also traceable in normal human heart and aorta. A possible dual consequence of increased myocardin and decreased HOP expression levels on serum response factor-dependent cardiac-specific expression in the normal heart and at heart failure is discussed. Therefore, increased abundance of the myocardin mRNA pool is judged to be a novel CM-related feature which, alone or in association with decreased HOP transcript levels, can be responsible for dysregulation of myocardin-mediated gene expression in failing myocardium.

Amino Acid Sequence↗
PubMed2003

[Use of anticoagulation at the time of discharge in patients with heart failure and atrial fibrillation].

INTRODUCTION AND OBJECTIVES: To assess the degree of compliance with current guidelines for chronic anticoagulation in patients with heart failure and atrial fibrillation. PATIENTS AND METHOD: From the INCARGAL Study database, we analyzed data from 195 consecutive patients (88 men; mean age 76 10 years) with both conditions, admitted to three Galician hospitals between January and March 1999. It was assumed that these patients should have received anticoagulant therapy at discharge, unless contraindicated. We studied the association of treatment at discharge (anticoagulation or not) with the presence or absence of contraindications. RESULTS: 152 patients (78%) had no contraindication for anticoagulation and 43 had at least one (absolute: 11, relative: 32). Only 50% of patients without contraindications received anticoagulation at the time of discharge. No patient with an absolute contraindication and 3 with a relative one received anticoagulation. Factors related with the less frequent prescription of anticoagulation therapy in patients without a formal contraindication were: age, a previous history of coronary heart disease, absence of valvular heart disease, prior myocardial infarction, treatment with beta-blocking agents, non performance of an echocardiogram, and admission to a department other than cardiology. On multivariate analysis, age, prior myocardial infarction, and non-valvular disease were found to be independent predictors of less use of anticoagulation. CONCLUSIONS: Anticoagulant therapy is used less often than recommended at discharge in patients with heart failure and atrial fibrillation for whom there were no contraindications. Advanced age reduces its use. The presence of other indications for antiplatelet or anticoagulation therapy appears to determine the choice of one or the other. Noncompliance with the guidelines due to overprescription was not found.

Adult↗
PubMed2002

[Familial dilated cardiomyopathy in patients transplanted for idiopathic dilated cardiomyopathy].

OBJECTIVE: To evaluate the prevalence, clinical features, and pattern of inheritance of familial dilated cardiomyopathy (DCM) in heart transplant patients. PATIENTS AND METHOD: Patients with idiopathic DCM who had undergone heart transplantation were invited to participate. Patients with alcohol abuse were excluded. A clinical evaluation, 12-lead ECG, echocardiogram, blood tests, and DNA extraction were performed in patients and relatives. Familial DCM was defined as the presence of at least one relative with idiopathic DCM. Possible familial DCM was considered when at least one relative had left ventricular enlargement (LVE) (> 112% predicted LVEDD). RESULTS: One hundred and ninety-nine relatives of 43 families were studied. DCM was familial in 11 probands (25.6%) and possibly familial in 11 (25.6%). Fifteen relatives had DCM (7.5%), 26 (13.1%) LVE, and 5 (2.5%) hypertrophic cardiomyopathy. The pattern of inheritance was autosomal dominant in most families. Five probands (3 with familial DCM) had antecedents of consanguinity and possible recessive inheritance. Six probands (14%, 1 with familial DCM) had relatives with conduction system defects. Creatine kinase was moderately increased in 9 relatives (4.5%), 3 of them with LVE. Fifteen patients had at least moderate alcohol intake. Three of them had familial DCM (relatives without alcohol abuse) and 6 had possible familial DCM. CONCLUSIONS: The prevalence of familial DCM is high in patients who undergo heart transplant. Left ventricular enlargement, conduction system abnormalities, and elevated creatine kinase may be early markers of familial disease. Hypertrophic cardiomyopathy is present in some relatives of patients with idiopathic DCM. Familial DCM is present in patients with a previous diagnosis of alcoholic DCM.

Biomarkers↗
PubMed2002

Effect of left ventricular global systolic function, mitral regurgitation, and left ventricular inflow pattern on exercise echocardiography results.

Diagnosis of coronary artery disease (CAD) by exercise echocardiography is usually based on rest or exercise-induced regional wall-motion abnormalities. Mitral regurgitation (MR), left ventricular (LV) global systolic function, and LV inflow measurements can be assessed during exercise echocardiography; however, their diagnostic value has not been analyzed consistently. Treadmill exercise echocardiography and coronary angiography were performed in 120 patients (94 male, 26 female; mean age 61 +/- 10 years [+/- 1 SD]) to evaluate known or suspected CAD. Positive exercise echocardiography was defined either as a rest- or exercise-induced regional wall-motion abnormalities. An abnormal response of LV ejection fraction (EF), LV volumes, MR (as assessed by color Doppler), and LV inflow pattern was defined as a fall in LVEF, a LV end-diastolic volume increase, a LV end-systolic volume increase, a new or increased MR, or a change from an impaired relaxation pattern (E < A) to a "pseudonormalized" pattern (E > A) from rest to exercise, respectively. CAD (> or = 50% luminal narrowing in at least one vessel) was found in 89 (74%) patients. EE-based regional wall-motion abnormality analysis was positive in 95 (79%) patients and negative in 25 (21%) patients. Feasible images for regional wall-motion abnormalities, LVEF and volumes, LV inflow, and MR measurements were acquired in 90% of patients. Regional wall-motion abnormality analysis and LVEF decrease provided the greatest sensitivities for CAD (94% and 75%, respectively), while the highest specificity was given by a new or increased MR (90%), the development of a pseudonormalized pattern (88%), and the appearance of angina (87%). A positive electrocardiogram (ECG) finding in patients with interpretable ECGs provided good sensitivity and specificity (67% and 85%, respectively). In conclusion, a complete rest and exercise Doppler echocardiography approach is feasible in most patients. Regional wall-motion abnormalities are the most accurate exercise echocardiography variable for diagnosing CAD, whereas exercise ECG remains a good test in patients with interpretable ECGs. Exercise echocardiography, exercise ECG, newly developed or increased MR, and change to a pseudonormalized LV inflow pattern are highly specific.

Aged↗
PubMed2002

Feasibility of pulsed-Doppler tissue imaging of the interventricular septum during exercise echocardiography.

BACKGROUND: A limitation of exercise echocardiography (EE) is its semiquantitative approach in analyzing wall-motion abnormalities. However, pulsed-Doppler tissue imaging is capable of a systolic and diastolic regional quantitative assessment. METHODS: To investigate the feasibility of performing pulsed-Doppler tissue imaging sampling of the basal left ventricular (LV) septum during EE, we studied 105 consecutive patients (71 men, 34 women, aged 61 +/- 11 years). Harmonic two-dimensional (2-D) echocardiography was performed at rest and peak EE, whereas pulsed-Doppler tissue imaging was performed at rest and immediately after EE. Adequate recordings for peak systolic velocity (Vs) were possible in all patients, but peak early diastolic (Ve) and peak late diastolic (Va) velocities were possible in 78 (74%) patients. Positive 2-D echocardiography was considered as infarction or an ischemic response. RESULTS: Forty-five (43%) patients (Group 1) had wall-motion abnormalities involving the left anterior descending artery (LAD) territory (29 with ischemia, 11 with ischemia and necrosis, and 5 with necrosis), 21 (20%) (Group 2a) had wall-motion abnormalities involving the left circumflex (LCX) and/or the right coronary artery (RCA) territories, and 39 (37%) (Group 2b) had normal EE. Heart rate increased from 72 +/- 17 beats/min to 143 +/- 18 beats/min (P < 0.0001) and systolic blood pressure from 129 +/- 19 mmHg to 174 +/- 26 mmHg (P < 0.001). Coronary angiography was performed in 30 (29%) patients, 29 of whom had positive findings on EE. LAD or diagonal branch coronary artery disease (CAD) (> or = 50% luminal narrowing) was present in 22 patients, 10 of whom had proximal severe stenosis (> or = 70% luminal narrowing). Vs increase was significatively lower in Group 1 (40 +/- 35%, from 6.0 +/- 1.5 cm/sec to 8.1 +/- 2.2 cm/sec) than Group 2a (75 +/- 35%, from 6.3 +/- 1.4 cm/sec to 10.8 +/- 2.1 cm/sec, P < 0.0001) and Group 2b (64 +/- 27%, from 6.7 +/- 1.3 cm/sec to 10.9 +/- 2.0 cm/sec, P < 0.001). Ve was not different at rest and at postexercise between groups. Va was similar at rest but higher at postexercise in Group 2b than Group 1 (11.8 +/- 2.3 cm/sec vs 10.3 +/- 3.0 cm/sec, P < 0.05). Failure to achieve Vs > or = 9.5 cm/sec after exercise was found to be the more accurate limit to detect necrosis or ischemia in the LAD territory according to EE criteria (sensitivity 76%, specificity 78%). When analysis was limited to the 30 patients who underwent angiography, we found that the 10 patients with proximal severe LAD or diagonal branch stenosis showed blunted increases in Vs (increase 9.4 +/- 19%, from 6.5 +/- 1.2 cm/sec at rest to 7.4 +/- 1.7 cm/sec at post-EE; P = 0.17) in contrast to the 20 patients having moderate or nonsignificant stenosis (increase 31 +/- 20%, from 6.2 +/- 1.5 cm/sec at rest to 9.3 +/- 1.8 cm/sec at post-EE, P < 0.0001). A failure to increase Vs > or = 30% had a sensitivity of 90% and a specificity of 80% in detecting proximal severe stenosis. CONCLUSION: Pulsed-Doppler tissue imaging sampling of the LV septum is feasible technically during EE and allows quantification of the regional response. This method may be accurate for detecting proximal severe stenosis in vessels supplying the LAD territory.

Adult↗
PubMed1998

Hemodynamic Comparison by Doppler Echocardiography of Valves in the Aortic Position: Value of the Continuity Equation to Assess Prosthetic Dysfunction.

In 281 patients, we used Doppler echocardiography to compare the hemodynamic performance of different aortic prosthetic valves at three postoperative stages and investigated the value of the continuity equation in diagnosing aortic prosthetic obstruction. A baseline study was performed in 163 patients, a 5 +/- 2-month follow-up study was performed in 103 patients, and a 15 +/- 5-month follow-up study was performed in 65 patients. From baseline to the second study, left ventricular diastolic diameter, heart rate, and maximum (MG) and mean Doppler-derived gradient (MeG) decreased significantly, and left ventricular shortening fraction, systolic blood pressure, stroke volume, and prosthetic valvular area (PVA) increased significantly. No changes were found between the second and third studies. Thus, noninvasive hemodynamic values at the time of follow-up are reported in 171 patients: 86 with Björk-Shiley Monostrut, 27 with Carbomedics, 11 with Medtronic-Hall, 18 with Hancock modified, and 29 with Toronto valve bioprosthesis. Patients implanted with the Toronto had a larger prosthetic size (Monostrut 23 +/- 2 mm, Carbomedics 23 +/- 3 mm, Medtronic-Hall 23 +/- 2 mm, Hancock 23 +/- 2 mm, Toronto 25 +/- 2 mm, P < 0.01) despite a similar body surface area. MeG and MG were lower (MeG [in mmHg] Monostrut 12 +/- 5, Carbomedics 14 +/- 6, Medtronic-Hall 19 +/- 6, Hancock 11 +/- 4, Toronto 7 +/- 5; P < 0.01 between Toronto and all others), and PVA was greater (Monostrut 2.0 +/- 0.7 cm(2), Carbomedics 1.8 +/- 0.8 cm(2), Medtronic-Hall 1.6 +/- 0.7 cm(2), Hancock 1.7 +/- 0.5 cm(2), Toronto 2.2 +/- 0.9 cm(2); P < 0.01 between Toronto and Carbomedics, Medtronic-Hall, and Hancock), even compared with the same sizes in the other valves. A PVA of 0.9 cm(2) or less and MeG of 28 mmHg or more identified prosthetic obstruction with 100% sensitivity and 99% specificity. Hemodynamics change significantly from the early to the late postoperative state. The Toronto valve stentless porcine bioprostheses performs hemodynamically better than other valves. PVA measurement using the continuity equation may accurately identify prosthetic obstruction.

Journal Article↗
PubMedDate not supplied

Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial.

BACKGROUND: In patients with ST-segment elevated myocardial infarction (STEMI), early post-thrombolysis routine angioplasty has been discouraged because of its association with high incidence of events. The GRACIA-1 trial was designed to reassess the benefits of an early post-thrombolysis interventional approach in the era of stents and new antiplatelet agents. METHODS: 500 patients with thrombolysed STEMI (with recombinant tissue plasminogen activator) were randomly assigned to angiography and intervention if indicated within 24 h of thrombolysis, or to an ischaemia-guided conservative approach. The primary endpoint was the combined rate of death, reinfarction, or revascularisation at 12 months. Analysis was by intention to treat. FINDINGS: Invasive treatment included stenting of the culprit artery in 80% (199 of 248) patients, bypass surgery in six (2%), non-culprit artery stenting in three, and no intervention in 40 (16%). Predischarge revascularisation was needed in 51 of 252 patients in the conservative group. By comparison with patients receiving conservative treatment, by 1 year, patients in the invasive group had lower frequency of primary endpoint (23 [9%] vs 51 [21%], risk ratio 0.44 [95% CI 0.28-0.70], p=0.0008), and they tended to have reduced rate of death or reinfarction (7% vs 12%, 0.59 [0.33-1.05], p=0.07). Index time in hospital was shorter in the invasive group, with no differences in major bleeding or vascular complications. At 30 days both groups had a similar incidence of cardiac events. In-hospital incidence of revascularisation induced by spontaneous recurrence of ischaemia was higher in patients in the conservative group than in those in the invasive group. INTERPRETATION: In patients with STEMI, early post-thrombolysis catheterisation and appropriate intervention is safe and might be preferable to a conservative strategy since it reduces the need for unplanned in-hospital revascularisation, and improves 1-year clinical outcome.

Angioplasty, Balloon, Coronary↗