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Biomedical subjects

D Martínez Caro

Publications and source records attributed to D Martínez Caro.

At least 19 recordsLinked to original sources
PubMed1997

[Myocardial perfusion reserve studied by single-photon emission-computed tomography with thallium-201 and a drug stress test with adenosine triphosphate in patients with cardiovascular risk factors].

INTRODUCTION AND OBJECTIVE: Recent studies have suggested that the evaluation of coronary reserve is a sensitive method in the early detection of vascular alterations before plaques exist, and certainly before clinical detection of atherosclerotic lesions. Single-photon emission-computed tomography (SPECT) with thallium-201 (201Tl) provides a noninvasive tool for evaluating myocardial perfusion reserve. The objective of this study was to measure the myocardial perfusion reserve in two groups of subjects, some with and some without cardiovascular risk factors and in a group of patients with coronary artery disease. METHODS: Seventy-four subjects, divided into three groups, were recruited to assess regional and global myocardial perfusion reserve. The control group consisted of 11 asymptomatic individuals without cardiovascular risk factors. The second group was composed of 49 patients with one or more risk factors. Finally, the third group included 14 patients with coronary artery disease. 201Tl-SPECT at rest and after pharmacological stress with a 7 minute adenosine triphosphate (ATP) infusion (140 micrograms/kg/min) was performed in all patients. ATP minus rest value subtraction was applied in order to obtain the stress data. Relative myocardial perfusion reserve indices were calculated as the ratio between stress and rest values. RESULTS: Global and regional myocardial perfusion reserves of the vascular territories were significantly lower in patients with cardiovascular risk factors than in control subjects (Global: 1.48 +/- 0.19 vs 1.81 +/- 0.08, LAD: 1.52 +/- 0.21 vs 1.85 +/- 0.09, CX: 1.45 +/- 0.2 vs 1.79 +/- 0.86, RCA: 1.47 +/- 0.2 vs 1.79 +/- 0.86) and higher than in patients with coronary artery disease (Global: 1.48 +/- 0.19 vs 1.31 +/- 0.14, LAD: 1.52 +/- 0.21 vs 1.35 +/- 0.15, CX: 1.45 +/- 0.2 vs 1.2 +/- 0.24). Univariate linear regression analysis in a group of 40 patients with high risk lipid profiles revealed a significant negative correlation between myocardial perfusion reserve and total cholesterol (r = -0.35; p = 0.01), LDL-cholesterol (r = -0.38; p = 0.036) and LDL/HDL ratio (r = -0.39; p = 0.029). CONCLUSION: Determination of myocardial perfusion reserve with 201Tl-SPECT allows the detection of abnormal vasodilatory response to intravenous ATP in patients with cardiovascular risk factors. These patients have higher reserves than patients with coronary disease, which might suggest an early phase of atherosclerosis.

Adenosine Triphosphate↗
PubMed1993

[Acute non-lethal complete occlusion of the left main coronary artery].

Myocardial infarction secondary to total obstruction of the left main coronary artery is an infrequent finding in clinical practice. Even though this disease usually results in high mortality rates, various cases have been described documenting survival after complete occlusion of the left main trunk. We present a patient who survived after a massive myocardial infarction due to total obstruction of the left main coronary artery. Orthotopic cardiac transplantation was subsequently performed with good results.

Acute Disease↗
PubMed1992

[Changes in diastolic function in heart rejection: role of Doppler echocardiography].

In acute cardiac rejection, left ventricular diastolic function is altered. To study these abnormalities and their utility in cardiac allograft rejection, we studied 56 cardiac transplant recipients. All patients were assessed with endomyocardial biopsy and Doppler echocardiography done in the same day. A total of 163 Doppler studies were recollected. Cardiac transplant recipients were excluded during the early 6 weeks postoperative period. Totally, 100 biopsies were normal, 48 positive for mild rejection (Billingham Gde I-II) and 15 positive for moderate or severe rejection (Billingham Gde III-IV). Compared to negative biopsies, during acute rejection left ventricular wald thickness significantly increased (p < 0.05); isovolumic relaxation period and pressure half-time significantly decreased (p < 0.05, p < 0.001 respectively). Nevertheless, increase in peak early mitral flow velocity was only significantly associated with severe rejection (p < 0.001). Correlating only progressive shortening of isovolumic relaxation period parameter in the diagnosis of graft rejection, we forward a high sensibility (85%) and low specificity (57%). Thus, Doppler echocardiographic evaluation of left ventricular diastolic function provides a non-invasive tool for early detection of acute rejection monitoring after the early postoperative period.

Adult↗
PubMed1989

[Value of the stress test in patients with coronary spasm].

UNLABELLED: Ninety-one consecutive patients with angiographically documented spasm who performed a bicycle stress test within one week before diagnostic coronary angiography are studied. Stress test induced ST elevation in 8 patients (9%), ST depression in 37 (41%) and no ST shifts in 46 (50%). ST response to exercise did not correlate with any of the clinical variables assessed except for coronary anatomy. ST depression was a highly specific sign of underlying coronary lesions, with a high positive predictive value (89%). Patients were stratified according to the type of angina and their post-test probability of significant coronary disease was calculated following Bayes' theorem. The post-test likelihoods of significant coronary stenosis (positive and negative test, respectively) were: 82 and 37% for patients with angina at rest; 90 and 53% for those with effort angina, and 98 and 85% for those with mixed angina. IN CONCLUSION: 1) stress testing in patients with coronary spasm correlates well with coronary anatomy; 2) ST depression strongly suggests the presence of underlying coronary stenosis; 3) stress testing is especially useful in patients with angina exclusively at rest.

Adult↗
PubMed1984

[Clinical characteristics of patients with coronary spasm demonstrated angiographically].

We studied a group of 112 patients with angiographically documented coronary artery spasm (CAS). In 102 of them (91%) was methylergonovine-induced. Mean age was 51,25 +/- 8,5, ranging from 28 to 76 years. Only 6 were females. We analized the prevalence of coronary risk factors; among them, heavy smoking was prominent. Clinical manifestations were: angina at rest 62%, effort angina 9%, mixed angina 24%, acute myocardial infarction 2%, asymptomatic with previous infarction 3%. Basal ECG was not a useful diagnostic tool, because in more than 50% of patients it was normal. Conversely, ECG during chest pain episodes was very useful, because only in 9% of patients it showed no changes. The most frequent alteration was ST segment elevation, observed in 53% of cases. Arrythmias during angina episodes were documented in 25% of cases. Stress test was negative in 50% of patients. Moreover, ST-segment depression was observed in 34% of patients.

Adult↗