Biomedical subjects

F Picó Aracil

Publications and source records attributed to F Picó Aracil.

14 recordsLinked to original sources

PubMed2000

[Subacute thrombosis with antiplatelet treatment in a non-selected population of intracoronary stents: incidence and predictors].

INTRODUCTION: After coronary stenting, the incidence of subacute stent thrombosis have been reduced to 0% using aspirin and ticlopidine, in studies with selected populations and intracoronary ultrasounds. OBJECTIVE: To evaluate the incidence and predictors of subacute stent thrombosis in a nonselected population, using antithrombotic therapy. METHODS: We studied 285 stents, consecutively and successfully implanted in 268 lesions of 226 patients. We used high pressure balloon inflation without intracoronary ultrasound. Post-stenting protocol included aspirin and ticlopidine during four weeks with no anticoagulation. We defined subacute stent thrombosis as death, acute myocardial infarction myocardial infarction or angiographic occlusion of stent, with TIMI flow 0-1, after the first 24 hours and during the first month. RESULTS: Four patients presented events (1.7%): Three nonfatal myocardial infarction after discharge, with documented angiographic thrombosis of stent, and one death due to in-hospital myocardial infarction. All three non-fatal AMI, occurred in vessels less than 3 mm (p = 0.07) and in patients taking aspirin without ticlopidine (p < 0.001). After discharge, three (17%) of 18 patients with inadvertent discontinuation of ticlopidine presented subacute stent thrombosis, in contrast to none of 25 patients taking ticlopidine without aspirin. Excluded patients with discontinuation of ticlopidine, the incidence of subacute stent thrombosis was 0.5%. CONCLUSION: After intracoronary stenting in a nonselected population, using antithrombotic treatment with aspirin and ticlopidine, we may expect a rate of subacute stent thrombosis about 1%. Ticlopidine seems to have the main role in preventing subacute stent thrombosis, above all in predisposing circumstances as small vessels.

Acute Disease↗

PubMed2000

[Usefulness of predictors of angiographic restenosis to predict clinical restenosis after coronary stent placement].

INTRODUCTION: After coronary stenting, several predictors of angiographic in-stent restenosis have been identified in different studies, however, little is known about predictors of clinical restenosis, a more functional aspect of coronary restenosis. AIM: To assess whether risk factors for angiographic restenosis previously described, are able to predict clinical restenosis and at what rate in current practice. PATIENTS AND METHODS: 216 consecutive patients (271 stents in 256 lesions) with procedural success were followed-up for 17.6 +/-10 months during periodic visits. Clinical restenosis was defined as the presence of symptoms or signs of myocardial ischemia, associated with >= 50% diameter stenosis on the angiogram. RESULTS: Clinical restenosis occurred in 33 lesions (13%), which were revascularized with 34 stents associated with unstable angina in 29, acute myocardial infarction in three and death in one case. Multivariate analysis identified as independent predictors of clinical restenosis, a vessel diameter less than 3 mm (p < 0.001, OR 4.5), a restenotic lesion (p = 0.01, OR 2.9) and the presence of residual stenosis by visual estimate (> 0%) after implantation (p = 0. 02, OR 2.5). These three risk factors explained most clinical restenosis (73%), with rates of 22% when at least one was present and 4% in absence of all these. The presence of diabetes mellitus, the location in the anterior descending coronary artery or at coronary ostium, and the number or total length of stents per lesion did not achieve an independent, significant association as predictors of clinical restenosis. CONCLUSIONS: Most clinical restenosis after coronary stenting can be predicted by the restenotic character of the revascularized lesion, the diameter of the vessel being less than 3 mm and the presence of residual stenosis by visual estimate at the end of procedure.

Aged↗

PubMed1998

[Role of adenosine triphosphate (ATP) in head-up tilt-induced syncope].

INTRODUCTION AND OBJECTIVES: Recent studies have demonstrated that adenosine is an endogenous modulator of the cardiac excitatory afferent nerves, and could provoke a vasovagal response during head-up tilt test. Isoproterenol has been the drug of choice to increase the sensitivity of this testing. The aim of the present study was to analyze the role of adenosine in head-up tilt-induced syncope in susceptible patients, and to compare the relative sensitivities of adenosine and isoproterenol. METHODS: Thirty patients with unexplained syncope (16 female and 14 male, mean age 37.1 +/- 18 years), no heart disease and negative baseline head-up tilt test were studied. After the baseline test, patients were randomized to receive adenosine triphosphate (bolus injections of 3, 6 and 9 mg/ 5 min) or isoproterenol (bolus injections of 2, 4 and 6 micrograms/5 min) and underwent a second tilt test. After 15 min at rest, patients received the alternative drug and a third test was performed. Eleven normal control subjects were tested with adenosine in the upright position to determine its effects. RESULTS: A vasovagal response was induced in 7 patients (23.3%) after ATP administration. Nine patients (30%) showed a positive response with isoproterenol. Only 2 patients (6.6%) showed a positive response with both drugs. Of the control subjects, one (9%) had a vasovagal response after ATP administration. CONCLUSIONS: We conclude that adenosine triphosphate seems to be a useful tool to provoke vasovagal reaction in susceptible patients during head-up tilt test.

Adenosine Triphosphate↗

PubMed1997

[Long-term prognosis of patients with syncope of unknown origin in prolonged asystole induced by the head-up tilt test].

INTRODUCTION AND OBJECTIVES: Prognosis and therapeutic assessment of patients with syncope and prolonged asystole during head-up tilt test remain unclear. The aim of the present study was to analyze the clinical evolution of patients with syncope of unknown origin, no heart disease and severe cardioinhibitory response induced by head-up tilt. METHODS: A prospective follow-up study was performed in 12 patients (6 male and 6 female, mean age 31 +/- 20 years) with recurrent syncope, no heart disease and affected by severe cardioinhibitory syncope induced by head-up tilt test. This was defined as syncope or near-syncope induced by baseline or isoproterenol tilt with asystole of > or = 3 seconds. All patients were re-tilted twice: with salt and fluid and with metoprolol (25 mg/b.i.d). According to the results of these tests, 5 patients were discharged with dietetic measures (salt & fluid) and 5 with metoprolol. In 2 patients who showed recurrent prolonged asystole a DDD pacemaker was implanted. RESULTS: After follow-up of 34 +/- 20 months all patients ae alive. The number of recurrences was small (2 syncopes and 2 near-syncopes). No relationship was observed between the number of syncopal recurrences and the applied treatment. CONCLUSIONS: We conclude that prolonged asystole induced by head-up tilt test does not confer an adverse prognosis in patients with syncope of unknown origin and no heart disease, thus, the clinical evolution of these patients is benign.

Adult↗

PubMed1996

[Percutaneous extraction of intravascular foreign bodies: a series of 38 cases].

BACKGROUND AND OBJECTIVES: Retained foreign bodies or embolization in cardiac chambers is a relatively common clinical problem. As experience was acquired, it became apparent that failure to remove such fragments could result in morbility or mortality. In the past, surgical removal was the only method available. We present our experience of percutaneous extractions of embolized foreign bodies. The technical aspects are discussed. PATIENTS AND METHODS: Twenty eight cases (age between 1 and 80 years) of cardiac and intravascular foreign bodies seen in two hospitals are reported. Seventeen were plastic catheters or fragments (two were radiotransparent), 5 guide wires in vena cava, right atrial and ventricle, pulmonary artery and abdominal aorta, 4 patients had pacemaker electrodes in the right atrium or ventricle. Stent embolization was observed in two patients. The stents were stripped from the delivery catheter and removed from iliac artery. A pigtail catheter was sometimes used to remove the fragment found in the right ventricle. In 8 cases the capture and extraction was made using a loop snare with a 0.025 inch guide J-wire device folded in half at its midsection and inserted through a long introducer, and in another 20 cases a Dormia basket system was used. In all four patients with pacemaker electrodes, simple counteraction was used with a 10 F left coronary directional atherectomy guide catheter. RESULTS: In two patients removal was impossible--in one the pacemaker electrode was caught but not retrieved because was densely adhered to the endocardium for several years; in another a guide wire was found in a child one year old--. In the other 26 patients, foreign body extraction was performed percutaneously without any complication with a basket or snare; only in one case (a radiotransparent catheter) both systems were used. CONCLUSIONS: Percutaneous removal of centrally embolized foreign bodies, cardiac or vascular, is a safe and successful procedure. The basket system needs to be used more carefully.

Adult↗

PubMed1995

[Usefulness of early exercise test after anterior infarction in the diagnosis of multivessel disease].

OBJECTIVE: The aim of the present study was to determine the reliability of early exercise test to detect multivessel disease in survivors of an uncomplicated first anterior Q-wave myocardial infarction. METHODS: Among 100 consecutive patients 64 (aged 55 +/- 10 years) were included in the study. Thirty-four patients (53.1%) received thrombolytic therapy and this was considered successful, by means of non-invasive criteria, in 24 patients (37.5%). A standard symptom-limited exercise test, 11-15 days after myocardial infarction, and coronary arteriography, < 72 hours later, were performed in all patients. RESULTS: On exercise test 6 (9.3%) patients developed significant ST segment depression, 48 (75%) significant ST segment elevation, 5 (7.8%) ST depression in inferior leads together with ST elevation in anterior leads and 3 (4.6%) angina. Of the 18 patients with multivessel disease 5 (27.8%) developed ST depression, 10 (55.5%) ST elevation, 1 (5.5%) ST depression in inferior leads together with ST elevation in anterior leads and 1 (5.5%) angina. CONCLUSIONS: Our study indicates that ST depression in a symptom-limited exercise test performed early after an anterior Q-wave acute myocardial infarction is unusual and has low sensitivity (27.8%) to detect multivessel disease. ST elevation is the more common finding in this test (75%) and has no relation with the severity of CAD.

Adult↗

PubMed1995

[Use of transdermal scopolamine in the prevention of neuro-cardiogenic syncope induced by the tilt test].

INTRODUCTION AND OBJECTIVES: The underlying mechanism of syncope induced by head-up tilt test is still incompletely understood. It has been proposed a sudden increase in parasympathetic's activity induced by the excessive activation of the cardiac mechanoreceptors. The aim of our study was to evaluate the clinical, electrocardiographic and hemodynamic responses to head-up tilt test before and after treatment with transdermal Scopolamine (anticholinergic agent). METHODS: We studied 17 patients (8 females, 9 males; mean age 43 +/- 19 years) with > or = 2 syncopal episodes of unknown origin and a positive tilt test (a positive response to tilt testing alone or in conjunction with an infusion of isoproterenol was defined as the appearance of syncope or presyncope associated to hypotension and/or bradycardia). Symptoms developed in 12 patients during the baseline tilt (Group I) and in 5 patients after infusion of isoproterenol (Group II). Mean time to symptoms was 8.5 +/- 7.9 minutes in group I. All patients were them treated with transdermal Scopolamine (1.5 mg/24 hours) and 48 hours later tilt test was repeated. RESULTS: In group I, 8 patients (66.6%) became tilt test negative and in the remaining 4 patients mean time before the appearance of symptoms was increased (8.5 +/- 7.9 vs 16.2 +/- 2.5 minutes; p < 0.05). In group II, 3 patients (60%) became tilt test negative and in the remaining 2 patients symptoms developed after an infusion of higher doses of isoproterenol than in the first study. So, with transdermal scopolamine 11 out of 17 patients became tilt test negative and time to symptoms was increased in all of the remaining 6 patients. CONCLUSIONS: Our study suggest that transdermal scopolamine is an usefull treatment in the prevention of neuro-cardiogenic syncope induced by head-up tilt test.

Administration, Cutaneous↗

PubMed1994

[Echocardiography during transesophageal atrial pacing. Its applicability and diagnostic value].

INTRODUCTION AND OBJECTIVES: Atrial pacing has been proposed as an alternative method to the isotonic exercise, to induce ischemia, and, joined to two-dimensional echocardiography, as one of the main modalities in stress echo. In order to analyse its applicability and diagnostic value in assessing coronary artery disease this study was undertaken. PATIENTS AND METHODS: 52 patients referred to coronarography for suspicion or evaluation of ischemic disease, were submitted to this technique. RESULTS: The study was completed in 44 patients (applicability rate of 84,7%). The results obtained showed a sensitivity, specificity and diagnostic accuracy for the regional wall motion abnormalities echocardiographically detected, of 88%, 68% and 79%, respectively. When electrocardiographic changes or presence of angina during atrial pacing were added to echocardiographic data, sensitivity increased to 96%. In 41 patients in which a conventional stress test was available, sensitivity was 55% electrocardiographically, 33% clinically and 68% globally. CONCLUSIONS: It is concluded that transthoracic two-dimensional echocardiography during atrial pacing is a safe, highly sensitive method for coronary artery disease detection. The limitations of the method for its routine clinical application are also analysed.

Adult↗

PubMed1993

[Malignant vasovagal syncope: its diagnosis and therapeutic trial based on the orthostatism test (the tilt-table test)].

Seventy consecutive patients with recurrent unexplained syncope were evaluated by use of an up-right tilt-table test for 45 minutes (with or without an infusion of isoproterenol) in an attempt to reproduce symptoms. There were 42 males and 28 females with a mean age of 49 +/- 20 years (range 7-86), and with a mean symptoms duration of 35.2 +/- 16 months. All the patients underwent clinical examination which includes cardiological and neurological evaluation. Some tilt positive patients received therapy with either transdermal scopolamine, metoprolol or clonidine, the efficacy of which was evaluated by another tilt-table test. Syncope occurred in sixteen patients (22.9%), during the baseline tilt associated with hypotension (2 patients), bradycardia-asystolia (3 patients), or both (11 patients). In 11 patients with normal baseline tilt test, isoproterenol infusion was used appearing 4 new cases of abnormal response. Some patients who had positive test results, eventually became tilt-table negative by therapy (5 out of 8 patients treated with scopolamine, 5 out of 6 patients with metoprolol, and 3 out of 5 patients with clonidine). Time before syncope during tilt-test was increased with therapy, being of 45 min in normalized cases, and increasing from 11.9 +/- 16 basal to 34.4 +/- 17 min with scopolamine (p < 0.05), to 40 +/- 12 min with metoprolol (p < 0.05) and to 33.7 +/- 16.7 min with clonidine (p = NS). We conclude that upright tilt-table alone or combined with isoproterenol infusion is an useful test in the diagnosis of vasovagal syncope and in the evaluation of therapy.

Adolescent↗

PubMed1991

[Hypertrophic myocardiopathy (II). 24-hour electrocardiographic monitoring and its relation to the echocardiographic characteristics].

Seventy-two patients with hypertrophic cardiomyopathy were evaluated by 24 hours of electrocardiographic ambulatory monitoring. The results were related to echocardiographic extent of hypertrophy, left ventricular outflow obstruction at rest, and transmitral flow parameters. Also, the symptoms and functional classification of NYHA were related to ventricular arrhythmias. Ventricular arrhythmias were detected in 68% of our patients: high degree of ventricular ectopia in 26 (36.1%), and ventricular tachycardia in 14 (19.4%). Most important supraventricular arrhythmias were: atrial fibrillation in 7 patients, atrial flutter in one, and supraventricular tachycardia in five. Asymmetric hypertrophy type I of Maron classification showed the lower number of ventricular arrhythmias. High degree of ventricular arrhythmias were more frequent in patients with: apical hypertrophy, worse functional classification of NYHA (I: 20%; II: 50%; III: 80%), and in patients with impaired distensibility detected by Doppler (80.7% vs 56.7%; p less than 0.05). There was no relationship between left ventricular outflow obstruction at rest and ventricular arrhythmias.

Adolescent↗

PubMed1990

[Intravenous verapamil in hypertrophic myocardiopathy. A study using Doppler ultrasound].

The effect of one intravenous dose of verapamil on left ventricular diastolic and systolic flow was studied by Doppler-echocardiography in 31 patients with hypertrophic cardiomyopathy. On diastolic flow, verapamil induced a decrease in "a" wave velocity (1.02 + 0.37 vs 0.91 + 0.29 m/seg, p less than 0.01), and in its relation with maximal protodiastolic velocity (1.08 + 0.56 vs 0.89 + 0.37, p less than 0.01), and a shortening in the isovolumic relaxation period (0.076 + 0.031 vs 0.068 + 0.02, p less than 0.05). On the ejection flow, verapamil decreased the peak velocity (2.82 + 1.28 vs 2.42 + 1.18 m/seg, p less than 0.001). Nor age, sex, ventricular mass, gradient, neither hypertrophic cardiomyopathy's classification relates with changes after intravenous verapamil. There were no adverse effects. This study by Doppler-echocardiography confirms the beneficial ++ effect of intravenous verapamil in patients with hypertrophic cardiomyopathy not only on gradient reduction but also in the improvement on left ventricular diastolic function.

Adolescent↗

PubMed1980

[The influence of cardiac frequency on the hemodynamic consequences of mitral stenosis (author's transl)].

In eleven patients with isolated mitral stenosis and regular sinus rhythm a right cardiac catheterization was performed and the wedged pulmonary capillary pressure recorded at rest and during electrical pacing of the right atrium at successive frequencies of 100, 120, 140, and, occasionally, 160 and 180 beats/min, while cardiac output was estimated by the Fick's principle. In all cases a significant elevation of pulmonary capillary pressure with a simultaneous reduction in cardiac output was obtained. The rise of wedged pulmonary pressure was proportional to the increment in cardiac frequency and related also to the calculated area of the mitral valve. The influence of active atrial contraction upon pulmonary pressure and cardiac output is discussed and comparisons with other studies are made. Emphasis is made on the value of atrial pacing as a diagnostic method in mitral stenosis, especially in cases in whom classical effort manoeuvres can not be applied or are insufficient to rise cardiac frequency.

Heart Rate↗

PubMedDate not supplied

[QRS in mitral stenosis: Electrohemodynamic correlation].

The electrocardiograms of 50 patients with mitral stenosis in sinus rhythm were reviewed (axis of QRS and T in the frontal and horizontal planes, with each one of their modules, Lewis index and right Sokolow-Lyon, quotient R/R + S in V1, time of beginning of the intrinsecoide deflection of QRS), they were related with the hemodynamic data; and the existence of clear relations between both methods of exploration were confirmed. 1. The QRS axis in the frontal plane kept a good relation with the hemodynamic data (mainly thzontal axis there proved to be a closer relation than in this one. 2. The quotient R/R + S in V1 was the parameter that best correlated with the mean pressure of the pulmonary artery and with the pulmonar capillary pressure. 3. Although the right Sokolow-Lyon index is not a definite criterion for recognizing a right ventricular hypertrophy; it is very useful in correlating the total pulmonary resistances with the mean pulmonary arterial pressure, even if it did not reach pathologic values. The same can be said the Lewis index, although the dependence is less important. 4. The horizontalization of the frontal axis of T becomes more important with the increase in the hemodynamic repercution. 5. As an expression of the systemic hemodynamic alteration, the decrease in time of inscription of the intrinsecoid deflection, of the left ventricle in V6 became evident when the mitral area diminished or by increase of mean pressure of the pulmonary artery. 6. The electrocardiographic characteristics that allow to recognize the existence of a mitral area smaller than 0.8 cm2, with a possibility of error of less than 5% (false positives), are: -- a horizontal axis of QRS less or equal to + 9 degrees -- a right Sokolow-Lyon index of more than 21.56. 7. The existence of a mean pressure of more than 25 mm. Hg in the pulmonary artery can be acknowledged, with a possibility of false positives of less than 5%, by the apparition of one or more of the following data: -- a frontal axis of QRS more or equal to + 87 degrees -- a Lewis index of less than -7.44. 8. The diagnosis of mean pressures of the pulmonary artery of more than 35 mm. Hg can be established, with the same degree of possibility, by: -- a T frontal axis of less or equal to + 10 degrees -- a horizontal axis of QRS of less or equal to + 13 degrees -- a right Sokolow-Lyon index of more than 19.71 -- a quotient R/R + S in V1 more or equal to 0.88. 9. The only finding that permits to establish of a pulmonary capillary pressure higher of 25 mm. Hg, with false positives possibility of less of 5% is: -- quotient R/R + S in higher or equal to 0.07 in V1.

Electrocardiography↗

PubMedDate not supplied

[Long-term follow up of Doppler parameters of ventricular diastolic function after myocardial infarct].

Forty-two survivors of a first transmural, noncomplicated myocardial infarction underwent mitral flow pulsed-Doppler studies both at predischarge time and 1 year later, in order to assess the long-term evolution of diastolic parameters in the absence of reinfarction or revascularization procedures. Results showed a decrease of mean value of E wave peak velocity (59.6 +/- 14 cm/sec vs 46.8 +/- 13 cm/sec, p < 0.001). Mean value of A wave peak velocity remained stable (59.4 +/- 16 cm/sec vs 58.8 +/- 13 cm/sec, p = 0.86). The mean value of the E/A ratio showed a significant decrease during follow-up from an initial value > or = 1 to a final value < 1 (1.08 +/- 0.4 vs 0.82 +/- 0.2, p < 0.01). From the point of view of individual results, only 8 of 22 patients with an E/A ratio > or = 1 before discharge presented the same ratio value 1 year later, whereas only 1 patient with a E/A ratio < 1 before discharge presented a > 1 value of this ratio in the late study. It is concluded that during the first year of evolution after transmural, nonrevascularized, noncomplicated infarction, the left ventricle filling pattern displays a significant change from predischarge phase (mainly protodiastolic with predominant E wave) to late follow-up (mainly telediastolic with predominant A wave). Different hypotheses to explain these results are discussed.

Adult↗