Biomedical subjects
Publications and source records attributed to I Terol.
Clinical and angiographic features are described in a fifty-five years old man, with long-standing clinical manifestations of ischemic heart disease. In addition to severe coronary atherosclerosis, congenital atresia of the left main coronary was present. A description of the coronary anomaly found and a discussion of its meaning and significance are presented.
Conflicting data have been reported about the implications of a decreased right ventricular (RV) contractile reserve (i.e., a < 5% stress-induced increase in ejection fraction [EF]). If a reduced reserve corresponds to ischemia, it will probably be associated with an electrocardiographic marker of RV ischemia, stress-induced ST-segment elevation (increases ST) in leads V3R to V6R. To test this hypothesis, 98 asymptomatic postinfarction patients (27 with RV infarction) were assigned to a dobutamine stress test (maximal dose 40 micrograms/kg/min) with equilibrium radionuclide angiography and electrocardiographic study, including leads V3R to V6R. All but 11 patients underwent coronary angiography. A dobutamine-induced increases ST in VR leads was seen in 24 patients with and in 8 without RV infarction. This electrocardiographic sign was 75% sensitive and 84% specific for the diagnosis of proximal right coronary artery disease. It was 61% sensitive and 74% specific for the detection of reduced RV contractile reserve. Patients with RV infarction had reduced RVEF at rest (38 +/- 9%), but the mean contractile reserve was normal (12 +/- 12%). The contractile reserve was significantly smaller in patients with proximal versus distal or no right coronary artery disease. It was also smaller (P < 0.01) in patients with increased ST versus no increased ST. In conclusion, high doses of dobutamine are useful in assessing RV contractile reserve after acute myocardial infarction. In these patients, a reduced RV contractile reserve is related to proximal right coronary artery disease and is associated with stress-induced increased ST in VR leads.
The meaning of a stress-induced ST-segment elevation (delta ST) after acute myocardial infarction is still controversial. Some studies show it is related to asynergy, and other studies show it is related to ischemia. However, no study has compared the delta ST with both stress-induced ischemia and stress-induced asynergy in the same group of patients. With this purpose, 88 patients were studied 16 +/- 4 days after acute myocardial infarction. They were submitted to a dobutamine stress test on two different occasions 1 to 2 days apart. Dobutamine was infused up to 40 micrograms/kg/min with blood pressure and electrocardiographic controls. Thallium-201 single-photon emission computed tomography was performed during the highest dobutamine dose and 3 to 4 hours later. Equilibrium radionuclide ventriculography was performed at rest and during the highest dobutamine dose. Global and regional (hypokinetic area) ejection fractions were quantified. The ST segment was elevated > or = 1 mm in 33 patients at rest and in 71 during stress. A stress-induced delta ST was seen in 66 patients. Redistribution was detected in 65 patients. Multiple regression analysis showed a significant correlation between ST elevation and thallium defect score both at rest and during stress. No correlation was found between delta ST and redistribution score. However, a significant inverse linear correlation was found between the delta ST and the change in regional ejection fraction: the greater the delta ST, the smaller the change in regional ejection fraction with dobutamine. In conclusion, a stress-induced delta ST is not related to ischemia but to stress-induced left ventricular asynergy.
Celiprolol (C) is a new selective beta 1-blocker with partial beta 2-agonistic activity. The purpose of this study was to explore its antihypertensive efficacy and its short-term effect on systemic vascular resistances (SVR), cardiac output (CO), left ventricular ejection fraction (LVEF), and left ventricular diastolic performance (LVDP). The Doppler technique was used. In an open-label study, 20 hypertensive patients (15 males, 5 females, age range of 29-68 years) with left ventricular hypertrophy detected by echography were daily treated with 400 mg of C in a single dose, for a period of 4 weeks. C reduced significantly the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) (158 +/- 12 vs. 142 +/- 11 mm Hg, p < 0.05 and 101 +/- 6 vs. 87 +/- 4 mm Hg, p < 0.001, respectively) with a decrease in heart rate (74 +/- 12 vs. 67 +/- 8 beats/min, p = NS). The SVR decreased significantly (2,050 +/- 22 vs. 1,495 +/- 23 dyn/s/cm5, p < 0.001) with a slight but not significant increase in the CO (4.5 +/- 0.69 vs. 5.11 +/- 0.82 L/min). The LVEF did not decrease significantly (58 +/- 5 vs. 56.9 +/- 6%, p = NS) while the LVDP was modified favorably, significantly reducing the early diastolic deceleration time (EDDT) (199 +/- 61 vs. 132 +/- 80 ms, p < 0.01) and reducing the isovolumetric relaxation time (IVRT) (167 +/- 16 vs. 117 +/- 23 ms, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of the study was to assess the efficacy and tolerance of the beta1-selective beta-adrenoceptor-blocking agent bisoprolol in patients with chronic stable angina pectoris. A total of 236 outpatients (158 male and 78 female) over 21 years of age (mean age of 57 years and 60 years for men and women, respectively) were included in an open trial of 4 weeks duration. A total of 32.5% of the patients were smokers. After a washout period of at least 1 week, patients were initially treated with 10 mg of bisoprolol o.d. for 2 weeks, after which the dose could be adjusted to 5, 15, or 20 mg in accordance with clinical criteria (efficacy, tolerance). Eighty-eight percent of the patients were maintained on 10 mg of bisoprolol. The frequency of angina attacks was reduced in 89% of all patients: 56% became free of angina attacks. There were no differences in response as related to age and smoking habits. Bisoprolol was well tolerated. Beta-blocker-specific side effects were observed in 12 patients (5.1%). In conclusion, bisoprolol administered once daily appears to be an effective and safe antianginal agent.
INTRODUCTION: The aim of this work was to describe the variables associated to silent ischemia in patients with reversible perfusion defects in poststress myocardial perfusion scintigraphy. METHODS: Tl-201 myocardial perfusion SPECT of 522 patients showing total or partially reversible perfusion defects after exercise testing were quantitatively analyzed retrospectively. Relationship between silent ischemia, size of perfusion defect and presence of risk factors was performed. RESULTS: Ischemia was silent in 412 (73 %) patients. In 176 (33 %) patients exercise test was electrically positive. There were no differences in perfusion defect size between patients with and without angina in exercise test (27 +/- 12 vs 27 +/- 14), but patients with angina had a greater degree of reversibility, in left descending artery (LDA) territory (56 +/- 40 vs 45 +/- 40 p < 0.01). Silent ischemia was more frequently observed in patients with previous acute myocardial infarction (46 % vs 35 %). There was no relationship between the production of exertional angina and the presence of risk factors. CONCLUSIONS: A high number of patients with reversible perfusion defects on SPECT had silent ischemia. Patients with angina during exercise test had more defect reversibility in LDA territory. Silent ischemia is more frequent in patients with previous acute myocardial infarction.
OBJECTIVE: The aim of this study was to compare a recently described method to evaluate endothelial function; the hyperemic reactivity scintigraphy (HRS) with the ultrasonographic flow-mediated dilatation (FMD) in brachial artery and its relationship with myocardial SPECT. METHODS: 42 consecutive patients that underwent myocardial scintigraphy were included. Thirty-six patients had simultaneous measurement of FMD. Both studies were obtained after 5 minutes occlusion of the upper arm with a blood pressure cuff inflated at 250 mmHg. HRS was performed dynamically at rate 1 frame/sec during 3 minutes after intravenous injection of 740 MBq of Tc-99 sestamibi. Time-activity curves allowed obtaining the following indexes: medium hyperemic activity/medium contrallateral activity (MHA/MCA) and maximum hyperemic activity/maximum contrallateral activity (MxHA/CxHA). RESULTS: In 13 patients SPECT was normal. Twenty-nine patients had perfusion defects in scintigraphy. There was relationship between the FMD and the MHA/MCA (r = 0.23; p = 0.018) and the FMD and the MxHA/CxHA (r = 0.18; p = 0.05). Patients with alterations in the SPECT had an index MxHA/CxHA lower than patients with normal SPECT (1.8 +/- 0.2 vs 1.5 +/- 0.4; p = 0.04). We did not find relationship between FMD and alterations in SPECT. CONCLUSIONS: There is relationship between FMD and HRS. HRS is lower in patients with perfusion defects in the SPECT. HRS could provide additional value to myocardial scintigraphy.
We have studied a total of 12,009 school children (age range 6 to 14 years) in order to determine the incidence of thoracic innocent murmurs. 6,816 were male and 5,193 female. A initial clinical evaluation was carried out in the school and the second examination was performed in our hospital. Global incidence of innocent murmurs was 9.57% with a female/male ratio of 1.73. We divided the innocent murmurs according with Fishleder's method: mesocardial systolic murmur (62%), pulmonary systolic murmur (26%), protosystolic apical murmur (7%), "whooping" murmur (5%). Afterwards, children with murmurs were divided in two groups of age and anthropometric characteristics observing a significative increment in the incidence of mesocardial systolic murmur in children which ranged ages from 6 to 10 years (74%) and of the pulmonary systolic murmur in the group of 10 to 14 years (40%).
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