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ABSTRACT: Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/month than in those with fewer episodes. Moreover, patients with variant angina pectoris also had greater levels of nitrite and nitrate plasma levels than did control subjects or patients with healed myocardial infarction, partly, perhaps, as a compensatory mechanism.
The American Journal of Cardiology 07/2005; 96(2):204-7. · 3.37 Impact Factor
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Mireia Torregrosa,
Santi Aguadé,
Laura Dos, Rosa Segura,
Antonio Gónzalez,
Artur Evangelista,
Joan Castell,
Carlos Margarit,
Rafael Esteban,
Jaume Guardia,
Joan Genescà
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ABSTRACT: Liver cirrhosis induces cardiac alterations. We aimed to define these alterations and assess their reversibility after transplantation.
Cirrhotic patients (n = 40) and controls (n = 15) underwent echocardiography and stress ventriculography. Fifteen cirrhotics were reevaluated 6-12 months after transplantation.
Cirrhotics had higher left ventricular wall thickness (9.6+/-1.2 vs. 8.8+/-1.2 mm; P < 0.05) and ejection fraction (73+/-6 vs. 65+/-4%, P < 0.001) than controls. Basal diastolic function was similar. During stress, cirrhotics presented lower increases of heart rate, left ventricular ejection fraction, stroke volume and cardiac index (P < 0.05 for all), and diastolic dysfunction with lower ventricular peak filling rate (P = 0.001). Exercise capacity was reduced (48+/-21 vs. 76+/-24 W; P < 0.001). Ascitic patients exhibited more diastolic dysfunction at rest and during stress compared to non-ascitic patients. Liver transplantation caused regression of ventricular wall thickness (10.2+/-1.3 vs. 9.5+/-1.2 mm; P < 0.05), improvement of diastolic function, and normalization of systolic response and exercise capacity during stress (significant increases in heart rate, ventricular ejection fraction, stroke volume and cardiac index; P < 0.05 for all).
Cardiac alterations in cirrhosis present with mild increases in ventricular wall thickness, diastolic dysfunction that worsens with ascites and physical stress, and abnormal systolic response to stress limiting exercise capacity. Liver transplantation reverses these alterations.
Journal of Hepatology 01/2005; 42(1):68-74. · 9.26 Impact Factor
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The American Journal of Gastroenterology 08/2004; 99(7):1400. · 7.28 Impact Factor
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Jaume Candell-Riera,
Guillermo Oller-Martínez,
Osvaldo Pereztol-Valdés,
Joan Castell-Conesa,
Santiago Aguadé-Bruix,
Carmen García-Alonso, Rosa Segura,
Joaquim Murillo,
Rosina Moreno,
Jordi Suriñach,
Jordi Soler-Soler
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ABSTRACT: To analyze the value of early resting myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department.
222 patients (49% women, mean age 61 [13] years) with atypical chest pain and with non-diagnostic ECG were randomized into two groups. Group A comprised 111 patients in whom early resting myocardial perfusion gated-SPECT (<6 hours since the end of chest pain) was performed and CK-MB mass and troponin I were determined at 0, 4 and 8 hours. Group B comprised 111 patients with conventional management in the emergency department without gated-SPECT.
Myocardial perfusion gated-SPECT was positive in all 8 patients with increased levels of CK-MB mass and troponin I. This corresponded to a sensitivity and a negative predictive value of 100% for the diagnosis of AMI. Specificity was 84% and positive predictive value was 33% when doubtful results were considered as negative. The number of patients admitted (18.4% vs 32.7%, P<.027) and length of stay (13 [6] hours vs 15.9 [8.6] hours, P<.009) in the emergency department were lower in group A.
In patients with atypical chest pain and non-diagnostic ECG in the emergency department, early resting gated-SPECT was highly sensitive and showed good negative predictive value for the diagnosis of AMI, but positive predictive value was low. This technique may reduce the number of hospitalized patients and length of stay in the emergency department.
Revista Espa de Cardiologia 03/2004; 57(3):225-33. · 2.53 Impact Factor
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ABSTRACT: Objetivo. Analizar la utilidad de la gated-SPECT precoz de perfusión miocárdica de reposo en los pacientes con dolor torácico y electrocardiograma no diagnóstico en urgencias. Pacientes y método. Se estudió a 222 pacientes (el 49% de mujeres, edad de 61 ± 13 años) con dolor torácico y electrocardiograma no diagnóstico que fueron distribuidos aleatoriamente en 2 grupos: grupo A, con 111 pacientes a los que se practicó una gated-SPECT antes de las 6 h de la finalización del dolor además del manejo estándar (determinaciones de la fracción MB de la creatincinasa masa y troponina I a las 0, 4 y 8 h), y grupo B, con 111 pacientes que sólo recibieron el manejo estándar en urgencias. Resultados. En los 8 pacientes del grupo A con criterios bioquímicos de infarto agudo de miocardio, la SPECT precoz de reposo fue positiva: sensibilidad y valor predictivo negativo del 100%. La especificidad fue del 84% y el valor predictivo positivo del 33% cuando los resultados dudosos fueron considerados como negativos. El número de pacientes ingresados (el 18,4 frente al 32,7%; p < 0,027) y el tiempo de estancia en urgencias (13 ± 6 frente a 15,9 ± 8,6 h; p < 0,009) fueron significativamente inferiores en el grupo A. Conclusiones. En los pacientes con dolor torácico y electrocardiograma no diagnóstico en urgencias, la sensibilidad y el valor predictivo negativo de la SPECT precoz de reposo son muy elevados para el diagnóstico de infarto agudo de miocardio, pero el valor predictivo positivo es bajo. La práctica de esta exploración permite reducir el número de pacientes ingresados y el tiempo de estancia en urgencias.
Revista española de cardiología, ISSN 0300-8932, Vol. 57, Nº. 3, 2004, pags. 225-233.
