RESUMEN
AIM: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. PATIENTS, METHODS: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curves and independent predictors were determined by Cox multivariate analyses. RESULTS: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 +/- 10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p < 0.0001), followed by history of CAD (Hazard Ratio (HR) = 15.9; p = 0.0001), diabetic retinopathy (HR = 10.0; p = 0.001) and inability to exercise (HR = 7.7; p = 0.02). Patients with normal MPI had a low revascularisation rate of 2.4% during the follow-up period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. CONCLUSION: Diabetic patients with normal MPI had an excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a >5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients.
Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Angiopatías Diabéticas/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/métodos , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tecnecio Tc 99m Sestamibi , Radioisótopos de TalioRESUMEN
The therapeutic acquisition to be retained for 2004 are: 1. The elderly patients with heart failure also should receive beta blocker treatment. The correction of anaemia, aggravating factor in heart failure, improves symptoms and survival of the patient. 2. It remains to prove that the treatment of sleep apnea, which seems to be an additional factor for mortality in cardiovascular diseases, is able to reduce the risk. 3. The interventions in the endocanabinoïd system which regulates weight and metabolic processes might be a promising new therapeutic acquisition. 4. Prevention of coronary disease with lipid lowering drugs is still a major topic, and the trend goes the lower the better. The problems observed with Rofecoxybe and other drug interactions reminds us to be conscious when prescribing multiple drugs. 5. The implantable defibrillator seems to be a life insurance in the event of ventricular fibrillation. However, it is not so easy to identify the patient who might really benefit.
Asunto(s)
Cardiopatías , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Desfibriladores Implantables , Cardiopatías/complicaciones , Cardiopatías/etiología , Cardiopatías/terapia , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , Humanos , Factores de Riesgo , Apnea Obstructiva del Sueño/complicacionesRESUMEN
We report the case of a repetitive and incessant activation of mode switch in a dual chamber pacemaker because of the inappropriate sensing by the atrial lead of far-fields signals from the ventricular evoked response. The incidence, consequences and prevention of the oversensing of far-field QRS complexes are discussed.
Asunto(s)
Sistema de Conducción Cardíaco/fisiopatología , Marcapaso Artificial , Anciano , Electrocardiografía , Falla de Equipo , Humanos , MasculinoRESUMEN
In anterior acute myocardial infarction, ST elevation in aVL and ST depression in II, III, and aVF predict a culprit lesion in the left anterior descending artery proximal to the origin of the first diagonal branch, with good specificity and positive predictive value. Inferior ST depression is not related to remote ischemia but represents an electrocardiographic phenomenon reciprocal to ST elevation in aVL.
Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Electrocardiografía , Infarto del Miocardio/diagnóstico , Angiografía Coronaria , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Ventriculografía con Radionúclidos , Reproducibilidad de los Resultados , Volumen SistólicoRESUMEN
A 76-year-old woman had a permanent transvenous DDDR pacemaker implanted for complete atrioventricular block. She was hospitalized 4 years later for recurrent transient ischaemic attacks related to dislodgment of the atrial lead into the left atrium through a patent foramen ovale. The patient was successfuly treated by transvenous extraction of the atrial lead. The follow-up has been uneventful 12 months after the procedure. Left atrially dislodged pacemaker leads have to be retracted under full anticoagulation.
Asunto(s)
Embolia/etiología , Migración de Cuerpo Extraño/complicaciones , Cardiopatías/etiología , Marcapaso Artificial/efectos adversos , Anciano , Femenino , Atrios Cardíacos , Humanos , RecurrenciaRESUMEN
We report the first case of Hb Boumerdes, an alpha chain variant alpha 2(37) (C2) Pro----Arg beta 2, in an Algerian family. The propositus was also homozygous for the sickle cell gene. The abnormal hybrid Hb alpha 2Boum. beta 2S had an electrophoretic mobility on cellulose acetate pH 8.7 electrophoresis between those of Hb S and Hb A2. Its expression was about 16%. The alpha 2Boum. beta 2A fraction has a mobility between those of Hb F and Hb S. The effects of this mutation on Hb oxygen affinity and deoxy Hb S polymer formation were not studied. The propositus' sickle cell phenotype was benign.
Asunto(s)
Anemia de Células Falciformes/genética , Enfermedad de la Hemoglobina SC/genética , Hemoglobinas Anormales/análisis , Mutación , Adolescente , Adulto , Argelia , Niño , Preescolar , Cromatografía Líquida de Alta Presión , Femenino , Enfermedad de la Hemoglobina SC/sangre , Enfermedad de la Hemoglobina SC/etnología , Homocigoto , Humanos , Focalización Isoeléctrica , Masculino , LinajeRESUMEN
The relative proportions of gamma chains of human fetal haemoglobin G gamma, A gamma 75 Ileu (A gamma I) and A gamma 75 Thr (A gamma T) were investigated in homogeneous populations of patients in Algeria exhibiting sickle cell disease and in patients in Algeria and Sardinia with beta-thalassaemia. The restriction site haplotypes within the beta gene cluster were known. The results suggest a tight genetic regulation of the G gamma/A gamma + G gamma ratio (G gamma ratio) which is associated with the G gamma Hind III site of polymorphism (p less than 0.0001). From the present results and those in the literature the high G gamma ratio is associated with the presence of 3 polymorphic restriction sites: Xmn1 5' to the G gamma gene, Hind III in the G gamma IVS II and Hinc II in the psi beta gene. Familial studies showed that the expression of the A gamma alleles is genetically determined. The wide variation of the A gamma T/A gamma T + A gamma I ratio (A gamma ratio) between families is most probably related to the various haplotypes bearing the A gamma I alleles.
Asunto(s)
Hemoglobina Fetal/genética , Argelia , Alelos , Anemia de Células Falciformes/genética , Genotipo , Haplotipos , Homocigoto , Humanos , Italia , Polimorfismo Genético , Talasemia/genéticaRESUMEN
The association between the polymorphism of the A gamma chain of human fetal haemoglobin and the DNA polymorphism at the beta gene cluster has been investigated. The A gamma 75 threonine mutation was found in association with haplotypes II and VI described by Orkin et al. (1982), which share the HindIII cleavage site in the A gamma IVS 2 sequence. The distance between the two polymorphic sites is 868 base-pairs. In contrast, haplotypes I, III, V and IX which do not possess this HindIII cleavage site were associated with the normal A gamma 75 isoleucine allele. The simple detection of the gamma gene polymorphism at the protein level can be useful for identifying DNA haplotypes, and therefore beta thalassaemic mutations.