RESUMEN
OBJECTIVES: Mitral annular calcifications (MAC) and aortic plaques are predictive for higher incidence of recurrent embolic events, the presence and severity of coronary artery disease and total cardiac deaths. However, no data exist comparing the impact of combined presence of both aortic plaques and MAC on embolic events, deaths associated with cerebral embolism or cardiac deaths during the follow-up. PATIENTS AND METHODS: In 100 consecutive patients with aortic plaques detected by transesophageal echocardiography (mean age 69.8 + 8.9 years, range 39-93 years, 49 males, 51 females) and in 49 age- and sex-matched control subjects (mean age 69.4 + 7.8 years, range 46-89 years, 27 males, 22 females) without aortic plaques (control group), the incidence of embolic events, deaths associated with embolic events and total cardiac deaths were evaluated during a mean follow-up of 32 +/- 9.7 months. The effect of the presence or absence of MAC on these parameters was also evaluated. RESULTS: Compared with the control group, patients with aortic plaques had a higher frequency of hypertension (p < 0.001), hypercholesterolemia (p < 0.01), smoking history (p < 0.01), MAC (p < 0.00001) and the presence of atherosclerotic changes in the carotid arteries (p < 0.05). During the follow-up, patients with aortic plaques had a higher incidence of stroke or transient ischemic attack (p < 0.0001), deaths associated with stroke (p < 0.005) and total cardiac deaths (p < 0.05) compared with the control group. Patients with both aortic plaques and presence of MAC had during the follow-up a significantly higher incidence of deaths associated with stroke (p < 0.0001, 16.0 times higher) and total cardiac deaths (p < 0.005, 4.7 times higher) compared with those without MAC and the presence of aortic plaques. Multivariant regression analysis showed MAC (p < 0.01) and hypercholesterolemia (p < 0.05) were the only independent predictors of stroke. MAC (p < 0.05) and age (p < 0.000001) were the only independent predictors of total cardiac death and stroke. Independent predictors of both aortic plaques and MAC were coronary artery disease (p < 0.00001), stroke (p < 0.005), hypertension (p < 0.001), female gender (p < 0.01) and hypercholesterolemia (p < 0.005). CONCLUSIONS: The findings of both aortic plaque and mitral annular calcification are highly predictive not only for strokes, but also for deaths associated with cerebral embolism and total cardiac deaths and are probably strong markers for higher severity of coronary artery disease. They are more predictive if both are present simultaneously compared to the presence of either MAC or aortic plaque alone.
Asunto(s)
Calcinosis/complicaciones , Enfermedades Cardiovasculares/mortalidad , Válvula Mitral , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Aorta/complicaciones , Arteriosclerosis/complicaciones , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , MorbilidadAsunto(s)
Trastornos Cerebrovasculares/diagnóstico por imagen , Ecocardiografía Transesofágica , Atrios Cardíacos/diagnóstico por imagen , Embolia y Trombosis Intracraneal/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico por imagen , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Tabiques Cardíacos/diagnóstico por imagen , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/diagnóstico por imagen , Análisis Multivariante , Prevalencia , Estudios Retrospectivos , Trombosis/diagnóstico por imagenRESUMEN
Of 815 patients referred for echocardiographic examination 77 were examined also by the transoesophageal route. The most frequent reason were pathological processes where standard echocardiography provides relatively limited information as well as technically inadequate transthoracic examinations, if the echogenicity of the patient is low. The reasons for examination were complications of myocardial infarctions, a cardiac source of embolization bacterial endocarditis, congenital heart defects, cardiac formations, aortal disease and comatose conditions. Transthoracic echocardiography was positive in 25 cases (32.4%), transoesophageal echocardiography in 44 cases (57.1%). In 15 patients the transthoracic approach was not conclusive from the diagnostic aspect (19.5%). From the results ensues that transesophageal echocardiography has a ca 30% higher sensitivity than transthoracic echocardiography, the specificity being equal. The authors emphasize that the transoesophageal approach is the method of choice in the diagnosis of sources of embolization (auricular appendage), in evaluation of the mitral apparatus, in affections of the thoracic aorta, in the diagnosis of intracardiac formations and defects of the atrial septum. It is very useful in the critically ill, in particular in patients with poor echogenicity. It helps in a significant way to rule out falsely positive transthoracic findings. The examination is safe, relatively well tolerated by out- and in-patients. Transoesophageal echocardiography supplements in an effective way the transthoracic approach but does not replace it.
Asunto(s)
Ecocardiografía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors' own experience as well as literary information on stress echocardiography in diagnosis of ischemic heart disease is presented. Besides dynamic postexercise echocardiography, which they consider to be the most adequate form of stress echocardiography, the authors analyze the possibilities of so-called alternative approaches, i.e. dipyridamole echocardiographic test and the use of transesophageal atrial pacing. The results of the three echocardiographic stress modalities show that their overall informative value is comparable. The practical performance is most favorable in the pharmacologic test, the highest safety is warranted in transesophageal atrial pacing, and tolerance proved to be best in the dynamic postexercise test. On choosing the actual stress modality, the authors recommend to weigh the advantages against the drawbacks before deciding on the approach of choice in the given situation so as to obtain optimal results.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Ecocardiografía/métodos , Estimulación Cardíaca Artificial , Dipiridamol/farmacología , Prueba de Esfuerzo , HumanosRESUMEN
The authors elaborated an automated preventive system and examined by means of it 1000 probands with regard to the incidence of cardiovascular and bronchopulmonary diseases and analyzed the results. In the submitted paper they present the results of an analysis of agreement of conclusions of examination made in the traditional way by the doctor and those obtained in the automated diagnostic preventive system. Agreement in the sense of a positive statement (presence of disease) was recorded in 54.1%, agreement in the sense of a negative finding (disease not detected) was recorded in 28.7%. Falsely negative conclusions (the doctor detected the disease, the system did not) were found in 5.6% and falsely positive conclusions (the doctor did not detect the disease, the system did) were found in 11.6% of the patients. The calculated sensitivity of the system is 0.90 and the specificity 0.72.