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BACKGROUND: Apical hypertrophy cardiomyopathy (ACM) is a rare condition characterized by asymmetric myocardial hypertrophy of the apex of the left ventricle. When two-dimensional echocardiography is limited by a poor acoustic window, patients are often referred for MRI. Our hypothesis is that a cheaper and more widely available diagnostic modality like myocardial perfusion single photon emission computed tomography (SPECT) may be helpful in the diagnosis of ACM. OBJECTIVE: The purpose of this prospective study was to define the characteristics of rest and stress SPECT studies in patients with known ACM, and whether SPECT may be helpful in the diagnosis of ACM. METHODS: Adult patients with ACM were enrolled in the study. Diagnosis was made with 2-D echo. A rest and exercise or dipyridamole stress SPECT study was performed in all patients with Tc-99m sestamibi. RESULTS: We enrolled 20 patients (mean age 60 +/- 16 years), 9 were female, with ACM. SPECT at rest revealed in 15 patients (75%) an increased apical tracer uptake, a spade-like deformity of the left ventricular chamber, and the "Solar Polar" map pattern consistent with ACM. The sensitivity, specificity, positive predictive value, and negative predictive value of SPECT for detecting ACM were 75%, 100%, 100%, and 80%, respectively. CONCLUSION: Three-fourths of adult patients with ACM showed, on myocardial perfusion SPECT, characteristic findings which were not seen in age-matched control subjects, such as a significant increased apical tracer uptake, a spade-like deformity of the left ventricle, and the "Solar Polar" map. Nuclear physicians should be aware of these SPECT findings because many ACM patients may first end up in the nuclear labs due to their markedly abnormal ECG for exclusion of obstructive coronary artery disease.

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Introducción La mortalidad atribuida a las enfermedades cardiovasculares se encuentra en primer lugar y en aumento en los países en vías de desarrollo. En la Argentina, las enfermedades cardiovasculares producen, junto con el cáncer, más del 50% de las muertes anuales. En contraposición a las enfermedades infecciosas, éstas se denominan genéricamente enfermedades no transmisibles y se ha demostrado que son prevenibles en gran medida a través del control y el manejo de los llamados factores de riesgo para el desarrollo de enfermedades cardiovasculares. Es por ello que la información sobre la prevalencia y la variación en el tiempo de estos factores de riesgo es fundamental para realizar una vigilancia epidemiológica del problema de las enfermedades cardiovasculares en la población y, a su vez, para proponer acciones comunitarias preventivas. Objetivos Obtener información sobre los factores de riesgo cardiovascular en la población de Tres Lomas (Buenos Aires), calcular el riesgo cardiovascular global (RCG) y comparar estos resultados con los descriptos para toda la Argentina. Material y métodos Se entrevistaron al azar 522 adultos de Tres Lomas. Se utilizó el cuestionario para vigilancia epidemiológica de la OPS y se realizaron mediciones antropométricas. En 100 individuos se determinaron lípidos y glucemia para estimar el RCG, definido como probabilidad de desarrollar un evento no fatal o muerte coronaria en los próximos 10 años. Por último, estas prevalencias se compararon con las estimadas a nivel nacional. Resultados Hubo menor prevalencia de diabetes (7,7% versus 11,9%; p < 0,0001), tabaquismo (27,7% versus 33,4%; p < 0,0054) y depresión (14,4% versus 22,8%; p < 0,0001), aunque más sobrepeso y obesidad que el promedio país (58,4% versus 49,1%; p < 0,0001). Aunque la medición de la tensión arterial fue más frecuente que el promedio (82,2% versus 68,4%; p< 0,0001), las determinaciones de glucemia (50,2% versus 69,3%; p < 0,0001) y de colesterol (60,3% versus 72,8%; p < 0,0001) fueron menos frecuentes que las esperadas. El consumo de frutas y verduras fue mayor que a nivel nacional (82,6% versus 64,7%; p < 0,0001). Por lo menos un quinto de la población presentaría un RCG moderado [21% (13,1-28,9%)] a alto [12% (5,4-18,6%)]. Conclusiones En Tres Lomas se observó una prevalencia menor de diabetes, tabaquismo y depresión y más sobrepeso y obesidad que el promedio país. El control de la tensión arterial fue más frecuente que el promedio, aunque las determinaciones de glucemia y colesterol fueron más bajas que las esperadas. Por lo menos un quinto de la población presentaría un RCG moderado a alto de sufrir un evento coronario o muerte en los próximos 10 años.

Background Cardiovascular diseases are the first cause of mortality in developing countries and deaths attributed to these conditions are increasing. In Argentina, cardiovascular diseases and cancer account for more than 50% of annual deaths. Unlike infectious diseases, these conditions are generically called non-communicable diseases, and it has been demonstrated that they can be prevented through an adequate control and management of cardiovascular risk factors. Thus, it is essential to report the prevalence of these risk factors and how they change over time in order to perform an epidemiological surveillance of the problem of cardiovascular diseases in the population and, in turn, propose preventive community actions. Objectives To obtain information on cardiovascular risk factors in the population of Tres Lomas (Buenos Aires), estimate the global cardiovascular risk (GCR) and compare these results with those described for the whole Argentina. Material and Methods Five hundred and twenty two adults from Tres Lomas were randomly surveyed. The PAHO questionnaire for epidemiological surveillance was used and anthropometric measurements were estimated. Lipid levels and glycemia were determined in 100 subjects in order to estimate GCR, defined as the probability to develop a new non-fatal event or coronary death over the next 10 years. Finally, these prevalence rates were compared to the national estimations. Results The prevalence of diabetes (7.7% versus 11.9%; p<0.0001), smoking habits (27.7% versus 33.4%; p<0.0054) and depression (14.4% versus 22.8%; p<0.0001), was lower than the country's average; however, the rate of overweight and obesity was greater (58.4% versus 49.1%; p<0.0001). Although blood pressure measurement was more frequent than the average (82.2% versus 68.4%; p<0.0001), determinations of glycemia and cholesterol levels were less frequent than expected (50.2% versus 69.3%; p<0.0001 and 60.3% versus 72.8%; p < 0.0001, respectively). Fruit and vegetable consumption was greater than in the whole country (82.6% versus 64.7%; p<0.0001). At least one fifth of the population presented a moderate [21% (13.1-28.9%)] to high [12% (5.4-18.6%)] GCR. Conclusions The prevalence of diabetes, smoking habits and depression was lower in Tres Lomas, although overweight and obesity were more frequent than the country's average. Blood pressure control was more frequent and determinations of glycemia and cholesterol levels were lower than expected. At least one fifth of the population presented a moderate to high GCR of developing a coronary event or death over the next 10 years.

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BACKGROUND: Several methods are available for the assessment of coronary endothelial function, but there are no reports to date regarding the usefulness of cold pressor stress echocardiography (CPSE). OBJECTIVE: To assess regional systolic and diastolic left ventricular function using CPSE in patients with endothelial dysfunction. METHODS: We studied 24 patients, of whom 10 were men, aged 27 to 68 years, who had coronary risk factors and a normal exercise MP-SPECT test. They were compared with 10 normal subjects (6 men), aged 21 to 44 years. All patients underwent a CPSE. RESULTS: The cold pressor-MP-SPECT revealed myocardial ischemia in 10 patients (Group I) and was normal in 14 patients (Group II). All normal subjects (Group III) had normal cold pressor-MP-SPECT. The cold pressor test caused a significant increase in systolic BP in the three groups (baseline 117 +/- 17 mmHg vs. postcold test 137 +/- 16 mmHg, P < 0.05), without changes in heart rate, PR interval, or the corrected QT interval. During the CPSE, no patient developed WMA in 2D echo or changes in regional systolic or diastolic LV function in the pulsed Doppler tissue imaging. CONCLUSIONS: In patients with endothelial dysfunction and no known coronary artery disease, the ischemic response to the cold pressor-MP-SPECT is not accompanied by WMA or changes in regional systolic or diastolic LV function during CPSE. Such negative findings indicate that the amount of ischemia that occurs secondarily to endothelial dysfunction does not involve sufficient myocardial mass to cause contractile dysfunction.

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Introducción Estudios previos han publicado la correlación entre defectos de perfusión miocárdica (PM) SPECT durante la prueba de frío (PF) y la acetilcolina intracoronaria y su utilidad como marcador independiente de disfunción endotelial (DE). Objetivo Analizar la incidencia de positivización de los estudios de PM de esfuerzo en el seguimiento de pacientes asintomáticos con riesgo cardiovascular (CV) moderado y DE detectada con la PF. Material y métodos De 301 pacientes del Registro PARADIGMA (PM SPECT esfuerzo normal y probabilidad clínica < 20% de eventos a 10 años [riesgo moderado por índice de Framingham]), 55 tuvieron PF positiva (+) (18,3%). Se analizaron en forma prospectiva y consecutiva 15 pacientes asintomáticos con PF (+) y un grupo control (GC) de 15 pacientes con PF negativa (-), con apareamiento de sexo, edad y factores de riesgo coronario (FRC), que cumplieron un seguimiento de 12 ± 2 meses, en quienes se realizó una nueva PM SPECT de reposo y esfuerzo. Se utilizó un score de extensión de PM en un modelo de 17 segmentos. Se analizaron los FRC y la incidencia de isquemia en la PM de esfuerzo de seguimiento en cada grupo. Resultado Edad: PF (-) 57,3 ± 8,9 versus TF (+) 52,5 ± 7,5 (p = 0,09). Positivizaron la PM de esfuerzo: grupo PF (+) 5/15: 33,3% y 0 del GC (p = 0,04). Sin diferencias estadísticamente significativas en los FRC entre ambos grupos. Conclusiones Una PM SPECT anormal durante la PF en pacientes asintomáticos con riesgo CV moderado diferenció a aquellos pacientes que positivizaron los estudios de PM de esfuerzo a un año de seguimiento y no hubo estudios anormales en el grupo control.

Introduction Previous studies have published the correlation between myocardial perfusion SPECT (MP) during cold pressor test (CPT) and intracoronary acetylcholine and its usefulness as independent marker of endothelial dysfunction (ED). Objective To analyze the incidence of positivization of MP exercise studies in the follow up of asymptomatic patients with moderate cardiovascular risk (CV) and ED detected by PF. Material and Methods Of 301 patients of the PARADIGMA Registry (normal exercise MP SPECT and clinical probability < 20% of events at 10 years [moderate risk by Framingham index] 55 had positive PF (+) (18.3%). Prospectively and consecutively, 15 asymptomatic patients with PF (+), and a control group (CG) of 15 patients with negative PF, with paired sex, age and coronary risk factors (CRF), that accomplished a 12 ± 2 months follow up, and that underwent a new exercise and resting MP SPECT were analyzed. An MP extension score was used in a model of 17 segments. The CRF and the incidence of ischemia during follow up exercise MP of each group were assessed. Results Age: PF (-) 57.3 ± 8.9 versus TF (+) 52.5 ± 7.5 (p = 0,09). Positivized the exercise MP: PF group (+) 5/15: 33.3% and 0 in the CG (p=0.04). No statistically significant differences between CRF in both groups. Conclusions An abnormal MP SPECT during PF in asymptomatic patients with moderate CV risk differentiated those patients who positivized exercise MP studies at one year follow up and there were no abnormal studies in the control group.

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OBJECTIVES: (1) Evaluate wall motion and perfusion abnormalities after reperfusion therapy of the culprit lesion, (2) delineate the ability of myocardial contrast echocardiography (MCE) to evaluate the microvasculature after reperfusion, in order to distinguish between stunning and necrosis in the risk area. METHODS: We analyzed 446 segments from 28 patients, 10 normal controls (160 segments), and 18 with a first AMI (286 segments). MCE was obtained with Optison and a two-dimensional echocardiography was performed at 3 months post acute myocardial infarction (AMI). RESULTS: In the group with AMI, we analyzed 286 segments, of which 107 had wall motion abnormalities (WMA) related to the culprit artery. Two subgroups were identified: Group I with WMA and normal perfusion (50 segments, 47%) and Group II with WMA and perfusion defects (57 segments, 53%). According to the 2D echocardiogram at 3 months, they were further subdivided into: Group IA: with wall motion improvement (stunning): 18 segments, 36%, Group IB: without wall motion improvement: 32 segments, 64%, Group IIA: with wall motion improvement: 12 segments, 21%, Group IIB: without wall motion improvement (necrosis): 45 segments, 79%. CONCLUSIONS: (1) The presence of myocardial perfusion in segments with WMA immediately after AMI reperfusion therapy predicts viability in most patients. Conversely, the lack of perfusion is not an absolute indicator of the presence of necrosis. (2) Perfusion defects allow to detect patients with thrombolysis in myocardial infarction (TIMI) 3 flow and "no-reflow" phenomenon who will not show improved wall motion in the 2D echocardiogram. However, some patients with initial no-reflow could have microvascular stunning and their regional contractile function will normalize after a recovery period.

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