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Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

https://doi.org/10.36660/abc.20210388

Asociación entre el fenotipo hipertrigliceridemia-obesidad abdominal, la resistencia a la insulina y las variables cardiometabólicas en el síndrome de ovario poliquístico
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Carmenate Pérez, Jaylin Vidilia

; Cabrera Rode, Eduardo

; Monteagudo Peña, Gilda

; Peix González, Amalia

; González Sánchez, Rogelio

; González Domínguez, Niurka

; Montes de Oca García, Pedro

Revista Cubana de Endocrinología

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Abr 2021, Volume 32 Nº 1 elocation e271

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT Introduction: The polycystic ovary syndrome is frequently associated to cardiometabolic alterations; and its relation with the hypertriglyceridemic waist phenotype has been poorly studied in Cuba. Objective: Identify the frequency of the hypertriglyceridemic waist phenotype in middle age women with polycystic ovary syndrome and its association with insulin resistance, disorders in the glucose metabolism and subclinical atherosclerosis. Methods: Descriptive, cross-sectional study in 30 women. As clinical variables there were used: age, weight, size, body mass index, waist-hip circumference, waist/hip index, blood pressure; glucose, insulin, total cholesterol, triglycerides, HDL-c and LDL-c concentrations, and HOMA-IR index. Subclinical atherosclerosis was assessed by a carotid doppler and an echocardiogram (left ventricular hypertrophy and epicardial fat). The hypertriglyceridemic waist phenotype was defined as high triglycerides levels (≥ 1.7 mmol/L) and CC ≥ 80 cm. Results: The frequency of the hypertriglyceridemic waist phenotype was 43.3% (13/30). The mean values of abdominal circumference, blood pressure, as well as glycemia (p < 0.003), insulinaemia (p = 0.028), triglycerides (p < 0.0001), and HOMA-IR index (p = 0.012) were higher in the group of women with that condition. Although there were not significant differences, the frequency of women with increase of the carotid intima-media thickness and epicardical fat was higher in those with the phenotype. Conclusions: The presence of the hypertriglyceridemic waist phenotype is frequent in women with the polycystic ovary syndrome, and it is associated with alterations of the glucose metabolism and insulin resistance. This can be used in the clinical practice as a marker of risk for cardiometabolic alterations.

RESUMEN Introducción: El síndrome de ovario poliquístico se asocia con frecuencia a alteraciones cardiometabólicas; y su asociación con el fenotipo hipertrigliceridemia-obesidad abdominal ha sido poco estudiada en Cuba. Objetivo: Identificar la frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal en mujeres de edad mediana con síndrome de ovario poliquístico y su asociación con la resistencia a la insulina, trastornos del metabolismo de la glucosa y ateroesclerosis subclínica. Método: Estudio descriptivo, transversal, en 30 mujeres. Se tomaron variables clínicas: edad, peso, talla, índice de masa corporal, circunferencia de cintura y cadera, índice cintura/cadera, tensión arterial, además de concentraciones de glucosa, insulina, colesterol total, triglicéridos, HDL-c y LDL-c, e índice HOMA-IR. La aterosclerosis subclínica se evaluó por doppler carotideo y ecocardiograma (hipertrofia ventricular izquierda y grasa epicárdica). El fenotipo hipertrigliceridemia-obesidad abdominal se definió como triglicéridos elevados (≥ 1,7 mmol/L) y circunferencia de la cintura ≥ 80 cm. Resultados: La frecuencia del fenotipo hipertrigliceridemia-obesidad abdominal fue 43,3 % (13/30). Los valores medios de circunferencia abdominal, tensión arterial, así como de glucemia (p < 0,003), insulinemia (p = 0,028), triglicéridos (p < 0,0001), e índice HOMA-IR (p = 0,012) fueron más elevados en el grupo de mujeres con esa condición. A pesar de no haber diferencias significativas la frecuencia de mujeres con incremento del grosor íntima-media carotídeo y de grasa epicárdica fue superior en aquellas con el fenotipo. Conclusiones: La presencia del fenotipo hipertrigliceridemia-obesidad abdominal es frecuente en mujeres con síndrome de ovario poliquístico, y se asocia con alteraciones del metabolismo de la glucosa y la resistencia a la insulina. Este pudiera ser utilizado en la práctica clínica como un marcador de riesgo para alteraciones cardiometabólicas.

Estudio de la deformación miocárdica longitudinal en pacientes con cardiopatía isquémica
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Pérez-Barreda, Aylen

; Román-Fernández, Idalys

; Peix-González, Amalia

; Rodríguez-Navarro, Ángel Y.

; Alfonso-Montero, Óscar A.

; Naranjo-Domínguez, Adrián

Archivos de cardiología de México

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Set 2020, Volume 90 Nº 3 Páginas 300 - 308

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Introduction: Cardiovascular diseases are the leading cause of death in Cuba and most of the developed countries. Two-dimensional speckle tracking echocardiography (2D ST) is a recent technique in the evaluation of cardiac function. Objectives: To determine the relationship between myocardial deformation measured by 2D ST and coronary circulation in patients with ischemic heart disease, in the CIMEQ, for 1 year. Material and method: An analytical, cross-sectional study was carried out with 55 patients with an indication for coronary angiography who underwent 2D echocardiography and 2D ST study with longitudinal strain measurement (LSM). Two groups significant coronary disease (SCD = 32) and not significant (NSCD = 23) were created. SSPS was used to analyze the results. Results: The average age was higher in SCD (55.6 ± 9.3 vs. 61.8 ± 8.8, p = 0.014). Men with SCD (47.3%), hypertensive (SCD = 90.6% and NSCD = 65.2%, p = 0.02) and smokers (SCD = 59.4% and NSCD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease (75%) prevailed in SCD. The LMS was lower in SCD ([−20.0 ± 3.2 vs. −22.1 ± 3.6, p = 0.035]; AUC = 0.458). There were no differences in LSM according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of 2D ST to discriminate SCD.

Resumen Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con speckle tracking bidimensional (ST 2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivos: Determinar la relación entre la deformación miocárdica medida por ST 2D y el estado de la circulación coronaria en pacientes con cardiopatía isquémica, en el CIMEQ, durante un año. Material y método: Se realizó un estudio analítico y transversal con 55 pacientes con indicación de coronariografía sometidos a ecocardiograma bidimensional y estudio de ST 2D con medición de la deformación longitudinal (DLG). Se crearon dos grupos: enfermedad coronaria significativa (ECS = 32) y no significativa (ECNS = 23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en la ECS (55.6 ± 9.3 vs. 61.8 ± 8.8; p = 0.014). Predominaron los hombres con ECS (47.3%), los hipertensos (ECS = 90.6% y ENCS = 65.2%; p = 0.02) y los fumadores (ECS = 59.4% y ENCS = 17.4%; p = 0.002). El diagnóstico más frecuente fue la angina crónica estable (87%). En la ECS predominó la enfermedad de tres vasos (75%). La DLG fue menor en la ECS [(-20.0 ± 3.2 vs. -22.1 ± 3.6; p = 0.035); AUC = 0.458]. No hubo diferencias en la DLG según el número de vasos significativamente afectados. Conclusiones: Los resultados encontrados no justifican el empleo del ST 2D para diferenciar la ECS.

https://doi.org/10.24875/acm.20000290 660 downloads

Cuba’s Role in International Atomic Energy Agency Regional Cooperation in Cardiology
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Peix, Amalia

; García, Berta

MEDICC Review

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Dez 2019, Volume 21 Nº 4 Páginas 78 - 81

Resumo: En | Texto: En | PDF: En

ABSTRACT Cardiovascular diseases are the leading cause of death worldwide, and a health problem in low- and middle-income as well as high-income countries. They also constitute the main cause of death in Latin America, with ischemic heart disease as the principal cause in most countries of the region. In Cuba, heart disease is the first cause of death, followed by cancer and stroke. In its 2030 Agenda for Sustainable Development, the UN recognizes the importance of chronic non-communicable diseases, including cardiovascular diseases. Cuba has participated actively as lead partner in design and implementation of the two regional technical cooperation projects conducted over the last six years by the International Atomic Energy Agency to address cardiovascular diseases in Latin American and Caribbean member states. These projects have generated greater interest among participating countries in the use of myocardial perfusion for dilated cardiomyopathy and coronary artery disease compared to other imaging techniques; disseminated knowledge about nuclear cardiology techniques and clinical applications in heart failure and coronary artery disease; and made important contributions to implementing harmonized, appropriate and safe clinical protocols. Cuba’s contribution to the International Atomic Energy Agency’s regional cardiology projects has fostered development of human resources and harmonized protocols both nationally and regionally, and demonstrated the importance of region-based scientific cooperation that ensures greater opportunities and more equitable access to resources. This participation has also accrued important benefits to Cuba’s own nuclear cardiology program.

Stress-Rest Myocardial Perfusion Scintigraphy and Adverse Cardiac Events in Heart Failure Patients
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Peix, Amalia

; Macides, Yanisbel

; Rodríguez, Lydia

; Cabrera, Lázaro O.

; Padrón, Kenia

; Heres, Flor

; Consuegra, Dania

; Fernández, Yoel

; Mena, Erick

MEDICC Review

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Abr 2015, Volume 17 Nº 2 Páginas 33 - 38

Resumo: En | Texto: En | PDF: En

INTRODUCTION Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population. OBJECTIVES Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODS A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress–rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTS No significant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were significantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (−1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05). CONCLUSIONS Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.

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La Cardiología nuclear en Cuba
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Peix González, Amalia

Nucleus

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Dez 2014, Nº 56 Páginas 21 - 26

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

This paper is a brief summary of the Nuclear Cardiology history in Cuba, mentioning the current main mortality causes, the usefulness and results of nuclear tests among the imaging techniques nowadays used in Cardiology, including gated-SPECT, PET and hybrid imaging combining anatomical and functional information. This paper also reviews our present worldwide performance in Nuclear Cardiology, with emphasis on our development and future trends, and proposes some recommendations

En este trabajo se presenta un breve resumen de la historia de la Cardiología Nuclear en Cuba; se refieren las principales causas de mortalidad en la actualidad y el valor e indicaciones de los estudios nucleares dentro de las técnicas de imagen que se emplean actualmente en cardiología, tanto lo referente al SPECT gatillado como al PET y a la imagen híbrida que combina información funcional y anatómica. Se refiere también cómo se inserta el país en la Cardiología Nuclear actual, cuál ha sido el desarrollo de la subespecialidad en los últimos años y cuáles son las perspectivas futuras, así como algunas recomendaciones de interés

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Prognostic value of gated SPECT after reperfusion for acute myocardial infarction
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Cabrera-Rodríguez, Lázaro O.

; Peix, Amalia T.

; Padrón, Kenia M.

; Chacón, Deilys

; Carrillo, Regla

; Fernández, Yoel

; Mena, Erick

MEDICC Review

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Abr 2013, Volume 15 Nº 2 Páginas 20 - 25

Resumo: En | Texto: En | PDF: En

INTRODUCTION: Myocardial reperfusion during the course of an acute myocardial infarction improves patients' short- and long-term prognosis; coronary blood flow is successfully re-established while preserving a large amount of at-risk muscle. Clinical evolution, however, varies. Presence of residual ischemia or viable myocardial tissue affects a patient's prognosis. Assessment by noninvasive methods allows better prognostic stratification. Cardiac-gated SPECT provides appropriate parameters to support treatment selection and monitoring of these patients. OBJECTIVES: Assess the prognostic value-ability to predict occurrence of major cardiac events-of perfusion and cardiac function obtained by myocardial perfusion scintigraphy in myocardial infarction patients treated by any myocardial reperfusion method, whether pharmacological or surgical. METHODS: Forty patients were included, mean age 58.8±9 years, diagnosed with myocardial infarction. Participants were divided into two groups: primary percutaneous transluminal coronary angioplasty (15) or thrombolysis (25). All received myocardial perfusion scintigraphy with cardiac-gated SPECT to assess perfusion and left ventricular function, and were followed for six months with telephone interviews and review of clinical records. RESULTS: In the 11 patients who had major cardiac events within six months of followup, a nonsignificant increase in perfusion defect extent was seen post reperfusion. Six (54.5%) of those with major cardiac events had anterior perfusion defects. In functional parameters, a significant increase in end-diastolic and end-systolic volumes and decrease in left ventricular ejection fraction were observed post stress (p = 0.006) and at rest (p = 0.001). Post-stress end-diastolic volume of >70 mL had a higher prognostic value for major cardiac events [sensitivity 100%; specificity 89%, area under ROC curve 0.835 (CI 0.702-0.969), p = 0.001]. CONCLUSIONS: Cardiac-gated SPECT is useful to identify variables (including left ventricular systolic dysfunction and dilation of left cavities, particularly left end-systolic volume of >70 mL) predictive of major cardiac events in reperfused patients, independent of treatment modality.

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Cintilografia de perfusão miocárdica e comprometimento cardíaco na fase indeterminada da doença de chagas
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Peix, Amalia

; García, Raymid

; Sánchez, Jesús

; Cabrera, Lázaro O.

; Padrón, Kenia

; Vedia, Oscar

; Choque, Hugo V.

; Fraga, Jorge

; Bandera, Juan

; Hernández-Cañero, Alberto

Arquivos Brasileiros de Cardiologia

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Fev 2013, Volume 100 Nº 2 Páginas 114 - 117

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A cintilografia de perfusão miocárdica (CPM) tem sido utilizada na avaliação da cardiopatia chagásica. OBJETIVO: Investigar o valor da CPM com tomografia computadorizada por emissão de fóton único (gated-SPECT) para detectar comprometimento cardíaco precoce em pacientes chagásicos na fase indeterminada, que apresentam anomalias de movimento segmentar detectadas por exame de imagem por Doppler tecidual (IDT) strain derivada. MÉTODOS: Foram incluídos 40 indivíduos (idade média: 25 ± 2 anos, 50% homens) de uma área endêmica da doença de Chagas e com diagnóstico sorológico positivo. Todos foram submetidos à CPM com gated-SPECT de 2 dias (repouso e estresse) e ecocardiografia. RESULTADOS: Trinta indivíduos (75%) apresentaram resultados normais. Em três casos (8%), a CPM apresentou resultado ligeiramente anormal e em sete foi ambígua. Em todos os casos com defeitos reversíveis, os segmentos afetados foram coincidentes com aqueles com anomalias de movimento. Foi encontrada redução na fração de ejeção ventricular esquerda (FEVE) > 5% (ΔLVEF% < -5) pós-estresse em 11 dos 40 indivíduos (28%). Tanto o desvio padrão fasederivado como a largura da banda do histograma mostraram diferença significativa entre o pós-estresse e a fase de repouso. Em ambos os casos, houve ligeira dessincronia em repouso normalizado no pós-estresse. CONCLUSÃO: Uma abordagem estresse-repouso com gated-SPECT é válida para detectar alterações miocárdicas precoces, bem como dessincronia intraventricular na fase indeterminada da doença de Chagas em pacientes com anomalias no movimento segmentar previamente detectadas pela IDT strain derivada.

BACKGROUND: Myocardial perfusion imaging (MPI) has been used in the assessment of chagasic heart disease. OBJECTIVE: To investigate the value of gated-single photon emission computed tomography (gated-SPECT) MPI to detect early cardiac involvement in chagasic patients in the indeterminate phase, who present segmental motion abnormalities detected by tissue Doppler imaging (TDI)-derived strain. METHODS: Forty individuals (mean age: 25±2 years, 50% males) from an endemic area of Chagas disease and with positive serologic diagnosis, were included. All underwent gated-SPECT two-day (stress-rest) MPI and echocardiography. RESULTS: Thirty individuals (75%) showed a normal scan. In three cases (8%) the MPI was slightly abnormal, and in seven it was equivocal. In all cases with reversible defects, the affected segments were coincident with those with motion abnormalities. A post-stress left ventricular ejection fraction (LVEF) reduction > 5% (ΔLVEF < -5%) was found in 11 out of 40 individuals (28%). Both the phase-derived standard deviation and the histogram bandwidth showed a significant difference between post-stress and rest. In both cases there was a slight dyssynchrony at rest which normalized at post-stress. CONCLUSIONS: A stress-rest gated-SPECT is a valid approach to detect early myocardial alterations, as well as intraventricular dyssynchrony in the indeterminate phase of Chagas disease in patients with segmental motion abnormalities previously detected by TDI-derived strain.

https://doi.org/10.5935/abc.20130023 5641 downloads

Usefulness of nuclear cardiology techniques for silent ischemia detection in diabetics
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Peix, Amalia

MEDICC Review

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Jan 2013, Volume 15 Nº 1 Páginas 33 - 36

Resumo: En | Texto: En | PDF: En

Cardiovascular disease is the main cause of death for diabetics, and in many cases its presence is silent due to cardiac autonomic neuropathy. Thus, early diagnosis of coronary disease is essential, permitting proper risk stratification and appropriate therapy. This paper examines the usefulness of several noninvasive imaging techniques to study cardiovascular diseases in individuals with diabetes mellitus, with emphasis on nuclear cardiology, and proposes a diagnostic algorithm for detection of silent ischemia.

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10.

Asociación de los resultados positivos del SPECT de Perfusión Miocárdica con <img width=31 height=17 id="_x0000_i1040" src="http://img/revistas/nuc/n51/img/e01065112.jpg" alt="http://img/revistas/nuc/n51/img/e01065112.jpg">-MIBI, con la presencia de Dislipidemia en pacientes ≥40 años de edad
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Rochela Vázquez, Luis Manuel

; Peix González, Amalia

; Batista Cuellar, Juan F.

; Romero Collado, Susana

; Oviedo Pérez, Lourdes

; Fernández-Britto, José E

; Peña Quián, Yamilé

; Hernández Cairo, Abel

Nucleus

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Jun 2012, Nº 51 Páginas 32 - 36

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The paper is aimed at establishing the association of the dyslipidemia with the positive results of the myocardial perfusion SPECT, for the optimization of the use. 152 MPSPECT were analyzed, different day, for an average age: 58.32 years, 86 (56.6%), were males. Considerating the presence of dyslipidemia , the patients were divided into two groups: dyslipidemia n=37(24.3%) and not-dyslipidemia, n=115 (75.7%). No significant differences were present in the age average (59.59/57.90 p=0.284), in body mass index (24.85/25.03, p=0.739), nor in the frequency of mature. Therefore , only dyslipidemia contributes to therefore the additional risk. Result: 102 (67.1%) MPSPECT were positive. In the comparison among groups no significant difference in the incidence of positive results was observed (67.60/67.00, p=0.945) and the same situation remained when the groups were subdivided into symptomatic and asymptomatic: As a result of the study, it was concluded that dyslipidemia does not represent a significant risk of ischemic cardiopathy in patient within the ages of risk, therefore there is no significant association with the positive results of the SPECTPM, within patient in ages of risk.

El trabajo tuvo como objetivo conocer la asociación de la dislipidemia con los resultados positivos del SPECT de perfusión miocárdica para la optimización del uso. Se analizaron 152 SPECTPM, días diferentes; la media de edad de 58,32 años; 86 (56,6%) fueron masculinos. Se dividieron en dos grupos según la presencia de dislipidemia; dislipidémicos, n=37 (24,3%) y no dislipidémicos, n=115 (75,7%). No presentaron diferencias significativas en las medias de edad (59,59/57,90 p=0,284) e índice de masa corporal (24,85/25,03, p=0,739), ni de la frecuencia de maduro/ra; por tanto el riesgo adicional solo lo aporta la dislipidemia. Los resultados 102 (67,10%) SPECT fueron positivos; en la comparación íntergrupos no se observó diferencia significativa de resultados positivos (67,60/67,00, p=0,945), que se mantuvo cuando se subdividieron los grupos en sintomáticos y asintomáticos. Se concluyó que la dislipidemia no aporta riesgo significativo de cardiopatía isquémica en pacientes en edad de riesgo, por tanto no hay asociación significativa con resultados positivos del SPECTPM en pacientes en edad de riesgo.

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11.

Experiencia cubana con el uso terapéutico de células madre adultas
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Hernández-Ramírez, Porfirio

; Alfonso-Simón, Amel

; Aparicio-Suárez, José L.

; Artaza-Sanz, Heriberto

; Baganet-Cobas, Aymara

; Blanco-Díaz, Ángela

; Cabrera-Zamora, Maritza

; Cruz-Tamayo, Fernando

; Díaz-Díaz, Antonio J.

; Díaz-Ramírez, Francisco

; Dorticós-Balea, Elvira

; Fernández-Águila, Julio

; García-Ibarra, Rafael

; Goicoechea-Díaz, Pedro

; González-Suárez, Tania

; González-Iglesias, Ana I.

; Hernández-Cañero, Alberto

; Lam-Díaz, Rosa M.

; León-Amado, Lisset

; Macías-Abraham, Consuelo

; Macías-González, Raúl

; Martínez-de Pinillos, María de los Á.

; Obregón-Santos, Ángel

; Peix-González, Amalia

; Pérez-Borrego, Amparo

; Pol-Marró, Natalia

; Socarrás-Ferrer, Berta B.

; Suárez-Monteagudo, Carlos

; del Valle-Pérez, Lázaro O.

; Wilford-de León, Mario

Revista Cubana de Hematología, Inmunología y Hemoterapia

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Mar 2011, Volume 27 Nº 1

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Las investigaciones básicas y clínicas realizadas en los últimos años sobre las células madre y sus posibilidades terapéuticas, son en la actualidad uno de los temas más excitantes de la medicina contemporánea. Ya se han obtenido importantes avances en el estudio y aplicación de las células madre adultas que muestran notables ventajas sobre las embrionarias, pues su manipulación resulta más simple, económica y se pueden obtener del propio individuo que va a ser tratado. Para la introducción en Cuba de la terapia celular regenerativa, en el Instituto de Hematología e Inmunología se seleccionaron como fuentes celulares las células madre adultas derivadas de la médula ósea y las movilizadas a la sangre periférica. Para facilitar la extensión del tratamiento a otros centros hospitalarios, se estandarizó una técnica para la movilización de las células madre hematopoyéticas a la sangre periférica, mediante un factor estimulador de colonias de granulocitos (Filgrastim, de producción nacional) y se desarrolló un método simple, económico y también más tolerable para los enfermos. De esta forma, se ha extendido la terapia celular a 6 provincias cubanas y hasta abril del año 2009 se habían tratado 563 casos con trasplante de células madre adultas autólogas, de los cuales el 81,7 % corresponde a pacientes con enfermedades angiológicas, en los que se ha logrado disminuir significativamente la indicación de amputaciones mayores. También los resultados han sido muy prometedores en las lesiones óseas y procesos periodontales, entre otras enfermedades tratadas. Los resultados obtenidos hasta el momento se pueden considerar como un nuevo logro de la ciencia revolucionaria y de nuestros sistemas nacionales de salud y de ciencia y técnica. El método empleado es un proceder económico y factible para instituciones con recursos limitados.

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12.

Gammagrafía de perfusión miocárdica con tecnecio 99m-MIBI en el diagnóstico de la enfermedad coronaria en mujeres
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Peix, Amalia T.

; Chacón, Deylis

; Llerena, Lorenzo

; Torres, Maritza B.

; García, Ernesto Javier

; Cabrera, Lázaro Omar

Revista Cubana de Medicina

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Jun 2006, Volume 45 Nº 2

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The results of technetium 99m - methoxy-isobutyl-isonitril scintigraphy in a one-day protocol: rest - physical or combined stress (bicycle plus endovenoous dipiridamole) were compared with those of coronary angiography in 20 women referred for the evaluation of precordial pain and of the usefulness of myocardial perfusion scintigraphy. The uptake of the radiodrug under stress and at rest varied from 93 ± 9 to 94 ± 7 % in the 204 segments with normal uptake under stress, from 67 ± 9 to 75 ± 17 % in the 89 with moderate reduction, and from 33 ± 9 to 64 ± 28 % in the 27 with severe reduction. The qualitative and quantitative uptake analyses coincided in 18 patients. The perfusion scintigraphy and the angiography agreed in 70 % of the patients. It was concluded that the myocardial perfusion scintigraphy with technetium 99-MIBI contributes to the diagnosis of the coronary artery disease in women.

Se compararon los resultados de la gammagrafía con tecnecio 99m- metoxi-isobutil-isonitrilo en protocolo de un día: reposo-estrés físico o combinado (bicicleta más dipiridamol endovenoso), con los de la angiografía coronaria, en 20 mujeres remitidas para evaluación de dolor precordial y de la utilidad de la gammagrafía de perfusión miocárdica en el diagnóstico de la enfermedad coronaria en la mujer. La captación del radiofármaco en estrés y reposo varió de: 93 ± 9 a 94 ± 7 % en los 204 segmentos con captación normal en estrés; 67 ± 9 a 75 ± 17 % en los 89 con moderada reducción y 33 ± 9 a 64 ± 28 % en los 27 con severa reducción. Los análisis cualitativo y cuantitativo de la captación coincidieron en 18 pacientes. La gammagrafía de perfusión y la angiografía concordaron en el 70 % de las pacientes. Se concluyó que la gammagrafía de perfusión miocárdica con Tc 99m-MIBI contribuye al diagnóstico de la enfermedad coronaria en mujeres.

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13.

Estimulación multisitio en pacientes con disfunción ventricular severa y trastornos de conducción
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Zayas Molina, Roberto

; Peix González, Amalia

; Castro Hevia, esús

; Quiñones Pérez, Miguel A.

; Fayat Rodríguez, Yanela

; Dorantes Sánchez, Margarita

; Dorticós Balea, Francisco

Revista Cubana de Medicina

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Jun 2003, Volume 42 Nº 2 Páginas 118 - 120

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The multisite pacing is a therapeutic alternative for patients with severe ventricular dysfunction. This technique was used in 6 patients with functional class III-IV refractory heart failure and left bundle branch block to evaluate its efficiency. Variable PR intervals were programmed for biventricular pacing between the output tract and the apex of the right ventricle. A nuclear ventriculography in basal state was performed on the 7th day and on the 6th month after the implantation to measure the ejection fractions, the ventricular synchronism and the mitral regurgitation index. During the follow-up, 2 patients had refractory heart failure and one of them died (bifocal pacing). The improvement of the ejection fraction and of the functional capacity were evident with the biventricular pacing. This technique proved to be efficient in the treatment of severe ventricular dysfunction.

La estimulación multisitio constituye una alternativa terapéutica para pacientes con disfunción ventricular severa. Esta técnica fue utilizada en 6 pacientes con insuficiencia cardíaca refractaria, clase funcional III-IV y bloqueo de rama izquierda, para evaluar su eficacia. Se programaron intervalos PR variables para estimulación: Biventricular: entre el seno coronario o el ventrículo izquierdo y la punta del ventrículo derecho; y Bifocal: entre el tracto de salida y la punta del ventrículo derecho. Se realizó una ventriculografía nuclear en estado basal, a los 7 días y a los 6 meses posimplantación, para medir las fracciones de eyección, el sincronismo ventricular y el índice de regurgitación mitral. Durante el seguimiento, 2 pacientes hicieron insuficiencia cardíaca refractaria y uno de ellos falleció (estimulación bifocal). La mejoría de la fracción de eyección y de la capacidad funcional fueron evidentes con la estimulación biventricular. Esta técnica resultó eficaz en el tratamiento de la disfunción ventricular severa.

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14.

Diagnóstico preclínico de la aterosclerosis: Función endotelial
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García Barreto, David

; García fernández, Raymid

; García Pérez-Velazco, Javier

; Concepción Milián, Ariadna

; Peix González, C. Amalia

Revista Cubana de Medicina

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Mar 2003, Volume 42 Nº 1 Páginas 58 - 63

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

A review of the technique is made to measure in an unbloody way, the function of the vascular endothelium in the human brachial artery. The main studies where this technique has been used are approached, making emphasis on its relationship with the arteriosclerosis of the coronary arteries. Finally, an account of its limitations and possibilities is made.

Se hace una revisión de la técnica para medir, de manera incruenta, la función del endotelio vascular en la arteria braquial humana. Se revisan los principales estudios donde se ha empleado esta técnica haciendo énfasis en su relación con la aterosclerosis de las arterias coronarias. Por último, se hace un recuento de sus limitaciones y posibilidades.

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15.

Empleo del dipiridamol en la gammagrafía de miocardio con tetrofosmín-Tc99m en pacientes con bloqueo completo de rama izquierda: Resultados preliminares
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Ponce Vicente, Felizardo

; Peix González, Amalia

; López Díaz, Adlín

; Filgueiras Frías, César E.

; Castillo Fundora, Maritza

; García Barreto, David

; Maltas Pineda, Ana Ma.

Revista Cubana de Medicina

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Out 2002, Volume 41 Nº 5 Páginas 251 - 255

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The partial results of the administration of endovenous dipyridamole are compared with physical effort in 7 patients with complete left bundle branch block (CLBB) during myocardial scintigraphy with Tetrofosmin-TC99m. Exercise was undertaken according to the habitual protocol of our laboratory. The following segments were analyzed: septum, apex, inferoapical, posterolateral, anterolateral, anterior, inferior, postero-inferior and postero-basal. The highest heart rate (HR) on exertion was 90 ±8 % and the maximum load was 61± 24 W. Heart rate, systolic and diastolic blood pressure under basal conditions had no significant changes, but when the stresses were compared they did (p<0.05). The global concordance for the reversibility or not of the uptake defect of the radiopharmaceutical was 96 %, k=0.83, whereas for identifying the type of defect it was 92 %, k=0.84. The worst concordance was for the septum 85 %, k=0.80; however, it was not significant in relation to other analyzed segments. Congruency was 71 % in the diagnostic result. Due probably to the unsuitability of the sample of studied patients, our results show a good concordance between the use of dipyridamole and physical effort with stress methods when only the images obtained are evaluated.

Se comparan los resultados parciales del empleo del dipiridamol endovenoso con el uso del esfuerzo físico en 7 pacientes con bloqueo completo de rama izquierda (BCRI) durante la gammagrafía de miocardio con tetrosfosmín-Tc99m. El dipiridamol fue administrado en una dosis única de 0,56 mg/kg durante 4 min. El esfuerzo se realizó siguiendo el protocolo habitual de nuestro laboratorio. Se analizaron los segmentos: septum, ápex, infero-apical, postero-lateral, antero-lateral, anterior, inferior, postero-inferior y postero-basal. La frecuencia cardíaca (FC) máxima alcanzada durante el esfuerzo físico fue 90±8 % y la carga máxima 61±24 W. LA FC, tensión arterial sistólica y diastólica en condiciones basales no tuvieron cambios significativos, pero sí cuando se compararon ambos estrés (p<0,05). La concordancia global para la reversibilidad o no del defecto de captación del radiofármaco fue 96 %, k=0,83 y para identificar el tipo de defecto fue 92 %, k=0,84. La peor concordancia fue para el septum 85 %, k=0,80 pero, no significativa con respecto a los otros segmentos analizados. En el resultado diagnóstico, la congruencia fue del 71 %. Probablemente por la no idoneidad de la muestra de pacientes estudiados nuestros resultados muestran buena concordancia entre el uso del dipiridamol y el esfuerzo físico como métodos de estrés cuando se evalúan solamente las imágenes obtenidas.

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