CARDIOLOGY (3)

Author: EREÑO BEROIZ FERNANDO.
Year: 2005.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The sensitivity of stress echocardiography for the diagnosis of coronary heart disease is significantly lower dela described so far in which assesses the cost-effectiveness of diagnostic testing, have not been taken into account the biases of patient selection and verification of proof Noninvasive. The interception joint stress echocardiogram and electrocardiogram involves a significant change in the estimate of the likelihood of post coronary artery disease. The sensitivity of stress echocardiography for the diagnosis of coronary disease does not depend on the patient's sex. We various forms of stress echocardiogram, being the most widely used technique of the echocardiogram exercise to be the most secur and with fewer complications vital. It was also suggested lines of future research for coronary artery disease.

Author: PÉREZ CIVANTOS DEMETRIO VÍCTOR.
Year: 2005.
University: EXTREMADURA [More theses of this university] [www.unex.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Incorporating the therapeutic arsenal of medicine and intensive care critics of a new inotropic agent as levosimenda, with a new mechanism of action, did raise the possibility of the value of their use as drug inotropic support in situations of low spending Heart and cardiogenic shock in patients with severe dysfunction ventrical in the immediate postoperative period of cardiac surgery. In this thesis is marked the following objectives: to estimate the mortality of patients, comparing hemodynamic variables and the possibility of withdrawing other vasoactive drugs or other means of support hemodynamic in patients treated with levosimendan compared to patients treated with conventional drug dobutamine . The study was conducted in 100 patients in the ICU Hospital Infanta Cristina de Badajoz after being subjected to various interventions cardiac surgery and providing a syndrome of low spending or shock cardiogéncio. All these patients had Parsonnet a scale of between 16 and 21 points. The results emphasize that the levosimendan exhibits the same beneficial effects on the parameters of distribution of oxygen, oxygen consumption, ejection fraction and mixed venous saturation. Likewise, both groups had the same mortality and morbidity. However, patients treated with levosimendan pespuntaron a vasodilatory effect sharper and less need other drugs vasocactivos. Similarly, patients treated with levosimendan requiring less use of mechanical systems such as intra ball. Based on the results the authors conclude that levosimendan is not just a drug to be used in most situations of low cardiac output and cardiogenic shock in patients undergoing cardiac surgery but is the drug of choice, leaving the other side as drugs and possible association to it first.

Author: SÁNCHEZ CALVELO DANIEL ALBERTO.
Year: 2005.
University: SANTIAGO DE COMPOSTELA [More theses of this university] [www.usc.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE SANTIAGO DE COMPOSTELA.

Summary: OBJECTIVES The temporary stimulation in postoperative cardiac surgery is underutilized as a therapeutic tool that applies only to increase the heart rate in the tables attending bradycardia ignoring the effect of electrostimulation on the preload and on the contractivilidad and efficiency of ventricular systole . The choice of the ventricular chamber, the number and location of the points where they can stimulate the emergence or conditional reversal asincronismo during systole and dysfunctional valves aurículo-ventriculares. MATERIALS AND METHODS We studied 50 patients, with an average age of 67.14 years. The 50% had less than 50% FE. The preoperative diagnosis was aortic stenosis 45%, ischemic heart disease 35%, insufficient aortic 12.5% and mitral insufficiency 7.5%. The 84% were RS and 16% in FA. Presentaban BRIHH, 18%, HBAIHH, 8%, BAV 6% and BRDHH 4%. Variants of stimulation were: 1, - stimulation sequential AV-VI anocatódica with cathode in VI. 2, - stimulation sequential AV-VD anocatódica with cathode in VD patients in the RS. In patients was conducted in FA: 1, - stimulation anocatódica left ventricular with cathode in VI. 2, - stimulation anocatódica right ventricular with cathode in you. The following parameters were evaluated hemodynamic: FC, PSS, PASG, PAPS, PAPD, GC and SVO2. RESULTS The analysis showed an improvement of the overall GC, PAPS, and PAPD during stimulation sequential AD-VI and lower during the same stimulation sequential AD-V in patients with R. In FA patients were improved GC, PASS and PASD during the mode of stimulation VI. Patients with BRIHH, FE depressed and preserved, had an increase of GC, PASS and PASD during mode stimulation sequential AD-VI and decline in these parameters during stimulation sequential AD-VD. The duration of the QRS complex showed an increase during the stimulation sequential AD-VI and AD-VD. CONCLUSIONS There is a great variability in terms of the magnitude of changes that appear hemodinámicos with each mode of ventricular stimulation. The stimulation anocatódica ventricular with cathode in VI should be used in preference in routine clinical practice to optimize cardiac output in all patients requiring electrostimulation except in the subjects with BRDHH.

Author: GONZÁLEZ VARELA ANTONIO.
Year: 2005.
University: OVIEDO [More theses of this university] [www.uniovi.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD DE LEON.

Summary: The aim of the thesis has been better known characteristics of the patients older than sixty-five years with ischemic heart of our health area, as our Community presents a high rate of aging, and despite the presence of such patients in practice daily care is becoming increasingly frequent, are poorly represented in clinical trials, with frequent extrapolating results obtained with younger populations and features more homogeneous. It has conducted an epidemiological study, analytical, the observational case-control design in a population of both sexes and greater than 65 years. The group of cases with ischemic heart disease consisted of 128 patients consecutively admitted to the hospital and presented in the electrocardiogram abnormalities increased according to the code of Minnesota and asinergía in echocardiogram, according to the nomenclature and standards of the Committee of Experts of the American Society of Echocardiography. The control group of 117 individuals have been chosen randomly among residents of the area health IV of Asturias, where the hospital is located, stratified by age and sex group over the case. In comparing cases and controls, patients with ischemic heart disease had significantly higher mean values of the index cintura-cadera (p less 0.01), white blood cells, platelets, fibrinogen, blood glucose and uric acid (p less 0.05) and lowest of apoproteina A and HDL-cholesterol (p less 0.05). Likewise, cardiovascular risk factors had detected a high prevalence in the two groups, with the percentage significantly higher in those with ischemic heart disease in relation to diabetes (35% vs. 11%, p less 0001), dyslipidemia (61% vs. 11%, p less 0001), hiperfibrinogemia (83.5% vs. 53%, p less 0001), hyperuricemia (31% vs 8%, p less 0001) and ventricular hypertrophy (67% vs. 38.5%, p less 0001). The half ventricular mass was significantly higher among patients with ischemic heart disease (247.8 +-100 vs. 184'5 +-71 grams, p less 0001) and the difference remained to be stratified by sex, 258'4 +-104 vs. 219'4 +-80 grams (p less 0.04) among men and 237 +-95 vs. 166'5 +-58 grams (p less 0001) for women. The morphology of the left ventricle showed low rates patterns of normalcy in the two groups and compared, individuals with ischemic heart disease had a significantly higher proportion of left ventricular hypertrophy (p less 0001), mainly at the expense of the eccentric (p less 0 , 01). However, the proportion of individuals with ventricular remodeling was significantly higher among the controls (p less 0001). Moreover, 46% of patients with ischemic heart disease met criteria for metabolic syndrome compared with 29% of controls (p less 0.01), found a significant association between metabolic syndrome and ischemic heart disease for which doubled the risk suffer from the disease among carriers syndrome (RR = 2.08, 95% CI, 1'2-3'5). After a logistic regression analysis to assess the likelihood of ischemic heart disease depending on whether or not to be the bearer of the factors that had shown significant association, remained as variables predoctoras type 2 diabetes (RR 4'37 CI 95% , 1'96-9'74) hiperfibrinogenemia (RR 3'23 CI 95%; 1'64-6'34), hyperuricemia (RR 2'62 CI 95%, 1'71-4'01) and ventricular hypertrophy (RR 3'41 CI 95%, 1'83-6'37). After correcting for sex, remained the same variables increase the probability among women with diabetes (RR = 6.1, 95%; 1,9-19,7). Finally, the genotypic and allelic frequencies of polymorphisms of the renin-angiotensin axis studied in our sample did not show significant differences between cases and controls, and similar distribution wing of the adult population youngest nu 8 strategies Co. 3ba munidad and the aforementioned for other towns in southern Europe. These results lead us to believe that the development of ischemic heart disease in this type of population is due more to prolonged exposure to environmental factors risk that the expression of these polymorphisms.

Author: LINARES SOLER EUGENIA.
Year: 2006.
University: GRANADA [More theses of this university] [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE GRANADA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The innervation of the heart and its influence on the dynamic cardiac have been subjects of controversy since the end of the year 1800 and the first decade of 1900, appears and strengthens the theory miógena, displacing the neurógena primitive. This occurs after the findings of His (1863, 1886), Keith and Flak (1907) and basically those of Tawara (1906), which shows the connections of the Purkinje fibers (1845) with the bundle of His and the nodule by he discovered. However, Pick (1970) points out the need for 'a complete reinvestigación in connection with the ongoing need and distribution of the nerves cardiacos'â |' in order to get very specific ideas about the meaning of the nervous control of the cardiac activity '. These demonstrations are still in force today regarding the undoubted presence of morphological nerve fibers vegetative, as corroboramos in this research work and, in turn, the lack of precise knowledge of its distribution and the important role that develop from the point sight anatomo-embriológico as clinical application, the latter which show Pauziene, Pauza and Stropus (2000), Pauziene and Pauza (2003) and Scherlag and Po (2006), directly linking the intrinsic innervation with different heart diseases. We have used 18 cats common adults who were carried estelectomías right, left and bilateral. It employed techniques silver impregnation of Gros and neurofibrillary double impregnation Soler-Viñolo, analyzing results under light microscope. Finally, it demonstrates the significant presence of vegetative nerve fibers in the heart observed after degeneration processes corresponding estelectomías.

Author: Fernández González Carmen Josefina.
Year: 2006.
University: A CORUÑA [More theses of this university] [www.udc.es].
Place of defense: Facultad de Ciencias de la Salud.
Place of preparation: Facultad de Ciencias de la Salud.

Summary: It describes the hospital management of acute myocardial infarction in Galicia in the year 2001. We are analyzing the changes in patient care with acute myocardial infarction in Galicia in the period 1995-2001. It assesses the adequacy of treatment with a clear advantage on the morbidity to the recommendations of the Class I ACA / AHA. For getting the job done using the database study RIGA (Registration Infartos Galicia) in the year 1995 (RIGA I) and 2001 (RIGA II), selecting data from the hospitals involved in both studies. The findings highlight the work:-an increase in the prescription and optimization of treatment with a clear advantage on morbidity (percutaneous coronary angioplasty primary fibrinolytic, antiplatelet agents, beta-blockers, enzyme inhibitors and angiotensin converting lipid-lowering) - increasing the percentage of patients who were evaluated ventricular function and more tests are performed to study residual ischemia. - Increases conducting coronariografías pre-discharge especially in patients with acute myocardial infarction in high-risk. - There is a significant decrease in mortality can be related to a good translation in everyday clinical practice knowledge acquired in clinical trials and greater use of the treatments optimal management of acute myocardial infarction. - Hospital care to acute myocardial infarction in Galicia is similar to the offered in the rest of Spain and in certain aspects such as conducting angioplasty pecutánea coronary primary is higher than in other national surveys.

Author: ANGUERA VILA ANNA.
Year: 2006.
University: ROVIRA I VIRGILI [More theses of this university] [www.urv.cat].
Place of defense: FACULTAD DE MEDICINA Y CIENCIAS DE LA SALUD.
Place of preparation: FACULTAT DE MEDICINA Y CIENCIAS DE LA SALUD.

Author: DALMAU I LLORCA M. ROSA.
Year: 2006.
University: ROVIRA I VIRGILI [More theses of this university] [www.urv.cat].
Place of defense: FACULTAT DE MEDICINA I CIÉNCIES DE LA SALUT.
Place of preparation: UNIVERSIDAD AUTÓNOMA DE BARCELONA.

Summary: OBJECTIVE To assess the relationship between coronary risk as Framingham and body composition (percentage of body fat) measured impedance bioeléctrica. SECONDARY OBJECTIVES Knowing the variables that determine the study increased coronary risk. Knowing the relationship between body composition (percentage of body fat) and physical exercise. Knowing the relationship between body composition (percentage of body fat) and quality of life. MATERIALS AND METHODS. DESIGN OF THE STUDY descriptive cross multicenter study, to learn about the main variables, coronary risk, body composition (% GC measured impedance bioeléctrica, OMRON BF 300 15), quality of life (EuroQol-5D160), physical activity (LTPA 159) and factors risk classics (HTA. DM, DL, Tobacco), from the spontaneous search of patients in the Primary Care since June 2004 until January 2006. SUBJECT n = 182, n1 = 91 subjects of coronary risk as high Framingham (RCA) and n2 = 91 subjects of coronary risk as low Framingham (RCB). We apply the tables in the number of subjects required for the comparison of two half through the test of t Student-Fisher and to detect a difference of% GC 5% and a standard deviation 9.1 15 with a = 0.05 and a beta = 0.05 and adjusting the number of subjects for 20% of probable losses n = 90 subjects under RC and n = 90 RC high with a final sample size N = 180. CRITERIA FOR INCLUSION Subjects between = 34 and = 74 years without disease cardivovascular after belonging to three basic areas of health. CRITERIA FOR EXCLUSION Patients with neoplastic disease pathology active terminal or chronic progressive degenerative neurological disease that may influence the patient's body composition. Patients with prior cardiovascular disease or less 34 years or less 74 years by the inability to calculate coronary risk as Framinghan. RESULTS We performed a logistic regression model to learn from the study variables that explain the increase in coronary risk. The dependent variable according to Framingham coronary risk (dichotomous variable large and under) and as independent variables and able to explain the increased risk, the percentage of body fat (stratified into 2 categories normal and high). These variables and through the model obtained an overall share of classification 76.4% of the risk with an R2 of risk of 42.5%. All variables of the model explained a significant increased risk of coronary except for the primary endpoint% body fat stratified and stresses the quotient waist / hip ratio * 100 (waist / hip ratio multiplied by 100 because hundredths of a change in the ratio explain major changes in the coronary risk) with ODDS 1107 and 95% CI for ODDS (1043-1174); explains that for every hundredth of increased risk quotient rises 1107. Likewise the family history of cardiovascular disease early with ODDS = 18343 and 95% CI for ODDS (4121-81655) and the A-level studies (studies comparing subjects without regard to subjects with secondary education or above) presents a ODDS = 5413 for those involved without explaining studies so that the studies have not take regarding secondary or higher education increased risk in coronary ODDS = 5413 with 95% CI for ODDS (1512-19380). The daily physical exercise among each group of body fat (Estratificada in res categories: normal, high and very high) is in the upper layer of CGE high with 510.95 mtes.min / day and CI 95% (366.65 - 655.25) with a significant difference (p = 0008) between groups and no linear relationship between these variables. The quality of life is greater than the lower amount of body fat (Estratificada into three categories), with no differences between the layers of body fat but with a linear relationship between two variables (p = 0043). CONCLUSIONS The body fat measured by impedance bioeléctrica does not change according to the Framingham coronary risk. The variables of the study to determine increase in coronary risk are: quotient waist / hip ratio, a history of illness caridovascular early educational level (without studies), fold s 8 ubescapu 357 lar. The exercise performed is greater in the high level of body fat. The quality of life is deteriorating while increasing body fat.

Author: MUÑOZ MARTÍNEZ TOMAS.
Year: 2006.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The high incidence of fibrialicón headset, particularly in people older than 65 years, constitutes a major public health problem. Being a possibility of electrical cardioversion treatment, the purpose of this study focuses on finding out what factors are related to the success of the same in this pathology. The study period was from July 1, 1998 until December 31, 2005, including in the same 328 patients who had conducted a total of 373 cardioversiones. The main variables studied were: sex, age, weight, type of arrhythmia, time evolution, size headset, ventricular ejection fraction, type and position of the electrodes, kind of wave and sedoanalgesia practiced. The response of atrial flutter to the electrical cardioversion is excellent, regardless of the nature of gracious. Since there is also curative treatment to prevent recurrences, it seems logical to raise it early in the crisis of this arrhythmia. In electrical cardioversion of atrial fibrillation will get better resutlados using biphasic shocks. The anterolateral position, at least biphasic waveform and through adhesive electrodes enables cardioversiones successful using the minimum shock and energy. No patient feature allows a priori identify a lack of response to electrical cardioversion.

Author: MARTÍNEZ MOYA LUIS.
Year: 2006.
University: ZARAGOZA [More theses of this university] [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The conclusions to be drawn from a study of Ambulatory Blood Pressure Monitoring (MAP) must comply with the regime's activities during the subject period of monitoring. Data analysis of the MAP without taking into account certain events that occurred during the monitoring (for example, episodes of intense physical or emotional stress, you take medication or proper separation of periods of sleep for not including erroneously hours of sleep in the vigil period) can lead to a distortion of the averages and falls in blood pressure, loss of reproducibility and definitely a little validity of the test. Ours is a descriptive study, and observational, prospective studies MAP conducted in the unit Hypertension and Vascular Risk attached to the service of Internal Medicine of the University Teaching Hospital in Zaragoza, collected consecutively for a period 24 months. The sample consists of 115 individuals in hypertensive drug treatment that comply with the inclusion and exclusion criteria and those who conducted a MAP in our unit for a period of 24 months. The conclusions of our work are as follows: In our sample, the population of which is a study of MAP, one of every three patients referred to have slept a nap. Typically nap not included in the anamnesis or in the newspaper of MAP and therefore are included erroneously records PA dream of a given period, as is the nap, in the computation period vigil. There are significant differences between the average daytime conventional PA, which includes records PA nap inside the counting period vigil, and the average daytime PA PA without records for the nap, which is what in effect corresponds to the period vigil. The average daytime PA calculated without records PA for the nap is significantly higher than the average daily conventional PA, and presents a better statistical correlation with the PA consultation. AI establish a statistical correlation between cardiovascular risk and the average daytime BP (including and excluding obtained records PA nap), it got better statistical correlation between cardiovascular risk and the average daytime PA without records PA the nap than the average conventional PA daytime. The PA declines occurring in the nap, are greater than those observed during sleep at night. By establishing a statistical correlation between decrease during nap and fall during sleep at night there was a significant positive correlation only for the decreases in DBP. Taking as a starting point for calculating the average decline Night PA daytime calculated excluding records PA nap, ie in strict vigil is for the period, instead of the average of PA which includes daytime nap, one out of every five individuals for PAS and one in seven for DBP change categorization from non descendedores to descendedores. In our sample, a change of subject categorization for both. As for the drop in blood during nap, no significant differences related to the position of the subject and quality of sleep. Ultimately, the nap is a frequent habit to be taken into account in the interview and the clinical journal MAP and should be separated from the rest of the daytime period, which was for real-hour vigil. Having in mind the nap in the MAP involves the exclusion of records PA nap to calculate the average daytime PA and provides an average of PA daytime significantly different, which correlates better with the pressures of consultation and risk vascular and may introduce a change in the status of the patient as descendedor or not descendedor.

Author: FÁCILA RUBIO LORENZO.
Year: 2006.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSITAT DE VALENCIA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: In recent years there is a growing scientific evidence that shows that the damage miocárdico markers of inflammation and thrombosis related to the forecast short and long term after an acute coronary syndrome. Most of these forecasters have been selected populations studied in clinical trials, they met the criteria for defining the previous SCA and beyond our means (almost all the literature is Anglo-Saxon). This study evaluated these factors in a population of consecutive patients (not selected) that meet the current criteria of SCASEST, and with a long term follow up. The working hypothesis that covers half of our patients with SCASEST defined by the existing criteria, and not selected (consecutive) with a profile biochemist worst, ie with impaired renal function, elevated markers of inflammation (protein C reactive, fibrinogen, WBC count greater) elevated homocysteine, elevated markers of myocardial injury (troponin and mioglobina), presented a worse developments both intermediate and long term, and this will be an independent prognostic factors of the classics (age, diabetes, hypertension, smoking etc.). OBJECTIVES Knowing the factors predictive of poor developments, especially biochemical, patients consecutively admitted for acute coronary syndrome without ST elevation in our midst. Knowing whether markers of inflammation (including C-reactive protein, fibrinogen and leukocyte count) acted as independent predictors of cardiovascular events in the short, medium and long-term follow-up in patients with SCASEST, and its relationship with markers of injury myocardial, specifically to troponin I and mioglobina. Studying whether the use of a combination of biochemical markers (myocardial injury and inflammation), provides information about the prognosis of patients with SCASEST. Evaluate the usefulness of homocysteine as a prognostic factor in this kind of sick. Assess power as a predictor of mortality biochemical determination of a simple and widely available (serum creatinine). To study whether the risk factors remain classic episodes of adverse prognostic value in our midst in patients admitted for SCASEST. PATIENTS AND METHODS That argument has been made through the collection of works already published in various journals of cardiovascular area, have been specifically selected 5 articles representing the research of this thesis. To do so it is included for a period of approximately two and a half years, consecutively, patients who enter the Chamber of Cardiology and coronary unit of a tertiary hospital, specifically, the University Teaching Hospital in Valencia, with characteristics of ischemic chest pain and if they met at least one of the following criteria: a) ECG sign of acute ischemic heart disease (down from ST or reversal of the T-wave), b) elevated markers myocardial injury (troponin I), c) ergometría positive ( in patients without changes and without electrocardiográficos elevated markers of myocardial injury), and d) in the absence of the first three criteria, were also included patients with clinical history highly suggestive: typical chest pain at rest or in the case of being of effort, with less than one week's developments, either with a clear decrease in the threshold of appearance (in patients with chronic angina). The monitoring was conducted by telephone in outpatient and review databases and medical history of the hospital. Inflammatory Markers RESULTS The results confirm the importance of PCRas and fibrinogen in the prognosis of patients 8 ingresad 180th os for high suspected acute coronary syndrome even in the very short term (hospital), and after being corrected by the variables classic type clinical electrocardiographic (ST segment depression and reversal of the T-wave myocardial injury (troponin and CK-MB). one patient to submit a PCRas> 11 mg / ml multiplied by 5.2 (1.8 to 14.5 ) and fibrinogen> 6 g / l multiplied by 7.1 (1.8 to 27.6) the risk of an episode higher (death or myocardial hospital). The study multivariate the PCRas was associated with an increased rate of death and greatest episode, and fibrinogen with an increased rate of heart attack (presumably as a result of their role in the aggregation and clotting). Regarding the WBC count, in our study population, while also adjusting for clinical and epidemiological Contrasting of prognostic value, the RL is shown as independent predictor of mortality at one year of follow-up. In this study, we have an RL in the second and third tercil multiplied by 1.61 and 2.07 respectively, the possibility of death from all causes for patients with acute myocardial infarction without ST elevation at 10-month follow-up as a medium. Homocysteine The study was conducted on 1029 patients shows that moderate elevations Ho obtained during admission for a SCASEST and storied in terciles, is a powerful predictor death from all causes in the follow-up to a year. Our study, adjusted for classic markers (epidemiological and clinical) and those newly established shows that this determination is independent predictive power for predicting long-term mortality in acute coronary syndrome ST elevation. Rising Ho above 10 mol / l (tercil 2) increasing the likelihood of death from all causes each year follow-up after a SCASEST, and this is independent of prognostic factors as important as age, risk factors, the degree of heart failure, or creatinine income. is the first study also demonstrates the power of the Ho prognosis regardless of acute phase reactants (PCR was part of the Cox regression). Function Following evaluation of renal kidney function, as determined by serum creatinine or glomerular filtration through the formula MDRD, according to previous publications shows that both are very important parameters to be taken into account for the prognostic stratification the initial patients SCASEST. there an increased risk of death proportional to the elevated levels of serum creatinine income (or decrease in the glomerular filtration). For every 0.1 mg / dl of elevated creatinine income multiply 1.46 times the risk of death from all causes and one year follow-up. This increase in risk is linear, with no cut-off point at which patients present a clear increase in risk, but at higher levels of creatinine, the greater risk (even with values regarded as normal), this observation is similar to that of recent studies. combination of biochemical markers in the analysis of 557 patients admitted for SCASEST, with a follow up to one month and one year, assesses the elevation of 0 to 5 markers quantified so dichotomous (TpI> 1 ng / ml Mioglobina> 70 ng / ml, homocysteine> 12 lcm / L, CRP> 11mg/ly Fibrinogen> 5 g / l) to predict death or myocardial at that track. Combining elevation of mioglobina-PCR increased 2.4 times the chance of death or myocardial per month for monitoring, the same thing happened a year with PCR-Ho-TpI which was compounded by 2. Furthermore rising 1 to 5 of markers described previously increased from a probability of episodes from 3.7% to 50% respectively, with a graduation intermediate if it is 2.3 or 4 markers .. A high elevation simultaneous multiple types of factors show the effect of different mechanisms damage and hence a worse prognosis. CONCLUSIONS In this observational study, unicéntrico and descriptive, in our environment and that has included consecutively over a thousand unselected patients with SCASEST (defined by current criteria), it has been shown that: 1. biochemical markers most current, both of inflammation (C-reactive protein, fibrinogen and leukocyte count), and myocardial injury (troponin I, mioglobina) or thrombosis (homocysteine), behave as predictive variables of cardiovascular events and death short-, intermediate-and long-term, regardless of the clinical, epidemiological classically contrasted. 2. markers are simple determination, inexpensive, widely available and that a large additional prognostic information such as serum creatinine and WBC count . 3. Homocysteine given during admission, by itself, it also acts as an independent prognostic factor in the long term. 4. traditional predictive factors (age, the presence of diabetes mellitus, heart failure at admission and declining ST ) maintain their power prognosis despite the new biochemical markers. 5. Combining markers types (classical, necrosis and inflammation) allows us to sharpen the evolution of the patient after the episode.

Author: PALACIOS MUÑOZ MANUEL EDUARDO.
Year: 2006.
University: POLITÉCNICA DE CATALUÑA [More theses of this university] [www.upc.edu].
Place of defense: Facultat de Matemàtiques i Estadística.
Place of preparation: EDIFICI U DESPATX 518 Campus SUD.

Summary: This PhD thesis has focused on the propose, design and evaluation a new methodology based on hidden Markov models (HMM) to characterize and to identify aspects of the complex autonomic communication present in the rhythms of the autonomous nervous system (ANS), i.e., the autonomic information flow (AIF) by the study of the RR series. The proposed methodology has been applied to the RR series obtained by linear interpolation of the RR tachogram, resampled and filtered in the frequency bands VLF (0.003-0.04 Hz), LF (0.04-0.15 Hz) and HF (0.15-0.45 Hz): HF RR , LF RR , VLF RR . Also the RR series have been considered without filtering RES RR . In chapter 1, the problems of the analysis of the heart rate variability are introduced together with an explanation of the organization of this PhD thesis. In chapter 2, the methods of analysis of the heart rate variability are discussed, together with the technical characteristics and the groups of patients of the databases used in this thesis, IDEAL (Intercity Digital ECG Alliance, Rochester University, USA) and NIC (National Institute of Cardiology of Warsaw, Poland). Also, physiologies of two types of Cardiomyopathy investigated in this thesis are explained. In chapter 3, the mathematical theory of the hidden Markov models and the HMM learning algorithms are detailed, and architectures of the models used in this thesis are described. In chapter 4, a new methodology of analysis of the heart rate variability has been identified by means of HMM, obtained by the transformation of the RR series in sequences of words provided by a nonlinear methodology of symbolic dynamics. The new methodology was applied to the IDEAL database. Finally, the results of the quantitative evaluation of the new proposed methodology are discussed. In chapter 5, an analysis based on nonlinear methodology of mutual information and a new methodology based on the final structure of the hidden Markov models are proposed. The RR series filtered according to the bands of frequency of the HRV are analyzed, which they characterize the autonomous nervous system, as well as the RR series in their entire bands. New indexes are constructed from these methodologies, which are used to characterize and differentiate the cardiac series of the patients of the risk groups of suffering sudden cardiac death. This is also applied to normal subjects, belonging to the IDEAL data base. A statistical analysis of the results of each of these indexes is performed. In chapter 6, the observation sequences obtained from the instantaneous phases of the RR series, filtered according to the frequency bands which characterize to the autonomous nervous system, as well as the entire band are analyzed. The results of the analysis of the instantaneous phases, obtained from the NIC data base, applying the new methodology base on HMM, together with the results of the Shannon entropy of the distribution of probabilities of these phases are presented.Finally, in chapter 7, the conclusions and contributions of this thesis and an outline of possible future lines of investigation are described. From the results obtained in this thesis, it is possible to conclude that the indexes obtained by means of the proposed methodologies have permitted to characterize the autonomic information low, offering information of the complex communications present in the autonomous nervous system.

Author: FERREIRA GONZALEZ Ignacio.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: Outcome variables combined (VRC) in clinical trials (CE) are a methodology commonly used but little analyzed. This memory consists of two jobs. The first one is a systematic review in which features metodológicaas basically advantages and disadvantages associated with the use of VRC. It has been documented that increase the efficiency of statistical CD is the main advantage. Among other benefits, valuation of the net profit of clinical intervention and avoid bias competitive risks are the most frequently cited. Among the disadvantages, it is mentioned that the heterogeneity of the components of the VRC as to the clinical significance of the same or in the magnitude of treatment effect complicate the interpretation of the effect of the intervention. To the extent that the heterogeneity in these domains increases, the interpretation is more complex. All authors agreed that, for the correct interpretation of the EC using VRC should report the event frequency and magnitude of the effect of the intervention on each component of the VRC. In a second work of this report analyzes what percentage of the EC cardiovascular used VRC potentially problematic. It conducted a systematic review of a sample of CD area cardiovascular.Se noted that more than half of them (56%) were the VRC heterogeneity in one or two domains. There was also that the components minor clinic are those who contribute most in the magnitude of the effect of the intervention and the frequency of events. By contrast, the contribution of the major components (eg death) is testimonial.