Revista Cubana de Medicina (Sep 2006)
Lesión carotídea extracraneal asintomática y su asociación con cardiopatía isquémica silente Carotid extracranial asymptomatic injury and its association with silent ischemic heart disease
Abstract
Se estudiaron 71 pacientes de los dos sexos, con edades comprendidas entre los 60 y 75 años, a quienes se les diagnosticó daño carotídeo extracraneal, pero se mantenían asintomáticos desde el punto de vista neurológico y cardiovascular. A todos se les realizó ecodoppler carotídeo a color de alta resolución y quedaron agrupados en 2 categorías, según daño vascular: 30 pacientes con engrosamiento íntima media > 1,1 mm y 41 con estenosis, además, un grupo control de 30 sujetos con factores de riesgo vascular sin lesión carotídea. A todos se les realizó electrocardiograma y prueba ergométrica para definir diagnóstico de cardiopatía isquémica silente. En relación con este medio diagnóstico, se realizaron modificaciones propias para el anciano, incluyendo recomendaciones de acondicionamiento y medidas preventivas para cualquier complicación. Además, se establecieron contraindicaciones específicas, criterios clínicos y electrocardiográficos de positividad y severidad. Las variables se codificaron en una base de datos computarizada, se realizaron tablas de contingencia (de doble entrada); para las variables cualitativas se empleó el test Chi2 para evaluar asociación entre las variables de interés, y para las cuantitativas, el t Student para comparar los promedios en las variables analizadas. Los resultados se consideraron significativos cuando la probabilidad de asociación de los tests fue 71 patients of both sexes aged 60-75 who were diagnosed extracranial carotid damage, but were asymptomatic from the neurological and cardiovascualr point of view, were studied. All of them underwent high resolution color carotid echodoppler and were divided into categories, according to the vascular damage: 30 with intima media thickness >1,1 mm and 41 con stenosis, in addition to a control group of 30 subjects with vascular risk factor without carotid injury. EKG and an ergometric test were performed in all the individuals to define the diagnosis of silent ischemic heart disease. This diagnostic tool was modified for the elderly. Recommendations of conditioning and preventive measures were included for any complication.The variables were codified in a computerized database, and contingency (doble entry) tables were made. Chi square test was used for the qualitative variables to evaluate the association between the variables of interest, whereas the t Students' test was applied to the quantitative variables.The results were considered significant when the probability of association of the tests was < 0.05. The time of action of the vascular risk factors showed a close relation to the carotid damage, mainly smoking (38.2 years as an average). The behavior of the action of the risk factors on the coronary arteries was evidenced in this same order of frequency by the ergometric test. The coincident relation between the carotid and the coronary damage was proved. There was a higher percentage of positive ergometric tests among the elderly with carotid stenosis (57.7 %).
