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Objetivos . Este estudio intenta determinar si las nuevas tecnicas mejoran de manera significativa la resolucion del borde endocardico en pacientes con ventana ultrasonica suboptima y la reproducibilidad en la interpretacion de la contraccion segmentaria, dependiendo de la tecnica empleada y el grado de experiencia del observador. Metodos . Estudiamos un total de 20 pacientes (240 segmentos) consecutivos, con mala ventana ultrasonica, para objetivar si el uso de segundo armonico tisular (2H) o el contraste mas segundo armonico (2HC) (Levovist® 4 g i.v.), mejoraba la definicion del borde endocardico, comparado con el modo fundamental (2D). Un total de 4 observadores, con diferentes grados de experiencia, analizaron la contraccion segmentaria de 32 pacientes (384 segmentos) consecutivos, para valorar la reproducibilidad del estudio de acuerdo con la tecnica empleada. Resultados . La calidad de la imagen fue superior con 2H y 2 HC en comparacion con 2D. La diferencia fue mayor en los bordes endocardicos lateral y apical (0,9 frente a 1,5 y 1 frente a 1,64; p Conclusiones . a) El segundo armonico tisular y el segundo armonico mas contraste mejoran significativamente la visualizacion del borde endocardico; b) las nuevas tecnicas de imagen mejoran de manera significativa el rendimiento del estudio, sin disminuir el grado de concordancia, y c) la experiencia en la valoracion del borde endocardico es el principal determinante en la variabilidad interobservador.

This study sought to determine if newer techniques significantly improve endocardial border definition in suboptimal acoustic windows, and the reproducibility of the evaluation of wall motion abnormalities according to the different techniques and degrees of expertise.We studied a total of 20 consecutive patients with poor ultrasound window, to assess, if the use of tissue harmonic imaging (2H) or contrast with second harmonic (Levovist ; 4 g i.v.), (2HC) improves endocardial border visualization. In order to analyze inter and intraobserver reliability with the different techniques, four observers with different degrees of expertise were each asked to assess the segmental wall motion score of 31 consecutive echocardiograms.The quality of the image was clearly superior with 2H and 2HC compared with 2D. This difference was larger in apex and lateral endocardial border from 0.9 and 1 to 1.5 and 1.64 (p0.001) with 2H. 2HC was found to slightly but significantly improve the endocardial definition in apex compared with 2H (1.64 vs 1.81; p = 0.016). The percentage of segments assessed for interobserver variability significantly improve with 2H and 2HC (2D = 50%, 2H = 75% and 2HC = 95%). Interobserver agreement with the different techniques between the experienced observers did not statistically differ. The less experienced observer presented a significantly lower interobserver reliability than those with experience, and did not improve with 2H and 2HC.a) Native tissue harmonic imaging and second harmonic imaging with contrast (Levovist ) significantly improves endocardial border visualization; b) the newer imaging techniques significantly improve performance (percentage of evaluated segments) without decreasing reliability, and c) experience in assessing wall motion is the main factor in interobserver agreement.

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

High blood pressure is a well-known cardiovascular risk factor that is responsible for an elevated morbidity and mortality. However, although efficacious drugs for treatment and numerous and updated scientific training programs are available, the reality is that only a low percentage of patients are followed up in accordance with the rates which are presently considered normal. The purpose of these guidelines is to provide medical guidance for the prevention, detection and evaluation of hypertension, and to provide the best diagnosis and treatment. The factors involved in cardiovascular complications in the hypertensive patient are multiple. That is why this report places more emphasis in the individual cardiovascular risk stratification as part of the treatment strategy. The information obtained in the most recent studies published confirms the interest in achieving the greatest decrease in rates of blood pressure. This treatment to lower levels is especially useful in the high-risk subgroup. It maintains the necessity of nonpharmacological measures or lifestyle modifications in all patients with high blood pressure who either need or do not need drug therapy. All pharmacological groups may be used, but it is appropriate to choose the specific antihypertensive agent adapted to the clinical and individual situation with the use of low doses of drugs to initiate therapy and the use of appropriate drug combinations.

fisicos existen papeles oficiales, fotograffas y otras pruebas inconcusas; mas no sucede lo mismo cuando se trata de opiniones cuya demostraci6n no se puede hacer de una manera tajante. Entre los varios puntos debatidos, el estilo barojiano ha sido objeto de comentarios diversos. De esta cuesti6n me ocupar6 yo aqui, si bien en s61o un aspecto: (son de origen vasco las incorrecciones barojianas? Alla por el afio de mil novecientos catorce, compafieros de correrias por los ambitos peninsulares, andaban por tierras de Coria Baroja y Ortega siguiendo los pasos de Aviraneta. Alli tiene el novelista una ocurrencia que la pluma elegante del ensayista encuadra en la an6cdota famosa "Baroja tropieza en Coria con la Gramitica."' Y la reputaci6n antigramatical del vasco estA lanzada. No importa que Ortega declare "yo leo para aumentar mi coraz6n y no para tener el gusto de contemplar c6mo las reglas de la Gramitica se cumplen una vez mais en el libro."2 Ni los manuales de estilistica dan normas fijas que determinen la bondad del estilo; ni los criticos literarios estin de acuerdo en qu6 sea el estilo. Parece cosa cierta que la correcci6n gramatical no significa precisamente buen estilo. Sin embargo, una porci6n de comentaristas, al tratar del estilo barojiano, ven en su origen vasco la raz6n de sus defectos y apuntan las incorrecciones de lenguaje, la falta de sintaxis, etc.. Ya oigo la replica: jel mismo Baroja lo dice! Si; v. g., por boca de Shanti Andia afirma: "como buen vasco, he sido siempre un poco irrespetuoso con esa respetable y honesta sefiora que se llama la Gramatica;"3 el supuesto autor de las Memorias de un hombre de accirn oye de labios de Dama Ursula que el vicario de pueblo, "buen gramitico ... dice a todo el mundo que yo, no s6lo no soy un prosista castizo de la vieja cepa castellana, sino que mi prosa parece traducida del vascuence."4 Mals directamente, D. Pio nos informa que tiene "falta de sentido idiomAtico, por ser vasco y no haber hablado mis ascendientes el castellano."5 Es una cuesti6n que tiene puntos de contacto con la psicologia y caracter de cosa heredada: "La sintaxis tipica viene de un fondo de raza, y en el escritor, cuanto mis personal es, mais se nota su ascendencia."6