Conclusions The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months.

Introduction and objectives. To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term.Methods. The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months.Results. Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001).Conclusions. The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months.

Para analizar las diferencias en la respuesta al test de tabla basculante (TTB) entre sujetos sin y con hipertensión arterial (HTA) hemos estudiado consecutivamente a los 338 pacientes con síncope que realizaron el TTB en nuestro servicio entre enero de 2003 y octubre de 2004. En 243 pacientes no se apreció hipertensión (grupo A), mientras que en 95 sí la había (grupo B). Encontramos diferencias entre ambos grupos en la edad (p = 0,0001), el sexo (p = 0,048), el tiempo de evolución de los síncopes (p = 0,0001) y el porcentaje de diabetes mellitus (p = 0,0001). El TTB fue positivo en 168 pacientes (69,1%) del grupo A y 63 (66,3%) del grupo B (p = 0,6; NS). No encontramos diferencias entre ambos grupos en el porcentaje de positividad al TTB durante la fase basal y durante la fase de nitroglicerina (p = 0,673; NS), ni en el tiempo de aparición del síncope en ambas fases (p = 0,69; NS, y p = 0,28; NS), aunque sí en el tipo de respuesta (respuesta vasodepresora del 33% en el grupo A frente al 49% en el grupo B; p = 0,01). En el análisis multivariable no se encontró ninguna variable independiente asociada con el resultado del TTB. We studied the difference in head-up tilt test responses between patients suffering from syncope who had hypertension and those who did not. A total of 338 consecutive patients with syncope underwent head-up tilt testing in our department from January 2003 to October 2004. Of these, 243 did not have hypertension (group A), whereas 95 did (group B). There were significant differences between the groups in age (P=.0001), sex (P=.048), timing of syncope development (P=.0001), and prevalence of diabetes mellitus (P=.0001). The head-up tilt test gave positive results in 168 patients (69.1%) in group A and in 63 (66.3%) in group B (P=.6; NS). There was no significant difference between the groups in the proportion of positive responses that occurred in either the baseline or nitroglycerin-enhanced phase of the test (P=.673; NS), nor in the time to onset of syncope in either phase (P=.69; NS, and P=.28; NS, respectively). However, there was a significant difference in the type of response (vasodepressor response, 33% in group A versus 49% in group B, P=.01). In the multivariate analysis, no independent variable was found to be associated with the result of the head-up tilt test.

BACKGROUND AND OBJECTIVE:The prevalence and morbidity of the vaso-vagal syncope are well-known. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure.PATIENTS AND METHOD:All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test.RESULTS:Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients.CONCLUSIONS:In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Son conocidas la prevalencia del síncope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administración de la versión española del Cuestionario de Salud SF-36 en esta población con los valores de la población general y de pacientes con insuficiencia cardíaca. Además se ha analizado la influencia de diversos parámetros clínicos. Se incluyó consecutivamente a todos los pacientes con síncope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contestó previamente a la realización del test. Se calcularon los valores utilizando estadísticos apropiados a la distribución de la muestra, se analizaron según la edad y el sexo, y se correlacionaron con diversos parámetros clínicos. Se incluyó a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardíaca. En el varón sólo 4 dimensiones del SF-36 fueron inferiores a la población general, y en la mujer lo fueron las 8. La mujer tuvo peor percepción de su CVRS que el varón (p < 0,05). La edad influyó negativamente en todas las dimensiones del SF-36, sobre todo en la mujer. El número de síncopes fue el parámetro clínico que más se relacionó con la CVRS. En nuestra serie, los pacientes con síncope vasovagal tienen peor CVRS respecto a la población general de referencia y similar a la que sufre insuficiencia cardíaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el número de síncopes es el parámetro clínico que mejor se correlaciona con la CVRS. The prevalence and morbidity of the vaso-vagal syncope are wellknown. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure. All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test. Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients. In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

El embarazo en adolescentes tiene un alto coste sanitario, social y económico en el conjunto de la sociedad. Las enfermedades de transmisión sexual y el sida son una causa importante de morbimortalidad en individuos jóvenes. El preservativo es el único método anticonceptivo que, además de evitar embarazos, evita la transmisión de enfermedades Conocer la proporción de mujeres menores de 22 años que utilizan el preservativo en todas las relaciones con penetración y conocer las características de la población de mujeres que abandonan el preservativo como método anticonceptivo único antes de los 22 años Estudio de corte transversal realizado en el centro de salud del Greco (Sevilla), entre junio de 1998 y mayo de 1999 sobre mujeres menores de 22 años que acudieron a consulta para solicitar un método anticonceptivo diferente al preservativo Un 53,7% de los casos usaron el preservativo de forma constante y un 46,3% de forma inconstante. Se encontraron diferencias significativas entre ambos grupos en cuanto a nivel académico, la situación laboral y el número de embarazos no deseados. La edad de inicio de las relaciones sexuales se correlaciona significativamente con la edad de abandono del preservativo como método único. Se debe iniciar, de forma precoz, la promoción en las escuelas del uso constante del preservativo. Son necesarios estudios posteriores para mejorar las intervenciones que se están realizando para conseguir un uso constante del preservativo Pregnancy is adolescent has a high health care, social and economic cost within the society. Sexually transmitted diseases and AIDS are the most important cause of morbi-mortality in youths. The condom is the only contraceptive method wich, in addition to avoiding pregnancy, avoids disease transmission To know the proportion of women under the age of 22 years who use condoms in all sexual relations with penetration and to know the characteristics of the female population who abandon the use of the condom as the only contraceptive method before the age of 22 years A transversal study was carried out in the health care center of Greco (Seville, Spain) from june 1998 to may 1999 in women under the age of 22 years who attended a consultory to request an contraceptive method other than the condom Fifty-three point seven percent of the cases always used the condom and 46.3% did so discontinuosly. Significant differences were found between the two groups with regard to educative level, laboral situation and the number of unwanted pregnancies. The age of initiation of sexual relations correlated significantly with the age of abandonment of the condom as the only contraceptive method The promotion of the constant use of condoms should be initiated early in schools. Further studies are required to improve the interventions carried out to achieve constant use of condoms