Showing papers by "José Luis Zamorano published in 2003"

Long term outcome of patients with postinfarction left ventricular pseudoaneurysm.

Abstract: Background: It is debatable whether surgical repair is routinely indicated in asymptomatic patients with left ventricular pseudoaneurysms. Objective: To evaluate the long term outcome of patients with pseudoaneurysm after myocardial infarction, focusing on those treated conservatively. Methods: 10 patients with postinfarction left ventricular pseudoaneurysm were followed up over a mean (SD) period of 3.8 (5.2) years. Results: In those treated conservatively (n = 9), cumulative survival was 88.9 (10.5)% and 74.1 (16.1)% at one and four years, respectively. The probability of being free of cardiac death was 88.9 (10.5)% at both one and four years. No patient had complete fatal heart rupture during follow up. Three patients suffered ischaemic stroke (at 1, 11, and 62 months). The cumulative incidence of ischaemic stroke was 10% at one year and 32.5% at four years. Conclusions: Long term outcome of patients with postinfarction left ventricular pseudoaneurysm is relatively benign, with a very low risk (none in this series) of fatal rupture. Taking into consideration the relatively high risk of stroke, chronic anticoagulant treatment could be considered.

Differences between endocarditis with true negative blood cultures and those with previous antibiotic treatment.

Abstract: Background and aim of the study High morbidity and mortality are attributed to patients with culture-negative endocarditis. The main reason for negative blood culture in infectious endocarditis (IE) is administration of antibiotics before sample withdrawal. The study aim was to determine any difference in prognosis between patients with 'aborted' culture-negative endocarditis (A-CNE) and those with true culture-negative endocarditis (T-CNE). Methods A total of 107 patients with a diagnosis of IE was studied retrospectively. Diagnosis was confirmed pathologically during surgery, at post-mortem examination, or by fulfillment of Duke's criteria. Twenty patients (18.7%) had negative-culture endocarditis and comprised the study population. Of these patients, 14 (70%) had received previous antibiotic therapy (A-CNE), and six (30%) were considered T-CNE cases. In-hospital outcome and clinical characteristics were compared between both patient groups. The main end-point was death or need for surgical repair of the heart valves during hospitalization. Results There were no significant inter-group differences with respect to mean age, gender distribution, and other clinical characteristics. The composite endpoint of death or surgical repair occurred more frequently in T-CNE patients (100% versus 64%, p = 0.0394). Anatomic complications also occurred more frequently in T-CNE patients, but the difference was statistically not significant. Conclusion Among patients with IE and a negative blood culture, those without previous antibiotic therapy (T-CNE) have the worse prognosis.

Endocarditis infecciosa en pacientes con hepatopatía crónica: valoración clínica y pronóstica

Abstract: Introduction and objectives. Chronic liver disease increases the susceptibility to bacterial infections and infective endocarditis. Our aim was to determine the clinical and microbiological features and the prognosis in patients with chronic liver disease who also had infective endocarditis. Patients and method. One hundred and seventy-four consecutive inpatients at our institution were recruited and followed. Thirty of them had chronic liver disease. Clinical, microbiological and echocardiographic variables were analyzed and, in some cases, histological variables were also recorded. Results. Patients with chronic liver disease were younger (36 ± 11 vs 54 ± 18 years; p < 0.01) and had a larger proportion of intravenous drug users (73 vs 16%; p < 0.01), HIV infection (47 vs 10%; p < 0.01), right valve involvement and spleen enlargement, but heart failure appeared less often (7 vs 34%; p = 0.003). Thirty percent of the patients with and 51% of patients without chronic liver disease underwent surgery for infective endocarditis. Total mortality among patients with and without chronic liver disease was 40% and 31%, respectively. After adjustment for age and for the incidence of congestive heart failure, chronic liver disease doubled mid-term mortality with a RR = 2.45 (p = 0.015). Conclusions. Chronic liver disease has a significant impact on the prognosis in patients with infective endocarditis, and these patients should therefore be considered a high risk group.

Phosphatidylcholine-Specific Phospholipase C Activity Is Necessary for the Activation of STAT6

Abstract: It is well established that Janus kinase (JAK) tyrosine kinases play a key role in the activation of STAT6 by IL-4. In this study, we investigated additional molecules involved in this process. We previously found that IL-4 and TNF-α cooperate in the activation of STAT6 and NF-κB, suggesting that these transcription factors are regulated by common intracellular signaling pathways. To test this hypothesis, we analyzed the effect of known inhibitors of NF-κB on the activation of STAT6. We discovered that inhibitors of phosphatidylcholine-specific phospholipase C (PC-PLC), but not other lipases, blocked the activation of STAT6 by IL-4. The activation of PC-PLC seems to be an early event in IL-4 signaling, because its inhibition abrogated JAK activation and STAT6 tyrosine phosphorylation. Interestingly, we found that the effects of pervanadate and sodium orthovanadate on STAT6 activation correspond to their effect on PC-PLC. Thus, pervanadate by itself activated PC-PLC, JAK, and STAT6, whereas sodium orthovanadate suppressed PC-PLC, JAK, and STAT6 activation by IL-4. We further found that PC-PLC activation is necessary but not sufficient to promote STAT6 activation, and therefore, additional intracellular pathways regulated by IL-4 and pervanadate may collaborate with PC-PLC to signal STAT6 activation. It has been reported that IL-4 signals PC-PLC activation; in this study, we provide evidence that this phospholipase plays a key role in IL-4 signaling.

Diagnóstico por imagen en el síndrome aórtico agudo

Abstract: Acute aortic dissection is a clinical emergency. Its prognosis is related mainly with prompt and accurate diagnosis, as well as rapid treatment. In this paper we review the importance of different imaging techniques in the diagnosis of patients with acute aortic syndrome. Aortic dissection, intramural haematoma, and penetrating aortic ulcer are discussed.

Ecocardiograma portátil: ¿qué añade a la valoración cardiovascular inicial?

Abstract: Introduccion y objetivos Desde hace poco tiempo disponemos de nuevos sistemas portatiles de ecocardiografia. Nuestro objetivo es determinar si un ecocardiograma portatil aporta informacion suplementaria al diagnostico cardiovascular inicial, basado en datos clinicos y tecnicas diagnosticas basicas. Pacientes y metodo Estudiamos prospectivamente la presencia y severidad (ausente, leve, significativa) de 7 cardiopatias frecuentes: estenosis-insuficiencia aortica y mitral, insuficiencia tricuspidea y disfuncion-hipertrofia ventricular izquierda en pacientes consecutivos mediante 3 tecnicas distintas: valoracion clinica junto con pruebas complementarias basicas, ecocardiograma portatil con imagen 2D y Doppler color (Optigo®, Philips Medical Systems) y ecocardiograma estandar de ultima generacion (Sonos 5500®, Philips Medical Systems). Comparamos los resultados obtenidos mediante las primeras 2 tecnicas y combinando los resultados de ambas, respecto al ecocardiograma estandar, mediante el porcentaje de concordancia y la medida de asociacion D de Somers. Resultados Estudiamos a 36 pacientes (50% varones; edad, 68 ± 12 anos). El ecocardiograma portatil obtuvo mejores resultados que la valoracion clinica (concordancia del 87 frente al 65%; D = 0,79 ± 0,04 frente a 0,19 ± 0,53) e identifico lesiones significativas incorrectamente valoradas por la clinica en un 39% (14/36) de los pacientes; sin embargo, en 8 pacientes (10 valoraciones) valoro erroneamente lesiones significativas. Conclusiones El ecocardiograma portatil, en manos experimentadas, aporta informacion adicional al diagnostico inicial de enfermedades cardiovasculares comunes, pero no resulta equivalente a un diagnostico ecocardiografico completo.

Relationship between the changes in myocardial perfusion and left ventricular ejection fraction after acute myocardial infarction. Study with myocardial contrast echocardiography.

Abstract: BACKGROUND AND OBJECTIVE Myocardial contrast echocardiography has recently been proposed as a valid technique in the evaluation of myocardial perfusion after myocardial infarction. The objective of this study was to evaluate the relation between changes in myocardial perfusion assessed by myocardial contrast echocardiography and left ventricular ejection fraction after myocardial infarction. PATIENTS AND METHODS We prospectively studied 17 patients with acute myocardial infarction, on whom two echocardiographic studies were performed, at 48-72 hours and at 6 months. Left ventricular ejection fraction and myocardial perfusion were evaluated with myocardial contrast echocardiography (Multiple-Frame Triggering and Harmonic Angio). Basal, medial and distal segments of the interventricular septum (anterior location infarction) and inferior wall (inferior infarction) were assessed. Myocardial perfusion was classified semi-quantitatively as grade 0, 1 or 2 (absent, heterogeneous or homogeneous opacification, respectively), giving a perfusion score. RESULTS Left ventricular ejection fraction improved in 9 patients (53%), the proportion of grade 0 segments decreasing by 11 +/- 17%; by contrast, this proportion increased by 9 +/- 13% in patients with no improvement in ejection fraction (p = 0.028). Additionally, a significant correlation was observed between changes in ejection fraction and both perfusion score (r = 0.625; p = 0.007) and the proportion of grade 2 segments (r = 0.649; p = 0.005). CONCLUSION After myocardial infarction, there is a significant relation between changes in left ventricular ejection fraction and myocardial perfusion assessed by myocardial contrast echocardiography with i.v. agents.

Myocardial Contrast Echocardiography in the Assessment of Patients with Chronic Coronary Artery Disease

Abstract: Echocardiography has been established as a very important tool for imaging the heart and the great vessels. It is readily available to cardiologists and is neither expensive nor time consuming. Similar data can be obtained using other techniques, but none of them is able to provide all the structural, functional and haemodynamic information that echocardiography does. The development of new contrast agents and new devices and methods for assessing myocardial perfusion has led to an emerging field of applications and indications for patients suffering from chronic ischaemic heart disease. Myocardial contrast echocardiography is now moving from the experimental laboratory to daily clinical practice for the evaluation of ischaemic heart disease, since the assessment of myocardial perfusion with this technique may provide important information at low additional cost.