Showing papers by "José Luis Zamorano published in 2009"

Guidelines for the diagnosis and treatment of pulmonary hypertension

Abstract: Guidelines and Expert Consensus Documents summarise and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. Unpublished clinical trial results are not taken into account. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in tables 1⇓ and 2⇓. The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must …

[Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation]

Abstract: [Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation]

European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography.

Abstract: The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. The purpose of this document is to provide the requirements for training and competence in echocardiography, to outline the principles of quality measurement, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice in Europe.

Three-dimensional-wall motion tracking: a new and faster tool for myocardial strain assessment: comparison with two-dimensional-wall motion tracking.

Abstract: Background Two-dimensional (2D) wall motion–tracking echocardiography (WMT) is a useful method to measure myocardial strain, but it is very limited because acquisition and analysis are time consuming. Three-dimensional (3D) WMT is a new method that might improve diagnostic usefulness and reduce study times. The aims of this study were to compare results on 2D and 3D WMT and to compare the times for the acquisition and analysis of regional myocardial strain between the two methods. Methods Measurements of the radial and longitudinal strain of every left ventricular (LV) segment and the time for acquisition and analysis were obtained using 3D and 2D WMT. Results Thirty patients were enrolled (mean age, 57.2 ± 19.6 years; 60% men). Three-dimensional WMT provided complete radial and longitudinal LV strain information, similar to 2D WMT ( P = NS), but it was less time consuming: the times for acquisition and analysis were 14.0 ± 1.9 minutes with 2D WMT and 5.1 ± 1.1 minutes with 3D WMT ( P Conclusions Three-dimensional WMT provides a faster, more complete, and similar analysis to assess LV longitudinal and radial strain compared with 2D WMT. Thus, 3D WMT is a potential clinical bedside tool for quantifying myocardial strain.

Minimizing Cardiotoxicity While Optimizing Treatment Efficacy with Trastuzumab: Review and Expert Recommendations

Abstract: Numerous clinical studies have demonstrated the therapeutic benefit of trastuzumab in women with breast cancer. However, a small but not insignificant proportion of patients have experienced trastuzumab-associated cardiotoxicity during these trials. This phenomenon is generally characterized by an asymptomatic reduction in left ventricular ejection fraction (LVEF) or, less often, congestive heart failure (CHF). Concomitant anthracycline therapy significantly increases the risk for cardiotoxicity during trastuzumab treatment, and such regimens are therefore not recommended. The cardiac dysfunction associated with trastuzumab is most often reversible upon discontinuation of treatment and initiation of standard medical therapy for CHF. Prior to treatment initiation, a risk-benefit analysis should be performed for each individual patient, including a thorough assessment of potential risk factors and cardiac function. Cardiac monitoring should be continued throughout trastuzumab therapy and the follow-up period, because early recognition of trastuzumab-associated cardiac dysfunction can allow effective medical intervention. Following the occurrence of asymptomatic LVEF reduction or CHF and appropriate medical intervention, reintroduction of trastuzumab may be considered in patients following resolution of normal cardiac function, or in those for whom the benefit of antitumor therapy outweighs the risk for CHF.

Detection of coronary artery disease with perfusion stress echocardiography using a novel ultrasound imaging agent: two Phase 3 international trials in comparison with radionuclide perfusion imaging

Abstract: Aims To determine if perfusion stress echocardiography (PSE) with Imagify™ (perflubutane polymer microspheres) is comparable to stress perfusion imaging using 99mTc single photon emission computed tomography (SPECT) for coronary artery disease (CAD) detection. PSE is a novel technique for evaluating myocardial perfusion. RAMP (real-time assessment of myocardial perfusion)-1 and -2 were international, Phase 3 trials that evaluated the ability of PSE with Imagify, to detect CAD. Methods and results Chronic, stable, chest pain patients ( n = 662) underwent Imagify PSE and gated SPECT imaging at rest and during dipyridamole stress. Independent blinded cardiologists [three PSE readers per trial, and four SPECT readers (one for RAMP-1, three for RAMP-2)] interpreted images. CAD was defined by quantitative coronary angiography or 90-day outcome with clinical review. Accuracy, sensitivity, and specificity were evaluated using non-inferiority analysis (one-sided alpha = 0.025) compared with SPECT. SPECT results for RAMP-1 and -2 were: accuracy (70%, 67%), sensitivity (78%, 61%), and specificity (64%, 76%). Accuracy of all six PSE readers was non-inferior to SPECT (66–71%, P ≤ 0.004). Four demonstrated non-inferior sensitivity (68–77%, P ≤ 0.002), three demonstrated non-inferior specificity (72–88%, P ≤ 0.013). Three PSE readers (RAMP-2) were superior for sensitivity. Two PSE readers (RAMP-1) were superior for specificity. Area under the multi-reader receiver operating characteristics curve (0.72) was equal for both modalities. Majority of adverse events followed dipyridamole dosing, and were mild, transient, and required no treatment. Conclusions Imagify PSE was well-tolerated. Its diagnostic performance in chest pain patients is comparable with SPECT perfusion imaging.

Chronic mitral regurgitation: a pilot study to assess preoperative left ventricular contractile function using speckle-tracking echocardiography

Abstract: Background The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral regurgitation (MR) and implies a poor prognosis The aim of this study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional echocardiography–based speckle-tracking analysis in patients with chronic severe MR Methods Thirty-eight consecutive patients with chronic severe MR scheduled for mitral valve replacement were prospectively enrolled Preoperative two-dimensional echocardiography–based speckle-tracking analysis at the level of the interventricular septum (IVS) was carried out, and strain and strain rate values were obtained LV dP/dt and Doppler tissue imaging–derived strain and strain rate measurements were also obtained LV volumes and LV ejection fraction (LVEF) were defined using three-dimensional echocardiography Results Preoperative speckle tracking–derived longitudinal strain and strain rate values at the level of the IVS strongly predicted a postoperative LVEF decrease of >10% Their predictive values were greater than those obtained for preoperative LV volumes and LVEF, LV dP/dt, and Doppler tissue imaging–derived strain and strain rate The best discriminant parameter to detect a postoperative LVEF reduction of >10% with speckle tracking was a longitudinal strain rate at the level of the mid IVS −1 (area under the receiver operating characteristic curve, 088; sensitivity, 60%; specificity, 965%; positive predictive value, 90%; negative predictive value, 8235%) Conclusions IVS longitudinal speckle tracking–derived strain rate allows the accurate detection of early abnormalities in LV contractile function It is a powerful predictor of early postoperative LVEF decreases in patients with chronic severe MR Furthermore, speckle-tracking technology is more accurate than other methods This new tool might assist clinicians in the optimal timing of surgery in patients with chronic severe MR

Speckle-tracking-derived strain and strain-rate analysis: a technique for the evaluation of early alterations in right ventricle systolic function in patients with systemic sclerosis and normal pulmonary artery pressure.

Abstract: Background and aim Systemic sclerosis is associated with pulmonary artery hypertension. Speckle-tracking-derived strain and strain rate may be a diagnostic tool to detect early changes in right ventricular function, before pulmonary artery hypertension development. Our aim was to assess whether speckle-tracking-derived strain and strain-rate parameters may detect right ventricular early alterations in patients with systemic sclerosis with normal pulmonary systolic artery pressure (PAP). Methods Seventeen asymptomatic patients with systemic sclerosis and 22 controls were enrolled. A complete two-dimensional echo with speckle-tracking-derived longitudinal strain and strain rate of the basal right ventricular free wall and interventricular septum was performed. Results Median age was 56 years (43.8-71.5) in the systemic sclerosis group and 48.5 years (32-56.5) in the control group. No differences in conventional left ventricular parameters, tissue Doppler indexes, or in tricuspid annular plane systolic excursion were found. Patients with systemic sclerosis had higher levels of peak tricuspid regurgitation velocity and less respiratory collapse in the inferior vena cava. There were no differences in the speckle-tracking-derived strain and strain-rate parameters measured at the level of the basal interventricular septum and in the strain values measured at the level of the basal lateral right ventricular free wall. Nevertheless, a significant increase of the longitudinal strain rate measured at the basal lateral free wall of the right ventricle was found in patients with systemic sclerosis when compared with controls [-5.5 (-6.4--2.6)/s vs. -1.8 (-3.9--1.4)/s; P = 0.014]. Conclusion Speckle-tracking-derived longitudinal strain rate is useful to detect early right ventricular function changes in patients with systemic sclerosis with normal pulmonary systolic artery pressure levels. This alteration may preclude pulmonary artery hypertension development and reflect an adaptive response to higher levels of pulmonary systolic artery pressure.

Omeprazole inhibits IL-4 and IL-13 signaling signal transducer and activator of transcription 6 activation and reduces lung inflammation in murine asthma.

Abstract: interaction was lacking. Of 10 SNPs evaluated, only rs8079416 was nominally significant at a P value of .01. There was no interaction with age or smoke exposure. This continues to suggest that the tagging SNPs are not linked strongly to the causal variant or that the causal variant is rare in this population. In conclusion, we confirm the interaction among the 17q12-21 variants, childhood smoke exposure, and pediatric asthma in a white population. However, our data show no age-of-onset effect. Although this study does not refute earlier findings suggesting such an effect, further prospective exploration of interaction between the 17q12-21 variants and age of onset is warranted. James H. Flory, MD, MS Patrick M. Sleiman, PhD Jason D. Christie, MD, MS Kiran Annaiah, MSc Jonathan Bradfield, BS Cecilia E. Kim, BA Joseph Glessner, MSc Marcin Imielinski, MD, PhD Hongzhe Li, PhD Edward C. Frackelton, BA Hou Cuiping, PhD George Otieno, MSc Kelly Thomas, BA Ryan Smith, BA Wendy Glaberson, BA Maria Garris, BA Rosetta Chiavacci, MSc Julian Allen, MD Jonathan Spergel, MD, PhD Robert Grundmeier, MD, PhD Michael Grunstein, MD, PhD Michael Magnusson, MD, PhD Struan F. A. Grant, PhD Klaus Bønnelykke, MD Hans Bisgaard, MD Hakon Hakonarson, MD, PhD From the Center for Applied Genomics, the Division of Pulmonary Medicine, the Division of Allergy and Immunology, the Department of Bioinformatics, and the Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pa; the Center for Clinical Epidemiology and Biostatistics, Department of Medicine, University of Pennsylvania, Philadelphia, Pa; and the Department of Health Sciences of the University of Copenhagen, Copenhagen, Denmark. E-mail: hakonarson@ CHOP.EDU. Disclosure of potential conflict of interest: J. H. Flory has received nonprofit grants from FOCUS, the University of Pennsylvania, and the National Institutes of Health. J. D. Christie receives grant support from the National Institutes of Health and has provided legal consultation/expert witness testimony in cases related to mesothelioma in brake workers. J. Allen receives grant support from the National Institutes of Health. J. Spergel receives grant support from Ception and is on the speakers’ bureau for Schering-Plough and AstraZeneca. R. Grundmeier receives grant support from the Agency for Healthcare Research and Quality. M. Magnusson has provided legal consultation/expert witness testimony in cases related to medical malpractice. S. F. A. Grant receives grant support from the National Institutes of Health. H. Bisgaard has been a consultant to and paid lecturer for and holds sponsored grants from Aerocrine, Altana, GlaxoSmithKline, Merck, MedImmune, NeoLab, and Pfizer and has provided legal consultation/expert witness testimony on behalf of NeoLab. The rest of the authors have declared that they have no conflict of interest.

Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009)

Abstract: El contenido de las Guias de Practica Clinica de la Sociedad Europea de Cardiologia (ESC) ha sido publicado para uso exclusivamente personal y educacional. No esta autorizado su uso comercial. No se autoriza la traduccion o reproduccion en ningun formato de las Guias de la ESC ni de ninguna de sus partes sin un permiso escrito de la ESC. El permiso puede obtenerse enviando una solicitud por escrito a Oxford University Press, la empresa editorial del European Heart Journal y representante autorizada de la ESC para gestionar estos permisos. Responsabilidad: Las Guias de Practica Clinica recogen la opinion de la ESC y se han elaborado tras una consideracion minuciosa de las evidencias disponibles en el momento en que fueron escritas. Se anima a los profesionales de la sanidad a que las tengan en plena consideracion cuando ejerzan su juicio clinico. No obstante, las Guias de Practica Clinica no deben invalidar la responsabilidad individual de los profesionales de la salud a la hora de tomar decisiones adecuadas a las circunstancias individuales de cada paciente, consultando con el propio paciente y, cuando sea necesario y pertinente, con su tutor o representante legal. Tambien es responsabilidad del profesional de la salud verificar las normas y los reglamentos que se aplican a los farmacos o dispositivos en el momento de la prescripcion. ©The European Society of Cardiology 2009. Reservados todos los derechos. Para la solicitud de permisos, dirijase por correo electronico a: journals. permissions@oxfordjournals.org Los comentarios-anotaciones (*) incluidos en esta traduccion de la guia han sido realizados por la Dra. Pilar Tornos (Barcelona, Espana).

Left ventricular trabeculae: quantification in different cardiac diseases and impact on left ventricular morphological and functional parameters assessed with cardiac magnetic resonance.

Abstract: OBJECTIVES Left ventricle trabeculae (LVT) are frequently seen in different cardiac diseases. Normal reference values of LVT in different cardiac conditions are not known. The aim of the study was to quantify with cardiac magnetic resonance (CMR), LVT mass (LVTM) and LVTM percentage (LVTM%) in different heart diseases and to evaluate their influence on left ventricular morphological and functional parameters. METHODS Fifty-nine patients (14 controls, 17 ischemic cardiomyopathy, 15 nonischemic dilated cardiomyopathy, 7 valvular heart disease and 6 with left ventricle hypertrophy) were enrolled. Cine-MR images were acquired with steady-state free-precession sequence in a short-axis view. LVTM was calculated as the difference between LVM excluding/including trabecuale from the blood cavity. LVTM% was calculated as the percentage of the whole left ventricle mass excluding trabeculae from the blood cavity. RESULTS Mean age was 47.60 +/- 22.03 years; male 62.7%. Mean LVTM was of 33.38 +/- 16.1 g with mean LVTM% of 19.22 +/- 6.5%. Significant differences between groups for both parameters with P values of 0.02 were obtained. Nonischemic dilated cardiomyopathy showed the highest degree of LVTM (44.73 +/- 16.0 g) and LVTM% (23.26 +/- 6%). Significant differences were noted in left ventricular morphological and functional parameters with inclusion/exclusion of LVT in the myocardial mass. CONCLUSIONS Reference values and differences of LVTM and LVTM% in various cardiac conditions are given for the first time. Quantification of these parameters with CMR may be clinically useful in the differential diagnosis between left ventricular noncompaction and other cardiac diseases. Exclusion of LVT from myocardium alters left ventricular morphological and functional parameters, which have significant clinical importance.

The Esc Textbook Of Cardiovascular Imaging

Abstract: The ESC Textbook of Cardiovascular Imaging - Libros de Medicina - Radiologia de Torax - 149,58

Usefulness of 3D transoesophageal echocardiography for guiding wires and closure devices in mitral perivalvular leaks.

Abstract: Sixty-three-year-old male patient. Previous history of rheumatic valvular disease. He underwent multiple mitral and aortic valve replacements. Nowadays, he presents a periprosthetic mitral leak. He underwent a leak closure by using a percutaneous approach. During the procedure, the superiority of 3D TEE over 2D TEE was confirmed for wires and device positioning, excluding interference with the prosthesis discs and evaluating the residual periprosthetic regurgitation.

Application of hypertension guidelines in clinical practice: implementation of the 2007 ESH/ESC European practice Guidelines in Spain.

Abstract: Clinical practice guidelines on the management of hypertension such as the 2007 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines were developed with the objective of allowing a greater number of patients with high blood pressure to be detected and effectively treated. The acceptance of hypertension guidelines and their implementation in clinical practice by ‘front-line’ physicians continues to be less than optimal for a variety of reasons, however, including the gap between academic guideline writers and those whose task it is to implement the guidelines, the physicians’ own attitudes and knowledge, the characteristics of the guideline itself, patient-related factors, and external barriers such as a lack of adequate resources. In Spain, a survey of the opinions of Spanish physicians on the 2007 ESH/ESC hypertension Guidelines found that there was agreement that the guidelines allow a better stratification of cardiovascular risk, better control of risk factors related to hypertension, better implementation of an individualized treatment programme, and facilitate choice of the best therapeutic approach for each patient, but there was no consensus that adherence to the guidelines achieves better control of hypertension or that it is more likely to prevent future cardiovascular events. In future, there needs to be a continuous process involving education and audit that takes into account the full spectrum of barriers to acceptance and implementation of hypertension guidelines to ensure that their full potential in reducing the strain on healthcare delivery systems imposed by undiagnosed, untreated and uncontrolled hypertension can be realized.

Guía de práctica clínica para el diagnóstico y manejo del síncope (versión 2009)

Abstract: Responsabilidad Las Guias de Practica Clinica recogen la opinion de la ESC y se han elaborado tras una consideracion minuciosa de las evidencias disponibles en el momento en que fueron escritas. Se anima a los profesionales de la sanidad a que las tengan en plena consideracion cuando ejerzan su juicio clinico. No obstante, las Guias de Practica Clinica no deben invalidar la responsabilidad individual de los profesionales de la salud a la hora de tomar decisiones adecuadas a las circunstancias individuales de cada paciente, consultando con el propio paciente y, cuando sea necesario y pertinente, con su tutor o representante legal. Tambien es responsabilidad del profesional de la salud verificar las normas y los reglamentos que se aplican a los farmacos o dispositivos en el momento de la prescripcion.

Medical therapy for rheumatic heart disease: is it time to be proactive rather than reactive?

Abstract: Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time The potential for statin therapy in slowing the progression of valvular heart disease is still controversial Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease However, the prospective randomized clinical trials have been negative to date This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late This is important in calcific aortic stenosis as well as in rheumatic valve disease There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves This review will summarize the potential for statin therapy for this patient population

Three-dimensional echocardiography for assessment of mitral valve stenosis.

Abstract: PURPOSE OF REVIEW Since the last few years, three-dimensional echocardiography (3DE) has become an accurate tool for mitral stenosis assessment We will review the latest developments of 3DE in this matter RECENT FINDINGS Accuracy of 3DE planimetry is superior to the accuracy of the invasive Gorlin's method for mitral valve area (MVA) measurements when a median value obtained from two-dimensional planimetry, pressure half-time, and proximal isovelocity surface area method is used as the gold standard 3DE improves MVA measurement particularly in less experienced operators compared with experienced operators 3DE also improves the measurement of MVA in patients with calcific mitral stenosis by means of colour planimetry of the flow stream Comparison of mitral valve volumes measured by 3DE in patients with critical and without critical stenosis has shown significantly larger volumes in patients with critical stenosis SUMMARY Currently, there is sufficient evidence that 3DE is superior to two-dimensional echocardiography and may be routinely used in the quantification of the MVA in mitral stenosis In the coming years, 3DE might replace Gorlin's method as the gold standard for MVA quantification and may eventually make cardiac catheterization unnecessary

Apnoeic and obstructive nonapnoeic sleep respiratory events

Abstract: Obstructive nonapnoeic event (ONE) scoring is shrouded in confusion. This is important in patients with mild disease, in whom precision is crucial. The aims of the present study were: 1) to identify ONEs using oesophageal pressure (OP) (OP-ONEs) and a noninvasive (NI) method (NI-ONEs); 2) to compare both methods of scoring; and 3) to determine the contribution of ONE definitions to clinical findings. Patients with suspected sleep apnoeas (respiratory disturbance index ≤10) during a first polysomnography were subjected to a second with an OP measurement. OP-ONEs and NI-ONEs were defined as an increase in OP or discernible reduction in the amplitude of thoracoabdominal bands with both desaturation and/or arousal. Bland–Altman analysis established agreement. Comparisons were made between OP-ONEs, NI-ONEs and clinical findings. In our sample (n = 90), the addition of an arousal to the NI-ONEs or OP-ONEs with only desaturation increased the number of NI-ONEs by 329 and 362%, respectively. NI-ONEs with arousal and/or desaturation detected 91% of OP-ONEs. The association with sleepiness depended on the incorporation of arousal into the definition of ONEs. In patients with mild disease, the addition of an arousal to ONEs, with only desaturation, markedly increased respiratory disturbance index, with probable therapeutic implications. Scoring respiratory events as apnoea and ONEs is easier and sufficiently accurate.

Short-term and mid-term follow-up of sutureless surgery for postinfarction subacute free wall rupture.

Abstract: We report our short-term and mid-term results with sutureless repair of postinfarction subacute left ventricular free wall rupture (LVFWR). For this purpose, we evaluated the short-term and mid-term postoperative results assessed by clinical examination and echocardiography of all patients who underwent surgery for subacute LVFWR between January 2004 and January 2009. Twenty-one patients were operated. Direct suture repair of LVFWR was carried out in only one patient. In all other cases we used a pericardial patch with biological glue. Early mortality was 19% (n=4). The median duration of follow-up was 17.3 months (interquartile range, 5-38.7), with a 13-month survival of 76%. Follow-up echocardiography showed no constriction associated with the rupture zone in any patient. According to our early experience, sutureless LVFWR repair is safe, effective and reproducible, and offers acceptable morbidity and mortality during follow-up.

Evaluación de tamaño, función y rangos de normalidad de la asincronía de la aurícula izquierda en sujetos sanos mediante ecocardiografía tridimensional

Abstract: El tamano y la funcion de la auricula izquierda tienen implicaciones pronosticas muy importantes. Nuestro objetivo fue evaluar el tamano, la funcion y la sincronia mecanica de la AI mediante ecocardiografia tridimensional (eco-3D), para establecer los valores de referencia normales. Sesenta y tres sujetos sanos fueron estudiados en 2 hospitales. Todos ellos fueron sometidos a una ecocardiografia bidimensional (eco-2D) y eco-3D. Para la valoracion de la asincronia, se obtuvo la desviacion estandar del tiempo que cada segmento auricular emplea en alcanzar el minimo volumen regional durante la sistole auricular, normalizado por el intervalo RR (IDS 16). El valor medio del IDS 16 fue 15,4 ± 10,9. En conclusion, la asincronia, el tamano y la funcion de la AI pueden ser analizados mediante eco-3D.

Three-dimensional echocardiographic assessment of left atrial size and function and the normal range of asynchrony in healthy individuals.

Abstract: Left atrial size and function are very important prognostic factors. Our aim was to evaluate left atrial size, function, and mechanical synchrony using threedimensional echocardiography in order to establish normal reference values. The study involved 63 healthy individuals enrolled at 2 hospitals. All underwent twodimensional and three-dimensional echocardiography. Mechanical asynchrony was assessed by determining the standard deviation of the time each left atrial segment took to reach the minimum volume during atrial systole, normalized by the RR interval. The mean value for this normalized standard deviation was 15.4 (10.9). In conclusion, it is possible to analyze left atrial asynchrony, size and function using three-dimensional echocardiography.

Ischemic mitral regurgitation and non-ST-segment elevation acute myocardial infarction: long-term prognosis.

Abstract: Introduction and objectives Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. However, few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Our objective was to investigate the incidence, clinical predictors, and long-term prognostic implications of MR in patients with NSTEMI. Methods The prospective study included 237 consecutive patients who were discharged in functional class I or II after a first NSTEMI. Each underwent echocardiography during the first week of admission, and patients were followed up clinically for a median of 1011 days. The incidence of readmission for heart failure, unstable angina, reinfarction, death, or all combined (ie, the combined event or major adverse cardiac event [MACE]) was recorded. Results The patients’ mean age was 66 (13) years and 74% were male. The incidence of MR was 40% (grade I in 71 patients, grade II in 15, grade III in 6, and grade IV in 3). Age, diabetes mellitus, multivessel disease and MR (HR=2.17; 95% confidence interval, 1.30-3.64; P =.003) were all independently associated with a poor long-term prognosis, in terms of MACEs. Even the milder grades of MR were associated with more events. Conclusions In our milieu, MR frequently occurs after NSTEMI. Its presence together with other unfavorable factors implies a poor long-term prognosis. This is also true for milder grades of MR. Consequently, MR should be fully assessed and followed-up after NSTEMI in all patients.

Calcified right ventricular thrombus and antiphospholipid syndrome

Abstract: Antiphospholipid syndrome has been associated with venous and arterial thrombotic events but intracardiac thrombosis is rare. We describe a case about a 30-year-old woman, admitted with a 6-month history of arthralgia, fatigue, and intermittent fever. Subsequent investigation revealed the presence of a large and calcified mass in the right ventricular outflow tract attached to the subvalvular tricuspid apparatus. Cardiac surgery was performed and histological examination demonstrated it to be composed entirely of calcified thrombus. Screening laboratory evaluation for hypercoagulable states confirmed the diagnosis of antiphospholipid syndrome.

Left atrium wall diverticulum: an additional anatomical consideration in atrial fibrillation catheter ablation.

Abstract: Current image technology with multidetector computed tomography (MCTC) allows the knowledge of anatomical details of structures completely unknown until recently. We describe two patients with left atrium (LA) diverticulums accidentally found in MCTC. The report of this anatomical characteristic is important because LA diverticulums may derive complications in atrial fibrillation (AF) catheter ablation, such as catheter trap and wall penetration. Patient …

Diastolic dysfunction in diabetic patients assessed with Doppler echocardiography: relationship with coronary atherosclerotic burden and microcirculatory impairment.

Abstract: Introduction and objectives. Diabetes mellitus (DM) is associated with the development of both impaired left ventricular diastolic function (LVDF) and pathological changes in the coronary macro- and microcirculation. The aim of this study was to investigate the relationship between these manifestations of diabetic heart disease. Methods. The severity of atherosclerosis in the left anterior descending coronary artery (LAD) was quantified using intravascular ultrasound (IVUS) in 13 patients with DM and ischemic heart disease. The coronary flow velocity reserve (CFVR), instantaneous hyperemic diastolic velocity pressure slope index (IHDVPS) zero-flow pressure were derived from digital intracoronary pressure and flow velocity measurements. The relationships between indices of LVDF (ie, E/A and E/e’ ratios) and intracoronary measurements were assessed. Results. The left ventricular ejection fraction was 66% (7%), and the LVDF indices were: E/A=0.92 (0.38) and E/e’=9.90 (2.80). There was a direct proportional relationship (r=0.62; P=.02) between E/e’ and coronary resistance (1.93 [0.74] mm Hg/s) and an inverse proportional relationship (r=–0.64; P=.02) between E/e’ and IHDVPS (1.56 [0.50] cm/s/mm Hg). However, no significant relationship was found between either LVDF index and CFVR (2.43 [0.56]) or coronary zero-flow pressure (40.41 [10.66] mm Hg). The volume of atheroma in the proximal 20 mm of the LAD (179.34 [57.48] µL, with an average plaque area of 8.39 [2.20] mm 2 ) was not related to either LVDF index. Conclusions. In patients with DM and coronary atherosclerosis, there appeared to be a relationship between LVDF impairment (assessed by the E/e’ ratio) and structural changes in the microcirculation.

Occlusion of the left main coronary artery and collateral circulation via the conus branch.

Abstract: We report the case of a 71-year-old-man, a smoker, admitted for unstable angina Subsequent investigation revealed complete proximal occlusion of the left main coronary with an unusual collateral circulation The left coronary artery was filled by a large conus branch originating from the right sinus of Valsalva This case shows the importance of looking for atypical collateral circulation in patients with chronic occlusion of the left main coronary artery and normal left ventricular function

Implantación de prótesis aórticas vía transapical. Experiencia inicial

Abstract: We report our initial experience with transapical aortic valve implantation. All six of our patients were octogenarians, all had significant associated comorbid conditions and, according to the logistic EuroSCORE, their mortality was expected to be 22%. All procedures were performed successfully and there were no intraoperative or postoperative complications. Five patients were discharged between postoperative days 5 and 7 with normally functioning prostheses.