Análisis tiempo-frecuencia de la fibrilación ventricular. Estudio experimental

Introduction and objectives. The analysis of frequency variability during ventricular fibrillation has yielded inconsistent results. We used an experimental model of ventricular fibrillation, with a short timescale, to analyze variations in frequency and their associated spatial distribution. Methods. Epicardial recordings of ventricular fibrillation were made in 10 perfused isolated rabbit heart preparations using a multiple electrode system (i.e., 240 unipolar electrodes). Both spectral and time-frequency analysis were used to derive the dominant frequency in the anterolateral wall of the left ventricle. Results. Linear regression analysis showed that there was a good correlation between …

Right Heart Dysfunction and Readmission Risk Across Left Ventricular Ejection Fraction Status in Patients With Acute Heart Failure.

BACKGROUND: Right heart dysfunction (RHD) parameters are increasingly important in heart failure (HF). This study aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We included 3383 consecutive patients discharged for acute HF. Of them, in 1435 patients (42.4%), the pulmonary artery systolic pressure could not be measured accurately, leaving a final sample size of 1948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure of less than 0.36 and significant tricuspid regurgitation…

EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Abstract Introduction and objectives Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours postreperfusion. All patients underwent CMR imaging 1 w…

Evaluation of the Complexity of Myocardial Activation During Ventricular Fibrillation. An Experimental Study

A B S T R A C T Introduction and objectives: An experimental model is used to analyze the characteristics of ventricular fibrillation in situations of variable complexity, establishing relationships among the data produced by different methods for analyzing the arrhythmia. Methods: In 27 isolated rabbit heart preparations studied under the action of drugs (propranolol and KB-R7943) or physical procedures (stretching) that produce different degrees of change in the complexity of myocardial activation during ventricular fibrillation, use was made of spectral, morphological, and mapping techniques to process the recordings obtained with epicardial multielectrodes. Results: The complexity of ve…

Effect of insulin on readmission for heart failure following a hospitalization for acute heart failure

AIMS: Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia-all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1year readmission for HF in patients discharged for acute HF.; METHODS AND RESULTS: We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and …

El suero de seno coronario tras un infarto de miocardio induce angiogénesis y reparación de la obstrucción microvascular. Implicación del factor inducible por hipoxia-1A

Resumen Introduccion y objetivos El objetivo es estudiar la angiogenesis coronaria inducida por el suero coronario y la implicacion del factor inducible por hipoxia-1A (FIH-1A) en la reparacion de la obstruccion microvascular (OMV) tras un infarto agudo de miocardio (IAM). Metodos Se indujo un IAM en cerdos mediante oclusion coronaria durante 90 min. Se dividio a los animales entre 1 grupo de control y 4 grupos con IAM: sin reperfusion y 1 min, 1 semana y 1 mes tras la reperfusion. Se cuantificaron la OMV y la densidad microvascular. Se determino la capacidad angiogenica del suero coronario mediante una prueba de tubulogenesis in vitro. Se determinaron las concentraciones circulantes del FI…

Texture analysis of cardiac cine magnetic resonance imaging to detect nonviable segments in patients with chronic myocardial infarction.

[EN] Purpose: To investigate the ability of texture analysis to differentiate between infarcted nonviable, viable, and remote segments on cardiac cine magnetic resonance imaging (MRI). Methods: This retrospective study included 50 patients suffering chronic myocardial infarction. The data were randomly split into training (30 patients) and testing (20 patients) sets. The left ventricular myocardium was segmented according to the 17-segment model in both cine and late gadolinium enhancement (LGE) MRI. Infarcted myocardium regions were identified on LGE in short-axis views. Nonviable segments were identified as those showing LGE 50%, and viable segments those showing 0 < LGE < 50% transmural …

Sex-related differences in mortality following an admission for acute heart failure across left ventricular ejection fraction spectrum

Abstract Background Prognosis in heart failure (HF) may differ between women and men. However, data is conflicting and sex-related differences in prognosis may be determined by left ventricular ejection fraction (LVEF) status. We sought to evaluate the prognostic differences between women and men with HF following an admission for acute HF (AHF). Methods We included 4,812 patients consecutively admitted for AHF in a multicenter registry from 3 hospitals in Valencia (Spain). Study endpoints were all-cause, cardiovascular (CV), and HF-related mortality at 6-months follow-up. Multivariable Cox regression models were fitted to investigate sex-related differences across LVEF status. Results 2,24…

ST2 and left ventricular remodeling after ST-segment elevation myocardial infarction: A cardiac magnetic resonance study.

Background: The association of soluble interleukin-1 receptor-like 1 (ST2) with left ventricular (LV) remodeling is unclear in patients with a first ST-segment elevation myocardial infarction (STEMI). The objective of this work was to assess the relationship between ST2, a marker of inflammation, and cardiac magnetic resonance (CMR) imaging-derived LV remodeling after a first STEMI. Methods: We prospectively evaluated 109 patients with a first STEMI treated with primary percutaneous coronary intervention who had ST2 assessed 24 h post-reperfusion. All patients underwent CMR imaging 1 week and 6 months after STEMI. The independent associations between ST2, LV diastolic and systolic volume in…

EpCAM y obstrucción microvascular en pacientes con un IAMCEST: estudio con resonancia magnética cardiaca

Resumen Introduccion y objetivos La obstruccion microvascular (OMV) se asocia negativamente con la estructura cardiaca y el pronostico de los pacientes tras un infarto agudo de miocardio con elevacion del segmento ST (IAMCEST). El factor epithelial cell adhesion molecule (EpCAM), implicado en la cohesion de las celulas epiteliales, esta poco estudiado en el contexto de la OMV. Por ello, el objetivo de este estudio es evaluar en una cohorte de pacientes con IAMCEST la asociacion entre la concentracion de EpCAM circulante con la extension de la OMV, determinada por resonancia magnetica cardiaca (RMC), y la funcion sistolica en fases cronicas. Metodos Se incluyo prospectivamente a 106 paciente…

Burden of Recurrent Hospitalizations Following an Admission for Acute Heart Failure: Preserved Versus Reduced Ejection Fraction.

Abstract Introduction and objectives Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. Methods We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. Results At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 pat…

Diet-Induced Rabbit Models for the Study of Metabolic Syndrome

Simple Summary In recent years, obesity and metabolic syndrome (MetS) have become more prevalent owing to increased unhealthy habits and sedentary lifestyles, becoming public health problems. Experimental studies have allowed us to explore the mechanisms underlying the pathophysiological processes related to MetS. Several research protocols can be carried out with minimal staff, maintenance, and resources in animals such as rabbits. High-fat diets enriched with other components, mainly cholesterol and sugars, result in the rapid development of hypercholesterolemia and vascular alterations as a response to dietary manipulation. Furthermore, other experimental models, including transgenic rab…

Usefulness of Clinical Data and Biomarkers for the Identification of Frailty After Acute Coronary Syndromes

Abstract Background Frailty predicts mortality after acute coronary syndrome (ACS). The standard frailty scales, such as the Fried score, consist of a variety of questionnaires and physical tests. Our aim was to investigate easily available clinical data and blood markers to predict frailty at discharge, in elderly patients after ACS. Methods A total of 342 patients older than 65 years, survivors after ACS, were included. A high number of clinical variables were collected. In addition, blood markers potentially linked to frailty and related to the processes of inflammation, coagulation, hormonal dysregulation, nutrition, renal dysfunction, and heart dysfunction were determined. Frailty was …

P312The selective late sodium current inhibitor eleclazine attenuates ventricular fibrillation spectral characteristics modifications produced by acute myocardial stretch

Papel del índice de Charlson en el pronóstico a 30 días y 1 año tras un infarto agudo de miocardio

Introduccion y objetivos.El indice de Charlson (iCh) ha sido utilizado como variable de ajuste en modelos multivariables como indicador de comorbilidad. Debido a que su valor pronostico per se para complicaciones cardiovasculares tras un infarto agudo de miocardio no ha sido ampliamente evaluado, nos propusimos determinar su valor predictivo para muerte de cualquier causa y/o reinfarto, a 30 dias y 1 ano del evento indice. Pacientes y metodo. Se incluyo a 1.035 pacientes con el diagnostico de infarto (508 con elevacion del segmento ST y 527 sin elevacion del segmento ST). La presencia de eventos se determino a 30 dias (13,9%) y a un ano (26,3%). El iCh se calculo junto con otras variables d…

Heart rate response and functional capacity in patients with chronic heart failure with preserved ejection fraction

Aims The mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF) are not yet elucidated. Chronotropic incompetence has emerged as a potential mechanism. We aimed to evaluate whether heart rate (HR) response to exercise is associated to functional capacity in patients with symptomatic HFpEF. Methods and results We prospectively studied 74 HFpEF patients [35.1% New York Heart Association Class III, 53% female, age (mean ± standard deviation) 72.5 ± 9.1 years, and 59.5% atrial fibrillation]. Functional performance was assessed by peak oxygen consumption (peak VO2 ). The mean (standard deviation) peak VO2 was 10 ± 2.8 mL/min/kg. The following chronotropic pa…

Microvascular obstruction in the right ventricle in reperfused anterior myocardial infarction: macroscopic and pathologic evidence in a swine model

Modifications in Ventricular Fibrillation and Capture Capacity Induced by a Linear Radiofrequency Lesion

[EN] Introduction and objectives: An analysis was made of the effects of a radiofrequency-induced linear lesion during ventricular fibrillation and the capacity to capture myocardium through high-frequency pacing. Methods: Using multiple epicardial electrodes, ventricular fibrillation was recorded in 22 isolated perfused rabbit hearts, analyzing the activation maps upon applying trains of stimuli at 3 different frequencies close to that of the arrhythmia: a) at baseline; b) after radio-frequency ablation to induce a lesion of the left ventricular free wall (length=10 [1] mm), and c) after lengthening the lesion (length=23 [2] mm). Results: Following lesion induction, the regularity of the r…

Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction.

Abstract Introduction and objectives A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Methods One week after a first ST-segment elevation myocardial infarction we carried out a comp…

Changes in the Spectral Characteristics of Ventricular Fibrillation in Lesions Produced by Radiofrequency Ablation. An Experimental Study

INTRODUCTION AND OBJECTIVES Although electro- physiological databases contain information about changes in the time domain in lesions produced by radiofrequency ablation, very few data on changes in the frequency domain are available. The aim of this study was to investigate changes in the spectral characteristics of ventricular fibrillation in zones with radiofrequency lesions. METHODS Recordings of ventricular fibrillation were obtained in 11 isolated perfused rabbit heart preparations using a multiple epicardial electrode located on the left ventricular free wall. Spectral parameters derived by Fourier analysis before and after the creation of transmural radiofrequency lesions were compa…

Ranolazine induced modifications of ventricular fibrillation activation complexity under mechanical stretch

Changes in myocardial iron content following administration of intravenous iron (Myocardial‐IRON): Study design

Treatment with intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms, functional capacity, and quality of life in patients with heart failure and iron deficiency. However, the underlying mechanisms for these beneficial effects remain undetermined. The aim of this study is to quantify cardiac magnetic resonance changes in myocardial iron content after administration of intravenous FCM in patients with heart failure and iron deficiency and contrast them with parameters of heart failure severity. This is a multicenter, double-blind, randomized study. Fifty patients with stable symptomatic heart failure, left ventricular ejection fraction <50%, and iron deficiency will be r…

P267Myocardial electrophysiological effects mediated by KATP channels: controversial aspects about their involvement in the protection by chronic exercise

Patrones de activación durante la fibrilación auricular en un modelo experimental

Introduccion y objetivos En la fibrilacion auricular junto a los mecanismos de reentrada y de activacion aleatoria se han descrito patrones de activacion focal que se han atribuido tanto a propagacion desde el endocardio como a la existencia de zonas de actividad automatica. Los objetivos del presente estudio son analizar y cuantificar los patrones de activacion auricular en un modelo experimental de fibrilacion. Material y metodos Se estudian 11 preparaciones de corazon aislado de conejo segun la tecnica de Langendorff en los que se inducen episodios de fibrilacion auricular mediante sobreestimulacion tras haber provocado dilatacion auricular derecha con un balon intraauricular. Utilizando…

Sequential cardiovascular magnetic resonance assessment of left ventricular ejection fraction for prediction of subsequent events in a large multicenter STEMI registry

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain. Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE. Methods. We recruited 1036 STEMI p…

Comparison of Intensity-based B-splines and Point-to-Pixel Tracking Techniques for Motion Reduction in Optical Mapping

Suppression of motion artifacts (MA) in cardiac optical mapping usually requires uncoupling of cardiac contraction by restriction techniques, which are known to have important effects on cardiac physiology deteriorating the quality of acquisitions and their interpretation. In this study, we propose to assess the performance of two independent intensity-based post-processing strategies to minimize MAs during registration. A point-to-pixel block-matching classical similarity-based tracking with displacement interpolation is compared to a well-known non-rigid registration algorithm where the deformation field is obtained using cubic splines. Both strategies were tested on synthetic and real op…

Magnetic Resonance Assessment of Left Ventricular Ejection Fraction at Any Time Post-Infarction for Prediction of Subsequent Events in a Large Multicenter STEMI Registry

Background Magnetic resonance imaging (MRI) is the most accurate imaging technique for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of LVEF assessment at any time after ST-segment elevation myocardial infarction (STEMI) for subsequent major adverse cardiac event (MACE) prediction is uncertain. Purpose To explore the prognostic impact of MRI-derived LVEF at any time post-STEMI to predict subsequent MACE (cardiovascular death or re-admission for acute heart failure). Study Type Prospective. Population One thousand thirteen STEMI patients were included in a multicenter registry. Field Strength/Sequence 1.5-T. Balanced steady-state free precession (c…

Prognostic value of the interaction between galectin-3 and antigen carbohydrate 125 in acute heart failure

AIM:Galectin-3 (Gal-3) and carbohydrate antigen 125 (CA125) have emerged as robust prognostic biomarkers in heart failure. Experimental data have also suggested a potential molecular interaction between CA125 and Gal-3; however, the biological and clinical relevance of this interaction is still uncertain. We sought to evaluate, in patients admitted for acute heart failure, the association between plasma Gal-3 with all-cause mortality and the risk for rehospitalizations among high and low levels of CA125. METHODS AND RESULTS: We included 264 consecutive patients admitted for acute heart failure to the Cardiology Department in a third-level center. Both biomarkers were measured on admission. …

Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial

Introduction and objectives: Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. Methods: A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the st…

Coronary Serum Obtained After Myocardial Infarction Induces Angiogenesis and Microvascular Obstruction Repair. Role of Hypoxia-inducible Factor-1A.

Microvascular obstruction (MVO) exerts deleterious effects following acute myocardial infarction (AMI). We investigated coronary angiogenesis induced by coronary serum and the role of hypoxia-inducible factor-1A (HIF-1A) in MVO repair.Myocardial infarction was induced in swine by transitory 90-minute coronary occlusion. The pigs were divided into a control group and 4 AMI groups: no reperfusion, 1minute, 1 week and 1 month after reperfusion. Microvascular obstruction and microvessel density were quantified. The proangiogenic effect of coronary serum drawn from coronary sinus on endothelial cells was evaluated using an in vitro tubulogenesis assay. Circulating and myocardial HIF-1A levels an…

Mediciones seriadas de antígeno carbohidrato 125 tras un ingreso por insuficiencia cardiaca aguda y riesgo de reingreso precoz

Resumen Fundamento y objetivos El reingreso precoz tras una hospitalizacion por insuficiencia cardiaca aguda (ICA) es frecuente, sin embargo, los factores asociados a este no estan claramente establecidos. Los valores plasmaticos del antigeno carbohidrato 125 (CA125) han mostrado asociarse con la presencia de congestion sistemica y aumento del riesgo de muerte en pacientes con ICA. El objetivo de este trabajo fue determinar la relacion entre los valores de CA125 (durante el ingreso, en la primera visita ambulatoria o sus cambios) y el reingreso por ICA a 6 meses de seguimiento. Pacientes y metodo Analizamos 293 pacientes consecutivos ingresados por ICA en los que se determino el CA125 duran…

Intracoronary Infusion of Thioflavin-S to Study Microvascular Obstruction in a Model of Myocardial Infarction

Abstract Introduction and objectives Microvascular obstruction exerts deleterious effects after myocardial infarction. To elucidate the role of ischemia-reperfusion injury on the occurrence and dynamics of microvascular obstruction, we performed a preliminary methodological study to accurately define this process in an in vivo model. Methods Myocardial infarction was induced in swine by means of 90-min of occlusion of the mid left anterior descending coronary artery using angioplasty balloons . Intracoronary infusion of thioflavin-S was applied and compared with traditional intra-aortic or intraventricular instillation. The left anterior descending coronary artery perfused area and microvas…

Role of antiangiogenic VEGF-A165b in angiogenesis and systolic function after reperfused myocardial infarction

Abstract Introduction and objectives Angiogenesis helps to reestablish microcirculation after myocardial infarction (MI). In this study, we aimed to further understand the role of the antiangiogenic isoform vascular endothelial growth factor (VEGF)-A165b after MI and to explore its potential as a coadjuvant therapy to coronary reperfusion. Methods Two mice MI models were formed: a) permanent coronary ligation (nonreperfused MI); b) transient 45-minute coronary occlusion followed by reperfusion (reperfused MI); in both models, animals underwent echocardiography before euthanasia at day 21 after MI induction. We determined serum and myocardial VEGF-A165b levels. In both experimental MI models…

[Effect of flecainide on longitudinal and transverse conduction velocities in ventricular myocardium. An experimental study].

It is known that the effect of flecainide on longitudinal and transverse ventricular conduction velocities depends on the coupling interval. If this is so, whether the longitudinal or transverse direction is predominantly affected could depend on the magnitude of the coupling interval. In order to investigate this hypothesis, we studied the effect of flecainide, 1 micromol/L, on conduction velocities in excised heart preparations from 11 rabbits using a basal cycle length of 250 ms and inserting two extrastimuli at a decreasing coupling interval. Flecainide significantly reduced both conduction velocities. However, the effect increased as the coupling interval decreased for only the longitu…

Prognostic usefulness of white blood cell count on admission and one-year outcome in patients with non-ST-segment elevation acute chest pain.

Little is known about the prognostic value of leukocyte count on admission for patients with chest pain. In total, 1,461 patients who presented to the emergency department with non–ST-segment elevation chest pain were studied by clinical history, electrocardiography, serial troponin I determination, and leukocyte count on admission. End points were 1-year mortality and major events (mortality or infarction). Overall patient distribution by quartiles of leukocyte count showed increased mortality (6%, 7%, 6%, and 17%, p = 0.0001) and major events (13%, 13%, 15%, and 24%, p = 0.0001) in the fourth quartile. After adjustment for other risk factors, the fourth quartile cut-off value (>10,000 cel…

Programmed death-1 (PD-1): A novel mechanism for understanding the acute immune deregulation in ST-segment elevation myocardial infarction

Usefulness of delta troponin for diagnosis and prognosis assessment of non-ST-segment elevation acute chest pain.

The additional diagnostic and prognostic information provided by delta high-sensitivity troponin T (hs-cTnT) in patients with acute chest pain and hs-cTnT elevation remains unclear.The study group consisted of 601 patients presenting at the emergency department with non-ST-segment elevation acute chest pain and hs-cTnT elevation after two determinations (admission and within the first six hours). Maximum hs-cTnT and delta hs-cTnT (absolute or percentage change between the two measurements) were considered. Cutoff values were optimized using the quartile distribution for the endpoints. The endpoints were diagnostic (significant stenosis in the coronary angiogram) and prognostic (death or rec…

P1602Basic electrophysiological modifications induced by carvedilol in unstrectched and stretched ventricular myocardium

Abstract Background Acute regional ventricular stretch (ARVS) is a pathophysiologic event that may occur in certain situations, originating arrhythmogenic effects through the mechanoelectrical feedback. Mechanical effects of stretch originate calcium-related changes as sarcoplasmic recticulum Ca2+ overload that can trigger Ca2+ diastolic leaks (store-overload-induced Ca2+ release, SOICR), mediated by the cardiac ryanodine receptor (RyR2). SOICR seems to be implicated in the mechanisms underlying stretch-induced arrhythmias. Carvedilol can inhibit the overload of Ca2+ through blocking of beta-adrenergic receptors, and also suppress the release of Ca2+ induced by the SOICR. Purpose The aim of…

Overexpression of genes involved in lymphocyte activation and regulation are associated with reduced CRM-derived cardiac remodelling after STEMI

Abstract Aims Lymphopenia after ST-segment elevation myocardial infarction (STEMI) correlates with deleterious cardiac consequences and worse prognosis. An in-depth examination of genes implicated in lymphocyte proliferation, activation and regulation and their association with short- and long-term cardiac structure and function is therefore of great interest. Methods Peripheral blood mononuclear cells were isolated from 10 control subjects and 64 patients with a first STEMI treated with primary percutaneous coronary intervention and submitted to cardiac magnetic resonance after 1 week and 6 months. mRNA expression of genes implicated in lymphocyte activation (CD25 and CD69) and regulation …

El consumo máximo de oxígeno predice los ingresos recurrentes por insuficiencia cardiaca con fracción de eyección conservada

Resumen Introduccion y objetivos La insuficiencia cardiaca con fraccion de eyeccion conservada (IC-FEc) es un sindrome muy prevalente con alto riesgo de morbilidad y mortalidad. Hasta la fecha, la evidencia acerca del papel del consumo maximo de oxigeno (VO 2max ) para predecir la carga de morbilidad en la IC-FEc es escasa. El objetivo de este estudio es evaluar la relacion entre el VO 2max y el riesgo de ingresos recurrentes de los pacientes con IC-FEc. Metodos A un total de 74 pacientes con IC-FEc sintomaticos y clinicamente estables, se les realizo una prueba de esfuerzo cardiopulmonar entre junio de 2012 y mayo de 2016. Se utilizo el metodo de regresion binomial negativa para determinar…

Development and Long-Term Follow-Up of an Experimental Model of Myocardial Infarction in Rabbits

Simple Summary Ischemic heart disease is one of the leading causes of death. A series of processes occur during acute myocardial infarction that contribute to the development of ventricular dysfunction, with subsequent heart failure and ventricular arrhythmias, which account for most episodes of sudden cardiac death in these patients. These complications are associated with the adverse cardiac remodeling that occurs during the healing process following an acute episode. The remodeling causes the appearance of a substrate that can trigger life-threatening arrhythmias, such as tachycardia and/or ventricular fibrillation. The development of experimental models for analyzing the basic mechanism…

Immunoglobulin G4-Related Aortitis and Severe Aortic Valve Stenosis Treated With Transcatheter Aortic Valve Replacement and Immunosuppression.

Abstract IgG4-related disease is an immune-mediated fibro-inflammatory disorder with multisystemic involvement. Aortitis and peri-aortitis are the most common cardiovascular manifestations of the disease. We present the case of a 65-year-old man with symptomatic severe aortic stenosis and concomitant IgG4 aortitis. The diagnosis was confirmed by IgG4 serum levels, positive positron emission computed tomography (PET-CT) scans, and pathology from mediastinal dissection. Surgical aortic valve replacement (SAVR) was unfeasible owing to extensive mediastinal fibrosis, and transcatheter aortic valve replacement (TAVR) was successfully performed. As ascending aorta access for SAVR in IgG4 aortitis…

Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction

Introduction and objectives: Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. Methods: A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak V02) and rec…

Right heart dysfunction and readmission risk across left ventricular ejection fraction status in patients with acute heart failure

Abstract Background Right heart dysfunction (RHD) parameters, such as right ventricular to pulmonary artery uncoupling or significant tricuspid regurgitation (TR) are increasingly important in heart failure (HF), especially in patients with preserved ejection fraction. In this study, we aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF). Methods We included 3,383 consecutive patients discharged for acute HF (AHF). Of them, in 1,435 (42.4%) pulmonary artery systolic pressure (PASP) could not be accurately measured, leaving a final sample size of 1,948 patients. Advanced RHD was defined as th…

The Sum of ST-Segment Elevation Is the Best Predictor of Microvascular Obstruction in Patients Treated Successfully by Primary Percutaneous Coronary Intervention. Cardiovascular Magnetic Resonance Study

Introduction and objectives The usefulness of ST-segment elevation resolution (STR) for predicting epicardial reperfusion is well established. However, it is still not clear how ST-segment changes are related to microvascular obstruction (MVO) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). Methods The study involved 85 consecutive patients admitted for a first STEMI and treated by pPCI who had a patent infarct-related artery. An ECG was recorded on admission and 90 min and 6, 24, 48 and 96 h after pPCI. Thereafter, STR and the sum of ST-segment elevation (sumSTE) in all leads…

High-sensitivity troponin T and the risk of recurrent readmissions after hospitalization for acute heart failure

Abstract Objectives High-sensitivity troponin is a biomarker of myocardial damage and is associated with a greater risk of mortality and disease progression in patients with acute heart failure (AHF). However, its relationship with the risk of future readmissions is less known. The aim of this study was to assess the association between ultrasensitive troponin T (TnT-us) values in patients with AHF and the risk of recurrent readmissions in the follow-up. Methods We prospectively included a cohort of 621 consecutive patients with AHF, excluding those patients with acute coronary syndrome. We measured the TnT-us levels obtained during the first medical contact in the emergency department. The…

International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists

Introduction and objectives: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. Methods: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, res…

Endurance training increases ventricular refractoriness and wavelength of the cardiac impulse without participation of parasympathetic postganglionic neurons. A study in isolated rabbit heart

Abstract Background Endurance physical training plays a protective role in against ventricular fibrillation (VF), but the exact underlying mechanisms are not completely understood. It is well-known that modifications in myocardial ventricular properties such as refractoriness, conduction velocity and wavelength are key in the initiation and maintenance of VF; furthermore, vagus nerve stimulation has prophylactic effects on malignant arrhythmias and VF. On the other hand, parasympathetic nervous system activity is increased in trained individuals, which in turn affects different ventricular electrophysiological properties. We hypothesized that physical training increases conduction velocity …

Antigen carbohydrate 125 and brain natriuretic peptide serial measurements for risk stratification following an episode of acute heart failure.

Abstract Background The prognostic utility of combining serial measurements of brain natriuretic peptide (BNP) and antigen carbohydrate 125 (CA125) is largely unknown. The aim of this work is to assess the prognostic utility of serial measurements of BNP, CA125, and their optimal combination for predicting long-term mortality, following a hospitalization for acute heart failure (AHF). Methods and results We analyzed 293 consecutive patients admitted with AHF where CA125 and BNP were measured at discharge (T1) and at the first ambulatory visit (T2: median 31days after discharge). Biomarkers were evaluated as snapshot determinations or as serial changes in absolute, relative or categorical ch…

Iron deficiency and risk of early readmission following a hospitalization for acute heart failure

Valor pronóstico de la isquemia miocárdica y la necrosis en pacientes con la función ventricular izquierda deprimida: un registro multicéntrico con resonancia magnética cardiaca de estrés

Resumen Introduccion y objetivos No se conoce el valor pronostico incremental que aporta la isquemia miocardica inducible respecto a la necrosis determinada por resonancia magnetica cardiaca de estres en pacientes con funcion ventricular izquierda deprimida. Se determina el valor pronostico de la necrosis y la isquemia en pacientes con funcion ventricular izquierda deprimida remitidos a exploracion por resonancia magnetica de estres con perfusion de dipiridamol. Metodos En un registro multicentrico basado en el uso de resonancia magnetica de estres, se determino la presencia (≥ 2 segmentos) de realce tardio de contraste y defectos de perfusion y su asociacion con eventos mayores (muerte car…

Factors associated with plasma antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide concentrations in acute heart failure

Background: Plasma amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 levels are positively associated with a higher risk of adverse clinical outcomes in acute heart failure. As a proxy of congestion, antigen carbohydrate 125 has also been proposed as a right-sided heart failure marker. Thus, we aimed to determine in this population the main factors – including echocardiographic right-sided heart failure parameters – associated with antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide. Methods and results: We prospectively included 2949 patients admitted with acute heart failure. Amino-terminal pro-B-type natriuretic peptide and antigen carbohy…

Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance

Abstract Introduction The prognostic value and therapeutic implications of ischemia as derived from vasodilator stress cardiovascular magnetic resonance (CMR) could differ in men and women, but it has not been stablished. Purpose We assessed the influence of the ischemic burden as derived from CMR on the risk of death and the effect of revascularization across sex. Methods We evaluated 6,237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischemia was defined as &amp;gt;5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used. Results A total of 2,371 (38.0%) patients were women and 583 (9.3%) underwent CMR-r…

Prediction of long-term major events soon after a first ST-segment elevation myocardial infarction by cardiovascular magnetic resonance.

Cardiovascular magnetic resonance (CMR) predicts combined clinical events in post-ST-segment elevation myocardial infarction (STEMI) patients. However, its contribution to predicting long-term major events (ME: cardiac death and non-fatal myocardial infarction [MI]) is unknown. We aimed to assess whether CMR predicts long-term MEs when performed soon after STEMI.We prospectively recruited 546 STEMI patients between 2004 and 2012. The Left ventricular (LV) ejection fraction (LVEF,%), infarct size (IS), edema, hemorrhage, microvascular obstruction, and myocardial salvage were quantified by CMR at pre-discharge. During a mean follow-up of 840 days, 57 ME events (10%; 23 cardiac deaths, 34 non-…

Combined assessment of stress cardiovascular magnetic resonance and angiography to predict the effect of revascularization in chronic coronary syndrome patients

Abstract Aims The role of revascularization in chronic coronary syndrome (CCS) and the value of ischaemia vs. anatomy to guide decision-making are in constant debate. We explored the potential of a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance (CMR) and presence of multivessel disease by angiography to predict the effect of revascularization on all-cause mortality in CCS. Methods and results The study group comprised 1066 CCS patients submitted to vasodilator stress CMR pre-cardiac catheterization (mean age 66 ± 11 years, 69% male). Stress CMR-derived ischaemic burden (extensive if &amp;gt;5 ischaemic segments) and presence of multivessel di…

Long-term serial kinetics of N-terminal pro B-type natriuretic peptide and carbohydrate antigen 125 for mortality risk prediction following acute heart failure.

Aim: Baseline values of N-terminal pro B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) predict all-cause mortality in acute heart failure (AHF). However, there is limited information about the added prognostic benefit of using longitudinal values, and how this predictive ability is modified when modelling together. The aim of this study was to determine the mutually-adjusted association between the longitudinal trajectories of NT-proBNP and CA125 with all-cause mortality after an episode of AHF. Methods and results: We included 946 consecutive patients discharged for AHF. NT-proBNP and CA125 were measured at each physician-patient encounter (median (interquartile…

Effect of invasive treatment on prognosis in non-ST-segment elevation acute coronary syndrome with or without systolic dysfunction.

Introduction and objectives. Few data are available on the use of invasive treatment in patients with non-STsegment elevation acute coronary syndrome (NSTEACS) and systolic dysfunction. The aim of this study was to determine the effect of invasive treatment on the prognosis of patients with NSTEACS, with or without systolic dysfunction. Methods. The study included 972 consecutive patients admitted for NSTEACS (i.e. ST-segment depression or an elevated troponin-I level). Systolic dysfunction was defined as an ejection fraction <50% on transthoracic echocardiography. The primary long-term endpoint was death or myocardial infarction. The effect of invasive treatment on prognosis was evaluated …

Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction

[EN] Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discriminati…

Estratificación del riesgo de pacientes con dolor torácico sin elevación del segmento ST en la puerta de urgencias

Objectives. To investigate the prognostic factors in patients who come to the emergency room with chest pain but without ST segment elevation. Patients and method. 743 consecutive patients were evaluated by recording clinical history, electrocardiogram and troponin I determination, and early (< 24 h) exercise testing was done for the low-risk subgroup of patients (n = 203). All patients were followed during 3 months for major events (acute myocardial infarction or death). Results. Major events occurred in 71 patients (9.6%). Multivariate analysis (C stadistic = 0.79; 95% CI 0.730.84; p = 0.0001) identified the following predictors: age ≥ 72 years (OR = 1.7; 95% CI, 1.0-2.9; p = 0.05), insul…

Contractile Reserve and Extent of Transmural Necrosis in the Setting of Myocardial Stunning: Comparison at Cardiac MR Imaging

To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI).Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment m…

An Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndromes. From Large Trials to the Real World

Introduction and objectives We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome. Patients and method We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a ) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b ) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for post-d…

P314Modifications of atrial refractoriness produced in an experimental rabbit model of diet-induced metabolic syndrome

P3492Carvedilol and its analogue VK-II-86 attenuate stretch-induced manifestations of mechanoelectric feedback

Abstract Background Mechanical stretch modifies Ca2+ handling and myocardial electrophysiology, favoring arrhythmogenesis. The store-overload-induced Ca2+ release (SOICR) through the ryanodine receptor (RyR2) seems to be implicated in this deleterious effect. Carvedilol and its analogue VK-II-86 (which does not have significant beta-blocking effects) suppress SOCIR by directly reducing the open duration of the cardiac RyR2, and could modulate calcium-related changes produced by myocardial stretch. Purpose The aim of this study was to investigate, by the ventricular fibrillation (VF) spectral analysis, whether carvedilol and VK-II-86 prevents stretch-induced arrhythmogenic effects. Methods T…

Diferencias entre sexos en la mortalidad a un mes y a un año tras un síndrome coronario agudo

Fundamento y objetivo Se pretende estudiar las diferencias entre sexos en la mortalidad a corto plazo (un mes) y a largo plazo (un ano) tras un sindrome coronario agudo Pacientes y metodo Despues de la publicacion de la nueva definicion de infarto de miocardio analizamos prospectivamente a 1.324 pacientes consecutivos ingresados con el diagnostico de sindrome coronario agudo en un hospital terciario. De estos pacientes, 483 (37%) presentaban un infarto con elevacion de ST; 439 (33%), infarto sin elevacion del ST (valores de troponina I superiores a 1 ng/ml), y 402 (30%), angina inestable (troponina I inferior a 1 ng/ml) Resultados Durante un ano hubo 177 muertes (13,4%). La mortalidad fue s…

The DD genotype of the angiotensin converting enzyme gene independently associates with CMR-derived abnormal microvascular perfusion in patients with a first anterior ST-segment elevation myocardial infarction treated with thrombolytic agents

Abstract Introduction The role of the angiotensin converting enzyme (ACE) gene on the result of thrombolysis at the microvascular level has not been addressed so far. We analyzed the implications of the insertion/deletion (I/D) polymorphism of the ACE gene on the presence of abnormal cardiovascular magnetic resonance (CMR)-derived microvascular perfusion after ST-segment elevation myocardial infarction (STEMI). Materials and Methods We studied 105 patients with a first anterior STEMI treated with thrombolytic agents and an open left anterior descending artery. Microvascular perfusion was assessed using first-pass perfusion CMR at 7 ±1 days. CMR studies were repeated 184 ± 11 days after STEM…

Effect of chronic exercise on myocardial electrophysiological heterogeneity and stability. Role of intrinsic cholinergic neurons: A study in the isolated rabbit heart

[EN] A study has been made of the effect of chronic exercise on myocardial electrophysiological heterogeneity and stability, as well as of the role of cholinergic neurons in these changes. Determinations in hearts from untrained and trained rabbits on a treadmill were performed. The hearts were isolated and perfused. A pacing electrode and a recording multielectrode were located in the left ventricle. The parameters determined during induced VF, before and after atropine (1 mu M), were: fibrillatory cycle length (VV), ventricular functional refractory period (FRPVF), normalized energy (NE) of the fibrillatory signal and its coefficient of variation (CV), and electrical ventricular activatio…

Comments on “New epicardial mapping electrode with warming/cooling function for experimental electrophysiology studies” [33 (5) (2011) 653–659]

Implicación de la isoforma antiangiogénica VEGF-A165b en la angiogénesis y la función sistólica tras un infarto de miocardio reperfundido

Resumen Introduccion y objetivos La angiogenesis participa en la restauracion de la microcirculacion despues de un infarto agudo de miocardio (IAM). El objetivo de este estudio es explorar el papel que juega la isoforma anti-angiogenica del factor de crecimiento endotelial vascular (VEGF)-A165b y explorar su potencial como terapia coadyuvante a la reperfusion coronaria. Metodos Se realizaron dos modelos murinos de IAM: a) ligadura permanente de la arteria coronaria (IAM no reperfundido) y b) oclusion transitoria durante 45 minutos de la arteria coronaria seguida de reperfusion (IAM reperfundido); en ambos modelos, se realizo a los animales una ecocardiografia previa a la eutanasia el dia 21…

Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease

Abstract Aims The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR). Methods and results We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association…

Diferencias entre sexos en pacientes con sospecha de síndrome coronario agudo sin elevación del segmento ST. Implicaciones en el tratamiento intervencionista

Sex differences have been observed in the clinical profile, prognosis, and treatment of patients with unstable ischemic heart disease. Men tend to receive more invasive management. We assessed these differences in 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation who were seen since our chest pain unit opened. A protocol for the management of unstable ischemic heart disease was followed. Women had a worse baseline clinical profile but men more frequently had a positive exercise stress test. Univariate analysis showed that angiography and revascularization procedures were performed more often in men. However, multivariate analysis did not c…

Prevalence and prognostic implications of active cytomegalovirus infection in patients with acute heart failure

AHF (acute heart failure) causes significant morbidity and mortality. Recent studies have postulated that the expression of inflammatory mediators, such as cytokines and chemokines, plays an important role in the development and progression of heart failure. A pro-inflammatory state has been postulated as a key factor in triggering CMV (cytomegalovirus) reactivation. Therefore we sought to determine the prevalence of active CMV infection in immunocompetent patients admitted for AHF and to quantify the association with the risk of the combined end point of death or AHF readmission. A total of 132 consecutive patients admitted for AHF were enrolled in the present study. Plasma CMV DNAaemia wa…

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

Objective: To assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). Methods: An observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per …

Predictors of cardiovascular magnetic resonance-derived microvascular obstruction on patient admission in STEMI

Early stratification of patients according to the risk for developing microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is desirable. We aimed to identify predictors of cardiovascular magnetic resonance (CMR)-derived MVO from clinical+ECG, laboratory and angiographic parameters available on admission.Characteristics available on admission were documented in 97 STEMI patients referred for primary angioplasty. MVO was determined using contrast-enhanced CMR.MVO was present in 44 patients (45%). The C-statistic for predicting MVO was: clinical+ECG (.832), laboratory (.743), and angiographic parameters (.669). Adding laboratory to clinical+ECG information d…

CA125 outperforms NT-proBNP in acute heart failure with severe tricuspid regurgitation.

In acute heart failure (AHF) with right ventricular dysfunction, the roles of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) are poorly understood, and functional tricuspid regurgitation (TR) severity is thought to indicate a poor prognosis. We examined the prognostic abilities of NT-proBNP and CA125 according to TR status among patients with AHF.TR severity was assessed during index hospitalization (108 ± 24 h after admission) and classified as none/trivial, mild, moderate, or severe. Multivariable Cox regression analysis was performed to assess how pre-discharge CA125 and NT-proBNP were associated with long-term all-cause mortality relative t…

Release of necrosis markers and cardiovascular magnetic resonance-derived microvascular perfusion in reperfused ST-elevation myocardial infarction

Abstract Introduction The association of the temporal evolution of cardiac necrosis marker release with cardiovascular magnetic resonance-derived microvascular perfusion after ST-elevation myocardial infarction is unknown. Methods We analyzed 163 patients with a first ST-elevation myocardial infarction and a patent infarct-related artery treated with thrombolysis (67%) or primary angioplasty (33%). Using first-pass perfusion CMR, abnormal perfusion was defined as a lack of contrast arrival into the infarct area in > 1 segment. Troponin I, creatine kinase MB and myoglobin were measured upon arrival and at 6, 12, 24, 48 and 96 hours after reperfusion. Results Abnormal perfusion was detected i…

Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure.

Aim Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought to assess whether CA125 adds prognostic value to BNP in predicting 6-month all-cause mortality in patients with AHF. Methods and results We analysed 1111 consecutive patients admitted for AHF. Antigen carbohydrate 125 (U/mL) and BNP (pg/mL) were measured at a median of 72 ± 12 h after instauration of treatment. Antigen carbohydrate 125 and BNP were dichotomized based on propos…

Magnetic resonance microscopy and correlative histopathology of the infarcted heart

Altres ajuts:The present study was supported by the EU Joint Programming Initiative 'A Healthy Diet for a Healthy Life' (JPI HDHL INTIMIC-085), Generalitat Valenciana (GV/2018/116), INCLIVA and Universitat de Valencia (program VLC-BIOCLINIC 20-nanomIRM-2016A). Delayed enhancement cardiovascular magnetic resonance (MR) is the gold-standard for non-invasive assessment after myocardial infarction (MI). MR microscopy (MRM) provides a level of detail comparable to the macro objective of light microscopy. We used MRM and correlative histopathology to identify infarct and remote tissue in contrast agent-free multi-sequence MRM in swine MI hearts. One control group (n = 3 swine) and two experimenta…

EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting. Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods.…

Risk stratification in non-ST elevation acute coronary syndromes

Abstract Introduction: In acute coronary syndromes, myocardial damage markers and acute-phase reactants predict adverse cardiac events. The aim of this study was to define the fitted prognostic value of the most widely used variables of necrosis and inflammation as well as of homocysteine. Methods and results: Troponin I, high-sensitivity C-reactive protein, fibrinogen and homocysteine were measured in 515 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) through 6 months of follow-up was analysed. In the univariate analysis, all markers were related to major events ( p 11 mg/l (…

Impacto pronóstico de una estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST según la presencia o no de disfunción sistólica

Introduccion y objetivos Escasa evidencia respalda la implantacion de una estrategia invasiva (EI) en pacientes con sindrome coronario agudo sin elevacion del segmento ST (SCASEST) y disfuncion sistolica (DS). El objetivo de este trabajo es evaluar el impacto pronostico atribuible a una EI en sujetos con SCASEST segun tengan DS o no. Metodos Se incluyo a 972 pacientes consecutivos ingresados por SCASEST (descenso del segmento ST y/o elevacion de troponina I). Se definio la DS como fraccion de eyeccion Resultados El 23,4% presento DS. Un total de 303 (31%) pacientes alcanzaron el objetivo primario, hecho que fue mas frecuente en los pacientes con DS (el 49,8 frente al 25,5%; p Conclusiones L…

Dominant frequency and complexity of electrical reentrant activation during ventricular fibrillation with releasing of NO after acute local stretching. A study in isolated rabbit heart

Decrease of CD4+ T Lymphocytes after myocardial infarction is related with extensive myocardial fibrosis

Purpose: Myocardial fibrosis plays a potential role in left ventricular remodeling and patients' outcome. After myocardial infarction innate immune cells infiltrate infarcted area and replace necrotic tissue by fibrotic tissue. However the role of adaptive immunity, especially T cells, has not yet been investigated in this scenario. Methods: We studied 94 patients with a first STEMI treated with percutaneous revascularization. Leucocyte subsets and a wide variety of lymphocyte subtypes were determined in peripheral blood 24 h after reperfusion by means of flow cytometry. Infarct size and cardiac fibrosis were measured by late enhancement Cardiac Magnetic Resonance (CRM) 1 week and 6 months …

Early Spot Urinary Sodium and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; In acute heart failure (AHF), early assessment of spot urinary sodium (U&lt;sub&gt;Na&lt;/sub&gt;) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot U&lt;sub&gt;Na&lt;/sub&gt; predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot U&lt;sub&gt;Na&lt;/sub&gt; in patients with AHF and concomitant renal dysfunction (RD). &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] &amp;#x3c;60 mL/min/1…

Lipoprotein(a) and long-term recurrent infarction after an episode of ST-segment elevation acute myocardial infarction

Background In established ischemic heart disease, the relationship between lipoprotein(a) and new cardiovascular events showed contradictory results. Our aim was to assess the relationship between lipoprotein(a) and very long-term recurrent myocardial infarction (MI) after an index episode of ST-segment elevation acute myocardial infarction (STEMI). Methods We included 435 consecutive STEMI patients discharged from October 2000 to June 2003 in a single teaching center. The relationship between lipoprotein(a) at discharge and recurrent MI was evaluated through negative binomial regression and Cox regression analysis. Results The mean age was 65 years (55-74 years), 25.5% were women, 34.7% we…

Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease.

ObjectivesWe evaluated the prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging (CMR) in patients with chest pain and known or suspected coronary artery disease.BackgroundStress perfusion CMR has been incorporated in daily practice. Data on its prognostic value are preliminary.MethodsDipyridamole stress CMR was performed in 420 patients with chest pain and known or suspected coronary artery disease. The extent (number of segments according to the 17-segment model) of abnormal wall motion at rest (AWM-rest), abnormal wall motion with dipyridamole (AWM-D), perfusion deficit (at stress first-pass perfusion imaging), and delayed enhancement (at late enhancement imag…

Carbohydrate Antigen-125–Guided Therapy in Acute Heart Failure

Abstract Objectives This study sought to evaluate the prognostic effect of carbohydrate antigen-125 (CA125)–guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF). Background CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding. Methods In a prospective multicenter randomized trial, 380 patients discharged for AHF and high CA125 were randomly assigned to the CA125 strategy (n = 187) or SOC (n = 193). The aim in th…

Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized study in patients and of an experimental model in swine.

Background: Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model. Methods: A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angio-plasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an ang…

Analyzing the electrophysiological effects of local epicardial temperature in experimental studies with isolated hearts

As a result of their modulating effects upon myocardial electrophysiology, both hypo- and hyperthermia can be used to study the mechanisms that generate or sustain cardiac arrhythmias. The present study describes an original electrode developed with thick-film technology and capable of controlling regional temperature variations in the epicardium while simultaneously registering its electrical activity. In this way, it is possible to measure electrophysiological parameters of the heart at different temperatures. The results obtained with this device in a study with isolated and perfused rabbit hearts are reported. An exploration has been made of the effects of local temperature changes upon…

Prognostic implications of pericardial effusion in acute heart failure: Does size matter?

Somedegreeofpericardialeffusion(PE)occurredinupto20%ofpa-tientswithheartfailure(HF)[1].Arecentstudyshowedthatinpatientswithchronicheartfailure(CHF),evenahemodynamicallyirrelevantPEwasassociated withincreasedriskofadverseevents [2,3]. Should thesefindings be extrapolated to patients with AHF? Moreover, the patho-physiology of such association remains to be determined. Thus, thisstudy sought to evaluate the association between PE and the risk of 1-year mortality in patients with AHF.Weincluded1827consecutivepatientsadmittedforAHFintheCar-diology department of a tertiary university hospital from January 2004to July 2013. Patients with a hemodynamically compromised PE wereexcluded (n = 16). In a…

Echocardiographic pulmonary artery pressure estimation and heart failure rehospitalization burden in patients with acute heart failure

Abstract Pulmonary hypertension (PH) is a strong predictor of mortality in patients with heart failure (HF). However, the relationship between PH, through echocardiographic pulmonary artery pressure (PASP) estimation, and the risk of HF rehospitalizations remains unclear. Methods We prospectively included 2343 consecutive patients discharged for acute heart failure (AHF). PH was estimated by echocardiography through PASP determination during the index admission. Patients were categorized as follows across PASP: non-measurable, normal (≤35mmHg), mild (36–45mmHg), moderate (46–60mmHg), or severe PH (>60mmHg). Negative binomial regression method was used to evaluate the association between PAS…

Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality

Background: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. Methods: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. Res…

Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality

Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method. The study included 1118 consecutive patients who were admitted with the diagnosis of AMI: 569 non-STEMI and 549 STEMI. The WBC was measured in the 24 hours following admission. Patients were divided into…

Upregulation of an antiangiogenic VEGFA165b isoform in patients with acute myocardial infarction

Utilidad de la troponina I para predecir la disfunción sistólica en los síndromes coronarios agudos. Resultados de un estudio prospectivo y cuantitativo

The relationship between troponin I and systolic function (quantitative contrast ventriculography) was evaluated in 137 consecutive patients with a first acute coronary syndrome (60 with and 77 without ST elevation). In general, a larger troponin I peak value was related with a more depressed ejection fraction and poorer regional systolic function (p < 0.0001). Nevertheless, this correlation was weaker than expected, especially in those cases without ST-segment elevation, suggesting that other factors apart from systolic dysfunction must be taken into account in order to explain the worse prognosis of those patients with increased serum levels of this marker of myocardial damage.

[Relationship of C-reactive protein levels with angiographic findings and markers of necrosis in non-ST-segment elevation acute coronary syndrome].

The mechanism responsible for elevated C-reactive protein levels (inflammation of the ruptured atherosclerotic plaque or myocardial necrosis) in acute coronary syndromes is controversial. The aim of this study was to investigate the relationship between C-reactive protein levels and angiographic complexity of the culprit lesion and troponin elevation in patients with non-ST elevation acute coronary syndromes.The study group consisted of 125 patients with single-vessel disease. Troponin-I and C-reactive protein were measured, and the complexity of the culprit lesion was analyzed (TIMI flow and thrombus). Information on age, sex, smoking habit, hypertension, hypercholesterolemia and diabetes …

Efecto de la implantación del cuidado transicional en una unidad de insuficiencia cardiaca tras un ingreso por insuficiencia cardiaca aguda

Resumen Introduccion y objetivos Los expertos recomiendan un seguimiento clinico especifico en los pacientes con insuficiencia cardiaca (IC). El objetivo de este trabajo fue evaluar el efecto de la implantacion de un modelo de cuidado transicional en una unidad de IC (UIC) tras una hospitalizacion por IC sobre el riesgo de muerte e ingresos recurrentes por IC. Metodos Estudio observacional retrospectivo que incluyo a todos los pacientes dados de alta por IC aguda en un hospital terciario en Espana entre 2004 y 2017. Desde el 2010 el seguimiento tras el alta se realizo en una UIC. Se compararon 2 cohortes cronologicas: antes (2004-2009) y despues del inicio de la UIC (2010-2017). Se evaluo e…

Noninvasive Imaging Estimation of Myocardial Iron Repletion Following Administration of Intravenous Iron : The Myocardial- Trial

Background Intravenous ferric carboxymaltose ( FCM ) improves symptoms, functional capacity, and quality of life in heart failure and iron deficiency. The mechanisms underlying these effects are not fully understood. The aim of this study was to examine changes in myocardial iron content after FCM administration in patients with heart failure and iron deficiency using cardiac magnetic resonance. Methods and Results Fifty‐three stable heart failure and iron deficiency patients were randomly assigned 1:1 to receive intravenous FCM or placebo in a multicenter, double‐blind study. T2* and T1 mapping cardiac magnetic resonance sequences, noninvasive surrogates of intramyocardial iron, were eval…

P3543Rehospitalization burden in heart failure with mid-range ejection fraction and morbidity burden. Is it a distinct phenotype?

Abstract Heart failure with mid-range ejection fraction (HFmrEF) has been recognized as a distinct HF phenotype, but wether patients on this category fare worse, similarly, or better than those with HF with reduced EF (HFrEF) or preserved EF (HFpEF) in terms of rehospitalization risk over time remains unclear. We therefore sought to characterize the mordibity burden of HFmrEF patients by evaluating the risk of recurrent hospitalizations following an admission for acute HF. Methods We prospectively included 2,961 consecutive patients discharged for acute HF in our institution from 2004 to 2017. Patients were categorized according to their ejection fraction (EF) obtained by an echocardiograph…

Prognostic implications of dipyridamole cardiac MR imaging: a prospective multicenter registry

Purpose: To evaluate dipyridamole cardiac magnetic resonance (MR) imaging in the prediction of major events (MEs) in patients with ischemic chest pain in a large multicenter registry. Materials and Methods: Institutional ethics committee approval and written informed consent were obtained. A total of 1722 patients who were undergoing cardiac MR imaging for chest pain were included. Wall motion abnormalities (WMAs) at rest, hyperemia perfusion defect (PD), late gadolinium enhancement (LGE), and inducible WMA were analyzed (abnormal if more than one abnormal segment was seen) with the 17-segment model. A cardiac MR categorization was created: category 1, no PD, LGE, or inducible WMA; category…

Additional diagnostic value of systolic dysfunction induced by dipyridamole stress cardiac magnetic resonance used in detecting coronary artery disease.

Dipyridamole stress perfusion cardiovascular magnetic resonance (CMR) is used to detect coronary artery disease (CAD). However, few data are available on the diagnostic value of the systolic dysfunction induced by dipyridamole. This study investigated whether the induction of systolic dysfunction supplements the diagnostic information provided by perfusion imaging in the detection of CAD.Overall, 166 patients underwent dipyridamole CMR and quantitative coronary angiography, with CAD being defined as a stenosisor =70%. Systolic dysfunction at rest, systolic dysfunction with dipyridamole, induced systolic dysfunction, and stress first-pass perfussion deficit (PD) and delayed enhancement were …

An Experimental Model of Diet-Induced Metabolic Syndrome in Rabbit: Methodological Considerations, Development, and Assessment

In recent years, obesity and metabolic syndrome (MetS) have become a growing problem for public health and clinical practice, given their increased prevalence due to the rise of sedentary lifestyles and unhealthy eating habits. Thanks to animal models, basic research can investigate the mechanisms underlying pathological processes such as MetS. Here, we describe the methods used to develop an experimental rabbit model of diet-induced MetS and its assessment. After a period of acclimation, animals are fed a high-fat (10% hydrogenated coconut oil and 5% lard), high-sucrose (15% sucrose dissolved in water) diet for 28 weeks. During this period, several experimental procedures were performed to…

Inhomogeneity of collagen organization within the fibrotic scar after myocardial infarction: results in a swine model and in human samples.

We aimed to characterize the organization of collagen within a fibrotic scar in swine and human samples from patients with chronic infarctions. Swine were subjected to occlusion of the left anterior descending artery followed by reperfusion 1 week (acute myocardial infarction group) or 1 month (chronic myocardial infarction group) after infarction. The organization of the collagen fibers (Fast Fourier Transform of samples after picrosirius staining; higher values indicate more disorganization) was studied in 100 swine and 95 human samples. No differences in collagen organization were found between the acute and chronic groups in the core area of the scar in the experimental model. In the ch…

Experience in daily clinical practice of ambulatory cardioversion of atrial fibrillation treated with new oral anticoagulants.

Influencia del tipo de registro (unipolar o bipolar) en las características espectrales de los registros epicárdicos de la fibrilación ventricular. Estudio experimental

Introduction and objectives. The aim of this study was to examine the hypothesis that the recording mode (ie, unipolar or bipolar) affects the information obtained using spectral analysis techniques during ventricular fibrillation by carrying out an experiment using epicardial electrodes. Methods. Recordings of ventricular fibrillation were obtained in 29 isolated rabbit hearts using a multipleelectrode probe located on the left ventricular free wall. The parameter values obtained in the frequency domain (by Fourier analysis) using unipolar or bipolar electrodes, different interelectrode distances, and different orientations (ie, horizontal, vertical, or diagonal) were compared. Results. Ch…

Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower mi…

Modificaciones de las características espectrales de la fibrilación ventricular en las lesiones producidas con radiofrecuencia. Estudio experimental

Introduccion y objetivos Aunque se dispone de informacion sobre las modificaciones en el dominio del tiempo de los registros electrofisiologicos en zonas lesionadas con radiofrecuencia, los datos disponibles en el dominio de la frecuencia son muy escasos. Se analizan las modificaciones de las caracteristicas espectrales de la fibrilacion ventricular en zonas lesionadas con radiofrecuencia. Metodos En 11 preparaciones de corazon aislado y perfundido de conejo, se registra la fibrilacion ventricular con un electrodo multiple epicardico situado en la pared libre ventricular izquierda. Se comparan los parametros espectrales obtenidos mediante analisis de Fourier antes y despues de practicar les…

Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic…

Estudio experimental de los efectos de EIPA, losartán y BQ-123 sobre las modificaciones electrofisiológicas inducidas por el estiramiento miocárdico

Resumen Introduccion y objetivos Se han implicado diversos mecanismos en la respuesta mecanica al estiramiento miocardico, que incluyen la activacion del intercambiador Na+/H+ por acciones autocrinas y paracrinas. Se estudia la participacion de estos mecanismos en las respuestas electrofisiologicas al estiramiento agudo miocardico mediante el analisis de los cambios inducidos con farmacos. Metodos Se analizan las modificaciones de la fibrilacion ventricular inducidas por el estiramiento agudo miocardico en corazones de conejo aislados y perfundidos utilizando electrodos multiples epicardicos y tecnicas cartograficas. Se estudian 4 series: control (n = 9); durante la perfusion del antagonist…

Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction.

BACKGROUND: Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients.; METHODS: We performed a multicenter prospective registry of reperfused STEMI patients (n=1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, non-fatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failur…

Effect of chronic exercise and ATP-sensitive potassium channel blockade on the spectral characteristics evolution of ventricular fibrillation in acute regional ischemia

Purpose: It has been proposed that chronic exercise produces a KATP channel blockade in ischemic myocardium. We have also reported that channel blockade and training exert very similar effects on energy required to defibrillate. In fact it is postulated that one mechanism by which exercise exerts an antiarrhythmic effect, is by blocking KATP channel. We have analyzed the evolution of spectrum characteristics of ventricular fibrillation (VF), in normoxic conditions and after acute myocardial ischemia, in isolated hearts from trained rabbits, and in hearts submitted to KATP channel blockade. Our hypothesis is that the spectrum characteristics of VF evolve similarly in trained hearts and in he…

Efecto pronóstico diferencial de la diabetes mellitus tipo 2 en mujeres y varones con insuficiencia cardiaca y fracción de eyección conservada

Resumen Introduccion y objetivos La diabetes mellitus tipo 2 (DM2) es una comorbilidad comun en pacientes con insuficiencia cardiaca (IC) con fraccion de eyeccion conservada (ICFEP). Estudios anteriores han demostrado que las mujeres diabeticas tienen mayor riesgo de desarrollar insuficiencia cardiaca que los hombres. Sin embargo, el pronostico a largo plazo de los pacientes diabeticos con insuficiencia cardiaca en funcion del sexo no se ha explorado ampliamente. En este estudio, nuestro objetivo fue evaluar el impacto diferencial de la DM2 en la mortalidad por todas las causas en hombres frente a mujeres con ICFEP tras un ingreso por IC aguda. Metodos Se incluyeron prospectivamente 1.019 p…

Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome

Background Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome. Methods A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up. Results Seventy…

Resonancia magnética cardiaca de estrés para predecir mortalidad y toma de decisiones: registro de 2.496 pacientes mayores con síndrome coronario crónico

Resumen Introduccion y objetivos El tratamiento del paciente mayor con sindrome coronario cronico (SCC) es un reto. Se exploro el valor pronostico y la utilidad para la toma de decisiones de la carga isquemica determinada mediante resonancia magnetica cardiaca (RMC) de estres con vasodilatador en pacientes mayores con SCC. Metodos Se incluyo a 2.496 pacientes mayores de 70 anos estudiados con una RMC de estres con vasodilatador por SCC conocido o sospechado. La carga isquemica (numero de segmentos con deficit de perfusion inducido por el estres) se calculo siguiendo el modelo de 17 segmentos. Posteriormente se analizo de manera retrospectiva su asociacion con la mortalidad por cualquier cau…

Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes

Introduction and objectives: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Methods: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angi…

Diuretic Strategies in Acute Heart Failure and Renal Dysfunction: Conventional vs Carbohydrate Antigen 125-guided Strategy. Clinical Trial Design

Abstract Introduction and objectives The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic str…

Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure.

Aims To evaluate the relationship between systolic blood pressure (SBP) and long-term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (≤40%) vs. preserved (≥50%). Methods and results We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left-ventricular ejection fraction was categorized as ≤40% (n = 288), 41–49% (n = 174), or ≥50% (n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 ± 11 years and 150 ± 36 mmHg, respectively. During a median follow-up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated …

Early serum creatinine changes and outcomes in patients admitted for acute heart failure: the cardio-renal syndrome revisited.

Background: The changes in renal function that occurred in patients with acute decompensated heart failure (ADHF) are prevalent, and have multifactorial etiology and dissimilar prognosis. To what extent the prognostic role of such changes may vary according to the presence of renal insufficiency at admission is not clear. Accordingly, we sought to determine whether early creatinine changes (Cr) (admission to 48-72 hours) had an effect on 1-year mortality relative to the presence of renal insufficiency at admission. Methods: We included 705 consecutive patients admitted with the diagnosis of ADHF. Admission renal insufficiency was defined as serum creatinine 1.4mg/dl (A-RIcr) or estimated gl…

Cartografía epicárdica de la activación reentrante durante la fibrilación ventricular. Estudio experimental

Introduccion y objetivos Analizar las caracteristicas de la activacion reentrante durante la fibrilacion ventricular en un modelo experimental mediante cartografia epicardica de alta resolucion. Metodos En 30 preparaciones de corazon aislado de conejo se ha registrado la actividad fibrilatoria ventricular utilizando un electrodo multiple epicardico. En los mapas de activacion con patrones de activacion reentrante se han determinado el numero de giros consecutivos, la longitud maxima de la zona central de la reentrada, el area abarcada por la zona central y dos electrodos alrededor de la misma y la duracion de los ciclos. Resultados En la mayor parte de los mapas se han observado patrones co…

Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized multicenter study in patients and data of an experimental model

Purpose: Ischemic Postconditioning (PCON) appears as a potentially beneficial tool to complement primary angioplasty in ST-segment elevation myocardial infarction (STEMI). We evaluated the impact of PCON on Microvascular Obstruction (MVO) both in patients and in a highly controlled swine model. Methods: In a multicenter study, 101 patients with a first STEMI were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone (non-PCON). MVO (lack of contrast uptake in the core of the hyperenhanced infarcted area) was quantified in late enhancement cardiac magnetic resonance imaging. In an anterior STEMI swine model based on a 90-min angioplasty balloon coronary occl…

P330Modifications of short-term heart rate varibility and intrinsic pacemaker variability in an experimental model of metabolic syndrome

Effects of chronic exercise on myocardial refractoriness: a study on isolated rabbit heart

Aim:  To determine whether chronic physical training increases atrial and ventricular refractoriness in isolated rabbit heart. Methods:  Trained rabbits were submitted to a protocol of treadmill running. The electrophysiological parameters of refractoriness investigated in an isolated heart preparation were: (1) atrial effective refractory period (AERP) and atrial functional refractory period and ventricular effective and functional refractory periods (VERP and VFRP) using the extrastimulus technique at four different pacing cycle lengths; (2) the dominant frequency (DF) of ventricular fibrillation (VF). A multi-electrode plaque containing 256 electrodes and a spectral method were used to o…

Modificaciones de la fibrilación ventricular y de la capacidad de captura inducidas por una lesión lineal con radiofrecuencia

Resumen Introduccion y objetivos Analizar los efectos, en la fibrilacion ventricular y en la capacidad de capturar al miocardio mediante estimulacion a frecuencias rapidas, de una lesion lineal producida con radiofrecuencia. Metodos En 22 corazones de conejo aislados y perfundidos, se utilizaron electrodos multiples epicardicos para registrar la fibrilacion ventricular. Se analizaron los mapas de activacion al aplicar trenes de estimulos a tres frecuencias distintas, cercanas a las de la arritmia, en tres situaciones: a) basalmente; b) tras producir con radiofrecuencia una lesion en la pared libre del ventriculo izquierdo (longitud, 10 ± 1 mm), y c) tras ampliar su extension (longitud, 23 ±…

A novel multielectrode for epicardial recording with temperature control based in Peltier cells

Electrophysiological parameters of the myocardium are influenced by temperature. Working with experimental models of isolated heart, the analysis of modulating effect exerted by local changes of temperature can provide some information about the mechanisms of certain arrhythmias and their electrophysiological bases, such as ventricular fibrillation. Conventional multiple electrodes do not seem to be appropriate, being necessary the development of specific devices. The design and implementation of a device adapted to these requirements is presented in this paper. This is a multi-electrode able to reproduce located and controlled conditions of hypothermia and hyperthermia, in a determined are…

La suma de la elevación del segmento ST predice mejor la obstrucción microvascular en pacientes tratados con éxito con una intervención coronaria percutánea primaria. Un estudio de resonancia magnética cardiovascular

Introduccion y objetivos La utilidad de la resolucion del segmento ST (RST) para la prediccion de la reperfusion epicardica esta bien establecida. La asociacion de los cambios del segmento ST con la obstruccion microvascular (OMV) observada en la resonancia magnetica cardiovascular (RMC) tras una intervencion coronaria percutanea primaria (ICPp) en el infarto de miocardio con elevacion del ST (IMEST) no se ha aclarado todavia. Metodos Estudiamos a 85 pacientes consecutivos ingresados por un primer IMEST y tratados con una ICPp que tenian una arteria relacionada con el infarto permeable. Se registro un ECG al ingreso, tras 90 min y tras 6, 24, 48 y 96 h de la ICPp. Se calculo la RST y la sum…

Entrenamiento de la musculatura inspiratoria y la electroestimulación muscular funcional en el tratamiento de la insuficiencia cardiaca con función sistólica conservada: estudio TRAINING-HF

SEC 2017: Congreso de las Enfermedades Cardiovasculares Introducción y objetivos No se dispone de tratamientos farmacológicos que demuestren reducir la morbimortalidad asociada en pacientes con insuficiencia cardiaca y función sistólica conservada (IC-FEc). El objetivo del presente estudio fue evaluar si en pacientes con IC-FEc, el entrenamiento de la musculatura inspiratoria (EMI), la electroestimulación muscular funcional (EMF) o la combinación de ambas (EMI + EMF) puede mejorar la capacidad funcional, calidad de vida, parámetros de disfunción diastólica o biomarcadores a las 12 y 24 semanas. Métodos Un total de 61 pacientes estables con IC-FEc (clase funcional de la New York Heart Associ…

Diet-Induced Metabolic Syndrome Reduced Heart Rate Variability and Increased Irregularity and Complexity of Short-Term RR Time Series in Rabbits.

Simple Summary In recent years, obesity and metabolic syndrome (MetS) have become more prevalent, owing to increased unhealthy habits and sedentary lifestyles becoming public health problems. Both conditions are linked with a higher prevalence of sudden cardiac death (SCD), but the exact mechanisms are not known. An autonomic nervous system imbalance can produce atrial and ventricular arrhythmias, which cause SCD, and this can be quantified by analyzing heart rate variability (HRV). We investigated HRV using time-domain, frequency-domain and nonlinear analyses during the development of MetS in rabbits and found HRV modifications that could be associated with the higher prevalence of SCD in …

2D Isochronal Correlation Method to Detect Pacing Capture during Ventricular Fibrillation

During ventricular fibrillation (VF), a portion of myocardial tissue can be captured by pacing at a rate near the fibrillation rate. Interruption of ventricular fibrillation can be favored by achieving stable myocardial capture, lowering the energy required for electrical cardioversion. Existence of myocardial capture during electrical stimulation is determined by visual inspection of electrograms (EGM) by an experienced observer. The objective of this work is the development of a semi-automatic method for the detection of myocardial capture based on the 2D correlation of isochronal maps. In 4 isolated rabbit hearts VF was induced by ventricular pacing with an increasing rate. An array of 1…

Razón internacional normalizada y mortalidad de los pacientes con insuficiencia cardiaca y fibrilación auricular tratados con antagonistas de la vitamina K

Resumen Introduccion y objetivos Los pacientes con insuficiencia cardiaca en tratamiento con antagonistas de la vitamina K (AVK) por fibrilacion auricular no valvular (FANV) a menudo presentan valores alterados de la razon internacional normalizada (INR). El objetivo es evaluar la asociacion entre la INR al ingreso por insuficiencia cardiaca y el riesgo de mortalidad en el seguimiento. Metodos Estudio observacional retrospectivo en el que se evaluo la INR al ingreso de 1.137 pacientes consecutivos con insuficiencia cardiaca aguda en tratamiento con AVK por FANV. Esta se categorizo en: INR en rango optimo (INR = 2-3, n = 210), infraterapeutica (INR 3, n = 267). La asociacion independiente en…

Tricuspid Regurgitation and Mortality Risk Across Left Ventricular Systolic Function in Acute Heart Failure.

BACKGROUND Tricuspid regurgitation (TR) is a common echocardiographic finding that has been related to adverse outcome under various clinical scenarios. Nevertheless, evidence supporting its prognostic value in heart failure (HF) is scarce, and, in most cases, contradictory. We evaluated the association of TR grade with 1-year all-cause mortality in acute HF (AHF). METHODS AND RESULTS: We included 1,842 consecutive patients admitted for AHF. Mean age was 72.8±11.3 years, 51% were female and 45.5% had LVEF <50%. The severity of TR was graded in non-TR, mild (1), moderate (2), moderate-severe (3) and severe (4). At 1-year follow-up, 370 patients (20.1%) had died. In patients with LVEF ≥50%, a…

Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes.

The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes.Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed.In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month we…

Refractory congestive heart failure: when the solution is outside the heart

Abstract Refractory congestive heart failure is associated with an ominous prognosis in which the treatments strategies remain scarce and not well validated. In the last years, continuous ambulatory peritoneal dialysis (CAPD) has emerged as a therapeutic alternative in this subset of patients. So far, it has been associated with a significant improvement in functional capacity and quality of life, together with a striking reduction in the risk of readmissions. We present the case of an elderly patient with severe left ventricular dysfunction and severe mitral and tricuspid regurgitation who presents recurrent admissions for anasarca. After its inclusion in a CAPD programme, the patient expe…

Unusual Hydatid Cyst-Like Images Caused by Staphylococcus Lugdunensis Infective Endocarditis

Right ventricular involvement in anterior myocardial infarction: a translational approach.

Aims The aim of the present study was to evaluate the involvement of the right ventricle (RV) in reperfused anterior ST-elevation myocardial infarction (STEMI). Methods and results Left anterior descending (LAD)-perfused area (using thioflavin-S staining after selective infusion in proximal LAD artery, %), infarct size (using triphenyltetrazolium chloride staining, %), and salvaged myocardium (% of LAD-perfused area) in the right and left ventricle (LV) were quantified in a 90-min LAD occlusion 3-day reperfusion model in swine ( n = 8). Additionally, we studied, using cardiovascular magnetic resonance, 20 patients with a first STEMI due to proximal LAD occlusion treated with primary angiopl…

Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. De los grandes estudios al mundo real

Introduccion y objetivos Presentamos el impacto pronostico de una estrategia invasiva (EI) en el sindrome coronario agudo sin elevacion del segmento ST en nuestra institucion. Pacientes y metodo Se ha estudiado a 504 pacientes consecutivos con dolor toracico tipico, cambios electrocardiograficos y elevacion de la troponina I divididos en 2 cohortes: a) grupo conservador, 272 pacientes ingresados entre octubre de 2001 y septiembre de 2002, manejados con una estrategia conservadora (EC); b) grupo invasivo, 232 pacientes ingresados entre octubre de 2002 y septiembre de 2003 y en los que se recomendo una EI. Se recogieron los eventos mayores (defuncion o reinfarto) y menores (reingreso o necesi…

Undetectable high-sensitivity troponin in combination with clinical assessment for risk stratification of patients with chest pain and normal troponin at hospital arrival

Background Undetectable high-sensitivity cardiac troponin (hs-cTn) in a single determination upon admission may rule out acute coronary syndrome. We investigated undetectable hs-cTnT (&amp;lt;detection limit; &amp;lt;5 ng/l) together with clinical risk scores (GRACE, TIMI, HEART and a previously published simple score), for one-year outcomes in patients with chest pain and normal hs-cTnT (&amp;lt;99th percentile; &amp;lt;14 ng/l) upon admission. Methods This study was a retrospective design involving 2254 consecutive patients (July 2016–November 2017). The primary endpoint was one-year death or acute myocardial infarction; the secondary endpoint added unstable angina requiring revasculariz…

Prognostic implications of arterial blood gases in acute decompensated heart failure

The prognostic value of arterial blood gases (ABG) in patients with acute decompensated heart failure (ADHF) is not well-established. We therefore conducted the present study to determine the relationship between ABG on admission and long-term mortality in patients with ADHF.We studied 588 patients consecutively admitted to our department with ADHF. ABG and classical prognostic variables were determined at patients' arrival to the emergency department. The independent association among the main variables of ABG (pO2, pCO2 and pH) and mortality was assessed with Cox regression analysis.At a median follow-up of 23months, 221 deaths (37.6%) were registered. 308 (52.4%), 54 (9.2%) and 50 (8.5%)…

Efectos de la estreptomicina en las modificaciones de la activación miocárdica durante la fibrilación ventricular inducidas por el estiramiento

Se ha evaluado si las modificaciones en la activacion miocardica durante la fibrilacion ventricular producidas por el estiramiento agudo pueden ser contrarrestadas por un bloqueador de los receptores sensibles al estiramiento. En 16 corazones aislados de conejo, se ha analizado la refractariedad y la frecuencia de activacion durante la fibrilacion ventricular antes, durante y despues de producir un estiramiento agudo localizado en la pared libre del ventriculo izquierdo, en ausencia (serie A, n = 8) o en presencia (serie B, n = 8) de estreptomicina 200 μmol. Durante la perfusion de estreptomicina (serie B), tanto basalmente como durante y despues del estiramiento, la fibrilacion ventricular…

Insuficiencia cardiaca aguda post-alta hospitalaria tras un síndrome coronario agudo sin elevación del segmento-ST y riesgo de muerte e infarto agudo de miocardio subsiguiente

Introduccion y objetivos. La informacion disponible acerca del impacto pronostico de un episodio de rehospitalizacion por insuficiencia cardiaca aguda (ICA) tras un sindrome coronario agudo sin elevacion del segmento ST (SCASEST) es escasa. El objetivo de este trabajo fue evaluar el valor pronostico atribuible a un primer ingreso por ICA en cuanto a riesgo de infarto agudo de miocardio (IAM) y mortalidad en pacientes supervivientes a un episodio de SCASEST de alto riesgo. Metodos. Analizamos consecutivamente a 972 pacientes supervivientes a la fase hospitalaria de un SCASEST de alto riesgo. El reingreso por ICA se considero como la variable principal de estudio, y su asociacion con IAM y mo…

New epicardial mapping electrode with warming/cooling function for experimental electrophysiology studies

Cardiac electrical activity is influenced by temperature. In experimental models, the induction of hypothermia and/or hyperthermia has been used for the study of mechanisms of cardiac arrhythmia. A system that allows for localized, controlled induction, besides simultaneously recording electrical activity in the same induced area, needs to be developed ad hoc. This article describes the construction and application of a new system capable of locally modifying the epicardial temperature of isolated hearts and of carrying out cardiac mapping with sufficient spatial resolution. The system is based on a thermoelectric refrigerator and an array of 128 stainless steel unipolar electrodes in encap…

Development and characterization of an experimental model of diet-induced metabolic syndrome in rabbit

Metabolic syndrome (MetS) has become one of the main concerns for public health because of its link to cardiovascular disease. Murine models have been used to study the effect of MetS on the cardiovascular system, but they have limitations for studying cardiac electrophysiology. In contrast, the rabbit cardiac electrophysiology is similar to human, but a detailed characterization of the different components of MetS in this animal is still needed. Our objective was to develop and characterize a diet-induced experimental model of MetS that allows the study of cardiovascular remodeling and arrhythmogenesis. Male NZW rabbits were assigned to control (n = 15) or MetS group (n = 16), fed during 2…

Trend in Spanish cardiology research and global comparative analysis of major topics.

Abstract Introduction and objectives We used bibliometric techniques to analyze the participation of Spanish institutions in research on major cardiovascular topics during the last 4 decades. Methods Bibliometric indicators of production, collaboration and impact were obtained from the Science Citation Index Expanded (SCIE) database. Search strategies were used in major topics and institutional collaboration networks were identified, represented using the Kamada-Kawai algorithm. Results Global cardiovascular publications doubled from 2000 to 2018. In 2018, those by Spanish authors represented 2.33%, with a participation of between 7% and 1.84%, depending on the topics analyzed. The offset w…

Microvascular perfusion 1 week and 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging

To characterise the evolution of myocardial perfusion during the first 6 months after myocardial infarction by first-pass perfusion cardiovascular magnetic resonance imaging (CMR) and determine its significance.Prospective cohort design.Single-centre study in a teaching hospital in Spain.40 patients with a first ST-elevation myocardial infarction, single-vessel disease and thrombolysis in myocardial infarction (TIMI) grade 3 flow (stent in 33 patients) underwent rest and low-dose dobutamine CMR 7 (SD 1) and 184 (SD 11) days after infarction. Microvascular perfusion was assessed at rest by visual assessment and quantitative analysis of first-pass perfusion CMR. Of the 640 segments, 290 segme…

A practical approach with outcome for the prognostic assessment of non-ST-segment elevation chest pain and normal troponin.

Patients with non-ST-elevation chest pain constitute a heterogeneous population. Our aim is to compare the outcome of patients with chest pain, non-ST-segment deviation, and normal troponin, categorized using a risk score, with that of patients with ST depression or troponin increase. A total of 1,449 patients with non-ST-elevation chest pain were evaluated. A validated risk score (using pain characteristics and risk factors) was applied to patients without ST depression or troponin increase. Accordingly, 4 risk categories were defined: group 1, no troponin increase, no ST depression, and risk score3 points (n = 633); group 2, no troponin increase, no ST depression, but risk scoreor = 3 poi…

Prognostic Value of Strain by Tissue Tracking Cardiac Magnetic Resonance After ST-Segment Elevation Myocardial Infarction

The aim of this study was to evaluate the prognostic value of strain as assessed by tissue tracking (TT) cardiac magnetic resonance (CMR) soon after ST-segment elevation myocardial infarction (STEMI).The prognostic value of myocardial strain as assessed post-STEMI by TT-CMR is unknown.The authors studied the prognostic value of TT-CMR in 323 patients who underwent CMR 1 week post-STEMI. Global (average of peak segmental values [%]) and segmental (number of altered segments) longitudinal (LS), circumferential, and radial strain were assessed using TT-CMR. Global and segmental strain cutoff values were derived from 32 control patients. CMR-derived left ventricular ejection fraction, microvasc…

Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease

Abstract Objectives This study explored the association of ischemic burden, as measured by vasodilator stress cardiovascular magnetic resonance (CMR), with all-cause mortality and the effect of revascularization on all-cause mortality in patients with stable ischemic heart disease (SIHD). Background In patients with SIHD, the association of ischemic burden, derived from vasodilator stress CMR, with all-cause mortality and its role for decision-making is unclear. Methods The registry consisted of 6,389 consecutive patients (mean age: 65 ± 12 years; 38% women) who underwent vasodilator stress CMR for known or suspected SIHD. The ischemic burden (at stress first-pass perfusion imaging) was com…

Stress cardiac magnetic resonance for mortality prediction and decision-making: registry of 2496 elderly patients with chronic coronary syndrome

Abstract Introduction and objectives The management of elderly patients with chronic coronary syndrome (CCS) is challenging. We explored the prognostic value and usefulness for decision-making of ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS. Methods The study group comprised 2496 patients older than 70 years who underwent vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Subsequently, we retrospectively analyzed its association with all-cause mortality and the effect of CMR-…

Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning

ObjectivesWe sought to evaluate the usefulness of a comprehensive assessment of four cardiovascular magnetic resonance imaging (CMR)-derived myocardial viability indexes in the setting of myocardial stunning.BackgroundCardiovascular magnetic resonance imaging allows the simultaneous assessment of several viability indexes.MethodsWe studied 40 patients with a first ST-segment elevation myocardial infarction (MI) and an open infarct-related artery. At the first week, using CMR, wall motion (WM), and four viability indexes were determined: wall thickness, WM improvement with low-dose dobutamine, perfusion, and transmural extent of necrosis. We created a comprehensive score based on the presenc…

Carotid artery stiffness as an early marker of vascular lesions in children and adolescents with cardiovascular risk factors.

INTRODUCTION AND OBJECTIVES The availability of a noninvasive marker of vascular lesions that enables their detection in the preclinical phase would be of great benefit for cardiovascular disease prevention. The aim of this study was to investigate the usefulness of a range of indices of arterial wall stiffness in the common carotid artery, as derived using high-resolution Doppler ultrasonography, for identifying vascular damage in children with risk factors. METHODS The study involved 99 children (age, 8-16 years) divided into two groups: 65 had cardiovascular risk factors (45 obesity, 20 dyslipidemia) and 34 were controls. Family histories of cardiovascular risk factors and anthropometric…

Analysis of the extension of Q-waves after infarction with body surface map: relationship with infarct size.

We aimed to characterize the extension of Q-waves after a first ST-segment elevation myocardial infarction using body surface map (BSM) and its relationship with infarct size quantified with cardiovascular magnetic resonance imaging (CMR).Thirty-five patients were studied 6 months after a first ST-segment elevation myocardial infarction (23 anterior, 12 inferior). All cases had single-vessel disease and an open artery. The extension of Q-waves was analyzed by means of a 64-lead BSM. Infarct size was quantified with CMR. Absence of Q-waves in BSM was observed in 5 patients (14%), 2 of whom (40%) had1 segment with transmural necrosis. Absence of Q-waves in 12-lead ECG was observed in 8 patien…

Differential mortality association of loop diuretic dosage according to blood urea nitrogen and carbohydrate antigen 125 following a hospitalization for acute heart failure.

Recent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood urea nitrogen (BUN), but recent findings have also indicated that diure- tics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF). Methods and results We analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72+12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent d…

Dynamics of serum-induced endothelial cell apoptosis in patients with myocardial infarction

In patients with ST-segment elevation myocardial infarction (STEMI) reperfused with primary coronary intervention (PCI), the dynamics of endothelial cell (EC) viability, apoptosis and necrosis and its relationship with the structural consequences on the left ventricle have not been addressed so far.In 20 STEMI patients, we incubated human umbilical vein endothelial cells (HUVECs) with serum drawn before reperfusion and subsequently afterwards (24, 96 h, 30 days). Viability, apoptosis and necrosis percentages were evaluated by flow cytometry. Values were compared with 12 age- and sex-matched control subjects with normal coronary arteries. Cardiac magnetic resonance (CMR) was performed during…

Role of PCSK9 in the course of ejection fraction change after ST-segment elevation myocardial infarction: a pilot study

Altres ajuts: Conselleria d'Educació, Investigació, Cultura i Esport GV/2018/116 Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI). We prospectively evaluated 40…

Estrategias diuréticas en insuficiencia cardiaca aguda con disfunción renal: terapia convencional frente a guiada por el antígeno carbohidrato 125. Diseño de ensayo clínico

Resumen Introduccion y objetivos El tratamiento optimo de pacientes con insuficiencia cardiaca aguda (ICA) y sindrome cardiorrenal tipo 1 (SCR-1) no esta bien definido. La hipoperfusion arterial y la congestion venosa tienen un papel fundamental en la fisiopatologia del SCR-1. El antigeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diuretico de pacientes con SCR-1. Metodos Ensayo clinico multicentrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a)  estrategia convencional: titulacion ba…

Experimental study on the effects of physical training on the defibrillation threshold

Background: Chest compression artifacts during cardiopulmonary resuscitation (CPR) deteriorate the rhythm diagnosis of automated external defibrillators (AED). Cardiopulmonary resuscitation must therefore be interrupted for a reliable shock/no-shock decision. However, these hands-off intervals adversely affect the defibrillation success, and, in addition, pauses in chest compressions compromise circulation. An accurate diagnosis of the rhythmwhile performing CPR is therefore needed to minimize these hands-off intervals. Methods: The characteristics of the CPR artifact are very variable, and the artifact presents an important spectral overlap with human cardiac arrest rhythms. Consequently, …

Limitaciones del blush miocárdico para el análisis de la perfusión miocárdica en pacientes con infarto agudo de miocardio y flujo TIMI 3

Introduccion y objetivos Analizamos la variabilidad en la medicion del indice angiografico de blush entre un hospital universitario y un laboratorio central independiente, asi como su correlacion con la perfusion analizada mediante ecocardiografia miocardica con contraste intracoronario (EMC) y con la funcion ventricular a los 6 meses Metodos Se incluyo en el estudio a 40 pacientes con un primer infarto agudo de miocardio con elevacion del segmento ST, enfermedad de un vaso y arteria relacionada con el infarto abierta. La perfusion se cuantifico por angiografia (mediana quinto dia, rango de 3-7) mediante el blush miocardico en nuestro laboratorio y en un laboratorio central independiente. S…

[Myocardial echocardiography with intracoronary injection of contrast in post-infarction patients. Implications and comparison with angiography and magnetic resonance imaging].

We analyzed the safety and feasibility of myocardial echocardiography with intracoronary injection of contrast, its effect on left ventricular remodeling and systolic function, and its relationship with angiography and magnetic resonance imaging (MRI) for the evaluation of post-infarction coronary microcirculation.Thirty patients with a first ST-elevation myocardial infarction and a patent infarct-related artery were studied. Mean perfusion score of the infarcted area was analyzed with myocardial echocardiography. TIMI and Blush grades (angiography) were determined. Mean perfusion score (MRI-perfusion), end-diastolic volume index and ejection fraction were determined with MRI. At 6 months a…

Functional Mitral Regurgitation Predicts Short-Term Adverse Events in Patients With Acute Heart Failure and Reduced Left Ventricular Ejection Fraction

Functional mitral regurgitation (FMR) is a common finding in patients with acute heart failure (AHF) and reduced left ventricular ejection fraction (heart failure and reduced ejection fraction [HFrEF]). However, its clinical impact remains unclear. We aimed to evaluate the association between the severity of FMR after clinical stabilization and short-term adverse outcomes after a hospitalization for AHF. We prospectively included 938 consecutive patients with HFrEF discharged after a hospitalization for AHF, after excluding those with organic valve disease, congenital heart disease, or aortic valve disease. FMR was assessed semiquantitatively by color Doppler analysis of the regurgitant jet…

Intrinsic changes on automatism, conduction, and refractoriness by exercise in isolated rabbit heart.

We have studied the intrinsic modifications on myocardial automatism, conduction, and refractoriness produced by chronic exercise. Experiments were performed on isolated rabbit hearts. Trained animals were submitted to exercise on a treadmill. The parameters investigated were 1) R-R interval, noncorrected and corrected sinus node recovery time (SNRT) as automatism index; 2) sinoatrial conduction time; 3) Wenckebach cycle length (WCL) and retrograde WCL, as atrioventricular (A-V) and ventriculoatrial conduction index; and 4) effective and functional refractory periods of left ventricle, A-V node, and ventriculoatrial retrograde conduction system. Measurements were also performed on coronary…

Prognostic Value of Myocardial Ischemia and Necrosis in Depressed Left Ventricular Function: a Multicenter Stress Cardiac Magnetic Resonance Registry

A B S T R A C T Introduction and objectives: The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. Methods: In a multicenter registry using stress magnetic resonance, the presence ( 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. Results: In 391 patients, perfusion defect or late enhancement were p…

Evolución de la investigación cardiológica española y análisis comparativo mundial de temas de especial relevancia

Resumen Introduccion y objetivos Se utilizan tecnicas bibliometricas para analizar la participacion de instituciones espanolas en la investigacion sobre temas relevantes en el ambito cardiovascular durante las ultimas 4 decadas. Metodos Se obtienen indicadores bibliometricos de produccion, colaboracion e impacto a partir de la base de datos Science Citation Index Expanded (SCIE). Se utilizan estrategias de busqueda en temas relevantes y se identifican las redes de colaboracion institucional, que se representan utilizando el algoritmo de Kamada-Kawai. Resultados Las publicaciones cardiovasculares en el mundo se han duplicado entre 2000 y 2018. Actualmente, las de autores espanoles representa…

Estudio de la perfusión coronaria postinfarto mediante análisis cuantitativo de la ecocardiografía miocárdica con inyección de contraste por vía intravenosa

Introduccion y objetivos. Tras un infarto de miocardio el dano en la microcirculacion indica un peor pronostico. Investigamos la utilidad del estudio cuantitativo de la ecografia miocardica con inyeccion de contraste por via intravenosa (EMC-i.v.) para analizar la perfusion coronaria en comparacion con la inyeccion intracoronaria (EMC-i.c.). Pacientes y metodo. Estudiamos a 42 pacientes con un primer infarto con elevacion del segmento ST, enfermedad de un vaso y arteria abierta (TIMI 3, estenosis 0,75) y EMC-i.v. (perfusion de SonoVue, imagenes unicas capturando 1 de cada 6 ciclos con trigger en telesistole, perfusion normal si > 0,9). Se considero que un paciente tenia perfusion alterada s…

P863Morphometric analysis of the dynamic changes of the interstitium after reperfused myocardial infarction

Abstract Background The interstitial space is mainly composed by cells, fibers and gels of polysaccharides, which act as a compression buffer against the stress placed on the extracellular matrix (ECM). After myocardial infarction (MI), heart has to withstand higher mechanical stress due to injured cardiomyocytes. ECM composition notably influences the mechanical properties of the myocardium and participates in left ventricular remodeling. Purpose To characterize the myocardial ECM changes from ischemia onset until late phases after coronary reperfusion in a swine model of reperfused MI. Methods MI was induced in swine by transient 90-min coronary occlusion using angioplasty balloons. One c…

Time and frequency domain analysis of long-term heart rate variability in an experimental model of diet-induced metabolic syndrome

Abstract Background Metabolic syndrome (MetS) is defined as the set of at least three of the following conditions: central obesity, elevation of triglycerides, decreased in high-density lipoproteins, systemic hypertension and glucose intolerance. MetS is linked with a high prevalence of cardiovascular disease, including sudden cardiac death and atrial arrhythmias, which may be a consequence of changes related to the structure, function and autonomic control of the heart. One of the underlying mechanisms responsible could be the alteration of sinus node automaticity. Heart rate variability (HRV) analysis is a useful non-invasive tool for evaluating alterations in neural control of cardiac au…

Ranolazine-Mediated Attenuation of Mechanoelectric Feedback in Atrial Myocyte Monolayers.

[EN] Background Mechanical stretch increases Na(+)inflow into myocytes, related to mechanisms including stretch-activated channels or Na+/H(+)exchanger activation, involving Ca(2+)increase that leads to changes in electrophysiological properties favoring arrhythmia induction. Ranolazine is an antianginal drug with confirmed beneficial effects against cardiac arrhythmias associated with the augmentation ofI(NaL)current and Ca(2+)overload. Objective This study investigates the effects of mechanical stretch on activation patterns in atrial cell monolayers and its pharmacological response to ranolazine. Methods Confluent HL-1 cells were cultured in silicone membrane plates and were stretched to…

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP &ge

Matrix metalloproteinase-12 cleaved fragment of titin as a predictor of functional capacity in patients with heart failure and preserved ejection fraction

Serum levels of matrix metalloproteinase-12 cleaved fragment of titin (TIM), a novel circulatory biomarker specific for cardiac titin degradation, has emerged as a potential biomarker in cardiovascular diseases. In this work, we aimed to evaluate the association between TIM and maximal functional capacity assessed by the percentage of predicted peak exercise oxygen uptake (pp-peakVO2) in patients with heart failure and preserved ejection fraction (HFpEF). Design. In this post-hoc study, we included 46 stable symptomatic (New York Heart Association II-III) HFpEF patients enrolled in the TRAINING-HF study (NCT02638961). pp-peak-VO2 was calculated from baseline values. Baseline circulating lev…

Beneficios del tratamiento con estatinas según los valores plasmáticos del antígeno carbohidrato 125 tras un ingreso por insuficiencia cardiaca aguda

Introduccion y objetivos La utilidad de las estatinas en pacientes con insuficiencia cardiaca es motivo de controversia. Bajo la hipotesis de que el tratamiento con estatinas seria util en los pacientes con insuficiencia cardiaca y mayor actividad inmunoinflamatoria, pretendimos conocer si la elevacion del antigeno carbohidrato 125, un biomarcador asociado a la congestion sistemica y actividad inflamatoria, identificaria a los que se beneficiarian, en cuanto a mortalidad, del tratamiento con estatinas tras un ingreso por insuficiencia cardiaca aguda. Metodos Analizamos a 1.222 pacientes consecutivos ingresados por insuficiencia cardiaca aguda. El antigeno carbohidrato 125 se determino duran…

Valor diagnóstico adicional de la disfunción sistólica inducida para la detección de enfermedad coronaria mediante resonancia magnética cardiaca de estrés con dipiridamol

Introduccion y objetivos La perfusion con dipiridamol en resonancia magnetica cardiaca (RMC) de estres se utiliza para la deteccion de enfermedad de las arterias coronarias (EAC). Sin embargo, se carece de informacion sobre el valor diagnostico de la disfuncion sistolica (DS) inducida con dipiridamol. Este estudio se centra en investigar si la DS inducida aporta un valor diagnostico adicional junto con la perfusion para la deteccion de las EAC. Metodos Se sometio a 166 pacientes a una RMC con dipiridamol y a una angiografia coronaria cuantitativa. Se definio EAC para valores ≥ 70% de estenosis. Se analizo la extension de la DS en reposo, la DS con dipiridamol, la DS inducida, el deficit de …

Implication of anti-angiogenic VEGF-A165b in angiogenesis and systolic function after reperfused myocardial infarction

Abstract Background Angiogenesis participates in re-establishing microcirculation after myocardial infarction (MI). Purpose In this study, we aim to further understand the role of the anti-angiogenic isoform vascular endothelial growth factor (VEGF)-A165b after MI and explore its potential as a co-adjuvant therapy to coronary reperfusion. Methods Two mice MI models were formed: 1) permanent coronary ligation (non-reperfused MI), 2) transient 45-min coronary occlusion followed by reperfusion (reperfused MI); in both models, animals underwent echocardiography before euthanasia at day 21 after MI induction. Serum and myocardial VEGF-A165b levels were determined. In both experimental MI models,…

Medida de la rigidez de la arteria carótida como marcador precoz de lesión vascular en niños y adolescentes con factores de riesgo cardiovascular

Introduccion y objetivos Para la prevencion de la enfermedad cardiovascular resulta de gran interes disponer de un marcador incruento de lesion vascular que permita su deteccion en fase preclinica. Nuestro objetivo fue analizar diversos indices de rigidez arterial de la carotida comun mediante ultrasonografia Doppler de alta resolucion para definir su utilidad como detector de dano vascular en ninos con factores de riesgo. Metodos Se estudio a 99 ninos (edades, 8-16 anos) divididos en dos grupos: 65 ninos con factores de riesgo cardiovascular (45 obesos, 20 dislipemicos) y 34 controles. Se recogieron antecedentes familiares de riesgo cardiovascular y variables antropometricas y bioquimicas.…

Are double potentials markers of a specific zone of the atrioventricular junction in the isolated rabbit heart?

A study is made of the characteristics of the atrial potentials recorded in the Koch triangle and its proximity, their variations on modifying the site of cardiac pacing, and their usefulness as markers of a distinct zone of the AV junction. In 12 isolated and perfused rabbit heart preparations an analysis was made of the endocardial atrial electrograms recorded with a multiple electrode positioned in the AV junction. The electrograms were obtained during spontaneous rhythm and on pacing at the crista terminalis (CT), interatrial septum (IAS), left atrium, and right ventricle. Double potentials were frequently obtained. On pacing at the CT, high-low double potentials (DP [H-L]) were more fr…

Efecto del estiramiento miocárdico sobre las frecuencias de activación determinadas mediante análisis espectral durante la fibrilación ventricular

Introduction and objectives. The aim of this study was to analyze the effects of myocardial stretching on excitation frequencies, as determined by spectral analysis, during ventricular fibrillation. Methods. In 12 isolated rabbit heart preparations, ventricular activation during ventricular fibrillation was recorded with multiple electrodes. Recordings were obtained before, during and after ventricular dilatation produced with an intraventricular balloon. The dominant frequency of the signals obtained with each of the electrodes was determined by spectral analysis. Results. During the control phase, the mean, minimum and maximum dominant frequencies were, respectively, 14.3 ± 1.7, 12.5 ± 1.…

Why does C-reactive protein increase in non-ST elevation acute coronary syndromes?

Abstract Introduction: C-reactive protein is an important prognostic indicator for early risk stratification in patients with an acute coronary syndrome. The mechanisms underlying the elevation of C-reactive protein in these patients have not been fully understood. We studied the factors related to the increase of this acute-phase reactant. Methods and Results: Within a single-centre registry, 419 consecutive patients admitted for a non-ST elevation acute coronary syndrome were studied. Serum high sensitivity C-reactive protein was measured late (median 3 days) after admission. Clinical, electrocardiographic, biochemical and angiographic variables were recorded. In the multivariate analysis…

Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome

Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear.We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death.During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndr…

Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: Influence on long-term prognosis, adverse left ventricular remodeling and relationship with microvascular obstruction

T2 weighted cardiovascular magnetic resonance (CMR) can detect intramyocardial hemorrhage (IMH) after ST-elevation myocardial infarction (STEMI). The long-term prognostic value of IMH beyond a comprehensive CMR assessment with late enhancement (LE) imaging including microvascular obstruction (MVO) is unclear. The value of CMR-derived IMH for predicting major adverse cardiac events (MACE) and adverse cardiac remodeling after STEMI and its relationship with MVO was analyzed.CMR including LE and T2 sequences was performed in 304 patients 1 week after STEMI. Adverse remodeling was defined as dilated left ventricular end-systolic volume indexes (dLVESV) at 6 months CMR.During a median follow-up …

Valor independiente de la proteína C reactiva para predecir acontecimientos mayores al primer mes y al año en los síndromes coronarios agudos sin elevación del ST

Fundamento y objetivo: Analizamos si la proteina C reactiva (PCR) aporta informacion pronostica independiente tras un sindrome coronario agudo sin elevacion del ST. Pacientes y metodo: Se estudio prospectivamente a 630 pacientes consecutivos ingresados por sindrome coronario agudo sin elevacion del ST. Los puntos de corte fueron: troponina I > 1 ng/ml (n = 354; 56%) y PCR > 11 mg/l (n = 273; 43%). Resultados: Durante un ano de seguimiento se detectaron 56 (9%) muertes de causa cardiaca, 85 (13%) infartos de miocardio y 127 (20%) primeros acontecimientos mayores. Los pacientes con PCR elevada mostraron mayor mortalidad al mes (el 8 frente al 1%) y al ano (el 15 frente al 4%); mayor porcentaj…

Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: Rationale and Study Design of a Prospective Randomized Controlled Trial

Heart failure with preserved ejection fraction (HFpEF) has become the most prevalent form of heart failure in developed countries. Regrettably, there is no evidence-based effective therapy for HFpEF. We seek to evaluate whether inspiratory muscle training, functional electrical stimulation, or a combination of both can improve exercise capacity as well as left ventricular diastolic function, biomarker profile, quality of life (QoL), and prognosis in patients with HFpEF. A total of 60 stable symptomatic patients with HFpEF (New York Heart Association class II-III/IV) will be randomized (1:1:1:1) to receive a 12-week program of inspiratory muscle training, functional electrical stimulation, a…

Inspiratory Muscle Function and Exercise Capacity in Patients With Heart Failure With Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity resulting from dyspnea and fatigue. The pathophysiological mechanisms underlying the exercise intolerance in HFpEF are not well established. We sought to evaluate the effects of inspiratory muscle function on exercise tolerance in symptomatic patients with HFpEF. Methods and Results: A total of 74 stable symptomatic patients with HFpEF and New York Heart Association class II-III underwent a cardiopulmonary exercise test between June 2012 and May 2016. Inspiratory muscle weakness was defined as maximum inspiratory pressure (MIP) <70% of normal predicted values…

Valor pronóstico a largo plazo del análisis completo de los índices de resonancia magnética cardiaca tras un infarto de miocardio con elevación del segmento ST

Resumen Introduccion y objetivos Se ha demostrado el valor pronostico de varios indices de resonancia magnetica cardiaca a medio plazo tras un infarto agudo de miocardio con elevacion del segmento ST. La extension de la necrosis transmural permite una prediccion simple y exacta de viabilidad miocardica. Sin embargo, se desconoce su valor pronostico a largo plazo mas alla de una completa evaluacion clinica y por resonancia. Nuestra hipotesis es que la evaluacion semicuantitativa de la extension de la necrosis transmural es el mejor indice de resonancia para predecir el pronostico a largo plazo tras un infarto con elevacion del segmento ST. Metodos Se realizo un estudio cuantitativo con reson…

Study of Post-Infarction Coronary Perfusion Using Quantitative Analysis of Myocardial Echocardiography With Intravenous Injection of Contrast

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis 0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if >0.9). Perfusion was considered abnormal if 2 or more segmen…

Metabolomic Profile of Human Myocardial Ischemia by Nuclear Magnetic Resonance Spectroscopy of Peripheral Blood Serum

Objectives The aim of this study was to investigate the metabolomic profile of acute myocardial ischemia (MIS) using nuclear magnetic resonance spectroscopy of peripheral blood serum of swine and patients undergoing angioplasty balloon‐induced transient coronary occlusion. Background Biochemical detection of MIS is a major challenge. The validation of novel biosignatures is of utmost importance. Methods High-resolution nuclear magnetic resonance spectroscopy was used to profile 32 blood serum metabolites obtained (before and after controlled ischemia) from swine (n 9) and patients (n 20) undergoing transitory MIS in the setting of planned coronary angioplasty. Additionally, blood serum of c…

Relación de los valores de proteína C reactiva con los hallazgos angiográficos y los marcadores de necrosis en el síndrome coronario agudo sin elevación del segmento ST

Introduccion y objetivos. El mecanismo implicado en la elevacion de la proteina C reactiva (PCR) en los sindromes coronarios agudos (inflamacion en la placa de ateroma o necrosis miocardica) es motivo de controversia. Se investigo la relacion de la PCR con la complejidad angiografica de la lesion causante y con la elevacion de la troponina en el sindrome coronario agudo sin elevacion del segmento ST. Pacientes y metodo. Se estudio a 125 pacientes consecutivos con enfermedad de un vaso. Se determinaron la troponina I y la PCR, y se analizo la complejidad angiografica de la lesion causante (flujo TIMI y trombo). De la historia clinica se recogieron la edad, el sexo, el tabaquismo, la hiperten…

Ischemia-reperfusion injury to coronary arteries: Comprehensive microscopic study after reperfused myocardial infarction.

Abstract Background Coronary arteries supply oxygen and nutrients to the heart. We evaluated the dynamics of microscopic damage throughout the ischemia-reperfusion process in the wall of coronary arteries following myocardial infarction (MI). Methods In a swine model of reperfused MI, animals were divided into one control and four MI groups: 90-min ischemia without reperfusion, or followed by one minute, one week or one month reperfusion. Left anterior descending (LAD; infarct-related artery) and control right coronary arteries (RCA) were isolated. Taking the balloon inflation region as a reference, we isolated the proximal and distal LAD areas, performing histological staining and immunohi…

Low-Cost Optical Mapping Systems for Panoramic Imaging of Complex Arrhythmias and Drug-Action in Translational Heart Models.

[EN] Panoramic optical mapping is the primary method for imaging electrophysiological activity from the entire outer surface of Langendorff-perfused hearts. To date, it is the only method of simultaneously measuring multiple key electrophysiological parameters, such as transmembrane voltage and intracellular free calcium, at high spatial and temporal resolution. Despite the impact it has already had on the fields of cardiac arrhythmias and whole-heart computational modeling, present-day system designs precludes its adoption by the broader cardiovascular research community because of their high costs. Taking advantage of recent technological advances, we developed and validated low-cost opti…

A quantitative structural and morphometric analysis of the Purkinje network and the Purkinje-myocardial junctions in pig hearts

The morpho-functional properties of the distal section of the cardiac Purkinje network (PN) and the Purkinje-myocardial junctions (PMJs) are fundamental to understanding the sequence of electrical activation in the heart. The overall structure of the system has already been described, and several computational models have been developed to gain insight into its involvement in cardiac arrhythmias or its interaction with implantable devices, such as pacemakers. However, anatomical descriptions of the PN in the literature have not enabled enough improvements in the accuracy of anatomical-based electrophysiological simulations of the PN in 3D hearts models. In this work, we study the global dis…

Home-based inspiratory muscle training for management of older patients with heart failure with preserved ejection fraction: does baseline inspiratory muscle pressure matter?

Background:Heart failure with preserved ejection fraction is a clinical syndrome characterised by reduced exercise capacity. Some evidence has shown that a simple and home-based programme of inspiratory muscle training offers promising results in terms of aerobic capacity improvement in patients with heart failure with preserved ejection fraction. This study aimed to investigate whether the baseline inspiratory muscle function predicts the changes in aerobic capacity (measured as peak oxygen uptake; peak VO2) after a 12-week home-based programme of inspiratory muscle training in patients with heart failure with preserved ejection fraction.Methods:A total of 45 stable symptomatic patients wi…

Heterogeneidades inducidas en el intervalo QT mediante enfriamiento/calentamiento epicárdico local. Estudio experimental

Resumen Introduccion y objetivos La duracion anormal del intervalo QT o su dispersion se han asociado con un incremento en el riesgo de arritmias ventriculares. Se analiza el posible efecto arritmogenico de sus variaciones inducidas mediante enfriamiento y calentamiento local epicardico. Metodos En 10 corazones aislados de conejo, se modifico escalonadamente la temperatura de una region epicardica del ventriculo izquierdo (22 a 42 ° C ), registrando simultaneamente los electrogramas en dicha zona y en otra del mismo ventriculo. En ritmo sinusal, se determino el QT y el intervalo de recuperacion de la activacion y, mediante estimulacion programada, la velocidad de conduccion y la induccion d…

Right ventricular function and iron deficiency in acute heart failure

Abstract Aims Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF. Methods and results We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was de…

Relation of Low Lymphocyte Count to Frailty and its Usefulness as a Prognostic Biomarker in Patients &gt;65 Years of Age With Acute Coronary Syndrome

Low lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low-relative lymphocyte count (Lymph%) and frailty status in patients >65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS >65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent as…

Usefulness of Right Ventricular to Pulmonary Circulation Coupling as an Indicator of Risk for Recurrent Admissions in Heart Failure With Preserved Ejection Fraction.

In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heart failure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index of RV to PC coupling. Thus, we hypothesized that TAPSE/PASP would be a predictor of readmission burden in HFpEF. One thousand one hundred and twenty seven consecutive HFpEF patients discharged for acute HF were included. In 367 patients (32.6%), PASP could not be accurately measured by echocardiography, leaving the final sample size to be 760 patients. Negative …

Usefulness of C-reactive protein and left ventricular function for risk assessment in survivors of acute myocardial infarction.

The additional prognostic information provided by C-reactive protein (CRP) to parameters of left ventricular function in survivors of acute myocardial infarction (AMI) was investigated in 665 patients (326 with ST elevation and 339 with non-ST elevation). Cox multivariable analysis identified the following predictors of 6-month cardiac death: age (per 5 years hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.1 to 1.4, p = 0.004), Killip class >I at presentation (HR 2.4, 95% CI 1.3 to 4.5, p = 0.0001), a reduced ejection fraction (per 5% HR 1.3, 95% CI 1.2 to 1.4, p = 0.0001), and greater CRP (per 5 mg/L HR 1.02, 95% CI 1.01 to 1.04, p = 0.02); the C-index of the model was 0.77 without a…

Troponina T de alta sensibilidad y riesgo de hospitalizaciones recurrentes tras un ingreso por insuficiencia cardíaca aguda

Resumen Objetivos La troponina de alta sensibilidad es un biomarcador de dano miocardico que se asocia a un mayor riesgo de mortalidad y progresion de la enfermedad en pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, su relacion con el riesgo de futuras rehospitalizaciones es menos conocido. El objetivo de este estudio fue evaluar la asociacion entre los valores de troponina T ultrasensible (TnT-us) en pacientes con ICA y el riesgo de hospitalizaciones recurrentes en el seguimiento. Metodos Se incluyo prospectivamente una cohorte de 621 pacientes consecutivos con ICA, excluyendose pacientes con sindrome coronario agudo. Se determino la TnT-us obtenida en el primer contacto med…

Prognostic Value of Charlson Comorbidity Index at 30 Days and 1 Year After Acute Myocardial Infarction

Introduction and objectives. The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for allcause mortality and recurrent AMI 30 days and 1 year after the index event. Patients and method. We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST elevation=508 and non-ST elevation=527). The composite endpoint was determined after 30 days (13.9%) and 1 year (26.3%) of follow-up. The CCI was calculated on admission, and other variables …

Valor pronóstico de la fracción de eyección del ventrículo izquierdo en pacientes con insuficiencia cardíaca aguda

Fundamento y objetivo La influencia de la fraccion de eyeccion del ventriculo izquierdo (FEVI) en el pronostico de los pacientes con insuficiencia cardiaca es motivo de controversia. El objetivo de nuestro estudio ha sido determinar, durante un seguimiento a largo plazo, el valor pronostico de la FEVI sobre la mortalidad y el reingreso hospitalario por insuficiencia cardiaca aguda (ICA) en una poblacion no seleccionada de pacientes ingresados por ICA. Pacientes y metodo Estudiamos a 507 pacientes consecutivos ingresados por ICA en el Servicio de Cardiologia de nuestro centro. Se determino la FEVI mediante ecocardiografia transtoracica durante el ingreso indice, y durante el seguimiento se r…

Effect of Streptomycin on Stretch-Induced Change in Myocardial Activation During Ventricular Fibrillation

The aim of this study was to determine whether the changes in myocardial activation pattern resulting from acute stretching during ventricular fibrillation can be counteracted by administering a compound that blocks receptors sensitive to stretch. The study involved 16 isolated rabbit hearts, in which refractoriness and activation frequency during ventricular fibrillation were measured before, during and after localized acute stretching of the left ventricular free wall, either without (series A, n=8) or with (series B, n=8) the presence of streptomycin, 200 micromol. At baseline and during and after stretching, ventricular fibrillation was slower with streptomycin perfusion in series B tha…

Estudio de perfusión en pacientes postinfarto mediante ecografía miocárdica con inyección de contraste intracoronario. Implicaciones y relación con la angiografía y la resonancia magnética

38 Objetivos. Analizamos la aplicabilidad y seguridad de la ecografia miocardica con inyeccion intracoronaria de contraste, su papel en la remodelacion ventricular y en la funcion sistolica, asi como su relacion con la angiografia y la resonancia magnetica para valorar la microcirculacion coronaria postinfarto. Pacientes y metodo. Se estudio a 30 pacientes con un primer infarto de miocardio con elevacion del segmento ST y arteria responsable abierta. Con inyeccion intracoronaria de contraste se determino la puntuacion media de perfusion en la zona infartada. Mediante angiografia se cuantificaron los grados TIMI y Blush. Se utilizo la resonancia magnetica para determinar la puntuacion media …

Prognostic differences between routine invasive and conservative strategies for the management of high-risk, non-ST segment acute coronary syndromes: Experience from two consecutive periods in a single center

Abstract Background The optimal revascularization strategy for non-ST elevation acute coronary syndromes (NSTE-ACS) remains controversial, especially in a real world context. The objective of this work was to assess differences at 1 year in all-cause mortality and the composite endpoint of mortality or acute myocardial infarction (MI) between two management strategies for NSTE-ACS: a conservative strategy (CS) versus a routine invasive strategy (RIS). Methods Of 799 consecutive patients admitted to our institution, 369 were treated with CS (from January 2001 to October 2002); 430 patients admitted with the same diagnosis were treated with RIS (from November 2002 to November 2004). A propens…

P864Histopathological damages in the epicardial coronary artery after ischemia and reperfusion injury in swine

Abstract Background The microscopic consequences in the myocardial capillaries after myocardial infarction (MI) have been widely addressed, but little attention has been paid to epicardial coronary arteries. Since epicardial circulation is responsible for providing blood flow to the heart, understanding the microscopical changes on the epicardial artery after MI becomes also crucial. Purpose To evaluate the dynamics of the microscopic damages in the coronary arteries post-MI in swine model of reperfused MI. Methods MI was induced in swine by transient 90-min coronary occlusion of the left anterior descending (LAD) coronary artery using angioplasty balloons. One control group and four MI gro…

Changes in the spatial distribution of the Purkinje network after acute myocardial infarction in the pig

Purkinje cells (PCs) are more resistant to ischemia than myocardial cells, and are suspected to participate in ventricular arrhythmias following myocardial infarction (MI). Histological studies afford little evidence on the behavior and adaptation of PCs in the different stages of MI, especially in the chronic stage, and no quantitative data have been reported to date beyond subjective qualitative depictions. The present study uses a porcine model to present the first quantitative analysis of the distal cardiac conduction system and the first reported change in the spatial distribution of PCs in three representative stages of MI: an acute model both with and without reperfusion; a subacute …

Differential prognostic impact of type 2 diabetes mellitus in women and men with heart failure with preserved ejection fraction

Introduction and objectives Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. Methods We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to …

Apoptosis and Mobilization of Lymphocytes to Cardiac Tissue Is Associated with Myocardial Infarction in a Reperfused Porcine Model and Infarct Size in Post-PCI Patients

ST-segment elevation myocardial infarction (STEMI) is the most severe outcome of coronary artery disease. Despite rapid reperfusion of the artery, acute irrigation of the cardiac tissue is associated with increased inflammation. While innate immune response in STEMI is well described, an in-depth characterization of adaptive immune cell dynamics and their potential role remains elusive. We performed a translational study using a controlled porcine reperfusion model of STEMI and the analysis of lymphocyte subsets in 116 STEMI patients undergoing percutaneous coronary intervention (PCI). In the animal model, a sharp drop in circulating T lymphocytes occurred within the first hours after reper…

Antigen carbohydrate 125 and creatinine on admission for prediction of renal function response following loop diuretic administration in acute heart failure.

The use of loop diuretics in acute heart failure (AHF) is largely empirical and has been associated with renal function impairment by reducing renal perfusion but also renal improvement by decreasing renal venous congestion. Antigen carbohydrate 125 (CA125) has emerged as a proxy for fluid overload. We sought to evaluate whether the early changes in creatinine (ΔCr) induced by intravenous furosemide doses (ivFD) differ among clinical groups defined by overload status (CA125) and creatinine on admission (Cr).We included 526 consecutive patients admitted for AHF. All patients received intravenous furosemide for the first 48 hours. CA125 and Cr were dichotomized at 35 U/ml and 1.4 mg/dl, respe…

Limitations of Myocardial Blush Grade in the Evaluation of Myocardial Perfusion in Patients With Acute Myocardial Infarction and TIMI Grade 3 Flow

Introduction and objectives An analysis was made of variability in the measurement of the angiographic index blush between a university hospital and an independent core laboratory, as well as its correlation with perfusion analised by intracoronary myocardial contrast echocardigraphy (MCE) and the ventricular function at the sixth month. Methods The study comprised 40 patients with a first ST-segment elevation myocardial infarction, single-vessel disease and open infarct-related artery. Perfusion was quantified by angiography (median fifth day, range 3-7) with blush in our laboratory and in an independent core laboratory. MCE was performed. Ejection fraction at the sixth month was determine…

P525Ranolazine attenuates stretch-induced modifications of the electrical characteristics of atrial fibrillation in HL-1 cells

Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

ObjectivesTo evaluate the prognostic value of a comprehensive cardiac magnetic resonance (CMR) assessment soon after a first ST-segment elevation myocardial infarction (STEMI).BackgroundCMR allows for a simultaneous assessment of wall motion abnormalities (WMA), WMA with low-dose dobutamine (WMA-dobutamine), microvascular obstruction, and transmural necrosis. This approach has been proven to be useful to predict late systolic recovery soon after STEMI. Its prognostic value and the relative prognostic weight of these indexes are not well-defined.MethodsWe studied 214 consecutive patients with a first STEMI treated with thrombolytic therapy or primary angioplasty discharged from hospital. In …

Iron deficiency and functional capacity in patients with advanced heart failure with preserved ejection fraction.

Experimental Study of the Effects of EIPA, Losartan, and BQ-123 on Electrophysiological Changes Induced by Myocardial Stretch

[ES] Introducción y objetivos Se han implicado diversos mecanismos en la respuesta mecánica al estiramiento miocárdico, que incluyen la activación del intercambiador Na+/H+ por acciones autocrinas y paracrinas. Se estudia la participación de estos mecanismos en las respuestas electrofisiológicas al estiramiento agudo miocárdico mediante el análisis de los cambios inducidos con fármacos. Métodos Se analizan las modificaciones de la fibrilación ventricular inducidas por el estiramiento agudo miocárdico en corazones de conejo aislados y perfundidos utilizando electrodos múltiples epicárdicos y técnicas cartográficas. Se estudian 4 series: control (n = 9); durante la perfusión del antagonista d…

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

Aims In patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency, treatment with intravenous iron has shown a clinical improvement regardless of anaemic status. Cardiac magnetic resonance (CMR) T2* sequence has shown a potential utility for evaluating myocardial iron deficiency. We aimed to evaluate whether T2* sequence significantly changes after ferric carboximaltose (FCM) administration, and if such changes correlate with changes in left ventricle ejection fraction (LVEF). Methods and results In this pilot study, we included eight patients with chronic symptomatic (New York Heart Association II–III) HFrEF and iron deficiency. A CMR, including T2* analysis, w…

Benefits of Statin Therapy Based on Plasma Carbohydrate Antigen 125 Values Following an Admission for Acute Heart Failure

The prognostic benefit of statins in patients with heart failure is a topic of controversy. Under the hypothesis that statins may provide greater benefit in a subgroup of patients with heightened inflammatory activity, we sought to explore whether statins are associated with a decreased risk of long-term mortality in patients with acute heart failure based on elevated levels of carbohydrate antigen 125, a biomarker related to systemic congestion and proinflammatory status.We analysed 1222 consecutive patients admitted with acute heart failure in a single teaching center during a median follow-up of 20 months. carbohydrate antigen 125 was measured during index hospitalization and dichotomize…

Perfusión miocárdica alterada tras un infarto en pacientes con flujo TIMI 3 mantenido. ¿Sólo un fenómeno agudo?

Introduccion y objetivos Se ha senalado que la perfusion anormal analizada mediante resonancia magnetica cardiaca (RMC) es una alteracion transitoria de la microcirculacion despues de un infarto agudo de miocardio (IAM) con flujo TIMI 3. Planteamos la hipotesis de que las alteraciones de la perfusion miocardica pueden persistir en los meses siguientes. Metodos Estudiamos 47 pacientes con un primer IAM y flujo TIMI 3 mantenido mediante ecografia miocardica con inyeccion intracoronaria de contraste (EMC) en la primera semana y el sexto mes postinfarto. Se considero que habia perfusion anormal mediante EMC si habia mas de un segmento hipoperfundido. Resultados En la primera semana 20 pacientes…

Early urinary sodium trajectory and risk of adverse outcomes in acute heart failure and renal dysfunction.

Introduction and objectives: Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24 hours (Delta UNa24 h) adds any additional prognostic information over baseline values. Methods: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydra…

Modificaciones agudas de la longitud de onda del proceso de activación auricular inducidas por la dilatación. Estudio experimental

Objetivos Estudiar en un modelo experimental las modificaciones agudas de la longitud de onda del proceso de activacion auricular inducidas por la dilatacion auricular. Material y metodos En 10 preparaciones de corazon aislado y perfundido de conejo segun la tecnica de Langendorff, mediante mapeo epicardico con un electrodo multiple se determina en la auricula derecha la longitud de onda del proceso de activacion auricular (periodo refractario funcional × velocidad de conduccion) y se analiza la inducibilidad de respuestas repetitivas auriculares rapidas, cuantificando su numero tras 20 episodios de sobreestimulacion auricular rapida. Las determinaciones se efectuan en situacion basal, tras…

Efectos de la flecainida sobre las velocidades de conducción longitudinal y transversal en el miocardio ventricular. Estudio experimental

Es conocido que el efecto de la flecainida sobre las velocidades de conduccion ventricular longitudinal y transversal depende del acoplamiento entre estimulos. Si esto es asi, el predominio de los efectos en sentido longitudinal frente al transversal puede variar en funcion de dicho acoplamiento. Con el objetivo de analizar dicha hipotesis, se ha estudiado el efecto de la flecainida (1 μmol/l) sobre dichas velocidades de conduccion en 11 preparaciones de corazon aislado de conejo, para lo que se ha utilizado un tren base de estimulacion de 250 ms y se han acoplado 2 extraestimulos con acoplamiento decreciente. La flecainida ha reducido ambas velocidades de forma significativa. Este efecto s…

An open access database for the evaluation of heart sound algorithms

In the past few decades, analysis of heart sound signals (i.e. the phonocardiogram or PCG), especially for automated heart sound segmentation and classification, has been widely studied and has been reported to have the potential value to detect pathology accurately in clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of high-quality, rigorously validated, and standardized open databases of heart sound recordings. This paper describes a public heart sound database, assembled for an international competition, the PhysioNet/Computing in Cardiology (CinC) Challenge 2016. The archive comprises nine different heart sound databases…

Characterization and implications of the dynamics of eosinophils in blood and in the infarcted myocardium after coronary reperfusion.

Objective We characterized the dynamics of eosinophils in blood and in the infarcted myocardium in patients and in a swine model of reperfused myocardial infarction (MI). The association of eosinophil dynamics with various outcomes was assessed. Methods Serial eosinophil count and pre-discharge cardiac magnetic resonance were carried out in a prospective series of 620 patients with a first ST-elevation MI. In a swine model of reperfused MI, the dynamics of circulating eosinophils and their presence in the infarcted myocardium were determined. In autopsies from chronic MI patients, eosinophils were quantified. Results Patient eosinophil count sharply decreased 12h post-reperfusion compared t…

New Risk Score for Patients With Acute Chest Pain, Non-ST-Segment Deviation, and Normal Troponin Concentrations

Objectives The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels. Background Prognosis assessment in this population remains a challenge. Methods A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days (similar to the Thrombol…

Homocysteine and long-term recurrent infarction following an acute coronary syndrome.

En Cardiology Journal. Gdańsk (Polonia) : Via Medica. Vol. 28, n. 4 (01 jul. 2021), pp. 598-606. ISSN 1897-5593. e-ISSN 1898-018X. Este artículo se encuentra disponible en la siguiente URL: https://journals.viamedica.pl/cardiology_journal/article/view/CJ.a2020.0170/52602 En este artículo de investigación también participan: Maria Marco, Teresa García-Ballester, Begoña Zorio, Eduardo Núñez, Francisco J. Chorro, Juan Sanchis y Julio Núñez. Background: There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoi…

Indicadores pronósticos del síndrome coronario agudo sin elevación del segmento ST

Objectives. We analyzed whether the study of systolic function by echocardiography adds independent information to that afforded by biochemical markers in predicting six-month major events after non-ST elevation acute coronary syndrome. Patients and method. Baseline clinical and electrocardiographic data as well as serum concentrations of troponin, myoglobin, C-reactive protein, fibrinogen and homocysteine were recorded prospectively in 515 consecutive patients admitted because of non-ST elevation acute coronary syndrome. Ejection fraction (echocardiogram) was determined in 248 cases (48%). Predictors of cardiac death or infarction within the following six months were analyzed. Results. In …

Heart rate response and functional capacity in patients with chronic heart failure with preserved ejection fraction

Aims: The mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF) are not yet elucidated. Chronotropic incompetence has emerged as a potential mechanism. We aimed to evaluate whether heart rate (HR) response to exercise is associated to functional capacity in patients with symptomatic HFpEF. Methods and results We prospectively studied 74 HFpEF patients [35.1% New York Heart Association Class III, 53% fe- male, age (mean ± standard deviation) 72.5 ± 9.1 years, and 59.5% atrial fi brillation]. Functional performance was assessed by peak oxygen consumption (peak VO 2 ). The mean (standard deviation) peak VO 2 was 10 ± 2.8 mL/min/kg. The following chronotro…

Pronóstico a corto plazo de los pacientes ingresados por probable síndrome coronario agudo sin elevación del segmento ST. Papel de los nuevos marcadores de daño miocárdico y de los reactantes de fase aguda

Objectives. The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed. Method. We prospectively studied 385 consecutive patients admitted from our chest pain unit with a highprobability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded. Results. During admission, 15 deaths (3.9%) and 16 complicative infarctions (4.2%) occurr…

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-gui…

Procalcitonin and long-term prognosis after an admission for acute heart failure

Abstract Background Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes. Methods and results We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regressi…

Evaluación de la complejidad de la activación miocárdica durante la fibrilación ventricular. Estudio experimental

Resumen Introduccion y objetivos Analizar en un modelo experimental las caracteristicas de la fibrilacion ventricular en situaciones con distintos grados de complejidad y establecer la relacion existente entre los datos aportados por distintos metodos de analisis de la arritmia. Metodos En 27 preparaciones de corazon aislado de conejo estudiadas bajo la accion de farmacos (propranolol y KB-R7943) o procedimientos fisicos (estiramiento) que causan distintos grados de variacion de la complejidad de la activacion miocardica durante la arritmia, se han utilizado tecnicas espectrales, morfologicas y cartograficas para procesar los registros obtenidos con multielectrodos epicardicos. Resultados L…

Hipertrofia ventricular izquierda y su significado pronóstico en la hipertensión arterial sistémica

En la hipertrofia ventricular izquierda existe un aumento de la masa ventricular y este hecho abarca distintos patrones morfologicos que incluyen desde el engrosamiento de las paredes ventriculares hasta la dilatacion de la cavidad ventricular. A su vez, el aumento del grosor de las paredes ventriculares puede deberse tanto al incremento de la masa muscular como a otros procesos caracterizados por la infiltracion o el deposito de sustancias entre las fibras miocardicas. Las causas predominantes de aumento de la masa ventricular son las sobrecargas mecanicas y, entre ellas, la mas frecuente es la hipertension arterial sistemica. Son menos frecuentes los casos de hipertrofia relacionados con …

A non-valvular infective endocarditis in an HIV patient with myocardiopathy

A 37-year-old woman presented in the emergency department revealing a history of HIV infection and C virus hepatitis diagnosed 15 years ago, acquired after a period of intravenous drug abusing. The patient was receiving triple antiHIV therapy and was in an A1 stage (last lymphocite recount of CD4: 0.63 10/l and no AIDS disease manifestation to the present moment). She described episodes, starting 20 days before, of torathic pain coexisting with shivers. There were no symptoms or signs of any focal infection. In the physical examination the only findings were a temperature of 38.4 8C, a 4 cm hepatomegaly and lipodystrophy. We found in the electrocardiogram a sinus rhythm, 96 bpm and no ST se…

Length of stay and risk of very early readmission in acute heart failure

In patients admitted for acute heart failure (AHF), optimal length of stay (LOS) remains controversial. Longer hospitalizations are associated with worse prognosis, but little is known about short hospitalizations. The aim of this work was to evaluate the relationship between LOS and the risk of short-term readmission in patients discharged after a hospitalization for AHF.We included 2110 consecutive patients. The independent associations between LOS and unplanned 10, 15 and 30-day readmissions were evaluated by Cox regression analysis adjusted for competing events. LOS was categorized as LOS1: ≤4days, LOS2: 5-7days, LOS3: 8-10days, and LOS4:10days.The mean age was 73±11years and 52.6% exhi…

Beta‐blockers withdrawal in patients with heart failure with preserved ejection fraction and chronotropic incompetence: Effect on functional capacity rationale and study design of a prospective, randomized, controlled trial (The Preserve‐HR trial)

Abstract Background The pathophysiology of heart failure with preserved ejection fraction (HFpEF) is complex and multifactorial. Chronotropic incompetence (ChI) has emerged as a crucial pathophysiological mechanism. Beta‐blockers, drugs with negative chronotropic effects, are commonly used in HFpEF, although current evidence does not support its routine use in these patients. Hypothesis We postulate beta‐blockers may have deleterious effects in HFpEF and ChI. This work aims to evaluate the short‐term effect of beta‐blockers withdrawal on functional capacity assessed by the maximal oxygen uptake (peakVO2) in patients with HFpEF and ChI. Methods This is a prospective, crossover, randomized (1…

Usefulness of concomitant myoglobin and troponin elevation as a biochemical marker of mortality in non–ST-segment elevation acute coronary syndromes

Koolen JJ. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996;334:1703–1708. 2. Senior R, Kaul S, Soman P, Lahiri A. Power-Doppler contrast echocardiography—a new technique for Assessing myocardial perfusion. Am Heart J 2000; 139:245–251. 3. Picano E, Parodi O, Lattanzi F, Sambuceti G, Andrade MJ, Marzullo P, Giorgetti A, Salvadori P, Marzilli M, Distante A. Assessment of anatomic and physiological severity of single-vessel coronary artery lesions by dipyridamole echocardiography. Comparison with positron emission tomography and quantitative arteriography. Circulation 1994;89:753–761. 4. Jayaweera AR, Wei K, Coggins M, Bin…

Características de los electrogramas auriculares registrados en las líneas de bloqueo producidas con radiofrecuencia en un modelo experimental

Objetivos Analizar y cuantificar las modificaciones de los electrogramas auriculares tras la realizacion de lesiones lineales en la pared auricular utilizando procedimientos de ablacion con radiofrecuencia. Metodos En 12 preparaciones de corazon aislado de conejo segun la tecnica de Langendorff se ha utilizado un electrodo multiple epicardico (221 electrodos unipolares) para analizar la activacion auricular antes y despues de la realizacion de una lesion lineal en la pared auricular izquierda mediante aplicaciones sucesivas de radiofrecuencia. Tras comprobar la existencia de bloqueo de la conduccion en la zona lesionada mediante cartografia epicardica y analisis de los vectores de propagaci…

P729PD-1/PD-L1 axis contributes to infarct size in ST elevation myocardial infarction

Programmed death-1 (PD-1) and Programmed death-1 ligand (PD-L1) regulate immune response. Previous studies associate an immune deregulation in ST-elevation myocardial infarction STEMI. We recruited 100 patients with a first STEMI treated with reperfusion. In all patients PD-1 and PD-L1 expression was studied 24 h post-reperfusion in peripheral blood mononuclear cells (PBMCs), by means of flow cytometry and molecular biology. PD-1 and PD-L1 expression was serially analyzed in the first 20 patients before reperfusion and 24h, 96h and 30 days afterwards. Results were compared with 30 age- and sex-matched controls. Cardiac Magnetic Resonance was used to quantify infarct size 1-week after infarc…

Characterization of normal regional myocardial function by MRI cardiac tagging

Purpose The aim of this study was to establish reference values for segmental myocardial strain measured by magnetic resonance (MR) cardiac tagging in order to characterize the regional function of the heart. Material and Methods We characterized the left ventricular (LV) systolic deformation in 39 subjects (26 women and 13 men, age 58.8 ± 11.6 years) whose cardiological study had not revealed any significant abnormality. The deformation was measured from MR-tagged (Siemens 1.5T MR) images using an algorithm based on sine wave modeling. Circumferential and radial peak systolic strain values along with the torsion angle and circumferential-longitudinal (CL) shear were determined in 16 LV seg…

Epicardial-limited electrophysiological heterogeneities do not facilitate ventricular arrhythmia induction. An experimental study

The electrophysiological heterogeneities of the myocardium are associated with vulnerability to arrhythmias. This study presents an experimental heterogeneity model based on local epicardial cooling/warming.

Trayectoria precoz del sodio urinario y riesgo de eventos adversos en insuficiencia cardiaca aguda y disfunción renal

Resumen Introduccion y objetivos El sodio urinario (UNa+) ha surgido como un biomarcador util para predecir eventos clinicos desfavorables en pacientes con insuficiencia cardiaca aguda (ICA). En este estudio pretendemos evaluar: a) la utilidad de una unica determinacion precoz de UNa+ para predecir eventos adversos en pacientes con ICA e insuficiencia renal (IR) concomitante, y b) si los cambios en el UNa+ a las 24 horas (ΔUNa24 h) anaden informacion pronostica adicional sobre los valores basales. Metodos Analisis post-hoc del ensayo clinico multicentrico, abierto y paralelo (IMPROVE-HF), (ClinicalTrials.gov NCT02643147) en el que 160 pacientes con ICA e IR concomitante al ingreso fueron al…

Uncontrolled immune response in acute myocardial infarction

Recently, the theory that hyperinflammation is the body's primary response to potent stimulus has been challenged. Indeed, a deregulation of the immune system could be the cause of multiple organ failure. So far, clinicians have focused on the last steps of the inflammatory cascade. However, little attention has been paid to lymphocytes, which play an important role as strategists of the inflammatory response. Experimental evidence suggests a crucial role of T lymphocytes in the pathophysiology of atherosclerosis and acute myocardial infarction (AMI). In summary, from the bottom of an imaginary inverted pyramid, a few regulatory T-cells control the upper parts represented by the wide spectr…

Evolution of 5 cardiovascular magnetic resonance–derived viability indexes after reperfused myocardial infarction

The objective of this study was to evaluate the simultaneous evolution of 5 cardiovascular magnetic resonance-derived myocardial viability indexes.We studied 72 patients with a first ST-elevation myocardial infarction and sustained TIMI 3 flow. In the first week and in the sixth month of the study, using cardiovascular magnetic resonance imaging, we determined wall thickening (WT) and the following viability indexes: wall thickness, WT with low-dose dobutamine, microvascular perfusion in first-pass imaging, microvascular obstruction in late-enhancement imaging, and transmural extent of necrosis.In 250 dysfunctional segments, the evolution outcomes for the viability indexes were as follows: …

Modelos animales de enfermedad cardiovascular

La utilizacion de modelos animales para el estudio de enfermedades cardiovasculares ha contribuido sustancialmente al progreso en el conocimiento de su patogenia y ha permitido el desarrollo de tecnicas diagnosticas y la validacion de procedimientos preventivos y terapeuticos, tanto farmacologicos como intervencionistas. Las diferencias existentes entre la enfermedad humana y la inducida experimentalmente, tanto en los mecanismos de regulacion genetica como en los factores que determinan la funcion cardiaca y vascular, son sus principales limitaciones. Entre los modelos y las preparaciones empleados en la investigacion cardiovascular, se encuentran los basados en la utilizacion de celulas a…

The Effects of Selective Stellate Ganglion Manipulation on Ventricular Refractoriness and Excitability

The effects of selective stellate ganglion stimulation or stellectomy on ventricular excitability were studied in 30 open chest mongrel dogs anesthetized with alpha-chloralose. The effective refractory period (ERP) and strength interval curves (stimulus intensity [S2] = twice the diastolic threshold [ERP], and 2, 3, 5, 7, and 14 mA) were determined using bipolar epicardial electrodes placed in the mid-anterior wall of the right ventricle (RV) and the mid-posterolateral wall of the left ventricle (LV) during left stellate ganglion stimulation (LSGSt, n = 8) or right stellate ganglion stimulation (RSGSt, n = 8), or after left stellectomy (LSGEx, n = 7) or right stellectomy (RSGEx, n = 7). LSG…

Abnormal Myocardial Perfusion After Infarction in Patients With Persistent TIMI Grade-3 Flow. Only an Acute Phenomenon?

Introduction and objectives It has been suggested that abnormal perfusion as derived from cardiovascular magnetic resonance imaging (CMR) is a transient dysfunction of microcirculation after myocardial infarction (MI) with TIMI 3 flow. We hypothesized that defects of myocardial perfusion may persist during the following months. Methods Forty-seven patients with MI and sustained TIMI 3 flow underwent intracoronary myocardial contrast echocardiography (MCE) 1 week and 6 months after infarction. Abnormal perfusion by MCE was regarded as >1 hypoperfused segment. Results At one week, 20 patients showed abnormal perfusion as derived from MCE. At six months 10 patients displayed chronic abnormal p…

Infusión intracoronaria de tioflavina-S para el estudio de la obstrucción microvascular en un modelo de infarto de miocardio

Resumen Introduccion y objetivos La obstruccion microvascular produce efectos nocivos despues del infarto de miocardio. Con objeto de esclarecer el papel de la lesion por isquemia-reperfusion en la aparicion y la dinamica de la obstruccion microvascular, se llevo a cabo un estudio metodologico preliminar para definir con exactitud este proceso en un modelo in vivo . Metodos Se indujo un infarto de miocardio en cerdos mediante una oclusion de 90 min en la parte media de la arteria coronaria descendente anterior izquierda empleando balones de angioplastia. Se aplico una infusion intracoronaria de tioflavina-S y se comparo con la instilacion tradicional intraaortica o intraventricular. Se cuan…

Carga de hospitalizaciones recurrentes tras una hospitalización por insuficiencia cardiaca aguda: insuficiencia cardiaca con función sistólica conservada frente a reducida

Introduction and objectives: Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. Methods: We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. Results: At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients …

Microvascular obstruction in the right ventricle in reperfused anterior myocardial infarction. Macroscopic and pathologic evidence in a swine model.

article i nfo Introduction: Data on right ventricular (RV) involvement in anterior myocardial infarction are scarce. The presence of RV microvascular obstruction (MVO) in this context has not been analyzed yet. The aim of the present study was to characterize the presence of MVO in the RV in a controlled experimental swine model of reperfused anterior myocardial infarction. Materials and Methods: Left anterior descending (LAD) artery-perfused area (thioflavin-S staining after selective infusioninLADartery),infarctsize(lackof triphenyltetrazolium-chloride staining) andMVO (lack of thioflavin-S staininginthe core oftheinfarctedarea) inthe RVwere studied.A quantitative(%of theventricularvolume…

Prognostic and therapeutic implications of dipyridamole stress cardiovascular magnetic resonance on the basis of the ischaemic cascade

To determine the prognostic and therapeutic implications of stress perfusion cardiovascular magnetic resonance (CMR) on the basis of the ischaemic cascade.Single centre study in a teaching hospital in Spain.Dipyridamole stress CMR was performed on 601 patients with ischaemic chest pain and known or suspected coronary artery disease. On the basis of the ischaemic cascade, patients were categorised in C1 (no evidence of ischaemia, n = 354), C2 (isolated perfusion deficit at stress first-pass perfusion imaging, n = 181) and C3 (simultaneous perfusion deficit and inducible wall motion abnormalities, n = 66). CMR-related revascularisation (n = 102, 17%) was defined as the procedure prompted by t…

Valor pronóstico del recuento leucocitario en el infarto agudo de miocardio: mortalidad a largo plazo

Introduccion y objetivos. Publicaciones recientes respaldan el papel pronostico del recuento leucocitario (RL) en pacientes con infarto agudo de miocardio (IAM). El objetivo de este trabajo fue determinar el valor predictivo atribuible al RL, con independencia de otras variables de contrastado valor pronostico, para predecir mortalidad a largo plazo en pacientes con IAM sin elevacion del segmento ST (IAMSEST) y con elevacion del segmento ST (IAMEST). Pacientes y metodo. Analizamos a 1.118 pacientes admitidos de forma consecutiva con el diagnostico de IAM (IAMSEST = 569; IAMEST = 549). El RL se obtuvo en la primera determinacion analitica. Se utilizaron modelos de regresion de Cox para deter…

Serum Heat Shock Protein 60 in Acute Heart Failure: A New Biomarker?

Heat shock protein 60 (HSP60) is a mitochondrial protein constitutively expressed in the majority of cells, and its expression is up-regulated by a variety of stressors. In heart failure, HSP60 is released from cardiomyocytes. The authors speculate that increased serum HSP60 (sHSP60) may be related to the severity of heart failure. This investigation sought to assess the association between sHSP60 and the composite end point of death ⁄ readmission in patients with acute heart failure (AHF). A total of 132 consecutive patients were admitted for AHF. The independent association between sHSP60 and the end point was assessed with Cox regression. During a median follow-up of 7 months (interquart…

Linfopenia post-reperfusión y obstrucción microvascular en el infarto agudo de miocardio con elevación del segmento ST

Introduccion y objetivos La obstruccion microvascular tras un infarto agudo de miocardio con elevacion del segmento ST se asocia a mal pronostico. La fisiopatologia de este fenomeno no esta totalmente definida. Analizamos las implicaciones de la linfopenia post-reperfusion en la existencia de obstruccion microvascular. Metodos Estudiamos prospectivamente a 212 pacientes que habian sufrido un primer infarto agudo de miocardio con elevacion del segmento ST reperfundido con agentes tromboliticos o con angioplastia primaria y con la arteria responsable abierta. Cuantificamos de manera seriada las cifras de linfocitos, neutrofilos y monocitos. Usamos la resonancia magnetica cardiaca para determi…

Post-Reperfusion Lymphopenia and Microvascular Obstruction in ST-Segment Elevation Acute Myocardial Infarction

The presence of microvascular obstruction after ST-segment elevation acute myocardial infarction is associated with a poor outcome. The pathophysiology of this process has not been fully defined. The aim of this study was to investigate the relationship between post-reperfusion lymphopenia and microvascular obstruction.This prospective study involved 212 patients with a first ST-segment elevation acute myocardial infarction who underwent reperfusion with thrombolytic agents or primary angioplasty and who had an open infarct-related artery. Serial measurements of lymphocyte, neutrophil and monocyte counts were taken. Cardiac magnetic resonance was used to detect microvascular obstruction dur…

Effect of acute heart failure following discharge in patients with non-ST-elevation acute coronary syndrome on the subsequent risk of death or acute myocardial infarction.

Little is known about how prognosis is influenced by readmission for acute heart failure (AHF) following non-ST-segment elevation acute coronary syndrome (NSTEACS). The aim of this study was to determine the prognostic effect of a first admission for AHF on the risk of acute myocardial infarction (AMI) or death in patients who survived an episode of high-risk NSTEACS.The study involved 972 consecutive patients with high-risk NSTEACS who survived after hospital admission. Readmission for AHF was selected as the main exposure variable, and its association with subsequent AMI or all-cause death was assessed using Cox proportional hazards models for time-dependent covariates that also included …

Dofetilide effects on the inhibition by trains of subthreshold conditioning stimuli.

We investigated the electrophysiological actions of dofetilide upon the ventricular myocardium to determine whether the drug modifies the inhibitory effects of subthreshold stimuli trains upon ventricular refractoriness. In nine Langendorff perfused rabbit hearts, ventricular epicardial electrodes were used to determine the following parameters at baseline and during dofetilide perfusion (0.5 micromolar): effective (ERP) and functional (FRP) refractory periods, conduction velocity (CV), wavelength (WL), and ERP prolongation (inhibitory effect) induced by subthreshold stimuli trains (STr) at pulse frequencies of 100, 300, and 600 Hz. Dofetilide significantly prolongs ventricular refractorine…

Applicability of Echocardiographic Strict Negative Criteria for Suspected Infective Endocarditis.

Echocardiography is the cornerstone imaging technique in the diagnosis of infective endocarditis (IE) but is often misused in clinical practice. Recently, strict negative criteria have been proposed to avoid unnecessary follow-up echocardiograms. We aimed to evaluate the use of echocardiography in real-world clinical daily practice and the usefulness of these criteria in the diagnosis of IE. We retrospectively retrieved every echocardiogram performed in our center for suspected IE between 2014 and 2018, including 905 transthoracic echocardiograms (TTEs). Of these, 451 (49.8%) fulfilled the strict negative criteria (group 1). In this group, IE was seldom diagnosed (n = 4, 0.9%). In 338 patie…

Stress cardiovascular magnetic resonance and mortality in a registry of 2496 elderly patients with chronic coronary syndrome. Prognosis and decision-making

Abstract Funding Acknowledgements Type of funding sources: None. Background. In recent guidelines, non-invasive imaging techniques play a pivotal role in the management of chronic coronary syndrome (CCS). The elderly represent a large percentage of our routine CCS population and risk stratification in this scenario is challenging. The potential of vasodilator stress cardiovascular magnetic resonance (CMR) for this purpose is unknown. Purpose. We explore the prognostic value and the usefulness for decision-making of the ischemic burden determined by vasodilator stress CMR imaging in a large cohort of elderly patients with known or suspected CCS. Methods. The study group was made up of 2496 p…

Antigen carbohydrate 125 as a biomarker in heart failure: a narrative review.

Congestion explains many of the signs and symptoms of acute heart failure (AHF) and disease progression. However, accurate quantification of congestion is challenging in daily practice. Antigen carbohydrate 125 (CA125) or mucin 16 (MUC16), a large glycoprotein synthesized by mesothelial cells, has emerged as a reliable proxy of congestion and inflammation in patients with heart failure. In AHF syndromes, CA125 is strongly associated with right-sided heart failure parameters and a higher risk of adverse clinical events beyond standard prognostic factors, including natriuretic peptides. Furthermore, CA125 has the potential for both monitoring and guide HF treatment following a decompensated H…

Animal Models of Cardiovascular Disease

The use of animal models to study cardiovascular disease has made a substantial contribution to increasing our understanding of disease pathogenesis, has led to the development of diagnostic techniques, and has made it possible to verify the effectiveness of different preventative and therapeutic approaches, whether pharmacological or interventional. The main limitations stem from differences between human and experimentally induced pathology, in terms of both genetic regulatory mechanisms and factors that influence cardiovascular function. The experimental models and preparations used in cardiovascular research include those based on isolated cells or tissues or structures immersed in orga…

Antigen carbohydrate 125 in heart failure: Not just a surrogate for serosal effusions?

Wehave readwith interest the letter CA-125andheart failure:Deja vu or “still to be seen” by Topatan B and Basaran A [1] where the authors concisely reviewed the current pathophysiological knowledgeof CA125 in heart failure (HF). As discussed by these authors, the pathogenesis of this biomarker's elevation inHF is complex andmultifactorial,with apparently different driven forces. For instances, a proinflammatory stimulus (IL-1, tumour necrosis factor-α, lipopolysaccharide) and mesothelial-induced stress appear thekeymechanisms related to the increaseof this biomarker in HF [1–5]. However, no clear evidence exists in regard to how these two mechanisms differentially participate in CA-125 elev…

Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes

[EN] Introduction and objectives: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Methods: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate…

P315Study of the induction and characteristics of ventricular fibrillation in an experimental model of metabolic syndrome

QT interval heterogeneities induced through local epicardial warming/cooling. An experimental study

[EN] ntroduction and objectives Abnormal QT interval durations and dispersions have been associated with increased risk of ventricular arrhythmias. The present study examines the possible arrhythmogenic effect of inducing QT interval variations through local epicardial cooling and warming. Methods In 10 isolated rabbit hearts, the temperatures of epicardial regions of the left ventricle were modified in a stepwise manner (from 22 °C to 42 °C) with simultaneous electrogram recording in these regions and in others of the same ventricle. QT and activation-recovery intervals were determined during sinus rhythm, whereas conduction velocity and ventricular arrhythmia induction were determined dur…