Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III.

BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.

Magnetic resonance imaging in patients with cardiac implantable electronic devices: A prospective study.

BACKGROUND: The number of patients with cardiac implantable electronic devices in whom magnetic resonance imaging (MRI) is indicated is constantly increasing. The potential risk of electromagnetic interference has limited its use and it is still contraindicated by the Food and Drug Administration in some cases. The aim of this study is to evaluate the safety and efficacy of MRI in these patients. METHODS: A prospective registry comprising patients with a pacemaker (PM) or implantable cardioverter-defibrillator (ICD), MRI-conditional or not, who were candidates for MRI (at 1.5 T) with no suitable alternative diagnostic technique. All devices were programmed before the procedure and patients were monitored throughout the test. Clinical, electrical, and technical parameters were evaluated before and after MRI. RESULTS: 147 MRI examinations (132 PM and 15 ICD) were performed. There were no clinical events or significant differences in the electrical parameters of the leads after MRI. A variation in the impedance of the ventricular leads was detected, although the difference was not clinically relevant. In one patient with a PM, a failure in release of the safety impulse was detected in the auto-threshold test, although the threshold was correctly determined. In 11 of the 17 thoracic MRIs, image artifacts were detected, preventing the diagnosis in two of them. CONCLUSIONS: In patients with cardiac implantable electronic devices, MRIs performed under a specific protocol has been shown to be safe in the short term even in the thoracic region, as well as interpretable in most cases.

[Atrial fibrillation predictors in patients with embolic stroke of undetermined source]. / Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado.

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) detection in patients with embolic stroke of underdetermined source (ESUS) entails a change of medical treatment and a significant decrease in the incidence of new strokes. It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring. Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS. METHODS: We performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS. An electrocardiogram, each subject in the study underwent a 24-hour Holter-electrocardiogram (Holter-ECG) and an echocardiogram. A 2-year follow up was also conducted, with a 24-hour Holter-ECG every 3months for the first year, and every 6months during the second one. RESULTS: During the follow-up, AF was detected in 11 patients (11.6%), with a detection rate of 3.2% at 6months, 7.4% at 12months, and 11.6% at 18months as well as at 24months. The variables that were independently related to AF detection included moderate or severe left atrium dilation (P=.02), interatrial advanced block (P=.04) and more than 1000 premature atrial beats on 24-hour Holter-ECG (P=.01). CONCLUSIONS: Moderate or severe atrial dilation, interatrial advanced block, and the presence of more than 1000 premature atrial beats on 24-hour Holter-ECG behave as AF predictors in patients with ESUS.

Predictors of lack of response to resynchronization therapy.

About 30% of patients treated with cardiac resynchronization therapy (CRT) do not respond to treatment. The aim of this study was to identify clinical predictors of lack of improvement in patients receiving CRT. From 197 consecutive patients scheduled to receive CRT, 143 fulfilled the inclusion criteria. Mean age was 68 +/- 7 years and 79% were men. Heart failure was due to ischemic heart disease in 49 patients (34%). Mean QRS duration was 165 +/- 26 ms, and left ventricular ejection fraction was 27 +/- 7%. Nonresponder patients were defined as those who died of heart failure, underwent heart transplantation, or did not increase the distance walked in 6 minutes >10%. At 6-month follow-up, there were 28 nonresponders (20%). Among nonresponders, 2 patients received a heart transplantation and 9 patients died of heart failure. In logistic regression analysis, independent predictors of lack of response to CRT were ischemic heart disease (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.2 to 7; p = 0.023), severe mitral regurgitation (OR 3.5, 95% CI 1.3 to 9; p = 0.014), and left ventricular end-diastolic diameter > or =75 mm (OR 3.1, 95% CI 1.1 to 8; p = 0.026). Patients with these 3 predictors had a probability response of 27%.

[Chest pain unit: one-year follow-up]. / Unidad de dolor torácico: seguimiento a un año.

INTRODUCTION AND OBJECTIVES: In Spain there is little information available about chest pain units for the treatment of patients of low-to-medium risk with suspected acute coronary syndrome. PATIENTS AND METHOD: A prospective study was performed among emergency room patients who complained about acute chest pain and were suspected of suffering an acute coronary syndrome with a normal or unspecific initial evaluation. They underwent an early submaximum stress test to decide on possible hospitalization. The follow-up time was 1 year. RESULTS: Of 472 emergency room patients with suspected acute coronary syndrome, 179 performed the stress-test during the first hours of the triggering chest pain episode. None met the high-risk criteria for unstable angina. In 78.8% of the cases, the test results were negative and the patients were discharged. The results were positive in 15.1% and inconclusive in 6.1%; there were no complications during the procedure. Patients with a negative stress test had a more favorable outcome than the rest, with fewer following visits to the emergency room (11% vs 22%, p<0.001). One patient with a negative stress test died of a non-cardiovascular complication. None of the patients suffered acute myocardial infarction during follow-up and 89% of the patients with negative stress test had a favorable outcome (in terms of visits to the emergency room, unstable angina, acute myocardial infarction, or cardiovascular death). CONCLUSIONS: Chest pain units for the care of low-to-medium risk patients with acute chest pain allow a fast and safe hospital release with a favorable mid-term outcome.

[Pulmonary hypertension associated with human immunodeficiency virus infection: a review of 4 cases]. / Hipertensión pulmonar asociada a infección por VIH: revisión de 4 casos.

Several cardiorespiratory diseases can complicate human immunodeficiency virus (HIV) infection. Primary pulmonary hypertension is a rare clinical disorder with a poor prognosis. We describe this syndrome in four HIV- positive patients who were examined in our hospital.

Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado / Atrial fibrillation predictors in patients with embolic stroke of undetermined source

Antecedentes y objetivos: En el accidente cerebrovascular embólico de origen indeterminado (ESUS) la detección de fibrilación auricular (FA) conlleva un cambio de tratamiento y una reducción drástica en la incidencia de nuevos ictus. Es necesario determinar qué pacientes se benefician en mayor medida de una monitorización electrocardiográfica prolongada. Nuestro objetivo fue la búsqueda de predictores electrocardiográficos y ecocardiográficos de FA en pacientes con ESUS.Materiales y métodosSe diseñó un estudio observacional de cohortes en el que se incluyeron 95 pacientes consecutivos que ingresaron por ESUS en un hospital terciario. A todos se les realizó un electrocardiograma (ECG), un Holter electrocardiograma (Holter-ECG) de 24h y un ecocardiograma durante el ingreso. Se realizó un seguimiento presencial durante 2años mediante Holter-ECG de 24h, trimestral durante el primer año y semestral durante el segundo.ResultadosDurante el seguimiento se detectó FA en 11 pacientes (11,6%), siendo la tasa detección del 3,2% a los 6meses, del 7,4% a los 12meses y del 11,6% a los 18 y a los 24meses. Las variables que se relacionaron de forma independiente con el desarrollo de FA fueron la dilatación en grado moderado o severo de la aurícula izquierda (AI) (p=0,02), el bloqueo interauricular avanzado (BIA-A) (p=0,04) y la presencia de más de 1.000 extrasístoles auriculares (EA) en Holter-ECG de 24h (p=0,01).ConclusionesLa dilatación en un grado moderado o severo de AI, el BIA-A y la presencia de más de 1.000 EA en Holter-ECG de 24h se comportan como predictores independientes de FA en pacientes con ESUS. (AU)

Background and objectives: Atrial fibrillation (AF) detection in patients with embolic stroke of underdetermined source (ESUS) entails a change of medical treatment and a significant decrease in the incidence of new strokes. It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring. Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS.MethodsWe performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS. An electrocardiogram, each subject in the study underwent a 24-hour Holter-electrocardiogram (Holter-ECG) and an echocardiogram. A 2-year follow up was also conducted, with a 24-hour Holter-ECG every 3months for the first year, and every 6months during the second one.ResultsDuring the follow-up, AF was detected in 11 patients (11.6%), with a detection rate of 3.2% at 6months, 7.4% at 12months, and 11.6% at 18months as well as at 24months. The variables that were independently related to AF detection included moderate or severe left atrium dilation (P=.02), interatrial advanced block (P=.04) and more than 1000 premature atrial beats on 24-hour Holter-ECG (P=.01).ConclusionsModerate or severe atrial dilation, interatrial advanced block, and the presence of more than 1000 premature atrial beats on 24-hour Holter-ECG behave as AF predictors in patients with ESUS. (AU)

Displasia arritmogénica del ventrículo derecho en mujer joven con síncopes de repetición / Arrythmogenic right ventricular dysplasia in a young woman with recurrents syncopes

No disponible

Hipertensión pulmonar asociada a infección por VIH: revisión de 4 casos / Pulmonary hypertension associated with human immunodeficiency virus infection: a review of 4 cases

Diversas enfermedades cardiorrespiratorias pueden complicar la infección por el virus de la inmunodeficiencia humana (VIH). La hipertensión pulmonar primaria es una rara entidad clínica que conlleva un mal pronóstico. Describimos este síndrome en 4 pacientes positivos para el VIH estudiados en nuestro hospital (AU)

Unidad de dolor torácico: seguimiento a un año / Chest Pain Unit: One-Year Follow-Up

Presentamos el caso de un varón de 37 años con distrofia muscular miotónica que ingresó por fibrilación auricular con alta respuesta ventricular. Durante la administración de amiodarona presentó un episodio de muerte súbita intrahospitalaria. En el estudio electrofisiológico se evidenció una taquicardia ventricular por reentrada rama y una fibrilación ventricular. Se realizó, con éxito, ablación mediante energía de radiofrecuencia de la rama derecha del haz de His y se implantó un cardiodes fibrilador bicameral. Se discuten los mecanismos y tratamiento de las arritmias en estos pacientes. Introducción y objetivos. El objetivo del estudio es analizar los resultados a medio plazo de una unidad de dolor torácico en nuestro medio, dada la escasez de información al respecto en nuestro país. Pacientes y método. Se estudiaron prospectivamente a pacientes que consultaron en urgencias por dolor torácico sospechoso de síndrome coronario agudo y cuya evaluación inicial era normal o inespecífica. Se les sometía a una prueba de esfuerzo submáxima temprana para decidir su hospitalización. El período de seguimiento fue de un año. Resultados. Un total de 472 pacientes consultaron por sospecha de síndrome coronario agudo, 179 fueron sometidos a una prueba de esfuerzo durante las primeras horas del dolor torácico. En el 78,8 por ciento de los casos, el resultado de la prueba fue negativo y se procedió al alta.En un 15,1 por ciento la prueba de esfuerzo fue positiva y en el 6,1 por ciento fue no concluyente, sin aparecer complicaciones durante la realización de la misma. Los pacientes con prueba de esfuerzo negativa tuvieron una evolución más favorable frente al resto, con un menor número de reconsultas en urgencias (11 frente a 22 por ciento; p = NS), y menor número de hospitalizaciones por dolor torácico (2 frente a 22 por ciento; p < 0,001). Un paciente con prueba de esfuerzo negativa falleció de causa no cardiovascular. Ningún paciente sufrió un infarto agudo de miocardio en la evolución y el 89 por ciento de los casos con prueba de esfuerzo negativa tuvo una evolución libre de acontecimientos (visita a urgencias, hospitalización por angina inestable, infarto agudo de miocardio o muerte cardiovascular).Conclusiones. Una unidad de dolor torácico en la atención de pacientes de bajo riesgo permite un alta temprana y segura, con una evolución favorable a medio plazo (AU)

Cisplatino intrapericárdico en el taponamiento neoplásico / Intrapericardial cisplatin for malignant tamponade

EEl tratamiento de elección de la efusión pericárdica maligna es controvertido. La pericardiocentesis suele ser eficaz para resolver el taponamiento pero, desafortunadamente, es frecuente que haya recurrencias, y los pacientes se exponen de nuevo a una situación crítica y necesitan hospitalización. Se han sugerido distintos protocolos para evitar la reacumulación de líquido pericárdico, la mayoría de ellos bastante molestos. Presentamos nuestra experiencia con la administración intrapericárdica de cisplatino. Fueron 6 pacientes, y los tumores primarios eran carcinoma de mama en 2, pulmón en 1, ovario en 1, fibrosarcoma mediastínico en 1 y desconocido en 1. La administración de cisplatino se desarrolló prácticamente sin incidencias, fue no dolorosa, y no hubo ninguna recurrencia, con una supervivencia de 2 a 18 meses (media, 5,6).Concluimos que el cisplatino es seguro y eficaz en el tratamiento del taponamiento pericárdico maligno y en la prevención de su recurrencia (AU)