Comparison of Different Bone Marrow-Derived Stem Cell Approaches in Reperfused STEMI. A Multicenter, Prospective, Randomized, Open-Labeled TECAM Trial.

BACKGROUND: Stem cell-based therapy has emerged as a potential therapy in acute myocardial infarction (AMI). Although various approaches have been studied, intracoronary injection of bone marrow autologous mononuclear cells (BMMC) and the ability of granulocyte colony-stimulating factor (G-CSF) to mobilize endogenous cells have attracted the most attention. OBJECTIVES: This study compares, for the first time, the efficacy of BMMC injection, G-CSF mobilization, and the combination of both with standard treatment. METHODS: On Day 1 after primary percutaneous coronary intervention, 120 patients were randomized to a 1) intracoronary BMMC injection; 2) mobilization with G-CSF; 3) both (BMMC injection plus G-CSF); or 4) conventional treatment (control group). G-CSF, 10 µg/kg/day subcutaneously, was started Day 1 and maintained for 5 days. BMMC injection was performed on Days 3 to 5. Our primary endpoint was absolute change in 12-month left ventricular ejection fraction (LVEF) and left ventricular end-systolic volume (LVESV) relative to baseline measured by cardiac magnetic resonance. RESULTS: The mean change in LVEF between baseline and follow-up for all patients was 4 ± 6% (p = 0.006). Change in LVEF and LVESV over time did not differ significantly among the 4 groups. Patients actively treated with any stem cell approach showed similar changes in LVEF and LVESV versus control subjects, with a small but significant reduction in infarct area (p = 0.038). CONCLUSIONS: In our study, 3 different bone marrow-derived stem cell approaches in AMI did not result in improvement of LVEF or volumes compared with standard AMI care (Trial of Hematopoietic Stem Cells in Acute Myocardial Infarction [TECAM]; NCT00984178).

[Use of bisoprolol in heart failure. The BISOCOR observational study]. / Empleo de bisoprolol en la insuficiencia cardíaca. Resultados del estudio BISOCOR.

INTRODUCTION AND OBJECTIVES: The benefits of beta blockers in heart failure are highly dependent on dosage. This study aimed to analyze the degree of concordance between targeted (CIBIS II) and achieved doses of bisoprolol in a group of patients with stable heart failure on conventional treatment. We also evaluated functional parameters, adverse effects and the reasons for withdrawal or drop-out. PATIENTS AND METHOD: The study group consisted of 334 patients with stable systolic heart failure who were receiving conventional treatment. Treatment with bisoprolol was initiated according to current guidelines (starting dose 1.25 mg/day, with weekly increments to 5 mg/day, and then increments every four weeks to a targeted dosis of 10 mg/day). The main endpoint was the comparison between targeted dose and dose reached at each follow-up. Secondary endpoints were quality of life assessment (Minnesota Living with Heart Failure Questionnaire), functional status (New York Heart Association), ejection fraction change, and side effects during the 9-month follow-up period. RESULTS: Thirty-four (10%) patients did not finish the study: 1 because of sudden death, 2 because of surgery, and 31 because of side effects. 63% of the patients attained the maximum targeted dose; the mean dose at the end of follow-up was 8.5 mg. Functional status, quality of life and ejection fraction improved significantly between the beginning and the end of the study. Only 4 patients had severe adverse effects. CONCLUSIONS: This is the first study in Spain to show that bisoprolol can be used effectively at the maximum recommended doses, for the outpatient treatment of heart failure.

[Catheter-related central venous thrombosis in the course of an uncomplicated acute myocardial infarction: diagnostic usefulness of echocardiography]. / Trombosis venosa central asociada a catéter en el curso de un infarto agudo de miocardio no complicado: utilidad diagnóstica de la ecocardiografía.

In certain cases such as cancer patients or patients with coagulopathies, the venous thrombosis is a frequent complication that is associated with the implantation of central venous catheters. However, it is uncommon in other contexts, such as acute myocardial infarction without complications in its fifth day of evolution, after being treated with platelet inhibitors in addition to the initial anticoagulant and fibrinolytic therapy. We present a case of thrombosis in the superior vena cava and in the right atrium related to a peripherally inserted central catheter in this clinical context. The utility of transesophageal and transthoracic echocardiography in the differential diagnosis with other cardiac structures and in the evolutionary control is commented. Likewise, potential complications and the treatment of