[Non-invasive methods for evaluating reperfusion in acute myocardial infarct: enzymes and MIBI-SPECT cardiac gammagraphy]. / Métodos no invasivos de valorar la reperfusión en el infarto agudo de miocardio: enzimas y gammagrafía cardíaca con MIBI-SPECT.

INTRODUCTION: Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective. PATIENTS AND METHOD: We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzymatic profiles of creatine kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship. RESULTS: In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p < 0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatine kinase (p < 0.0001) as well as for the MB (p < 0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demonstrated by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p < 0.0001). In relation with gammagraphy, values of K1 higher or equal to 0.19 for the creatine kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion. CONCLUSION: We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.

[Comparison between the unipolar and bipolar mode for estimation and detection of auricular and ventricular duration in acute and chronic cardiac pacing]. / Comparación entre los umbrales monopolares y bipolares, de estimulación y de detección, en aurícula y ventrículo durante la fase aguda y crónica de la estimulación cardíaca.

UNLABELLED: To add data on controversy between the advantages and inconveniences of using either unipolar or bipolar modes for permanent cardiac pacing, we have studied 15 patients. In all of them a CPI Delta-925 (DDD) pulse generator was implanted. Non invasive pacing threshold values in volts were measured at 0.05, 0.08 and 0.1 ms for each chamber programmed either to unipolar or bipolar mode, at 1, 2, 3, 4, 5, 6, 7, 8, 14, 21, 30, 60, 90, 120, 180 and 365 days after the implant. Sensing thresholds were measured at the same time. For any pulse width the mean pacing thresholds in atrium and ventricle increase uniformly, reaching its maximum values between the days 8 and 14 after the implant and decreases to a stable value between 90 and 120 days after the implant, without statistically significant differences for both: unipolar and bipolar modes. Pacing thresholds (V +/- SD) for 0.05 ms in the day 365th were in atrium: unipolar 2.85 +/- 0.79, bipolar 3.35 +/- 0.92 (p = 0.56) and ventricle: unipolar 3.92 +/- 1.01, bipolar 4.36 +/- 1.35 (p = 0.58). Sensing thresholds in atrium and ventricle decreases from the 1st day after the implant with the minimum mean value the day 8th, increasing eventually. No statistically significant differences were found between sensing unipolar/bipolar mode at each chamber. Sensing thresholds (mV +/- SD) in the 365th day were in atrium: unipolar 4.40 +/- 2.07, bipolar 4.10 +/- 2.10 (p = 0.82) and ventricle: unipolar 11.20 +/- 3.63, bipolar 10.10 +/- 5.13 (p = 0.71). CONCLUSIONS: for every single patient: 1) There are not statistically significant differences in the evolution of unipolar and bipolar pacing thresholds both in atrium and ventricle, regarding rate and time of increase, maximum value, rate of decrease and stable chronic values. 2) There are neither statistically significant differences regarding unipolar and bipolar sensing in atrium and ventricle respect to rate of decrease, time and value of the minimum and stable chronic values.

[Myocardial sarcoidosis treated with implantable defibrillator]. / Sarcoidosis miocárdica tratada con desfibrilador implantable.

We describe the case of a 33 year old diabetic patient with systemic sarcoidosis who, prior to this, had episodes of myocardiac alterations such as ventricular tachycardia, which partially improved with steroid therapy. She eventually needed a defibrillator-pacemaker implant which serves to reduce the high risk of sudden death in this type of patient. The myocardiac biopsy did not show granuloma. The diagnosis, prognosis and treatment of cardiac sarcoidosis are commented on, as well as its association to diabetes mellitus, such as in this case.

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure.

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years. Socioeconomic, demographic, electrocardiographic, echocardiographic, spirometric, and chest radiograph data were obtained at the initial examination. In a random sample of half the patients, ergometric, echocardiographic, and Holter records were obtained at entry and at 3 and 18 months. Patients were followed up for > or = 3 years. The end points were mortality, hospitalization for cardiac events, deterioration in quality of life, worsening of functional class, and need for digoxin or captopril in the captopril and digoxin groups, respectively. The trial had to be terminated prematurely owing to the difficulty in finding candidates free of angiotensin-converting enzyme (ACE)-inhibitor treatment. Baseline patient characteristics were similar in both groups. From the clinical point of view, only the 48-month mortality was relevantly lower (20.9 vs. 31.9%, respectively) among patients treated with captopril than that in those receiving digoxin (log rank test, p = 0.07). No statistically or clinically relevant differences were found in other end points or adverse effects. The results suggest but do not confirm the hypothesis that captopril treatment in mild to moderate heart failure might provide better long-term survival than digoxin.