Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity.

BACKGROUND: Inconsistencies in the grading of aortic valve stenosis are frequent (24-38%). Guidelines highlight the waveform shape when discrepancies are present. Our aim was to evaluate the severity of aortic stenosis by the ratio of acceleration time to ejection time (AT/ET). METHODS: Between January 2011 and January 2013, patients with at least moderate aortic stenosis (valve area < 1.5 cm(2) ) evaluated in our echocardiography laboratory were enrolled. Clinical data were recorded including symptoms attributable to aortic stenosis. Quantitative echocardiographic Doppler parameters as ejection dynamics (ejection time and acceleration time) and conventional parameters, and usual laboratory test including natriuretic peptides (NT-proBNP) were analyzed. RESULTS: One hundred eight patients with aortic valve stenosis were recruited (mean age 77 ± 7 years; 57% women). Comorbidity of the patients was frequent: 85% hypertension, 59% diabetes, 31% chronic renal failure, 26% smokers, mean body mass index 30.0 ± 6.6 kg/m(2) . Ninety-six patients (90%) were symptomatic at the index visit. Using a cutoff of 0.35, AT/ET had a sensitivity of 77% and a specificity of 100% to discriminate symptomatic patients. Serum value of NT-proBNP was higher in patients with AT/ET > 0.35 (9885 ± 3111 vs. 2600 ± 1175, P < 0.001). This ratio showed a good correlation with indexed left ventricle mass (r = 0.60, P < 0.001), DVI (r = -0.56, P < 0.001), and AVA (r = -0.49, P < 0.001). CONCLUSIONS: Ejection dynamics through aortic valve, particularly AT/ET ratio, is a useful tool for assessing aortic stenosis severity, with a good correlation with flow-independent parameters in aortic stenosis.

[Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?]. / Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.

Invasive assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy: the index of microvascular resistance.

We present a review of microvascular dysfunction in hypertrophic cardiomyopathy (HCM) and an interesting case of a symptomatic familial HCM patient with inducible ischemia by single photon emission computed tomography. Coronary angiography revealed normal epicardial arteries. Pressure wire measurements of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microvascular resistance (IMR) demonstrated a significant microcirculatory dysfunction. This is the first such case that documents this abnormality invasively using the IMR. The measurement of IMR, a novel marker of microcirculatory dysfunction, provides novel insights into the pathophysiology of this condition.

Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente? / Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.