Baseline glutathione peroxidase activity affects prognosis after acute coronary syndromes.

Oxidative stress is associated with atherosclerosis and plaque lesions in experimental in vitro models. Few in vivo studies have examined the association between redox status and the prognosis of acute coronary syndromes.We undertook a prospective, observational study of 137 patients who had been admitted because of an acute coronary syndrome. We determined glutathione peroxidase activity (a marker of systemic antioxidant status) and recorded clinical and angiographic features and cardiovascular events (cardiovascular death, reinfarction, readmission with a new ischemic event, or need for coronary revascularization).The mean age of the patients (78% of whom were men) was 61.7 +/- 10.9 years; 76% were admitted with non-ST-segment-elevation acute coronary syndrome. Left ventricular ejection fraction was normal in 61%. In the 23.4% who experienced cardiovascular events, glutathione peroxidase activity was higher (mean, 2.38 vs 1.76 mU/mg of protein; P < 0.01). Two-year event-free survival was lower in patients whose glutathione peroxidase activity was higher than the 50th percentile (63% vs 82%; P = 0.01). Multivariate analysis showed a direct independent relationship between glutathione peroxidase activity and cardiovascular events (hazard ratio, 3.72; 95% confidence interval, 1.53-9.02; P < 0.01).We conclude that patients who experienced acute coronary syndromes and events during follow-up had higher plasma glutathione peroxidase activity, and that glutathione peroxidase activity was an independent predictor of events during follow-up.

[Mild hyperhomocysteinemia, low folate levels and prognosis of acute coronary syndrome without ST elevation]. / Hiperhomocisteinemia moderada, déficit basal de folatos y pronóstico del síndrome coronario agudo sin elevación del segmento ST.

BACKGROUND AND OBJECTIVE: The influence of homocysteine metabolism on the prognosis of acute coronary syndrome without ST elevation is controversial. PATIENTS AND METHOD: Prospective study of 109 patients admitted because of acute coronary syndrome without ST elevation. Basal plasmatic levels of homocysteine and folates were obtained. Clinical features and survival data on follow-up were registered. RESULTS: Both two years-free-of-events and total survival were lower in patients with low folate levels (36.5% vs 72.5%, p = 0.02; 48% vs 94%, p < .001). Patients with high homocysteine levels had lower two years-free-of-events survival (57.4% vs 89.1%, p < .01); but no difference in the total survival was observed (86.3% vs 97.3%, p = 0.11). The multivariate analysis showed that low folate levels was an independent predictor of mortality (odds ratio [OR] = 8.33; 95% confidence interval [CI], 1.88-33.33; p < 0.01), and moderate high homocysteine was an independent predictor of events on follow-up (OR = 4.34; 95% CI, 1.47-12.50; p < 0.01). CONCLUSIONS: Patients with high homocysteine or low folate levels have a poor prognosis compared with those with normal levels. On the other hand, low folate levels and moderate hyiperhomocysteinemia are independent predictors of bad prognosis in the follow-up.

Hiperhomocisteinemia moderada, déficit basal de folatos y pronóstico del síndrome coronario agudo sin elevación del segmento ST / Mild hyperhomocysteinemia, low folate levels and prognosis of acute coronary syndrome without ST elevation

FUNDAMENTO Y OBJETIVO: La influencia de las alteraciones del metabolismo de la homocisteína en el pronóstico del síndrome coronario agudo sin elevación del segmento ST está sujeta a controversias. PACIENTES Y MÉTODO: Estudio prospectivo de 109 pacientes con síndrome coronario agudo sin elevación del segmento ST. Se determinaron los valores plasmáticos basales de homocisteína y folatos. Se analizaron sus características clínicas y se estudió la supervivencia según la presencia de concentración alta de homocisteína o baja de folatos en plasma. RESULTADOS: Tanto la supervivencia libre de episodios, como la supervivencia total a 2 años fue menor en los pacientes con folatos bajos (el 36,5 frente al 72,5%, p = 0,02, y el 48 frente al 94%, p < 0,001, respectivamente). Los pacientes con homocisteína elevada presentaron una menor supervivencia libre de episodios a los 2 años (el 57,4 frente al 89,1%, p < 0,01), y no se encontraron diferencias en términos de supervivencia total (el 86,3 frente al 97,3%, p = 0,11). En el análisis mediante regresión de Cox, la presencia de folatos bajos se identificó como predictor independiente de mortalidad (odds ratio [OR] = 8,33; intervalo de confianza [IC] del 95%, 1,88-33,33; p < 0,01); además, la hiperhomocisteinemia moderada fue un predictor independiente de episodios en el seguimiento (OR = 4,34; IC del 95%, 1,47-12,50; p < 0,01). CONCLUSIONES: En esta serie, los pacientes con hiperhomocisteinemia y/o valores bajos de folatos presentaron un pronóstico peor que el de aquéllos con valores normales. La presencia de valores bajos de folatos y la existencia de hiperhomocisteinemia moderada fueron predictores independientes de mal pronóstico en el seguimiento

BACKGROUND AND OBJECTIVE: The influence of homocysteine metabolism on the prognosis of acute coronary syndrome without ST elevation is controversial. PATIENTS AND METHOD: Prospective study of 109 patients admitted because of acute coronary syndrome without ST elevation. Basal plasmatic levels of homocysteine and folates were obtained. Clinical features and survival data on follow-up were registered. RESULTS: Both two years-free-of-events and total survival were lower in patients with low folate levels (36.5% vs 72.5%, p = 0.02; 48% vs 94%, p <.001). Patients with high homocysteine levels had lower two years-free-of-events survival (57.4% vs 89.1%, p <.01); but no difference in the total survival was observed (86.3% vs 97.3%, p = 0.11). The multivariate analysis showed that low folate levels was an independent predictor of mortality (odds ratio [OR] = 8.33; 95% confidence interval [CI], 1.88-33.33; p < 0.01), and moderate high homocysteine was an independent predictor of events on follow-up (OR = 4.34; 95% CI, 1.47-12.50; p < 0.01). CONCLUSIONS: Patients with high homocysteine or low folate levels have a poor prognosis compared with those with normal levels. On the other hand, low folate levels and moderate hyiperhomocysteinemia are independent predictors of bad prognosis in the follow-up

Influence of 677 C-->T polymorphism of methylenetetrahydrofolate reductase on medium-term prognosis after acute coronary syndromes.

Various common genotypes of the polymorphism 677 C-->T of the methylenetetrahydrofolate reductase enzyme result in lower activity of the enzyme and in a subsequent increase in homocysteine levels. Many studies have analyzed the connection between this polymorphism and the beginning of coronary artery disease. However, conclusions have been controversial, and evidence of a connection between this polymorphism and the prognosis of coronary artery disease has been poorly evaluated. This prospective study evaluated the prognostic relevance of genotype TT in a cohort of 155 patients admitted to our hospital for treatment of an acute coronary syndrome accompanied by evidence of coronary atherosclerosis on coronary angiography. We found that patients with the genotype TT had higher homocysteine levels than did patients with the CT and CC genotypes (15.72 +/- 6.92 micromol/L vs 12.11 +/- 5.40 micromol/L and 12.01 +/- 4.25 micromol/L, P=0.01). After a mean follow-up of 13.4 +/- 7.4 months, we observed similar rates of major adverse cardiovascular events (CC, 29%; CT, 22%; and TT, 25%) and cardiovascular death (CC, 11%; CT, 7%; and TT, 8%). No difference in cardiovascular-death-free survival (log-rank analysis, 0.81; P=0.66) or event-free survival (log-rank analysis, 0.76; P=0.68) was found. The presence of genotype TT was not an independent predictor of prognosis after multivariate analysis by means of the Cox regression survival model. In conclusion, the presence of the TT genotype of the 677 C-->T polymorphism of the methylenetetrahydrofolate reductase enzyme was not related to prognosis in patients admitted to the hospital after an acute coronary syndrome.

Influence of high homocysteine and low folate plasmatic levels in medium-term prognosis after acute coronary syndromes.

BACKGROUND: To test prospectively whether moderate hyperhomocysteinemia and low folate levels could have an influence in the prognosis of 155 patients who presented with an acute coronary syndrome. METHODS AND RESULTS: After a mean follow-up of 13.4+/-7.4 months, patients with low folate levels had higher percentages of cardiovascular death and major cardiovascular events (33% vs. 5%, p<0.001; 44% vs. 22%, p<0.05) and patients with high homocysteine levels had a higher percentage of major cardiovascular events (31% vs. 14.5%, p<0.03). Kaplan-Meier survival estimates analysis showed that patients with low folate levels had a significantly higher probability of cardiovascular death and lower free-of-events survival (log rank statistic: 21.17, p<0.001 and 6.59, p=0.01). Patients with high homocysteine levels had a lower free-of-events survival (log rank statistic: 4.95, p=0.02). Different survival multivariate analysis model showed that the presence of low folate levels was an independent predictor of cardiovascular death (hazard ratio 8.85, 95% confidence interval 2.6-29.3, p<0.000) and high homocysteine levels was identified as independent predictor of major cardiovascular events (hazard ratio 2.34, 95% confidence interval 1.07-5.12, p<0.03). CONCLUSIONS: Low folate levels and moderate hyperhomocysteinemia were identified as independent predictors of cardiovascular events in the follow-up.

[Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care]. / Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria.

INTRODUCTION AND OBJECTIVES: To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infarction. PATIENTS AND METHOD: The participants in this 12-month prospective study were 153 consecutive patients with low-risk myocardial infarction (MI) referred to their primary care center for follow-up care. Of these patients, 113 were referred to a mixed primary and specialized care program that included physical exercise, cardiovascular risk control, an antismoking program, health education talks and psychological evaluation. The other 40 patients served as controls. We analyzed the results after 3 months and 1 year of follow-up. RESULTS: There were no differences between the two groups at baseline. After 1 year, improvements were seen in smoking habit (4.6% vs 15.6%; P<.05) and body mass index (26 [2] vs 29 [2]; P<.05). Dyslipidemia, glucose and blood pressure were similar in both groups after follow-up. Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life (78 [2] vs 91 [2]; P<.05), exercise capacity (10.3 [2] vs 8.4 [3]; P<<.01) and return to active employment (84.6% vs 53.3%; P<.05). CONCLUSIONS: After 1 year of follow-up, the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life, and increased exercise tolerance, active employment, and the number of participants who quit smoking. The mixed program also reduced body mass index. These results suggest the need for similar programs.

Rehabilitación cardíaca postinfarto de miocardio en enfermos de bajo riesgo. Resultados de un programa de coordinación entre cardiología y atención primaria / Postmyocardial infarction cardiac rehabilitation in low risk patients. Results with a coordinated program of cardiological and primary care

Introducción y objetivos. Evaluar la eficacia de un programa de rehabilitación cardíaca para pacientes con infartos de miocardio de bajo riesgo coordinados por la cardiología especializada y en colaboración con atención primaria. Pacientes y método. Un total de 153 pacientes con infarto de miocardio de bajo riesgo fueron remitidos de forma consecutiva al centro de atención primaria para proseguir con el control evolutivo. En 113 pacientes se aplicó un programa conjunto que incluía ejercicio físico, control de los factores de riesgo, programa antitabaco, charlas de educación sanitaria y valoración psicológica Los 40 pacientes restantes en los que no se aplicó el programa formaron el grupo control. Resultados. No se observaron diferencias basales entre los 2 grupos. A los 3 y a los 12 meses mejoró el abandono de tabaco (4,6 frente al 15,6 por ciento a los 12 meses; p < 0,05) y el índice de masa corporal (26 ñ 2 frente a 29 ñ 2 a los 12 meses; p < 0,05). La dislipemia, la glucemia y la presión arterial estuvieron controladas por igual. El grupo activo mejoró la calidad de vida al año de seguimiento (78 ñ 2 frente a 91 ñ 2, p < 0,05), la capacidad de esfuerzo medida en equivalentes metabólicos (10,3 ñ 2 frente a 8,4 ñ 3; p < 0,01) y el retorno laboral (el 84,6 frente al 53,3 por ciento; p < 0,05).Conclusiones. En enfermos con antecedentes de infarto de miocardio de bajo riesgo que realizan un programa de rehabilitación cardíaca coordinado entre cardiología y atención primaria se observa una mejoría de la calidad de vida y de la tolerancia al esfuerzo, un mayor retorno laboral, un mayor abandono del hábito tabáquico y una disminución del índice de masa corporal al año de seguimiento. Estos resultados indican la necesidad de potenciar programas similares (AU)

Diagnóstico ecocardiográfico de la calcificación valvular pulmonar / Calcification of the pulmonary valve: echocardiographic diagnosis

Hasta la fecha, y en nuestro conocimiento, estos son los dos primeros casos descritos de calcificación en la válvula pulmonar por Ecocardiografía, sin patología subyacente y sin datos de endocarditis infecciosa previa. Esto nos sugiere que se podría tratar de una displasia congénita de la válvula pulmonar. El objetivo de este trabajo es informar dos casos con calcificación valvular pulmonar, enfatizando la gran utilidad que tiene la Ecocardiografía para el diagnóstico y seguimiento de estos casos. La presencia de calcificación en la válvula pulmonar es una entidad poco frecuente. Con el advenimiento de los métodos de diagnóstico no invasivos comco la Ecocardiografía modo-M y bidimensional, el hallazgo de vegetaciones y/o calcificaciones en la válvula pulmonar se ha facilitado. La cancificación de la válvula pulmonar aislada ha sido descrita en muy pocos casos y casi siempre existe una lesión valvular pulmonar previa