Safety of regadenoson for vasodilation in cardiac MRI stress tests. / Seguridad del empleo de regadenosón como fármaco vasodilatador en resonancia magnética cardíaca de estrés.

OBJECTIVE: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p=0.001). No severe adverse effects were observed. CONCLUSION: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests.

Hyponatraemia and congestive heart failure refractory to diuretic treatment. Utility of tolvaptan. / Hiponatremia e insuficiencia cardiaca congestiva refractaria a tratamiento diurético. Utilidad del tolvaptán.

Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment.

Increased liver stiffness values in patients with heart failure.

BACKGROUND: Liver stiffness has been claimed to be increased in patients with heart failure. AIMS: To determine the magnitude of this increase in liver stiffness, and to clarify whether it is related to the degree of heart failure or not. METHODS: Twenty-six patients were prospectively collected, and divided in groups CHF (those with compensated chronic heart failure) and AHF (those with acute decompensated heart failure). Patients underwent routine blood chemistries, pro-BNP determination, echocardiography and transient elastography during outpatient care (group CHF) or at hospital admission (group AHF). Blood chemistries, pro-BNP and transient elastography were repeated in patients in group AHF before being discharged. RESULTS: Correlation between liver stiffness and pro-BNP levels was statistically significant (Rho = 0.747, p = 0.001). Patients in group CHF had lower values of liver stiffness and pro-BNP when compared with patients in group AHF at admission. Median liver stiffness and pro-BNP values were 6.5 vs 14.4 kPa (p = 0.009) and 1511 vs 3535 pg/ml (p = 0.025) respectively. After clinical compensation, liver stiffness decreased in all patients in group AHF. Liver stiffness was 14.4 kPa at admission and 8.2 kPa at discharge (p = 0.008). Pro-BNP values also decreased from a median of 3535 pg/ml to a median of 1098 pg/ml (p = 0.025). CONCLUSIONS: Patients with heart failure have increased liver stiffness, that appears to be related with the severity of heart failure.

Función, volúmenes y masa ventricular izquierda por resonancia magnética en estudios realizados en un modelo animal con secuencias SSFP y FLASH: comparación de los resultados / Left ventricular function, volumes, and mass in MRI studies using SFPP versus FLASH sequences in an animal model

Objetivo Comparar la exactitud de 2 secuencias cine eco de gradiente para cuantificar función, volúmenes y masa ventricular izquierda en un modelo animal. Material y métodosSe estudiaron 10 cerdos miniatura tipo Goettingen (7 machos, 3 hembras; peso medio: 49,8±10,65kg; rango: 35¿65kg) en un equipo 1,5 Tesla con secuencias precesión libre en estado estacionario (SSFP) y eco de gradiente convencionales (FLASH) en respiración libre. Se utilizaron imágenes de 8mm de grosor obtenidas en el eje corto para cuantificar los parámetros del ventrículo izquierdo. Se calcularon la fracción de eyección (FE), volúmenes (volumen telediastólico [VTD], volumen telesistólico [VTS], volumen latido [VL]), masa ventricular y la relación señal ruido (RSR) con cada secuencia. Se estudiaron la correlación y concordancia entre las distintas secuencias para cada variable. ResultadosUtilizando la secuencia SSFP, la FE media estimada fue 77,35±3,13%; VTD medio 61,55±8,64ml; VTS medio 13,83±1,92ml; VL medio 47,72±7,78ml y la masa miocárdica media calculada fue de 75,87±11,44g. Mediante la secuencia FLASH se calculó una FE media de 81,87±2,22%; VTD medio 55,4±8,08ml; VTS medio 10,03±1,87ml; VL medio 45,38±6,83ml, y masa miocárdica media 87,74±15,21g. Se demostró una correlación excelente entre SSFP y FLASH para cuantificar VTD, VL y masa miocárdica (r>0,8) y moderada para VTS y FE (r>0,4). La RSR que se obtuvo con la secuencia SSFP fue significativamente superior a la estimada con la secuencia FLASH (diferencia media 120,94±42,94). ConclusionesCon la secuencia SSFP se obtienen volúmenes ventriculares ligeramente superiores y masa ventricular izquierda ligeramente inferior a los calculados con la secuencia FLASH probablemente por su mayor RSR (AU)

ObjectiveTo compare the accuracy of two cine-gradient-echo sequences to quantify left ventricular function, volumes, and mass in an animal model. Material and methodsWe studied ten Gottingen miniature pigs (seven male, three female; mean weight 49.8±10.65kg; range: 35¿65kg) with a 1.5 Tesla MRI scanner using free-breathing SSFP and FLASH sequences. We used 8-mm short-axis images to estimate left ventricular ejection fraction (EF), volumes (end-diastolic (EDV), end-systolic (ESV), and stroke volume (SV)), mass, and signal-to-noise ratio (SNR) on SSFP and FLASH sequences. We analyzed the correlation and concordance of the two sequences for each variable. ResultsUsing the SSFP sequence, the mean estimated EF was 77.35±3.13%; mean EDV 61.55±8.64ml; mean ESV 13.83±1.92ml; mean SV 47.72±7.78ml; and mean myocardial mass 75.87±11.44g. Using the FLASH sequence, the mean EF was 81.87±2.22%; mean EDV 55.4±8.08ml; mean ESV 10.03±1.87ml; mean SV 45.38±6.83ml; and mean myocardial mass 87.74±15.21g. The correlation between SSFP and FLASH to quantify EDV, SV, and myocardial mass was excellent (r>0.8) and moderate (r>0.4) for quantifying ESV and EF. The SNR in the SSFP sequence was significantly higher than in the FLASH sequence (mean difference 120.94±42.94). ConclusionsIn the SSFP sequence, ventricular volumes are slightly higher and ventricular mass is slightly lower than in the FLASH sequence, probably because of the higher SNR on SSFP sequences (AU)

[Left ventricular function, volumes, and mass in MRI studies using SFPP versus FLASH sequences in an animal model.]. / Función, volúmenes y masa ventricular izquierda por resonancia magnética en estudios realizados en un modelo animal con secuencias SSFP y FLASH: comparación de los resultados.

OBJECTIVE: To compare the accuracy of two cine-gradient-echo sequences to quantify left ventricular function, volumes, and mass in an animal model. MATERIAL AND METHODS: We studied ten Gottingen miniature pigs (seven male, three female; mean weight 49.8+/-10.65kg; range: 35-65kg) with a 1.5 Tesla MRI scanner using free-breathing SSFP and FLASH sequences. We used 8-mm short-axis images to estimate left ventricular ejection fraction (EF), volumes (end-diastolic (EDV), end-systolic (ESV), and stroke volume (SV)), mass, and signal-to-noise ratio (SNR) on SSFP and FLASH sequences. We analyzed the correlation and concordance of the two sequences for each variable. RESULTS: Using the SSFP sequence, the mean estimated EF was 77.35+/-3.13%; mean EDV 61.55+/-8.64ml; mean ESV 13.83+/-1.92ml; mean SV 47.72+/-7.78ml; and mean myocardial mass 75.87+/-11.44g. Using the FLASH sequence, the mean EF was 81.87+/-2.22%; mean EDV 55.4+/-8.08ml; mean ESV 10.03+/-1.87ml; mean SV 45.38+/-6.83ml; and mean myocardial mass 87.74+/-15.21g. The correlation between SSFP and FLASH to quantify EDV, SV, and myocardial mass was excellent (r>0.8) and moderate (r>0.4) for quantifying ESV and EF. The SNR in the SSFP sequence was significantly higher than in the FLASH sequence (mean difference 120.94+/-42.94). CONCLUSIONS: In the SSFP sequence, ventricular volumes are slightly higher and ventricular mass is slightly lower than in the FLASH sequence, probably because of the higher SNR on SSFP sequences.

18F-FDG metabolism in a rat model of chronic infarction: a 17-sector semiquantitative analysis.

UNLABELLED: Strategies to establish the functional benefit of cell therapy in cardiac regeneration and the potential mechanism are needed. AIMS: Development of a semi-quantitative method for non invasive assessment of cardiac viability and function in a rat model of myocardial infarction (MI) based on the use of microPET. ANIMALS, METHODS: Ten rats were subjected to myocardial imaging 2, 7, 14, 30, 60 and 90 days after left coronary artery ligation. Intravenous 18F-fluoro-2-deoxy-2-D-glucose (18F-FDG) was administered and regional 18F activity concentrations per unit area were measured in 17 regions of interest (ROIs) drawn on cardiac polar maps. By comparing the differences in 18F uptake between baseline and each of the follow up time points, parametric polar maps of statistical significance (PPMSS) were calculated. Left ventricular ejection fraction (LVEF) was blindly assessed echocardiographically. All animals were sacrificed for histopathological analysis after 90 days. RESULTS: The diagnostic quality of 18F-FDG microPET images was excellent. PPMSS demonstrated a statistically significant decrease in 18F concentrations as early as 48 hours after MI in 4 of the 17 ROIs (segments 7, 13, 16 and 17; p < 0.05) that persisted throughout the study. Semiquantitative analysis of 18F-FDG uptake correlated with echocardiographic decrease in LVEF (p < 0.001). CONCLUSION: The use of PPMSS based on 18F-FDG-microPET provides valuable semi-quantitative information of heart glucose metabolism allowing for non-invasive follow up thus representing a useful strategy for assessment of novel therapies in cardiac regeneration.

[Heart transplant]. / Trasplante cardíaco.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

[Cell transplant and regenerative therapy with stem cells]. / Trasplante celular y terapia regenerativa con células madre.

One of the fields of medicine that has raised the most expectations in recent years is cell therapy with stem cells. The isolation of human embryo cells, the apparent and unexpected potentiality of adult stem cells and the development of gene therapy lead us to imagine a hopeful future for a significant number of diseases that are at present incurable. In this article we will sketch out the panorama of stem cell research, describing the main achievements in this field as well as some of the questions that await an answer. In spite of the great expectations, it is essential that we maintain a critical and realistic spirit when it comes to analysing the scientific advances in this area.

Trasplante celular y terapia regenerativa con células madre / Cell transplant and regenerative therapy with stem cells

Uno de los campos de la medicina que más expectativas ha levantado en los últimos años es la terapia celular con células madre. El aislamiento de células embrionarias humanas, la aparente e inesperada potencialidad de las células madre adultas y el desarrollo de la terapia génica nos lleva a imaginar un futuro esperanzador para un importante número de enfermedades actualmente incurables. A lo largo de las siguientes páginas vamos a tratar de dibujar el panorama de la investigación con células madre, describiendo los principales logros en este campo así como algunas de las preguntas pendientes de responder. A pesar de las grandes expectativas, es fundamental que mantengamos un espíritu crítico y realista a la hora de analizar los avances científicos en este área

One of the fields of medicine that has raised the most expectations in recent years is cell therapy with stem cells. The isolation of human embryo cells, the apparent and unexpected potentiality of adult stem cells and the development of gene therapy lead us to imagine a hopeful future for a significant number of diseases that are at present incurable. In this article we will sketch out the panorama of stem cell research, describing the main achievements in this field as well as some of the questions that await an answer. In spite of the great expectations, it is essential that we maintain a critical and realistic spirit when it comes to analysing the scientific advances in this area

Regeneración miocárdica: el futuro al alcance de la mano / Myocardial regeneration: future at reach

En los últimos años hemos asistido a un interés creciente por eltratamiento de la insuficiencia cardíaca mediante el trasplante decélulas madre. Mientras que los estudios con células madre de músculo(mioblastos) se iniciaron hace mas de 10 años, la posibilidadde que las células madre de la médula ósea tengan un enorme potencialde diferenciación y proliferación han estimulado la investigacióncon otros tipos de células madre. Estos estudios experimentales handemostrado, en no pocas ocasiones, resultados contradictorios loque ha llevado a posturas enfrentadas en cuanto a la ética de iniciarestudios clínicos. Creemos que es adecuado tratar de ofrecer unavisión crítica sobre la utilización de las células madre en la insuficienciacardíaca. Quizá la pregunta mas difícil de contestar en estemomento es, si la realización de ensayos clínicos esta justificado ono a la luz de los conocimientos actuales o si por el contrario debemosadquirir un conocimiento mucho más preciso de la posibleeficacia de este tipo de tratamiento y de los mecanismos que justificandicha eficacia, antes de siquiera iniciar los estudios en humanos.En nuestra opinión existen suficientes evidencias que justifican eldesarrollo de ensayos clínicos a pesar de que, sin duda, existenmuchos interrogantes que debemos resolver mediante estudios experimentalesen animales

The last few years have witnessed a growing interest in regenerative therapy of the failing heart by cell transplantation. Initial studies with skeletal myoblasts were conducted more than 10 years ago. However, the potential of bone marrow derived cells has more recently led to a flurry of experimental studies generating overall positive but occasionally conflicting results. The ethics of initiating clinical trials with stem cells in patients with heart failure has been questioned. Although laboratory research attempts to overcome a number of questions surrounding the usefulness and safety of cell therapy, the accumulated body of evidence warrants implementation of clinical trials. The earliest of these have now documented the feasibility of cell therapy. It is now appropriate to conduct safety and efficacy studies which, if carefully done, should allow assessment of the extent to which this concept of regenerative therapy can be made a clinical reality (AU)

Preliminary results of the effect of treatment of hyperhomocysteinemia and its relationship with inflammation, coagulation status, and endothelial function after renal transplantation.

The aim of this study was to assess the relationship between total plasma homocysteine (tHC) and several markers of endothelial function, coagulation, and pro-inflammatory status in renal transplant recipients. Our own previous study demonstrated the efficacy of folic acid (FA) and vitamin B(12) (B(12)) treatment to reduce tHC. Using 70 stable recipients, 56 of whom showed hyperhomocisteinemia (HHC) (tHC > or = 14 micromol/L) and a control group (n = 14, tHC < 14 micromol/L), we treated 29 patients in the HHC group (10 mg FA and 500 mg B(12) daily) and determined their endothelial function, inflammatory activity, and coagulation status. We assessed plasma levels of von Willebrand Factor and fibrinogen as the prothrombotic profile and C-reactive protein and plasma albumin as inflammation markers. We performed Doppler sonography of the brachial artery to assess endothelial function. The mean value of plasma tHC of 19.05 +/- 3.70 micromol/L before treatment decreased to 13.45 +/- 3.25 micromol/L after 3 months of treatment (P < .001). The vWF was significantly correlated with tHC (P < .05) and was higher in the HHC patients (P < .05). The fibrinogen mean level was also significantly higher in HHC patients (P < .05). The C-reactive protein level was significantly higher and the albumin level was lower among patients with HHC. The endothelium-dependent dilation (EDD) correlated with baseline tHC (P < .05). In preliminary data we observed that homocysteine-lowering therapy may provide cardiovascular protection by enhancing endothelial function, limiting oxidative stress, and reducing procoagulation status.

Arritmias supraventriculares. Posibles aplicaciones del esmolol / Supraventricular arrhythmias. Possible esmolol applications

Dentro de las arritmias supraventriculares podemos encontrar a la fibrilación auricular, el fluter, las taquicardias paroxísticas supraventriculares y las taquicardias auriculares. La más frecuente es la fibrilación auricular. En la presente revisión repasamos su fisiopatología, clínica, y posibles tratamientos, prestando atención a las posibles aplicaciones del esmolol (AU)

[Supraventricular arrhythmia. Potential applications of esmolol]. / Arritmias supraventriculares. Posibles aplicaciones del esmolol.

Atrial fibrillation, atrial flutter, paroxistical supraventricular tachycardias and atrial tachycardias are the main supraventricular arrhythmias. Atrial fibrillation is the most common. In this review we comment their physiopathology, clinical manifestations, and treatments, paying special attention to the possible esmolol applications.