Relationship Among Risk Score Systems and Coronary Atherosclerosis Determined by Multislice Computed Tomography.

BACKGROUND: Risk score systems (RSS) were designed to estimate the risk of cardiac events. Their ability to predict coronary atherosclerosis (CA) has not been established. HYPOTHESIS: Risk score systems can predict presence of CA in patients without typical symptoms or ischemia. Because design of each RSS is different, their predictive value could also differ. METHODS: A retrospective analysis was done on patients from a low-risk region referred for cardiac multislice computed tomography (MSCT). The sample included low- to intermediate-risk patients with nontypical chest pain and asymptomatic high-risk patients. Patients with documented ischemia were excluded. Three RSS were determined: Framingham Risk Score (FRS), Regicor (FRS calibrated for Spanish population), and Systematic Coronary Risk Evaluation (SCORE). Coronary arteries were investigated to determine calcium score and presence of protruding atheromas. RESULTS: We analyzed 582 patients (53.8% male; mean age 51 ± 11.5 years). Their mean estimated risk was intermediate: 15.6 ± 10.4 by FRS, 6.3 ± 4.3 by Regicor, and 3.9 ± 4.1 by SCORE. The MSCT showed no CA in 38.8%, nonobstructive plaques in 28.7%, and obstructive ones in 32.5%. The ability of the RSS to predict CA was not significantly different, with moderate diagnostic value (areas under ROC curves, 0.72-0.65). The prevalence of CA was high in low-risk patients: 40%, 47%, and 53% in FRS, Regicor, and SCORE low-risk patients, respectively. CONCLUSIONS: Risk score systems have only moderate diagnostic value to predict presence of CA, without significant differences among them. Coronary artery disease is highly prevalent in patients considered low risk.

Flow mapping inside a left ventricular aneurism: a potential tool to demonstrate thrombogenicity.

We describe the use of vector flow mapping (VFM), a novel echocardiographic technique allowing intracardiac flow visualization, to quantify flow intensity inside a left ventricular aneurysm in a 68-year-old man. VFM successfully identified areas of stagnant flow corresponding to the wall region where a thrombus had been formed.

Dilatación aneurismática auricular en pacientes no valvulares / Nonvalvular atrial aneurysmal dilation

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[Update in cardiac imaging techniques. Echocardiography and magnetic resonance imaging]. / Actualización en técnicas de imagen cardíaca. Ecocardiografía y cardiorresonancia magnética.

This article is a review of the main developments in cardiac imaging techniques reported in publications during 2005. Recent advances in digital technology have led to steadily increasing reliance on imaging techniques in the management of cardiovascular disease. We discuss advances in two techniques that fall under the remit of the echocardiography working group: echocardiography and magnetic resonance imaging.

Actualización en técnicas de imagen cardíaca. Ecocardiografía y cardiorresonancia magnética / Update in Cardiac Imaging Techniques. Echocardiography and Magnetic Resonance Imaging

En este artículo se revisan los principales avances publicados en diferentes técnicas de imagen cardíaca durante el año 2004. Los recientes avances en la tecnología digital han hecho que el clínico se apoye cada vez más en las técnicas de imagen no invasiva para el diagnóstico de las enfermedades cardíacas. Comentamos algunas novedades en ecocardiografía y cardiorresonancia magnética (AU)

This article is a review of the main developments in cardiac imaging techniques reported in publications during 2005. Recent advances in digital technology have led to steadily increasing reliance on imaging techniques in the management of cardiovascular disease. We discuss advances in two techniques that fall under the remit of the echocardiography working group: echocardiography and magnetic resonance imaging (AU)

Valoración ecocardiográfica de la asincronía / Echocardiographic Assessment of Asynchrony

La terapia de resincronización cardíaca ha logrado beneficios tanto a corto como a largo plazo en determinados pacientes con insuficiencia cardíaca. Los criterios actuales de selección para la implantación de un marcapasos bicameral son: a) insuficiencia cardíaca en clase funcional III-IV de la NYHA (New York Heart Association) a pesar de un tratamiento óptimo; b) función ventricular izquierda deprimida (FEVI < 35%); c) diámetro telediastólico del ventrículo izquierdo ≥ 55 mm, y d) morfología de bloqueo de rama izquierda en el electrocardiograma, con una duración del complejo QRS > 130 ms. Pero estos criterios están en revisión. Si consideramos como criterio para la resincronización un complejo QRS > 130 ms, aproximadamente un 30% de los pacientes no responden de manera favorable a la terapia. Se sabe que hasta un 51% de los pacientes con un complejo QRS < 120 ms tiene asincronía mecánica durante la sístole. Además, la duración del QRS tiene una escasa correlación con la asincronía intraventricular. La ecocardiografía es una técnica superior para evaluar la asincronía mecánica y los datos actuales indican que es la técnica que mejor predice la mejoría tras la resincronización. Diversos métodos han demostrado su eficacia en este sentido y, aunque hay discrepancia de unos métodos a otros y no se ha definido aún el método ideal, la ecocardiografía debería estar incluida en la evaluación de los posibles candidatos para resincronización. El objetivo de esta monografía es revisar los criterios analizados hasta la actualidad, sus ventajas y sus limitaciones (AU)

Cardiac resynchronization therapy has been shown to be effective in selected patients with heart failure. The current selection criteria are: a) New York Heart Association (NYHA) functional class III or IV heart failure despite optimized medical therapy; b) depressed left ventricular ejection fraction (LVEF<35%); c) left ventricular end-diastolic diameter 55 mm; and d) a wide QRS complex (>130 ms) with evidence of left bundle branch block (LBBB). However, these criteria are under revision. Around 30% of patients selected using these criteria do not respond to resynchronization therapy. There is a poor correlation between QRS interval and mechanical asynchrony, with over 51% of patients with a QRS interval less than 120 ms having mechanical asynchrony. Echocardiography is better at assessing mechanical asynchrony than QRS interval measurement. Moreover, recent data suggest that echocardiography provides the best predictors of improvement after resynchronization therapy. Several methods have been shown to be useful in predicting a good response. However, there are discrepancies between the results of the different methods and no consensus on the best approach has yet been reached. Nevertheless, echocardiography should be included in any evaluation of candidates for resynchronization therapy. The aim of this article was to review the benefits and limitations of existing criteria (AU)

[Cardiac resynchronization for heart failure: background, methods, indications and results]. / Resincronización cardíaca en la insuficiencia cardíaca: bases, métodos, indicaciones y resultados.

Heart failure is one of the most prevalent diseases in industrialized countries. Although the prognosis of patients with heart failure is still poor, in recent decades new therapies have been investigated in order to improve quality of life and survival. However, up to 30% of the patients with advanced heart failure present disturbances in intraventricular conduction, and this produces asynchrony of ventricular contractility, leading to further deterioration in heart function. Cardiac resynchronization therapy can improve the synchrony of ventricular contractility. Numerous studies have demonstrated the benefits of biventricular stimulation therapy for improving hemodynamic parameters, quality of life, 6-minute walking test performance and functional class in patients with heart failure, ventricular systolic dysfunction and disturbances in intraventricular conduction. Some studies have demonstrated longer survival times in patients treated with cardiac resynchronization plus a defibrillator. Nonetheless, many questions about the benefits of heart resynchronization therapy, site of stimulation and best type of device (pacemaker or defibrillator) remain unresolved.

[Closure of an iatrogenic coronary artery fistula with a PTFE-coated stent]. / Cierre percutáneo de fístula coronaria iatrogénica con stent recubierto de politetrafluoroetileno expandido.

Acquired coronary-cameral fistula is an uncommon disorder. We describe a 50-year-old man with rheumatic valvular disease who required emergency mitral and aortic valve replacement due to Staphylococcus aureus acute infective endocarditis. He underwent further surgical interventions due to bleeding and prosthetic dehiscence. During follow-up, a continuous parasternal murmur was noted. Echocardiography showed continuous coronary fistula flow from the left anterior descending artery to the right ventricle. Elective closure of the ostium was achieved with direct implantation of a 3.5 x 16 mm PTFE-coated stent (Jostent Coronary System Graft, Jomed, Germany).

Resincronización cardíaca en la insuficiencia cardíaca: bases, métodos, indicaciones y resultados / Cardiac resynchronization for heart failure: background, methods, indications and results

La insuficiencia cardíaca es una de las enfermedades más prevalentes en los países desarrollados. El pronóstico de los pacientes con insuficiencia cardíaca avanzada es todavía malo, a pesar de que en las últimas décadas se han investigado nuevas terapias para mejorar la calidad de vida y la supervivencia de estos enfermos. Por otra parte, hasta el 30 por ciento de los pacientes con insuficiencia cardíaca avanzada presenta alteraciones de la conducción intraventricular, lo que condiciona una asincronía en la contractilidad normal del ventrículo que deteriorará la función cardíaca. Mediante la terapia de estimulación cardíaca con resincronización se puede conseguir una mayor sincronía en la contractilidad ventricular. Numerosos estudios han demostrado el beneficio que produce la terapia de estimulación biventricular en la mejora de los parámetros hemodinámicos, la calidad de vida, el test de los 6 min y la clase funcional en pacientes con insuficiencia cardíaca, disfunción sistólica ventricular y retraso de la conducción intraventricular. Algunos estudios han demostrado una mayor supervivencia en los pacientes tratados con resincronización y desfibrilador. Todavía quedan bastantes interrogantes por resolver sobre los efectos de la terapia de resincronización cardíaca, el lugar de estimulación y el tipo de dispositivo a implantar (desfibrilador o marcapasos) (AU)

[Usefulness of brain natriuretic peptide to evaluate patients with heart failure treated with cardiac resynchronization]. / Utilidad del péptido natriurético BNP en la evaluación de pacientes con insuficiencia cardíca tratados con resincronización cardíaca.

INTRODUCTION AND OBJECTIVES: The aim of the present study was to document the evolution of the blood levels of brain natriuretic peptide (BNP) in patients with heart failure and their correlation with the clinical course after implantation of a biventricular pacemaker. PATIENTS AND METHOD: Twenty-eight patients with heart failure associated to left bundle branch block and left ventricular systolic dysfunction were included in the study. In each patient we performed laboratory tests, chest X-ray, electrocardiogram and echocardiogram, and measured blood levels of BNP. RESULTS: During follow-up (10 [6] months) functional capacity improved, decreasing from 3.3 (0.6) to 2.10 (0.4) (P=.03). The rate of hospitalizations for heart failure decreased from an average of 1.8 (0.7) (6 months before the procedure) to 0.8 (0.3) (6 months after the procedure; P=.04). The basal value of BNP decreased from 193 (98) pg/mL to 52 (14) at the end of the follow-up in the responder group (22 patients) and increased from 564 (380) to 650 (80) pg/mL in the nonresponder group (6 patients). Patients who responded showed significant clinical improvement and decreasing levels of BNP, which reached a plateau an average of 6 months after implantation. Multivariate logistic regression analysis identified lower levels of BNP, idiopathic dilated cardiomyopathy, and functional class as independent predictors of response to therapy. Age, QRS width and left ventricular ejection fraction were not predictors of response. CONCLUSIONS: Brain natriuretic peptide concentrations allowed us to monitor, in an objective manner, the clinical course of patients with biventricular resynchronization therapy.