Early and late onset cardiotoxicity following anthracycline-based chemotherapy in breast cancer patients: Incidence and predictors.

INTRODUCTION: Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data on longitudinal studies about early and late onset cardiotoxicity in this group of patients is scarce. The objective of the present study was to assess predictors of early and late onset cardiotoxicity in patients with breast cancer treated with A. METHODS: 100 consecutive patients receiving anthracycline-based chemotherapy (CHT) to treat breast cancer were included in this prospective study. All patients underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac biomarkers including high sensitivity Troponin T (TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and Heart-type fatty acid binding protein (H-FABP) were assessed. RESULTS: Mean doxorubicin dose was 243 mg/m2. Mean follow-up was 51.8 ± 8.2 months. At one-year incidence of anthracycline related-cardiotoxicity (AR-CT) was 4% and at the end of follow-up was 18% (15 patients asymptomatic left ventricular systolic dysfunction, 1 patients heart failure and 2 patients a sudden cardiac death). Forty-nine patients developed diastolic dysfunction (DD) during first year. In the univariate analysis DD during first year was the only parameter associated with AR-CT (Table 1). In the logistic regression model DD was independently related with the development of AR-CT, with an odds ratio value of 7.5 (95% CI 1.59-35.3). CONCLUSIONS: Incidence of late-onset cardiotoxicity is high but mostly subclinical. Diastolic dysfunction early after chemotherapy is a strong predictor of anthracycline cardiotoxicity.

[The Cinematographic Narration of the Posthumanism]. / La Narración Cinematográfica del Posthumanismo.

The cinema constitutes today the aesthetic forefront of the posthumanism and a powerful instance of reflection on the posthuman future. In its more futurist dimension, the films present an evolutionary irreversible process linked to the technological development, which will determine the end of the human kind and its birth to a new posthuman reality. But it turns out paradoxical that the process of dehumanization of the human beings appears like inevitable and, nevertheless, appears as ideally Utopian the desire of humanization of the androids (to support the human values beyond the human kind). In consequence, the cinematographic reflection on posthumanism seems to be headed not towards the appearance of a new nature but towards the recovery of the genuine human values.

La narración cinematográfica del posthumanismo / The cinematographic narration of the posthumanism

El cine constituye hoy día la vanguardia estética del posthumanismo y una poderosa instancia de reflexión sobre el horizonte posthumano. En su dimensión más futurista nos presenta un proceso evolutivo irreversible, vinculado al desarrollo tecnológico, que determinará el fin del hombre y su nacimiento a una nueva realidad posthumana. Pero resulta paradójico que se presente como inevitable el proceso de deshumanización de los humanos y, sin embargo, se plantee como ideal utópico el deseo de humanización de los androides (mantener los valores humanos más allá de la especie humana). En consecuencia, la reflexión cinematográfica sobre el posthumanismo parece apuntar no tanto hacia la aparición de una nueva naturaleza sino hacia la recuperación de lo genuinamente humano

The cinema constitutes today the aesthetic forefront of the posthumanism and a powerful instance of reflection on the posthuman future. In its more futurist dimension, the films present an evolutionary irreversible process linked to the technological development, which will determine the end of the human kind and its birth to a new posthuman reality. But it turns out paradoxical that the process of dehumanization of the human beings appears like inevitable and, nevertheless, appears as ideally Utopian the desire of humanization of the androids (to support the human values beyond the human kind). In consequence, the cinematographic reflection on posthumanism seems to be headed not towards the appearance of a new nature but towards the recovery of the genuine human values

Diastolic Dysfunction Following Anthracycline-Based Chemotherapy in Breast Cancer Patients: Incidence and Predictors.

INTRODUCTION: Cardiotoxicity represents a major limitation for the use of anthracyclines or trastuzumab in breast cancer patients. Data from longitudinal studies of diastolic dysfunction (DD) in this group of patients are scarce. The objective of the present study was to assess the incidence, evolution, and predictors of DD in patients with breast cancer treated with anthracyclines. METHODS: This analytical, observational cohort study comprised 100 consecutive patients receiving anthracycline-based chemotherapy (CHT) for breast cancer. All patients underwent clinical evaluation, echocardiogram, and measurement of cardiac biomarkers at baseline, end of anthracycline-based CHT, and at 3 months and 9 months after anthracycline-based CHT was completed. Fifteen patients receiving trastuzumab were followed with two additional visits at 6 and 12 months after the last dose of anthracycline-based CHT. A multivariate analysis was performed to find variables related to the development of DD. Fifteen of the 100 patients had baseline DD and were excluded from this analysis. RESULTS: At the end of follow-up (median: 12 months, interquartile range: 11.1-12.8), 49 patients (57.6%) developed DD. DD was persistent in 36 (73%) but reversible in the remaining 13 patients (27%). Four patients developed cardiotoxicity (three patients had left ventricular systolic dysfunction and one suffered a sudden cardiac death). None of the patients with normal diastolic function developed systolic dysfunction during follow-up. In the logistic regression model, body mass index (BMI) and age were independently related to the development of DD, with the following odds ratio values: BMI: 1.19 (95% confidence interval [CI]: 1.04-1.36), and age: 1.12 (95% CI: 1.03-1.19). Neither cardiac biomarkers nor remaining clinical variables were predictors of DD. CONCLUSION: Development of diastolic dysfunction after treatment with anthracycline or anthracycline- plus trastuzumab chemotherapy is common. BMI and age were independently associated with DD following anthracycline chemotherapy.

¿Bivalirudina o heparina asociada a inhibidores de la glucoproteína IIb/IIIa en el síndrome coronario agudo sin elevación del ST? / Bivalirudin or heparin plus glycoprotein-IIb/IIIa inhibitors for non-ST-elevation acute coronary syndrome?

La bivalirudina, análogo sintético de la hirudina que se une reversiblemente a la trombina, pertenece al grupo de anticoagulantes que son inhibidores directos de la trombina con un efecto muy predecible. El objetivo de esta revisión es responder a la pregunta: ¿cuáles son la eficacia y la seguridad del tratamiento con bivalirudina en pacientes con síndrome coronario agudo sin elevación del ST, en comparación con la combinación de heparina (no fraccionada o de bajo peso molecular) e inhibidores de la glucoproteína IIb/ IIIa? Ambas estrategias han sido comparadas en dos estudios (ACUITY y REPLACE-2), de diseño e interpretación difícil, y que han mostrado una eficacia en términos de prevención de eventos cardiacos similar y disminución de las complicaciones hemorrágicas en los grupos asignados a recibir tratamiento con bivalirudina. Se realiza un análisis crítico de las evidencias y de las limitaciones existentes, que pueden servir de base para implantar una u otra estrategia en los protocolos de manejo del síndrome coronario agudo sin elevación del ST (AU)

Bivalirudin is a synthetic analog of hirudin that binds reversibly to thrombin. It belongs to a group of anticoagulants that act as direct thrombin inhibitors and whose effect is highly predictable. The aim of this review was to answer the question: How does the efficacy and safety of bivalirudin in patients with nonST-elevation acute coronary syndrome compare with that of the combination of (unfractionated or lowmolecular-weight) heparin and a glycoprotein-IIb/IIIa inhibitor? The two treatment strategies have been compared in two studies (i.e. ACUITY and REPLACE-2), both of which had a complex design and were difficult to interpret. These studies demonstrated that the two treatment strategies had similar efficacy in terms of preventing cardiac events and that fewer hemorrhagic complications occurred in the groups assigned to bivalirudin. We carried out a thorough analysis of the data available and their limitations, the results of which can serve as a basis for implementing one or other strategy in treatment protocols for nonST-elevation acute coronary síndrome (AU)

[Congenital atrioventricular block and Wolff-Parkinson-White Syndrome]. / Bloqueo auriculoventricular congénito y síndrome de Wolff-Parkinson-White.

We report the case of a patient followed since childhood for congenital complete atrioventricular block. At 28 years of age, atrioventricular conduction through an accessory pathway with long conduction times was detected. Periods of atrioventricular conduction alternated with periods of atrioventricular block. Sinus tachycardia and 1:1 exclusive conduction through the accessory pathway developed with increased sympathic activity (exercise, isoproterenol infusion). We discuss the special features of this case.

Bloqueo auriculoventricular congénito y síndrome de Wolff-Parkinson-White / Congenital atrioventricular block and Wolff-Parkinson-White syndrome

Presentamos el caso de una paciente seguida desde la infancia por bloqueo auriculoventricular completo (BAVC) congénito. A los 28 años se detectó una conducción auriculoventricular (AV) a través de una vía accesoria con tiempos de conducción largos que alternaba con rachas de BAVC. Con el aumento de la actividad simpática (ejercicio, infusión de isoproterenol) se produjo una taquicardia sinusal y conducción 1:1 exclusiva a través de la vía accesoria. Se comentan las peculiaridades de este caso (AU)