Cardiogenic shock and coronary endothelial dysfunction predict cardiac allograft vasculopathy after heart transplantation.

Cardiac allograft vasculopathy remains one of the major causes of death post-heart transplantation. Its etiology is multifactorial and prevention is challenging. The aim of this study was to prospectively determine factors related to cardiac allograft vasculopathy after heart transplantation. This research was planned on 179 patients submitted to heart transplant. Performance of an early coronary angiography with endothelial function evaluation was scheduled at three-month post-transplant. Patients underwent a second coronary angiography after five-yr follow-up. At the 5- ± 2-yr follow-up, 43% of the patients had developed cardiac allograft vasculopathy (severe in 26% of them). Three independent predictors of cardiac allograft vasculopathy were identified: cardiogenic shock at the time of the transplant operation (OR: 6.49; 95% CI: 1.86-22.7, p = 0.003); early coronary endothelial dysfunction (OR: 3.9; 95% CI: 1.49-10.2, p = 0.006), and older donor age (OR: 1.05; 95% CI: 1.00-1.10, p = 0.044). Besides early endothelial coronary dysfunction and older donor age, a new predictor for development of cardiac allograft vasculopathy was identified: cardiogenic shock at the time of transplantation. In these high-risk patient subgroups, preventive measures (treatment of cardiovascular risk factors, use of novel immunosuppressive agents such as mTOR inhibitors) should be earlier and much more aggressive.

Measure of hemodynamic patterns by thoracic electrical bioimpedance in normal pregnancy and in preeclampsia.

OBJECTIVE: To compare the differences in the hemodynamics between normal pregnancy and preeclampsia, using thoracic electrical bioimpedance. STUDY DESIGN: We compared heart rate, end-diastolic volume, systolic volume, cardiac output, ejection fraction and peripheral vascular resistances in 18 healthy pregnant women with 15 with preeclamptic women at the following intervals: third trimester, 48 h post-partum, 2 and 6 months post-partum. We took the measurements by thoracic electrical bioimpedance. Statistical analysis was performed by means of Wilcoxon rank-sum test and p < 0.05 was considered statistically significant. RESULTS: The heart rate was lower in the preeclampsia group during the third trimester and the systolic volume was also lower at 48 h post-partum; this implies a lower cardiac output in women with preeclampsia during pregnancy and in the immediate puerperium. The systemic vascular resistances were higher in preeclampsia in the third trimester and at 48 h post-partum. At 2 and 6 months post-partum, the hemodynamic situation had equalized in both groups. CONCLUSIONS: Preeclampsia is a situation of low cardiac output and high peripheral resistances compared with a normal pregnancy.

Curación del síndrome de Wolff-Parkinson-White con electrocatéter diagnóstico / Wolff-Parkinson-White Syndrome Cured with a Conventional Diagnostic Electrode Catheter

El traumatismo mecánico de las vías accesorias es un fenómeno infrecuente que habitualmente es producido con el catéter de ablación y resulta en un bloqueo de la conducción de carácter casi siempre transitorio. Presentamos el caso clínico de un paciente afectado de síndrome de Wolff-Parkinson-White por vía accesoria medioseptal, con crisis de taquicardia frecuentes no controladas con medicación, lo que motivó la realización de estudio electrofisiológico. Durante el estudio previo a la ablación, coincidiendo con la manipulación del catéter de His (tetrapolar de 5 French), se produjo un traumatismo mecánico de la vía accesoria, no recuperando la conducción durante el seguimiento a medio plazo (28 meses). Este caso excepcional abunda en la complejidad de la toma de decisiones cuando de forma inadvertida se produce el traumatismo de una vía accesoria (AU)

Los resultados del ensayo RALES constituyen una buena noticia para los pacientes con insuficiencia cardíaca y... las administraciones sanitarias / Results of the RALES trial: good news for patients with heart failure and... for health administrations

No disponible