[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.

Trasplante cardíaco / Heart transplant

El trasplante cardíaco es considerado actualmente como el tratamiento de elección en la insuficiencia cardíaca terminal refractaria a tratamiento médico o quirúrgico. Debido a factores como la mayor esperanza de vida de la población y el manejo más eficaz de los síndromes coronarios agudos, cada vez hay un número mayor de personas que padecen fallo cardíaco. Se estima que la prevalencia de la enfermedad en países desarrollados está en torno al 1%; de éstos, un 10% está en una etapa avanzada y por tanto son potenciales receptores de un trasplante cardíaco. El problema está en que aún no es posible ofrecer esta modalidad terapéutica a todos los pacientes que la requieren. Por consiguiente, se hace necesario optimizar los resultados del trasplante cardíaco mediante la selección de pacientes, selección y manejo de los donantes, manejo perioperatorio y control de la enfermedad por rechazo del injerto. Desde el primer trasplante efectuado en diciembre de 1967, numerosos avances y cambios se han producido, lo que ha permitido aumentar la supervivencia y calidad de vida de quienes han recibido un nuevo corazón. A continuación se revisarán los aspectos más relevantes del trasplante cardíaco y los desafíos que enfrenta en la actualidad

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

[Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients]. / Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios.

INTRODUCTION: The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). METHODS: We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. RESULTS: The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). CONCLUSIONS: MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity.

Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios / Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients

Introducción. El síndrome metabólico (SM) es una asociación de factores de riesgo cardiovascular con un nexo fisiopatológico común: la resistencia insulínica. Analizamos su prevalencia y su impacto para la presencia de cardiopatía isquémica (CI). Métodos. Se registraron los datos de 1.000 pacientes consecutivos que acudieron por primera vez a la consulta externa de un Servicio de Cardiología de un hospital terciario. El diagnóstico del SM se realizó según los criterios del Adult Treatment Pannel (ATP-III). Resultados. La prevalencia global de SM fue del 27,3% (IC al 95%: 25,6-29,0) y aumentó de forma paralela a la edad. La mayor prevalencia se encontró entre los pacientes con diabetes mellitus o intolerancia hidrocarbonada (70,1%) seguidos de los que tienen obesidad (58,6%) o hipertensión (48,3%). El SM confirió mayor riesgo de CI (odds ratio [OR]: 5,5) que la diabetes (OR: 3,8). La mitad de los pacientes con CI presentaron síndrome metabólico y el 90% de los diabéticos con CI. El SM confiere el mayor riesgo de tener CI en los pacientes con obesidad (OR: 8,6), hipertrigliceridemia (OR: 6,5), antecedentes familiares de CI (OR: 5,6), sobrepeso (OR: 5,5) o hipertensión arterial (OR: 4,6). Conclusiones. El SM es altamente prevalente en los pacientes atendidos en una consulta de Cardiología y es un importante factor de riesgo para la CI, especialmente en los pacientes que tienen obesidad

Introduction. The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). Methods. We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. Results. The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). Conclusions. MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity

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)

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

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.