Novel Imaging Techniques for Heart Failure.

Imaging techniques play a main role in heart failure (HF) diagnosis, assessment of aetiology and treatment guidance. Echocardiography is the method of choice for its availability, cost and it provides most of the information required for the management and follow up of HF patients. Other non-invasive cardiac imaging modalities, such as cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT) could provide additional aetiological, prognostic and therapeutic information, especially in selected populations. This article reviews current indications and possible future applications of imaging modalities to improve the management of HF patients.

Fontan Circulation in Adult Patients: Acoustic Radiation Force Impulse Elastography as a Useful Tool for Liver Assessment.

OBJECTIVE: The development of liver fibrosis and cirrhosis due to long-standing liver congestion is known to occur in adult patients with Fontan circulation. Hepatic elastography has shown to be a useful tool for the noninvasive assessment and staging of liver fibrosis in chronic liver diseases, although the utility of this technique in Fontan patients remains to be adequately studied. METHODS: Twenty-one patients with Fontan circulation underwent an abdominal ultrasound and an acoustic radiation force impulse (ARFI) elastography. In order to compare the results from this group, a cohort of 14 healthy controls and another group containing 17 patients with cirrhosis were included. The association between the velocity values measured with elastography and clinical and analytical parameters were also studied. RESULTS: Mean shear waves propagation velocity in liver tissue in the Fontan group was 1.86 ± 0.5 m/s, with 76% of patients over the cirrhosis threshold (1.55 m/s). The control group had a mean velocity of 1.09 ± 0.06 m/s, while the cirrhotic group obtained 2.71 ± 0.51 m/s. Seven patients with Fontan circulation had increased liver enzymes. Liver ultrasound showed evidence of chronic liver disease in six patients. Velocity values obtained in the presence or absence of analytical or liver ultrasound abnormalities showed significant differences in the univariate analysis (P = .04 and P = .03 respectively). CONCLUSION: In conclusion, ARFI elastography showed increased wave propagation velocity values in the Fontan population suggesting increased liver stiffness which could be related to advanced fibrosis. A statistically significant association between ARFI values and the presence of analytical and ultrasound abnormalities has been demonstrated.

Impact of basal heart rate on long-term prognosis of heart transplant patients.

Previous studies in patients with heart failure have shown that an elevated basal heart rate (HR) is associated with a poor outcome. Our aim with this study was to investigate if this relationship is also present in heart transplantation (HTx) recipients. From 2003 until 2010, 256 HTx performed in our center were recruited. Patients who required pacemaker, heart-lung transplants, pediatrics, retransplants, and those patients with a survival of less than 1 year were excluded. The final number included in the analysis was 191. Using the HR obtained by EKG during elective admission at 1 year post-HTx and the survival rate, an ROC-curve was performed. The best point under the curve was achieved with 101 beats per minute (bpm), so patients were divided in two groups according to their HR. A comparison between survival curves of both groups was performed (Kaplan-Meier). Subsequently, a multivariate analysis considering HR and other variables with influence on survival according to the literature was carried out. A total of 136 patients were included in the group with HR ≤100 bpm, and 55 in the one with HR >100 bpm. There were no basal differences in both groups except for primary graft failure, which was more frequent in the >100 bpm group (30.9 vs. 17%, P = 0.033). Patients with ≤100 bpm had a better long prognosis (P < 0.001). The multivariate analysis proved that high HR was an independent predictor of mortality. Our study shows that HR should be considered as a prognosis factor in HTx patients.

Repeated CMV infection in a heart transplantation patient.

Infections are one of the leading causes of morbidity and mortality in heart transplantation (HTx). Cytomegalovirus (CMV) is the most common viral infection during the first year after HTx, but it is more unusual after this time. We present the case of a patient who underwent an HTx due to a severe ischemic heart disease. Although the patient did not have a high risk for CMV, infection, he suffered a reactivation during the first year and then up to six more episodes, especially in his eyes. The patient received different treatments against CMV and the immunosuppression was changed several times. Finally, everolimus was introduced instead of cyclosporine, and mycophenolate mofetil was withdrawn. The presented case provides an example of how the immunosupresion plays a key role in some infections in spite of being a suitable antiviral treatment.

[Acute acalculous cholecystitis associated with acute hepatitis A virus infection]. / Colecistitis aguda acalculosa asociada a infección aguda por el virus de la hepatitis A.

Although acute cholecystitis in the context of acute hepatitis A virus (HAV) infection is extremely rare, previous cases have been reported. However, this manifestation of HAV infection is little known. In the present article, we briefly review previously documented cases and present a new case. We report the case of a 39-year-old woman with fever, abdominal pain and moderately elevated transaminase levels who developed jaundice and peritoneal irritation. Diagnosis of acute cholecystitis was given by abdominal ultrasound and magnetic resonance imaging. The patient underwent surgery. In the postoperative period, positive IgM antibody titers for HAV were obtained, confirming the diagnosis of HAV infection.

Colecistitis aguda acalculosa asociada a infección aguda por el virus de la hepatitis A / Acute acalculous cholecystitis associated with acute hepatitis a virus infection

La colecistitis aguda en el contexto de una hepatitis A aguda,pese a tratarse de una combinación muy rara, ya ha sidopreviamente descrita. Sin embargo, se conoce muy pocoacerca de esta manifestación de la infección por el virus dela hepatitis A (VHA). En este trabajo presentamos un nuevocaso y repasamos brevemente los anteriormente documentados.Nuestro caso trata acerca de una mujer de 39 años deedad, con fiebre, dolor abdominal y elevación moderada delas transaminasas, que desarrolló ictericia y signos de irritaciónperitoneal. A través de la ecografía abdominal y de laresonancia magnética se llegó al diagnóstico de colecistitisaguda. La paciente fue intervenida y durante el postoperatoriose descubrieron anticuerpos IgM positivos para el VHA,lo que confirmó el diagnóstico de hepatitis aguda A (AU)

Although acute cholecystitis in the context of acute hepatitisA virus (HAV) infection is extremely rare, previous caseshave been reported. However, this manifestation of HAV infectionis little known. In the present article, we briefly reviewpreviously documented cases and present a new case.We report the case of a 39-year-old woman with fever, abdominalpain and moderately elevated transaminase levelswho developed jaundice and peritoneal irritation. Diagnosisof acute cholecystitis was given by abdominal ultrasoundand magnetic resonance imaging. The patient underwentsurgery. In the postoperative period, positive IgM antibodytiters for HAV were obtained, confirming the diagnosis ofHAV infection (AU)

Colecistitis aguda acalculosa asociada a infección aguda por el virus de la hepatitis A / Acute acalculous cholecystitis associated with acute hepatitis a virus infection

La colecistitis aguda en el contexto de una hepatitis A aguda,pese a tratarse de una combinación muy rara, ya ha sidopreviamente descrita. Sin embargo, se conoce muy pocoacerca de esta manifestación de la infección por el virus dela hepatitis A (VHA). En este trabajo presentamos un nuevocaso y repasamos brevemente los anteriormente documentados.Nuestro caso trata acerca de una mujer de 39 años deedad, con fiebre, dolor abdominal y elevación moderada delas transaminasas, que desarrolló ictericia y signos de irritaciónperitoneal. A través de la ecografía abdominal y de laresonancia magnética se llegó al diagnóstico de colecistitisaguda. La paciente fue intervenida y durante el postoperatoriose descubrieron anticuerpos IgM positivos para el VHA,lo que confirmó el diagnóstico de hepatitis aguda A

Although acute cholecystitis in the context of acute hepatitisA virus (HAV) infection is extremely rare, previous caseshave been reported. However, this manifestation of HAV infectionis little known. In the present article, we briefly reviewpreviously documented cases and present a new case.We report the case of a 39-year-old woman with fever, abdominalpain and moderately elevated transaminase levelswho developed jaundice and peritoneal irritation. Diagnosisof acute cholecystitis was given by abdominal ultrasoundand magnetic resonance imaging. The patient underwentsurgery. In the postoperative period, positive IgM antibodytiters for HAV were obtained, confirming the diagnosis ofHAV infection