Prognostic value of ACE I/D, AT1R A1166C, PAI-I 4G/5G and GPIIIa a1/a2 polymorphisms in myocardial infarction.

BACKGROUND: Coronary artery disease (CAD) has turned into a prevalent cause of morbi-mortality contributing some polymorphisms in the recurrence of major adverse cardiac events (MACE). METHODS: Three hundred and fifty six patients with first myocardial infarction (MI) were followed up during a 60-month period to find out if ACE I/D, AT1R A1166C, PAI-I 4G/5G and GPIIIa a1/a2 polymorphisms, in combination with other classical cardiovascular risk factors, can contribute to the relapse of MACE. RESULTS: Two hundred and eighty five (80.1%) men and 71 (19.9%) women were followed up after first MI. The primary clinical endpoint, a composite of MACE, was reached in 106 (29.8%) patients. In the Cox univariate survival analysis those risk factors influencing a poorer prognosis were age (p = 0.004), a positive family history of CAD (p = 0.007), diabetes (p = 0.004), smoking (p = 0.024), fibrinolytic therapy (p = 0.012) and having 2 or 3 vessels CAD (p = 0.046). Cox proportional hazards regression model showed that patients with the DD genotype had a 1.5 increased risk of having an unfavorable outcome when compared with No-DD genotype patients (RR 1.561, 95% CI 1.048-2.326, p = 0.028) and that patients with the ACE DD genotype plus the AT1R No-AA genotype, the GPIIIa No-a1a1 genotype or a combination of both, had a twice higher risk than any other genotype of MACE in the follow-up (RR 1.978, 95% CI 1.286-3.043, p = 0.002). CONCLUSIONS: Patients with the ACE DD genotype plus 1 or 2 unfavorable genotypes, the AT1R No-AA, the GPIIIa No-a1a1 or a combination of both, have twice higher the risk of MACE during their clinical follow-up.

Subclinical hypothyroidism in grown-up congenital heart disease patients.

Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.

Androgenic anabolic steroid, cocaine and amphetamine abuse and adverse cardiovascular effects.

INTRODUCTION: Anabolic-androgenic steroids (AAS), a synthetic derivate of testosterone, have become a popular drug among athletes and bodybuilders to enhance muscle mass and improve the athletic performance. Many pathological effects such as hepatic and endocrine dysfunction, behavioural changes and cardiovascular complications have been reported. CASE REPORT: Within these ast ones, we find an increase in left ventricular muscle mass, concentric myocardial hypertrophy, left ventricular diastolic dysfunction, arterial hypertension, prothrombotic effects, changes in the concentration of cholesterol levels, particularly a reduction in HDL cholesterol concentration, myocardial infarctions in relation to endothelial dysfunction, vasospasms or thrombosis and sudden cardiac death. DISCUSSION: We report the case of a 32-year-old patient with a history of arterial hypertension, depressive syndrome and consumption of cocaine, amphetamines and AAS who developed severe left ventricular systolic dysfunction and myocardial hypertrophy with signs of heart failure and peripheral arterial embolism.

Efecto de los ácidos grasos omega-3 en la evolución clínica, biomarcadores inflamatorios y el péptido natriurético cerebral de pacientes con cardiopatía isquémica / Effect of omega-3 acids on clinical evolution, plasma inflammatory biomarkers and B-type natriuretic peptide levels in patients with coronary heart disease

Background and objective: The consumption of fish has been associated with aminor risk of cardiovascular mortality. Patients and methods: Thirty-one patients with clinical and angiographic evidence of coronary illness and no data of heart failure were followed up. One gram per day of omega-3-acid ethyl esters was added to their usual cardiologic treatment. Demographic, clinical and analytical data (lipid, ESR, CRP, lipoprotein[a], fibrinogen, and BNP levels) were evaluated at the beginning and at 9 months. Results: Six patients had cardiologic events in the follow up although none presented acute coronary syndrome. Significant differences were seen in HDL cholesterol (mg/dL) (38,5[9,6] vs. 42,1 (11,0), p = 0,000), hemoglobin (g/dL) (13,2 [1,7] vs. 13,9 (1,7), p = 0,009) and pro-BNP (pg/dL) (745,5 [1,035,7] vs. 235,8 [194,0], p = 0,008) levels. No significant differences existed either in the inflammatory parameters or in total cholesterol, LDL cholesterol and triglycerides Conclusion: One gram day of omega-3-acid ethyl esters added to the usual cardiologic treatment in patients with coronary heart disease improves pro BNP levels of patients with preserved left ventricular function without modifying serum inflammatory parameters (AU)

Fundamento y objetivo: El consumo de pescado se ha asociado a un menor riesgo de mortalidad cardiovascular. Pacientes y método: Se siguió a un total de 31 pacientes con evidencia clínica y angiográfica de enfermedad coronaria sin datos de insuficiencia cardiaca. Se añadió al tratamiento habitual un gramo al día de ésteres etílicos de ácidos grasos omega-3 al 90%. Se determinaron parámetros demográficos, clínicos y analíticos (lipidograma, velocidad de sedimentación globular [VSG], proteína C reactiva [PCR], fibrinógeno, lipoproteína [a] y propéptido natriurético cerebral [proBNP]) al inicio y a los 9 meses.Resultados: Seis pacientes presentaron eventos cardiológicos en el seguimiento, aunque ninguno presentó síndrome coronario agudo. De los parámetros analíticos estudiados existieron diferencias significativas, entre el inicio y el final del seguimiento, en las cifras de colesterol unido a lipoproteínas de alta densidad (colesterol HDL, media [DE] de 38,5 [9,6] frente a 42,1 [11,0] mg/dL, p=0,000), hemoglobina (media de 13,2 [1,7] frente a 13,9 [1,7] g/dL, p=0,009) y pro-BNP (media de 745,5 [1.035,7] frente a 235,8 [194,0] pg/dL, p=0,008). No existieron diferencias significativas en los parámetros inflamatorios ni en los valores de colesterol total, colesterol unido a lipoproteínas de baja densidad (colesterol LDL) ni triglicéridos.Conclusión: Un gramo al día de ácidos grasos omega-3 contribuye a una mejoría en los valores de pro-BNP en pacientes con cardiopatía isquémica y función ventricular izquierda global conservada, sin modificar los parámetros inflamatorios (AU)

[Effect of omega-3 acids on clinical evolution, plasma inflammatory biomarkers and B-type natriuretic peptide levels in patients with coronary heart disease]. / Efecto de los ácidos grasos omega-3 en la evolución clínica, biomarcadores inflamatorios y el péptido natriurético cerebral de pacientes con cardiopatía isquémica.

BACKGROUND AND OBJECTIVE: The consumption of fish has been associated with a minor risk of cardiovascular mortality. PATIENTS AND METHODS: Thirty-one patients with clinical and angiographic evidence of coronary illness and no data of heart failure were followed up. One gram per day of omega-3-acid ethyl esters was added to their usual cardiologic treatment. Demographic, clinical and analytical data (lipid, ESR, CRP, lipoprotein[a], fibrinogen, and BNP levels) were evaluated at the beginning and at 9 months. RESULTS: Six patients had cardiologic events in the follow up although none presented acute coronary syndrome. Significant differences were seen in HDL cholesterol (mg/dL) (38,5[9,6] vs. 42,1 (11,0), p=0,000), hemoglobin (g/dL) (13,2 [1,7] vs. 13,9 (1,7), p=0,009) and pro-BNP (pg/dL) (745,5 [1,035,7] vs. 235,8 [194,0], p=0,008) levels. No significant differences existed either in the inflammatory parameters or in total cholesterol, LDL cholesterol and triglycerides. CONCLUSION: One gram day of omega-3-acid ethyl esters added to the usual cardiologic treatment in patients with coronary heart disease improves pro BNP levels of patients with preserved left ventricular function without modifying serum inflammatory parameters.

Pulmonary artery aneurysmal dilatation in adult patients with congenital heart disease.

BACKGROUND: Aneurysmal dilatation of the main pulmonary artery and its peripheral branches are rare lesions that account for less than 1% of all thoracic aneurysms and have a number of possible pathogenetic causes such as congenital heart disease (CHD), pulmonary artery hypertension, vasculitis, mycotic aneurysm, neoplasm, iatrogenic causes, trauma-related events, or connective tissue abnormalities. METHODS: We conducted a retrospective review of the demographic data and the results of clinical examinations, laboratory tests, echocardiography, and angiography of patients managed at the Adult Congenital Heart Disease Unit of the Complejo Hospitalario Universitario Insular-Materno Infantil, between January 2004 and May 2010. RESULTS: A total of 352 adult patients with CHD were studied. Of these, 8 (2.3%) patients had pulmonary artery aneurysmal dilatation (PAAD): 4 with low pressure of the pulmonary artery and 4 with pulmonary hypertension. Only 1 patient showed PAAD-related symptoms. Patients with CHD having PAAD had significantly higher prevalence of pulmonary artery hypertension and higher levels of C-reactive protein (CRP) than those without PAAD (incidence: 4 patients [50%] vs 18 patients [5.2%], P < .000; CRP in mg/dL: 0.52 [0.4; 1.2] vs 0.2 [0.0; 1.6], P = .016). No significant differences were found in cholesterol levels (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], or triglycerides) between CHD patients with or without PAAD. CONCLUSION: In patients with CHD, PAAD is a rare finding. The PAAD size, etiology, symptoms, and association with pulmonary hypertension should guide decisions on whether conservative or surgical treatment should be applied.

Clinical outcome in Down syndrome patients with congenital heart disease.

BACKGROUND: Long-term complications of Down syndrome patients with congenital heart disease are poorly known. METHODS: We carried out a retrospective study of Down syndrome patients with congenital heart disease and patients with atrioventricular septal defect with and without Down syndrome. RESULTS: Between 2004 and 2008, 317 patients with congenital heart disease were followed-up in the Adult Congenital Heart Disease Unit. Of these patients, 19 (6%) with a mean age of 26.8 +/- 8.1 years had Down syndrome. Atrioventricular septal defect was the most frequent congenital heart disease(63%) followed by ventricular septal defect (26%). Ten patients (53%) were operated on during childhood. Three of these patients required reoperation during adulthood (two patients due to left ventricle outflow tract obstruction and one patient due to left atrioventricular valve insufficiency). Four patients (21%) had Eisenmenger syndrome with improvement of functional class in those treated with bosentan, two patients (10.5%) had bacterial endocarditis and two patients (10.5%) died. No significant differences were seen in left atrioventricular valve insufficiency between atrioventricular septal defect in patients with and without Down syndrome (1.5 +/- 0.9 vs. 1.7 +/- 0.8, p = 0.689). CONCLUSIONS: Left atrioventricular valve insufficiency and left ventricle outflow tract obstruction were the most frequent long-term complications requiring surgical reintervention in patients with atrioventricular septal defect.

Evolución clínica en pacientes con síndrome de Down y cardiopatía congénita / Clinical outcome in Down syndrome patients with congenital heart disease

Introducción: La evolución a largo plazo de pacientes con síndrome de Down y cardiopatía congénita es poco conocida. Material y métodos: Estudio retrospectivo de pacientes con síndrome de Down y cardiopatía congénita y pacientes con defecto del tabique auriculoventricular y sin trisomía 21. Resultados: Entre 2004 y 2008 se hizo seguimiento a 317 pacientes con cardiopatía congénita; 19 pacientes (6%) con edad media de 26.8 ± 8.1 años tenían síndrome de Down. Las cardiopatías congénitas más frecuentes fueron el defecto del tabique auriculoventricular (63%) y la comunicación interventricular (26%); 10 (53%) habían sido intervenidos quirúrgicamente en la infancia, tres de ellos con defecto auriculoventricular completo requirieron reintervención en la edad adulta (dos por obstrucción al tracto de salida del ventrículo izquierdo y uno por insuficiencia severa de la válvula auriculoventricular izquierda); cuatro (21%) desarrollaron hipertensión arterial pulmonar, con mejoría del grado funcional al recibir tratamiento con bosentan; dos (10.5%) tuvieron endocarditis bacteriana; dos (10.5%) fallecieron. No existieron diferencias en el grado de insuficiencia de la válvula auriculoventricular izquierda (1.5 ± 0.9 versus 1.7 ± 0.8, p = 0.689) entre pacientes con defecto auriculoventricular con y sin síndrome de Down. Conclusiones: La insuficiencia de la válvula auriculoventricular izquierda y la obstrucción al tracto de salida del ventrículo izquierdo fueron las causas más frecuentes de reintervención en la edad adulta en pacientes con defectos del tabique auriculoventricular.

BACKGROUND: Long-term complications of Down syndrome patients with congenital heart disease are poorly known. METHODS: We carried out a retrospective study of Down syndrome patients with congenital heart disease and patients with atrioventricular septal defect with and without Down syndrome. RESULTS: Between 2004 and 2008, 317 patients with congenital heart disease were followed-up in the Adult Congenital Heart Disease Unit. Of these patients, 19 (6%) with a mean age of 26.8 +/- 8.1 years had Down syndrome. Atrioventricular septal defect was the most frequent congenital heart disease(63%) followed by ventricular septal defect (26%). Ten patients (53%) were operated on during childhood. Three of these patients required reoperation during adulthood (two patients due to left ventricle outflow tract obstruction and one patient due to left atrioventricular valve insufficiency). Four patients (21%) had Eisenmenger syndrome with improvement of functional class in those treated with bosentan, two patients (10.5%) had bacterial endocarditis and two patients (10.5%) died. No significant differences were seen in left atrioventricular valve insufficiency between atrioventricular septal defect in patients with and without Down syndrome (1.5 +/- 0.9 vs. 1.7 +/- 0.8, p = 0.689). CONCLUSIONS: Left atrioventricular valve insufficiency and left ventricle outflow tract obstruction were the most frequent long-term complications requiring surgical reintervention in patients with atrioventricular septal defect.

Serum glucose and lipid levels in adult congenital heart disease patients.

Atherosclerosis has been correlated with known cardiovascular risk factors such as serum glucose or lipid levels. Because congenital heart disease patients tend to survive until adulthood, atherosclerosis has also become a matter of concern in these patients. One hundred fifty-eight congenital heart disease patients and 152 patients selected at random from the population were studied and compared to determine serum glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, and triglycerides levels. Both groups had similar socioeconomic status levels and the same environmental influences. Significant differences were seen between congenital heart disease patients and the control group, after sex, age, and body mass index adjustment, in fasting plasma glucose (97.7 [94.2-101.2] vs 86.9 [83.2-90.7], P < .001), total cholesterol (171.5 [165.7-177.3] vs 199.8 [90.7-206.0], P < .001), LDL cholesterol (103.9 [98.8-108.8] vs 123.8 [118.5-129.1], P < .001), and high-density lipoprotein cholesterol (48.1 [46.2-50.0] vs 54.2 [52.1-56.2], P < .001) levels. Nonsignificant differences were seen in triglycerides concentrations. Those patients with ventricular septal defect, coarctation of the aorta, and cyanosis had the lowest total cholesterol and LDL cholesterol concentrations. Congenital heart disease patients have lower plasma cholesterol concentrations and higher serum glucose levels than noncongenital ones.

Biomarcadores en los síndromes coronarios agudos con y sin elevación del ST / Biomarkers in acute coronary syndromes with and without ST elevation

Introducción y objetivos. En el síndrome coronario agudo se produce un fenómeno inflamatorio con alteración de diversos marcadores analíticos. Su conocimiento podría ayudarnos a estratificar mejor el riesgo y a elegir el tratamiento más adecuado. Métodos. Se estudió a 151 pacientes consecutivos ingresados con síndrome coronario agudo sin elevación del ST (SCASEST) y síndrome coronario agudo con elevación del ST (SCACEST). Se determinaron los factores de riesgo cardiovascular clásicos (diabetes mellitus, hipertensión arterial, hipercolesterolemia, antecedentes familiares y personales de cardiopatía isquémica y tabaquismo) y diversos marcadores analíticos entre los que se incluyeron la insulinemia, el fibrinógeno, la proteína C reactiva, la lipoproteína (a) y la velocidad de sedimentación globular. Resultados. Del total de pacientes, 88 (58,3%) presentaron SCASEST y 63 (41,7%), SCACEST. Los pacientes con SCASEST tuvieron de forma significativa una incidencia mayor de diabetes mellitus y de antecedentes personales de cardiopatía isquémica que los que presentaron SCACEST. En los pacientes con SCACEST se obtuvieron de forma significativa cifras más elevadas de fibrinógeno, proteína C reactiva, transaminasa glutamicoxalacética y transaminasa glutámico pirúvica. El análisis multivariante mostró que la diabetes mellitus y los antecedentes personales eran más frecuentes en pacientes con SCASEST, mientras que los valores de fibrinógeno eran más elevados en pacientes con SCACEST. Conclusiones. Los pacientes diabéticos y con antecedentes personales de cardiopatía isquémica presentaron SCASEST de forma más frecuente. De los parámetros estudiados, el fibrinógeno se encontró de forma significativa más elevado en los pacientes con SCACEST (AU)

Introduction and objectives. Acute coronary syndrome involves an inflammatory process which has several analytical markers. Knowledge of those could help us improve the risk classification and choose the most appropriate treatment. Methods. A total of 151 consecutive patients with STE-ACS and NSTE-ACS (ST elevated and non-ST elevated acute coronary syndrome) were studied. The classic cardiovascular risk factors (diabetes mellitus, high blood pressure, family and personal history and smoking habits) were determined along with several analytical markers, among which were included insulin, fibrinogen, C-reactive protein, Lp(a) and erythrocyte sedimentation rate. Results. Of the total pateints, 88 (58.3%) had NSTE-ACS and 63 (41.7%) with STE-ACS . Patients with NSTE-ACS had a significantly higher incidence of diabetes mellitus and personal history of ischaemic heart disease than those who had a STE-ACS. Significantly higher levels of fibrinogen, C-reactive protein, GoT and GPT were obtained in patients with STE-ACS. The multivariate analysis showed that diabetes mellitus and a personal history were more frequent in NSTE-ACS, while fibrinogen levels were higher in those who had STE-ACS. Conclusions. NSTE-ACS is more frequent in patients with diabetes and those with a personal history of ischaemic heart disease. Of the parameters studied, fibrinogen was found to be significantly higher in patients with STE-ACS (AU)

Serum and 24-hour urine analysis in adult cyanotic and noncyanotic congenital heart disease patients.

INTRODUCTION: Glomerulopathy is a complication of congenital heart disease patients. The risk of developing renal impairment is particularly high in cyanotic patients. OBJECTIVE: The aim of this study was to determine the prevalence of renal dysfunction and microalbumiuria in adult cyanotic and non cyanotic congenital heart disease patients. METHODS: Fourteen cyanotic and 22 noncyanotic congenital heart disease patients were studied in the Adult Congenital Heart Disease Unit at the Complejo Hospitalario Universitario Insular-Materno Infantil. Demographic characteristics, complete blood count, and 24-hour urianalysis were obtained, including abdominal ultrasound in those with cyanosis. RESULTS: No differences were seen between age (years) (27.4 +/- 8.2; 26.4 +/- 8.3; P = .71), sex, size, weight, or glomerular filtration rate (mL/min/1.73 m(2)) (81.1 +/- 22.9 vs. 84.9 +/- 9.2, P = .482) between cyanotic and noncyanotic patients. However, Eisenmenger patients had significantly impaired renal function when compared with noncyanotic patients (73.0 +/- 17.3 vs. 84.9 +/- 9.2 mL/min/1.73 m(2), P = .023). Significant differences were obtained in oxygen saturation (%) (83.8 +/- 5.8 vs. 97.8 +/- 0.8; P = .000), hematocrit (%) (59.3 +/- 8.1 vs. 40.9 +/- 8.5; P = .000), platelets (10(3)/microL) (161.5 +/- 70.5 vs. 277.9 +/- 57.6; P = .000), serum uric acid (mg/dL) (7.5 +/- 2.3 vs. 5.6 +/- 1.5; P = .008) and microalbuminuria (mg/24 hours) (12.8 [0, 700.2] vs. 2.4 [0, 18.9]; P = .000) between cyanotic and noncyanotic patients. Five cyanotic patients (35.7%) had microalbuminuria (>30 mg/24 hours) and three of them (21.4%) proteinuria (>1 g/24 hours). No significant differences were seen between serum and urine parameters between cyanotic patients who had microalbuminuria (>30 mg/24 hours) and those cyanotic patients who did not have it (<30 mg/24 hours). CONCLUSIONS: Renal impairment is frequently seen in congenital heart disease patients, being associated occasionally with proteinuria and microalbuminuria in cyanotic ones.

Utilidad del consejo escrito cardiológico en el paciente con síndrome coronario agudo / Usefulness of cardiological written advice in patients with acute coronary syndrome

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[Valvular heart disease associated with ergotamine]. / Valvulopatía por uso de ergotamina.

Ergotamine is used to abort or prevent migraine. The most common adverse reactions are nausea, vomiting, myalgia, diarrhea or mouth dryness, and the contraindications are peripheral vascular disease because of its vasospastic effect, and liver disease because the drug is metabolized in this organ. Its effects on the heart are less frequent and less well known. We report two patients on long-term ergotamine treatment who developed valvular disorders.

Valvulopatía por uso de ergotamina / Valvular heart disease associated with ergotamine

La ergotamina se usa para tratar o prevenir migrañas. Las reacciones adversas más comunes son náuseas, vómitos, mialgias, diarreas o xerostomía; su uso está contraindicado en la enfermedad vascular periférica por la producción de vasoespasmos o en enfermedades hepáticas por su metabolización en esta localización. La afección cardíaca es mucho menos frecuente y conocida. Describimos los casos de 2 pacientes con uso crónico de ergotamina con repercusión valvular cardíaca

Ergotamine is used to abort or prevent migraine. The most common adverse reactions are nausea, vomiting, myalgia, diarrhea or mouth dryness, and the contraindications are peripheral vascular disease because of its vasospastic effect, and liver disease because the drug is metabolized in this organ. Its effects on the heart are less frequent and less well known. We report two patients on long-term ergotamine treatment who developed valvular disorders