GDF15 as a potential biomarker to distinguish fibrotic from non-fibrotic hypersensitivity pneumonitis.

Hypersensitivity Pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) characterized by fibrotic HP (fHP) or non-fibrotic HP (non-fHP). Fibrosis is associated with poor prognosis, emphasizing the need for biomarkers to distinguish fHP from non-fHP. This study aimed to determine the plasma levels of GDF15 in HP patients and assess its association with lung function and phenotype classification. GDF15 levels were quantified by ELISA in HP (n = 64), idiopathic pulmonary fibrosis (n = 54), and healthy control (n = 128) groups. Clinical, demographic, and functional data were obtained from medical records. High-resolution chest CT scans were used to classify HP patients into fHP and non-fHP groups. In addition, receiver operating characteristic analysis was performed to determine the cut-off point, sensitivity, and specificity. Our results revealed significantly elevated GDF15 levels in fHP compared to non-fHP (2539 ± 821 pg/ml versus 1783 ± 801 pg/ml; p = 0.009). The estimated cut-off point for plasma GDF15 levels to distinguish fHP from non-fHP was 2193.4 pg/ml (AUC 0.75). These findings suggest that GDF15 may serve as a valuable biomarker for differentiating between fHP and non-fHP, potentially indicating its involvement in lung fibrosis development in HP.

Valoración del tromboembolismo pulmonar relacionado con infección SARS-CoV-2 activa en pacientes embarazadas / Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women

Objetivo Analizar la muestra de pacientes embarazadas a las que se les realizó una gammagrafía de perfusión pulmonar para descartar la sospecha de tromboembolismo pulmonar (TEP) durante el ingreso en nuestro centro por infección aguda por COVID-19. Material y métodos A todas las pacientes (n=5) se les realizó una gammagrafía SPECT con dosis reducida (111MBq) de 99mTc-macroagregados de albúmina. Las imágenes obtenidas se interpretaron comparando los hallazgos con la imagen radiológica según criterios PISAPED. Resultados De las 5 pacientes, tan solo en una se diagnosticó TEP. En 2 pacientes los hallazgos patológicos de la gammagrafía fueron atribuibles a alteraciones radiológicas por neumonía COVID-19, y otras 2 mostraron una perfusión pulmonar normal. Conclusión Dado lo inespecífico de las manifestaciones clínicas y los valores del dímero D dentro de la COVID-19, así como su similitud con los de TEP, la gammagrafía de perfusión pulmonar, por su alta sensibilidad y menor irradiación que la TC, tiene un papel crucial en el despistaje de TEP en estas pacientes. Los resultados obtenidos son de especial relevancia, a pesar del número limitado de pacientes, dada la ausencia de publicaciones científicas en este grupo de pacientes dentro de la situación excepcional por la pandemia de COVID-19 (AU)

Aim To analyze the sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out the pulmonary embolism (PE) suspicion during the acute COVID-19 infection hospitalization period in our hospital. Material and methods SPECT scintigraphy with a reduced dose (111MBq) of 99mTc-macroaggregated albumin was performed in all of the patients (n=5). The obtained images were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. Results Only one of the 5 patients was diagnosed with PE. Two patients obtained pathological findings of the scintigraphy attributable to radiological alterations due to COVID-19 pneumonia, and the other 2 had normal pulmonary perfussion. Conclusion Given the non-specific features of the clinical manifestations and D-dimer values in COVID-19, as well as their similarity to those of PE, the pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance related to the absence of scientific publications on this group of patients within the context of COVID-19 pandemic exceptional situation (AU)

Assessment of pulmonary embolism related to active SARS-CoV-2 infection in pregnant women.

AIM: To analyze a sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out suspicion of pulmonary embolism (PE) during the acute COVID-19 infection hospitalization period in our hospital. MATERIAL AND METHODS: SPECT scintigraphy with a reduced dose (111MBq) of 99mTc-macroaggregated albumin was performed in all the patients (n=5). The images obtained were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. RESULTS: Only one of the 5 patients was diagnosed with PE. Two patients showed pathological scintigraphy findings attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfusion. CONCLUSION: Given the non-specific features of the clinical manifestations and d-dimer values ​​in COVID-19, as well as their similarity to those of PE, pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance due to the absence of scientific publications in this group of patients within the exceptional context of the COVID-19 pandemic.

Mitochondrial redox impairment and enhanced autophagy in peripheral blood mononuclear cells from type 1 diabetic patients.

Type 1 diabetes (T1D) involves critical metabolic disturbances that contribute to an increased cardiovascular risk. Leukocytes are key players in the onset of atherosclerosis due to their interaction with the endothelium. However, whether mitochondrial redox impairment, altered bioenergetics and abnormal autophagy in leukocytes contribute to T1D physiopathology is unclear. In this study we aimed to evaluate the bioenergetic and redox state of peripheral blood mononuclear cells (PBMCs) from T1D patients in comparison to those from healthy subjects, and to assess autophagy induction and leukocyte-endothelial interactions. T1D patients presented lower levels of fast-acting and total antioxidants in their blood, and their leukocytes produced higher amounts of total reactive oxygen species (ROS) and superoxide radical with respect to controls. Basal and ATP-linked respiration were similar in PBMCs from T1D and controls, but T1D PBMCs exhibited reduced spare respiratory capacity and a tendency toward decreased maximal respiration and reduced non-mitochondrial respiration, compared to controls. The autophagy markers P-AMPK, Beclin-1 and LC3-II/LC3-I were increased, while P62 and NBR1 were decreased in T1D PBMCs versus those from controls. Leukocytes from T1D patients displayed lower rolling velocity, higher rolling flux and more adhesion to the endothelium versus controls. Our findings show that T1D impairs mitochondrial function and promotes oxidative stress and autophagy in leukocytes, and suggest that these mechanisms contribute to an increased risk of atherosclerosis by augmenting leukocyte-endothelial interactions.

Cardiovascular and Respiratory Interactions in Idiopathic Pulmonary Fibrosis by Extended Partial Directed Coherence: Short-term Effects of Supplemental Oxygen.

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease that can lead to chronic arterial hypoxemia, hypercapnia, and dyspnea. To improve clinical symptoms in IPF patients, supplemental oxygen (SupplO2) has been prescribed with the aim to maintain SpO2 level, and consequently to relieve dyspnea, increase physical activity and improve quality of life. In this study, we investigated the effect of disease and short-term SupplO2 on cardiovascular and respiratory autonomic regulation. Linear and nonlinear indices were extracted from the beat-to-beat variability of heart rate (HR), systolic (SYS) blood pressure and respiration (RESP) in IPF patients and healthy subjects spontaneously breathing ambient air (AA) and during SupplO2 at 3 L/min. It was found that the effects on autonomic nervous systems (ANS) regulation were better demonstrated by the Granger causality (GC) method. GC was significantly higher (p<0.01) in patients compared to controls for the interactions RESP→SYS and BBI→SYS.Clinical Relevance-Short-term SupplO2 in IPF could adversely affect systolic blood pressure variability in particular. This study may help in the management of SupplO2 administration.

[Design of a thromboprophylaxis care process in patients with atrial fibrillation]. / Diseño del proceso asistencial de profilaxis de la tromboembolia en pacientes con fibrilación auricular.

OBJECTIVE: To describe the milestones in the anticoagulant care process of atrial fibrillation patients (AF), as well as quality and safety indicators, in order to establish an integrated care process of these patients in the Community of Madrid. METHODS: A consensus conference technique was applied, with the participation of 21 professionals (seven in the Steering Group and 14 known experts), from the specialties of Emergency, Internal Medicine, Cardiology, Neurology, Haematology, Family Medicine, Nursing, and Quality. Hospitals and Primary Care were represented. Milestones, elements and barriers/limitations were agreed upon in the care process of anticoagulated AF patients. A minimum set of indicators were also defined to assess the quality of care. RESULTS: Four milestones (stratification of thromboembolism and bleeding risk, evaluation for anticoagulant treatment, follow-up of direct-acting oral anticoagulants, and follow-up of treatment with vitamin K antagonists) were identified. A total of 14 barriers/limitations were also prioritised. In total, six indicators were defined (two structural-related, two processes-related, and two outcomes-related). CONCLUSIONS: Milestones and critical activities, together with a set of indicators, have been agreed for the development of guidelines with which to achieve a better therapeutic approach for anticoagulated AF patients.

Fetal brain MRI texture analysis identifies different microstructural patterns in adequate and small for gestational age fetuses at term.

OBJECTIVES: We tested the hypothesis whether a texture analysis (TA) algorithm applied to MRI brain images identified different patterns in small for gestational age (SGA) fetuses as compared with adequate for gestational age (AGA). STUDY DESIGN: MRI was performed on 83 SGA and 70 AGA at 37 weeks' GA. Texture features were quantified in the frontal lobe, basal ganglia, mesencephalon, cerebellum and cingulum. A classification algorithm based on discriminative models was used to correlate texture features with clinical diagnosis. RESULTS: Region of interest delineation in all areas was achieved in 61 SGA (12 vasodilated) and 52 AGA; this was the sample for TA feature extraction which allowed classifying SGA from AGA with accuracies ranging from 90.9 to 98.9% in SGA versus AGA comparison and from 93.6 to 100% in vasodilated SGA versus AGA comparison. CONCLUSIONS: This study demonstrates that TA can detect brain differences in SGA fetuses. This supports the existence of brain microstructural changes in SGA fetuses.

Genetic variants associated with severe pneumonia in A/H1N1 influenza infection.

The A/H1N1 influenza strain isolated in Mexico in 2009 caused severe pulmonary illness in a small number of exposed individuals. Our objective was to determine the influence of genetic factors on their susceptibility. We carried out a case-control association study genotyping 91 patients with confirmed severe pneumonia from A/H1N1 infection and 98 exposed but asymptomatic household contacts, using the HumanCVD BeadChip (Illumina, San Diego, CA, USA). Four risk single-nucleotide polymorphisms were significantly (p<0.0001) associated with severe pneumonia: rs1801274 (Fc fragment of immunoglobulin G, low-affinity IIA, receptor (FCGR2A) gene, chromosome 1; OR 2.68, 95% CI 1.69-4.25); rs9856661 (gene unknown, chromosome 3; OR 2.62, 95% CI 1.64-4.18); rs8070740 (RPA interacting protein (RPAIN) gene, chromosome 17; OR 2.67, 95% CI 1.63-4.39); and rs3786054 (complement component 1, q subcomponent binding protein (C1QBP) gene, chromosome 17; OR 3.13, 95% CI 1.89-5.17). All SNP associations remained significant after adjustment for sex and comorbidities. The SNPs on chromosome 17 were in linkage disequilibrium. These findings revealed that gene polymorphisms located in chromosomes 1 and 17 might influence susceptibility to development of severe pneumonia in A/H1N1 infection. Two of these SNPs are mapped within genes (FCGR2A, C1QBP) involved in the handling of immune complexes and complement activation, respectively, suggesting that these genes may confer risk due to increased activation of host immunity.

Abnormal brain microstructure and metabolism in small-for-gestational-age term fetuses with normal umbilical artery Doppler.

OBJECTIVES: To assess microstructural and metabolic brain differences between small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) fetuses at 37 weeks' gestation by magnetic resonance imaging (MRI) spectroscopy and diffusion weighted imaging. METHODS: Eight SGA and five matched AGA singleton fetuses, all with normal umbilical artery Doppler, were evaluated using MRI at 37 weeks to measure markers of brain microstructure and metabolism. The metabolic spectrum of N-acetyl-aspartate/choline, choline/creatine, inositol/choline and creatine/choline ratios in the left frontal lobe and the apparent diffusion coefficient from the right and left basal ganglia and frontal and occipital lobes, pyramidal tract and corpus callosum were analyzed and compared. RESULTS: As compared with controls, SGA fetuses showed a significant increase in inositol/choline ratio (SGA, 0.57 vs. AGA, 0.25; P = 0.04) and significantly higher ADC values in the pyramidal tract (SGA, 119.87 x 10(-5) mm(2)/s vs. AGA, 105.11 x 10(-5) mm(2)/s; P = 0.04). CONCLUSIONS: SGA fetuses with normal umbilical artery Doppler present microstructural and metabolic brain changes, suggesting the existence of an abnormal in-utero brain development in fetuses with this condition.

Resonancia magnética del ventrículo izquierdo en sujetos sanos: valores normales de morfología, función, perfusión y viabilidad / Magnetic resonance Imaging of the left ventricle in healthy subjects: normal values for morphology, function, perfusion, and viability

Objetivos: Definir unos patrones de normalidad en la cuantificación de la función, la perfusión y la viabilidad cardíaca del ventrículo izquierdo (VI) mediante resonancia magnética (RM), analizando las diferencias relevantes por edad y sexo. Material y métodos: Se analizaron 18 sujetos sanos con edad comprendida entre los 15 y los 77 años. Las adquisiciones se realizaron utilizando 2 equipos de RM de 1,5 y 3 teslas. Mediante una herramienta informática para el procesado de las imágenes (Cardio-RM, View Forum, Philips Sistemas Médicos) se evaluaron parámetros morfofuncionales (volumen telediastólico y telesistólico, volumen latido, fracción de eyección, gasto cardíaco, masa miocárdica, espesor miocárdico, engrosamiento y movimiento miocárdico), de perfusión (pendiente ascendente máxima relativa, realce máximo relativo) y de realce tardío (porcentaje de hiperrealce tardío). Para el análisis estadístico se utilizó la prueba de la t de Student. Resultados: Se observaron diferencias entre sexos, con un aumento estadísticamente significativo de los volúmenes telediastólico y telesistólico, del volumen latido y de la masa miocárdica en los varones. Las mujeres presentaron un aumento estadísticamente significativo de la fracción de eyección. Los sujetos sanos mayores de 45 años presentan diferencias estadísticamente significativas en el espesor del miocardio. Conclusión: Se describen los valores de referencia de los parámetros morfofuncionales, de perfusión y de realce tardío para los estudio de RM del corazón. El sexo y la edad tienen que tenerse en cuenta como covariables relacionadas con algunos de estos parámetros (AU)

Objective: To define normal values of MRI parameters related to cardiac morphology, function, perfusion, and delayed enhancement of the left ventricle and to analyze differences based on age and sex. Material and methods: We used 1.5T and 3T MRI scanners to analyze 18 healthy subjects ranging in age from 15 to 77 years old. Dedicated image processing software (Cardio-MR, View Forum, Philips Medical Systems) was used to evaluate morphological and functional parameters (end-diastolic and end-systolic volume, stroke volume, ejection fraction, cardiac output, wall mass, wall thickness, wall thickening, wall motion), perfusion parameters (relative maximum upslope, relative maximum enhancement), and delayed enhancement (percentage of late hyperenhancement). Student's t-test was used for statistical analyses. Results: Sex differences were observed: end-diastolic and end-systolic volumes, stroke volume, and wall mass were significantly higher in men and the ejection fraction was significantly larger in women. Healthy subjects over 45 years of age had significantly greater wall thickness. Conclusion: We report cardiac MRI reference values for morphological, functional, perfusion, and delayed enhancement parameters. Sex and age should be taken into account as important variables related to some of these parameters (AU)

[Magnetic resonance imaging of the left ventricle in healthy subjects: normal values for morphology, function, perfusion, and viability]. / Resonancia magnética del ventrículo izquierdo en sujetos sanos: valores normales de morfología, función, perfusión y viabilidad.

OBJECTIVE: To define normal values of MRI parameters related to cardiac morphology, function, perfusion, and delayed enhancement of the left ventricle and to analyze differences based on age and sex. MATERIAL AND METHODS: We used 1.5T and 3T MRI scanners to analyze 18 healthy subjects ranging in age from 15 to 77 years old. Dedicated image processing software (Cardio-MR, View Forum, Philips Medical Systems) was used to evaluate morphological and functional parameters (end-diastolic and end-systolic volume, stroke volume, ejection fraction, cardiac output, wall mass, wall thickness, wall thickening, wall motion), perfusion parameters (relative maximum upslope, relative maximum enhancement), and delayed enhancement (percentage of late hyperenhancement). Student's t-test was used for statistical analyses. RESULTS: Sex differences were observed: end-diastolic and end-systolic volumes, stroke volume, and wall mass were significantly higher in men and the ejection fraction was significantly larger in women. Healthy subjects over 45 years of age had significantly greater wall thickness. CONCLUSION: We report cardiac MRI reference values for morphological, functional, perfusion, and delayed enhancement parameters. Sex and age should be taken into account as important variables related to some of these parameters.

[MRI quantification of myocardial function, perfusion, and enhancement in patients with left-ventricular noncompaction]. / Cuantificación de la función, perfusión y realce tardío del ventrículo izquierdo no compactado mediante resonancia magnética.

OBJECTIVE: Left ventricular noncompaction is a congenital malformation characterized by a myocardium organized into two layers, one compacted and one noncompacted. We aimed to quantify myocardial function, perfusion, and delayed enhancement using MRI in patients with left-ventricular noncompaction and to compare these results with those of normal patients. MATERIAL AND METHODS: We included 12 patients with a myocardial noncompaction / compaction ratio>2.3 at end-diastole in at least one segment apart from the apex and 12 healthy subjects matched for age and sex. We calculated the end-diastolic and end-systolic volumes, stroke volume, ejection fraction, cardiac output, myocardial volume and mass, end-diastolic thickness, and left-ventricular wall thickening and motion. From the delayed enhancement images, we obtained the volume and percentage of hyperenhanced myocardium. Student's t test was used to compare groups. RESULTS: We observed a statistically significant increase in end-diastolic and end-systolic volumes in patients with left-ventricular noncompaction, as well as decreased ejection fraction, wall motion, and relative maximum upslope in segments 4, 9, and 10. No significant differences were found in delayed hyperenhancement. CONCLUSION: MRI quantification revealed decreased systolic cardiac function and decreased perfusion (lower relative maximum upslope) in the lower segments in patients with noncompaction.

Cuantificación de la función, perfusión y realce tardío del ventrículo izquierdo no compactado mediante resonancia magnética / MRI quantification of myocardial function, perfusion, and enhancement in patients with left-ventricular noncompaction

Objetivo: el ventrículo izquierdo no compactado es una alteración congénita que se caracteriza por un miocardio organizado en dos capas, no compactada y compactada. Nuestro objetivo es cuantificar mediante resonancia magnética (RM) la función, perfusión y realce tardío miocárdico en estos pacientes y compararlos con una población normal. Material y métodos: se incluyó a 12 pacientes con una ratio no compactación/compactación miocárdica > 2,3 en telediástole en, al menos, un segmento distinto del apical, y 12 sujetos sanos con edad y sexo similares. Se calcularon los volúmenes telediastólico y telesistólico, volumen latido, fracción de eyección, gasto cardíaco, volumen y masa del miocardio, espesor telediastólico, engrosamiento y movimiento miocárdico del ventrículo izquierdo. De los estudios de perfusión se obtuvieron la pendiente ascendente máxima, la pendiente ascendente máxima relativa, el tiempo al valor máximo, el realce máximo relativo y el realce acumulado por segmentos, y de las imágenes de realce tardío, el volumen y el porcentaje de miocardio con hiperrealce. Las medidas se compararon con la prueba de la t de Student. Resultados: se observó un aumento estadísticamente significativo de los volúmenes telediastólico y telesistólico en el ventrículo izquierdo no compactado, con disminución de la fracción de eyección, el movimiento miocárdico y la pendiente ascendente máxima relativa de los segmentos 4, 9 y 10. No se obtuvieron diferencias significativas en el hiperrealce tardío. Conclusión: la cuantificación con RM revela en estos pacientes una disminución de la función sistólica cardíaca y de la perfusión en segmentos inferiores (menor pendiente ascendente máxima relativa) (AU)

Objective: left ventricular noncompaction is a congenital malformation characterized by a myocardium organized into two layers, one compacted and one noncompacted. We aimed to quantify myocardial function, perfusion, and delayed enhancement using MRI in patients with left-ventricular noncompaction and to compare these results with those of normal patients. Material and methods: we included 12 patients with a myocardial noncompaction / compaction ratio > 2.3 at end-diastole in at least one segment apart from the apex and 12 healthy subjects matched for age and sex. We calculated the end-diastolic and end-systolic volumes, stroke volume, ejection fraction, cardiac output, myocardial volume and mass, end-diastolic thickness, and left-ventricular wall thickening and motion. From the delayed enhancement images, we obtained the volume and percentage of hyperenhanced myocardium. Student's t test was used to compare groups. Results: we observed a statistically significant increase in end-diastolic and end-systolic volumes in patients with left-ventricular noncompaction, as well as decreased ejection fraction, wall motion, and relative maximum upslope in segments 4, 9, and 10. No significant differences were found in delayed hyperenhancement. Conclusion: MRI quantification revealed decreased systolic cardiac function and decreased perfusion (lower relative maximum upslope) in the lower segments in patients with noncompaction (AU)

Starch-based backwards SHG for in situ MEFISTO pulse characterization in multiphoton microscopy.

We report a simple methodology to provide complete pulse characterization at the sample plane of a two-photon excited fluorescence (TPEF) microscope. This is achieved by using backward propagating second-harmonic generation (SHG) from starch granules. Without any modification to the microscope, SHG-autocorrelation traces were obtained by using a single starch granule that was placed alongside the biological specimen being imaged. A spectrally resolved SHG autocorrelation was acquired by placing a spectrometer at the output port of the microscope. Complete in situ pulse information is then directly retrieved in an analytical way using the measurement of electric filed by interferometric spectral trace observation (MEFISTO) technique.

[Antiphospholipid syndrome with myocardial infarction and aortic valve involvement]. / Síndrome antifosfolípido con infarto de miocardio y afectación valvular aórtica.

The primary antiphospholipid syndrome is a disorder which is characterized by: arterial and/or venous thrombosis, thrombocytopenia, recurrent fetal loss and high plasma levels of antiphospholipid antibodies. Valvular involvement is associated with arterial thrombosis and the most frequent manifestation is regurgitation. We report the case of a young male with primary antiphospholipid syndrome and previous cerebrovascular thrombosis hospitalized for subacute myocardial infarction. Coronary angiography revealed right and left anterior descendent coronary artery stenosis, the latter being successfully recanalized by direct percutaneous transluminal coronary angioplasty. Transthoracic echocardiography demonstrated aortic valve involvement with predominant regurgitation and transesophageal echocardiography detected valve excrescences on the aortic leaflets. Laboratory study demonstrated thrombocytopenia, prolonged activated partial thromboplastin time and high titers of anticardiolipin antibodies. Oral anticoagulation therapy was started. Thrombotic events have not recurred after three months of follow-up.

[Left to right shunt for congenital coronary arterio-venous fistulas]. / Cortocircuito izquierda-derecha por fístulas coronarias congénitas.

Congenital coronary artery fistulas are rare malformations that may evolve to pulmonary hypertension, heart failure and myocardial ischemia, although some may close spontaneously. Complications such as endocarditis, rupture, aneurysm or thrombosis may also be observed. Most patients are asymptomatic and the fistulas are usually detected by doppler echocardiography and angiography. We report the case of an asymptomatic 10-year-old male who was submitted because he of a heart murmur, and three coronary fistulas were diagnosed. Two originated in the left coronary artery draining into the right ventricle and the other origin was in the right coronary artery draining into the pulmonary artery trunk.

[Practice guidelines of the Spanish Society of Cardiology. Recommendations for the use of antithrombotic treatment in cardiology]. / Guías de actuación clínica de la Sociedad Española de Cardiología. Recomendaciones para el uso del tratamiento antitrombótico en cardiología.

The indications for the use of antithrombotic therapy are evolving as new drugs become available or new indications or dosages are recommended for drugs already in use. This document reviews and updates the former one published in 1994. To that end, an exhaustive revision of the literature published in the last 15 years has been undertaken. Following the evidence based medicine dictates, and aiming to select all the relevant publications for each pathology, all studies were selected through MEDLINE, using the specified key words for each subject, and were filtered using the following steps: a) only randomized, controlled studies, meta-analysis, guidelines and review articles were chosen; b) then, the Best-Evidence and Cochrane Collaboration databases were consulted; c) finally, the evidence based medicine validation, relevance and applicability criteria were assessed for each publication. The use of antiaggregants and anticoagulants are given for the following conditions: a) prevention of deep vein thrombosis and pulmonary embolism; b) prevention of systemic emboli in patients with lone atrial fibrillation, atrial fibrillation associated or not with rheumatic heart disease, in patients with biological or mechanical cardiac valvular prostheses and in dilated cardiomyopathy; c) antithrombotic therapy in coronary heart disease and in coronary intervention; d) the interactions with oral anticoagulants and how to control these therapies are also discussed.

[Long-term results of percutaneous mitral valvuloplasty]. / Resultados a largo plazo de la valvuloplastia mitral percutánea.

OBJECTIVES: The aim of this study was to assess the long-term results of percutaneous transvenous mitral commisurotomy in our institution, and to evaluate potential predictors of long-term event-free survival. PATIENTS AND METHODS: Between 1990 and 1996, 204 patients underwent percutaneous transvenous mitral commisurotomy with an Inoue balloon. One hundred and thirty two patients were followed for up to 9 months. Mean time of follow-up was 2.6-1.5 years (7 days-5.7 years). End points were considered mitral surgery, death and functional class III-IV. Long-term event-free survival analysis was performed to determine independent predictors of event-free survival. RESULTS: At the end of the study, 88% of patients were classified as New York Heart Association class I-II. Multivariate analysis revealed that independent predictors of major events were stiffness and thickening of the valve, presence of severe left atrial enlargement as factors pre-procedure; with suboptimal results and significant mitral regurgitation after percutaneous transvenous mitral commisurotomy. CONCLUSIONS: Percutaneous transvenous mitral commisurotomy with Inoue balloon is a safe and effective technique. Good results are maintained at long-term follow-up and the best results are obtained in patients with flexible and thin valves, with mild or moderate enlargement of left auricle and in cases with optimal results and without severe mitral regurgitation as a complication of the procedure.