[Urinary levels of B-type natriuretic peptide (BNP) and ventricular systolic dysfunction in heart failure patients]. / Niveles urinarios de péptido natriurético tipo B (BNP) y disfunción ventricular sistólica en pacientes con insuficiencia cardiaca.

BACKGROUND: It was aimed to compare urine B-type natriuretic peptide (BNP) according to left ventricular systolic dysfunction and to investigate its diagnostic value in heart failure (HF) patients. MATERIAL AND METHODS: A total of 90 HF outpatients (61 men, age 66 +/- 12) and 30 age- and gender-matched controls were studied. RESULTS: An increase in urine BNP was observed in patients with EF 40% (p < 0.0001), and controls (p < 0.0001). Significant correlations between urinary BNP and left ventricular functional parameters were obtained. A multivariate regression analysis was performed and the best model associated with urine BNP included plasma BNP (p < 0.0001), EF (p = 0.02) and LV volume indexes (p < 0.0001). The ROC for detection of EF

Analysis of heart rate turbulence in advanced heart failure and heart transplantation patients.

OBJECTIVE: The objective of this study was to describe heart rate turbulence (HRT) in advanced heart failure (HF) patients and in a group of patients who underwent heart transplantation (HT). MATERIALS AND METHODS: We performed 24-hour Holter recordings in 20 patients with advanced HF referred to our hospital for HT, including 16 males of overall mean age of 44 +/- 13 years and with a mean ejection fraction (EF) 21 +/- 7%. An additional set of recordings was obtained in a second group of 27 patients who had already undergone HT, including of 21 males of overall mean age of 47 +/- 14 years. We recorded the number of premature ventricular contractions (PVCs), mean heart rate (MHR), and 2 parameters of HRT-turbulence onset (TO) and turbulence slope (TS). RESULTS: Patients with HT showed a low density of premature ventricular complexes, in contrast to patients in the advanced HF group. For this reason, HRT could only be analyzed in 15 of the patients with advanced HF (66%) and in 10 of the patients who underwent HT (37%). MHR was 77 +/- 10 bpm in the advanced HF group and 90 +/- 10 bpm in the HT group. In both groups, TO and TS showed highly attenuated values. CONCLUSIONS: Patients with advanced HF showed a high number of PVCs with attenuated HRT parameters, reflecting increased circulating catecholamine levels and decreased response of the autonomic nervous system. Patients who underwent HT showed elevated MHRs, a small number of PVCs, and attenuated HRT values, as corresponds to a denervated heart.

[Doppler ultrasonography diagnosis of right ventricular outflow tract obstruction caused by mediastinal tumor and its reversibility after treatment]. / Diagnóstico por ecocardiografía-Doppler de obstrucción al tracto de salida del ventrículo derecho por tumor mediastínico y su reversibilidad después del tratamiento.

Doppler-echocardiography has proved useful in the assessment of mediastinal masses. We present the case of a young man with fever and new systolic murmur. Echocardiographic examination revealed a paracardiac mass compressing the right ventricular outflow tract and Doppler flow study detected marked acceleration in luminal narrowing. Complete remission of the tumour was obtained with subtotal resection and chemotherapy. Histological diagnosis was of embryonary carcinoma with areas of endodermic sinus. A new Doppler-echocardiography study showed disappearance of both the mass and the compression and showed normal right ventricular outflow tract flow.

[Cor triatriatum in the adult. Its diagnosis by Doppler echocardiography]. / Cor triatriatum en el adulto. Diagnóstico por ecocardiografía-Doppler.

We present an adult with echocardiographic diagnosis of cor triatriatum. Continuous wave Doppler echocardiography was able to assess correctly the severity of the left ventricular inflow obstruction caused by the intra-atrial membrane. Even though the diagnosis was confirmed by catheterization, the surgical decision was based in noninvasive data. Postoperative Doppler echocardiography proved the disappearance of the intra-atrial obstruction. The anatomical information obtained by echocardiography as well as the assessment of the intra-atrial obstruction by cardiac Doppler seem to be sufficient to make surgical decisions in patients suffering from this disease. Both are also suitable to test the result of the surgical intervention.

[Dysphagia of vascular origin]. / Disfagia de origen vascular.

Three adult patients presented with dysphagia due to vascular compression of the esophagus. In one case, a dysphagia aortica was diagnosed. In the remaining two cases a congenital vascular anomaly--aberrant right subclavian artery and right aortic arc, respectively--was proved by arteriography. The final diagnosis was suspected after the barium meal and confirmed by computarized tomography in each case.

[Hemodynamic benefits of AV interval adjustment and heart rate increase during exercise in dual-chamber pacing as determined by Doppler]. / Determinación por técnica de Doppler de la importancia hemodinámica del ajuste de sincronía auriculoventricular y del incremento de la frecuencia cardíaca durante el ejercicio en la estimulación bicameral.

In order to determine the relative significance of ventricular rate increase and AV delay on exercise cardiac output, we have studied 10 patients (8 male and 2 female, 16-59 years) with complete chronic heart block treated with AV sequential pacing. Cardiac output variations (delta CO) were estimated by pulsed Doppler comparisons of the aortic flow velocity in the supine position, at rest and during bicycle exercise. The following pacing programs were tested: DDD with AV intervals of 50, 100 and 150 ms (DDD50 o DDDD100, DDD150), VVI at 70 ppm (VVI70), and VVI at the maximal available rate in this pacing mode-113 or 130 ppm depending on the PM type (VVIM). Exercise measurements in DDD mode were taken when that rate was reached. The delta CO was calculated as a percent change of the product flow velocity integral x heart rate, from that obtained with VVI70 mode at rest. At rest, the delta CO obtained with DDD pacing was 20.4 +/- 14.7% and the optimal AV delay was 50 ms in 1 patient, 100 ms in 3 patients and 150 ms in six. During exercise, the delta CO was higher in DDD and VVIM modes (82.0 +/- 30.8% and 56.2 +/- 37.6%, respectively; p less than 0.01) than in VVI70 mode (20.4 +/- 10.4%; p less than 0.005), the greatest delta CO was reached at DDD mode in 8 out of 10 patients (p less than 0.03). The optimal AV delays were 50 ms in 5 patients, 100 ms in 4 patients and 150 ms in one. Thus, DDD pacing with the optimal AV delay seems to obtain greater haemodynamic benefits during exercise than does rate-responsive pacing; the optimal exercise AV delay varies from patient to patient and is usually less than 150 ms.