Compromiso cardiovascular en pacientes recuperados de COVID-19: ¿realidad o fantasía? / Cardiovascular Involvement in Patients Recovered from COVID-19: Reality or Fantasy?

RESUMEN Introducción: Se ha descrito que la infección por COVID-19 se asocia a complicaciones cardiovasculares en pacientes hospitalizados en 7-28%de los casos, con diagnóstico basado en elevación de biomarcadores. La afección cardiaca subclínica post COVID-19 en pacientes ambulatorios representa una preocupación creciente, así como las secuelas cardiovasculares a mediano y largo plazo. El objetivo del presente trabajo fue determinar la utilidad de la detección de compromiso cardiovascular en pacientes post COVID-19 ambulatorios, y su asociación con síntomas y factores de riesgo. Material y métodos: Se incluyeron 668 pacientes de manera prospectiva, >18 años entre septiembre de 2020 y marzo de 2021. Debían tener polimerasa de transcriptasa inversa (PCR) positiva en una muestra del tracto respiratorio positiva para COVID-19, y se les realizó evaluación con examen físico, electrocardiograma (ECG) y eco Doppler cardíaco. A quienes presentaban síntomas de riesgo o anomalías en el ECG o el eco Doppler, se les solicitó resonancia cardíaca (RMC) con contraste endovenoso. Resultados: La edad media fue de 42,9 ± 14,9 años; el 56,9% fueron mujeres. El 12,9% eran hipertensos, el 4,3% diabéticos y el 6,9% obesos. El 57,6% no tenía factores de riesgo cardiovascular y solo el 4,2% contaba con antecedentes cardiovasculares. El 73,2% presentó enfermedad leve, un 16,3% requirió internación y el 1,05% asistencia ventilatoria mecánica. Solo 5 pacientes tuvieron diagnóstico por RMC de miocarditis, y tanto el derrame pericárdico como la presencia de trastornos de la repolarización se asociaron significativamente con la misma (p <0,0001). Conclusiones: La presencia de alteraciones en el ECG o el eco Doppler cardíaco en nuestra cohorte fue infrecuente. Se diagnosticaron 5 casos de miocarditis viral con clínica compatible y confirmación por RMC.

ABSTRACT Introduction: COVID-19 infection has been associated with cardiovascular complications in 7-28% of hospitalized patients, with the diagnosis based on biomarkers elevation. Subclinical cardiac involvement in outpatients recovered from COVID-19 represents a growing concern, as well as mid- or long-term cardiovascular effects. Objective: The aim of the present study was to determine the usefulness of detecting cardiovascular involvement in outpatients recovered from COVID-19, and its association with symptoms and risk factors. Methods: Between September 2020 and March 2021, 668 patients >18 years were prospectively included. All the patients had to have COVID-19 confirmed diagnosis by a positive reverse transcription-polymerase chain reaction (RT-PCR) test in a respiratory tract sample COVID-19. They were evaluated with physical examination, electrocardiogram (ECG) and Doppler echocardiography. Patients with symptoms suggestive of risk or abnormal findings on ECG or echocardiogram underwent cardiac magnetic resonance imaging (CMRI) with gadolinium-based contrast agent. Results: Mean age was 42.9 ± 14.9 years and 56.9% were women; 12.9% were hypertensive, 4.3% were diabetic and 6.9% obese. Overall, 57.6% had no cardiovascular risk factors and only 4.2% had a history of cardiovascular disease. The disease was mild in 73.2%; 16.3% required hospitalization and 1.05% needed mechanical ventilation. Only 5 patients had myocarditis diagnosed by CMRI, and both pericardial effusion and abnormal repolarization were significantly associated with myocarditis (p < 0.0001). Conclusions: Abnormal ECG or echocardiographic findings were uncommon in our cohort. The diagnosis of viral myocarditis was made in 5 cases with clinical signs and symptoms, and was confirmed by CMRI.

Estimación del riesgo en cirugía cardíaca en el "mundo real": ArgenSCORE ajustado al centro / Cardiovascular Surgery Risk Assessment in the "Real World": ArgenSCORE Adjusted by Center

RESUMEN Introducción: El ArgenSCORE tiene una versión original (I) desarrollada en 1999 sobre una población con mortalidad del 8% y una versión II (recalibración del modelo en 2007) sobre una población con una mortalidad del 4%. Evaluamos en el registro CONAREC XVI la hipótesis de que el ArgenSCORE II podría estimar mejor el riesgo de mortalidad intrahospitalaria en los centros con baja mortalidad; en cambio, el ArgenSCORE I estimaría mejor la mortalidad en los centros con alta mortalidad. Material y métodos: Se analizaron 2548 pacientes de 44 centros del registro prospectivo y multicéntrico en cirugía cardíaca, CONAREC XVI. En cada centro se evaluó la mortalidad media observada (MO) y se calculó la mortalidad estimada media (ME) aplicando ambas versiones del ArgenSCORE. Se calculó la relación MO/ME de cada centro para los dos modelos y se evaluó si había diferencias significativas mediante el test Z. Resultados: La mortalidad intrahospitalaria del registro fue del 7,69%. El 75% de los centros (33/44) presentaban una mortalidad mayor del 6%. En centros con mortalidad menor del 6%, al aplicar el ArgenSCORE II, la relación MO/ME mostró valores cercanos a 1 y sin diferencias significativas. En centros con mortalidad mayor del 6%, el ArgenSCORE II subestima significativamente el riesgo. En cambio, cuando se aplica en estos centros el ArgenSCORE I, la relación MO/ME es cercana a 1 (sin diferencias significativas). Conclusiones: En centros con mortalidad menor del 6%, es recomendable utilizar el ArgenSCORE II-recalibrado; en centros con mortalidad mayor del 6%, tiene mejor desempeño el ArgenSCORE I-original.

ABSTRACT Background: The ArgenSCORE I was developed in 1999 on a population with 8% mortality. The ArgenSCORE II emerged after recalibrating the original model in 2007 on a validation population with 4% mortality. Using the CONAREC XVI registry, we evaluated the hypothesis that the ArgenSCORE II could better predict the risk of in-hospital mortality in centers with low mortality, whereas the ArgenSCORE I could better predict mortality in centers with high mortality. Methods: A total of 2548 patients from 44 centers of the prospective and multicenter cardiac surgery CONAREC XVI registry, were analyzed. Mean observed mortality (OM) and mean expected mortality (EM) were estimated applying both versions of the ArgenSCORE. The OM/EM ratio was calculated in each center for both models and the Z test was used to evaluate significant differences. Results: In-hospital mortality was 7.69% for the entire registry. In 75% of the centers (33/44) mortality was >6%. In centers with mortality <6%, the OM/EM ratio was close to 1 after applying the ArgenSCORE II, without significant differences. In centers with mortality >6%, the ArgenSCORE II significantly underestimated the risk. On the contrary, when the ArgenSCORE I was applied in these centers, the OM/EM ratio was close to 1, without significant differences. Conclusions: The recalibrated ArgenSCORE II is recommended in centers with mortality <6%, while in those with mortality >6% the original ArgenSCORE I has better performance.

Atrial size and sports. A great training for a greater left atrium: how much is too much?

Athlete's heart results from physiological adaptations to the increased demands of exercise, and left atrial (LA) enlargement (LAE) is a fundamental component. However, LAE occurs in certain pathological conditions and it might represent a diagnostic challenge in athletes. LA volume index (LAVi) by echo is a convenient diagnostic tool for LAE identification. We hypothesized that accumulated lifetime training thousand hours (LTH) would have a main role in LAE. Therefore, our aim was to assess the association between LTH, LAVi and LAE in athletes. Young and middle-aged males with different training levels were included and grouped as recreational (REa, n = 30), competitive (COa, n = 169) and elite (ELa, n = 80) athletes for LTH calculation and echo assessment. LA dimensions resulted greater in ELa when compared to other groups (p < 0.001). LAVi correlated stronger with LTH than with age (p < 0.001). Polynomial regression analysis showed a non-linear, almost triphasic, effect of cumulative training on LA size (p < 0.02). Multivariate logistic regression, including LTH, age, body surface area, systolic blood pressure and other explanatory variables to predict LAE, showed LTH as the sole significant factor [OR 1.45 (CI 1.1-1.92), p < 0.008]. ROC analysis found an optimal cut off point of 3.6 LTH for LAE identification (AUC = 0.84, p < 0.001. RR = 5.65, p < 0.001). We conclude that LAE associates with LTH more than with other clinical parameters, and with less impact at higher amounts of LTH. Lifetime training greater than 3600 hours increases the probability of finding LAE in athletes. Future research should provide more insights and implications of these findings.

Papillary muscles. Dark side of the heart: A simple approach for a forgotten structure.

PURPOSE: Transthoracic echocardiography (TTE) is currently the election method for initial screening of left ventricular papillary muscles (PM). However, diagnosis of borderline PM hypertrophy with TTE is not always feasible due to cumbersome interpretation of different PM diameters and the absence of precise normal ranges in the literature. The objective of this study was to obtain TTE normal cutoff values and to describe convenient indexes of PM dimensions. METHODS: Healthy volunteers with normal electrocardiogram were included for TTE assessment. Vertical (Vd) and horizontal (Hd) PM diameters were measured to obtain maximum diameter (Md) and areas of the anterolateral PM (APM) and posteromedial PM (PPM) to obtain PM total area (PMTA). RESULTS: A total of 82 patients were screened, and 6 (7.3%) with bifid PM were excluded from analysis. APM and PPM had similar Vd (APM: 8.3 ± 1.2, PPM: 7.9 ± 1.1 mm2 , P = NS) and Hd (APM: 8.2 ± 1.3, PPM: 8.3 ± 1.2 mm2 , P = NS). Finally, Md (9 ± 1.2 mm; P95 = 11 mm) and PMTA (106.5 ± 24.2 mm2 ; P95 = 150.8 mm2 ) were obtained. Correlation between PMTA and Md was positive (P < .001), and out-of-range values for Md and PMTA were similar (2.6% vs 5.3%); there was excellent agreement between both indexes (K = 0.82). CONCLUSIONS: Maximum diameter and PMTA are convenient indexes to describe PM dimensions. However, given the high equivalence between both indexes, we propose the use of Md due to its simplicity and ease of calculation. Our findings suggest that patients with any PM diameter ≥12 mm should be considered abnormal.

Válvula aórtica bicúspide: El prolapso y la calcificación valvular aórtica son marcadores de disfunción valvular significativa y de eventos cardiovasculares mayores a 5 años / Bicuspid Aortic Valve: Prolapse and Aortic Valve Calcification are Markers of Significant Valve Dysfunction and Major Cardiovascular Events at 5 Years

RESUMEN Introducción: La válvula aórtica bicúspide (VAB) es una cardiopatía congénita que puede asociarse a complicaciones aórticas y/o valvulares. Resulta importante identificar los grupos de riesgo para realizar un estrecho seguimiento e indicar la intervención a tiempo. Este trabajo propone analizar el impacto que tienen las características clínicas y morfológicas valvulares en el desarrollo de la disfunción valvular aórtica moderada/grave (significativa) y en la incidencia de eventos cardiovasculares mayores en adultos con VAB. Material y métodos: Se seleccionaron pacientes consecutivos con diagnóstico de VAB no sindromática (2010-2019) en seguimiento en el ICSI. Se recabó información clínica y ecocardiográfica de manera prospectiva. Se realizó análisis uni y multivariado para identificar las características clínicas y morfológicas predictoras de disfunción valvular significativa y de eventos cardiovasculares mayores (muerte, cirugía, síndrome aórtico). Una p menor a 0,05 fue considerada significativa. Resultados: Se siguieron 300 pacientes (44.3 ± 15.3 años, 71% varones). La mayoría con VAB tipo I y con presencia de rafe (79,6% y 77%, respectivamente). La edad media de diagnóstico fue de 36.3 ±16.2 años. Hubo 84 pacientes (31,2%) que presentaban disfunción valvular aórtica significativa al momento del inicio del estudio. Con un seguimiento de 4.9 ± 1.7 años, 23 pacientes requirieron cirugía cardíaca (7,7%) y 3 fallecieron (1%). Al final del seguimiento 101 pacientes (33,6%) presentaban disfunción valvular aórtica significativa. La presencia de al menos uno de los siguientes factores: prolapso valvular, calcificación valvular aórtica basal > 1 y edad > 50 años, se asoció a menor sobrevida libre de disfunción valvular aórtica significativa y de eventos mayores. Conclusiones: En nuestra cohorte, observamos una alta incidencia de eventos asociados a VAB. Dentro de las variables analizadas, la presencia de al menos un factor de riesgo se asoció a menor sobrevida libre de eventos mayores y disfunción significativa a 4.9 años.

ABSTRACT Background: Bicuspid aortic valve (BAV) is a congenital heart disease that can be associated with aortic and/or valve complications. It is important to identify risk groups for a closer follow up and timely intervention. Objective: The aim of this work is to analyze the impact of clinical and morphological valve characteristics in the development of moderate/severe (significant) aortic valve dysfunction and in the incidence of major cardiovascular events in adults with BAV. Methods: Consecutive patients with diagnosis of non-syndromic BAV (2010-2019) followed up at our institution were incorporated in the study. Clinical and echocardiographic information was prospectively collected. Univariate and multivariate analyses were performed to identify clinical and morphological characteristics that predict significant valve dysfunction and major cardiovascular events (death/surgery/aortic syndrome). A p value <0.05 was considered significant. Results: Three-hundred patients (44.3 ± 15.3 years, 71% men), the majority with type I BAV and presence of raphe (79.6% and 77%, respectively) were included. Mean age at diagnosis was 36.3±16.2 years, and 84 patients (31.2%) presented significant aortic valve dysfunction at the onset of the study. Twenty-three patients required cardiac surgery (7.7%) and 3 died (1%) during a follow-up of 4.9±1.7 years. At the end of the followup period, 101 (33.6%) patients had significant aortic valve dysfunction. The presence of at least 1 of the following factors: valve prolapse, baseline aortic valve calcification >1 and age >50 years were associated with lower significant aortic valve dysfunction and major cardiovascular event-free survival. Conclusions: In our cohort, we observed a high incidence of events associated with BAV. Among the variables analyzed, the presence of at least 1 risk factor was associated with lower event-free survival and significant dysfunction at 4.9 years.

Dimensiones aórticas en deportistas de elite / Aortic Diameters in Elite Athletes

RESUMEN Introducción: Algunos autores sugieren que la dilatación aórtica forma parte del corazón de atleta. Las guías recientes proponen indexar los diámetros aórticos por superficie corporal (SC). En deportistas esta variable puede aumentar solo a expensas de la masa muscular y la indexación podría subestimar las dimensiones. El objetivo del estudio fue comparar los diámetros aórticos en jugadores de rugby de elite vs controles, evaluando distintas formas de cuantificación. Material y métodos: Se cuantificó mediante ecocardiografía el diámetro aórtico máximo (AoMax) y el diámetro máximo indexado a SC (AoSC). Se calculó en forma adicional el peso ideal esperado para cada individuo y se estableció el diámetro aórtico indexado por SC esperada (AoSCe). Se definió como dilatación un AoMax mayor que 40 mm o un AoSC/AoSCe mayor que 21 mm/m². Resultados: El AoMax fue mayor en deportistas (34,9 ± 2,6 vs 32,4 ± 2,9 mm; p < 0,01). Los atletas tuvieron una SC significativamente mayor y, en este contexto, presentaron menor AoSC (15,6 ± 1,2 vs 16,2 ± 1,6 mm/m2; p = 0,02). Al realizar el cálculo del peso ideal y comparar el AoSCe, no se observaron diferencias (16,6 ± 1,3 vs 16,3 ± 1,3 mm/m2; p = 0,2). El porcentaje de pacientes con AoMax mayor que 40 mm fue similar en controles y deportistas (2,3% y 1,7%; p = NS). Ningún paciente presentó diámetros indexados en rango patológico. Conclusiones: Los deportistas presentan mayores diámetros aórticos en términos absolutos, en contexto de una mayor SC. Debido al desarrollo muscular, la indexación por SC podría subestimar las dimensiones. El cálculo del AoSCe podría ser un parámetro útil. Las dimensiones aórticas en rango patológico deben ser consideradas anormales.

ABSTRACT Background: Some authors suggest that aortic dilatation is part of the athlete's heart. The recent guidelines recommend indexing aortic diameters by body surface area (BSA). This variable can be greater in athletes due to increased muscle mass, and indexing for this parameter might underestimate the measurements. Objective: The aim of this study was to compare aortic dimensions between elite rugby athletes and controls, evaluating different methods of quantification. Methods: Maximum aortic diameter (MAD) and maximum diameter indexed by BSA (MAD-BSA) were quantified by echocardiography. The expected ideal weight was calculated for each individual and MAD was indexed by the expected body surface area (eBSA). Aortic dilatation was defined as MAD >40 mm or MAD-BSA to MAD-eBSA ratio >21 mm/m2. Results: Maximum aortic diameter was greater in athletes (34.9±2.6 mm vs.32.4±2.9 mm; p <0.01). Body surface area was significantly increased in athletes and, in this setting, MAD-BSA was lower (15.6±1.2 mm/m2 vs. 16.2±1.6 mm/m2; p=0.02). After estimating the ideal weight, MAD-eBSA was not significantly different in both populations (16.3±1.3 mm/m2 vs. 16.6±1.3 mm/m2; p=0.2) The percentage of patients with MAD >40 mm was similar in controls and athletes (2.3% vs. 1.7%, respectively; p=NS). None of the patients presented indexed diameters above the normal ranges. Conclusions: Elite rugby players present larger maximum aortic diameters in absolute values in the context of greater BSA. Due to increased muscle mass, indexing by BSA could underestimate the measurements. The MAD-eBSA ratio could be a useful parameter. Aortic diameters above reference values should be considered abnormal.

Mecanismos de la disfunción y marcadores pronósticos en la válvula aórtica bicúspide / Mechanisms of Dysfunction and Prognostic Markers in Bicuspid Aortic Valve

RESUMEN Introducción: La complicación más frecuente de la válvula aórtica bicúspide (VAB) es la disfunción valvular aórtica, pero resulta complejo predecir qué pacientes desarrollarán estenosis aórtica (EAO) o insuficiencia aórtica (IAO) significativa (moderada/grave). Objetivos: Este trabajo busca analizar la progresión y las variables asociadas con el desarrollo de EAO e IAO significativa en adultos con VAB. Material y métodos: Se incluyeron pacientes consecutivos con VAB (2009-2017), se analizó la progresión de la disfunción valvular aórtica y en el grupo sin disfunción basal se identificaron variables predictoras de IAO y EAO significativas mediante análisis uni- y multivariados. Resultados: Se incluyeron 243 pacientes (43 ± 14,9 años, 73,2% hombres). La mayoría (n = 194, 79,8%) con VAB tipo I y rafe (n = 179; 73,6%). En el ecocardiograma basal, 111 pacientes presentaban IAO leve (45,6%); 49, moderada (20,1%); y 10, grave (4,1%). La EAO basal fue menos frecuente: 20 sujetos tuvieron EAO moderada (8,2%) y 12, EAO grave (4,9%). Hubo 2 muertes y 20 cirugías valvulares (8,2%) en 4,7 ± 1,7 años de seguimiento. Los pacientes con disfunción valvular significativa basal presentaron mayor tasa de progresión y requerimiento de cirugía valvular (p < 0,0001). Hubo 39 nuevos casos (17,2%) de IAO o EAO significativas en el seguimiento. El prolapso valvular aórtico(p < 0,001) y el sexo masculino (p < 0,04) se asociaron al desarrollo de IAO significativa (p < 0,001). El score de calcificación basal se asoció con EAO significativa (p < 0,02). Conclusiones: Los pacientes con VAB y disfunción valvular aórtica significativa basal requirieron cirugía en una elevada proporción a corto plazo. Se identificaron características clínicas y morfológicas asociadas con el desarrollo de disfunción valvular aórtica significativa.

ABSTRACT Introduction: The most common complication of the bicuspid aortic valve (BAV) is aortic valve dysfunction, but it is difficult to predict which patients will develop aortic stenosis (AS) or significant aortic regurgitation (AoR) (moderate/severe). Objectives: The aim of this work was to analyze the progression and the variables associated with the development of AS and significant AoR in adults with BAV. Methods: Consecutive patients with BAV were studied between 2009 and 2017. The progression of their aortic valve dysfunction was analyzed and in the group without baseline dysfunction, significant predictors of AoR and AS were identified through univariate and multivariate analysis. Results: Two hundred and forty-three patients (mean age 43±14.9 years, 73.2% men) were included in the study. The majority (n=194, 79.8%) with type I and raphe BAV (n=179, 73.6%). In the baseline echocardiogram, 111 patients presented mild (45.6%); 49, moderate (20.1%); and 10, severe (4.1%) AoR. Baseline AS was less frequent: 20 subjects had moderate (8.2%) and 12, severe (4.9%) AS. Two patients died and 20 valve surgeries (8.2%) were performed in 4.7±1.7 follow-up years. Patients with significant baseline valve dysfunction presented a higher rate of progression requiring valve surgery (p<0.0001). There were 39 new cases (17.2%) of significant AoR or AS at follow-up. Aortic valve prolapse (p<0.001) and male sex (p<0.04) were associated with the development of significant AoR (p<0.001). Baseline calcification score was associated with significant AS (p<0.02). Conclusions: A high proportion of patients with BAV and significant baseline aortic valve dysfunction required short-term surgery. Clinical and morphological characteristics associated with the development of significant aortic valve dysfunction were identified.

Endothelial and leukocyte adhesion molecules in primary hypertriglyceridemia.

Hypertriglyceridemia is known to be associated to functional impairment of the endothelium and, consequently, to higher risk of atherosclerosis. Nevertheless, some crucial steps in the development of the atherosclerotic plaque are still unknown in primary hypertriglyceridemia. The aim of the present study was to explore the expression of soluble and leukocyte-associated cell adhesion molecules in a group of patients with primary hypertriglyceridemia, both including (n=50) and excluding (n=24) subjects with metabolic syndrome, in comparison with control normotriglyceridemic individuals (n=30). Lipid profile, CETP activity, HDL and VLDL chemical composition were evaluated. Soluble (VCAM-1, ICAM-1 and E-selectin) and leukocyte cell adhesion molecules (CD18, CD49d and CD54) were measured by enzyme-linked immunosorbent assay and flow cytometry, respectively. Patients with primary hypertriglyceridemia as compared with control subjects showed significantly higher VCAM-1 (15.6+/-4.5 ng/ml versus 13.9+/-3.8 ng/ml, respectively; p<0.05) and ICAM-1 (16.9+/-3.1 ng/ml versus 15.2+/-3.2 ng/ml, respectively; p<0.05). Regarding leukocyte cell adhesion molecules, significant increases were also detected in monocyte CD18 (398+/-180 versus 332+/-136 arbitrary units, respectively; p<0.05) and CD54 (49+/-14 versus 42+/-12 arbitrary units, respectively; p<0.05), and lymphocyte CD18 (122+/-53 versus 101+/-33 arbitrary units, respectively; p<0.05). ICAM-1 plasma levels, as well as monocyte CD18 and CD54, and lymphocyte CD18 persisted elevated even if patients with metabolic syndrome were discarded among those with hypertriglyceridemia. The increase in circulating and leukocyte cell adhesion molecules in primary hypertriglyceridemic patients would highlight the inflammatory process which is a key event in atherogenesis.

Development of mild aortic valve stenosis in a rabbit model of hypertension.

OBJECTIVES: This study was designed to investigate the association between hypertension and aortic valve stenosis (AVS) in a rabbit model. BACKGROUND: Degenerative AVS is a prevalent disease in elderly persons. Its molecular mechanisms remain unclear, in part because of the absence of experimental models. Epidemiologic data suggest a link between hypertension and AVS. However, there has been no evidence of a cause-effect relationship. METHODS: New Zealand White rabbits were divided into two groups: 1) animals (n = 20) instrumented according to one-kidney/one-clip hypertensive model; and 2) control animals (n = 10) sham operated. Echocardiography (S12 MHz) was used to assess aortic valve (AV) morphology and function as well as left ventricular mass at baseline and after two and four months of hypertension. RESULTS: Blood pressure and left ventricular mass increase were highly significant in the animal model but not in controls at two months, without noticeable AV function abnormalities. After 4 months, however, 14 hypertensive survived animals showed a 14.6% reduction of AV area (0.240 +/- 0.063 cm2 vs. 0.205 +/- 0.060 cm2, p < 0.05), a 19.6% increase of AV thickness (0.056 +/- 0.011 cm vs. 0.067 +/- 0.010 cm, p < 0.001), a 40.4% increase of transvalvular mean gradient (5.35 +/- 2.26 mm Hg vs. 7.51 +/- 3.73 mm Hg, p < 0.05) and a 63.6% increase of transvalvular maximal gradient (10.56 +/- 3.68 mm Hg vs. 17.28 +/- 10.95 mm Hg, p < 0.05). Control animals did not show significant changes. CONCLUSIONS: We report a novel experimental model of AVS in rabbits that may prove useful in studying the progression of the disease and the efficacy of new treatments. The present findings support the hypothesis of a causal link between hypertension and AVS.

Nuevo modelo experimental de Estenosis Valvular Aórtica / New experimental model of aortic valve stenosis in rabbits

Aortic valve stenosis is a chronic progressive disease, being the most common type of valvular disease in developed countries. Despite its increasing incidence, both molecular and celular mechanisms of the disorder have not been adequately determined, in part because of lack of appropriate experimental models. This study was designed to assay an experimental new model of aortic valve stenosis in hypertensive rabbits which could be useful to study the early evolution of the disease, and also to test different pharmacological treatments to prevent its progression

Nuevo modelo experimental de Estenosis Valvular Aórtica / New experimental model of aortic valve stenosis in rabbits

Aortic valve stenosis is a chronic progressive disease, being the most common type of valvular disease in developed countries. Despite its increasing incidence, both molecular and celular mechanisms of the disorder have not been adequately determined, in part because of lack of appropriate experimental models. This study was designed to assay an experimental new model of aortic valve stenosis in hypertensive rabbits which could be useful to study the early evolution of the disease, and also to test different pharmacological treatments to prevent its progression

[Predictors of hospital mortality in 186 cases of active infective endocarditis treated in a tertiary medical center (1992-2001)]. / Predictores de mortalidad hospitalaria en 186 episodios de endocarditis infecciosa activa en un centro de tercer nivel (1992-2001).

INTRODUCTION AND OBJECTIVES: The aim of this study was to describe the predictors of hospital mortality found in patients admitted for infective endocarditis (IE) to a cardiovascular surgery ward. Patients and method. Prospective study of 186 patients with IE treated in our hospital between 1992 and 2001. RESULTS: One hundred fourteen patients (61.3%) had native valve endocarditis and 72 (38.7%) had prosthetic valve endocarditis (early in 28 patients [up to 12 months after surgery] and late in 44 [later than 12 months]). Blood cultures were positive in 82%. The predominant organism was Streptococcus viridans (36%) in native valve endocarditis and Staphylococcus aureus (33%) in prosthetic valve endocarditis. The hospital mortality was 22.6%. Severe sepsis (4.8%) produced a high mortality rate (88%) and was caused by Staphylococcus aureus in 60%. One hundred nineteen patients (64%) required surgery, 79 (66.4%) of them urgently. Negative blood cultures predicted need for surgery in native valve endocarditis (p < 0.05). The surgical mortality was 21.8% and was related to NYHA III-IV class (p = 0.014) and emergency surgery (p = 0.009) in patients with native valve endocarditis. This last factor also predicted higher surgical mortality in patients with early prosthetic valve endocarditis (p < 0.001). CONCLUSIONS: The hospital mortality of this group of patients with infective endocarditis treated in a tertiary medical center was high. The presence of severe sepsis, although infrequent, had a somber prognosis. Severe heart failure in native valve endocarditis and urgent surgery in native and prosthetic valve endocarditis increased surgical mortality.