[Inflammatory state in patients with atrial fibrillation before and after electrical cardioversion]. / Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica.

OBJECTIVE: To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. DESIGN: Prospective observational case-control study. PATIENTS: We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. RESULTS: Median age was 66 +/- 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). CONCLUSIONS: There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation.

Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica / Inflammatory condition of patients with atrial fibrillation before and after electrical cardioversion

Objetivo. Evaluar el estado inflamatorio en pacientes con fibrilación auricular persistente, y analizar su influencia en el éxito de la cardioversión y la recurrencia a los 30 días. Diseño. Estudio prospectivo, observacional, de casos y controles. Pacientes. Se incluyeron 49 pacientes consecutivos con fibrilación auricular persistente remitidos a la Unidad Coronaria para cardioversión eléctrica programada. Se registraron las variables clínicas y ecocardiográficas y se determinaron PCR-ultrasensible, IL-1ß, IL-6 y FNTα. A los 30 días se reevaluaron ritmo y biomarcadores. Como grupos control se incluyeron 27 individuos sanos y 16 pacientes emparejados en edad, sexo y antecedentes de riesgo cardiovascular. Resultados. La edad media fue de 66 ± 10 años y el 38% eran mujeres. Todos los biomarcadores analizados fueron más altos en los pacientes con fibrilación auricular que en ambos grupos de control (p < 0,05). Los niveles de IL-6 y FNT-α estaban más elevados en los pacientes que no respondieron a la cardioversión, pero el éxito de la misma sólo se asoció al tamaño de la aurícula izquierda (p = 0,036). Los niveles de PCR-ultrasensible situados en el cuartil superior mostraban una tendencia a asociarse con la recurrencia de la arritmia (p = 0,06). Conclusiones. Existe un estado inflamatorio incrementado en los pacientes con fibrilación auricular persistente. Ningún biomarcador se relacionó significativamente con el éxito de la cardioversión ni con ritmo a los 30 días. Sin embargo, los niveles más elevados de PCR-ultrasensible tendían a relacionarse con la recurrencia de la arritmia

Objective. To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. Design. Prospective observational case-control study. Patients. We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. Results. Median age was 66 ± 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). Conclusions. There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation

[Role of noninvasive examinations in the management of ischemic cardiopathy. V. Noninvasive examinations in the management of patients with chronic ischemic cardiopathy]. / Papel de las exploraciones no invasivas en el manejo de la cardiopatía isquémica. V. Las exploraciones no invasivas en el manejo de los pacientes con cardiopatía isquémica crónica. Recomendaciones para su utilización.

In the last few years the has been an enormous development in noninvasive testing in the field of clinical cardiology. In fact, excellent monographs on each one of these techniques have been published elsewhere, but fewer publications exist that treat the topic of their indications and use in an integrated way, except for in the most common clinical situations. In this paper, the treatment of patients who present chest pain, stable and unstable angina is discussed, including the study of postinfarction patients. Furthermore, the role of noninvasive tests in the detection of coronary heart disease in women and in patients with left bundle branch block is thoroughly analyzed; as well as their usefulness after surgical or percutaneous coronary revascularization and in patients with peripheral vascular disease.

[Intracranial hemorrhage following second thrombolytic treatment of myocardial reinfarction]. / Hemorragia intracraneal tras un segundo tratamiento trombolítico por reinfarto de miocardio.

Intracranial hemorrhage was observed in a man, aged 66, after a second thrombolytic treatment due to myocardial reinfarction. The patient presented no potential risk factors which have often been associated to intracranial hemorrhage whereas no complications had occurred when thrombolytic therapy was given some months before because of the first infarction. This report emphasizes that a previous thrombolytic treatment with no secondary effects involves no lack of intracranial hemorrhage risk for a second thrombolysis. More research is needed in order to elucidate intracranial hemorrhage mechanisms associated to thrombolytic therapy.