[Non compaction cardiomyopathy: a series of 15 cases]. / Miocardiopatía no compactada: una serie de 15 casos.

BACKGROUND: Non compaction cardiomyopathy is a rare disorder caused by the arrest of myocardial compaction during embryogenesis, leading to a non compacted endocardial layer with marked hypertrabeculation and deep recesses. AIM: To report the clinical and echocardiographic characteristics of a series of 15 adult patients with non-compaction cardiomyopathy. PATIENTS AND METHODS: We included a total of 15 patients aged 52 ± 17 years (40% males) diagnosed at our echocardiography laboratory between January 2001 and July 2010. RESULTS: The form of presentation was heart failure in 53% of subjects, syncope in 20%o, ventricular arrhythmias in 13%o and stroke in 7%>. Left ventricular end-diastolic diameter was 66 ± 11 mm and estimated ejection fraction was 27 ± 10%>. Apical and/or mid-ventricular segments of the left ventricle were involved in all the cases. Pulmonary hypertension was present in 40%o. The average follow-up was 19 months and no patient died during this period. Sixty seven percent of the patients had manifestations of heart failure, 27%o presented sustained ventricular arrhythmias and 20%> had atrial fibrillation or flutter, whereas 13%o had cerebral embolic events. An automated internal cardioverter defibrillator was implanted in 47%o of patients. CONCLUSIONS: Non-compaction cardiomyopathy is associated with high cardiovascular morbidity. The diagnosis is made in advanced stages of the disease, with significant dilation and ventricular dysfunction.

Miocardiopatía no compactada: una serie de 15 casos / Non compaction cardiomyopathy: a series of 15 cases

Background: Non compaction cardiomyopathy is a rare disorder caused by the arrest of myocardial compaction during embryogenesis, leading to a non compacted endocardial layer with marked hypertrabeculation and deep recesses. Aim: To report the clinical and echocardiographic characteristics of a series of 15 adult patients with non-compaction cardiomyopathy. Patients and Methods: We included a total of 15 patients aged 52 ± 17 years (40 percent males) diagnosed at our echocardiography laboratory between January 2001 and July 2010. Results: Theform of presentation was heart failure in 53 percent of subjects, syncope in 20 percento, ventricular arrhythmias in 13 percento and stroke in 7 percent>. Left ventricular end-diastolic diameter was 66 ±11 mm and estimated ejection fraction was 27 ± 10 percent>. Apical and/or mid-ventricular segments of the left ventricle were involved in all the cases. Pulmonary hypertension was present in 40 percento. The average follow-up was 19 months and no patient died during this period. Sixty seven percent ofthe patients had manifestations of heart failure, 27 percento presented sustained ventricular arrhythmias and 20 percent> had atrial fibrillation orflutter, whereas 13 percento had cerebral embolic events. An automated internal cardioverter defibrillator was implanted in 47 percento of patients. Conclusions: Non-compaction cardiomyopathy is associated with high cardiovascular morbidity. The diagnosis is made in advanced stages of the disease, with significant dilation and ventricular dysfunction.

[Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting. A prospective analysis]. / Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica. Un estudio prospectivo.

BACKGROUND: Atrial fibrillation (AF) is a relevant complication after coronary artery bypass grafting (CABG). However there is controversy regarding possible contributing factors. AIM: To study the incidence of AF, its risk factors and its repercussion on hospital stay and charges, in patients undergoing CABG. MATERIAL AND METHODS: We prospectively collected information from all patients undergoing CABG in our institution, including demographic, surgical and laboratory variables. Exclusion criteria were chronic AF, recent onset AF and patients who needed additional surgical procedures. The primary endpoint was the incidence of AF during the hospital stay. Secondary endpoints were hospital length of stay and hospital charges. RESULTS: We included 250 patients aged 62+/-9 years (199 males) in the analysis. Incidence of AF was 22% (54 patients). Multivariable analysis showed that age (Odds Ratio (OR) =1.10), previous CABG (OR =9.39), previous use of ACE inhibitors (OR =3.28) and aortic clamp >57 minutes (OR =3.97) were significantly associated with an increased risk of postoperative AF. Previous use of beta-blockers was associated with risk reduction (OR =0.43). Patients who developed AF had a longer hospital stay (p <0.001) and higher hospital charges (p =0.003). CONCLUSION: AF is a frequent complication in patients undergoing CABG. Risk factors are age, time of aortic clamp, previous CABG and ACE inhibitors. Beta-blockers may prevent its occurrence. Furthermore, AF has a negative impact on both hospital stay and hospital charges.

Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica: un estudio prospectivo / Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting: a prospective analysis

Background: Atrial fibrillation (AF) is a relevant complication after coronary artery bypass grafting (CABG). However there is controversy regarding possible contributing factors. Aim: To study the incidence of AF, its risk factors and its repercussion on hospital stay and charges, in patients undergoing CABG. Material and methods: We prospectively collected information from all patients undergoing CABG in our institution, including demographic, surgical and laboratory variables. Exclusion criteria were chronic AF, recent onset AF and patients who needed additional surgical procedures. The primary endpoint was the incidence of AF during the hospital stay. Secondary endpoints were hospital length of stay and hospital charges. Results: We included 250 patients aged 62±9 years (199 males) in the analysis. Incidence of AF was 22 percent (54 patients). Multivariable analysis showed that age (Odds Ratio (OR) =1.10), previous CABG (OR =9.39), previous use of ACE inhibitors (OR =3.28) and aortic clamp >57 minutes (OR =3.97) were significantly associated with an increased risk of postoperative AF. Previous use of beta-blockers was associated with risk reduction (OR =0.43). Patients who developed AF had a longer hospital stay (p <0.001) and higher hospital charges (p =0.003). Conclusion: AF is a frequent complication in patients undergoing CABG. Risk factors are age, time of aortic clamp, previous CABG and ACE inhibitors. Beta-blockers may prevent its occurrence. Furthermore, AF has a negative impact on both hospital stay and hospital charges.

Biomarcadores coronarios y evolución clínica alejada en pacientes con síndromes coronarios agudos sin elevación del segmento ST / Coronary biomarkers and long-term clinical outcome in acute coronary syndrome without ST segment elevation

Background: The use of new biomarkers improved risk stratification for patients with acute coronary syndromes (ACS). Aim: To evaluate the relationship between multiple biomarkers and long-term clinical outcome in ACS without ST segment elevation. Patients and Methods: Consecutive patients presenting with suspected ACS were studied. On admission to the emergency room, serum was obtained to determine highly sensitive C reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), lipoprotein (a) (LPa) and soluble P selectin (sPS). Clinical endpoints were mortality and a composite endpoint of major adverse cardiovascular events (MACE) including death, re-infarction, and angina. Results: Seventy patients, aged 63±13 years, 54 males, were studied. Final diagnosis was unstable angina in 71% and non-ST-segment elevation myocardial infarction in 29%. MACE and mortality rate were 17% and 5.8%, respectively. We found higher plasma levels of hsCRP, ESR and Lp(a) in patients with MACE (p=0.032, p=0.015 and p=0.010, respectively). Plasma levels of hsCRP and ESR were also higher in patients who died during the follow up (p=0.002 y p=0.045, respectively). Conclusion: Plasma levels of inflammatory markers and atherosclerosis biomarkers are associated with a worse long-term clinical outcome in ACS without ST segment elevation. The inclusion of these biomarkers in the routine blood test on admission, could improve risk stratification of patients with ACS in the future.

[Coronary biomarkers and long-term clinical outcome in acute coronary syndrome without ST segment elevation]. / Biomarcadores coronarios y evolución clínica alejada en pacientes con síndromes coronarios agudos sin elevación del segmento ST.

BACKGROUND: The use of new biomarkers improved risk stratification for patients with acute coronary syndromes (ACS). AIM: To evaluate the relationship between multiple biomarkers and long-term clinical outcome in ACS without ST segment elevation. PATIENTS AND METHODS: Consecutive patients presenting with suspected ACS were studied. On admission to the emergency room, serum was obtained to determine highly sensitive C reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), lipoprotein (a) (LPa) and soluble P selectin (sPS). Clinical endpoints were mortality and a composite endpoint of major adverse cardiovascular events (MACE) including death, re-infarction, and angina. RESULTS: Seventy patients, aged 63+/-13 years, 54 males, were studied. Final diagnosis was unstable angina in 71% and non-ST-segment elevation myocardial infarction in 29%. MACE and mortality rate were 17% and 5.8%, respectively. We found higher plasma levels of hsCRP, ESR and Lp(a) in patients with MACE (p=0.032, p=0.015 and p=0.010, respectively). Plasma levels of hsCRP and ESR were also higher in patients who died during the follow up (p=0.002 y p=0.045, respectively). CONCLUSION: Plasma levels of inflammatory markers and atherosclerosis biomarkers are associated with a worse long-term clinical outcome in ACS without ST segment elevation. The inclusion of these biomarkers in the routine blood test on admission, could improve risk stratification of patients with ACS in the future.

Síndromes coronarios agudos: utilidad pronóstica de nuevos biomarcadores y eficacia de un score mixto en el pronóstico clínico alejado / Acute coronary syndromes: practical utility of new biomarkers and mix score efficacy in a long term prognosis

Antecedentes: el uso de biomarcadores ha permitido el diagnóstico y estratificación de pacientes con síndromes coronarios agudos (SCA). Los nuevos biomarcadores en esta área deberán aportar información pronóstica para estratificar pacientes de mayor riesgos en quienes enfocar terapias más agresivas. Objetivo: Estudiar la utilidad de nuevos biomarcadores y el uso un score mixto en la evaluación pronóstica alejada, en pacientes con SCA. Método: Prospectivamente se incorporaron al estudio, pacientes con SCA sin elevación del segmento ST, en quienes se determinó al ingreso niveles plasmáticos de Troponina I específica, proteína C reactiva (PCR), P selectina (PS), Lipoproteína (a) (Lp(a)) y VHS. El seguimiento clínico se extendió por el plazo de un año tras el evento índice. El score mixto fue confeccionado en base a la distribución porcentual de cada biomarcador. Se definieron como endpoints clínicos, mortalidad y nuevos eventos cardiovasculares adversos (ECVA) compuestos ( muerte, reinfarto, angina y rehospitalización por nuevo SCA. Resultados: estudiamos 70 pacientes, con edad promedio de 63 años, 77 por ciento hombres, 21 por ciento diabéticos y 63 por ciento hipertensos. El diagnóstico final fue angina inestable en 71 por ciento e infarto sin elevación del ST en 29 por ciento. El seguimiento clínico se completó en 100 por ciento de los casos. Los valores promedios de los distintos marcadores fueron: Trop I 3,8±7 ng/ml, PCR 25±43 mg/dl, PS 48±28, LPa 16±16 y VHS 23±27. De la serie analizada 17 por ciento tuvo nuevos ECVA y la mortalidad fue de 5,8 por ciento. Los valores de PCR mostraron una asociación significativa con EVCA (p=0,004) y mortalidad (p<0,001). Los valores de Lp(a) también mostraron una asociación con EVCA (P=0,009)pero no con mortalidad (p=0,53). Los valores del score mixto mostraron una fuerte asociación con EVCA y mortalidad (p=0,001). Conclusión: la incorporación de nuevos biomarcadores en la evaluación de pacientes con SCA, puede permitir una mejor estratificación y un mejor uso de las terapias en pacientes de alto riesgo.

Solución GIK en el infarto agudo al miocardio: el resurgimiento de una antigua terapia / Glucose-insulin-K solution for acute myocardial infarction: rebirth of an old form of therapy

La terapia con solución de glucosa insulina y potasio en el infarto o solución GIK fue inicialmente utilizada por Sodi-Pallares. Desde entonces muchos trabajos con esta solución han sido publicados con resultados disímiles. Sin embargo el resultado de un meta-análisis reciente, que incluye sólo trabajos randomizados con dosis adecuadas de GIK, parece confirmar la disminución de la mortalidad asociada a solución GIK. Para comprender mejor los fundamentos y posibles mecanismos de beneficio con el empleo de la solución GIK en el infarto del miocardio, revisaremos primero el metabolismo miocárdico normal y en condiciones de isquemia, luego el daño por reperfusión post infarto y los efectos de la solución GIK en el miocardio. Por último, analizaremos las experiencias clínicas publicadas con esta terapia

Efectos tardíos post fulguración con radiofrecuencia: experiencia clínica en 5 casos / Late effects of radiofrecuency fulguration: report of 5 cases

Radiofrecuency fulguration is the definitive treatment of several supraventricular and ventricular arrythmias. During radiofrecuency application, the conduction in a specific zone is interrupted as a consequence of cellular necrosis and edema. The disappearance of edema, minutes or hours after the procedure, allows the reappearance of conduction and arrythmias. On the other hand, the definitive lesion is larger than the one caused acutely, due to the progression of the scar. We report four patients, in whom there was an apparent failure of the fulguration, since at the end of the procedure there was conduction in the fulgurated zone, the tachycardia was inducible or pre excitation and arrythmias reappeared during the follow up. All four were subjected to a new eletrophysiological study and in all, fulguration had been effective. We conclude that these late effects of fulguration are due to the slow progression of fibrosis, that continues days or weeks after the procedure