Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

BACKGROUND: Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. METHODS: Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. RESULTS: Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). CONCLUSIONS: Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.

Hendidura de velo posterior que simula una válvula mitral de tres velos / Cleft of the posterior mitral valve leaflet simulating a three leaflet valve

Reportamos el caso de una mujer de 55 años, que completo terapia antibiótica por una periodontitis con buena respuesta clínica. Posteriormente, presentó fiebre y dolor lumbar, hospitalizándose para estudio. Destacaban parámetros inflamatorios elevados y hemocultivos positivos para Streptococcus Viridans. Estudio de imágenes confirmaron espondilodiscitis de L5-S1. Se efectuó un Ecocardiograma transesogáfico (ETE), que mostró una válvula mitral de aspecto tricúspide, con prolapso del velo posterior (P2-P3) e insuficiencia severa, más una endocarditis mural auricular izquierda por lesión de jet. Se efectuó cirugía cardíaca con reparación mitral. Los hallazgos intraoperatorios mostraron el aparato subvalvular y músculos papilares habituales. Por lo tanto, el aspecto de la válvula mitral fue interpretado como una hendidura profunda del velo posterior.

We report the case of a 55 year old woman, previously treated with antibiotics for periodontitis. She was admitted with fever and lumbar pain. An elevated C reactive protein (CRP) and positive blood cultures for Streptococcus Viridans were found and infectious spondylodiscitis of L5-S1 was confirmed. Transeso-phageal echocardiography (TEE) was performed. A tri-leaflet mitral valve and prolapse of posterior leaflet (P2-P3) were found and severe mitral regurgitation was present on doppler examination In addition, a left atrial mural vegetation (jet lesion) was found. At cardiac surgery mitral valve repair and resection of the mural vegetations were performed. The papillary muscles were normal, and this tri-leaflet aspect of the mitral valve was interpreted as a deep posterior cleft with symmetrical distribution of all remaining segments.

Cambios agudos en la función auricular derecha post uso de iloprost inhalatorio en pacientes con hipertensión arterial pulmonar: estudio con técnicas de deformación de imagen / Acute changes in right atrial funcion after Iloprost inhalation in patients with pulmonary hypertension: a study using image deformation techniques

Introducción: El efecto de prostanoides inhalatorios sobre la función auricular derecha (AD) en hipertensión arterial idiopática (HAP) no ha sido estudiado. Objetivo: Evaluar cambios agudos en la función AD y función diastólica del ventrículo derecho en pacientes con HAP post uso de Iloprost inhalatorio. Métodos: Se incluyeron pacientes con HAP sin uso previo de prostanoides. Se realizó un ecocardiograma transtorácico basal y 30 min posterior a la inhalación de iloprost. Se midió dimensión AD, relación E/e' y strain de la AD por speckle tracking, registrando la onda negativa de contracción auricular (SaAD) y la onda positiva de la fase de reservorio (SsAD). Se midió el tiempo de inicio de la fase de reservorio AD durante el sístole ventricular. Resultados: Se estudiaron 16 pacientes (15 mujeres), con edad promedio 44 ± 7,8 años. Post Iloprost disminuyó el volumen AD (basal: 140ml, post Iloprost: 109 ml; p 0,008) y las presiones de llenado (E/e’ basal: 13, post Iloprost: 9,8; p 0,028). No se registraron diferencias en el SaAD (basal: -8,4%, post Iloprost: -8,5%; p 0,834). El SsAD fue mayor post Iloprost (basal: 8,6%, post Iloprost: 11,7%; p 0,002) iniciándose antes durante el sístole ventricular (basal: 445ms, post Iloprost: 368ms; p 0,001). Conclusión: Con Iloprost inhalatorio en pacientes con HAP se observa una reducción aguda en el tamaño de la AD y en las presiones de llenado del VD. La deformación durante la fase de reservorio de la AD aumenta y se inicia significativamente antes. Esto sugiere que el Iloprost podría mejorar en forma aguda el trabajo mecánico de la AD en paciente con HAP.

Background: The effects of inhaled prostanoids on right atrial (RA) function in patients with Pulmonary Arterial Hypertension (PAH) have not been studied. We evaluated acute changes in RA function and right ventricular diastolic function after inhaled iloprost. Methods: We included PAH patients without prior prostanoid treatment. A surface echocardiogram was performed at baseline and 30 minutes after iloprost inhalation. Measurements included RA dimensions, right E/e’ ratio and RA strain by speckle tracking, registering a RA contraction wave (RASa) and RA reservoir wave (RASs). RA time to peak of deformation during the reservoir phase was also measured. Results: We included 16 patients (15 females, aged 44±7.8 years. Post iloprost there was a reduction in RA volume (baseline: 140ml, post iloprost: 109ml; p 0.008) and right ventricular filling pressure (baseline E/e’: 13, post iloprost: 9.8; p 0.028). There was no difference in the magnitude of the RASa wave (baseline: -8.4%, post iloprost: -8.5%; p 0.834). The RASs wave was larger post iloprost (baseline: 8.6%, post iloprost: 11.7%; p 0.002), and began earlier (baseline RA time to peak of deformation during reservoir phase: 445ms, post iloprost: 368ms; p 0.001). Conclusion: Inhaled iloprost acutely reduces RA size and right ventricular filling pressure in patients with HAP It also significantly increases the magnitude of RA systolic deformation as well as making it occur earlier in RA filling phase. This suggests that iloprost might improve RA mechanical performance.

Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica / Clinical usefulness of biomarkers in cardiac failure

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

[Clinical usefulness of biomarkers in cardiac failure]. / Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica.

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

[Depressive symptoms after an acute myocardial infarction]. / Síntomas depresivos posinfarto al miocardio: detección precoz en una población hospitalizada.

BACKGROUND: Depression after myocardial infarction (MI) is a frequent disorder and it increases the long-term risk of cardiac mortality. AIM: To assess the frequency of depressive symptoms and the history of depression in hospitalized post-MI patients. PATIENTS AND METHODS: During three months, depressive symptoms and history of depression were studied in 47 consecutive patients (mean age 59.8+/-9.5 years, 68% male), admitted for MI to the Barros Luco Trudeau Hospital. The Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI 2.1) were used with DSM-IV diagnosis criteria. RESULTS: According to the results obtained using the CIDI, 27,7% of the patients had a history of depression. This occurred in 53,3% of women and 15,6% of men (p <0.01). During the hospitalization, 38.3% of patients had depressive symptoms (BDI > or =17 points), affecting 60% of women and 28,1% of men (p <0.02). In women and patients with history of depression, depressive symptoms tended to be more common and more severe. CONCLUSIONS: Depressive symptoms in post-MI patients are frequent and attending physicians should actively detect them.