Repercusión de la pérdida ponderal tras cirugía bariátrica en la estructura y función cardiaca / Impact of ponderal loss after bariatric surgery on the cardiac structure and function

Introducción y objetivoEl exceso de peso puede inducir modificaciones en la estructura y función del miocardio. La presencia de hipertrofia ventricular izquierda es un predictor independiente de morbimortalidad cardiovascular.El objetivo principal del estudio ha sido conocer la prevalencia de alteraciones morfofuncionales cardiacas en pacientes con obesidad y su modificación tras la pérdida de peso después de una cirugía bariátrica (CB).Pacientes y métodosEstudio de cohortes prospectivo de 75 pacientes con obesidad y sin cardiopatía conocida a los que se les realizó un bypass gástrico. Se midieron parámetros antropométricos, analíticos y ecocardiográficos antes, a los 6 y 12 meses de la intervención.ResultadosSe incluyeron 75 pacientes (66,6% mujeres, edad media 39,3 [9,7] años e índice de masa corporal [IMC] 47,8 [7,1] kg/m2). A los 6 y 12 meses de la CB se produjo una reducción significativa del peso corporal, una mejora en los parámetros metabólicos, inflamatorios y protrombóticos, así como en los factores de riesgo cardiovascular asociados a la obesidad (hipertensión arterial [HTA], diabetes mellitus tipo 2 [DM2], dislipemia [DLP] y síndrome de apnea-hipopnea del sueño [SAHOS]).Antes de la intervención, el 62,7% de los pacientes presentaba alteración en la geometría del ventrículo izquierdo, siendo el remodelado concéntrico la más frecuente (38,7%). Además, el 50,7% presentaba disfunción diastólica. Al año de la CB, el patrón ventricular fue normal en el 92% de los casos y la función diastólica mejoró significativamente.ConclusionesNuestros resultados corroboran el efecto negativo de la obesidad sobre el miocardio, así como la potencial reversibilidad de estas alteraciones tras una pérdida significativa de peso después de una CB. (AU)

Introduction and objectiveExcess weight can cause structural and functional cardiac disorders. The presence of left ventricular hypertrophy in the obese patient is an independent predictor of cardiovascular morbidity and mortality.The major aim of the present study is to know the prevalence of cardiac morphofunctional disorders in obese patients, before and after weight loss due to bariatric surgery (BS).Patients and methodsProspective cohort study of 75 patients with obesity without known heart disease referred to gastric bypass. Anthropometric, analytical and echocardiographic parameters were measured before and after 6 and 12 months after BS.ResultsThe study included 75 patients (66.6% women, mean age 39.3 [9.7] years and BMI 47.8 [7.1] kg/m2). At 6 and 12 months after BS there was a significant reduction in body weight and an improvement in metabolic, inflammatory and prothrombotic parameters and in cardiovascular risk factors associated with obesity (hypertension, type 2 diabetes, dyslipidemia and obstructive sleep apnea−hypopnea syndrome).Before surgery, cardiac remodeling was present in 62.7%, most frequently in the form of concentric remodeling (38.7%). Diastolic dysfunction occurred in 50.7% of the patients.One year after surgery, the ventricular pattern was normal in 92% of cases and the diastolic function improved significantly.ConclusionsOur results support the negative effect of obesity on cardiac geometry and function and the potential reversibility of these cardiac alterations after marked weight loss due to BS. (AU)

Impact of ponderal loss after bariatric surgery on the cardiac structure and function. / Repercusión de la pérdida ponderal tras cirugía bariátrica en la estructura y función cardiaca.

INTRODUCTION AND OBJECTIVE: Excess weight can cause structural and functional cardiac disorders. The presence of left ventricular hypertrophy in the obese patient is an independent predictor of cardiovascular morbidity and mortality. The major aim of the present study is to know the prevalence of cardiac morphofunctional disorders in obese patients, before and after weight loss due to bariatric surgery (BS). PATIENTS AND METHODS: Prospective cohort study of 75 patients with obesity without known heart disease referred to gastric bypass. Anthropometric, analytical and echocardiographic parameters were measured before and after 6 and 12 months after BS. RESULTS: The study included 75 patients (66.6% women, mean age 39.3 [9.7] years and BMI 47.8 [7.1] kg/m2). At 6 and 12 months after BS there was a significant reduction in body weight and an improvement in metabolic, inflammatory and prothrombotic parameters and in cardiovascular risk factors associated with obesity (hypertension, type 2 diabetes, dyslipidemia and obstructive sleep apnea-hypopnea syndrome). Before surgery, cardiac remodeling was present in 62.7%, most frequently in the form of concentric remodeling (38.7%). Diastolic dysfunction occurred in 50.7% of the patients. One year after surgery, the ventricular pattern was normal in 92% of cases and the diastolic function improved significantly. CONCLUSIONS: Our results support the negative effect of obesity on cardiac geometry and function and the potential reversibility of these cardiac alterations after marked weight loss due to BS.

Use of edoxaban in clinical practice: Comparison of data from the Spanish population in the ETNA-AF-Europe registry.

Aim: To ascertain the clinical profile and management of edoxaban in clinical practice. Materials & methods: Prospective, noninterventional postauthorization study of nonselected patients with atrial fibrillation treated with edoxaban from 12 European countries. Patients' baseline characteristics are presented. Results: A total of 13,638 patients (73.6 ± 9.5 years; 76.6/23.4% edoxaban 60/30 mg; CHA2DS2-VASc 3.1; 838 [6.1%] from Spain) were included. In Spain, the percentage of very elderly and fragile patients was greater and the risk of thromboembolism (CHA2DS2-VASc ≥2, 98.0 vs 87.3%; p < 0.001) and bleeding (HAS-BLED, 3.2 vs 2.7; p < 0.001) was greater in patients treated with edoxaban 30 mg. The proportion of patients taking edoxaban 30 mg was similar than in ENGAGE AF-TIMI 48. Conclusion: In Spain, patients treated with edoxaban were older and fragile.

Resistin in morbidly obese patients before and after gastric bypass surgery.

BACKGROUND AND OBJECTIVES: Resistin was originally suggested to be a potential mediator of obesity-related insulin resistance in rodents. However, in humans, the role of resistin in obesity and insulin resistance has not yet been demonstrated. The present study investigates whether there are differences in resistin levels between patients with morbid obesity and lean subjects, and analyzes changes in resistin levels after significant weight loss secondary to bariatric surgery. METHODS: Sixty-eight patients with morbid obesity (body mass index [BMI] ≥ 40 kg/m2) and 31 lean subjects (BMI < 25 kg/m2) were selected. The study variables were: weight, height, BMI, waist-hip ratio (WHR), fat mass, family history of cardiovascular disease (CVD), type 2 diabetes mellitus (DM), hypertension, dyslipidemia, smoking, glucose, glycated hemoglobin (HbA1c), insulin, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin and resistin. Homoeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were calculated. The obese patients underwent gastric bypass surgery, and the above mentioned variables were reassessed after 12 months and major weight loss. RESULTS: There were no significant differences in resistin levels between morbidly obese patients and healthy subjects of normal weight, or between obese patients before and after weight loss. Resistin levels in morbidly obese patients were not correlated to adiposity anthropometric measures, insulin, glucose, HOMA, QUICKI, hsCRP, IL-6 or adiponectin. In the morbid obesity group, after one year of weight loss, the only study parameter correlated to resistin levels was IL-6. CONCLUSION: Our results do not support a relationship among resistin levels, obesity and insulin resistance in humans.

Resistin in morbidly obese patients before and after gastric bypass surgery / Resistina en obesos mórbidos antes y después de un bypass gástrico

Background and objectives: Resistin was originally suggested to be a potential mediator of obesity-related insulin resistance in rodents. However, in humans, the role of resistin in obesity and insulin resistance has not yet been demonstrated. The present study investigates whether there are differences in resistin levels between patients with morbid obesity and lean subjects, and analyzes changes in resistin levels after significant weight loss secondary to bariatric surgery. Methods: Sixty-eight patients with morbid obesity (body mass index [BMI] ≥ 40 kg/m2) and 31 lean subjects (BMI < 25 kg/m2) were selected. The study variables were: weight, height, BMI, waist-hip ratio (WHR), fat mass, family history of cardiovascular disease (CVD), type 2 diabetes mellitus (DM), hypertension, dyslipidemia, smoking, glucose, glycated hemoglobin (HbA1c), insulin, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin and resistin. Homoeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were calculated. The obese patients underwent gastric bypass surgery, and the above mentioned variables were reassessed after 12 months and major weight loss. Results: There were no significant differences in resistin levels between morbidly obese patients and healthy subjects of normal weight, or between obese patients before and after weight loss. Resistin levels in morbidly obese patients were not correlated to adiposity anthropometric measures, insulin, glucose, HOMA, QUICKI, hsCRP, IL-6 or adiponectin. In the morbid obesity group, after one year of weight loss, the only study parameter correlated to resistin levels was IL-6. Conclusion: Our results do not support a relationship among resistin levels, obesity and insulin resistance in humans (AU)

Introducción y objetivos: inicialmente se sugirió que la resistina era un mediador potencial de la resistencia a la insulina relacionada con la obesidad en roedores. Sin embargo, en seres humanos, el papel de la resistina en la obesidad y la resistencia a la insulina aún no se ha demostrado. El presente estudio investiga si existen diferencias en los niveles de resistina entre pacientes con obesidad mórbida y sujetos con normopeso, y analiza los cambios en los niveles de resistina después de la pérdida significativa de peso debida a cirugía bariátrica. Métodos: se seleccionaron 68 pacientes con obesidad mórbida (IMC ≥ 40 kg/m2) y 31 sujetos normopeso (IMC < 25 kg/m2). Las variables del estudio fueron peso, talla, IMC, relación cintura-cadera (WHR), masa grasa, antecedentes familiares de enfermedad cardiovascular, diabetes mellitus tipo 2 (DM), hipertensión arterial, dislipidemia, tabaquismo, glucosa, hemoglobina glicosilada (HbA1c), insulina, proteína C reactiva de alta sensibilidad (hsCRP), interleucina-6 (IL-6), adiponectina y resistina. Se calcularon la evaluación del modelo de homeostasis (HOMA) y el índice cuantitativo de control de sensibilidad a la insulina (QUICKI). Los pacientes obesos se sometieron a un bypass gástrico, y las variables mencionadas fueron reevaluadas después de 12 meses y una pérdida de peso importante. Resultados: no hubo diferencias significativas en los niveles de resistina entre pacientes obesos mórbidos y sujetos sanos de peso normal, ni entre pacientes obesos antes y después de la pérdida de peso. Los niveles de resistina en pacientes obesos mórbidos no se correlacionaron con medidas antropométricas de adiposidad, insulina, glucosa, HOMA, QUICKI, hsCRP, IL-6 o adiponectina. En el grupo de obesos mórbidos, al año de la pérdida de peso experimentada, el único parámetro del estudio correlacionado con los niveles de resistina fue la IL-6. Conclusión: nuestros resultados no apoyan una relación entre los niveles de resistina, la obesidad y la resistencia a la insulina en los seres humanos (AU)

Obesity, endothelial function and inflammation: the effects of weight loss after bariatric surgery.

OBJECTIVE: Obesity is associated with a high risk for atherosclerotic cardiovascular disease. There is a causal association between obesity, inflammation, insulin resistance (IR) and endothelial dysfunction. The aim of this study was to evaluate changes in IR, proinflammatory state and markers of endothelial dysfunction in morbidly obese patients after weight loss following bariatric surgery. METHODS: In this study, we measured the levels of soluble intracellular adhesion molecule-1 (sICAM1), plasminogen activator inhibitor 1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) in 79 morbidly obese patients at baseline and 3, 6 and 12 months after gastric bypass. Also, we evaluated changes in IR. RESULTS: Twelve months after surgery, there was a significant decrease in plasma levels of sICAM1 (p < 0.001), PAI-1 (p < 0.05), hs-CRP (p < 0.001), IL-6 (p < 0.001) and homeostasis model assessment (HOMA) (p < 0.001) and a significant increase of McAuley index (McAuley) (p < 0.001). Baseline levels of hs-PCR were positively correlated with sICAM-1 (r = 0.450, p < 0.01) and IL-6 (r = 0.451, p < 0.01). Significant correlations were also found between the decrease of PAI-1 and the decrease of hs-PCR (r = 0.425, p < 0.01) and tryglicerides (r = 0.351, p < 0.01). CONCLUSIONS: In patients with morbid obesity, substantial surgically induced weight loss is followed by a significant improvement in the endothelial function, inflammatory state and insulin sensitivity, that may reduce their cardiovascular risk. A relationship exists between improved inflammatory profile and endothelial function.

Obesity, endothelial function and inflammation: the effects of weight loss after bariatric surgery / Obesidad, inflamación y función endotelial: efectos de la pérdida de peso tras cirugía bariatrica

Objective: Obesity is associated with a high risk for atherosclerotic cardiovascular disease. There is a causal association between obesity, inflammation, insulin resistance (IR) and endothelial dysfunction. The aim of this study was to evaluate changes in IR, proinflammatory state and markers of endothelial dysfunction in morbidly obese patients after weight loss following bariatric surgery. Methods: In this study, we measured the levels of soluble intracellular adhesion molecule-1 (sICAM1), plasminogen activator inhibitor 1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) in 79 morbidly obese patients at baseline and 3, 6 and 12 months after gastric bypass. Also, we evaluated changes in IR. Results: Twelve months after surgery, there was a significant decrease in plasma levels of sICAM1 (p < 0.001), PAI-1 (p < 0.05), hs-CRP (p < 0.001), IL-6 (p < 0.001) and homeostasis model assessment (HOMA) (p < 0.001) and a significant increase of McAuley index (McAuley) (p < 0.001). Baseline levels of hs-PCR were positively correlated with sICAM-1 (r = 0.450, p < 0.01) and IL-6 (r = 0.451, p < 0.01). Significant correlations were also found between the decrease of PAI-1 and the decrease of hs-PCR (r = 0.425, p < 0.01) and tryglicerides (r = 0.351, p < 0.01). Conclusions: In patients with morbid obesity, substantial surgically induced weight loss is followed by a significant improvement in the endothelial function, inflammatory state and insulin sensitivity, that may reduce their cardiovascular risk. A relationship exists between improved inflammatory profile and endothelial function (AU)

Objetivo: la obesidad está asociada con un aumento del riesgo de enfermedad cardiovascular. Se ha propuesto una relación causal entre obesidad, inflamación, resistencia a la insulina, y disfunción endotelial. El objetivo de este estudio fue valorar marcadores de insulinorresistencia, infl amación y disfunción endotelial en pacientes con obesidad mórbida antes y después de la pérdida de peso por cirugía bariátrica. Métodos: se midieron las concentraciones séricas de moléculas solubles de adhesión intercelular tipo 1 (sICAM-1), inhibidor del activador del plasminógeno tipo 1 (PAI-1), proteína C reactiva de alta sensibilidad (hs-PCR) e interleucina 6 (IL-6) en 79 pacientes con obesidad mórbida antes y a los 3, 6 y 12 meses de la realización de un by-pass gástrico. También se evaluaron índices de resistencia a la insulina. Resultados: a los 12 meses de la cirugía disminuyeron los niveles de sICAM1 (p < 0,001), PAI-1 (p < 0,05), hs-CRP (p < 0,001), IL-6 (p < 0,001) y el índice homeostasis model assessment (HOMA) (p < 0,001) y aumentó el índice McAuley (p < 0,001). Los niveles basales de hs-PCR estaban correlacionados con los de sICAM-1 (r = 0,450, p < 0,01) y de IL-6 (r = 0,451, p < 0,01). También existía correlación entre el descenso de los niveles de PAI-1 y el descenso de hs-PCR (r = 0,425, p < 0,01) y triglicéridos (r = 0,351, p < 0,01). Conclusiones: en pacientes con obesidad mórbida una importante pérdida de peso por cirugía bariátrica se acompaña de una mejora significativa de marcadores inflamatorios, de función endotelial e insulinorresistencia, lo que puede suponer una disminución del riesgo cardiovascular. Existe una relación entre mejora del perfil inflamatorio y función endotelial (AU)

Schwannoma pericárdico. La ecoendoscopia como herramienta de apoyo en el estudio de lesiones cardiacas / Pericardial schwannoma. Echoendoscopy as an aid in the study of cardiac lesions

No disponible

Obesity and inflammation: change in adiponectin, C-reactive protein, tumour necrosis factor-alpha and interleukin-6 after bariatric surgery.

BACKGROUND: Obesity is associated with a low-grade inflammatory state. A causal association between inflammation and atherosclerosis has been suggested. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients after weight loss following bariatric surgery. METHODS: In this study, we measured levels of adiponectin, high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) and their relation to insulin resistance and lipid parameters in 60 morbidly obese women at baseline and 3, 6 and 12 months after gastric bypass. RESULTS: Twelve months after surgery, there was a significant increase in plasma levels of adiponectin (p < 0.001) and high-density lipoprotein cholesterol (p < 0.01) and a significant decrease in levels of IL-6 (p < 0.001), hs-CRP (p < 0.001), cholesterol (p < 0.001), triglycerides (p < 0.001), low-density lipoprotein cholesterol (p < 0.001), glucose (p < 0.001), insulin (p < 0.001) and homeostasis model assessment (HOMA; p < 0.001). At 12 months, correlations were seen between IL-6 levels and the following: body mass index (BMI) (r = 0.53, p < 0.001), insulin (r = 0.51, p < 0.001) and HOMA (r = 0.55, p < 0.001). Also, hs-CRP levels correlated with BMI (r = 0.40, p = 0. 004), triglycerides (r = 0.34, p = 0.017), insulin (r = 0.50, p = 0.001) and HOMA (r = 0.46, p = 0.002). CONCLUSIONS: In patients with morbid obesity, significant weight loss is followed by a significant improvement in the inflammatory state, insulin sensitivity and lipid profile. A relationship exists between improved inflammatory profile and insulin sensitivity.

[Soluble intercellular adhesion molecule-1 and C reactive protein after bariatric surgery]. / Moléculas solubles de adhesión intercelular tipo 1 y proteína C reactiva tras cirugía bariátrica.

BACKGROUND AND OBJECTIVES: Obesity is associated with a state of chronic low-grade inflammation. A causal association between inflammatory processes and atherogenesis has been proposed. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients who underwent bariatric surgery. Serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations were measured before and after massive weight loss due to gastric bypass. METHODS: In this prospective study we measured CRP and sICAM-1 concentrations in 50 morbidly obese patients (19 men and 31 women) at baseline and 3, 6 and 12 months after gastric bypass. RESULTS: Body mass index (BMI), CRP, and sICAM-1 decreased significantly. BMI correlated with CRP but not with sICAM-1. CONCLUSIONS: The improvement in vascular risk profile after weight loss in morbidly obese patients could be partially explained by changes in inflammatory status.

Moléculas solubles de adhesión intercelular tipo 1 y proteína C reactiva tras cirugía bariátrica / Soluble intercellular adhesion molecule-1 and C reactive protein after bariatric surgery

Background and objectives Obesity is associated with a state of chronic low-grade inflammation. A causal association between inflammatory processes and atherogenesis has been proposed. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients who underwent bariatric surgery. Serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations were measured before and after massive weight loss due to gastric bypass. Methods In this prospective study we measured CRP and sICAM-1 concentrations in 50 morbidly obese patients (19 men and 31women) at baseline and 3, 6 and 12 months after gastric bypass. Results Body mass index (BMI), CRP, and sICAM-1 decreased significantly. BMI correlated with CRP but not with sICAM-1.ConclusionsThe improvement in vascular risk profile after weight loss in morbidly obese patients could be partially explained by changes in inflammatory status (AU)

Antecedentes y objetivos La obesidad se asocia a un desorden inflamatorio de bajo grado. Se ha propuesto una asociación causal entre inflamación y arteriosclerosis. El objetivo de este trabajo fue valorar el perfil inflamatorio en pacientes obesos mórbidos determinando las concentraciones de proteína C reactiva (PCR) y de moléculas solubles de adhesión intercelular tipo 1 (sICAM-1) antes y después de la pérdida de peso por cirugía bariátrica. Método Se realizó un estudio prospectivo en el que se midieron las concentraciones séricas de PCR y de sICAM-1 en 50 pacientes con obesidad mórbida (19 hombres y 31 mujeres) antes y a los 3, 6 y 12 meses de la realización de un by-pass gástrico. Resultados Se observó una disminución significativa de índice de masa corporal (IMC), PCR y sICAM-1. Se encontró correlación entre IMC y PCR, pero no entre IMC y sICAM-1.ConclusiónLa mejora del perfil de riesgo vascular en pacientes obesos tras la pérdida de peso podría atribuirse, en parte, a la mejora del estado inflamatorio (AU)

Safety and predictors of complications with a new accelerated dobutamine stress echocardiography protocol.

BACKGROUND: This study sought to document the safety of a new accelerated dobutamine-atropine stress echocardiography protocol and to analyze its complications. METHODS: Dobutamine-atropine stress echocardiography studies were performed using an incremental dobutamine infusion protocol from 20 to 40 microg/kg/min in 3-minute stages and followed by atropine. RESULTS: A total of 962 patients were included. Mean age was 64 +/- 11 years and 584 were male (61%). Mean ejection fraction was 62 +/- 10%. Complications included hypertensive responses in 66 patients (7%), arrhythmias in 26 (2.7%), and symptomatic hypotension in 16 (1.7%). No patient developed heart failure, acute myocardial infarction, ventricular fibrillation, or died. The independent predictors of hypertensive responses were age, baseline systolic blood pressure, and treatment with nitrates. The independent predictors of arrhythmias were history of hypertension, previous coronary artery disease, and baseline heart rate. CONCLUSIONS: This accelerated dobutamine-atropine stress echocardiography protocol is safe in a low-risk population and has a rate of complications similar to that reported for the standard protocol.

[Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction]. / Valor pronóstico del factor de necrosis tumoral alfa en pacientes con infarto agudo de miocardio con elevación del segmento ST.

INTRODUCTION AND OBJECTIVES: Tumor necrosis factor-alpha (TNFalpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNFalpha in this clinical setting at six-month follow-up. METHODS: The levels of TNFalpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied. RESULTS: Overall, TNFalpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNFalpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNFalpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNFalpha level, at admission was found to be an independent predictor of the development of a cardiovascular events. CONCLUSIONS: In patients with STEMI, the plasma TNFalpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events.

Valor pronóstico del factor de necrosis tumoral alfa en pacientes con infarto agudo de miocardio con elevación del segmento ST / Prognostic value of tumor necrosis factor-alpha in patients with ST-segment elevation acute myocardial infarction

Introducción y objetivos. Entre la variedad de procesos inflamatorios que implican al factor de necrosis tumoral alfa (TNFα), se encuentra la enfermedad cardiovascular. Su valor pronóstico en el infarto agudo de miocardio con elevación del segmento ST (IAMEST) es poco conocido. Este estudio trata de determinar el valor pronóstico del TNFα en este marco clínico tras 6 meses de seguimiento. Métodos. Se midieron las concentraciones de TNFα, proteína C-reactiva (PCR), interleucina 6 y moléculas solubles de adhesión celular tipo 1 en las primeras 10 h tras el inicio de los síntomas y tras 48 h en 74 pacientes con IAMEST. Se correlacionaron sus valores con la incidencia de eventos isquémicos (angina, reinfarto y muerte), insuficiencia cardiaca o ambos (eventos cardiovasculares). Resultados. Los valores de TNFα fueron significativamente mayores en pacientes con eventos isquémicos o insuficiencia cardiaca que en aquellos sin eventos (p < 0,02 para todos). A las 48 h, las odds ratio (OR) ajustadas para el último cuartil de TNFα (2,92 pg/ml) eran OR = 13,1; OR = 9,59 y OR = 9,75 para el desarrollo de eventos isquémicos, insuficiencia cardiaca y eventos cardiovasculares combinados, respectivamente. La concentración de TNFα a las 48 h de 2,04 pg/ml tuvo una sensibilidad del 78% y una especificidad del 72,5% en la predicción conjunta de dichos eventos. Al ingreso, la PCR, pero no el TNFα, mostró valor predictivo independiente en el desarrollo de eventos cardiovasculares. Conclusiones. En pacientes con IAMEST, la concentración plasmática de TNFα a las 48 h y la PCR al ingreso son predictores independientes de eventos cardiovasculares (AU)

Introduction and objectives. Tumor necrosis factor-alpha (TNF-alpha) is implicated in a variety of inflammatory processes, including cardiovascular disease. Little is known about the prognostic value of TNF-alpha in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the prognostic value of TNF-alpha in this clinical setting at six-month follow-up. Methods. The levels of TNF-alpha, C-reactive protein (CRP), interleukin 6 and type 1 soluble intercellular adhesion molecules measured within the first 10 h of symptom onset and at 48 h in 74 consecutive patients admitted with STEMI. The relationships between these levels and the incidence of ischemic events (i.e., angina, reinfarction, and death), heart failure (HF), or both (i.e., all cardiovascular events) were studied. Results. Overall, TNF-alpha levels were significantly higher in patients who had an ischemic event or HF than in those who did not (P<.02 for both). At 48 h, the adjusted odds ratios of those in the highest TNF-alpha quartile (2.92 pg/mL) for the development of ischemic events, HF, and all cardiovascular events combined were 13.1, 9.59 and 9.75, respectively. A TNF-alpha level of 2.04 pg/mL at 48 h had a sensitivity of 78% and a specificity of 72.5% in predicting a cardiovascular event of any form. The CRP level, but not the TNF-alpha level, at admission was found to be an independent predictor of the development of a cardiovascular events. Conclusions. In patients with STEMI, the plasma TNF-alpha level 48 h after symptom onset and the CRP level at admission were independent predictors of cardiovascular events (AU)

[Assessment of left atrial wall velocities by pulsed wave tissue Doppler imaging. A new approach to the study of atrial function]. / Evaluación de las velocidades de pared de la aurícula izquierda mediante Doppler pulsado tisular. Una nueva aproximación al estudio de la función auricular.

INTRODUCTION AND OBJECTIVES: To analyze the profile of left atrial wall velocities by pulsed wave tissue Doppler imaging, and to compare the relationship between these observations and the transmitral and pulmonary vein flow velocities obtained by conventional pulsed Doppler echocardiography. PATIENTS AND METHOD: We studied 90 patients (50 women and 40 men, mean age 48 [22] years). Pulsed tissue Doppler images of the left atrial wall were obtained and analyzed in all subjects. The study population was then divided in two groups: group I (age < 45 years) and group II (age > 45 years). Transmitral and pulmonary vein flow velocity tracings were obtained simultaneously by pulsed Doppler echocardiography. RESULTS: With pulsed tissue Doppler interrogation of the left atrial wall, a triphasic signal was recorded in all patients, consisting of a positive wave (A1) followed by two negative waves (A2 and A3). Younger subjects (group I) showed a pattern with a prominent A2 wave and an A2/A3 ratio > 1. In older patients (group II) peak velocity of the A2 wave diminished and peak velocity of the A3 wave increased, so that the A2/A3 ratio was < 1. We found no differences in peak velocity of the A1 wave between the two age groups (13.5 (3.9) cm/s in group I vs 13.1 (5.4) cm/s in group II; P = .59). Significant concordance was observed between the transmitral flow pattern and the left atrial pulsed tissue Doppler tracing (kappa = 0.584; P < .0001). CONCLUSIONS: Evaluation of the left atrial wall using pulsed tissue Doppler imaging is feasible and reproducible. Tissue Doppler imaging provides new quantitative insights of potential use in the assessment of left atrial function.

[Effect of the early administration of pravastatin on C-reactive protein and interleukin-6 levels in the acute phase of myocardial infarction with ST segment elevation]. / Efecto de la administración precoz de pravastatina en los valores de proteína C reactiva y de interleucina 6 en la fase aguda del infarto de miocardio con elevación del segmento ST.

INTRODUCTION AND OBJECTIVES: C-reactive protein (CRP), whose synthesis in the liver is regulated by interleukin 6 (IL-6), is related with the prognosis for ischemic heart disease. The aim of this study was to evaluate the effect of early administration of pravastatin on plasma levels of CRP and IL-6 in patients with acute myocardial infarction and ST segment elevation. PATIENTS AND METHOD: 71 patients were randomized during the first 10 hours from the onset of symptoms to receive 40 mg of pravastatin once a day or not. CRP and IL-6 were measured on admission, 48 hours and 7 days later. CRP was also measured 2 months later. RESULTS: On admission, levels of CRP and IL-6 were similar in both groups. After 7 days of treatment the administration of pravastatin was associated with a lower level of CRP (P=.002). Mean and median CRP levels decreased from 48 hours to day 7 by 48.4% and 51.9% respectively in the pravastatin group, and by 32.5% and 15.9% respectively in the control group. In contrast, no significant differences in IL-6 levels were observed between the two groups. After 2 months of follow-up, 50% of the treated patients and 25% of the control patients had CRP levels lower than 6.6 mg/L (P=.039). CONCLUSIONS: Early administration of pravastatin in the acute phase of myocardial infarction with ST segment elevation was associated with a lower level of CRP after 7 days of treatment, with no concomitant changes in IL-6 levels.

[Predictors of myocardial contractile reserve in patients with nonischemic dilated cardiomyopathy. An echo-stress dobutamine study]. / Predictores de reserva contráctil miocárdica en pacientes con miocardiopatía dilatada no isquémica. Estudio mediante ecocardiografía de estrés con dobutamina.

INTRODUCTION AND OBJECTIVES: Myocardial contractile reserve studies with low-dose dobutamine echocardiography have been shown to be useful to assess functional myocardial status. However, the variables associated with contractile reserve after inotropic stimulation are not well known. PATIENTS AND METHOD: We studied 50 patients (35 men, mean age 56.4 +/- 9.5 years) with nonischemic dilated cardiomyopathy (NIDC), LVEF 28.7% +/- 8.5% and wall motion score index (WMSI) 2.42 +/- 0.34 with low-dose dobutamine echocardiography. Left ventricular contractile reserve was assessed by a differential parameter defined as the difference between rest and stress WMSI (DeltaWMSI). RESULTS: After dobutamine infusion the WMSI was 1.95 +/- 0.58; from this value we calculated a DeltaWMSI of 0.45 +/- 0.39. None of the clinical variables showed a relationship with the presence of contractile reserve. In contrast, the following echocardiographic parameters correlated with DeltaWMSI: end-diastolic (p=0.05) and end-systolic (p=0.02) diameters, end-systolic volume index (p=0.01) and LVEF (p=0.002). In the multivariate analysis, only end-diastolic diameter was an independent predictor of contractile reserve (hazard ratio=0.852; 95% CI, 0.735-0.987; p=0.03). CONCLUSIONS: Ventricular diameters, end-systolic volume index and LVEF are related with improvements in myocardial contractility after dobutamine infusion, although only end-diastolic diameter was an independent predictor of contractile reserve. Thus, this parameter should receive particular attention in evaluations of the functional status of the myocardium in patients with NIDC.

Predictores de reserva contráctil miocárdica en pacientes con miocardiopatía dilatada no isquémica. Estudio mediante ecocardiografía de estrés con dobutamina / Predictors of myocardial contractile reserve in patients with nonischemic dilated cardiomyopathy. An echo-stress dobutamine study

Introducción y objetivos. Los estudios de reserva contráctil con dobutamina han demostrado su utilidad en la valoración del estado funcional del miocardio. Sin embargo, no se conocen bien las variables asociadas a la presencia de reserva contráctil tras la estimulación inotrópica. Pacientes y método. Con este fin, estudiamos a 50 pacientes (35 varones con una edad de 56,4 ñ 9,5 años) con miocardiopatía dilatada no isquémica (MDNI), fracción de eyección (FE) de 28,7 ñ 8,5 por ciento e índice de motilidad parietal (IMP) de 2,42 ñ 0,34, a los que se realizó una ecocardiografía de estrés con dobutamina a dosis bajas. Se evaluó la respuesta contráctil mediante un parámetro diferencial obtenido de restar del índice de motilidad parietal basal el obtenido al pico del estrés ( IMP).Resultados. Tras la dobutamina se obtuvo un IMP pico de 1,95 ñ 0,58, pudiéndose calcular un IMP medio de 0,45 ñ 0,39. Ninguna variable clínica ni electrocardiográfica mostró relación con la presencia de reserva contráctil. Por el contrario, los diámetros telediastólico (p = 0,05) y telesistólico (p = 0,02), el índice de volumen telesistólico (p = 0,01) y la FE (p = 0,002) se asociaron con la presencia de reserva contráctil. En el análisis multivariable, únicamente el diámetro telediastólico se asoció de forma independiente con el grado de reserva contráctil (OR = 0,852; IC del 95 por ciento, 0,735-0,987; p = 0,03).Conclusiones. Los diámetros ventriculares, el volumen telesistólico y la FE se relacionan con la mejoría de la contractilidad miocárdica tras la infusión de dobutamina, aunque únicamente el diámetro telediastólico es predictor independiente de la presencia de reserva contráctil. Por ello, este parámetro debe ser especialmente considerado a la hora de evaluar el estado funcional del miocardio en pacientes con MDNI (AU)

Endocarditis pulmonar aislada sobre válvula nativa en un paciente anciano sin factores predisponentes / Isolated Pulmonary Valve Endocarditis in an Older Patient without Predisposing Factors

La endocarditis infecciosa aislada sobre válvula pulmonar nativa es una entidad clínica muy poco frecuente en pacientes sin factores predisponentes y no usuarios de drogas por vía parenteral. Presentamos el caso de un paciente de 75 años con un cuadro clínico subagudo de fiebre e infiltrados pulmonares cavitados ingresado en nuestro centro con sospecha inicial de tuberculosis pulmonar. La presencia de hemocultivos positivos para Enterococcus faecalis y la visualización por ecocardiografía transtorácica y transesofágica de una vegetación adherida a la válvula pulmonar condujeron al diagnóstico final (AU)