Valvulopatía mitral y tricuspídea: diagnóstico y tratamiento. Posicionamiento conjunto de la Sección de Valvulopatías y las Asociaciones de Imagen, Cardiología Clínica y Cardiología Intervencionista de la SEC / Mitral and tricuspid valve disease: diagnosis and management. Consensus document of the Section on Valvular Heart Disease and the Cardiovascular Imaging, Clinical Cardiology, and Interventional Cardiology Associations of the Spanish Society of Cardiology

El diagnóstico y el tratamiento de la valvulopatía mitral y tricuspídea han sufrido unos cambios extraordinarios en los últimos años. La irrupción de las intervenciones percutáneas y la generalización de las nuevas técnicas de imagen han modificado las recomendaciones para el diagnóstico y el tratamiento de estas afecciones. La ingente cantidad de publicaciones y estudios en este campo obliga a una continua actualización de nuestros protocolos. La publicación de la guía de la Sociedad Europea de Cardiología de 2021 sobre el tratamiento de las valvulopatías no cubre algunos aspectos novedosos de estos tratamientos y, además, el número de intervenciones realizadas en los países de nuestro entorno es muy variable, lo que exige una adecuación de las recomendaciones al contexto local. Además, es indispensable un resumen de toda esta información para que se pueda generalizar su uso. Por estos motivos, se considera necesario el posicionamiento común de la Asociación de Cardiología Intervencionista, la Asociación de Imagen Cardiaca, la Asociación de Cardiología Clínica y la Sección de Valvulopatías y Patología Aórtica de la Sociedad Española de Cardiología para el diagnóstico y el tratamiento de la valvulopatía mitral y tricuspídea (AU)

The diagnosis and management of mitral and tricuspid valve disease have undergone major changes in the last few years. The expansion of transcatheter interventions and widespread use of new imaging techniques have altered the recommendations for the diagnosis and treatment of these diseases. Because of the exponential growth in the number of publications and clinical trials in this field, there is a strong need for continuous updating of local protocols. The recently published 2021 European Society of Cardiology guidelines for the management of valvular heart disease did not include some of the new data on these new therapies and, moreover, the number of mitral and tricuspid interventions varies widely across Europe. Therefore, all this information must be summarized to facilitate its use in each specific country. Consequently, we present the consensus document of the Section on Valvular Disease, Cardiovascular Imaging, Clinical Cardiology, and Interventional Cardiology Associations of the Spanish Society of Cardiology for the diagnosis and management of mitral and tricuspid valve disease (AU)

Impacto de la adherencia a las recomendaciones de hábitos de vida cardiosaludables en la capacidad funcional a largo plazo en pacientes que han completado un programa de rehabilitación cardíaca / Impact of adherence to recommendations on a healthy heart lifestyle on long-term functional capacity in patients completing a cardiac rehabilitation programme

Objetivo. Estudiar el grado de adherencia a largo plazo a los hábitos de vida cardiosaludables en pacientes isquémicos que han completado un programa de rehabilitación cardíaca y prevención secundaria (PRCyPS) y su impacto en la capacidad funcional. Diseño. Estudio analítico de cohortes histórico de pacientes isquémicos de riesgo moderado que completaron un PRCyPS en una Unidad de Rehabilitación Cardíaca en 2006-2007. Material y método. Las variables de estudio se recogieron en 3períodos: antes de empezar, tras terminar y a los 6 años de finalizar el PRCyPS. Como instrumentos de medida se utiliza el cuestionario sobre dieta mediterránea de Trichopoulou, el test de Morisky Green, el cuestionario internacional sobre actividad física y una ergometría. Se consideró cumplidor al paciente que seguía los 4 consejos cardiosaludables. La significación estadística se estableció en p<0,05. Resultados. Un total de 41 pacientes revisados a los 6 años (38 hombres, con 56 años de edad media). La adherencia a las recomendaciones cardiosaludables a los 6 años la cumplían 13 pacientes (32%). Los no cumplidores alcanzaron una capacidad funcional al finalizar el programa y a los 6 años de 10,4 y 8,3 respectivamente, mientras que los cumplidores alcanzaron 9,8 y 8,9. La pérdida de capacidad funcional en los no cumplidores fue del 20% frente a solo el 6% en los cumplidores (p=0,02). Conclusión. La adherencia a las recomendaciones de hábitos de vida cardiosaludables transmitidas en los PRCyPS a los 6 años es bajo (32%). Los pacientes que siguen todas las recomendaciones solo pierden un 6% de la capacidad funcional a los 6 años frente al 20% de la capacidad funcional que pierden los pacientes que no tienen una buena adherencia (AU)

Objective. To evaluate long-term adherence to healthy heart lifestyle habits in ischemic patients completing a cardiac rehabilitation/secondary prevention (CR/SP) programme and its impact on functional capacity. Design. Analytic historical cohort study of ischemic patients at moderate-risk who completed a CR/SP programme in a Cardiac Rehabilitation Unit from 2006-2007. Material and method. The study variables were collected in 3periods: Before and after the programme and 6 years later. Measurement instruments included Trichopoulou's Mediterranean diet questionnaire, the Morisky Green test, the International Physical Activity Questionnaire and a stress test. Patients following 4 healthy heart recommendations were considered to be adherent. Statistical significance was set at P<.05. Results. A total of 41 patients were evaluated at 6 years; 38 were men and the mean age was 56 years. Thirteen patients (32%) were considered adherent to healthy heart recommendations at 6 years. At the end of the programme and at 6 years, functional capacity was 10.4 and 8.3, respectively, in adherent patients and 9.8 and 8.9 in non-adherent patients. Loss of functional capacity in non-adherent patients was 20% compared with only 6% in adherent patients (P=.02). Conclusion. Adherence to healthy heart recommendations made in a CP/SP programme was low (32%). Patients who adhered to all the recommendations lost only 6% of their functional capacity at 6 years compared with 20% of functional capacity in non-adherent patients (AU)

Importancia de la hipertrofia ventricular izquierda hipertensiva en pacientes con eventos isquémicos coronarios o cerebrales / Importance of hypertensive left ventricular hypertrophy in patients with ischemic events of the heart or brain

Introducción y objetivo: La hipertrofia ventricular izquierda hipertensiva (HVI-H) es un factor de riesgo cardiovascular (FRV) potencialmente modificable que a menudo se pasa por alto en la práctica clínica. Nos planteamos evaluar la frecuencia de la HVI-H en pacientes con enfermedad coronaria (EC) o ictus isquémico (IS). Pacientes y métodos: Estudio retrospectivo de todos los estudios ecocardiográficos de los pacientes ingresados por EC o IS durante un período de 4 años. Resultados: Se estudió a 533 pacientes, 330 con EC y 203 con IS. Edad media 69 (±11) años; el 61,5% varones. La hipertensión fue el más común de los FRV: 362 pacientes (67,9%) (EC vs. IS: 70 vs. 64,5%; p = NS). La HVI-H se observó en 234 pacientes (43,9%) (EC vs. IS: 44,8 vs. 42,3%; p = NS). Los pacientes con HVI-H tenían mayor edad y recibieron un mayor número de fármacos antihipertensivos al alta. La mitad de los pacientes con hipertensión (184 pacientes; 50,8%) presentó HVI-H, con una frecuencia similar en ambos grupos (EC vs. IS: 50,6 vs. 51,1%; p = NS). Ninguna de las características de los pacientes ni ningún FRV salvo la hipertensión (p = 0,0001) se asoció con la HVI-H. Conclusiones: La HVI-H es un FRV importante en los pacientes con eventos isquémicos en el corazón y el cerebro. Casi la mitad de los pacientes presentan HVI-H, con una frecuencia similar en ambos grupos. Es importante identificar la HVI-H en estos pacientes para optimizar el tratamiento y mejorar el pronóstico a largo plazo

Introduction and objective: Hypertensive left ventricular hypertrophy (H-LVH) is a potentially modifiable vascular risk factor (VRF) often overlooked in clinical practice. We aimed to evaluate the frequency of H-LVH in patients with coronary heart disease (CHD) or ischemic stroke (IS). Patients and methods: We retrospectively assessed all the echocardiography studies of patients admitted with the diagnosis CHD or IS over a 4-year period. Results: We studied 533 patients, 330 with CHD and 203 with IS. Mean age was 69 (±11) years, 61.5% males. Hypertension was the most common RF: 362 patients (67.9%) (CHD vs. IS: 70 vs. 64.5%; P=NS). H-LVH was seen in 234 patients (43.9%) (CHD vs. IS: 44.8 vs. 42.3%; P=NS). Patients with H-LVH were older and received a greater number of antihypertensive drugs at discharge. Half of patients with hypertension presented H-LVH (184 patients; 50.8%), with similar frequency in both groups (CHD vs. IS: 50.6 vs. 51.1%; P=NS). Neither patients’ characteristics nor VRF with the exception of hypertension (P=.0001) were associated with H-LVH. Conclusions: H-LVH is a major VRF in patients with ischemic events in the heart and brain. Nearly half the patients present H-LVH, with a similar frequency in both groups. It is important to identify H-LVH in these patients to optimize treatment and improve long-term prognosis

[Importance of hypertensive left ventricular hypertrophy in patients with ischemic events of the heart or brain]. / Importancia de la hipertrofia ventricular izquierda hipertensiva en pacientes con eventos isquémicos coronarios o cerebrales.

INTRODUCTION AND OBJECTIVE: Hypertensive left ventricular hypertrophy (H-LVH) is a potentially modifiable vascular risk factor (VRF) often overlooked in clinical practice. We aimed to evaluate the frequency of H-LVH in patients with coronary heart disease (CHD) or ischemic stroke (IS). PATIENTS AND METHODS: We retrospectively assessed all the echocardiography studies of patients admitted with the diagnosis CHD or IS over a 4-year period. RESULTS: We studied 533 patients, 330 with CHD and 203 with IS. Mean age was 69 (±11) years, 61.5% males. Hypertension was the most common RF: 362 patients (67.9%) (CHD vs. IS: 70 vs. 64.5%; P=NS). H-LVH was seen in 234 patients (43.9%) (CHD vs. IS: 44.8 vs. 42.3%; P=NS). Patients with H-LVH were older and received a greater number of antihypertensive drugs at discharge. Half of patients with hypertension presented H-LVH (184 patients; 50.8%), with similar frequency in both groups (CHD vs. IS: 50.6 vs. 51.1%; P=NS). Neither patients' characteristics nor VRF with the exception of hypertension (P=.0001) were associated with H-LVH. CONCLUSIONS: H-LVH is a major VRF in patients with ischemic events in the heart and brain. Nearly half the patients present H-LVH, with a similar frequency in both groups. It is important to identify H-LVH in these patients to optimize treatment and improve long-term prognosis.

Recomendaciones sobre rehabilitación cardíaca en la cardiopatía isquémica de la Sociedad de Rehabilitación Cardio-Respiratoria (SORECAR) / Recommendations of the Cardio-Respiratory Rehabilitation Society (SORECAR) on cardiac rehabilitation in ischemic heart disease

La cardiopatía isquémica supone la mayor causa de muerte en España y en el mundo occidental. El programa de rehabilitación cardíaca engloba todas las medidas para realizar prevención secundaria en estos pacientes y mejorar la morbimortalidad. Es un programa eficaz, pero su implementación es escasa y variable, siendo inferior al 5% en España, por lo que se debería priorizar estrategias para facilitar la realización de estos programas. Un grupo de expertos fue nombrado por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para realizar una revisión de todas las evidencias disponibles en rehabilitación cardíaca y elaborar un documento aplicándolo a la práctica clínica. El resultado ha sido la elaboración final de un protocolo de actuación en rehabilitación cardíaca, con instrucciones o recomendaciones a modo de resumen. Contiene aspectos sobre rehabilitación cardíaca para disminuir la variabilidad entre dichas Unidades y crear las bases para una adecuada acreditación de Unidades de Rehabilitación Cardíaca (AU)

Ischemic heart disease is the largest cause of death in Spain and the Western world. Cardiac rehabilitation programs encompass all the measures necessary for secondary prevention in these patients and to improve morbidity and mortality. These programs are effective, but their implementation is low and variable, being less than 5% in Spain. Consequently, priority should be given to strategies that facilitate the implementation of these programs. A group of experts was appointed by the Cardio-Respiratory Rehabilitation Society (SORECAR) to review all the available evidence on cardiac rehabilitation and apply it to develop a clinical practice document. The end result was the development of a protocol for cardiac rehabilitation, with instructions or summarized recommendations. The document discusses aspects of cardiac rehabilitation that reduce variation among these units and provides a basis for proper accreditation of cardiac rehabilitation units (AU)

Mortalidad total y morbilidad cardiovascular a largo plazo en pacientes con cardiopatía isquémica que han completado un programa de rehabilitación cardíaca y prevención secundaria / Long-term total mortality and cardiovascular morbidity in patients with ischemic cardiac disease who completed a cardiac rehabilitation and secondary prevention program

Introducción y objetivos. Estudiar mortalidad total y morbilidad cardiovascular a largo plazo en pacientes isquémicos que han completado un programa de rehabilitación cardíaca y prevención secundaria analizando qué factores pueden predecir la presentación de dicha morbimortalidad. Métodos. Análisis retrospectivo de una muestra recogida prospectivamente de 342 pacientes que completaron un programa de rehabilitación cardíaca y prevención secundaria en el período 2005-2008. Se revisaron ingresos hospitalarios por causa cardiovascular, tipo de reingreso (urgencias/hospitalario), necesidad de revascularización (percutánea/quirúrgica) y mortalidad. La asociación de los factores estudiados con la morbimortalidad fueron analizados mediante análisis univariante y curvas de supervivencia Kaplan-Meier. La significación estadística se establece en p < 0,05. Resultados. Durante el seguimiento (media de 2.105 días) fallecieron 12 pacientes (3,5%). La principal causa fue el cáncer. Reingresaron 116 pacientes (34%). El 10,5% precisó nueva revascularización coronaria. El accidente vascular cerebral fue el evento vascular no cardíaco más frecuente (4,7%), seguido de claudicación intermitente (2,3%). Un paciente precisó amputación. Los factores predictores de morbimortalidad fueron edad (p = 0,005), hábito tabáquico (p = 0,016) y grupo de riesgo (p = 0,002). La diabetes mellitus mostró mayor morbimortalidad durante el seguimiento. Conclusiones. Nuestros resultados muestran baja mortalidad en los pacientes que han completado un programa de rehabilitación cardíaca y prevención secundaria tras sufrir un evento coronario pero con una morbilidad cardiovascular alta (34% a 5 años). Los factores asociados con la aparición de morbimortalidad fueron edad mayor de 65 años, grupo de riesgo moderado-alto, hábito tabáquico y presencia de diabetes mellitus. Estos resultados muestran la necesidad de establecer estrategias individuales para aumentar la adherencia a las medidas de prevención secundaria de eventos cardiovasculares (AU)

Introduction and objectives. To study long-term mortality and cardiovascular morbidity in ischemic patients who completed a cardiac rehabilitation and secondary prevention program by analyzing the factors that may predict the occurrence of these events. Methods. We carried out a retrospective analysis of a prospectively enrolled sample of 342 patients who completed a cardiac rehabilitation and secondary prevention program between 2005 and 2008. We reviewed hospital admissions for cardiovascular causes, type of readmission (emergency unit/hospital), need for revascularization (percutaneous versus surgical) and mortality. The association of the studied factors with morbidity and mortality was determined by univariate analysis and Kaplan-Meier survival curves. Statistical significance was set at p < 0.05. Results. During follow-up (mean 2105 days), 12 patients (3.5%) died. The main cause was cancer. A total of 116 patients (34%) were readmitted for cardiovascular causes, while 10.5% needed revascularization. The most frequent non cardiac vascular event was stroke (4.7%), followed by intermittent claudication (2.3%). One patient required amputation. Predictors associated with morbidity and mortality were age (p = 0.005), smoking (p = 0.016), and risk group (p = 0.002). Diabetes mellitus also increased morbidity and mortality during follow-up. Conclusions. Patients who completed a cardiac rehabilitation and secondary prevention program after a coronary event had low mortality but high cardiovascular morbidity (34% at 5 years). The factors associated with this morbidity and mortality were age over 65 years, belong to a moderate to high risk group, smoking, and diabetes mellitus. These results demonstrate the need for individual strategies to increase adherence to secondary prevention measures for cardiovascular events (AU)

Time-course effects of aerobic interval training and detraining in patients with metabolic syndrome.

BACKGROUND AND AIMS: Exercise training can improve health of patients with metabolic syndrome (MetS). However, which MetS factors are most responsive to exercise training remains unclear. We studied the time-course of changes in MetS factors in response to training and detraining. METHODS AND RESULTS: Forty eight MetS patients (52 ± 8.8 yrs old; 33 ± 4 BMI) underwent 4 months (3 days/week) of supervised aerobic interval training (AIT) program. After 1 month of training, there were progressive increases in high density lipoprotein cholesterol (HDL-c) and reductions in waist circumference and blood pressure (12 ± 3, -3.9 ± 0.4, and -12 ± 1%, respectively after 4 months; all P < 0.05). However, fasting plasma concentration of triglycerides and glucose were not reduced by training. Insulin sensitivity (HOMA), cardiorespiratory fitness (VO2peak) and exercise maximal fat oxidation (FOMAx) also progressively improved with training (-17 ± 5; 21 ± 2 and 31 ± 8%, respectively, after 4 months; all P < 0.05). Vastus lateralis samples from seven subjects revealed that mitochondrial O2 flux was markedly increased with training (71 ± 11%) due to increased mitochondrial content. After 1 month of detraining, the training-induced improvements in waist circumference and blood pressure were maintained. HDL-c and VO2peak returned to the values found after 1-2 months of training while HOMA and FOMAx returned to pre-training values. CONCLUSIONS: The health related variables most responsive to aerobic interval training in MetS patients are waist circumference, blood pressure and the muscle and systemic adaptations to consume oxygen and fat. However, the latter reverse with detraining while blood pressure and waist circumference are persistent to one month of detraining.

Efectividad de la rehabilitación cardiaca en pacientes con diabetes mellitus tipo ii / Effectiveness of cardiac rehabilitation in patients with type ii diabetes mellitus

Introducción y objetivos. Los pacientes con diabetes mellitus tipo ii tienen un riesgo cardiovascular de 2 a 4 veces mayor a la población general, siendo esta la principal causa de muerte. El objetivo del estudio es comparar los resultados de los pacientes con diabetes mellitus tipo ii frente a los no diabéticos que completan un programa de rehabilitación cardiaca, y analizar la incidencia de complicaciones cardiológicas y del aparato locomotor. Material y método. Estudio cuasiexperimental comparando los subgrupo de pacientes diabéticos frente a los no diabéticos, en cuanto a control de factores de riesgo y capacidad funcional de los pacientes que han completado el programa en nuestra Unidad entre 01/01/2009 y 31/12/2010. Resultados. Trescientos ochenta y seis pacientes, de los cuales 81 con diabetes mellitus tipo ii. La edad media era de 54,5 años y el 92% son varones. Los pacientes diabéticos tenían una menor capacidad funcional al inicio del programa mejorando de forma similar tras realizar el programa de rehabilitación cardiaca (8±1,9 vs. 9,2±2), que los no diabéticos (9,2±2,2 vs. 10,3±2,2). Presentaron un aumento del HDL en ambos grupos de forma estadísticamente significativa, sin cambios en colesterol total y colesterol LDL. Mayor porcentaje de incidencias cardiológicas en el grupo de diabéticos (6,2 vs. 1,6%; p<0,04). Conclusiones. Los pacientes con diabetes mellitus tipo ii han presentado una mejoría similar con el programa de rehabilitación cardiaca respecto a los no diabéticos. El grupo de diabéticos presentaron una mayor incidencia de eventos cardiológicos, aunque ningún evento fatal, durante el programa de ejercicio lo que nos obliga a considerar este factor como predictor de riesgo de estos eventos durante la realización del ejercicio físico (AU)

Introduction and objectives. Type ii diabetic patients have two to four times more cardiovascular risk than the general population, cardiovascular disease being their main cause of death. The aim of this study was to compare the results between type ii diabetic patients and non-diabetic patients who underwent a cardiac rehabilitation program and to analyze the incidence of cardiologic and musculoskeletal complications. Material and method. A quasiexperimental study comparing the subgroup of diabetic and non-diabetic patients in regards to risk factors and the functional capacity of patients who had completed the program in our Unit between 1/1/2009 and 12/31/2010. Results. The 386 patients, 81 of whom were diabetic, mean age 54.5 years, 92% of whom were male. The diabetic patients had less functional capacity before starting the program (8±1.9 vs. 9.2±2) than the non-diabetics (9.2±2.2 vs. 10.3±2.2). There was a statistically significant increase in HDL in both groups, while total cholesterol and LDL-cholesterol remained unchanged. The diabetic group had a higher percentage of cardiological complications (6.2 vs. 1.6%; P<.04). Conclusions. Type ii diabetic patients presented a similar improvement after the cardiac rehabilitation program compared to non-diabetic ones. The diabetic group had a greater incidence of cardiological events during the exercise program, although none of them were lethal, so we must consider diabetes as a risk predictor of these events during exercise (AU)

[Calcific myonecrosis of the leg]. / Mionecrosis calcificante de la pierna.

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate. We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases.

Mionecrosis calcificante de la pierna / Calcific myonecrosis of the leg

La mionecrosis calcificante es una rara secuela postraumática que se localiza casi exclusivamente en la extremidad inferior, y que puede ser confundida con una neoplasia primaria agresiva. Esta lesión, descrita inicialmente por Gallei y Thompson en 1960, se caracteriza por la formación de una masa calcificada que aparece varias décadas después de un traumatismo. El mecanismo fisiopatológico no es conocido, sin embargo la lesión parece que es debida a una isquemia postraumática y puede asociarse con una lesión del ciático poplíteo externo. La imagen radiográfica típica es una masa de partes blandas fusiforme con calcificaciones lineales. El tratamiento de elección es conservador en los casos asintomáticos ya que el tratamiento quirúrgico tiene un alto porcentaje de complicaciones. Presentamos 4 casos de mionecrosis calcificante tratados quirúrgicamente en nuestro hospital. Tres de los casos se infectaron por lo que precisaron sendos desbridamientos y terapias especiales para su resolución definitiva (AU)

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate. We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases (AU)

Prolonged treatment with the anabolic-androgenic steroid stanozolol increases antioxidant defences in rat skeletal muscle.

Testosterone and its synthetic derivatives anabolic-androgenic steroids have been shown to increase skeletal muscle work capacity and fatigue resistance, but the molecular basis for these effects remains uncertain. Since muscle performance has been related to redox status of exercising muscles, this investigation was aimed at testing whether a treatment with suprapharmacological doses of the anabolic-androgenic steroid stanozolol, (2 mg/kg body weight, 5 days/week, for 8 weeks), either alone or in conjunction with treadmill training (12 weeks), enhanced antioxidant defences in rat muscles. Stanozolol treatment did not modify thiobarbituric acid reactive substances and glutathione content in soleus and extensor digitorum longus (EDL) homogenates. In soleus from sedentary rats, superoxide dismutase and glutathione reductase activities were increased by 25% (P < 0.05) and by 40% (P < 0.01) after stanozolol administration, whereas catalase and glutathione peroxidase activities were not modified. This response was similar to that induced by training alone. In EDL from sedentary rats, stanozolol increased only superoxide dismutase activity (20%, P < 0.05). In no case, the effects of steroid administration and training were additive. HSP72 levels were up-regulated in soleus (1.5-fold, P < 0.01) and EDL (threefold, P < 0.001) following training but remained unchanged after stanozolol treatment. Endurance capacity, assessed in a treadmill endurance test, was similar for treated and control rats. We conclude that stanozolol treatment increases antioxidant capacity in selected skeletal muscles from sedentary rats. However, the steroid was not effective in improving endurance capacity or enhancing the training effects on muscle antioxidant defence systems.

Prolonged treatment with the anabolic–androgenic steroid stanozolol increases antioxidant defences in rat skeletal muscle

No disponible

Testosterone and its synthetic derivatives anabolic–androgenic steroids have been shown to increase skeletal muscle work capacity and fatigue resistance, but the molecular basis for these effects remains uncertain. Since muscle performance has been related to redox status of exercising muscles, this investigation was aimed at testing whether a treatment with suprapharmacological doses of the anabolic–androgenic steroid stanozolol, (2 mg/kg body weight, 5 days/week, for 8 weeks), either alone or in conjunction with treadmill training (12 weeks), enhanced antioxidant defences in rat muscles. Stanozolol treatment did not modify thiobarbituric acid reactive substances and glutathione content in soleus and extensor digitorum longus (EDL) homogenates. In soleus from sedentary rats, superoxide dismutase and glutathione reductase activities were increased by 25% (P < 0.05) and by 40% (P < 0.01) after stanozolol administration, whereas catalase and glutathione peroxidase activities were not modified. This response was similar to that induced by training alone. In EDL from sedentary rats, stanozolol increased only superoxide dismutase activity (20%, P < 0.05). In no case, the effects of steroid administration and training were additive. HSP72 levels were up-regulated in soleus (1.5-fold, P < 0.01) and EDL (threefold, P < 0.001) following training but remained unchanged after stanozolol treatment. Endurance capacity, assessed in a treadmillendurance test, was similar for treated and control rats. We conclude that stanozolol treatment increases antioxidant capacity in selected skeletal muscles from sedentary rats. However, the steroid was not effective in improving endurance capacity or enhancing the training effects on muscle antioxidant defence systems (AU)

Trombosis protésica tricúspide sometida a fibrinolisis con control ecocardiográfico seriado / Tricuspid prosthetic trombosis treated with fibronolisis with sequential echocardiographic control

No disponible

[Mitral prosthetic valve and presyncope]. / Prótesis mecánica mitral y cuadros presincopales.

The incidence of mitral prosthetic valve thrombosis is low and generally dependent on low levels of anticoagulation. The clinical presentation is highly variable and ranges from asymptomatic patient though to arterial embolism or hemodynamic symptoms of valve obstruction. We report a case of a patient with presyncope and prosthetic mitral valve dysfunction with intermittent flow obstruction.

Prótesis mecánica mitral y cuadros presincopales / Mitral prosthetic valve and presyncope

La trombosis protésica mitral es una entidad poco frecuente, cuya incidencia se relaciona habitualmente con niveles bajos de anticoagulación. La presentación clínica varía desde pacientes asintomáticos, embolismo arterial o compromiso hemodinámico por obstrucción. Presentamos el caso de una disfunción protésica mitral con cuadros presincopales por obstrucción intermitente al flujo

The incidence of mitral prosthetic valve thrombosis is low and generally dependent on low levels of anticoagulation. The clinical presentation is highly variable and range from asintomatic patient though to arterial embolism or hemodinamic symptoms of valve obstruction. We report a case of a patient with presyncope and prosthetic mitral valve dysfunction with intermitent flow obstruction

Regulation of transverse tubule ecto-ATPase activity in chicken skeletal muscle.

Transverse tubule (T-tubule) ecto-ATPase from chicken skeletal muscle is an integral membrane glycoprotein that seems to exist as a homodimer and exhibits unusual properties. Treatment of T-tubule membranes with concanavalin A (Con A) did not significantly affect the thermal variation of the fluorescence anisotropy of vesicles labelled with 1,6-diphenyl-1,3,5-hexatriene or trimethylammonium-1,6-diphenyl-1,3,5-hexatriene. Cross-linking of membrane components with glutaraldehyde elicited effects on ecto-ATPase activity very similar to those of Con A treatment: a severalfold increase in activity, a decrease in Triton X-100 sensitivity and a requirement to be present before ATP to exert its action. In addition, glutaraldehyde and Con A normalized the temperature dependence and the kinetic behaviour of the enzyme. Membrane-perturbing agents (detergents, alcohols and cholesterol oxidase), with the sole exception of digitonin, caused a marked decrease in ecto-ATPase activity; the prior presence of Con A prevented this inhibition, whereas when the lectin was added after the membrane perturbing agent, recovery of the activity was not always possible. The addition of nucleotides before Con A led to a suppression of ecto-ATPase stimulation; it occurred when the nucleotide was hydrolysed (ATP or UTP) and when it was not (adenosine 5'-[beta,gamma-imido]triphosphate) and even in the presence of 3 mM P(i). A model is proposed for the complex regulatory mechanisms of chicken T-tubule ecto-ATPase that involves the occurrence of two different catalytic states in an equilibrium modulated by lectins and cross-linking agents, by the structure of the membrane and by the presence of ligands for a regulatory site.

Short-term effects of marathon running in master runners: no evidence of myocardial injury.

The purpose of this investigation was to analyze the short-term effects of marathon running on serum levels of cardiac markers in a group of master runners (> 60 yrs). Ten marathoners (9 male and 1 female; 63+/-4 yrs) were enrolled in the study. All of them completed the Madrid Marathon (1998). Venous blood was drawn from each subject three times during the study (48 h before the race, immediately after the race, and 24 h post-competition) for the determination of the several biochemical markers, such as total creatine kinase catalytic activity (total CK), mass concentration of creatine kinase isoenzyme MB (CK-MB mass), and cardiac troponin I (Tnl-c). The most important finding was that in each sample (pre- or post-race) serum Tnl-c was below the commonly accepted level of 0.1 ng x m(-1) indicative of myocardial injury. Although further research is needed using more complete methodology, our results suggest that marathon running does not have an acute deleterious effect on the hearts of the elderly.

Short-term effects of marathon running: no evidence of cardiac dysfunction.

PURPOSE: The purpose of this study was to analyze the short-term effects of a marathon race (Madrid Marathon) on both markers of cardiac damage and echocardiographic parameters in a group of 22 runners (17 male and 5 female; 34 +/- 5 yr; VO2max: 55.7 +/- 9.1 mL x kg(-1) x min(-1) with a wide range of fitness levels. METHODS: Venous blood samples were collected from each subject 48 h before the race, at race finish, and 6, 24, and 48 h postexercise for the determination of myoglobin, total creatine kinase catalytic activity (total CK), mass concentration of creatine kinase isoenzyme MB (CK-MB mass), and cardiac isoforms of troponin T and I (TnT-c and TnI-c, respectively). In addition, echocardiographic parameters (M-mode two-dimensional and Doppler analysis) indicative of both left ventricular (LV) systolic and diastolic function were obtained three times from each runner: 2-5 d before the race, at race finish, and 24-36 h after exercise. RESULTS: Except in one subject, levels of TnT-c and TnI-c were within normal limits (<0.1 ng x mL(-1)) in all the samples collected before or after the race. Overall LV systolic function was not altered by marathon running. Finally, LV diastolic function was transiently altered after the race since the ratio between peak early and late transmitral filling velocities (E/A) was significantly reduced at race finish (P < 0.01) and returned to resting levels after 24-36 h. CONCLUSIONS: Our findings suggest that marathon running does not adversely affect the hearts of healthy individuals independently from their training status.