Toxic effects of domoic acid in the seabream Sparus aurata.

Neurotoxicity induced in fish by domoic acid (DA) was assessed with respect to occurrence of neurotoxic signs, lethality, and histopathology by light microscopy. Sparus aurata were exposed to a single dose of DA by intraperitoneal (i.p.) injection of 0, 0.45, 0.9, and 9.0 mg DA kg(-1) bw. Mortality (66.67 ± 16.67%) was only observed in dose of 9.0 mg kg(-1) bw. Signs of neurological toxicity were detected for the doses of 0.9 and 9.0 mg DA kg(-1) bw. Furthermore, the mean concentrations (±SD) of DA detected by HPLC-UV in extracts of brain after exposure to 9.0 mg DA kg(-1) bw were 0.61 ± 0.01, 0.96 ± 0.00, and 0.36 ± 0.01 mg DA kg(-1) tissue at 1, 2, and 4 hours. The lack of major permanent brain damage in S. aurata, and reversibility of neurotoxic signs, suggest that lower susceptibility to DA or neuronal recovery occurs in affected individuals.

[Clinical and echocardiographic follow-up of patients with hypertrophic obstructive cardiomyopathy treated by percutaneous septal ablation]. / Seguimiento clínico y ecocardiográfico de pacientes con miocardiopatía hipertrófica obstructiva tratados con ablación septal percutánea.

INTRODUCTION AND OBJECTIVES: Alcohol septal ablation is a therapeutic option for patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. Our aim was to monitor clinical and echocardiographic progression in patients with hypertrophic obstructive cardiomyopathy treated by septal ablation at our center. METHODS: Thirty-five septal ablations were performed in 34 patients (79% male) who had symptomatic hypertrophic obstructive cardiomyopathy despite optimum medical treatment. The procedure was successful in 32 (i.e., the reduction in left ventricular outflow tract pressure gradient, or LVOTPG, was >50%). During clinical and echocardiographic follow-up, New York Heart Association (NYHA) functional class and LVOTPG were monitored. RESULTS: The patients' mean age was 63 (12) years. The mean follow-up period was 9 (3) months. Immediately after septal ablation, LVOTPG decreased significantly, from 74.2 (25.3) mm Hg to 26 (25) mm Hg (P<.001), and remained low throughout follow-up. Moreover, echocardiography showed that the interventricular septum thickness also decreased during follow-up, from 19 (3) mm to 15 (2) mm (P<.0001). A significant improvement in NYHA functional class (from 93% in class III-IV to 84% in class I-II) was also observed. Two deaths occurred within 48 hours after the procedure. The most frequent complication was complete heart block (20%; n=6). CONCLUSIONS: Alcohol septal ablation is effective in patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. However, the procedure is associated with a significant rate of complications and should, therefore, be reserved for selected patients, in particular for elderly patients and those with comorbid conditions.

[Left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy treated with percutaneous alcohol septal ablation: an echocardiographic study]. / Remodelado ventricular izquierdo tras ablación septal percutánea con alcohol en pacientes con micardiopatía hipertrófica obstructiva: estudio ecocardiográfico.

INTRODUCTION: In patients with hypertrophic obstructive cardiomyopathy, obstruction in the left ventricular outflow tract may generate more hypertrophy. Our aim was to evaluate the impact of reducing ventricular outflow tract obstruction on left ventricular hypertrophy and remodeling after alcohol septal ablation. PATIENTS AND METHOD: 20 patients with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation were included. Doppler echocardiography was performed in all patients at baseline, immediately after alcohol septal ablation, and at 3 and 12 months' follow-up. Left ventricular diameters and wall thickness and pressure gradients in the ventricular outflow tract were determined. RESULTS: Immediately after alcohol septal ablation, ventricular outflow tract pressure gradient decreased from 63.0 27.7 to 28.2 24.7 mmHg (p < 0.001), without significant changes in left ventricular dimensions. However, after 12 months we observed an increase in left ventricular end-diastolic (from 47.1 4.9 to 50.8 4.5 mm) and end-systolic diameter (from 27.1 3.0 to 33.7 4.6 mm), as well as a reduction in septal (from 19.5 4.0 to 15.5 2.7 mm) and posterior wall thickness (from 14.0 2.2 to 12.9 1.3 mm) (p < 0.01 in all cases). Left ventricular end-diastolic and end-systolic volumes increased (from 106.4 26.9 to 123.1 28.7 ml and from 50.2 17.3 to 56.7 18.3 ml, respectively, p < 0.01 in both cases), without changes in left ventricular ejection fraction. The reduction in ventricular outflow tract pressure gradient at 12 months' follow-up correlated significantly with the increase in left ventricular end-systolic diameter (r = 0.63; p < 0.01). CONCLUSIONS: In patients with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation, relief of ventricular outflow tract obstruction is associated with an increase in left ventricular chamber diameters and volume. These findings suggest that middle- and long-term ventricular remodeling and regression of hypertrophy occur in these patients, which may contribute to their clinical improvement.

Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case-control echocardiographic study.

AIM: Idiopathic paroxysmal atrial fibrillation (AF) occurs in patients with apparently normal heart. Its mechanisms may be complex and are poorly understood. The aim of the study was to evaluate whether patients with idiopathic AF have any structural abnormality that may explain the occurrence of AF. METHODS AND RESULTS: A case-control study was undertaken including 60 consecutive patients (mean age 48 +/- 12 years; 75% men) with idiopathic AF admitted to the emergency department. Sixty sex- and age-matched healthy volunteers made up the control group. An echocardiogram was performed in all patients and volunteers to assess the left atrial (LA) and ventricular (LV) dimensions and valvular function. LV diastolic function was also evaluated by analysis of the LV inflow and pulmonary vein flow velocity patterns and tissue Doppler imaging of the mitral annulus. All AF patients showed normal echocardiographic studies with similar LV dimensions, ejection fraction, and diastolic function when compared with normal controls. However, patients with AF had larger LA dimensions (27 +/- 3 vs. 24 +/- 3 mm/m(2)), LA area (10 +/- 2 vs. 8 +/- 2 mm(2)/m(2)), and LA volume (27 +/- 9 vs. 19 +/- 6 mL/m(2)) (P < 0.05 for all). Among patients with AF, there were no differences in LA size between patients with a first episode or recurrent paroxysmal episodes. CONCLUSION: Patients with idiopathic AF showed larger left atria when compared with controls, there being no differences between patients with a first episode or a recurrence. This suggests the presence of an enhanced substrate to develop idiopathic lone AF.

Seguimiento clínico y ecocardiográfico de pacientes con miocardiopatía hipertrófica obstructiva tratados con ablación septal percutánea / Clinical and echocardiographic follow-up of patients with hypertrophic obstructive cardiomyopathy treated by percutaneous septal ablation

Introducción y objetivos. La ablación septal percutánea (ASP) es una opción terapéutica para pacientes con miocardiopatía hipertrófica obstructiva (MCHO) con mala respuesta al tratamiento médico. El objetivo fue evaluar de forma prospectiva la evolución clínica y ecocardiográfica de los pacientes con MCHO tratados con ASP en nuestro centro. Métodos. Se practicaron 35 ASP en 34 pacientes (79% varones) con MCHO sintomática pese a que recibían un tratamiento médico optimizado. Se consideró eficaz en 32 (reducción del gradiente de presión en el tracto de salida del ventrículo izquierdo [GPTSVI] > 50%). Se realizó un seguimiento clínico y ecocardiográfico, y se evaluaron la clase funcional (CF) y el GPTSVI. Resultados. La edad media fue de 63 ± 12 años. El seguimiento medio fue de 9 ± 3 meses. Inmediatamente después de la ASP se redujo de manera significativa el GPTSVI (74,2 ± 25,3 a 26 ± 25 mmHg; p < 0,001) y se mantuvo así durante todo el seguimiento. Asimismo, se redujo el grosor del septo interventricular (de 19 ± 3 a 15 ± 2 mm; p < 0,0001). La CF de los pacientes mejoró (desde un 93% en CF III-IV de la NYHA hasta un 84% en CF I-II). Dos pacientes fallecieron en las primeras 48 h posprocedimiento y la complicación más frecuente fue el bloqueo auriculoventricular completo (n = 6, 20%). Conclusiones. La ASP es una terapia eficaz en pacientes con MCHO sintomática refractaria al tratamiento médico. Sin embargo, se asocia con un riesgo significativo de complicaciones, por lo que se reserva para pacientes seleccionados, especialmente para los de mayor edad o con alguna comorbilidad asociada

Introduction and objectives. Alcohol septal ablation is a therapeutic option for patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. Our aim was to monitor clinical and echocardiographic progression in patients with hypertrophic obstructive cardiomyopathy treated by septal ablation at our center. Methods. Thirty-five septal ablations were performed in 34 patients (79% male) who had symptomatic hypertrophic obstructive cardiomyopathy despite optimum medical treatment. The procedure was successful in 32 (i.e., the reduction in left ventricular outflow tract pressure gradient, or LVOTPG, was >50%). During clinical and echocardiographic follow-up, New York Heart Association (NYHA) functional class and LVOTPG were monitored. Results. The patients' mean age was 63 (12) years. The mean follow-up period was 9 (3) months. Immediately after septal ablation, LVOTPG decreased significantly, from 74.2 (25.3) mm Hg to 26 (25) mm Hg (P<.001), and remained low throughout follow-up. Moreover, echocardiography showed that the interventricular septum thickness also decreased during follow-up, from 19 (3) mm to 15 (2) mm (P<.0001). A significant improvement in NYHA functional class (from 93% in class III-IV to 84% in class I-II) was also observed. Two deaths occurred within 48 hours after the procedure. The most frequent complication was complete heart block (20%; n=6). Conclusions. Alcohol septal ablation is effective in patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. However, the procedure is associated with a significant rate of complications and should, therefore, be reserved for selected patients, in particular for elderly patients and those with comorbid conditions

Remodelado ventricular izquierdo tras ablación septal percutánea con alcohol en pacientes con miocardiopatía hipertrófica obstructiva: estudio ecocardiográfico / Left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy treated with percutaneous alcohol septal ablation: an echocardiographic study

Introducción. Evaluamos el impacto de la reducción de la obstrucción en el tracto de salida del ventrículo izquierdo tras la ablación septal percutánea con alcohol sobre la hipertrofia y el remodelado del ventrículo izquierdo (VI). Pacientes y método. Se incluyó a 20 pacientes con miocardiopatía hipertrófica tratados con ablación septal percutánea. Se realizó ecocardiograma Doppler en situación basal, inmediatamente después de la ablación septal percutánea y a los 3 y 12 meses de seguimiento, en el que se midieron los diámetros y grosores del VI y del gradiente de presión en el tracto de salida del ventrículo izquierdo. Resultados. Inmediatamente después de la ablación septal percutánea, el gradiente de presión en el tracto de salida del VI disminuyó de 63,0 ñ 27,7 a 28,2 ñ 24,7 mmHg (p < 0,001), sin que se apreciaran cambios significativos en las dimensiones del VI. Doce meses después se observó un incremento en los diámetros telediastólico (de 47,1 ñ 4,9 a 50,8 ñ 4,5 mm; p < 0,01) y telesistólico del VI (de 27,1 ñ 3,0 a 33,7 ñ 4,6 mm; p < 0,01) y una reducción en los grosores del septo (de 19,5 ñ 4,0 a 15,5 ñ 2,7 mm; p < 0,01) y de la pared posterior del VI (de 14,0 ñ 2,2 a 12,9 ñ 1,3 mm; p < 0,01). Los volúmenes telediastólico y telesistólico del VI aumentaron (de 106,4 ñ 26,9 a 123,1 ñ 28,7 ml; p < 0,01, y de 50,2 ñ 17,3 a 56,7 ñ 18,3 ml; p < 0,01, respectivamente), sin que se observaran cambios en la fracción de eyección del VI. La reducción del gradiente de presión en el tracto de salida del ventrículo izquierdo observada a los 12 meses de la ablación septal percutánea se correlacionó de manera significati a con el incremento del diámetro telesistólico del VI (r = 0,63; p < 0,01).Conclusiones. La reducción de la obstrucción en el tracto de salida del ventrículo izquierdo en pacientes con miocardiopatía hipertrófica tratados con ablación septal percutánea se acompaña de un incremento de los diáme tros y volúmenes del VI en el seguimiento. Esto indica el desarrollo de un remodelado cardíaco y de una regresión en la hipertrofia del VI de estos pacientes que podría contribuir a su mejoría sintomática (AU)