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Influencia del sexo sobre la indicación de revascularización coronaria quirúrgica. Peculiaridades técnicas y resultados en la mujer

2013-06-05T01:39:50Z

Title: Influencia del sexo sobre la indicación de revascularización coronaria quirúrgica. Peculiaridades técnicas y resultados en la mujer Author(s) : Llorens, R. (Rafael)

Normas de actuación en el paciente con infarto agudo de miocardio

2013-06-05T01:38:51Z

Title: Normas de actuación en el paciente con infarto agudo de miocardio Author(s) : Alegria, E. (Eduardo); Lopez-Bescos, L. (L.); Asin, E. (E.); Cabades, A. (A.); San-Jose, J.M. (J. M.)

Aneurisma de aorta ascendente en pacientes con sustitución valvular aórtica previa

2013-06-05T01:35:47Z

Title: Aneurisma de aorta ascendente en pacientes con sustitución valvular aórtica previa Author(s) : Gonzalez-Fernandez, A.L. (A. L.); Martin-Trenor, A. (Alejandro); Herreros, J. (Jesús); Llorens, R. (Rafael); Gil, O. (O.); Calabuig, J. (José); Alava, E. (Enrique) de Abstract: We conclude that an aggressive surgical approach should be adopted in patients with degenerative aortic regurgitation and moderate dilatation of the ascending aorta because of the rapid progression of the aortic disease. We advise complete replacement of the aortic root.

Endocarditis por Listeria monocytogenes sobre bioprótesis de Hancock

2013-06-05T01:35:46Z

Title: Endocarditis por Listeria monocytogenes sobre bioprótesis de Hancock Author(s) : Aparici, M. (M.); Saenz-de-Buruaga, J.D. (J. D.); Castello, R. (R.); Hidalgo, R. (R.); Peteiro, J. (J.); Frades, M. (M.); Martin-Trenor, A. (Alejandro)

Xenoinjerto de Carpentier-Edwards: evolución a los 13 años

2013-06-05T01:37:07Z

Title: Xenoinjerto de Carpentier-Edwards: evolución a los 13 años Author(s) : Casillas, J.A. (J. A.); Llorens, R. (Rafael); Herreros, J. (Jesús); Martin-Trenor, A. (Alejandro); Arcas, R. (R.)

Clonidina en el tratamiento de la deshabituación tabáquica. Comparación con chicles de nicotina

2013-06-04T09:58:47Z

Title: Clonidina en el tratamiento de la deshabituación tabáquica. Comparación con chicles de nicotina Author(s) : Aparici, M. (M.); Fernandez-Gonzalez, A.L. (Ángel L.); Alegria, E. (Eduardo) Abstract: The objective of our work was to carry out a prospective study on the effectiveness of clonidine and nicotine gum in the treatment of tobacco withdrawal. Sixty smokers were randomly distributed in two groups and were included in a tobacco withdrawal program. One group received oral clonidine treatment while the other group was given nicotine gum. Adjuvant therapy such as group therapy or psychotherapy was not performed. At the end of one year there were no significant differences between the two groups with regards to the number of subjects who have continued to stop smoking. There were also no significant differences between the two groups with regards to the symptoms of tobacco abstinence. When we studied the relation between treatment fulfillment and tobacco withdrawal we observed that the clonidine treated group had a significantly greater number of success compared to the nicotine group (p < 0.01).

Fijación activa y perforación ventricular: ¿una nueva entidad?

2012-12-21T01:08:10Z

Title: Fijación activa y perforación ventricular: ¿una nueva entidad? Author(s) : Rodriguez-Mañero, M. (Moisés); Bastarrika, G. (Gorka); Macias, A. (Alfonso) Abstract: First, a new active fixation lead was implanted in the interventricular septum; the old lead was then extracted with a Cook stylet. The patient’s clinical course was satisfactory and there were no procedure-related complications. In conclusion, within the battery of diagnostic tests available to investigate suspected cardiac perforation, computed angiotomography of the chest is a highly useful complementary technique for the management of this complication.

Neurohormonas y citocinas en la insuficiencia cardíaca. Correlación con la reserva de flujo coronario

2012-10-27T00:07:14Z

Title: Neurohormonas y citocinas en la insuficiencia cardíaca. Correlación con la reserva de flujo coronario Author(s) : Coma-Canella, I. (Isabel); Macias, A. (Alfonso); Varo, N. (Nerea); Sanchez-Ibarrola, A. (Alfonso) Abstract: Introduction and objectives. In heart failure, the coronary flow reserve (CFR) measured by positron-emission tomography (PET) is reduced. As neurohormone and cytokine levels are also altered in patients with the condition, our aim was to determine whether there is a correlation between CFR and neurohormone and cytokine levels. Patients and method. The study included 40 patients with heart failure but without ischemic heart disease. Myocardial blood flow was measured by PET using nitrogen- 13 ammonia at baseline and during ATP infusion. The CFR was calculated for each patient. In addition, levels of the following were determined: norepinephrine, endothelin- 1, angiotensin-II, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), tumor necrosis factor-alpha, interleukin (IL)-1β, soluble IL-2 receptor, and IL-6. Results. All neurohormone levels were elevated above reference values. The levels of all cytokines, except IL-1β, were also elevated. There was a significant negative correlation between CFR and the levels of several neurohormones: ANP (r=–0.476), BNP (r=–0.442), and IL-6 (r=–0.509). Conclusions. In heart failure, the decrease in CFR is correlated with increases in the levels of certain neurohormones (i.e., ANP and BNP) and cytokines (i.e., IL-6), with vasodilatory effect. These increases are probably are related to compensatory mechanisms that are unable to correct for the endothelial dysfunction present in these patients.

Técnica de primera elección para la valoración de la viabilidad miocárdica. Gammagrafía cardiaca de perfusión

2012-10-12T00:10:08Z

Title: Técnica de primera elección para la valoración de la viabilidad miocárdica. Gammagrafía cardiaca de perfusión Author(s) : Coma-Canella, I. (Isabel) Abstract: Stress echocardiography and perfusion scintigraphy are both useful techniques in the assessment of myocardial viability. The use of one technique or the other as the first choice test depends mainly on each hospital’s experience. Perfusion scintigraphy should be chosen as the first technique in the following situations: a) hospitals with little experience in stress echocardiography and a good Nuclear Medicine department; b) patients with a bad acoustic window in rest echocardiography; c) contraindication of a high dobutamine dose, and d) need of quantification of viable area. When having chosen echocardiography as the first technique, perfusion scintigraphy is indicated when the response to dobutamine of the asynergic area does not allow the confirmation or the rejection of the presence of viability.

Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos

2012-10-10T00:10:56Z

Title: Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos Author(s) : Garcia-Bolao, I. (Ignacio); Macias, A. (Alfonso); Alegria, E. (Eduardo); Berenguel, A. (Alejandro); Gavira, J.J. (Juan José); Azcarate, P.M. (Pedro María); Barba, J. (Joaquín) Abstract: Recent data suggest that biventricular pacing may play an important role in treating advanced heart failure in the presence of a significant interventricular and/or intraventricular conduction disorder by correcting cardiac dysynchrony. In this article, we review the initial technical and clinical experience with cardiac resynchronization therapy in an electrophysiology laboratory. METHODS: The first 22 consecutive patients with severe congestive heart failure, ejection fraction < 0.35, NYHA functional class III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers were studied. Clinical, electrocardiographic, and echocardiographic evaluations were made before and three months after pacemaker implantation. Acute functional capacity testing with peak oxygen uptake was measured during biventricular pacing and during intrinsic rhythm or right ventricular pacing three months after the implantation procedure. RESULTS: The success rate of pacemaker implantation was 95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039) from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure decreased from an average of 3.12 (0.58) three months before the procedure to 1.38 (0.34) three months after the procedure. Peak oxygen uptake was significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1) ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3) ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely and with a high success rate in the electrophysiology laboratory. Biventricular pacing seems to improve the symptoms of congestive heart failure in patients with evidence of atrioventricular and/or interventricular/intraventricular dysynchrony. An acute benefit in peak oxygen uptake was associated with biventricular pacing after the implantation procedure.

Disminución de la reserva de flujo coronario en pacientes con insuficiencia cardíaca no isquémica

2012-10-10T00:04:53Z

Title: Disminución de la reserva de flujo coronario en pacientes con insuficiencia cardíaca no isquémica Author(s) : Coma-Canella, I. (Isabel); Garcia-Velloso, M.J. (María José); Macias, A. (Alfonso); Villar, L. (Luis); Cosin, J. (Juan); Marti-Climent, J.M. (Josep M.); Artaiz, M. (Miguel) Abstract: Introduction and objectives. Coronary flow reserve (CFR) is impaired not only in ischemic heart disease, but also in cardiac diseases that may or may not course with heart failure. The aim of the present study was to determine if the severity of heart failure can influence CFR impairment. Methods. Forty patients with non-ischemic heart disease and heart failure were studied 41 times. Four groups were established: 1. 10 patients in functional class III-IV; 2. 10 patients in functional class II not taking beta-blockers; 3. 11 patients in class II treated with carvedilol, and 4. 10 patients in class I. These patients had a history of heart failure and systolic dysfunction. Myocardial blood flow (MBF) was measured with positron emission tomography (PET) and N-13 ammonia at rest (r) and during adenosine triphosphate (ATP) infusion. Results. MBF and CFR were significantly higher in group 4 (1.95 ± 0.58 and 2.40 ± 0.95 ml/min/g) than in group 1 (1.02 ± 0.52 and 1.46 ± 0.48 ml/min/g). CFR tended to be higher in groups 2 (1.73 ± 0.72), and 3 (1.89 ± 0.75) vs group 1. No significant correlation was found between CFR and the following variables: age, systolic blood pressure, ventricular mass index, ventricular volume indexes, and ejection fraction. Conclusions. Coronary microvascular function is impaired in non-ischemic heart failure, and the impairment is related to functional class, regardless of the underlying responsible heart disease.

Hematoma pericárdico dos años después de cirugía coronaria

2012-10-03T00:04:20Z

Title: Hematoma pericárdico dos años después de cirugía coronaria Author(s) : Garcia-Fuster, R. (Rafael); Llorens, R. (Rafael); Melero, J.M. (José María); Barba, J. (Joaquín); Stefano, S. (Salvatore) di; Legarra, J.J. (Juan José); Alegria, E. (Eduardo) Abstract: Cardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones ocurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis. Because of its atypical late appearance, a case of a 65 year old man is presented who developed a postpericardiotomy syndrome and subsequently a pericardial clot nearly two years after aortocoronary bypass grafting.

Induction of TIMP-1 expression in rat hepatic stellate cells and hepatocytes: a new role for homocysteine in liver fibrosis

2012-09-30T00:09:05Z

Title: Induction of TIMP-1 expression in rat hepatic stellate cells and hepatocytes: a new role for homocysteine in liver fibrosis Author(s) : Torres, L. (Luis); Garcia-Trevijano, E.R. (Elena R.); Rodriguez, J.A. (José A.); Carretero, M.V. (M. Victoria); Bustos, M. (Matilde); Fernandez, E. (Estefanía); Eguinoa, E. (Ezequiel); Mato, J.M. (José María); Avila, M.A. (Matías Antonio) Abstract: Elevated plasma levels of homocysteine have been shown to interfere with normal cell function in a variety of tissues and organs, such as the vascular wall and the liver. However, the molecular mechanisms behind homocysteine effects are not completely understood. In order to better characterize the cellular effects of homocysteine, we have searched for changes in gene expression induced by this amino acid. Our results show that homocysteine is able to induce the expression and synthesis of the tissue inhibitor of metalloproteinases-1 (TIMP-1) in a variety of cell types ranging from vascular smooth muscle cells to hepatocytes, HepG2 cells and hepatic stellate cells. In this latter cell type, homocysteine also stimulated alpha 1(I) procollagen mRNA expression. TIMP-1 induction by homocysteine appears to be mediated by its thiol group. Additionally, we demonstrate that homocysteine is able to promote activating protein-1 (AP-1) binding activity, which has been shown to be critical for TIMP-1 induction. Our findings suggest that homocysteine may alter extracellular matrix homeostasis on diverse tissular backgrounds besides the vascular wall. The liver could be considered as another target for such action of homocysteine. Consequently, the elevated plasma levels of this amino acid found in different pathological or nutritional circumstances may cooperate with other agents, such as ethanol, in the onset of liver fibrosis.

Apoptosis en la cardiopatía hipertensiva

2012-09-28T07:16:51Z

Title: Apoptosis en la cardiopatía hipertensiva Author(s) : Diez, J. (Javier); Fortuño, M.A. (María Antonia); Ravassa, S. (Susana)

Respuestas del miocardio al estrés biomecánico

2012-08-17T00:09:05Z

Title: Respuestas del miocardio al estrés biomecánico Author(s) : Diez, J. (Javier); Lopez, B. (Begoña); Gonzalez, A. (Arantxa); Ardanaz, N. (Noelia); Fortuño, M.A. (María Antonia) Abstract: El estrés biomecánico del miocardio hace referencia a la situación que se genera cuando, debido a la hipertensión, la hipoxia u otras formas de daño miocárdico, están aumentadas las demandas de trabajo cardíaco y/o se ha perdido miocardio funcionante. Como consecuencia del estrés biomecánico se producen diversas respuestas que afectan a todas las células miocárdicas, en particular a los cardiomiocitos. El resultado final de las mismas son distintas modificaciones fenotípicas que inicialmente son compensadoras (p. ej., hipertrofia), pero que si persiste el estrés pueden mediar la transición de la hipertrofia a la insuficiencia cardíaca (p. ej., apoptosis y fibrosis). Esta revisión se centra en la descripción de las distintas fases de las respuestas miocárdicas al estrés, así como en la consideración de los hallazgos más recientes sobre los mecanismos moleculares implicados en el desarrollo de insuficiencia cardíaca.