[Imaging following valve replacement]. / Bildgebung nach Klappenersatz.

Patients who undergo heart valve replacement require lifelong cardiac follow-up care. Although the primary pathology of the patient is treated by valve replacement, the risk of postoperative complications and structural failure of the implanted device requires regular check-ups where imaging plays an important role. Immediately after surgery reference values regarding prosthetic and cardiac function for further check-ups are obtained. Transthoracic and transesophageal echocardiography are the imaging modalities of choice for standard examination and follow-up due to their availability and low costs. However, when it comes to identification of complications they are often insufficient. Magnetic resonance imaging (MRI) and computed tomography (CT) play an increasingly important role as complementary modalities for the detection and monitoring of complications after valve replacement. The following article gives an overview of the current non-invasive examination methods and the use in the investigation of postoperative complications.

Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio / No disponible

Objetivo: Evaluar si el tamaño del infarto agudo de miocardio (IAM) presenta variabilidad circadiana. Diseño: Estudio prospectivo observacional. Ámbito: Unidad coronaria de 12 camas. Pacientes: Enfermos consecutivos con diagnóstico de IAM con elevación del segmento ST sometidos a intervención coronaria percutánea primaria. Intervenciones: Se dividió a los pacientes en 2 grupos, dependiendo del horario de inicio de los síntomas del IAM (grupo A: 0-12 h; grupo B: 12-24 h). Variables de interés principales: Edad, sexo, factores de riesgo cardiovascular, anatomía coronaria, fracción de eyección del ventrículo izquierdo, localización del infarto, tiempo de inicio de los síntomas y reperfusión, presencia de insuficiencia cardiaca al ingreso, pico de troponina I. Resultados: Se incluyeron un total de 108 pacientes con diagnóstico de IAM con elevación del segmento ST. Los pacientes del grupo A presentaron concentración de troponina I mayor con respecto al grupo B (70,85±16,38 frente a 60,90±22,92 ng/ml, p=0,003). En el análisis multivariado el inicio del IAM entre las 0-12 h se mostró como un predictor independiente del tamaño del infarto (OR: 1,133, IC del 95% 1.012-1,267; p=0,01). Conclusiones: El inicio del IAM entre las 0-12 h resulta en un tamaño necrótico final significativamente mayor que cuando se inicia en cualquier otro momento del día (AU)

Objective: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. Design: An observational, prospective study. Setting: A 12-bed coronary care unit. Patients: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Interventions: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24 hours). Main variables of interest: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. Results: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12 hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). Conclusions: An onset of AMI between 0-12 hours results in a significantly larger final size of necrosis compared with any other time of presentation (AU)

[Influence of diurnal variation in the size of acute myocardial infarction]. / Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio.

OBJECTIVE: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. INTERVENTIONS: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24hours). MAIN VARIABLES OF INTEREST: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. RESULTS: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). CONCLUSIONS: An onset of AMI between 0-12hours results in a significantly larger final size of necrosis compared with any other time of presentation.

Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST / Differential characteristics of patients with acute coronary syndrome without

ObjetivoEvaluar características diferenciales de los pacientes con síndrome coronario agudo (SCA) sin elevación del segmento ST en comparación con elevación transitoria del segmento ST.DiseñoEstudio prospectivo observacional.ÁmbitoUnidad coronaria de 12 camas.PacientesEnfermos consecutivos de SCA sin elevación persistente del segmento ST.Principales variables de interésLa población se dividió en 2 grupos, en función de la presencia de elevación transitoria del segmento ST. Las variables de interés fueron: edad, factores de riesgos cardiovasculares, concentraciones de troponina I y glucemia al ingreso, anatomía coronaria, fracción de eyección del ventrículo izquierdo, mortalidad intrahospitalaria y fármacos intrahospitalarios.ResultadosLos pacientes identificados con SCA y elevación transitoria del segmento ST eran significativamente más jóvenes, fumadores y con predominio del sexo masculino. A su vez, presentaban una elevación pico de troponina I menor, mayor fracción de eyección y principalmente enfermedad coronaria de un vaso.ConclusionesLos pacientes con SCA con elevación transitoria del segmento ST presentan diferencias en cuanto al tipo de población, daño miocárdico y resultados angiográficos con respecto a los pacientes con SCA sin elevación del segmento ST. Son necesarias más investigaciones para esclarecer si dichas diferencias implicarían un manejo terapéutico diferente (AU)

AbstractObjective: To evaluate different characteristics of patients with acute coronary syndrome (ACS)without ST-segment elevation compared with transient St-segment elevation.Design: An observational, prospective study.Setting: A 12-bed coronary care unit.Patients: Consecutive patients of ACS without persistent ST-segment elevation.Main variables of interest: The population was divided intro 2 groups according to the presenceof transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors,troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejectionfraction, inhospital mortality and drugs.Results: Patients identified as ACS with transient ST-segment elevation were significantly younger,smokers and predominantly male. At the same time, they showed a minor peak elevationof troponin I, a higher ejection fraction and, mainly single-vessel coronary disease.Conclusions: Patients with ACS with transient ST-segment elevation differ in the type of population,myocardial damage and coronary angiographic results with respect to patients with ACSwithout ST-segment elevation. More research is needed to clarify whether these differencesimply a different therapeutic approach (AU)

El ligando soluble CD40 en pacientes con síndrome coronario agudo consumidores de cocaína / Soluble CD40 ligand in acute coronary syndrome in cocaine users

Objetivo: El ligando soluble CD40 (sCD40L) es una molécula que se expresa en el proceso de activación plaquetaria. Analizamos la concentración sérica de dicha molécula en pacientes consumidores de cocaína con síndrome coronario agudo (SCA).Método: Se realizó un análisis retrospectivo de 40 pacientes con SCA y test de cocaína positiva en orina, quienes se compararon con 40 pacientes con este diagnóstico y sinconsumo de cocaína. Resultados: Los valores del sCD40L en los pacientes con SCA y cocaína negativa fueron más bajos que los consumidores de cocaína (110 ± 41,1 frente a 135,7 ± 65,3pg/ml; p = 0,03). En el análisis multivariable y tras ajustar por la edad y los factores deriesgo coronario, los pacientes con SCA y cocaína positiva se relacionaron de forma independiente con niveles séricos más elevados de sCD40L. Conclusiones: El sCD40L está implicado en el proceso proinflamatorio-trombótico de los pacientes consumidores de cocaína y SCA (AU)

Background and objectives: The soluble CD40 ligand (sCD40L) expressed on platelets is released in the activation process. We analyzed the sCD40L serum concentration in cocaine users with acute coronary syndrome (ACS).Patients and methods: Retrospective comparison of sCD40L serum concentration between 40 patients with ACS and apositive test for cocaine in urine and 40 ACS patients with a negative cocaine test.Results: The mean (SD) sCD40L serum concentration in the patients with ACS and a negative cocaine test was lower(110 [41.1] pg/mL) than in patients who were not cocaine users (65.3 pg/mL) (P=.03). In the multivariable analysis, after adjustment for age and coronary risk in these patients with ACS, a positive cocaine test remained associated withs CD40L concentration. Conclusions: The sCD40L plays a part in the proinflammatory thrombotic process in cocaine users who develop ACS (AU)

[Differential characteristics of patients with acute coronary syndrome without ST-segment elevation compared to those with transient ST-segment elevation]. / Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST.

OBJECTIVE: To evaluate different characteristics of patients with acute coronary syndrome (ACS) without ST-segment elevation compared with transient St-segment elevation. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients of ACS without persistent ST-segment elevation. MAIN VARIABLES OF INTEREST: The population was divided intro 2 groups according to the presence of transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors, troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejection fraction, inhospital mortality and drugs. RESULTS: Patients identified as ACS with transient ST-segment elevation were significantly younger, smokers and predominantly male. At the same time, they showed a minor peak elevation of troponin I, a higher ejection fraction and, mainly single-vessel coronary disease. CONCLUSIONS: Patients with ACS with transient ST-segment elevation differ in the type of population, myocardial damage and coronary angiographic results with respect to patients with ACS without ST-segment elevation. More research is needed to clarify whether these differences imply a different therapeutic approach.