Elevated Lipoprotein A Levels and Development of Moderate or Severe Cardiac Allograft Vasculopathy in Patients with Heart Transplants.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a high-incident complication of heart transplant (HT) and is the leading cause of death beyond the first post-HT year. Traditional risk factors have been related to CAV development. Elevated lipoprotein (a) (Lp[a]) is an independent, genetic, and causal risk factor for cardiovascular disease; nonetheless, its association with the development or worsening of CAV in HT has not been firmly established. METHODS: An observational nested case-control study including HT recipients under follow-up in a tertiary center. Lipoprotein (a) levels were determined at the time of inclusion. We considered elevated Lp(a) ≥30 mg/dL. We evaluated the association between Lp(a) levels and the presence and severity of CAV (The International Society For Heart And Lung Transplantation [ISHLT] Cardiac Allograft Vasculopathy Grading Scheme), dividing the sample between No or Mild CAV (0-1) and Moderate-Severe CAV (2-3). Routine coronary angiographies were performed the first year after the transplant and were subsequently symptom-driven. RESULTS: One hundred fifty patients with HTs were included, with a mean follow-up of 110 ± 77 months. Patients with CAV 2 to 3 presented higher median Lp(a) levels (17 vs 86 mg/dL, P = 0.001). Elevated Lp(a) level was an independent risk factor for developing CAV 2 to 3 (odds ratio 8.57 [95% CI 2.82-26.04]; P < .001). Patients with Lp(a) ≥30 mg also showed an earlier onset compared with those with Lp(a) <30 mg/dL. CONCLUSIONS: Our study suggests that Lp(a) may play a role in the development of CAV. Lipoprotein (a) ≥30 mg/dL defines a subgroup of high-risk patients with HTs as portends to earlier onset and more severe CAV. Lipoprotein (a) determination should be a standard-of-care test in patients with HTs.

Epidemiología de la fibrilación auricular / Epidemiology of atrial fibrillation

La fibrilación auricular es la arritmia cardiaca sostenida más frecuente en la población general. En España, los últimos datos indican que en mayores de 40 años la prevalencia de fibrilación auricular puede ser > 4%. La prevalencia y la incidencia de FA se han incrementado con el tiempo. Las posibles causas de este incremento son el envejecimiento de la población, el aumento de los factores de riesgo cardiovascular y la mejora de la supervivencia a enfermedades cardiovasculares. También puede influir la disponibilidad de mejores herramientas diagnósticas para su detección. Este artículo revisa los datos epidemiológicos de fibrilación auricular disponibles en España y los países occidentales (AU)

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In Spain, the latest data suggest that the prevalence in people aged over 40 years could be greater than 4%. Both the prevalence and incidence of atrial fibrillation have increased substantially over time. Possible reasons for this rise are the aging of the population, an increase in the number of cardiovascular risk factors and better cardiovascular disease survival. In addition, the increased availability of improved diagnostic tools for detecting atrial fibrillation could have contributed. This article provides a review of the evidence available on the epidemiology of atrial fibrillation in Spain and other western countries (AU)

Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly.