Long-term prognostic role of CA-125 in noncongestive patients undergoing a cardiac transplantation.

AIM: To evaluate the possible relationship between high levels of CA-125 and long-term prognosis in chronic heart failure patients after they undergo a cardiac transplantation (CT). MATERIALS & METHODS: We retrospectively studied all patients who underwent a CT and had a previous determination of CA-125. Congestive patients and those whose survival was <1 year after CT were excluded. RESULTS: Of 55 patients, 23 had elevated CA-125 levels (>35 U/ml). After CT, survival was significantly inferior in this group (96.3 vs 81%, 84.9 vs 64%, 70.7 vs 32.9% at 2, 5 and 8 years, p = 0.014). CA-125 >35 U/ml was the only factor independently associated to long-term mortality (OR: 3.94; 95% CI: 1.2-12.82; p = 0.023). CONCLUSION: Noncongestive patients with high levels of CA-125 had inferior long-term survival after CT.

Clinical and echocardiographic course in tako-tsubo cardiomyopathy: Long-term follow-up from a multicenter study.

OBJECTIVES: To jointly describe clinical characteristics, ECG and echocardiographic findings, and adverse cardiovascular events in patients with tako-tsubo cardiomyopathy (TC) in the long-term. METHODS: Longitudinal multicenter study including retrospective analysis of clinical and ECG data, and follow-up evaluation with clinical interview, electrocardiogram and echocardiogram. RESULTS: Data from 66 cases of TC were available for analysis of clinical and adverse cardiovascular events, and 56 of them completed the follow-up visit including electrocardiogram and echocardiogram. Most patients (97%) were asymptomatic or oligosymptomatic (NYHA I [58%] or II [39%], respectively) at follow-up (median time: 3.7 [1.8-6.6] years). The vast majority of individual QRS complex and repolarization abnormalities had disappeared (87% with no ECG abnormalities at follow-up). On echocardiography, left ventricular ejection fraction was ≥50% in all patients (mean: 63±6%). Wall motion abnormalities were observed in 4 patients (7%; 3 with apical wall motion abnormalities and 1 with mild global hypokinesia). Long-term outcomes were as follows: 4 deaths (6%), 2 cardiovascular and 2 non-cardiovascular; no atrial fibrillation development; no stroke events; 5 acute recurrence events of TC (8%). Globally, 57 patients (86%) had a clinical course free from adverse cardiovascular events. CONCLUSIONS: After a long period following the admission event, patients discharged from TC remain asymptomatic or minimally symptomatic, and feature a low prevalence of both ECG and left ventricular wall motion abnormalities; moreover, the latter lead to a very mild impairment of ejection fraction. Among cardiovascular adverse events, recurrence of the TC event appears to play the most significant role.

Value of NT-ProBNP level and echocardiographic parameters in ST-segment elevation myocardial infarction treated by primary angioplasty: relationships between these variables and their usefulness as predictors of ventricular remodeling.

INTRODUCTION AND OBJECTIVES: To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term. METHODS: The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months. RESULTS: Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/ Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001). CONCLUSIONS: The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months.

Spontaneous coronary dissection and its long-term prognostic implications in a cohort of 19 cases.

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection.

Ivabradina en el tratamiento de la taquicardia sinusal inapropiada / Ivabradine as treatment of inappropriate sinus tachycardia

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NT-proBNP y variables ecocardiográficas en el infarto con elevación del ST tratado con angioplastia primaria: relación entre ambos y utilidad como predictores de remodelado ventricular / Value of NT-ProBNP Level and Echocardiographic parameters in ST-segment elevation myocardial infarction treated by primary angioplasty: relationships between these variables and their usefulness as predictors of ventricular remodeling

Introducción y objetivos. Estudiar el valor del fragmento aminoterminal del péptido natriurético cerebral (NT-proBNP) y del ecocardiograma para predecir remodelado tras infarto y relacionar el NT-proBNP con el ecocardiograma al alta y en fase crónica. Métodos. Estudiamos a 159 pacientes con infarto tratados con angioplastia primaria. Se determinó el NT-pro-BNP al ingreso, al alta y al sexto mes. Se hizo ecocardiograma al alta y al sexto mes. Resultados. Treinta y un pacientes (19,5%) sufrieron remodelado. Al alta se asociaron con remodelado: el cociente entre velocidades E y A del llenado mitral (E/A), la velocidad sistólica del anillo mitral (Sm), la velocidad diastólica precoz del anillo mitral (Em), el cociente entre onda E del llenado mitral y velocidad diastólica precoz del anillo mitral (E/Em), el volumen auricular izquierdo (VAI), los volúmenes telediastólico (VTD) y telesistólico (VTS) ventriculares izquierdos y el NT-proBNP al alta. De ellas, sólo el E/Em fue predictor independiente de remodelado (odds ratio [OR] = 1,143; intervalo de confianza [IC] del 95%, 1,039-1,258; p = 0,006). Al alta, el NT-pro-BNP se correlacionó con el VTD, el VTS, la fracción de eyección (FE) y el E/Em. Al sexto mes, había similar correlación con volúmenes ventriculares y FE, mejoró la correlación con el E/Em (r = 0,47 frente a r = 0,69) y apareció correlación modesta con el VAI (r = 0,43; p = 0,001). Conclusiones. El cociente E/Em es el mejor predictor ecocardiográfico de remodelado tras infarto. El NT-pro-BNP pierde valor predictor al considerarlo junto con el ecocardiograma. El NT-proBNP se correlaciona igualmente con volúmenes ventriculares y FE al alta y al sexto mes, mientras que la correlación con el cociente E/Em y el VAI es más relevante al sexto mes (AU)

Introduction and objectives. To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term. Methods. The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months. Results. Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/ Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001). Conclusions. The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months (AU)

Disección coronaria espontánea y sus implicaciones pronósticas a largo plazo en una cohorte de 19 casos / Spontaneous coronary dissection and its long-term prognostic implications in a cohort of 19 cases

La disección coronaria espontánea es una causa infrecuente de síndrome coronario agudo que afecta predominantemente a mujeres sin apenas factores de riesgo cardiovascular y cuya presentación varía desde la angina inestable hasta la muerte súbita. Los conocimientos de esta entidad se reducen a casos clínicos aislados, y la ausencia de grandes series hace que su tratamiento y sus implicaciones pronósticas no estén plenamente establecidos. Presentamos los datos de 19 casos en 18 pacientes atendidos en nuestro centro desde mayo de 1998 hasta enero de 2009, con una mediana [intervalo intercuartílico] de 3,8 [1,3-4,6] años de seguimiento. Una vez superada la fase aguda, el pronóstico fue favorable sin implicaciones funcionales. Una paciente presentó una recidiva en una coronaria diferente y otra paciente dio a luz sin complicaciones a los 3 años de la disección (AU)

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It mainly affects women with no significant cardiovascular risk factors and its presentation varies from unstable angina to sudden death. Knowledge of the condition is based only on individual case reports and the lack of large case series means that its treatment and prognostic implications have not been fully established. We present data on 19 instances of spontaneous coronary artery dissection in 18 patients who were treated at our center between May 1998 and January 2009. The median follow-up period was 3.8 years (interquartile range: 1.3-4.6 years). Once the acute phase had passed, the prognosis was favorable and there were no implications for functioning. One patient presented with a relapse in another coronary artery and another patient gave birth without complications 3 years after the dissection (AU)

Patent foramen ovale not so patent.

Transesophageal echocardiography (TEE) with agitated saline contrast is the most sensitive tool for diagnosing patent foramen ovale (PFO), but false positives can result. We report a patient who underwent a TEE during the study of a cryptogenic stroke. Contrast appeared in the left atrium with the Valsalva maneuver. However, the contrast exit site was not identified, and contrast continued to appear with Valsalva once the saline microbubbles had disappeared. Combined with the contrast characteristics, this suggested a spontaneous contrast phenomenon rather than a PFO. This phenomenon must be kept in mind to avoid overdiagnosing PFO.

A heart inside the heart: blood cyst of mitral valve.

We report a case of giant blood cyst originating from the anterior mitral valve leaflet, which was discovered during a two-dimensional echocardiography examination performed for investigation of a systolic murmur in a 34-year-old healthy man. Three-dimensional microbubble-enhanced images showed a heart-shape appearance that may be pathognomonic for blood cyst of the mitral valve.

[How many patients admitted for heart failure are eligible for cardiac resynchronization therapy? Analysis of the Andalusian Heart Failure Registry (RAIC) study]. / Cuántos pacientes ingresados por insuficiencia cardiaca son elegibles para terapia de resincronización cardiaca? Análisis del estudio RAIC (Registro Andaluz de Insuficiencia Cardiaca).

INTRODUCTION AND OBJECTIVES: The objective was to determine what percentage of patients admitted for heart failure met criteria for cardiac resynchronization therapy. METHODS: The study involved registry data on heart failure admissions at 16 public hospitals in Andalusia, Spain between May and July 2004. Criteria for cardiac resynchronization therapy from American College of Cardiology and American Heart Association guidelines were applied: a left ventricular ejection fraction < or = 0.35, New York Heart Association functional class III or IV, and a QRS interval > 120 ms. Outcome was evaluated at 3 months. Multivariate (i.e., logistic regression) analysis was used to identify independent variables associated with meeting resynchronization therapy criteria. RESULTS: The study included 674 patients (43.3% women, mean age 71[11] years). Of these, 5.6% met resynchronization therapy criteria at admission. There was no significant difference in the cardiovascular event rate at 3 months between patients who met resynchronization therapy criteria and those who did not (34.2% vs 23.4%, respectively). Admitting hospital (odds ratio [OR]=0.30, 95% confidence interval [CI], 0.11-0.79), ischemic etiology (OR=2.71, 95% CI, 1.26-5.81), the presence of left bundle branch block (OR=14.97, 95% CI, 5.95-37.64), and mitral regurgitation (OR=4.18, 95% CI, 1.93-9.04) were all independently associated with meeting resynchronization therapy criteria at both admission and short-term follow-up. CONCLUSIONS: The percentage of patients who met cardiac resynchronization therapy criteria was small, but their short-term prognosis was poor. A number of clinical variables associated with meeting resynchronization therapy criteria were identified.

¿Cuántos pacientes ingresados por insuficiencia cardiaca son elegibles para terapia de resincronización cardiaca? Análisis del estudio RAIC (Registro Andaluz de Insuficiencia Cardiaca) / How many patients admitted for heart failure are eligible for cardiac resynchronization therapy? Analysis of the andalusian heart failure registry (RAIC) study

Introducción y objetivos. Nuestro objetivo fue evaluar qué porcentaje de pacientes ingresados por insuficiencia cardiaca presentaba criterios para resincronización. Métodos. Registro prospectivo de pacientes ingresados por insuficiencia cardiaca en 16 hospitales andaluces entre mayo y julio de 2004. Se analizó la presencia de criterios para resincronización cardiaca según las guías de la American Heart Association/American College of Cardiology (fracción de eyección ventricular izquierda ≤ 0,35, grado funcional III-IV de la New York Heart Association, complejo QRS > 120 ms). Se evaluó el pronóstico a los 3 meses. Mediante análisis multivariable (regresión logística) se estudió qué variables se relacionaban de manera independiente con la presencia de criterios para resincronización. Resultados. Se incluyó a 674 pacientes (43,3% mujeres, edad media 71 ± 11 años). Un 5,6% de los pacientes reunía criterios de resincronización en el momento del ingreso. La tasa de sucesos cardiovasculares a 3 meses (el 34,2 frente al 23,4%) no fue distinta entre los pacientes con y sin criterios para resincronización. El servicio de ingreso (odds ratio [OR] = 0,30; intervalo de confianza [IC] del 95%, 0,11-0,79), junto con la etiología isquémica (OR = 2,71; IC del 95%, 1,26-5,81), la presencia de bloqueo de rama izquierda (OR = 14,97; IC del 95%, 5,95-37,64) y la regurgitación mitral (OR = 4,18; IC del 95%, 1,93-9,04) se relacionaron de manera independiente con la presencia de criterios para resincronización, tanto en el momento del ingreso como en el seguimiento a corto plazo. Conclusiones. El porcentaje de pacientes que reunieron criterios para resincronización cardiaca fue pequeño y su pronóstico fue malo a corto plazo. Se identificó una serie de variables clínicas como relacionadas con la elegibilidad para resincronización cardiaca

Introduction and objectives. The objective was to determine what percentage of patients admitted for heart failure met criteria for cardiac resynchronization therapy. Methods. The study involved registry data on heart failure admissions at 16 public hospitals in Andalusia, Spain between May and July 2004. Criteria for cardiac resynchronization therapy from American College of Cardiology and American Heart Association guidelines were applied: a left ventricular ejection fraction ≤ 0.35, New York Heart Association functional class III or IV, and a QRS interval > 120 ms. Outcome was evaluated at 3 months. Multivariate (i.e., logistic regression) analysis was used to identify independent variables associated with meeting resynchronization therapy criteria. Results. The study included 674 patients (43.3% women, mean age 71[11] years). Of these, 5.6% met resynchronization therapy criteria at admission. There was no significant difference in the cardiovascular event rate at 3 months between patients who met resynchronization therapy criteria and those who did not (34.2% vs 23.4%, respectively). Admitting hospital (odds ratio [OR]=0.30, 95% confidence interval [CI], 0.11-0.79), ischemic etiology (OR=2.71, 95% CI, 1.26-5.81), the presence of left bundle branch block (OR=14.97, 95% CI, 5.95-37.64), and mitral regurgitation (OR=4.18, 95% CI, 1.93-9.04) were all independently associated with meeting resynchronization therapy criteria at both admission and short-term follow-up. Conclusions. The percentage of patients who met cardiac resynchronization therapy criteria was small, but their short-term prognosis was poor. A number of clinical variables associated with meeting resynchronization therapy criteria were identified

Brain natriuretic peptide in patients with congestive heart failure and central sleep apnea.

STUDY OBJECTIVE: To assess the possible relationship between Cheyne-Stokes respiration (CSR) associated with central sleep apnea (CSA) syndrome and brain natriuretic peptide (BNP) in an outpatient population presenting with stable congestive heart failure (CHF). MEASUREMENTS AND RESULTS: Ninety patients with CHF due to systolic dysfunction (left ventricular ejection fraction

[Combined treatment with intravenous prostacyclin and sildenafil in patients with pulmonary hypertension: report of 4 cases]. / Tratamiento combinado con prostaciclina intravenosa y sildenafilo en pacientes con hipertensión arterial pulmonar: descripción de 4 casos.

BACKGROUND AND OBJECTIVE: Here we report the experience obtained from a combined treatment with intravenous (i.v) prostacyclin and oral sildenafil in patients with severe pulmonary hypertension (PHT) who had a poor response to prior treatment with prostacyclin alone. PATIENTS AND METHOD: Sildenafil was added to the treatment in four patients with PHT (primary in two patients and secondary to collagenosis in the other two) with no adequate response to i.v. prostacyclin treatment. The clinical course, 6minutes walking test and echocardiogram were evaluated. RESULTS: Initial sildenafil dose was 12.5 mg three times daily, which was increased up to 50 mg three times daily in one patient and up to 50 mg four times daily in the other three. The symptoms of right heart failure were controlled in all cases. Before the start of sildenafil administration, two patients had class III dyspnea and two patients had class IV dyspnea. Two patients converted to class I (previously class III and IV), and the other two converted to class II. The distance walked within 6 minutes increased (average increase 55%) and systolic pulmonary artery pressure decreased in all patients (average reduction 27%). Effects of sildenafil were substained. The only side effect seen was mild headache. CONCLUSIONS: Our experience supports the value of sildenafil in the treatment of PHT and suggests that combined treatment is useful for rescuing patients who fail to respond to initial treatment with i.v. prostacyclin.

Tratamiento combinado con prostaciclina intravenosa y sildenafilo en pacientes con hipertensión arterial pulmonar: descripción de 4 casos / Combined treatment with intravenous prostacyclin and sildenafil in patients with pulmonary hypertension: report of 4 cases

FUNDAMENTO Y OBJETIVO: Se describe la experiencia con el tratamiento combinado con prostaciclina intravenosa y sildenafilo oral en pacientes con hipertensión arterial pulmonar grave con mala respuesta a prostaciclina sola. PACIENTES Y MÉTODO: Se asoció sildenafilo al tratamiento en 4 pacientes con hipertensión arterial pulmonar (primaria en dos y secundaria a colagenosis en dos) sin respuesta favorable a prostaciclina intravenosa. Se valoró la evolución clínica, la prueba de caminar durante 6 min y el ecocardiograma. RESULTADOS: La dosis inicial de sildenafilo fue 12,5 mg tres veces al día, con incremento hasta 50 mg tres veces al día en un paciente y 50 mg 4 veces al día en los otros tres. Se controlaron los síntomas de insuficiencia cardíaca derecha en todos los casos. Antes de iniciar la administración de sildenafilo, dos pacientes tenían disnea de clase III y dos de clase IV. Dos pacientes (antes clases III y IV, respectivamente) pasaron a clase I y los otros dos pasaron a clase II. Tras alcanzar la dosis final, la distancia caminada en 6 min aumentó (incremento medio del 55 por ciento) y la presión arterial pulmonar se redujo (porcentaje medio de reducción del 27 por ciento para la sistólica) en todos los pacientes, efecto que se mantuvo durante el seguimiento. El único efecto secundario observado fue cefalea leve. CONCLUSIONES: Nuestra experiencia apoya la posible utilidad del sildenafilo en el tratamiento de la hipertensión arterial pulmonar y sugiere su utilidad en tratamiento combinado para rescatar a pacientes que no responden al tratamiento inicial con prostaciclina intravenosa (AU)

[Utility of cardiac event recorders in diagnosing arrhythmic etiology of palpitations in patients without structural heart disease]. / Utilidad de un grabador de acontecimientos en el diagnóstico de la etiología arrítmica de las palpitaciones en pacientes sin cardiopatía estructural.

OBJECTIVE: To determine the diagnostic yield of transtelephonic event monitors for identifying the reason for palpitations in patients with no structural heart disease. PATIENTS AND METHOD: For 20 months we enrolled all patients reporting palpitations in whom heart disease had been ruled out by medical history, physical examination, ECG and transthoracic echocardiography. All patients underwent 24 h Holter monitoring, which did not provide diagnostic information. Later, a Cardiotest 4DM transtelephonic event monitor was provided to each patient for a mean of 15 3 days. We used SPSS V 10 for statistical analysis. RESULTS: Two hundred twenty-seven consecutive patients were enrolled. Mean age was 45 3 years (range 12-85); 167 were females (74%). Two hundred twelve of the 227 patients (93.3%) experienced palpitations while wearing the device, and 210 (92.5%) used the monitor correctly, recording the cardiac rhythm during palpitations. Fifteen patients (6.6%) had no palpitations during the days of study. In 125 (55%) the Cardiotest 4DM correctly recorded and transmitted arrhythmia that justified the patients' reference to palpitations. In 35 (15.4%) significant arrhythmia was detected: paroxysmal supraventricular tachycardia in 21, atrial fibrillation in 9, atrial flutter in 5, runs of ventricular extrasystoles in 4 and right outflow tract ventricular tachycardia in 1. Sinus rhythm was recorded during palpitations in 85 patients (37%), and arrhythmia as the cause could be ruled out. CONCLUSIONS: Cardiotest 4DM identifies arrhythmia in a very high proportion of patients with palpitations and no structural heart disease.

Utilidad de un grabador de acontecimientos en el diagnóstico de la etiología arrítmica de las palpitaciones en pacientes sin cardiopatía estructural / Utility of Cardiac Event Recorders in Diagnosing Arrhythmic Etiology of Palpitations in Patients without Structural Heart Disease

Introducción y objetivos. El objetivo del presente trabajo es determinar cuál es el rendimiento de la utilización del grabador de acontecimientos en el diagnóstico de la etiología de las palpitaciones como síntoma en pacientes sin cardiopatía estructural. Pacientes y método. Durante 20 meses se han incluido en el estudio a todos los pacientes que consultaban por palpitaciones y en los que se descartaba mediante historia clínica, exploración, ECG y ecocardiografía la existencia de cardiopatía estructural. A todos se les realizó un Holter de 24 h que no resultó diagnóstico. Posteriormente se les proporció un registrador de acontecimientos Cardiotest 4DM® durante una media de 15 ñ 3 días. Utilizamos el paquete estadístico SPSS V.10.Resultados. Se incluyeron en el estudio 227 pacientes consecutivos. La edad media fue de 45 ñ 3 años (rango, 12-85 años) y 167 eran mujeres (74 por ciento). Un total de 212 de los 227 pacientes incluidos (93,3 por ciento) tuvieron palpitaciones durante los 15 días que dispusieron del monitor, y 210 (92,5 por ciento) utilizaron correctamente el monitor, grabando el ritmo cardíaco coexistente con dichas palpitaciones. Quince pacientes (6,6 por ciento) no tuvieron palpitaciones durante los días de estudio. En 125 (55 por ciento) el Cardiotest 4DM® grabó y transmitió por vía transtelefónica correctamente arritmias que justificaban las palpitaciones referidas por los pacientes. En 35 pacientes (15,4 por ciento) se detectaron arritmias significativas: 21 taquicardias paroxísticas supraventriculares, 9 fibrilaciones auriculares, 5 aleteos auriculares, 4 tripletes de extrasístoles ventriculares y una taquicardia ventricular de tracto de salida de ventrículo derecho. En 85 pacientes (37 por ciento), durante las palpitaciones no se detectó arritmia alguna que las justificara, excluyendo así las arritmias como etiología de la misma. Conclusiones. El Cardiotest 4DM® permite identificar arritmias en una proporción muy elevada de pacientes con palpitaciones y sin cardiopatía estructural conocida (AU)

Hipotiroidismo y daño miocárdico en donantes cardíacos / Hypothyroidism and Myocardial Damage in Cardiac Donors

Introducción y objetivos. La muerte cerebral es capaz de provocar disfunción contráctil del miocardio e hipotiroidismo. Dicha disfunción miocárdica es un factor limitante al considerar el corazón del donante para trasplante. Se ha demostrado que el daño miocárdico es el mecanismo a través del cual se establece la disfunción contráctil en los donantes. Por otro lado, se ha invocado al hipotiroidismo como un factor causal primordial en las alteraciones cardiovasculares que acontecen en los sujetos en muerte cerebral. No se conoce si existe alguna relación entre este hipotiroidismo y el daño miocárdico que aparecen en la muerte cerebral. En este estudio cuantificamos el daño miocárdico y el estado hormonal tiroideo en un grupo de donantes y analizamos si existe una relación entre hipotiroidismo y el daño del músculo cardíaco. Pacientes y método. En el suero de 45 donantes se cuantificaron troponinas T e I como marcadores de daño miocárdico, así como hormonas tiroideas. Se analizó la correlación entre las troponinas y el estado tiroideo. Resultados. Una o ambas troponinas estaban elevadas en 19 donantes (42,2 por ciento). El hipotiroidismo fue muy frecuente, ya que estuvo presente en 39 donantes (86,7 por ciento). No hubo correlación alguna entre ninguna de las troponinas y las concentraciones de triyodotironina. Conclusiones. El hipotiroidismo y el daño miocárdico son frecuentes en los donantes en muerte cerebral, sin que exista asociación alguna entre ambas alteraciones (AU)