Profilaxis de la nefropatíá inducida por contraste en pacientes de alto riesgo con síndrome coronario agudo sin elevación del segmento ST / Prophylaxis of contrast-induced nephropathy in high risk patients with non-ST-segment elevation acute coronary syndrome

Introducción y objetivos: La eficacia de la administración conjunta de suero salino isotónico y N-acetilcisteína presenta resultados dispares en la prevención de la nefropatía por contraste yodado. Nuestro objetivo fue valorar la posible eficacia de esta estrategia combinada en pacientes con alto riesgo de desarrollar nefropatía inducida por contraste, ingresados y sometidos a intervencionismo coronario percutáneo por síndrome coronario agudo sin elevación del segmento ST en nuestro centro. Método: Se aplicó esta estrategia en los pacientes referidos, con al menos un factor de alto riesgo para desarrollar la nefropatía inducida por contraste: mayores de 80 años, diabetes mellitus, creatinina basal mayor de 1,5 mg/dl o alto volumen de contraste (mayor de 400 ml). El protocolo se aplicó durante 12 meses (pacientes que recibieron el protocolo de prevención) y se comparó con similares pacientes en los 12 meses previos que no recibieron profilaxis. Resultados: Un total de 30 pacientes (24 por ciento) desarrollaron nefropatía inducida por contraste. El porcentaje fue significativamente mayor en el grupo que no recibió profilaxis: 35,9 por ciento vs. 11,5 por ciento (p = 0.003). Conclusiones: La combinación de N-acetilcisteína por vía oral e hidratación parenteral en pacientes de alto riesgo, con síndrome coronario agudo sin elevación de ST, podría ser beneficiosa para evitar la aparición de la nefropatía inducida por contraste(AU)

Sustained benefit of left ventricular remodelling after valve replacement for aortic stenosis.

BACKGROUND: Valve replacement for aortic stenosis (AS) determines negative ventricular remodelling. We used cross sectional and Doppler echocardiography to check how rapidly it occurs and to assess if these changes are sustained over time. METHODS: We evaluated in 34 patients subjected to aortic valve replacement for AS morphological and functional (ejection fraction and E:A ratio) left ventricular data by echocardiography prior to surgery and 2 postoperative studies: early after surgery (pQ1) and at mid-term evolution (pQ2). RESULTS: Left ventricular mass index was reduced at pQ1 (from 152 +/- 47 g/m2 to 113 +/- 31 g/m2; p < 0.01) as well as end-diastolic (from 51.3 mm to 48.3 mm; p < 0.03), end-systolic (from 32.2 mm to 29.4 mm; p < 0.02), interventricular septum (from 12.9 mm to 10.3 mm; p < 0.01), and posterior wall (from 12.5 mm to 11 mm; p < 0.01) dimensions. Left ventricular ejection fraction (from 61.2% to 65.2%; p < 0.04) and E:A ratio (from 0.94 to 0.98; p < 0.01) increased significantly at pQ1. There were no significant differences in measurements between pQ1 and pQ2. CONCLUSIONS: Aortic valve replacement surgery leads to a rapid negative left ventricular remodelling during the first 7 months, including a decrease in myocardial hypertrophy and an improvement in systolic and diastolic function. These beneficial hemodynamic changes are sustained for at least 3 years.

Disfunción endotelial, enfermedad coronaria y diabetes mellitus / Endothelial dysfunction, coronary heart disease and diabetes mellitus

Fundamento y objetivo: La diabetes mellitus es un factor de riesgo cardiovascular que propicia la aparición de una lesión endotelial, fundamental en la fisiopatología de la cardiopatía isquémica, por lo que sería útil la investigación de marcadores que indiquen la lesión en pacientes diabéticos. Pacientes y método: Estudio observacional, realizado con 25 pacientes diagnosticados de cardiopatía isquémica y alteración endotelial confirmada mediante coronario grafía, cuyo único factor de riesgo cardiovascular es la diabetes mellitus (grupo I). Tomamos 2 grupos control, uno de 10 sujetos diabéticos sin más factores de riesgo ni clínica de cardiopatía isquémica (grupo II), y otro de 17 sujetos sanos sin factores de riesgo cardiovascular (grupo III). Comparamos entre los grupos la actividad del factor de von Willebrand (FvW) antigénico, como marcador de lesión endotelial. Empleamos como herramientas estadísticas la prueba de la t de Student y la de la 2, el coeficiente de correlación y análisis de regresión múltiple, con un intervalo de confianza del 95%.Resultados: Los pacientes diabéticos tienen mayores concentraciones de FvW que los sujetos sanos; además, los sujetos con cardiopatía isquémica presentan valores más elevados que los diabéticos sin complicaciones vasculares. Se comprueba cierto grado de relación entre las concentraciones de FvW y fibrinógeno en el grupo I. Conclusiones: El FvW es un factor de riesgo de lesión endotelial en diabéticos, y un marcador de riesgo de complicaciones vasculares (AU)

Background and objective: Diabetes mellitus is a cardiovascular risk factor that promotes the development of endothelial injury, which is fundamental in the physiopathology of ischemic heart disease. Therefore, investigation of markers indicating the presence of endothelial injury in diabetic patients would be useful. Patients and method: We performed an observational study of 25 patients with ischemic heart disease and coronary atherosclerosis, diagnosed by coronary angiography, whose only cardiovascular risk factor was diabetes mellitus (group I). There were 2 control groups, one with 10 diabetic controls without ischemic heart disease or other cardiovascular risk factors (group II) and another group with 17 healthy controls (group III). Activity of von Willebrand factor (vWf) antigen, as a marker of endothelial injury, was compared among the groups. Student’s ttest, the 2 test, the coefficient of correlation, and multiple regression analysis, with a 95% confidence interval, were used in the statistical analysis. Results: Diabetic patients had higher vWf levels than healthy controls. Diabetic patients with coronary atherosclerosis had higher vWf levels than diabetics without vascular complications. There was a correlation between vWF and fibrinogen concentrations in group I. Conclusions: vWf is a risk factor for the development of endothelial injury in diabetics and is also a marker of risk for the development of vascular complications in these patients (AU)

[Cardiovascular risk factor progression in young males at 15-year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study]. / Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA).

INTRODUCTION AND OBJECTIVES: The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. METHODS: In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. RESULTS: In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m(2), cholesterol +68.0 mg/dL, HDL cholesterol -5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. CONCLUSIONS: Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups.

Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA) / Cardiovascular risk factor progression in young males at 15-Year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study

Introducción y objetivos. La cohorte AGEMZA son varones militares cuyos factores de riesgo fueron estudiados en 1985 a la edad de 20 años. A la edad de 35 años se estudian la antropometría, los lípidos y la presión arterial y se investiga su estabilidad, sus cambios y la interdependencia en su evolución. Métodos. En 2000, se obtuvieron datos (encuesta transversal) que se compararon con los originales: índice de masa corporal (IMC), colesterol y sus fracciones, triglicéridos y presiones arteriales. La persistencia o tracking se evalúa mediante el coeficiente de regresión estandarizado y la permanencia en quintiles. Se crearon modelos de regresión multivariante para los datos actuales. Resultados. Tras estudiar a 250 sujetos, se observaron modificaciones significativas de los siguientes factores: peso, +12,1 kg; IMC, +3,9 kg/m², colesterol, +68,0 mg/dl; colesterol unido a lipoproteínas de alta densidad, -­5,2 mg/dl; colesterol unido a lipoproteínas de baja densidad (cLDL), +57,9 mg/dl, y triglicéridos, +76,3 mg/dl. Todos los factores presentaron una persistencia elevada, excepto la presión arterial diastólica. Es más pronunciada la persistencia de IMC, colesterol y cLDL. Estos cambios suponen un peor riesgo cardiovascular independientemente de la diferente edad. El perfil de lípidos se vio influido por el incremento del IMC experimentado y los valores de presión arterial por el IMC alcanzado. Ser fumador activo también se asoció a peores valores de las fracciones de colesterol y triglicéridos. Conclusiones. Durante la tercera década de la vida los factores de riesgo cardiovascular se incrementan. Estudios precoces (en la postadolescencia) permiten identificar sujetos con mayor riesgo posterior. Se constató la influencia en el perfil final de circunstancias modificables (incremento ponderal, tabaquismo). Es razonable planificar medidas preventivas orientadas a estos colectivos

Introduction and objectives. The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. Methods. In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. Results. In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m², cholesterol +68.0 mg/dL, HDL cholesterol ­-5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. Conclusions. Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups

Multiple congenital coronary artery fistulae draining into the left ventricle.

Coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition, especially when multiple fistulas communicate with the left ventricle. Herein we report a case of an elderly woman with multiple diffuse coronary artery-left ventricular fistulas diagnosed by angiography. Since the coronary artery-cardiac chamber communications were multiple and diffuse neither surgery nor transcatheter coil occlusion was considered in this case.

Multiple congenital coronary artery fistulae draining into the left ventrice / Físulas coronariias congénitas múltiples drenando el ventrículo izquierdo

Coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition, especially when multiple fistulas communicate with the left ventricle. Herein we report a case of an elderly woman with multiple diffuse coronary artery-left ventricular fistulas diagnosed by angiography. Since the coronary artery-cardiac chamber communications were multiple and diffuse neither surgery nor transcatheter coil occlusion was considered in this case.

Las fístulas de las arterias coronarias que drenan a las cavidades cardíacas son una anomalía infrecuente, especialmente cuando son múltiples y drenan hacia el ventrículo izquierdo. Presentamos el caso de una mujer octogenaria con múltiples fístulas difusas que se originan de la coronaria izquierda y que drenan al ventrículo izquierdo. El hecho de que fuesen múltiples y difusas imposibilitó una intervención quirúrgica o percutánea como se recomienda en estos casos. (Arch Cardiol Mex 2004; 74:45-48).