Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study.

AIM: To evaluate the association between mode of birth and the resumption of sexual intercourse, self-reported decline in sexual intercourse and dyspareunia in women at the 6th week and 6th month postpartum. BACKGROUND: Interest in the relationship between mode of birth and postpartum sexual functioning is increasing. However, previous findings are contradictory. DESIGN: Prospective, longitudinal, observational study. METHOD: The participants comprised 552 healthy primiparous women aged 18-45 years who gave birth at a hospital between February 2013 - April 2014. Interviews were performed at the hospital and via telephone at the 6th week and 6th month postpartum. We constructed multivariate logistic regression models to examine the relationship between mode of birth and resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia at the 6th week and 6th month postpartum. RESULTS: At the 6th week postpartum, forceps-assisted birth, combination of episiotomy plus perineal tear and belonging to a higher socio-economic status were related to a higher risk of non-resumption of sexual intercourse, while breastfeeding was related to a higher probability of dyspareunia. At the 6th month postpartum, the likelihood of self-reported decline in sexual intercourse was higher among women who screened positive for postpartum depression and a higher number of breastfeeding women reported a decline in sexual intercourse and dyspareunia. Furthermore, at the 6th month postpartum, women who reported the use of emergency services for a health problem had a higher risk of not having resumed intercourse and of experiencing dyspareunia.

Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth.

BACKGROUND: Health-related quality of life of women in the postpartum period may depend on the mode of birth. However, previous findings are contradictory. AIM: To explore health-related quality of life of women at the sixth week and sixth month postpartum by mode of birth. METHODS: We performed a longitudinal prospective study in Spain that included 546 healthy primiparae aged 18 to 45 years who gave birth to a healthy newborn. At the sixth week and sixth month postpartum, we analysed sociodemographic and clinical characteristics and compared health-related quality of life (measured using the SF-36) by mode of birth (normal vaginal, forceps, vacuum-extraction, elective caesarean section, emergency caesarean section). In addition, we analysed the change in health-related quality of life between the two time points for each mode of birth. FINDINGS: We did not find differences in health-related quality of life by mode of birth at the sixth week or sixth month postpartum. At the sixth week postpartum, regardless of the mode of birth, women with postpartum urinary incontinence reported lower health-related quality of life. Between the sixth week and sixth month postpartum, health-related quality of life improved for all modes of birth. CONCLUSION: While mode of birth is not directly associated with health-related quality of life, it does have an indirect relationship in the short term. Women who reported the lowest health-related quality of life were those with postpartum urinary incontinence. Most women with postpartum urinary incontinence were in the forceps group.

Quality of life of mothers at the sixth week and sixth month post partum and type of infant feeding.

INTRODUCTION: there is little scientific evidence on the relationship between maternal quality of life and type of infant feeding. The purpose of this study was to determine if there were differences in mother's quality of life by type of infant feeding. MATERIAL AND METHODS: longitudinal prospective study with 364 women who gave birth at a public hospital at Madrid, Spain, between February and October 2013. To be included, the participants had to be a healthy primigravida aged 18-45 years who gave birth to a healthy newborn with a gestational age between 36 and 42 completed weeks, regardless of birth type. The hospital interviews were performed between 36 and 48 hours post partum in women who had case of vaginal/instrumental births and 60-72 hours post partum for women who had a caesarean birth. Telephone interviews were conducted at the sixth week and sixth month post partum, and included the SF-36 to measure quality of life. SF-36 scores were compared between breast feeding and artificial milk feeding. We also analysed the longitudinal change in SF-36 scores in both groups. RESULTS: at the sixth week post partum, regardless of the infant feeding modality, an increased mental health score was recorded for mothers who reported that their children ate and slept well and for those who did not go to the emergency hospital service because of concern over their baby's health. No significant differences in quality of life were found between the two groups at six months post partum. Between the sixth week and sixth month post partum, quality of life improved significantly in both groups. DISCUSSION: at the sixth week post partum, the proportion of children who ate and slept well and did not have to attend in an emergency hospital service was higher in the breast feeding group. This observation was associated with greater maternal quality of life. This positive indirect relationship between breast feeding and quality of life should be considered an additional maternal health benefit in the short term.

[Urinary NT-proBNP level: relationship with ventricular function parameters in heart failure]. / NT-proBNP en orina y su relación con los parámetros de la función ventricular en la insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is a sensitive marker of ventricular dysfunction. The diagnostic and prognostic value of urinary NT-proBNP measurement has been demonstrated. The objective of this study was to determine the relationship between established parameters of ventricular function and the urinary NT-proBNP level. METHODS: The study involved 74 patients with heart failure (54 male, age 66 [12] years). A Doppler echocardiographic study was performed to measure atrioventricular plane displacement (AVPD), ejection fraction, mitral flow propagation velocity, and E/A. Urinary and plasma NT-proBNP levels, and the plasma aldosterone level were measured. RESULTS: In the whole group, the plasma NT-proBNP level was 948 (961) pg/mL, the urinary NT-proBNP level was 88.7 (17.8) pg/mL, and the aldosterone level, 165 (145) pg/mL. There were correlations between urinary NT-proBNP level and AVPD (r=-0.5; P< .0001), ejection fraction (r=-0.3; P< .01), and mitral flow propagation velocity (r=-0.24; P< .05). On dividing AVPD and ejection fraction measurements into quartiles, respectively, the urinary NT-proBNP levels for these quartiles were Q1: 103 (28) pg/mL, Q2: 89 (9) pg/mL, Q3: 86 (9) pg/mL, and Q4: 78 (9) pg/mL (P< .0001) and Q1: 101 (26) pg/mL, Q2: 85 (12) pg/mL, Q3: 83 (10) pg/mL, and Q4: 85 (11) pg/mL (P< .05), respectively. Multiple linear regression analysis showed that the plasma NT-proBNP level was an independent predictor of the urinary NT-proBNP level (P< .0001). When the plasma NT-proBNP level was excluded, AVPD and ejection fraction appeared as alternative independent predictors (P< .05). CONCLUSIONS: There is a correlation between the urinary NT-proBNP level and left ventricular function parameters. This study supports the use of the urinary NT-proBNP level as a biochemical marker of ventricular function in heart failure patients.

NT-proBNP en orina y su relación con los parámetros de la función ventricular en la insuficiencia cardiaca / Urinary NT-proBNP level: relationship with ventricular function parameters in heart failure

Introducción y objetivos. La concentración plasmática de N-terminal propéptido natriurético cerebral (NT-proBNP) es un marcador sensible de disfunción ventricular. Se ha demostrado el valor diagnóstico y pronóstico de sus concentraciones urinarias. Nuestro objetivo es determinar la relación entre parámetros consolidados de la función ventricular y concentraciones urinarias de NT-proBNP. Métodos. Hemos estudiado 74 pacientes diagnosticados de insuficiencia cardiaca (54 varones, edad 66 ± 12 años). Se les realizó un estudio eco-Doppler y se determinaron el desplazamiento del plano auriculoventricular (DPAV) (mm), la fracción de eyección (FE), la velocidad de propagación del flujo mitral (Vp) (cm/s) y la relación E/A. Se midieron las concentraciones plasmáticas y urinarias de NT-proBNP y las de aldosterona (pg/ml). Resultados. Para toda la población, los valores plasmáticos de NT-proBNP fueron 948 ± 961 pg/ml, los urinarios 88,7 ± 17,8 pg/ml y los de aldosterona 165 ± 145 pg/ml. Correlacionamos las concentraciones urinarias de NT-proBNP con el DPAV (r = -0,5; p < 0,0001), la FE (r = -0,3; p < 0,01) y con Vp (r = -0,24; p < 0,05). Dividimos los valores de DPAV y FE en cuartiles y en cada uno calculamos el NT-proBNP urinario (C1: 103 ± 28, C2: 89 ± 9, C3: 86 ± 9, C4: 78 ± 9; p < 0,0001 y C1: 101 ± 26, C2: 85 ± 12, C3: 83 ± 10, C4: 85 ± 11; p < 0,05). Al realizar un análisis de regresión lineal múltiple se muestra que NT-proBNP plasmático es un factor pronóstico independiente de NT-proBNP urinario (p < 0,0001). Si excluimos el NT-proBNP plasmático surgen de manera alternativa, como factores pronóstico independientes, el DPAV y la FE (p < 0,05). Conclusiones. El NT-proBNP en la orina se correlaciona con parámetros de función del ventrículo izquierdo. Este estudio da soporte al papel del NT-proBNP urinario como marcador bioquímico de la función ventricular en pacientes con insuficiencia cardiaca (AU)

Introduction and objectives. The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is a sensitive marker of ventricular dysfunction. The diagnostic and prognostic value of urinary NT-proBNP measurement has been demonstrated. The objective of this study was to determine the relationship between established parameters of ventricular function and the urinary NT-proBNP level. Methods. The study involved 74 patients with heart failure (54 male, age 66 [12] years). A Doppler echocardiographic study was performed to measure atrioventricular plane displacement (AVPD), ejection fraction, mitral flow propagation velocity, and E/A. Urinary and plasma NT-proBNP levels, and the plasma aldosterone level were measured. Results. In the whole group, the plasma NT-proBNP level was 948 (961) pg/mL, the urinary NT-proBNP level was 88.7 (17.8) pg/mL, and the aldosterone level, 165 (145) pg/mL. There were correlations between urinary NT-proBNP level and AVPD (r=-0.5; P<.0001), ejection fraction (r=-0.3; P<.01), and mitral flow propagation velocity (r=-0.24; P<.05). On dividing AVPD and ejection fraction measurements into quartiles, respectively, the urinary NT-proBNP levels for these quartiles were Q1: 103 (28) pg/mL, Q2: 89 (9) pg/mL, Q3: 86 (9) pg/mL, and Q4: 78 (9) pg/mL (P<.0001) and Q1: 101 (26) pg/mL, Q2: 85 (12) pg/mL, Q3: 83 (10) pg/mL, and Q4: 85 (11) pg/mL (P<.05), respectively. Multiple linear regression analysis showed that the plasma NT-proBNP level was an independent predictor of the urinary NT-proBNP level (P<.0001). When the plasma NT-proBNP level was excluded, AVPD and ejection fraction appeared as alternative independent predictors (P<.05). Conclusions. There is a correlation between the urinary NT-proBNP level and left ventricular function parameters. This study supports the use of the urinary NT-proBNP level as a biochemical marker of ventricular function in heart failure patients (AU)

[Myocardial remodeling and immunologic activation in patients with heart failure]. / Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. METHODS: We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor alpha (TNFalpha), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. RESULTS: Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P< .05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P< .05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P< .05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P< .05) and sTNF-RII levels (r=0.32; P< .05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r(2)=0.16; P< .0001) and of ventricular volumes (LV end-systolic volume index, adjusted r(2)=0.034; P< .05; and LV end-diastolic volume index, adjusted r(2)=.048; P< .05) in both groups. CONCLUSIONS: In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling.

Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca / Myocardial remodeling and immunologic activation in patients with heart failure

Introducción y objetivos. No se comprende bien la regulación del colágeno miocárdico mediada por la respuesta inmunitaria. Nuestro objetivo fue determinar las relaciones entre remodelado ventricular y activación inmunitaria en pacientes con insuficiencia cardiaca comparando miocardiopatía isquémica y dilatada. Métodos. Estudiamos a 94 pacientes con insuficiencia cardiaca: miocardiopatía dilatada (n = 46) e isquémica (n = 48). Determinamos volúmenes ventriculares, E/A y FE. Medimos las concentraciones de TNFα, sTNF-RI, sTNF-RII, IL-6 e IL-10 y calculamos los valores de PIIINP. Resultados. Los volúmenes ventriculares en la miocardiopatía dilatada fueron superiores a los del grupo isquémico (p < 0,05). Sin embargo, los valores de sTNF-RI, sTNF-RII y PIIINP fueron más elevados en el grupo isquémico (p < 0,05). En éste, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y sTNF-RII. El PIIINP se correlacionó significativamente con sTNF-RII (r = 0,30; p < 0,05). En el grupo de miocardiopatía dilatada, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y el PIIINP se correlacionó con IL-6 (r = 0,32; p < 0,05) y sTNF-RII (r = 0,32; p < 0,05). La regresión lineal múltiple, que incluyó citocinas, edad, sexo y función ventricular, demuestra que el sTNF-RII es un factor pronóstico independiente del PIIINP (r² ajustada = 0,16; p < 0,0001) y de los volúmenes ventriculares (IVTSVI, r² ajustada = 0,034; p < 0,05; IVTDVI, r² ajustada = 0,048; p < 0,05) en ambos grupos. Conclusiones. En la insuficiencia cardiaca hay una interacción de citocinas proinflamatorias con la matriz extracelular. La implicación inmunitaria es diferente dependiendo de la etiología. Las citocinas proinflamatorias y los valores de PIIINP son más elevados en los pacientes con miocardiopatía isquémica. La regresión múltiple demostró que el sTNF-RII es un factor pronóstico independiente de remodelado ventricular (AU)

Introduction and objectives. Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. Methods. We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor α (TNFα), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. Results. Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P<.05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P<.05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P<.05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P<.05) and sTNF-RII levels (r=0.32; P<.05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r²=0.16; P<.0001) and of ventricular volumes (LV end-systolic volume index, adjusted r²=0.034; P<.05; and LV end-diastolic volume index, adjusted r²=.048; P<.05) in both groups. Conclusions. In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling (AU)

Maximum longitudinal relaxation velocity of the left ventricle: its clinical value and relationship with NT-proBNP plasma levels in heart failure.

BACKGROUND: M-mode recordings of the mitral annulus to measure the maximum ascending velocity during early diastole as an expression of maximum longitudinal relaxation velocity of the left ventricle (RVm) can be used as an index of left ventricular (LV) diastolic function. The purpose of this study was to determine the relationship of RVm with LV functional parameters in patients with heart failure, with N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels, and with their functional classification. METHODS AND RESULTS: RVm was recorded in 97 patients by M-mode echocardiography. Patients were classified according to the New York Heart Association (NYHA) and the concentration of NT-proBNP was determined. Patients with ejection fraction (EF)>40 showed a significant correlation between RVm and mitral annulus motion (MAM), mitral flow propagation velocity, E/A, age, deceleration time (DT), and NT-proBNP. In patients with EF40, though its relationship with NT-proBNP both in patients with EF>or40 it is influenced only by age. RVm values showed a significant decrease in NYHA class II and III.

Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure.

AIMS: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. METHODS AND RESULTS: We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). CONCLUSIONS: In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that when adjusted for age and BMI, LVFAC and LVESAI are independent predictors of NT-proBNP levels in both dilated and ischemic etiologies. Patients with dilated cardiomyopathy showed better results than those with ischemic cardiomyopathy. We think LV areas are a useful and reproducible parameter, do not need geometric assumptions and reflect NT-proBNP plasma levels.

Obese subjects with heart failure have lower N-terminal pro-brain natriuretic peptide plasma levels irrespective of aetiology.

N-terminal pro-brain natriuretic peptide (NT-proBNP) may be useful in the diagnosis of heart failure and ventricular dysfunction. Obesity is an independent cardiovascular risk factor. The purpose of this study was to measure NT-proBNP plasma levels in obese and non-obese subjects with heart failure and to compare levels in subjects with ischaemic and dilated aetiology. In this study, obese subjects had 63% lower NT-proBNP plasma levels than non-obese subjects (p < 0.01). In multivariate analysis, BMI was inversely associated with NT-proBNP plasma levels (p < 0.05) and a 17% decrease in natriuretic peptide levels was attributed to obesity (p < 0.036). When we analyzed data according to the aetiology of heart failure, we found that both groups (ischaemic and dilated) had a 65% decrease in NT-proBNP plasma levels in obese subjects compared to non-obese subjects.

[Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients]. / Relación de los valores plasmáticos de big endotelina-1 con NT-proBNP y la función ventricular de pacientes con insuficiencia cardíaca.

INTRODUCTION AND OBJECTIVES: Elevated plasma concentrations of big endothelin-1 (big ET-1) are related with severity and prognosis in patients with heart failure, and N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of ventricular remodeling. The purpose of this study was to investigate the relationship between plasma levels of big ET-1 and NT-proBNP, and between the former and ventricular function. PATIENTS AND METHOD: We studied 103 patients with heart failure (75 men, mean age 63 [13] years). Each participant completed a questionnaire and underwent Doppler echocardiographic study to measure ejection fraction (EF), mitral flow propagation velocity (Vp) and atrioventricular plane displacement (AVPD). Blood samples were also taken to determine plasma levels of big ET-1, aldosterone and NT-proBNP. RESULTS: For the whole population big ET-1 concentration was 1.03 [0.75] fmol/m, NT-proBNP 619 (307-1328) pg/mL, aldosterone 168 [102] pg/mL, EF 37 [10], Vp 37 [11] cm/s, and AVPD 8.0 [1.7] mm. Plasma big ET-1 correlated positively with plasma NT-proBNP (r=0.50, P<.0001). However, a negative correlation was found between big ET-1 and EF (r=-0.30, P<.01), Vp, (r=-0.30, P<.01) and AVPD (r=-0.21, P<.05). When ET-1 levels were divided into quartiles and the corresponding NT-proBNP, EF, Vp and AVPD values were compared, we found significant differences (ANOVA P<.0001, P<.01, P<.05 and P<.05, respectively). CONCLUSIONS: Plasma levels of big ET-1 correlated positively with NT-proBNP levels and inversely with EF, Vp and AVPD. These findings help clarify the relationships between ventricular function and the neurohormonal activation involved in heart failure, and may aid the search for therapeutic interventions.

Relación de los valores plasmáticos de big endotelina-1 con NT-proBNP y la función ventricular de pacientes con insuficiencia cardíaca / Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients

Introducción y objetivos. Las concentraciones elevadas de big endotelina 1 (big ET-1) se relacionan con la gravedad y el pronóstico de los pacientes con insuficiencia cardíaca (IC), mientras que N-terminal proBNP (NTproBNP) es un marcador de remodelado ventricular. El objetivo de nuestro estudio fue relacionar los valores debig ET-1 con NT-proBNP y con la función miocárdica. Pacientes y método. Estudiamos a 103 pacientes (75varones; 63 ± 13 años) diagnosticados de IC. Cada participante completó un cuestionario y fue sometido a un estudio eco-Doppler para la medición de la fracción de eyección (FE), la velocidad de propagación del flujo mitral (Vp) y el desplazamiento del plano auriculo ventricular(DPAV). Se realizó una extracción de sangre para determinarlos valores de big ET-1, aldosterona y NT-proBNP. Resultados. Para toda la población, el valor de big ET-1 fue de 1,03 ± 0,75 fmol/ml, el de NT-proBNP de 619(307-1.328) pg/ml, el de aldosterona de 168 ± 102 pg/ml,la FE de 37 ± 10, la Vp de 37 ± 11 cm/s y el DPAV de 8,0± 1,7 mm. La big ET-1 se correlacionó positivamente con el NT-proBNP (r = 0,50; p < 0,0001) e inversamente conla FE (r = -0,30; p < 0,01), la Vp (r = -0,30; p < 0,01) y elDPAV (r = -0,21; p < 0,05). Al dividir la big ET-1 en cuartiles y comparar los valores de NT-proBNP, FE, Vp y DPAV obtuvimos diferencias estadísticamente significativas(ANOVA p < 0,0001, p < 0,01, p < 0,05 y p < 0,05,respectivamente). Conclusiones. Los valores plasmáticos de big ET-1muestran una correlación positiva con los de NT-pro BNP y una correlación inversa con la FE, la Vp y el DPAV. Estos hallazgos ayudan a esclarecer las relaciones entre la función ventricular y la activación neurohormonal en la insuficiencia cardíaca y facilitan la búsqueda de nuevas intervención es terapéuticas

Introduction and objectives. Elevated plasma concentrations of big endothelin-1 (big ET-1) are related with severity and prognosis in patients with heart failure, and N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of ventricular remodeling. The purpose of this study was to investigate the relationship between plasma levels of bigET-1 and NT-proBNP, and between the former and ventricular function. Patients and method. We studied 103 patients with heart failure (75 men, mean age 63 [13] years). Each participant completed a questionnaire and underwent Doppler echocardiographic study to measure ejection fraction(EF), mitral flow propagation velocity (Vp) and atrioventricular plane displacement (AVPD). Blood samples were also taken to determine plasma levels of big ET-1, aldosterone and NT-proBNP. Results. For the whole population big ET-1 concentration was 1.03 [0.75] fmol/m, NT-proBNP 619 (307-1328)pg/mL, aldosterone 168 [102] pg/mL, EF 37 [10], Vp 37[11] cm/s, and AVPD 8.0 [1.7] mm. Plasma big ET-1 correlated positively with plasma NT-proBNP (r=0.50,P<.0001). However, a negative correlation was found between big ET-1 and EF (r=-0.30, P<.01), Vp, (r=-0.30,P<.01) and AVPD (r=-0.21, P<.05). When ET-1 levels were divided into quartiles and the corresponding NT proBNP, EF, Vp and AVPD values were compared, we found significant differences (ANOVA P<.0001, P<.01,P<.05 and P<.05, respectively). Conclusions. Plasma levels of big ET-1 correlated positively with NT-proBNP levels and inversely with EF, Vpand AVPD. These findings help clarify the relationships between ventricular function and the neurohormonal activation involved in heart failure, and may aid the search for therapeutic interventions

Cortocircuito izquierda-derecha por fístulas coronarias congénitas / Left to right shunt for congenital coronary arterio-venous fistulas

Las fístulas coronarias congénitas son una cardiopatía poco frecuente que, dejada a su evolución, puede producir clínica de hipertensión pulmonar e insuficiencia cardíaca e isquemia miocárdica, aunque en un porcentaje no despreciable pueden cerrarse espontáneamente. Además, son posibles las complicaciones por endocarditis, rotura, aneurisma o trombosis. Los pacientes afectados están en su gran mayoría asintomáticos y los métodos usualmente empleados para su detección son la ecocardiografía-Doppler y la angiografía. Presentamos el caso de un varón de 10 años, asintomático, remitido para estudio de soplo cardíaco, con tres fístulas, dos de ellas originadas en la arteria coronaria izquierda que drenaban al ventrículo derecho, y otra con origen en coronaria derecha y drenaje en la arteria pulmonar (AU)

Síndrome antifosfolípido con infarto de miocardio y afectación valvular aórtica / Antiphospholipid syndrome with myocardial infarction and aortic valve involvement

El síndrome antifosfolípido primario se caracteriza por trombosis arteriales y/o venosas, trombocitopenia, abortos de repetición o muerte fetal y anticuerpos antifosfolípido elevados. La afectación valvular provoca con mayor frecuencia regurgitación y se asocia a trombosis arterial. Se presenta el caso de un varón joven con diagnóstico de síndrome antifosfolípido primario y antecendentes de trombosis cerebrovascular, que ingresó por infarto subagudo de miocardio. La coronariografía demostró estenosis en las arterias coronaria derecha y descendente anterior, practicándose con éxito angioplastia transluminal percutánea sobre esta última. El ecocardiograma transtorácico demostró afectación valvular aórtica con regurgitación predominante, y el transesofágico la presencia de excrecencias sobre los velos aórticos. El estudio de laboratorio puso de manifiesto trombocitopenia, alargamiento del tiempo parcial de tromboplastina activada y anticuerpos anticardiolipina elevados. Se inició tratamiento anticoagulación oral. Tras tres meses de seguimiento, no se ha observado recurrencia alguna de los fenómenos trombóticos (AU)