Aplicación intracoronaria de levosimendán en la prueba de fracción de flujo de reserva coronaria (Simdax) / Intracoronary administration of levosimendan in the coronary fractional flow reserve test

Introducción: El estudio hemodinámico de una estenosis coronaria de severidad intermedia mediante la prueba de fracción de flujo de reserva (FFR) coronaria es fundamental en términos de eventos cardiovasculares principales a corto y largo plazo. Actualmente, no se ha publicado en este contexto la aplicación intracoronaria de levosimendán. Objetivos: Determinar los efectos hemodinámicos de la administración intracoronaria de levosimendán como vasodilatador en la prueba FFR, comparado contra adenosina intracoronaria. Material y métodos: Se estudiaron mediante FFR 48 lesiones intermedias en las coronarias epicárdicas principales. Resultados: De las 48 lesiones valoradas con FFR en relación con la aplicación de adenosina versus levosimendán intracoronarios, el porcentaje de estenosis coronaria fue del 55.83 (± 11.64), FFR adenosina intracoronaria 0.8633 (± 0.1130) y FFR levosimendán intracoronario 0.8652 (± 0.1090); coeficiente de correlación 0.9859 y correlación cuadrática 0.9720. Demostrando que la inducción de vasodilatación es semejante, incluyendo casos positivos para revascularización con relación FFR < 0.80. Conclusiones: El levosimendán intracoronario en la prueba FFR presentó semejanza en la valoración de las estenosis coronarias intermedias, comparado con adenosina intracoronaria. El levosimendán representa una alternativa favorable en la inducción de hiperemia coronaria, para normar decisiones de revascularización mediante asistencia fisiológica.

Aims: The hemodynamic study of a coronary stenosis of intermediate severity, by testing fraction flow reserve (FFR) is essential in terms of major cardiovascular events in the short and long term. Currently not published in this context the intracoronary application of levosimendan. Objectives: To determine the hemodynamic effects of intracoronary administration of levosimendan, a vasodilator in the FFR test, compared with intracoronary adenosine. Material and methods: Were evaluated by FFR, 48 intermediate lesions in major epicardial coronary arteries. Results: Of the 48 lesions with FFR assessed, the application of adenosine versus intracoronary levosimendan, the percentage of coronary stenosis was 55.83 (± 11.64), intracoronary adenosine FFR 0.8633 (± 0.1130) and 0.8652 FFR intracoronary levosimendan (± 0.1090) correlation coefficient of 0.9859 and 0.9720 quadratic correlation. Demonstrating that induction of vasodilatation is similar, including revascularization positive cases compared FFR < 0.80. Conclusions: Intracoronary levosimendan in the FFR test showed similarity in the assessment of intermediate coronary stenosis compared with intracoronary adenosine. Levosimendan is an excellent alternative in the induction of coronary hyperemia decisions to regulate physiological revascularization with assistance.

[Effect of metoprolol on ventricular relaxation in experimental myocardial infarction]. / Efecto del metoprolol sobre la relajación ventricular en el infarto del miocardio experimental.

During the initial phases of myocardial infarction the relaxation ventricular time increases. To assess the effect of metoprolol, a beta-blocker agent, on constant T, an index derived from left ventricular pressure during the isovolumic relaxation phase, 12 mongrel dogs underwent surgical ligation of the anterior descending coronary artery. Constant T, diastolic ventricular pressure, heart rate and mean arterial pressure were measured at control and after 15, 30, 60, 120 and 180 minutes after arterial occlusion. Six dogs were used as controls while the other six received 35 mg/kg/min of methoprolol, infused during 5 minutes. Untreated dogs had longer T times, higher ventricular filling pressures and hypotension at the end of the study in comparison with the treated does, who maintained diastolic function and did not show important changes of arterial pressure. The beta-blocker decreased the abnormality of relaxation time and preserved ventricular filling and systemic pressures in this model of experimental infarction.

[The relationship between Chlamydia pneumoniae and atherosclerotic lesions of the aorta]. / La relación entre Chlamydia pneumoniae y las lesiones aterosclerosas aórticas.

Although atherogenic main factors have been extensively studied, there are others whose real importance has not been well defined. There are some pathologic and immunologic evidences relating several infectious agents with the genesis or development of coronary atherosclerosis. Recently, a link has been established between Chlamydia pneumoniae and atherogenesis, due to immunological evidence of infection in human atherosclerotic lesions. We studied 16 aortic specimens obtained from necropsies performed in subjects who died with coronary heart disease. The infection of Ch. pneumoniae was determined by means of an immunofluorescent technique using a specific monoclonal murine antibody. A positive reaction was found in advanced non-ulcerated fibrolipid lesions in just 2 patients (13%), according with several other observations. It is not known the true relationship between the chlamydia infection and atherogenesis, neither if the infection starts or aggravates the atherosclerotic process or if it is an independent phenomenon.