The Role of Left Atrial Longitudinal Strain in the Diagnosis of Acute Cellular Rejection in Heart Transplant Recipients.

Our aim was to investigate the role of left atrial longitudinal strain (LALS) in the non-invasive diagnosis of acute cellular rejection (ACR) episodes in heart transplant (HTx) recipients. Methods: We performed successive echocardiographic exams in 18 consecutive adult HTx recipients in their first year after HTx within 3 h of the routine surveillance endomyocardial biopsies (EMB) in a single center. LALS parameters were analyzed with two different software. We investigated LALS association with ACR presence, as well as inter-vendor variability in comparable LALS values. Results: A total of 147 pairs of EMB and echo exams were carried out. Lower values of LALS were significantly associated with any grade of ACR presence. Peak atrial longitudinal strain (PALS) offered the best diagnostic value for any grade of ACR, with a C statistic of 0.77 using one software (95% CI 0.68−0.84, p < 0.0005) and 0.64 with the other (95% CI 0.54−0.73, p = 0.013) (p = 0.02 for comparison between both curves). Reproducibility between comparable LALS parameters was poor (intraclass correlation coefficients were 0.60 for PALS, 95% CI 0.42−0.73, p < 0.0005; and 0.42 for PALS rate, 95% CI −0.13−0.68, p < 0.0005). Conclusions: LALS variables might be a sensitive marker of ACR in HTx recipients, principally discriminating between those studies without rejection and those with any grade of ACR. Inter-vendor variability was significant.

Spanish heart transplant registry. 33rd official report of the Heart failure Association of the Spanish Society of Cardiology.

INTRODUCTION AND OBJECTIVES: This report updates the annual data of the Spanish Heart Transplant Registry with the procedures performed in 2021. METHODS: We describe the clinical profile, therapeutic characteristics and outcomes in terms of survival of the procedures performed in 2021. Their temporal trends are updated for the 2012 to 2020 period. RESULTS: In 2021, 302 heart transplants were performed (8.6% increase versus 2020). The tendency in 2021 confirmed that of prior years, with fewer urgent transplants and a preference for the use of ventricular assist devices. The remaining characteristics and survival showed a clear trend toward stability in the last decade. Compared with 2019, the SARS-CoV-2 pandemic (2020 and 2021) did not affect short- or long-term survival. CONCLUSIONS: In 2021, transplant activity returned to prepandemic levels. The SARS-CoV-2 pandemic did not significantly affect transplant outcomes. The main transplant features and outcomes have clearly stabilized in the last decade.

Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology.

INTRODUCTION AND OBJECTIVES: The present report updates the main characteristics and outcomes of heart transplants in Spain to 2020. METHODS: We describe the main features of recipients, donors, surgical procedure, and immunosuppression in 2020. We also analyze the temporal trends of these characteristics and outcomes (survival) for the period 2011 to 2019. RESULTS: In 2020, 278 heart transplants were performed (7.3% decrease vs 2019). The findings in 2020 confirmed previous observations of an increase in pretransplant sternotomy, a slight decrease in urgent transplants carried out with ventricular assist devices, a slight decrease in donor age, an increase in the use of allografts with previous arrest, and a decrease in ischemia time. Survival continued to improve in recent triennia, reaching 82.0% at 1 year in the period 2017 to 2019. CONCLUSIONS: The slight decrease in the number of heart transplants performed in 2020 in Spain, most likely due to the SARS-CoV-2 pandemic, did not change the main characteristics of the procedure. No change was observed in the tendency to improved survival.

Tissue Doppler velocities for ruling out rejection in heart transplant recipients in the context of myocardial strain imaging: a multivariate, prospective, single-center study.

To investigate the value of tissue Doppler velocities for ruling out treatment-requiring acute cellular rejection (TR-ACR), in the context of myocardial deformation analysis performed by means of speckle tracking echocardiography. We performed serial echocardiograms in 37 heart transplant recipients in their first year post-transplantation within 3 h of the routine surveillance endomyocardial biopsies (EMB). The association of the sum of lateral mitral annulus systolic (s') and early diastolic (e') velocities, in absolute values, measured by tissue Doppler echocardiography (s'+ e'), with TR-ACR (ACR grade ≥ 2R) was investigated by multivariate analysis, including classic echocardiographic parameters and myocardial deformation variables. A total of 251 pairs of EMB and echo exams were performed, 35 (14%) with rejection grade ≥ 2R (TR-ACR). s' + e' was independently associated to TR-ACR (OR 0.80, 95%CI 0.72-0.89, p < 0.0005), with a C statistic of 0.79 (95%CI 0.71-0.87, p < 0.0005) by ROC curve analysis. An s'+ e' value ≥ 23 cm/s, present in 43% of studies, had a negative predictive value of 98% for ruling out TR-ACR. Moreover, in the same patients, s'+ e' significantly decreased when TR-ACR occurred after a study without this condition (- 3.7 ± 3.3 cm/s, p = 0.003), but it was similar when rejection status was the same in the present versus the previous study. A drop in s'+ e' value < 2.7 cm/s from the previous echocardiogram, had a 99% negative predictive value for ruling out TR-ACR. Tissue Doppler velocities, a widely available echo parameter, were found to be a valuable marker for ruling out TR-ACR in this multivariate study which included myocardial deformation variables.

Registro Español de Trasplante Cardiaco. XXVIII Informe Oficial de la Sección de Insuficiencia Cardiaca de la Sociedad Española de Cardiología (1984-2016) / Spanish Heart Transplant Registry. 28th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2016)

Introducción y objetivos: El presente artículo presenta las características y resultados del trasplante cardiaco en España, desde que empezó su actividad en mayo de 1984. Métodos: Se realiza un análisis descriptivo de las características de los receptores, donantes, procedimiento quirúrgico y resultados de los trasplantes cardiacos realizados en España hasta el 31 de diciembre de 2016. Resultados: Durante 2016 se han realizado 281 procedimientos, con lo que la serie histórica consta de 7.869 trasplantes. Las características generales del procedimiento son similares a las observadas en los últimos años y destacan el alto porcentaje de procedimientos realizados en código urgente y, sobre todo, la extensión del uso de dispositivos de asistencia circulatoria, particularmente de asistencia ventricular de flujo continuo (el 19,1% del total de trasplantes). La supervivencia ha aumentado significativamente en la última década con respecto a periodos anteriores. Conclusiones: La actividad de trasplante cardiaco en España permanece estable en los últimos años, con alrededor de 250-300 procedimientos al año. A pesar de la mayor complejidad del contexto clínico, se observa una mejoría de la supervivencia en los últimos años (AU)

Introduction and objectives: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. Methods: We summarize the main features of recipients, donors, surgical procedures, and outcomes of all cardiac transplants performed in Spain up to December 31, 2016. Results: A total of 281 cardiac transplants were performed in 2016. The whole historical series consisted of 7869 procedures. The main features of transplant procedures in 2016 were similar to those observed in recent years. A high percentage of procedures were urgent, particularly those with use of pretransplant continuous-flow left ventricular assist devices (19.1% of all transplants). Survival significantly improved in the last decade compared with previous periods. Conclusions: During the last few years, transplant activity in Spain has remained steady, with approximately 250-300 transplants/year. Despite a more complex clinical context, survival has improved in recent years (AU)

Spanish Heart Transplant Registry. 28th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2016).

INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. METHODS: We summarize the main features of recipients, donors, surgical procedures, and outcomes of all cardiac transplants performed in Spain up to December 31, 2016. RESULTS: A total of 281 cardiac transplants were performed in 2016. The whole historical series consisted of 7869 procedures. The main features of transplant procedures in 2016 were similar to those observed in recent years. A high percentage of procedures were urgent, particularly those with use of pretransplant continuous-flow left ventricular assist devices (19.1% of all transplants). Survival significantly improved in the last decade compared with previous periods. CONCLUSIONS: During the last few years, transplant activity in Spain has remained steady, with approximately 250-300 transplants/year. Despite a more complex clinical context, survival has improved in recent years.

Impact of short-term mechanical circulatory support with extracorporeal devices on postoperative outcomes after emergency heart transplantation: data from a multi-institutional Spanish cohort.

OBJECTIVES: We sought to investigate the potential impact of preoperative short-term mechanical circulatory support (MCS) with extracorporeal devices on postoperative outcomes after emergency heart transplantation (HT). METHODS: We conducted an observational study of 669 patients who underwent emergency HT in 15 Spanish hospitals between 2000 and 2009. Postoperative outcomes of patients bridged to HT on short-term MCS (n=101) were compared with those of the rest of the cohort (n=568). Short-term MCS included veno-arterial extracorporeal membrane oxygenators (VA-ECMOs, n=23), and both pulsatile-flow (n=53) and continuous-flow (n=25) extracorporeal ventricular assist devices (VADs). No patient underwent HT on intracorporeal VADs. RESULTS: Preoperative short-term MCS was independently associated with increased in-hospital postoperative mortality (adjusted odds-ratio 1.75, 95% CI 1.05-2.91) and overall post-transplant mortality (adjusted hazard-ratio 1.60, 95% CI 1.15-2.23). Rates of major surgical bleeding, cardiac reoperation, postoperative infection and primary graft failure were also significantly higher among MCS patients. Causes of death and survival after hospital discharge were similar in MCS and non-MCS candidates. Increased risk of post-transplant mortality affected patients bridged on pulsatile-flow extracorporeal VADs (adjusted hazard-ratio 2.21, 95% CI 1.48-3.30) and continuous-flow extracorporeal VADs (adjusted hazard-ratio 2.24, 95% CI 1.20-4.19), but not those bridged on VA-ECMO (adjusted hazard-ratio 0.51, 95% CI 0.21-1.25). CONCLUSIONS: Patients bridged to emergency HT on short-term MCS are exposed to an increased risk of postoperative complications and mortality. In our series, preoperative bridging with VA-ECMO resulted in comparable post-transplant outcomes to those of patients transplanted on conventional support.

Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry.

BACKGROUND: Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. METHODS AND RESULTS: By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles. CONCLUSIONS: Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.

Insuficiencia cardiaca derecha grave debida a la conjunción de una anomalía de Ebstein y una constricción pericárdica / Severe right heart failure due to the combination of Ebstein's anomaly and pericardial constriction

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[Oral anticoagulation for nonvalvular atrial fibrillation: are scientific recommendations effective and safe in daily clinical practice?]. / Anticoagulación oral en la fibrilación auricular no valvular: 'son efectivas y seguras las recomendaciones científicas en la práctica clínica diaria?

INTRODUCTION AND OBJECTIVES: To study the efficacy and safety of an oral anticoagulation protocol for the treatment of nonvalvular atrial fibrillation, based on scientific associations' recommendations, in unselected patients seen in daily clinical practice. METHODS: The study included all consecutive patients with permanent nonvalvular atrial fibrillation who attended two outpatient cardiology clinics between February 1, 2000 and February 1, 2002. They were treated according to an anticoagulation protocol based on Spanish Society of Cardiology and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Patients were followed up prospectively for major events, such as death, stroke, transient ischemic attack, peripheral embolism and severe hemorrhage, which were recorded by treatment group. RESULTS: A total of 624 patients were included in the study. Those receiving anticoagulation therapy (n=425; 68%) more frequently had hypertension, diabetes and previous embolism as well as a greater number of cardioembolic risk factors (P< .001). Overall, 93% of non-anticoagulated patients received platelet aggregation inhibitors (92% received aspirin). After a median follow-up of 21 months, the probability of an embolic event was lower in anticoagulated patients (0.81% vs 14.04%; P< .001), as was all-cause mortality (3.27% vs 6.42%; P=.003). However, there was no significant difference in the probability of severe bleeding (2.75% vs 2.93%; P=.96). Results were unchanged after adjustment for age, sex, and previous embolic events. CONCLUSIONS: Oral anticoagulation therapy for nonvalvular atrial fibrillation implemented according to scientific associations' recommendations is effective and safe in daily clinical practice.

Anticoagulación oral en la fibrilación auricular no valvular: ¿son efectivas y seguras las recomendaciones científicas en la práctica clínica diaria? / Oral anticoagulation for nonvalvular atrial fibrillation: are scientific recommendations effective and safe in daily clinical practice?

Introducción y objetivos. Estudiar la efectividad y la seguridad de un protocolo prospectivo de anticoagulación en la fibrilación auricular no valvular, basado en las recomendaciones de las sociedades científicas, en pacientes no seleccionados de la práctica clínica diaria. Métodos. Todos los pacientes consecutivos con fibrilación auricular permanente atendidos del 1 de febrero de 2000 al 1 de febrero de 2002 en 2 consultas ambulatorias de cardiología fueron incluidos en un protocolo de anticoagulación basado en las guías de la Sociedad Española de Cardiología y del American College of Cardiology/American Heart Association/European Society of Cardiology, y seguidos prospectivamente para eventos mayores (muerte, ictus, accidente isquémico transitorio, embolias periféricas o hemorragia severa) por grupo de tratamiento. Resultados. Se incluyó en el estudio a un total de 624 pacientes. Los pacientes anticoagulados (n = 425; 68%) presentaron una mayor frecuencia de hipertensión, diabetes y embolia previa, así como un mayor número de factores de riesgo cardioembólicos (p < 0,001). El 93% de los pacientes no anticoagulados recibió antiagregantes (el 92%, aspirina). Tras un seguimiento (mediana) de 21 meses, las probabilidades de eventos embólicos (el 0,81 frente al 14,04%; p < 0,001) y de mortalidad (el 3,27 frente al 6,42%; p = 0,003) fueron menores en los pacientes anticoagulados, sin una diferencia significativa en la probabilidad de sangrado severo (el 2,75 frente al 2,93%; p = 0,96). Los resultados fueron consistentes tras ajustar por edad, sexo y embolias previas. Conclusiones. La anticoagulación oral en la fibrilación auricular no valvular siguiendo las recomendaciones de las sociedades científicas es efectiva y segura en la práctica clínica diaria

Introduction and objectives. To study the efficacy and safety of an oral anticoagulation protocol for the treatment of nonvalvular atrial fibrillation, based on scientific associations' recommendations, in unselected patients seen in daily clinical practice. Methods. The study included all consecutive patients with permanent nonvalvular atrial fibrillation who attended two outpatient cardiology clinics between February 1, 2000 and February 1, 2002. They were treated according to an anticoagulation protocol based on Spanish Society of Cardiology and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Patients were followed up prospectively for major events, such as death, stroke, transient ischemic attack, peripheral embolism and severe hemorrhage, which were recorded by treatment group. Results. A total of 624 patients were included in the study. Those receiving anticoagulation therapy (n=425; 68%) more frequently had hypertension, diabetes and previous embolism as well as a greater number of cardioembolic risk factors (P<.001). Overall, 93% of non-anticoagulated patients received platelet aggregation inhibitors (92% received aspirin). After a median follow-up of 21 months, the probability of an embolic event was lower in anticoagulated patients (0.81% vs 14.04%; P<.001), as was all-cause mortality (3.27% vs 6.42%; P=.003). However, there was no significant difference in the probability of severe bleeding (2.75% vs 2.93%; P=.96). Results were unchanged after adjustment for age, sex, and previous embolic events. Conclusions. Oral anticoagulation therapy for nonvalvular atrial fibrillation implemented according to scientific associations' recommendations is effective and safe in daily clinical practice

[Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-2001)]. / Pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Resultados durante un período de 15 años (1987-2001).

INTRODUCTION AND OBJECTIVES: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. PATIENTS AND METHOD: We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. RESULTS: Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. CONCLUSIONS: Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.

Pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Resultados durante un período de 15 años (1987-2001) / Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-­2001)

Introducción y objetivos. La endocarditis infecciosa ha experimentado cambios importantes en los últimos años. El objetivo de nuestro trabajo es estudiar las características clínicas y el pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Pacientes y método. Hemos analizado 222 casos diagnosticados consecutivamente en nuestros centros desde 1987 hasta junio de 2001. Resultados. La edad media fue de 48 ± 19 años y 145 pacientes (65%) eran varones. En 154 casos se trataba de una endocarditis nativa (69%) y en 68 (31%) de una endocarditis protésica. En 61 pacientes (27%) no había cardiopatía predisponente. Los gérmenes causales más frecuentes fueron estafilococos (81 casos; 37%) y estreptococos (78 casos; 35%). Un 48% de los casos (107 pacientes) precisó cirugía durante la fase activa de la enfermedad. La mortalidad hospitalaria global fue del 17% (39 casos) y se redujo de forma significativa en los años más recientes (el 25% en 1989-1995 frente al 12% en 1996-2001; p < 0,01). La tasa de cirugía precoz electiva aumentó del 22% en 1989-1995 al 32% en 1996-2001 (p < 0,05). Tras un seguimiento de 60 ± 48 meses, 15 pacientes (8%) necesitaron cirugía tardía y 18 (10%) murieron. La supervivencia global a los 6 años fue del 72% y la de los pacientes que habían sobrevivido a la fase activa de la enfermedad del 80%. Conclusiones. El pronóstico a corto y largo plazo de los pacientes con endocarditis infecciosa parece estar mejorando en nuestro medio en los últimos años, en comparación con el de épocas más antiguas

Introduction and objectives. The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. Patients and method. We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. Results. Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. Conclusions. Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals

[A prospective protocol increases oral anticoagulant prescription in patients with chronic, nonvalvular atrial fibrillation]. / Un protocolo prospectivo permite incrementar la utilización de anticoagulación oral en pacientes con fibrilación auricular crónica no valvular.

INTRODUCTION AND OBJECTIVES: Observational studies have shown that oral anticoagulants (OAC) prescription is suboptimal in patients with nonvalvular atrial fibrillation (NVAF). Our objective was to evaluate the usefulness of a prospective protocol for increasing OAC usage in these patients. PATIENTS AND METHOD: From 1 February 2000 until 31 October 2002 we enrolled all patients with chronic NVAF seen in two outpatient cardiology clinics, excluding candidates for cardioversion. Each patient was studied to identify cardioembolic risk factors (CERF) and contraindications for OAC. Anticoagulation was suggested to all patients with > or =2 CERF and without contraindications for OAC. The decision to prescribe OAC was made by the physician in charge when there was only one CERF. RESULTS: 721 patients fulfilled the inclusion criteria. Mean age was 73 +/- 8 years; 44% were men. In most cases NVAF was related with hypertension (57%), followed by no structural heart disease (25%) or ischemic heart disease (9%). The most frequent CERFs were hypertension (66%), age > or =75 years (45%) and diabetes (24%). A total of 663 patients had > or =1 CERF (92%), and 125 (19%) of these presented at least one contraindication for OAC. Of the 538 remaining patients (90%), 485 (67% of the whole series) were treated with anticoagulation. Of the patients with > or =2 CERF and without contraindications for OAC, 95% were treated. CONCLUSIONS: A prospective protocol for use in the outpatient cardiology clinic allows to prescribe OAC in a large percentage of patients with NVAF.

Un protocolo prospectivo permite incrementar la utilización de anticoagulación oral en pacientes con fibrilación auricular crónica no valvular / A Prospective protocol increases oral anticoagulant prescription in patients with chronic, nonvalvular atrial fibrillation

Introducción y objetivos. Los estudios observacionales han constatado una infrautilización de la anticoagulación oral (ACO) en la fibrilación auricular no valvular (FANV). Nuestro objetivo ha sido valorar si un protocolo prospectivo es útil para aumentar la utilización de ACO en estos pacientes. Pacientes y método. Desde el 1 de febrero de 2000 hasta el 31 de octubre de 2002 se han seleccionado todos los sujetos con FANV permanente, no candidatos a cardioversión, revisados en dos consultas de cardiología. Se estudió a cada paciente para identificar factores de riesgo cardioembólicos (FRCE) y contraindicaciones para ACO. Se ofreció ACO a todos los enfermos con 2 FRCE y sin contraindicación para ACO. Se dejó a juicio del cardiólogo responsable la ACO de los que tenían un solo FRCE. Resultados. Cumplieron los criterios de inclusión 721 pacientes. Su edad media fue 73 ñ 8 años, con un 44 por ciento de varones. La FANV se asoció más frecuentemente a hipertensión (57 por ciento), seguida de ausencia de cardiopatía (25 por ciento) y cardiopatía isquémica (9 por ciento). Los FRCE más frecuentes fueron: hipertensión (66 por ciento), edad 75 años (45 por ciento) y diabetes (24 por ciento). Un total de 663 pacientes presentaron 1 FRCE (92 por ciento). De éstos, 125 (19 por ciento) tuvieron al menos una contraindicación para ACO. De los 538 restantes fueron anticoagulados 485 pacientes (el 90 por ciento; un 67 por ciento del total). Fueron anticoagulados el 95 por ciento de los pacientes con 2 FRCE y sin contraindicaciones para ACO. Conclusiones. La utilización de un protocolo prospectivo en la consulta de cardiología hace posible la aplicación de ACO en pacientes con FANV en un alto porcentaje de casos (AU)

[Isolated form of spongy myocardiopathy]. / Forma aislada de miocardiopatía espongiforme.

Noncompaction of the ventricular myocardium sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The characteristic echocardiographic findings of this disease consist of multiple myocardial trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity. Familial occurrence has been observed. We present an illustrative case of isolated noncompaction of the ventricular myocardium in a 16-year-old patient, with the typical clinical and echocardiographic features of the disease. The literature on the topic is reviewed.