Sum of effects of myocardial ischemia followed by electrically induced tachycardia on myocardial function.

BACKGROUND: The alteration of contractile function after tachyarrhythmia ceases is influenced by the type of prior ischemia (acute coronary syndrome or ischemia inherent in a coronary revascularization procedure). We aimed to analyze cardiac dysfunction in an acute experimental model of supraphysiological heart rate preceded by different durations and types of ischemia. MATERIAL AND METHODS: Twenty-four pigs were included in: (S1) series of ventricular pacing; (S2, A and B) series with 10 or 20 min, respectively, of coronary occlusion previous to ventricular pacing; S3 with 20 brief, repeated ischemia/reperfusion processes prior to ventricular pacing and; (S4) control series. Overall cardiac function parameters and regional myocardial contractility at the apex and base of the left ventricle were recorded, as were oxidative stress markers (glutathione and lipid peroxide serum levels). Left ventricular pacing at 60% over baseline heart rate was performed for 2 h followed by 1 h of recovery. RESULTS: High ventricular pacing rates preceded by short, repeated periods of coronary ischemia/reperfusion resulted in worse impairment of overall cardiac and regional function that continued to be altered 1 h after tachycardia ceased. There was significant reduction of stroke volume (26.9 ± 5.3 basal vs. 16 ± 6.2 ml; p<0.05), LVP; dP/dt and LAD flow (13.1 ± 1.5 basal vs. 8.4 ± 1.6 ml/min; p<0.05); the base contractility remained altered when recovering compared to baseline (base SF: 5.6 ± 2.8 vs. 2.2 ± 0.7%; p<0.05); and LPO levels were higher than less aggressive series at the end of recovery. CONCLUSIONS: Ischemia and tachycardia accumulate their effects, with increased cardiac involvement depending on the type of ischemia.

Prevention of myocardial dysfunction by Eplerenon in experimental tachycardiomyopathy.

BACKGROUND: High-rate short-duration ventricular pacing induces myocardial hypokinesis that persists once the hemodynamic conditions have been recovered. The aim was to study the factors that determine the persistence of myocardial dysfunction when ventricular tachycardia has ceased and hemodynamic conditions have been restored. MATERIAL/METHODS: An in vivo experimental pig model was used consisting of a ventricular pacing series (n=10), a ventricular pacing and aldosterone blockade (eplerenon) series (n=6), and a control series without ventricular pacing (n=6). Electrical stimulation was performed from the epicardial base of the left ventricle at a frequency 60% above the basal rate for 2 hours followed by a recovery period of 60 minutes. Cardiac and myocardial function parameters were studied. Plasma levels of aldosterone, renin activity, and glutathione were measured. RESULTS: Electrically induced tachycardia produced hemodynamic and myocardial changes that persisted after stimulation had ceased, accompanied by an increase in aldosterone and a coronary flow decrease. These changes were not seen when aldosterone activity was blocked by eplerenon. There was a non-significant elevation in glutathione levels. CONCLUSIONS: These data show that although participation of other neurohormones cannot be ruled out, aldosterone blockade (eplerenon) ameliorates myocardial dysfunction persisting after ventricular tachycardia by preventing coronary endothelial dysfunction.

Experimental study of the so called left ventricular isovolumic relaxation phase.

INTRODUCTION AND OBJECTIVES: Left ventricular filling begins in the ventricular isovolumic relaxation phase. According to the Torrent-Guasp myocardial band theory, this phase results from the contraction of the final portion of the myocardial band: the ascending segment of the apical loop. The objectives were to study the myocardial mechanisms influencing transmitral flow during early diastole and to determine whether the rapid ventricular filling phase involves contraction or relaxation. METHODS: An experimental in vivo pig model was used. Regional contractility in three segments of the myocardial band was assessed using piezoelectric crystals and mitral flow was measured by echo-Doppler ultrasonography at baseline and after akinesia had been induced in the ascending segment by 2.5% formaldehyde infusion. Changes in intracavitary pressure in the left ventricle and left atrium and flow alterations in the aortic root were recorded. The start of the isovolumic relaxation phase was identified using the time at which the ejection of blood ceases, as indicated by aortic flow measurements. RESULTS: During the left ventricular isovolumetric relaxation phase, the ascending segment of the apical loop was undergoing contraction. The infusion of formaldehyde into this segment affected the extent to which the intraventricular pressure could decrease, prolonged the isovolumic relaxation phase and resulted in a lower minimum pressure. It also produced a significant decrease in transmitral flow velocity in early diastole and an increase at end-diastole. CONCLUSIONS: The rapid ventricular filling phase is characterized by contraction.

Estudio experimental de la llamada fase de relajación isovolumétrica del ventrículo izquierdo / Experimental study of the so called left ventricular isovolumic relaxation phase

Introducción y objetivos. El llenado del ventrículo izquierdo se inicia con la fase de relajación isovolumétrica ventricular. En la teoría de la banda miocárdica de Torrent-Guasp, esta fase se produce como consecuencia de la contracción de la porción final de la banda muscular, el segmento ascendente de la lazada apexiana. El objetivo es estudiar los mecanismos miocárdicos involucrados en el flujo transmitral durante la protodiástole y discernir si la fase de llenado rápido ventricular es un proceso de relajación o de contracción. Métodos. Modelo experimental in vivo en cerdos. Se estudia la contractilidad regional con cristales piezoeléctricos en tres segmentos de la banda miocárdica y el flujo transmitral con eco-Doppler, en situación basal y tras la producción de acinesia del segmento ascendente mediante la infiltración con formaldehído al 2,5%. Se registran las curvas de presión intracavitarias del ventrículo izquierdo y la aurícula izquierda y el flujo en la raíz aórtica. Para determinar el inicio de la fase de relajación isovolumétrica, hemos identificado el final de la expulsión de sangre en la curva del flujo aórtico. Resultados. Durante la fase de relajación isovolumétrica del ventrículo izquierdo, el segmento ascendente de la lazada apexiana está contrayéndose. La infiltración con formaldehído de este segmento afecta a la capacidad de reducir la presión intraventricular, y la duración de la fase de relajación isovolumétrica se prolonga y se alcanza una menor presión mínima. Se produce un descenso significativo en las velocidades del flujo transmitral de la protodiástole y un incremento en la telediástole. Conclusiones. La fase de llenado rápido ventricular es un proceso de contracción (AU)

Introduction and objectives. Left ventricular filling begins in the ventricular isovolumic relaxation phase. According to the Torrent-Guasp myocardial band theory, this phase results from the contraction of the final portion of the myocardial band: the ascending segment of the apical loop. The objectives were to study the myocardial mechanisms influencing transmitral flow during early diastole and to determine whether the rapid ventricular filling phase involves contraction or relaxation. Methods. An experimental in vivo pig model was used. Regional contractility in 3 segments of the myocardial band was assessed using piezoelectric crystals and mitral flow was measured by echo-Doppler ultrasonography at baseline and after akinesia had been induced in the ascending segment by 2.5% formaldehyde infusion. Changes in intracavitary pressure in the left ventricle and left atrium and flow alterations in the aortic root were recorded. The start of the isovolumic relaxation phase was identified using the time at which the ejection of blood ceases, as indicated by aortic flow measurements. Results. During the left ventricular isovolumetric relaxation phase, the ascending segment of the apical loop was undergoing contraction. The infusion of formaldehyde into this segment affected the extent to which the intraventricular pressure could decrease, prolonged the isovolumic relaxation phase and resulted in a lower minimum pressure. It also produced a significant decrease in transmitral flow velocity in early diastole and an increase at end-diastole. Conclusions. The rapid ventricular filling phase is characterized by contraction (AU)

Effect of short-duration electrically induced tachycardia on regional myocardial contractility.

BACKGROUND: Tachycardia is a physiological mechanism for adapting cardiac output to modifications in energy consumption in the organism. The repercussions that short-duration tachycardia has on myocardial contractility have not been sufficiently studied.
To study the effects of short-duration tachycardia on regional myocardial function in the anterior face of the left ventricle depending on the rate, duration, and origin of the electrical stimulation producing the tachycardia. MATERIAL/METHODS: Two series were studied in an in vivo canine experimental model. Stimulation was performed in the right atrium and in the base of the left ventricle at a frequency 20 and 40% above the basal rate. The duration of each pacing episode was 10, 20, and 40 minutes followed by a recovery period of 40 minutes. ECG, left ventricular pressure, and regional function curves of a myocardial segment were studied. RESULTS: During atrial pacing there was a similar decrease in both regional segment lengths (end-systolic and end-diastolic lengths) and no variation in the shortening fraction or in hemodynamic parameters. During ventricular pacing, systolic pressure in the left ventricle decreased, end-diastolic pressure increased, end-diastolic length shortened (meaning less ventricular filling), and the end-systolic length increased, leading to a reduced shortening fraction or regional contractility alteration which was temporarily maintained once pacing ceased. CONCLUSIONS: The transient persistence of segment dysfunction after induced ventricular tachycardia ceases indicates the activation of a different, unknown mechanism.

[Overweight and obesity in hypertensive Spanish patients. The CORONARIA study]. / Sobrepeso y obesidad en pacientes con hipertensión arterial. Estudio CORONARIA.

BACKGROUND AND OBJECTIVE: Obesity is a major and independent cardiovascular risk factor. The aim of this study was to know overweight and obesity distribution in a sample of Spanish high systemic pressure patients (CORONARIA study), the risk factors associated and the calculated cardiovascular risk (CR) that the overweight produces. MATERIAL AND METHOD: 1,720 family physicians included 7,087 hypertensive patients with at least another CR factor associated. Patients were classified depending on their body mass index: its value was < 25 kg/m2 in 1,150 patients; > or = 25 and < 30 kg/m2 in 3,724 (overweight); and > or = 30 kg/m2 in 2,213 patients (obesity). RESULTS: 83.7% of patients showed overweight or obesity; and 36.1% of women included were obese. Overweight was significantly more prevalent in the hypertensive population of Andalucía, Murcia, Canarias and Extremadura, and less frequent than the Spanish mean in Catalonia and Asturias. Hypertensive and obese patients showed higher prevalence of diabetes than normal weight patients (34.3% vs 24%); higher levels of triglycerides; high values of systemic pressure; and lower levels of high density lipoproteins-cholesterol; all these facts raised the CR, calculated value between a 19.7% in the overweight cases and a 11.6% in the obese patients compared with normal weight patients. Heart failure was two times more prevalent in obese patients. CONCLUSIONS: Overweight in hypertensive patients raises the cardiovascular risk by 20%, and has a strong association with diabetes and heart failure.

Sobrepeso y obesidad en pacientes con hipertensión arterial. Estudio CORONARIA / Overweigth and obesity in hypertensive Spanish patients. The CORONARIA study

Fundamento y objetivo: La obesidad es un factor de riesgo mayor e independiente para enfermedad cardiovascular. Hemos estudiado la distribución del sobrepeso y la obesidad en una muestra de pacientes hipertensos de España (estudio CORONARIA), los factores de riesgo que se asocian a ambos y el riesgo cardiovascular (RCV) que el exceso de peso comporta en ellos. Material y método: Un total de 1.720 médicos de atención primaria incluyeron en el estudio a 7.087 pacientes hipertensos y con al menos otro factor de riesgo cardiovascular añadido. Los pacientes se clasificaron según su índice de masa corporal: en 1.150 éste era menor de 25 kg/m2; en 3.724 se situaba entre 25 y 30 kg/m2, y en 2.213 era igual o superior a 30 kg/m2. Resultados: El 83,7% de los pacientes hipertensos estudiados presentaban sobrepeso u obesidad y el 36,1% de las mujeres estudiadas eran obesas. El exceso de peso fue significativamente más prevalente en las poblaciones hipertensas de Andalucía, Murcia, Canarias y Extremadura, y menor que la media nacional en Cataluña y Asturias. En los pacientes hipertensos y obesos destacó el incremento de la prevalencia de diabetes en comparación con los pacientes de peso normal (el 34,3 frente al 24,0%), junto a cifras promedio más altas de triglicéridos, menores de colesterol unido a lipoproteínas de alta densidad y valores más elevados de presión arterial; todos estos factores incrementaron el RCV, calculado entre un 19,7% en el sobrepeso y un 11,6% en la obesidad. En pacientes obesos la prevalencia de insuficiencia cardíaca congestiva se duplicó. Conclusiones: El exceso de peso en los hipertensos supone un incremento adicional del RCV, próximo al 20%, acompañado de una mayor asociación a diabetes e insuficiencia cardíaca congestiva

Background and objective: Obesity is a major and independent cardiovascular risk factor. The aim of this study was to know overweight and obesity distribution in a sample of Spanish high systemic pressure patients (CORONARIA study), the risk factors associated and the calculated cardiovascular risk (CR) that the overweight produces. Material and method: 1,720 family physicians included 7,087 hypertensive patients with at least another CR factor associated. Patients were classified depending on their body mass index: its value was < 25 kg/m2 in 1,150 patients; >= 25 and < 30 kg/m2 in 3,724 (overweight); and >= 30 kg/m2 in 2,213 patients (obesity). Results: 83.7% of patients showed overweight or obesity; and 36.1% of women included were obese. Overweight was significantly more prevalent in the hypertensive population of Andalucía, Murcia, Canarias and Extremadura, and less frequent than the Spanish mean in Catalonia and Asturias. Hypertensive and obese patients showed higher prevalence of diabetes than normal weight patients (34.3% vs 24%); higher levels of triglycerides; high values of systemic pressure; and lower levels of high density lipoproteins-cholesterol; all these facts raised the CR, calculated value between a 19.7% in the overweight cases and a 11.6% in the obese patients compared with normal weight patients. Heart failure was two times more prevalent in obese patients. Conclusions: Overweight in hypertensive patients raises the cardiovascular risk by 20%, and has a strong association with diabetes and heart failure

Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE).

BACKGROUND: Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes. METHODS AND RESULTS: A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with > or = 1 episode of myocardial ischemia that lasted > or = 3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both P<0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; P=0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; P=0.014). CONCLUSIONS: Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol-lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy.

[Coronary disease risk and prevalence of heart disease in primary care patients with hypertension and renal disease]. / Riesgo coronario y prevalencia de cardiopatías en pacientes hipertensos con afectación renal en asistencia primaria.

INTRODUCTION AND OBJECTIVES: The presence of renal disease significantly alters the cardiovascular risk of patients with high blood pressure. However, few studies have examined renal parameters in primary care patients. The objectives of this study were to investigate cardiovascular risk and the factors influencing it in hypertensive patients with renal disease and to compare the findings with those in hypertensive patients without renal disease. METHODS: The CORONARIA study involved primary care patients with hypertension from all regions of Spain and included two groups with different degrees of renal disease. RESULTS: In total, 703 patients (9.8%) had renal disease. Hypertensive patients with renal disease had a worse cardiovascular risk profile than other hypertensives. The prevalence of diabetes was double in patients with renal disease. Moreover, the risk of a coronary event was significantly higher in those with renal disease. One-third of hypertensives with renal disease had another previously diagnosed cardiovascular disease. In addition, they more frequently had a history of angina, were twice as likely to have had a myocardial infarction, and were more than twice as likely to have undergone revascularization or to have peripheral vascular disease or cerebrovascular disease. Heart failure was four times more frequent in these patients with renal disease than in other hypertensives. CONCLUSIONS: Patients with hypertension and renal disease have a higher risk of cardiovascular disease, exhibit an increased prevalence of diabetes, and suffer from more extensive target organ damage.

Riesgo coronario y prevalencia de cardiopatías en pacientes hipertensos con afectación renal en asistencia primaria / Coronary disease risk and prevalence of heart disease in Primary Care patients with hypertension and renal disease

Introducción y objetivos. La afectación renal supone un cambio importante en la evolución de la enfermedad cardiovascular del hipertenso, pero la frecuencia con que las manifestaciones renales se estudian en el paciente ambulatorio es muy escasa. Se ha estudiado el riesgo cardiovascular y los factores que intervienen en él en una población de hipertensos con afectación renal y se han comparado con los de otros hipertensos. Métodos. En el estudio CORONARIA, realizado en pacientes hipertensos ambulatorios de todas las regiones de España, se incluyeron 2 apartados relativos a los grados de afectación renal. Resultados. Un total de 703 pacientes incluidos (9,8%) presentaban afectación renal. Los hipertensos con afectación renal tuvieron peor perfil de factores de riesgo cardiovascular en comparación con los demás hipertensos. La prevalencia de la diabetes fue el doble en los grupos de pacientes renales. El riesgo de presentar un accidente coronario fue significativamente mayor en los pacientes con afectación renal. Un tercio de los hipertensos con afectación renal tenía otra enfermedad cardiovascular diagnosticada. Además, estos pacientes presentaban una mayor incidencia de angina de pecho, el doble de infartos, y más del doble tenía el antecedente de revascularización o enfermedad vascular periférica y/o cerebral. La insuficiencia cardiaca llegaba a ser 4 veces más frecuente en los pacientes con afectación renal grave que en los otros hipertensos. Conclusiones. Los pacientes hipertensos con afectación renal presentan un riesgo cardiovascular más elevado, una prevalencia mayor de diabetes y una mayor afectación de los órganos diana

Introduction and objectives. The presence of renal disease significantly alters the cardiovascular risk of patients with high blood pressure. However, few studies have examined renal parameters in primary care patients. The objectives of this study were to investigate cardiovascular risk and the factors influencing it in hypertensive patients with renal disease and to compare the findings with those in hypertensive patients without renal disease. Methods. The CORONARIA study involved primary care patients with hypertension from all regions of Spain and included two groups with different degrees of renal disease. Results. In total, 703 patients (9.8%) had renal disease. Hypertensive patients with renal disease had a worse cardiovascular risk profile than other hypertensives. The prevalence of diabetes was double in patients with renal disease. Moreover, the risk of a coronary event was significantly higher in those with renal disease. One-third of hypertensives with renal disease had another previously diagnosed cardiovascular disease. In addition, they more frequently had a history of angina, were twice as likely to have had a myocardial infarction, and were more than twice as likely to have undergone revascularization or to have peripheral vascular disease or cerebrovascular disease. Heart failure was four times more frequent in these patients with renal disease than in other hypertensives. Conclusions. Patients with hypertension and renal disease have a higher risk of cardiovascular disease, exhibit an increased prevalence of diabetes, and suffer from more extensive target organ damage

[Cardiovascular risk in diabetes mellitus and hypertension in Spain. The CORONARIA study]. / Riesgo cardiovascular en diabetes mellitus e hipertensión arterial en España. Estudio CORONARIA.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is a prevalent disease with high cardiovascular mortality. Treatment of risk factors can reduce the associated cardiovascular risk. The CORONARIA study included 7253 patients with high risk systemic hypertension from different regions of Spain. The aim of this study was to analyze the cardiovascular risk (CR) of diabetic patients at baseline and after one-year follow-up. PATIENTS AND METHOD: A total of 2105 (29%) patients with type 2 diabetes and systemic hypertension are included in the CORONARIA study. The CR profile is evaluated at baseline and after treatment of systemic hypertension with amlodipine (5-10 mg), while other cardiovascular risk factors were also treated. Data were compared with non diabetics. RESULTS: Patients with systemic hypertension in Spain show a very high prevalence of diabetes (29%); it is higher in women than men (p<0.05) and higher in secondary prevention than primary prevention (p<0.05). Prevalence diabetes was higher in Murcia, Andalucía, Extremadura and Comunidad Valenciana, and lower in Madrid and País Vasco than the Spanish mean. The CR in primary prevention was significantly higher in diabetics than in non-diabetics (female: 22.9% vs 12.3% in Framingham, and 10.1% vs 5.2% in REGICOR; male: 39.9% vs 27.8% in Framingham and 15.7% vs 10.3% in REGICOR). After one year treatment, cardiovascular risk decreased significantly in both groups of patients, but it did more in diabetics (Framingham: -11.6% vs -6.7%; REGICOR: -5.3% vs -2.8%). CONCLUSIONS: Most patients with diabetes and systemic hypertension did not have an adequate control of CR factors and presented a high cardiovascular risk. Treatment reduced the CR significantly in a greater proportion of diabetic than non diabetic-patients.

Riesgo cardiovascular en diabetes mellitus e hipertensión arterial en España. Estudio CORONARIA / Cardiovascular risk in diabetes mellitus and hypertension in Spain. The CORONARIA study

Fundamento y objetivo: La diabetes mellitus es una enfermedad con una elevada prevalencia y mortalidad cardiovasculares. En el estudio CORONARIA se incluyeron datos de 7.253 pacientes con hipertensión arterial y otro factor de riesgo de las 17 comunidades autónomas. El objetivo de este trabajo es analizar el riesgo cardiovascular (RCV) de los pacientes diabéticos incluidos en el estudio CORONARIA en el momento de su inicio y tras un año de tratamiento de la presión arterial. Pacientes y método: Se ha incluido a 2.105 pacientes con diabetes mellitus tipo 2 e hipertensión arterial mal controlada. El perfil de RCV se evaluó al inicio del estudio y después del tratamiento de la hipertensión (5-10 mg de amlodipino) y otros factores de riesgo durante un año. Los datos se compararon con los de los no diabéticos. Resultados: La prevalencia de la diabetes mellitus en pacientes hipertensos en España es muy alta (29%), mayor en la mujer que en el varón (p < 0,05) y asimismo mayor en prevención secundaria que en primaria (p < 0,05). Es más alta que la media en Murcia, Andalucía, Extremadura y Comunidad Valenciana, e inferior en Madrid y País Vasco. El riesgo basal de enfermedad coronaria en prevención primaria fue significativamente superior en los diabéticos, tanto en mujeres (Framingham: el 22,9 frente al 12,3%; REGICOR: el 10,1 frente al 5,2%) como en varones (Framingham: el 39,9 frente al 27,8%; REGICOR: el 15,7 frente al 10,3%). Tras un año de tratamiento, el RCV disminuyó significativamente en ambos grupos, pero lo hizo más en los diabéticos (Framingham: el ­11,6 frente al ­6,7%; REGICOR: un ­5,3 frente al ­2,8%). Conclusiones: Los pacientes hipertensos diabéticos presentan un RCV aumentado y un peor control de los factores de riesgo. El tratamiento de la presión arterial redujo el riesgo en una proporción mayor que en los no diabéticos

Background and objective: Diabetes mellitus is a prevalent disease with high cardiovascular mortality. Treatment of risk factors can reduce the associated cardiovascular risk. The CORONARIA study included 7253 patients with high risk systemic hypertension from different regions of Spain. The aim of this study was to analyze the cardiovascular risk (CR) of diabetic patients at baseline and after one-year follow-up. Patients and method: A total of 2105 (29%) patients with type 2 diabetes and systemic hypertension are included in the CORONARIA study. The CR profile is evaluated at baseline and after treatment of systemic hypertension with amlodipine (5-10 mg), while other cardiovascular risk factors were also treated. Data were compared with non diabetics. Results: Patients with systemic hypertension in Spain show a very high prevalence of diabetes (29%); it is higher in women than men (p<0.05) and higher in secondary prevention than primary prevention (p<0.05). Prevalence diabetes was higher in Murcia, Andalucía, Extremadura and Comunidad Valenciana, and lower in Madrid and País Vasco than the Spanish mean. The CR in primary prevention was significantly higher in diabetics than in non-diabetics (female: 22.9% vs 12.3% in Framingham, and 10.1% vs 5.2% in REGICOR; male: 39.9% vs 27.8% in Framingham and 15.7% vs 10.3% in REGICOR). After one year treatment, cardiovascular risk decreased significantly in both groups of patients, but it did more in diabetics (Framingham: -11.6% vs -6.7%; REGICOR: -5.3% vs -2.8%). Conclusions: Most patients with diabetes and systemic hypertension did not have an adequate control of CR factors and presented a high cardiovascular risk. Treatment reduced significantly the CR in a greater proportion of diabetic than non diabetic-patients

Mitochondrial changes induced by trimetazidine in the myocardium.

BACKGROUND: The aim was to assess the effect of trimetazidine (TMZ) on mitochondrial alterations induced in a canine model of brief, repeated episodes of ischemia. MATERIAL/METHODS: Twelve crossbred dogs were analyzed, after double-blind randomization, to a 7-day treatment with either TMZ or placebo. Twenty brief, complete occlusions of the left anterior descending coronary artery were performed. Mitochondrial analysis entailed a qualitative (percentage of mitochondrial damage, merging, pairing, vacuoles, and lipofucsin granules) and a quantitative size analysis (major and minor axes, perimeter, and area) of the mitochondria in the ischemic and control zones. RESULTS: Comparative study of the control zones revealed an increase in lipofucsin granules in the TMZ series and a greater percentage of damaged mitochondria and vacuoles. The control-zone mitochondria treated with TMZ presented a significant increase in the perimeter and major axis and a decrease in the minor axis (p<0.005). No significant differences were found between the series in the qualitative analysis of mitochondrial damage in the ischemic zone. The mitochondria in the TMZ series presented a greater major axis and perimeter than those in the placebo series (p<0.05), which presented a smaller minor axis. CONCLUSIONS: TMZ made the mitochondria adopt an elongated, "rod-like" morphology in both the control and ischemic zones. This is interpreted as an increase in the membrane surface. In the non-ischemic zone, TMZ produced an increase in mitochondrial turnover. There were no differences in the myocardium subjected to ischemia in both series in terms of observable mitochondrial damage.

[Value of NTproBNP concentration in an out-of-hospital adult population]. / Valor del nivel de NTproBNP en población adulta extrahospitalaria.

INTRODUCTION: The diagnosis of chronic heart failure (CHF) is based on demonstrating the cardiac origin of clinical manifestations. Echocardiography is the method of choice for the detection of left ventricular systolic dysfunction (LVSD). Brain natriuretic peptide (BNP) rises during LVSD. OBJECTIVES: To analyze the plasma concentration of N-terminal brain natriuretic propeptide (NTproBNP) in a general adult population in relation to different spontaneous circumstances and to study its capacity for identifying patients with LVSD.Methods. A cardiological examination was made and plasma NTproBNP levels were measured in a randomized group of 203 people (49-81 years old) from the Community of Valencia. RESULTS: The average NTproBNP concentration was 52.2 98.2 pmol/l. NTproBNP levels varied with age, gender and functional stage (NYHA). The highest NTproBNP values were observed in people who had previously suffered from acute pulmonary edema or who had an ejection fraction (EF) of less than 40%. There was also a significant elevation in patients with nocturnal dyspnea, orthopnea, atrial fibrillation, EF < or = 50%, angina, and ankle edema. The best concentration of NTproBNP for differentiating EF < or = 50% was 37.7 pmol/l, with 92% sensitivity and 68% specificity. CONCLUSIONS: The elevation of NTproBNP concentration indicates the cardiac origin of clinical manifestations and serves to select patients for echocardiographic examination. Low NTproBNP concentrations help to rule out LVSD.

Valor del nivel de NTproBNP en población adulta extrahospitalaria / Value of NTproBNP Concentration in an Out-Of-Hospital Adult Population

Introducción. El diagnóstico de insuficiencia cardíaca crónica se basa en la demostración del origen cardíaco de las manifestaciones clínicas. El ecocardiograma es el método de elección para la detección de disfunción sistólica ventricular izquierda (DSVI). El péptido natriurético cerebral se incrementa durante la DSVI. Objetivo. Estudiar las concentraciones plasmáticas del N terminal propéptido natriurético cerebral (NTproBNP) en un grupo de población general adulta y relacionarlas con las distintas circunstancias que se dan espontáneamente y su capacidad para identificar DSVI (ecocardiográfica).Métodos. Se realizó un estudio cardiológico y una determinación válida de las concentraciones séricas de NTproBNP a 203 personas (entre 49 y 81 años), seleccionadas de la Comunidad Valenciana mediante un método de azar. Resultados. La cifra promedio de NTproBNP fue de 52,2 ñ 98,2 pmol/l. Los valores de NTproBNP variaron en razón de sexo, edad y estadio funcional (NYHA). Los más elevados coincidieron con antecedentes de edema de pulmón o con una fracción de eyección (FE) < 40 por ciento. También resultaron significativamente aumentados en presencia de disnea nocturna, ortopnea, FE 50 por ciento, fibrilación auricular, angina y edemas maleolares. El valor de NTproBNP que mejor discriminó la FE 50 por ciento fue de 37,7 pmol/l con una sensibilidad del 92 por ciento y una especificidad del 68 por ciento. Conclusiones. Valores elevados de NTproBNP apoyan un origen cardíaco de las manifestaciones clínicas y seleccionan pacientes para ecocardiografía. Valores bajos descartan DSVI (AU)

Análisis económico y de coste-beneficio de los tratamientos en cardiología. Enfoque en insuficiencia cardíaca / Economic and Cost-Benefit Analysis of Treatments in Cardiology

No disponible

Guías de práctica clínica de la Sociedad Española de Cardiología en la angina estable / Guidelines of the Spanish Society of Cardiology on stable angina

Tras una breve introducción histórica y después de la codificación genérica de los diferentes modos de estimulación, se describen las técnicas de implantación y se enumeran los requisitos que se consideran imprescindibles para configurar una unidad de marcapasos, en lo que concierne a recursos humanos, su cualificación y los requisitos materiales que se precisan. Se enumeran las indicaciones actuales de estimulación cardíaca permanente, clasificadas por apartados en tablas y siguiendo las normas de la ACC/AHA de 1998. En otro apartado se describen con más detalle las indicaciones en situaciones especiales, como la miocardiopatía hipertrófica o la dilatada. Se comenta la modulación de frecuencias de estimulación, gracias a la incorporación de biodetectores en los marcapasos modernos o en sus sondas y la estimulación ventricular atriosincrónica con electrodo único (VDD).A continuación se pasa revista a los recientes automatismos que se han introducido en los marcapasos actuales y se analiza la forma más adecuada de seleccionar el modo de estimulación para cada paciente, que queda reflejado en una tabla de fácil interpretación. Tras establecer el protocolo recomendable para proceder al seguimiento de los pacientes portadores de marcapasos, se enumeran los criterios aceptados como indicadores de reemplazo. En un breve apartado se comentan algunos aspectos legales (carnet de conducir, consentimientos informados) y se analizan con más detalle las posibles fuentes de interferencia con la función del sistema implantado, tanto médicas como ambientales o laborales. Se finaliza el capítulo con un breve apartado sobre la supervivencia de los pacientes portadores de marcapasos (AU)

La formación de especialistas en cardiología en España / Training in Cardiology in Spain

No disponible