[Peripartum cardiomyopathy: clinical key to diagnosis]. / Miocardiopatía periparto: claves clínicas para su sospecha.

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that is caused by heart failure secondary to a dysfunction of the left ventricle at the end of pregnancy or in the first months following childbirth. The diagnosis is performed by electrocardiogram, radiography of the thorax and increase of natriuretic peptides. Bedside radiography can contribute with data that help early diagnosis. Treatment is carried out following clinical guidelines for heart failure, taking into account potentially teratogenic drugs. The importance of this pathology lies in that it affects women at a fertile age and is potentially mortal, which is why there must be a high index of suspicion for its diagnosis and a differential diagnosis with other entities. In this clinical note we present a series of cases of PPCM with the goal of reviewing the diagnosis and treatment of this entity.

Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: calcineurin-inhibitors conversion or minimization?

BACKGROUND: In the last decade, mTOR inhibitors (mTOR-is) have become the cornerstone of the calcineurin inhibitor (CNI)-reduced/free regimens aimed to the preservation of post-transplant renal function. We compared utility and safety of the total replacement of calcineurin inhibitors with a mTOR-i with a strategy based on calcineurin inhibitor minimization and concomitant use of m-TOR-i. METHODS: In a retrospective multi-center cohort of 394 maintenance cardiac recipients with renal failure (GFR<60 mL/min/1.73 m(2)), we compared 235 patients in whom CNI was replaced with a mTOR-i (sirolimus or everolimus) with 159 patients in whom mTOR-is were used to minimize CNIs. A propensity score analysis was carried out to balance between group differences. RESULTS: Overall, after a median time of 2 years from mTOR-i initiation, between group differences for the evolution of renal function were not observed. In a multivariate adjusted model, improvement of renal function was limited to patients with mTOR-i usage within 5years after transplantation, particularly with the conversion strategy, and in those patients who could maintain mTOR-i therapy. Significant differences between strategies were not found for mortality, infection and mTOR-i withdrawal due to drug-related adverse events. However, conversion group tended to have a higher acute rejection incidence than the minimization group (p=0.07). CONCLUSION: In terms of renal benefits, our results support an earlier use of mTOR-is, irrespective of the strategy. The selection of either a conversion or a CNI minimization protocol should be based on the clinical characteristics of the patients, particularly their rejection risk.

[Effect of 3 hypertensive++ agents on ventricular geometry and function]. / Efecto de tres antihipertensivos sobre la geometría y función ventriculares.

BACKGROUND: To assess the prevalence of left ventricular hypertrophy in hypertensive patients referred to an outpatient cardiology unit, and to assess its evolution under antihypertensive treatment. METHODS: One hundred and seven mild to moderate hypertensive patients were randomized to receive either xipamide, verapamil or atenolol. Cross-sectional echocardiography was performed in order to assess left ventricular mass and function. RESULTS: Mean age was 56 years, with a 4:1 female/male ratio. Mean follow-up was 120 days. Left ventricular hypertrophy was very common (65%) and decreased to 54% under antihypertensive treatment. Left ventricular mass decreased from 134.3 g/m2 to 118.1 g/m2 (p < 0.001). Concentric hypertrophy was the most common geometric pattern (42%), decreasing to 30% with treatment. Xipamide decreased ventricular mass by decreasing left ventricular diameters, while verapamil and atenolol decreased left ventricular thickness, mainly in septal wall. Systolic function was not modified during the treatment period. Diastolic function was not modified by xipamide and verapamil, and improved with atenolol. CONCLUSIONS: Left ventricular hypertrophy is very frequent when determined by echocardiography and all three drugs produced regression of left ventricular hypertrophy in a different way with respect to left ventricle geometry, an effect which could have potential therapeutic implications.

[Relationship between echocardiographic measurement of left atrial size and the incidence of systemic embolism in mitral stenosis]. / Relación entre el tamaño ecocardiográfico auricular izquierdo con la incidencia de embolia sistémica en la estenosis mitral.

In order to correlate left atrial diameter (LAD) with the prevalence of systemic embolism (SE) in mitral stenosis (MS), we assessed LAD by M mode tracings in 51 patients with SE and in 50 patients with MS without ES as control group (C). Mean age was similar in both groups (SE 47.3 +/- 12 vs C 46.8 +/- 14 years; p NS) (mean +/- SD). Functional class, cardiothoracic ratio and association of other valvular lesions were similar in both groups. Atrial fibrillation (AF) was more frequent in SE group (n = 39) than in C group (n = 20) (p less than 0.01). LAD in SE patients ranged from 2.9 to 9 cm (5.2 +/- 1) whereas in C patients range was from 2.8 to 7.5 (4.6 +/- 1) (p less than 0.01). Nevertheless, LAD in patients with AF was rather similar in both groups (SE 5.3 +/- 1.1 vs C 5.3 +/- 1; p NS). Our results suggest that LAD is not a good predictive parameter for SE in MS. The main risk factor for SE was the existence of AF. Echocardiographic LAD is not a useful parameter to prescribe chronic oral anticoagulation as prophylaxis for SE in patients with MS.