A. Bayés de Luna

Colchicine Treatment for Recurrent Pericarditis A Decade of Experience

BACKGROUND The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. METHODS AND RESULTS Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for < or = 10 years. CONCLUSIONS In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.

Characterization of QT interval adaptation to RR interval changes and its use as a risk-stratifier of arrhythmic mortality in amiodarone-treated survivors of acute myocardial infarction

A new method is proposed to evaluate the dynamics of QT interval adaptation in response to heart rate (HR) changes. The method considers weighted averages of RR intervals (R~R~) preceding each cardiac beat to express RR interval history accounting for the influence on repolarization duration. A global optimization algorithm is used to determine the weight distribution leading to the lowest regression residual when curve fitting the [QT, R~R~] data using a patient- specific regression model. From the optimum weight distribution, a memory lag L/sub 90/ is estimated, expressing the delay in the QT adaptation to HR changes. On average, RR intervals of the past 150 beats (approximately 2.5 min) are required to model the QT response accurately. From a clinical point of view, the interval of the initial tens of seconds to one minute seems to be most important in the majority of cases. A measure of the optimum regression residual (r/sub opt/) has been calculated, discriminating between post-myocardial infarction patients at high and low risk of arrhythmic death while on treatment with amiodarone. A similar discrimination has been achieved with a variable expressing the character of QT lag behind the RR interval dynamics.

Recurrent pericarditis. Relief with colchicine.

Recurrence is one of the major complications of pericarditis. Treatment of recurrence is often difficult, and immunosuppressive drugs or surgery may be necessary. We conducted an open-label prospective study of nine patients (seven men and two women; age, 18-64 years; mean age, 41.7 +/- 13.7 years). Patients were treated with colchicine (1 mg/day) to prevent recurrences. All patients had suffered at least three relapses despite treatment with acetylsalicylic acid, indomethacin, prednisone, or a combination. Pericarditis was classified as idiopathic in five patients, postpericardiotomy in two, post-myocardial infarction in one, and associated with disseminated lupus erythematosus in one. For statistical analysis, we conducted a paired comparison design (Students t test). All patients treated with colchicine responded favorably to therapy. Prednisone was discontinued in all patients after 2-6 weeks (mean, 26.33 +/- 10.9 days), and colchicine alone was continued. After a mean follow-up of 24.3 months (minimum, 10 months; maximum, 54 months), no recurrences were observed in any patient; there was a significant difference between the symptom-free periods before and after treatment with colchicine (p less than 0.002). Our study suggests that colchicine may be useful in avoiding recurrence of pericarditis, although these results need to be confirmed in a larger, double-blind study.

Coronary artery spasm and acute myocardial infarction in naproxen‐associated anaphylactic reaction

We present the case of a 43‐year‐old man who suffered an acute myocardial infarction after oral administration of 250 mg of naproxen, prescribed as antiinflammatory‐analgesic agent after tooth extraction. Both intradermal skin test and human basophil degranulation test were positive to naproxen. These findings suggest a naproxen‐associated anaphylactic reaction with concomitant coronary artery spasm and posteroinferior infarction, a clinical event previously not reported with the use of this drug.

Spectral analysis of heart period variance (HPV) – a tool to stratify risk following myocardial infarction

The purpose of this study was to contribute to the improvement of stratification of post-myocardial infarction patients at increased risk of malignant ventricular arrhythmia (MVA). Power spectral analysis of heart period variability (HPV) was used as a non-invasive tool to assess cardiac autonomic control. Three groups were used: (1) post-myocardial infarction patients with MVA; (2) post-myocardial infarction patients without MVA; and (3) a control group without heart disease. Spectral analysis of HPV (AR model) was performed on four minute long RR-interval time series derived from consecutive hours of Holter ECG. Significant decrease of powers of mid-frequency (MF) (70-150 mHz) and high-frequency (HF) (150-450 mHz) spectral components of HPV was obtained in Group 1 as compared to Group 2 (p = 0.001 and p = 0.02, respectively). There were no significant differences between groups concerning the power of low frequency (LF) (10-70 mHz) component HPV, spectra of patients in Group 1 were dominated by a single low frequency spectral peak (with a central frequency of 37 mHz). The relative power was computed as the percentage of power in each of the above (HF, MF, LF) components related to the total spectral power. Highly significant differences (p = 0.04) were obtained between Group 1 and Group 2 concerning relative powers of MF and LF components as well as LF/MF ratio. The above method appeared to be highly sensitive in differentiating patients with increased risk of MVA.

Moderate Daily Intake of Red Wine Inhibits Mural Thrombosis and Monocyte Tissue Factor Expression in an Experimental Porcine Model

Background—Moderate consumption of red wine has been epidemiologically associated with a reduction in cardiovascular disease, but its mechanism of action is not fully understood. The objective was to study whether the protective effects of a daily intake of red wine (Tempranillo, 12.8% alcohol vol/vol) could be related to inhibition of thrombosis in an experimental model of diet-induced hyperlipemia. Methods and Results—For 100 days, animals were fed a western-type proatherogenic diet containing 2% cholesterol and 20% saturated fat. Three doses of red wine were studied (20, 30, and 40 g wine-ethanol/d) and compared with placebo-control animals not taking any wine. Thrombosis under flow conditions was evaluated by radioisotopic quantification of deposited platelets on damaged arteries. Changes in RhoA translocation in platelets and monocyte tissue factor expression were also analyzed. Mural platelet deposition was significantly reduced in animals ingesting red wine with their food. Expression of RhoA in the platelet cytoplasm (inactive form) was increased in wine-fed animals. Tissue factor mRNA expression in lipopolysaccharide-stimulated monocytes was reduced in wine-fed animals. Total cholesterol levels were not significantly different among groups. Conclusions—Moderate red wine intake significantly reduces platelet deposition triggered by damaged vessel wall, partially explained by inhibition of RhoA translocation to the platelet membrane. Hence, a daily moderate intake of wine seems to inhibit different pathways that converge in a reduced thrombotic risk on vessel wall injury.

Complexity of the short-term heart-rate variability

This work has proposed a methodology based on the concept of entropy rates to study the complexity of the short-term heart-rate variability (HRV) for improving risk stratification to predict sudden cardiac death (SCD) of patients with established ischemic-dilated cardiomyopathy (IDC). The short-term HRV was analyzed during daytime and nighttime by means of RR series. An entropy rate was calculated on the RR series, previously transformed to symbol sequences by means of an alphabet. A statistical analysis permitted to stratify high- and low-risk patients of suffering SCD, with a specificity (SP) of 95% and sensitivity (SE) of 83.3%. To get a better characterization of short-term HRV, the study has also considered the adjustment of the parameters involved in the proposed methodology. Finally, a statistical analysis was applied to recognize valid prognostic markers.

Linear and nonlinear heart rate variability risk stratification in heart failure patients

Chronic heart failure (CHF) is a major and growing public health concern (~23 million people worldwide) with five-year survival rates of 25% in men and 38% in women. Objective of this study was to investigate whether linear and nonlinear heart rate variability (HRV) indices enhance risk prediction in patients with CHF. To discriminate between low risk (stable condition, N = 459) and high risk (cardiac death, N = 50) CHF patient groups, nonlinear indices from compression entropy (CE), detrended fluctuation analysis (DFA), symbolic dynamics (SD) and standard linear HRV analysis were calculated from 24 h Holter ECG recordings. Indices from nonlinear dynamics (CE, DFA, SD: p < 0.001) contribute together with clinical parameters NYHA and LVEF to an enhanced risk stratification in CHF patients.

3-dimensional Poincare plots of the QT intervals-an approach to nonlinear QT analysis

The Poincare plots-a simple graphical, nonlinear method was implemented to express 24-h QT interval changes. The group of 23 pts with hypertrophic cardiomyopathy was analyzed (11 pts. with higher and 12 with lower risk of sudden cardiac death). The control group consisted of 10 healthy subjects. 24-h Holter ECG recordings were analyzed and RR and QT intervals were measured beat by beat. 3 dimensional QT and RR plots were constructed in the time delay coordinates. Three main forms of QT plots were observed, highly different in cases with hypertrophic cardiomyopathy compared to normals. Different shapes of QT and RR plots revealed a complex nonlinear relation of the QT and RR intervals.

Fibrinolytic therapy for superior vena cava and right atrial thrombosis: Diagnosis and follow-up with biplane transesophageal echocardiography

Thrombosis of the superior vena cava and other central venous trunks is a complication that is associated with the implantation of pacemakers and central venous catheters that are used for chemotherapy or total parenteral nutrition. This complication occurs somewhat more frequently than expected because many of these thrombi are clinically unnoticed and are finally diagnosed at autopsy. Phlebographic studies have shown that thrombosis is related to central venous catheters in up to 52 “;# of patients who have not received anticoagulation therapy.l This complication may be treated satisfactorily with fibrinolytic agents such as streptokinase (SK), urokinase (UK), and tissue plasminogen activator. We report a patient with ischemic heart disease who had a catheter-related superior vena cava thrombosis with protrusion of the thrombus t,owards the right atrium, successfully treated with SK. Diagnosis and follow-up examinations were carried out by transthoracic and biplane transesophageal echocardiography. The patient was a 59-year-old man who had antecedents