Amalio Ruiz-Salas

Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator

AIMS Hypertrophic cardiomyopathy is one of the main causes of sudden death in young people. Recent clinical practice guidelines include a risk prediction model for sudden death (HCM Risk-SCD), which facilitates the decision of whether to implant a defibrillator. The aim of our study was to ascertain the percentage of events in our series of primary prevention implantable cardioverter-defibrillator recipients with hypertrophic cardiomyopathy and whether HCM Risk-SCD predicts the onset of arrhythmic events. METHODS AND RESULTS This was an observational, retrospective cohort study, which included 48 primary prevention defibrillator recipient patients with HCM. We compiled their demographic and clinical characteristics, estimated 5-year risk using HCM Risk-SCD, and collected the documentation on arrhythmias during follow-up. The majority was male (66.7%) and mean age at implantation was 44.44 ± 14.46 years. Non-sustained ventricular tachycardia was the most prevalent risk factor (66.67%), followed by a family history of sudden death (47.92%). Mean HCM Risk-SCD was 6.15 ± 5.01%. HCM Risk-SCD was the only factor independently associated with the onset of ventricular tachyarrhythmia, above any other classic risk factor or association [odds ratio = 1.46 (95% confidence interval 1.051-2.013); P = 0.02]. None of the 11 patients estimated as low risk using HCM Risk-SCD suffered any appropriate events (P < 0.05). CONCLUSIONS During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.

Serum levels of interleukin-2 predict the recurrence of atrial fibrillation after pulmonary vein ablation.

AIMS Interleukin-2 has a significant antitumor activity in some types of cancer, and has been associated with the development of atrial fibrillation (AF). In addition, IL-2 serum levels in recent onset AF have been related with pharmaceutical cardioversion outcomes. We evaluated the hypothesis that a relationship exists between inflammation and the outcome of catheter ablation of AF. METHODS We studied 44 patients with paroxysmal AF who underwent catheter ablation. Patients with structural heart disease, coronary artery or valve disease, active inflammatory disease, known or suspected neoplasm, endocrinopathies, or exposure to anti-inflammatory drugs were excluded. All study participants underwent evaluation with a standardized protocol, including echocardiography, and cytokine levels of interleukin-2, interleukin-4, interleukin-6, interleukin-10, tumour necrosis factor-alpha, and gamma-interferon determination before procedure. Clinical and electrocardiographic follow-up were performed with Holter-ECG at 3, 6 and 12months in order to know if sinus rhythm was maintained. RESULTS After catheter ablation of the 44 patients included (53±10years, 27.3% female), all patients returned to sinus rhythm. During the first year of follow-up seven patients (15.9%) experienced recurrence of AF. The demographics, clinical and echocardiographic features, and pharmacological treatments of these patients were similar to those who maintained sinus rhythm. The only independent factor predictive of recurrence of AF was an elevated level of IL-2 (OR 1.18, 95% CI 1.12-1.38). CONCLUSIONS High serum levels of interleukin-2, a pro-inflammatory non-vascular cytokine, are associated with the recurrence of AF in patients undergoing catheter ablation.

Long-term prognosis of patients with arrhythmogenic right ventricular cardiomyopathy and implantable defibrillator.

reference group. They also found that normotensive individuals with preserved eGFR (≥90 ml/min/1.73 m) and moderately high ACR (30 to 299 mg/g) have an elevated risk of all-cause death [5]. The results are very similar to the results of our study. Therefore, to conclude that our results are inconsistent with the results of the previous studies may be the result of an incorrect interpretation of the results from the previous studies. Dr. Kawada requested the authors to add medication profiles for hypertension and diabetes mellitus [1]. We added the prevalence of hypertensive subjects on medication and diabetic subjects on medication in Table 2 of this paper. We are confident that the high risks of outcomes in individuals with preserved eGFR and albuminuria observed in our study reflect a true relationship. However, we agree with some of the comments by Dr. Kawada. We used too many explanatory variables in the multivariate-adjusted Poisson model and we share Dr. Kawadas concerns about type I error (overfitting) [6]. We hope the analyses were performed in the spirit of Dr. Kawadas intent. Finally, we strongly agree with the phrase “keeping a satisfactory number of events for the epidemiological study to keep the validity of the outcome” provided by Dr. Kawada. We appreciate having the opportunity to discuss the problem and we express our deepest gratitude to Dr. Kawada.

Expression of Sterol Regulatory Element-Binding Proteins in epicardial adipose tissue in patients with coronary artery disease and diabetes mellitus: preliminary study

Objectives: Sterol regulatory element-binding proteins (SREBP) genes are crucial in lipid biosynthesis and cardiovascular homeostasis. Their expression in epicardial adipose tissue (EAT) and their influence in the development of coronary artery disease (CAD) and type-2 diabetes mellitus remain to be determined. The aim of our study was to evaluate the expression of SREBP genes in EAT in patients with CAD according to diabetes status and its association with clinical and biochemical data. Methods: SREBP-1 and SREBP-2 mRNA expression levels were measured in EAT from 49 patients with CAD (26 with diabetes) and 23 controls without CAD or diabetes. Results: Both SREBPs mRNA expression were significantly higher in patients with CAD and diabetes (p<0.001) and were identified as independent cardiovascular risk factor for coronary artery disease in patients with type-2 diabetes (SREBP-1: OR 1.7, 95%CI 1.1-2.5, p=0.02; SREBP-2: OR 1.6, 95%CI 1.2-3, p=0.02) and were independently associated with the presence of multivessel CAD, left main and anterior descending artery stenosis, and higher total and LDL cholesterol levels, and lower HDL cholesterol levels, in patients with CAD and diabetes. Conclusions: SREBP genes are expressed in EAT and were higher in CAD patients with diabetes than those patients without CAD or diabetes. SREBP expression was associated as cardiovascular risk factor for the severity of CAD and the poor lipid control. In this preliminary study we suggest the importance of EAT in the lipid metabolism and cardiovascular homeostasis for coronary atherosclerosis of patients with diabetes and highlight a future novel therapeutic target.

Relación entre cistatina C y calcificación coronaria en pacientes con riesgo cardiovascular intermedio

BACKGROUND AND OBJECTIVE Cardiovascular disease is the leading cause of morbimortality in industrialized countries. Quantification of coronary artery calcium (CAC) has been shown to have an independent and incremental prognostic value over traditional risk factors for the prediction of mortality and cardiovascular events. The aim of our study was to determine the possible relationship between CAC and cystatin C (CTC). PATIENTS AND METHOD We included 104 patients with stable chest pain, free of cardiovascular disease and nephropathy, with intermediate cardiovascular risk. Both CAC (Agatston) and CTC were determined. RESULTS CTC was independently associated with the CAC level and the presence of coronary disease. CONCLUSIONS CTC values may be associated with CAC and coronary disease. Further studies are needed to know the importance of these markers in clinical practice.