Borja Ibanez

Asociación del síndrome tako-tsubo con la arteria coronaria descendente anterior con extensa distribución por el segmento diafragmático

Introduccion y objetivos. El sindrome de disfuncion ventricular transitoria tako-tsubo ha sido descrito en Japon y se han publicado casos aislados en Occidente. Mostramos una de las primeras series descritas fuera de Japon y presentamos nueva informacion sobre su anatomia coronaria. nnPacientes y metodo. Entre enero de 1998 y abril de 2003 identificamos a 11 pacientes con sospecha de infarto agudo de miocardio, arterias coronarias normales y disfuncion ventricular transitoria tipo tako-tsubo. Estudiamos la anatomia coronaria de estos 11 pacientes, asi como de 44 controles ajustados por edad y sexo: 22 con coronarias normales y 22 con infarto agudo de miocardio en relacion con oclusion en la arteria coronaria descendente anterior. nnResultados. Al igual que en los pacientes japoneses, el sindrome tako-tsubo en pacientes caucasicos generalmente ocurre en mujeres en la septima u octava decadas de la vida y con frecuencia se precede de estres emocional o fisico. La arteria coronaria descendente anterior de nuestros pacientes con sindrome tako-tsubo tiene mayor longitud y un segmento diafragmatico (recurrente) mas largo que la de los controles. Para compararlos disenamos un indice de recurrencia ([segmento recurrente de descendente anterior/longitud total de la descendente anterior] x 100). En los pacientes con sindrome tako-tsubo, este indice fue del 22,3 ± 1,5%, en controles normales fue del 10,9 ± 6,7% (p < 0,001) y en los pacientes de control con infarto del 11,3 ± 7,7% (p < 0,001). Los pacientes de control con infarto presentaban una ventriculografia identica a la de los enfermos con sindrome tako-tsubo cuando su indice de recurrencia era alto (= 16%). nnConclusiones. Todos nuestros pacientes con sindrome tako-tsubo presentan una descendente anterior con un gran segmento recurrente. La morfologia identica de la ventriculografia de los pacientes con sindrome tako-tsubo y los controles con infarto con un elevado indice de recurrencia de la descendente anterior puede deberse a una etiopatogenia comun.

Corrigendum to "Effects of Fibrosis Morphology on Reentrant Ventricular Tachycardia Inducibility and Simulation Fidelity in Patient-Derived Models"

This corrigendum concerns: Ringenberg et al. Effects of Fibrosis Morphology on Reentrant Ventricular Tachycardia Inducibility and Simulation Fidelity in Patient-derived Models. Clinical Medicine Insights: Cardiology 2014:8(S1) 1–13 doi: 10.4137/CMC.s15712. Two authors’ names were omitted from the original article, Natalia Trayanova and Michael Miller. The affiliations of Drs. Trayanova and Miller are listed in the amended author list above. n nThe labs of Drs. Trayanova and Miller jointly developed the method used in the original paper to estimate the fiber orientations in each patient’s heart.1 Some fiber estimations conducted in the course of the research published in the original paper were conducted in Dr. Miller’s lab, using software developed by Dr. Miller’s team. The methodology for image-based fiber estimation has been previously used in a human retrospective study to assess, in a patient-specific manner, the pattern of infarct-related ventricular tachycardia (study involving 13 patients).2 n nThe editor in chief has reviewed this matter against the relevant Committee on Publication Ethics procedure and agrees to the publication of this corrigendum. The editor-in-chief thanks Dr. Trayanova for bringing this matter to the journal’s attention.

Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine.

The goal of this paper is to provide an updated review for scientists and clinicians on the major areas in cardiovascular medicine published in the Journal. Leading topics in regenerative and personalized medicine are presented along with a critical overview of the field. New standards in large preclinical animal models of pulmonary hypertension and left bundle branch block are highlighted. Finally, clinical care in the areas of atherosclerosis, the aortic valve, platelet biology, and myocarditis is discussed as well as autonomic modulation therapies.

Tako-Tsubo Transient Left Ventricular Apical Ballooning Is Associated With a Left Anterior Descendig Coronary Artery With a Long Course Along the Apical Diaphragmatic Surface of the Left Ventricle

Introduction and objectives Tako-tsubo-like transient left ventricular apical ballooning has been described in Japan, but few cases have been reported in Western countries. We report one of the first series outside Japan, which provides new information on the coronary anatomy of this disorder. Patients and Methods From January 1998 to February 2003 we observed 11 patients with a clinical suspicion of acute myocardial infarction, normal coronary arteries, and transient tako-tsubo-like systolic left ventricular apical ballooning. We compared the coronary artery anatomy in these 11 patients with that in 44 controls matched for age and sex: 22 with normal coronary arteries and 22 with acute myocardial infarction related with an obstructive thrombus in the left anterior descending coronary artery. Results As in Japanese patients, tako-tsubo syndrome in Caucasian patients frequently occurs in women in their seventh or eighth decades of life, and is usually preceded by emotional or physical stress. The left anterior descending in our patients with tako-tsubo syndrome was longer overall, and its recurrent diaphragmatic segment was longer, than in controls. To compare these groups we designed a measure termed recurrent segment index (left anterior descending recurrent segment length/total left anterior descending length x 100). In tako-tsubo syndrome this index was 22.3 (1.5)%, vs 10.9 (6.7)% in normal controls (P Conclusions All our patients with tako-tsubo syndrome had a left anterior descending with a long recurrent segment. The identical ventriculographic findings in patients with tako-tsubo syndrome and those with acute myocardial infarction with a long recurrent segment may be due to a common etiology.

Prevention of Microvascular Obstruction by Addressing Ischemia Reperfusion Injury—Part B

Abstract ST-segment elevation acute myocardial infarction (STEMI) is a major health problem. The implementation of reperfusion strategies has resulted in a very significant reduction of shortterm mortality. However, STEMI survivors with large infarctions are at high risk of chronic heart failure and associated comorbidities. The possibility of reducing infarct size might help alleviating the epidemics of heart failure. In many cases, despite optimal opening of the occluded epicardial coronary artery, tissue perfusion is inadequate due to microvascular obstruction (MVO). Given the central role of MVO in final infarct size, it is the target of different interventions. In the past decades, many strategies (pharmacological and mechanical) have been tested with the aim of reducing MVO and in turn lessen infarct size. Many interventions have failed in the translation from positive experimental studies into clinical trials, while some others have passed the initial checkpoint of pilot trials and are being tested in properly sized endpoints-oriented clinical trials. In this chapter we will describe the state of the art of the different strategies that are actively being tested in this field.

Danger to the ventricular myocardium from prolonged ablation procedures combined with a long-lasting catecholamine infusion for provocative arrhythmia testing

In this issue of Europace , Hasdemir et al. report on a case of what they term ‘stress cardiomyopathy ( tako-tsubo )’ following radiofrequency ablation in the right ventricular outflow tract.1 The most relevant lesson from this case report is that very prolonged ablation procedures may result in a transient left ventricular (LV) systolic dysfunction or stress cardiomyopathy, particularly when catecholamines are infused over a long period to test the result of intervention. In this case, radiofrequency was delivered for up to 21 min, which meant that the procedure was very long-lasting and most likely stressful for a non-sedated patient. This, together with the also very prolonged duration of the dopamine infusion (maintained during the whole ablation procedure plus for 90 min after the last radiofrequency application) implies a strong and protracted intrinsic and extrinsic adrenergic stimulus, the known common denominator for developing a stress cardiomyopathy.2nnA second issue raised … nn*Corresponding author. Tel: +34 91 544 1636; fax: +34 91 549 9402. E-mail address: jfarre{at}fjd.es

Atypical left bundle branch block in dilative "burned-out" phase of hypertrophic cardiomyopathy.

We present the case of a 70‐year‐old man admitted in congestive heart failure. The patient was diagnosed 22 years ago of hypertrophic cardiomyopathy (HC). ECG showed a very peculiar and pathological form of left bundle branch block (LBBB). 2D‐echocardiogram revealed a dilated left ventricle (LV) and ejection fraction of 25%. LV remodeling represents an important component of the pathophysiology of HC and, paradoxically, some patients develop LV wall thinning, systolic dysfunction, and congestive heart failure (in the absence of coronary artery disease). This evolution is designated as “end‐stage” or “burned‐out” phase. We present this rare LBBB and his pathological evolution along the time as unique manifestation of this “burned‐out” phase. The mechanism of this wall thinning remains unclear but changes in ECG may alert us about it.