Carlos Alberola López

NEW INSIGHTS INTO THE CIRCADIAN RHYTHM OF ACUTE MYOCARDIAL INFARCTION IN SUBGROUPS

The aim of this study was to determine the existence of the circadian rhythm (CR) in the onset of acute myocardial infarction (AMI) in different patient subgroups. Information was collected about 41,244 infarctions from the database of the ARIAM (Analysis of Delay in AMI) Spanish multicenter study. CR in AMI were explored in subgroups of cases categorized by age, gender, previous ischemic heart disease (PIHD), outcome in coronary care unit, infarction electrocardiograph (ECG) characteristics (Q wave or non‐Q wave), and location of AMI. Cases were classified according to these variables in the different subgroups. To verify the presence of CR, a simple test of equality of time series based on the multiple‐sinusoid (24, 12, and 8 h periods) cosinor analysis was developed. For the groups as a whole, the time of pain onset as an indicator of the AMI occurrence showed a CR (p<0.0001), with a morning peak at 10:10 h. All the analyzed subgroups also showed CR. Comparison between subgroups showed significant differences in the PIHD (p<0.01) and infarction ECG characteristics (p<0.01) groups. The CR of the subgroup with Q‐wave infarction differed from that of non‐Q wave subgroup (p<0.01) when the patients had PIHD (23% in Q wave infarction vs. 39.2% in non‐Q wave). AMI onset followed a CR pattern, which is also observed in all analyzed subgroups. Differences in the CR according to the Q/non‐Q wave infarction characteristics could be determined by PIHD. The cosinor model fit with three components (24, 12, and 8 h periods) showed a higher sensitivity than the single 24 h period analysis.

Cardiovascular Risk Factors in the Circadian Rhythm of Acute Myocardial Infarction

Introduction and objectives. The aim of this study was to analyze the influence of modifiable cardiovascular risk factors on the circadian rhythm of acute myocardial infarction. Patiens and method. We analyzed a retrospective cohort of 54 249 patients from a multicenter study of acute myocardial infarction (the Spanish ARIAM study). The variables were time of onset of symptoms, age, sex, previous ischemic heart disease, coronary unit discharge status, previous stroke, familial antecedents of ischemic heart disease, hypertension, diabetes, dyslipidemia, smoking, and reinfarction. To verify the presence of circadian rhythm, we developed a simple test of equality of time series based on cosinor analysis of multiple sinusoid curves. Three sinusoids (24,12, and 8 hour periods) were used. Results. The time of onset of pain showed a circadian rhythm (P<.01), with a peak at 10:07 am and a trough at 4:46 am. All subgroups categorized according to the presence of the variables analyzed here showed a circadian rhythm, with a sinusoid curve after adjustment. In patients with diabetes or reinfarction or who were smokers, the sinusoid curve was bimodal. Conclusions. Time of onset of symptoms in patients with acute myocardial infarction follows a circadian rhythm. Diabetes, smoking and reinfarction can modify the standard circadian rhythm of onset of myocardial infarction.

Factores de riesgo cardiovascular en el ritmo circadiano del infarto agudo de miocardio

Introduccion y objetivos El objetivo de este trabajo es analizar la influencia de los factores de riesgo cardiovascular modificables en el ritmo circadiano del infarto agudo de miocardio. Pacientes y metodo. Analisis retrospectivo de 54.249 pacientes incluidos en la base de datos del proyecto ARIAM con diagnostico de infarto agudo de miocardio. Se analizan las variables hora de inicio, edad, sexo, cardiopatia isquemica previa, estado en el momento del alta de la unidad coronaria, antecedentes familiares de cardiopatia isquemica, accidente cerebrovascular previo, hipertension arterial, dislipemia, diabetes, tabaquismo y reinfarto. El analisis de ritmo se ha efectuado utilizando un test simple de igualdad de series basado en el analisis cosinor de multiples sinusoides, eligiendo 3 armonicos (24,12 y 8 h) para su ajuste. Resultados La hora de inicio del infarto muestra ritmo circadiano (p Conclusiones El infarto agudo de miocardio presenta ritmo circadiano. La diabetes, el tabaquismo y el reinfarto pueden modificar el ritmo habitual de aparicion del infarto.

Multiple morphologies of ventricular tachycardia assessed by implantable cardioverter-defibrillator electrograms in a patient with Chagas disease, successfully treated with catheter ablation: modern problems, old solutions

A 60-year-old man with Chagas disease, implanted with an implantable cardioverter defibrillator (ICD), experienced electrical storm. The ICD-stored electrograms revealed several ventricular tachycardia (VT) episodes with two different morphologies, confirmed thereafter by surface electrocardiogram. Both VTs originated from two different re-entry circuits and were successfully ablated. This case highlights the usefulness of ICD electrograms in identifying two VTs as having different sites of origin. Analysis of implantable cardioverter-defibrillator electrograms (ICD-EG) showed that monomorphic ventricular tachycardia (VT) with different QRS morphologies during different episodes (multiple morphologies, MM) predicted higher mortality. 1 A 60-year-old man implanted with an ICD (Medtronic Maximo-VR7232) for secondary prevention of death, with Chagas disease and left ventricular ejection fraction (LVEF), 0.45 was hospitalized for electrical storm. The ICD interrogation revealed 62 episodes of monomorphic VT. Analysing ICD-EG, a difference in morphology was seen only in the HVA/HVB electrogram (a QS complex in Figure 1A; a Qr complex in Figure 1B). During hospitalization he experienced several VT episodes and surface-electrocardiogram Figure 1 Schematic representation of the endocardial surface of the left ventricle. (A) and (B) Implantable cardioverter defibrillator- stored electrograms showing two different morphologies of the HVA/HVB electrogram. Note that this difference is not evident in the Vtip-Vring electrogram

Ubiquitous tele-monitoring kit (UTK): measuring physiological signals anywhere at anytime

The Ubiquitous Tele-monitoring Kit (UTK) is aimed at helping the clinician in acquiring, managing and normalizing information coming from the patients at home and storing the data in a distributed system. This approach aims to reduce costs in the healthcare system and alleviate the inherent problems to chronic patients who usually may visit the doctors. The proposed system closes the tele-monitoring loop; wearable and ergonomic sensors integrated in the textile, automatic detection and storage of the information coming from the sensors in a common platform (XNAT) and processing and visualization of the retrieved physiological signals presenting the data treated to the clinician to optimize the continuum of care and the decision-making.

Strain Rate Tensor Estimation in Cine Cardiac MRI Based on Elastic Image Registration

In this work we propose an alternative method to estimate and visualize the Strain Rate Tensor (SRT) in Magnetic Resonance Images (MRI) when Phase Contrast MRI (PCMRI) and Tagged MRI (TMRI) are not available. This alternative is based on image processing techniques. Concretely, image registration algorithms are used to estimate the movement of the myocardium at each point. Additionally, a consistency checking method is presented to validate the accuracy of the estimates when no golden standard is available. Results prove that the consistency checking method provides an upper bound of the mean squared error of the estimate. Our experiments with real data show that the registration algorithm provides a useful deformation field to estimate the SRT fields. A classification between regional normal and dysfunctional contraction patterns, as compared with experts diagnosis, points out that the parameters extracted from the estimated SRT can represent these patterns. Additionally, a scheme for visualizing and analyzing the local behavior of the SRT field is presented.

Obstrucción laringotraqueal completa idiopática. Tratamiento con mitomicina C

Exponemos el caso de una paciente de 69 anos en la que se desarrollo una estenosis laringotraqueal idiopatica con obstruccion completa. Se tuvo que intervenir a la paciente 7 veces, con distintas tecnicas endoscopicas o abiertas, por reobstrucciones postoperatorias. Lo novedoso del caso es que el exito final se obtuvo tras la aplicacion de mitomicina C. Es conocida la accion de este farmaco, pero tiene interes mostrar un caso complejo en el que solo se obtiene exito cuando se aplica mitomicina C.

Total idiopathic laryngotracheal stenosis. Treatment with mitomycin C

This case report involves a 69-year-old woman who presented idiopathic laryngotracheal stenosis with total obstruction of the airway. Seven surgical procedures involving open field and endoscopy techniques had to be performed due to repeated re-obstructions. The novelty in this case is that success was finally obtained with the use of mitomycin C. The drug action is well known, but is interesting to report a case in which success was only obtained when we used mitomycin C.

Termination mode of a broad QRS complex tachycardia: is the surface electrocardiogram the key?

A 45-year-old man with a long history of palpitations and absence of pre-excitation in baseline electrocardiogram underwent a Holter recording, revealing several episodes of regular non-sustained broad QRS complex tachycardia that terminated following the occurrence of a narrow QRS. (Panel A). The analysis of the last narrow QRS showed a signal compatible with a retrograde P wave. An electrophysiological study was performed. During the procedure, short episodes of orthodromic tachycardia (OT) with functional left bundle branch block (LBBB) were reproduced and consistently interrupted following the occurrence of a single narrow QRS complex with exactly the same cycle length as that of the tachycardia (Panel B). The intracardiac recordings showed a 40 ms shortening of the ventriculo-atrial interval in the narrow beat and an-