Eduardo Arroyo-Ucar

Decreased level of melatonin in serum predicts left ventricular remodelling after acute myocardial infarction

Abstract:  As experimental studies suggest that melatonin is cardioprotective after myocardial infarction (MI), this study sought to investigate the relationships between circulating levels of melatonin and left ventricular (LV) remodelling in patients after acute MI. This prospective study included 161 patients (age 61 ± 3 yr; 78% men) undergoing primary percutaneous coronary intervention who were assessed echocardiographically at hospital discharge (day 3–7) and at 12 months. LV remodelling was defined as >20% increase in LV end‐diastolic volume at 12‐month follow‐up compared with baseline. Serum melatonin concentrations were measured at admission, during the light period. Twenty‐four patients showed LV remodelling, and 137 had no evidence of LV remodelling. Patients with LV remodelling had lower levels of melatonin at study entry [9.96 (8.28–11.03) versus 16.74 (13.77–19.59) pg/mL, respectively; P < 0.0001]. Multivariate analysis showed that melatonin levels (OR = 2.10, CI 95% 1.547–2.870, P < 0.001) were an independent predictor of LV remodelling at 12‐month follow‐up. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.959 (CI 95% 0.93–0.98; P < 0.0001). To our knowledge, this is the first study to show the relationship between melatonin and LV remodelling during the chronic phase post‐MI.

Estudio comparativo de las partículas en aire ambiente en pacientes ingresados por insuficiencia cardiaca y síndrome coronario agudo

INTRODUCTION AND OBJECTIVES Currently air pollution is considered as an emerging risk factor for cardiovascular disease. Our objective was to study the concentrations of particulate matter in ambient air and analyze their relationship with cardiovascular risk factors in patients admitted to a cardiology department of a tertiary hospital with the diagnosis of heart failure or acute coronary syndrome (ACS). METHODS We analyzed 3950 consecutive patients admitted with the diagnosis of heart failure or ACS. We determined the average concentrations of different sizes of particulate matter (<10, <2.5, and <1 μm and ultrafine particles) from 1 day or up to 7 days prior to admission (1 to 7 days lag time). RESULTS There were no statistically significant differences in mean concentrations of particulate matter <10, <2.5 and <1 μm in size in both populations. When comparing the concentrations of ultrafine particles of patients admitted due to heart failure and acute coronary syndrome, it was observed that the former had a tendency to have higher values (19 845.35 ± 8 806.49 vs 16 854.97 ± 8005.54 cm⁻³, P <.001). The multivariate analysis showed that ultrafine particles are a risk factor for admission for heart failure, after controlling for other cardiovascular risk factors (odds ratio=1.4; confidence interval 95%, from 1.15 to 1.66 P=.02). CONCLUSIONS In our study population, compared with patients with ACS, exposure to ultrafine particles is a precipitating factor for admission for heart failure.

Relación entre exposición a corto plazo a dióxido de azufre atmosférico y lesiones obstructivas en el síndrome coronario agudo

BACKGROUND AND OBJECTIVES Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries. PATIENTS AND METHODS Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL. RESULTS Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93 ± 8.33 versus 9.31 ± 6.77 μg/m(3); P = .004). Multivariate analysis shows that for every 10 μg/m(3) increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P = .028). CONCLUSIONS In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL.

Global left ventricular longitudinal strain is associated with decreased melatonin levels in patients with acute myocardial infarction: a two-dimensional speckle tracking study

Abstract Low circulating melatonin levels predict poor outcome in patients with ST-segment elevation myocardial infarction (STEMI). In the present study, we investigated whether a relationship between myocardial deformation in parameters measured by echocardiography and circulating melatonin level exists. We prospectively included 112 patients with STEMI who performed echocardiography and simultaneous measurement of serum melatonin, during the light period within 72 h of admission. We found a negative correlation between circulating melatonin levels and global longitudinal strain (p = 0.006, r = −0.33). In conclusion, melatonin levels have a correlation with two-dimensional speckle tracking in patients with STEMI.

Air pollution and heart failure: Relationship with the ejection fraction.

AIM To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m(3) vs 4.50 ± 2.34 μg/m(3), P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

Cardiopulmonary exercise testing and prognostic assessment of hypertensive cardiomyopathy: An emerging application

Cardiopulmonary exercise testing and prognostic assessment of hypertensive cardiomyopathy: An emerging application Alberto Dominguez-Rodriguez ⁎, Eduardo Arroyo-Ucar , Pedro Abreu-Gonzalez , Maria Carrillo-Perez Tome , Celestino Hernandez-Garcia , Maria del Carmen Garcia-Baute , Pablo Avanzas e a Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain b Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain c Instituto Universitario de Tecnologias Biomedicas, Tenerife, Spain d University of La Laguna, Department of Physiology, Tenerife, Spain e Hospital Central de Asturias, Department of Cardiology, Oviedo, Spain

Usefulness of serum neopterin levels in acute decompensated heart failure to predict renal dysfunction.

Context: Neopterin serum concentration increases in the presence of renal dysfunction. Objective: We sought to determine the relationship between admission serum neopterin levels and worsening renal function (WRF) in patients with heart failure (HF). Methods: We prospectively measured serum neopterin levels in patients with HF and the patients were subdivided into two groups: with and without WRF during hospital admission. Results: Logistic regression analysis showed that high serum neopterin levels at admission were associated with a greater likelihood of developing WRF. Conclusions: Patients admitted to hospital with HF, elevated serum neopterin levels are associated with an increased risk of developing WRF.

Echogenic mobile images in intraprocedural three-dimensional transesophageal echocardiographic monitoring during percutaneous aortic valve implantation: Incidence, characteristics and clinical implications

INTRODUCTION AND OBJECTIVES To investigate the incidence and clinical relevance of the presence of mobile echogenic images (MEI) during transesophageal echocardiography (TEE) for monitoring of transcatheter aortic valve implantation (TAVI). METHODS Consecutive patients referred to our center for transfemoral or transapical TAVI were included. The procedure was monitored by three-dimensional (3D) TEE and images were analyzed by two independent experts. In-hospital follow-up was carried out and correlated with imaging findings. RESULTS A total of 104 patients were included. MEI were visualized in 11 patients during the procedure (11%) and in over 50% of cases were identified as thrombi, however no differences in periprocedural stroke were found in follow-up. CONCLUSIONS Visualization of MEI during 3D TEE monitoring of TAVI is relatively common (11%) and in over 50% of cases they are identified as thrombi. The clinical implications of this finding are uncertain, as despite their frequency, the incidence of clinical stroke in this patient population was no higher. 3D TEE is a useful tool for diagnosis of MEI and can alert the operator to their presence.

Serum ferritin deficiency and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction without anemia.

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