Eduardo Guevara

Predictores de mortalidad hospitalaria en 186 episodios de endocarditis infecciosa activa en un centro de tercer nivel (1992-2001)

Introduction and objectives. The aim of this study was to describe the predictors of hospital mortality found in patients admitted for infective endocarditis (IE) to a cardiovascular surgery ward. Patients and method. Prospective study of 186 patients with IE treated in our hospital between 1992 and 2001. Results. One hundred fourteen patients (61.3%) had native valve endocarditis and 72 (38.7%) had prosthetic valve endocarditis (early in 28 patients [up to 12 months after surgery] and late in 44 [later than 12 months]). Blood cultures were positive in 82%. The predominant organism was Streptococcus viridans (36%) in native valve endocarditis and Staphylococcus aureus (33%) in prosthetic valve endocarditis. The hospital mortality was 22.6%. Severe sepsis (4.8%) produced a high mortality rate (88%) and was caused by Staphylococcus aureus in 60%. One hundred nineteen patients (64%) required surgery, 79 (66.4%) of them urgently. Negative blood cultures predicted need for surgery in native valve endocarditis (p < 0.05). The surgical mortality was 21.8% and was related to NYHA III-IV class (p = 0.014) and emergency surgery (p = 0.009) in patients with native valve endocarditis. This last factor also predicted higher surgical mortality in patients with early prosthetic valve endocarditis (p < 0.001). Conclusions. The hospital mortality of this group of patients with infective endocarditis treated in a tertiary medical center was high. The presence of severe sepsis, although infrequent, had a somber prognosis. Severe heart failure in native valve endocarditis and urgent surgery in native and prosthetic valve endocarditis increased surgical mortality.

Assessment of training-dependent changes in the left ventricle torsion dynamics of professional soccer players using speckle-tracking echocardiography

Recently, it has been proposed the use of speckle- tracking echography (STE) to study the left ventricle (LV) torsion dynamics, which would make LV torsion assessment more available in clinical and research cardiology. LV torsion has been described during exercise and in some sportsmen, but so far, its dynamics has not been studied in soccer players. The aims were to characterize and to compare LV apical and basal rotation, and to analyze LV torsion in professional soccer players using STE, and to determine the main differences in torsion between soccer players and age-matched non-trained individuals. The STE allowed characterizing LV rotation and torsion in both groups. LV torsion level and velocities were lesser in soccer players than in non-trained individuals. Changes in torsion in soccer players could represent physiological adaptations to training.

La reducción en el nivel y la velocidad de la torsión ventricular puede asociarse a incremento en la eficiencia ventricular izquierda: evaluación mediante ecografía speckle-tracking

Introduccion y objetivos. Los cambios estructurales y funcionales existentes en el ventriculo izquierdo (VI) de futbolistas profesionales podrian determinar cambios en el movimiento de rotacion ventricular (Rv) y torsion ventricular (Tv). El objetivo fue caracterizar los cambios en la Tv existentes en futbolistas profesionales. Metodos. A 17 futbolistas y 10 voluntarios sanos no entrenados (grupo control), se les realizo un estudio ecocardiografico en modos M y B y Doppler. Se cuantificaron parametros estructurales y de funcion sistolica y diastolica del VI. La Rv basal y apical y la Tv se evaluaron utilizando un software disenado para estos fines (EchoPAC, GE Medical Systems). La Tv se caracterizo en el dominio temporal. Resultados. Todos los sujetos presentaron estructura y funcion del VI dentro del rango de normalidad. La fraccion de eyeccion y la de acortamiento fueron mayores en los futbolistas (p < 0,05). Los niveles de Rv apical y basal y los niveles y velocidades de Tv fueron menores en los futbolistas (p < 0,05). En los futbolistas, la Tv maxima alcanzada y la fraccion de eyeccion y la de acortamiento mostraron correlacion negativa (p < 0,05). Conclusiones. Los niveles y las velocidades de TV fueron menores en los futbolistas. Las reducciones en la Tv pueden ocurrir en condiciones fisiologicas y podrian representar una respuesta adaptativa que contribuye a aumentar la eficiencia ventricular.

[A reduction in the magnitude and velocity of left ventricular torsion may be associated with increased left ventricular efficiency: evaluation by speckle-tracking echocardiography].

INTRODUCTION AND OBJECTIVESnThe structural and functional changes observed in the left ventricle in professional soccer players could cause alterations in ventricular rotation (Rv) and ventricular torsion (Tv). Our aim was to characterize the changes in Tv that occur in professional soccer players.nnnMETHODSnIn total, 17 professional soccer players and 10 healthy volunteers who had not undergone training (control subjects) were investigated by M-mode, B-mode and Doppler echocardiography. Left ventricular systolic and diastolic functional and structural parameters were measured. Basal and apical Rv, and Tv were determined using specially developed software (EchoPAC, GE Medical Systems). In addition, Tv was characterized in the time domain.nnnRESULTSnIn all subjects, left ventricular structural and functional parameters were within the normal ranges. Both left ventricular ejection fraction and shortening were greater in soccer players (P< .05). The magnitude of apical and basal Rv and the magnitude and velocity of Tv were all lower in soccer players (P< .05). In soccer players, there were negative correlations between the maximum Tv achieved and left ventricular shortening and ejection fraction (P< .05).nnnCONCLUSIONSnThe magnitude and velocity of Tv were lower in soccer players. A reduction in Tv might take place under certain physiological conditions and could represent an adaptive response that contributes to increased ventricular efficiency.

Reversion by vagal reflex of a fetal paroxysmal atrial tachycardia detected by echocardiography

We report the reversion of fetal paroxysmal atrial tachycardia with 2:1 atrioventricular block obtained by vagal maneuvers during week 35 of gestation in a 31-year-old woman. All events were documented by fetal echocardiography.

Usefulness of Myocardial Contrast Echocardiography Early After Acute Myocardial Infarction

Objectives: (1) Evaluate wall motion and perfusion abnormalities after reperfusion therapy of the culprit lesion, (2) delineate the ability of myocardial contrast echocardiography (MCE) to evaluate the microvasculature after reperfusion, in order to distinguish between stunning and necrosis in the risk area. Methods: We analyzed 446 segments from 28 patients, 10 normal controls (160 segments), and 18 with a first AMI (286 segments). MCE was obtained with Optison and a two‐dimensional echocardiography was performed at 3 months post acute myocardial infarction (AMI). Results: In the group with AMI, we analyzed 286 segments, of which 107 had wall motion abnormalities (WMA) related to the culprit artery. Two subgroups were identified: Group I with WMA and normal perfusion (50 segments, 47%) and Group II with WMA and perfusion defects (57 segments, 53%). According to the 2D echocardiogram at 3 months, they were further subdivided into: Group IA: with wall motion improvement (stunning): 18 segments, 36%, Group IB: without wall motion improvement: 32 segments, 64%, Group IIA: with wall motion improvement: 12 segments, 21%, Group IIB: without wall motion improvement (necrosis): 45 segments, 79%. Conclusions: (1) The presence of myocardial perfusion in segments with WMA immediately after AMI reperfusion therapy predicts viability in most patients. Conversely, the lack of perfusion is not an absolute indicator of the presence of necrosis. (2) Perfusion defects allow to detect patients with thrombolysis in myocardial infarction (TIMI) 3 flow and “no‐reflow” phenomenon who will not show improved wall motion in the 2D echocardiogram. However, some patients with initial no‐reflow could have microvascular stunning and their regional contractile function will normalize after a recovery period.

Time and frequency-domain characterization of the left ventricle torsion pattern of professional soccer players using speckle-tracking echocardiography

The left ventricle (LV) torsion is an important feature of the ventricle’s biomechanics. Using speckle-tracking echography (STE) the assessment of LV torsion dynamics would be more available in clinical and research cardiology Particular features of the LV torsion have been described during exercise and in some sportsmen, but up to now the LV torsion dynamics has not been studied in soccer players. The aims were to characterize the LV systolic and diastolic torsion dynamic in professional soccer players using STE, and to analyze the main differences in torsion dynamics between soccer players and age-matched non-trained individuals. To this end the LV apical and basal rotation were quantified, and the systolic and diastolic torsion dynamic was characterized using a time and frequency-domain approach. The STE allowed characterizing the LV torsion level in both groups. The LV torsion level was lesser in soccer players than in non-trained individuals. Soccer players showed lesser amplitudes in the low frequency components of the LV torsion Fourier spectrum.