Francesc Planas

Idiopathic dilated cardiomyopathy exhibits defective vascularization and vessel formation

Ultrastructural findings of idiopathic dilated cardiomyopathy (IDCM) include myocyte atrophy and myofilament loss, yet little is known about the vascular abnormalities present in IDCM.

Relationship Between Adiponectin and Left Atrium Size in Uncomplicated Obese Patients: Adiponectin, a Link Between Fat and Heart

BackgroundIt is well known that obesity is a risk factor for severe cardiovascular complications, such as coronary heart disease, heart failure, stroke, venous thromboembolic disease, and atrial fibrillation. Left ventricle (LV) and left atrium (LA) enlargement is a characteristic feature of these patients with the consequent cardiovascular risk. Factors other than hemodynamic may influence LA remodeling. The aim of the study is to evaluate the relationship between adiponectin and LA size in uncomplicated obese patients.MethodsSeventy-four asymptomatic obese patients and an age- and sex-matched control group (N = 70) were recruited. A detailed clinical, echocardiographic, and analytical study was performed. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR) method. Insulin sensitivity was assessed measuring serum total adiponectin concentrations.ResultsAdiponectin levels were lower in the obese group (P < 0.001) and particularly so in those obese participants with enlarged LA (32%; P < 0.0005). LA sizes were higher in the obese group (P < 0.0005). Adiponectin displayed significant correlations with body mass index, glucose, insulin, high-density lipoprotein cholesterol, and triglyceride concentrations as well as HOMA-IR (P < 0.001 for all). Adiponectin displayed significant correlations with LV mass and LA size, diastolic and systolic cardiac volumes and diameters, and cardiac output (P < 0.001 for all). Adiponectin correlations with LA size (r = −0.429; P < 0.001) persisted after adjustment for HOMA-IR, age, sex, and LV mass.ConclusionsA novel inverse relationship between adiponectin and LA size independent of age, sex, insulin resistance, and LV mass appears in our series. Adiponectin could be a link between adipose tissue and the heart, having an influence on cardiac remodeling.

Resultados inmediatos y a largo plazo de la angioplastia con stent del tronco común

Introduccion y objetivos La cirugia de derivacion aortocoronaria ha sido considerada el tratamiento de eleccion de la estenosis del tronco comun. Diversos estudios multicentricos sugieren la posibilidad de la angioplastia con stent. El objetivo del presente estudio fue analizar los resultados inmediatos y a largo plazo de la angioplastia con stent en el tronco comun, asi como identificar los factores predictores de mortalidad. Pacientes y metodo Se incluyo a 38 pacientes no consecutivos de 69 ± 8 anos de edad con una lesion severa del tronco comun a los que se implanto un stent entre noviembre de 1997 y marzo del 2003. La indicacion de la angioplastia fue «electiva» en 27 pacientes y «urgente » en los 11 restantes. El tronco comun no estaba protegido en 23 pacientes (60,5%). En todos los pacientes se realizo el seguimiento clinico a los 25 ± 20 meses. Resultados En todos los pacientes, el procedimiento angiografico se realizo con exito. Un paciente presento una oclusion aguda 1 h despues. En 4 pacientes (10%) se produjo un infarto de miocardio no transmural. La mortalidad hospitalaria fue del 15,8%. En el grupo con indicacion urgente, 5 de 11 pacientes (45,4%) fallecieron por fallo cardiaco severo (clase Killip III-IV) en el contexto de un infarto agudo de miorcadio. En cambio, solo fallecio 1 de los 27 pacientes (3,7%) del grupo electivo (p = 0,007). Durante el seguimiento se produjeron eventos clinicos mayores en 5 pacientes (13%): 3 fallecieron y los 2 restantes presentaron recurrencia de la angina. Todos los pacientes que fallecieron tenian el tronco comun desprotegido. La probabilidad acumulada de supervivencia para el grupo electivo fue del 92 ± 0,5, 88 ± 0,6 y 86 ± 0,7% a los 6 meses, 1 y 3 anos, respectivamente. En cambio, para el grupo urgente fue del 54 ± 0,2% a partir del sexto mes (p Conclusiones La angioplastia con stent del tronco comun en pacientes seleccionados se asocia con una elevada tasa de exito inmediato. En la angioplastia electiva, la incidencia de eventos cardiacos durante el seguimiento es relativamente baja. La angioplastia urgente y la presencia de signos de disfuncion ventricular izquierda son los principales predictores de mortalidad.

Association between sleep-disordered breathing, aminoterminal pro-brain natriuretic peptide (NT-proBNP) levels and insulin resistance in morbidly obese young women.

OBJECTIVE Sleep-disordered breathing (SDB) is often encountered in morbid obesity (MO) in conjunction with insulin resistance (IR) and several cardio-vascular risk factors. Aminoterminal pro-brain natriuretic peptide (NT-proBNP) is a promising marker for left ventricular dysfunction (LVD) in MO. The aim of this study was to look for possible correlations between SDB, IR, heart structure and function indexes and NT-proBNP levels in MO female subjects. MATERIALS AND METHODS Cross-sectional study involving 110 MO (44.5+/-0.7 kg m(-2)) apparently healthy, young (37.8+/-1.0 y.o.) female patients. NT-proBNP was measured using an ELISA kit (Roche). Echo-cardiograms were performed to quantify left ventricular ejection fraction values (LVEF), cardiac output (CO), left ventricular mass (LVM), left atria size (LA) and left ventricular filling pressures (the E/Em ratio). The Berlin Questionnaire (BQ) was used to assess the risk of SDB. IR and sensitivity were assessed using the HOMA index and adiponectin measurements, respectively. RESULTS All patients had a normal LVEF (>50%). Hypertension and Type 2 diabetes mellitus prevalences were 34.5 and 4.5% (respectively). Log-transformed NT-proBNP levels correlated with BQ categories (P<0.0005), creatinine (P<0.001), age (P<0.05), LVM (P<0.001), CO (P<0.001), LA (P<0.0005) and E/Em (P<0.01). NT-proBNP levels, LVD and LVM increased significantly along with BQ scores (P<0.0001). Stepwise multiple regression analysis identified BQ and log-transformed HOMA as independent variables predicting as much as 48.0% of log-transformed NT-proBNPs variability (dependent variable). CONCLUSIONS NT-proBNP levels are independently predicted by SDB and IR in asymptomatic MO women. Additionally, SDB worsens along with LVH and diastolic dysfunction. Larger prospective studies are warranted.

Natural History of and Risk Factors for Idiopathic Atrial Fibrillation Recurrence (FAP Registry)

INTRODUCTION AND OBJECTIVES The natural history of idiopathic atrial fibrillation is not well understood. The aim of this study was to investigate the frequency of and risk factors for disease recurrence. METHODS The study involved 115 patients with a first episode of paroxysmal atrial fibrillation of unknown origin who were included the FAP registry, which contains data from 11 district hospitals in Catalonia, Spain. All patients underwent comprehensive clinical, laboratory, electro-cardiographic and echocardiographic investigations at baseline and were followed up periodically every 6 months to identify the occurrence of new symptomatic episodes and their complications. RESULTS During a mean follow-up period of 912 (445) days, 32 (27.8%) patients experienced recurrence of atrial fibrillation. Those who experienced recurrence had a significantly higher left ventricular ejection fraction (P=.023) and smaller end-systolic volume (P<.001), and they were more likely to consume alcohol regularly (P=.013). Cox regression analysis confirmed that these variables had independent prognostic value. In contrast, the occurrence of syncope during the initial episode was associated with a lower likelihood of recurrence (P=.017). CONCLUSIONS The risk of recurrence of idiopathic atrial fibrillation was high, and was enhanced by moderate alcohol consumption and increased left ventricular activity, probably of sympathetic origin. This trend was less marked in paroxysmal atrial fibrillation of vagal origin.

Utilidad de un equipo de ecocardiografía portátil en un servicio de urgencias generales

Fundamento y objetivo: La ecocardiografia con equipos portatiles se plantea como una potente herramienta diagnostica del area de urgencias, aunque deben aclararse su utilidad en este entorno y su capacidad diagnostica cuando es realizada por personal medico con entrenamiento ecocardiografico basico. Pacientes y metodo: Un ecocardiografista experto y un medico no cardiologo con entrenamiento ecocardiografico basico estudiaron a 33 pacientes de urgencias utilizando un ecocardiografo portatil. Resultados: La concordancia interobservador fue aceptable y no existieron discrepancias relevantes que afectaran a la utilidad practica del estudio. El ecocardiograma condujo al cambio del diagnostico y del tratamiento en el 27 y el 46% de los pacientes, respectivamente, y facilito el alta en el 49% de los casos. Conclusiones: La ecocardiografia portatil es util en urgencias y puede ser realizada de forma fiable por personal medico con entrenamiento ecocardiografico basico.