Ignacio Laynez-Cerdeña

Neopterin predicts left ventricular remodeling in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BACKGROUND Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We prospectively assessed 108 STEMI patients (age 64 + or - 11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96 + or - 10h after the onset of symptoms and 12 month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12 months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI. RESULTS At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45 + or - 1.04 vs 5.19 + or - 1.39 nmol/L; p<0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928-4.990, p<0.001] to [3.32, CI 95% 1.999-5.532, p<0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84-0.96, p<0.0001) compared to 0.579 for BNP (CI 95% 0.409-0.748) regarding LVR. CONCLUSIONS In STEMI patients undergoing primary PCI, high neopterin levels - but not BNP - predict LVR at 1-year follow-up.

Ventricular septal defect as an unusual complication of percutaneous transcatheter implantation of an aortic valve prosthesis: two-year follow-up.

1. Swedberg K, Komajda M, Bohm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;376:875–85. 2. Anguita M, Comı́n J, Almenar L, Crespo M, Delgado J, González-Costello J, et al. Comentarios a la guı́a de práctica clı́nica de la ESC sobre diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica 2012. Un informe del Grupo de Trabajo del Comité de Guı́as de Práctica Clı́nica de la Sociedad Española de Cardiologı́a. Rev Esp Cardiol. 2012;65:874–8. 3. Anguita M, Fernandez-Ortiz A, Worner F, Alonso A, Cequier A, Comin J, et al. La Sociedad Espanola de Cardiologia y las guı́as de práctica clı́nica de la SEC: hacia una nueva orientación. Rev Esp Cardiol. 2011;64:795–6. 4. Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261–74. 5. Keteyian SJ, Kitzman D, Zannad F, Landzberg J, Arnold JM, Brubaker P, et al. Predicting maximal HR in heart failure patients on ß-blockade therapy. Med Sci Sports Exerc. 2012;44:371–6. 6. Volterrani M, Cice G, Caminiti G, Vitale C, D’Isa S, Perrone Filardi P, et al. Effect of Carvedilol. Ivabradine or their combination on exercise capacity in patients with Heart Failure (the CARVIVA HF trial). Int J Cardiol. 2011;151:218–24.

Valve Calcification in Aortic Stenosis: Etiology and Diagnostic Imaging Techniques

Aortic stenosis is the most common valvulopathy in the Western world. Its prevalence has increased significantly in recent years due to population aging; hence, up to 8% of westerners above the age of 84 now have severe aortic stenosis (Lindroos et al., 1993). This causes increased morbidity and mortality and therein lies the importance of adequate diagnosis and stratification of the degree of severity which allows planning the best therapeutic option in each case. Long understood as a passive age-related degenerative process, it is now considered a rather more complex entity involving mechanisms and factors similar to those of atherosclerosis (Stewart et al., 1997). In this review, we summarize the pathophysiological mechanisms underlying the onset and progression of the disease and analyze the current role of cardiac imaging techniques for diagnosis.

Simultaneous Transfemoral Aortic Valve Implantation and Endovascular Repair of Abdominal Aortic Aneurysm

We report a percutaneous transfemoral aortic valve implantation (TAVI) procedure in a patient with infrarenal saccular abdominal aortic aneurysm (SAAA) treated by endovascular surgery during the same procedure. We present the case of an 82-year-old man, with a history of smoking, adenocarcinoma of the colon treated by surgery and adjuvant chemotherapy in the previous 6 months, and SAAA extending to both iliac arteries with maximum diameters of 69 57 mm in multiplane reformat on computed tomography), admitted for non–ST-segment elevation acute coronary syndrome and left heart failure. Echocardiography showed a very calcified aortic valve and severe stenosis, with valve area of 0.88 cm, peak and mean gradients of 71.7 mmHg and 35 mmHg, respectively, and mild left ventricular hypertrophy with normal ejection fraction. Catheterization showed coronary artery disease with a large obstructive lesion in the proximal left anterior descending artery. The patient had a logistic EuroSCORE of 19.06%. The medicalsurgical team decided to treat the diseased artery and aortic stenosis using a percutaneous approach and the SAAA by endovascular repair. During the first procedure, a conventional stent (Stent Vision 3.5 23 mm; Abbot Vascular, Santa Clara, California, Unites States) was implanted in the proximal left anterior descending artery via the right femoral artery, without complications and with a good angiographic result. Three weeks later, a second procedure was performed with the patient under general anesthesia. After both femoral arteries were exposed, an abdominal aortic stent and the aortic valve (EdwardsSAPIEN XT 26; Life Sciences, Irvine, California, United States) were implanted. The vascular surgeon began the percutaneous procedure with exclusion of the SAAA, achieved by placing a bifurcated stent with extensions into both iliac arteries. Final angiographic control showed that there were no leaks and minimum diameters of 10 mm were obtained in both iliac arteries (Figure 1). Subsequently, TAVI was performed via the left femoral artery following standard procedures, with a good final outcome and mild residual paravalvular regurgitation (Figure 2). The procedure ended with surgical closure of both femoral arteries. Rev Esp Cardiol. 2014;67(5):408–416

An appropriate use criterion is very important to reduce overuse for SPECT in coronary heart disease: Economic burden in time of crises

heart disease: Economic burden in time of crises Alberto Dominguez-Rodriguez ⁎, María Angeles Gomez , Maria del Carmen Garcia-Baute , Pedro Abreu-Gonzalez , Antonieta Gonzalez-Diaz , Ignacio Laynez-Cerdeña a a Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain b Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, Spain c Instituto Universitario de Tecnologías Biomédicas, Tenerife, Spain d Hospital Universitario de Canarias, Department of Nuclear Medicine, Tenerife, Spain e Universidad de La Laguna, Department of Physiology, Tenerife, Spain

Congenital multiple coronary arteriovenous fistulas

Coronary arteriovenous fistulas are congenital or acquired abnormalities characterized by abnormal communication between the coronary circulation and cardiac chambers or other vessels. Frequently, patients are asymptomatic and their diagnosis can be carried out incidentally by echocardiography. Knowing the echocardiographic findings characteristic of this malformation will prevent the diagnosis from going unnoticed.

Bayes Syndrome and Imaging Techniques.

BACKGROUND Interatrial block (IAB) is due to disruption in the Bachmann region (BR). According to whether interatrial electrical conduction is delayed or completely blocked through the BR, it can be classified as IAB of first, second or third degree. On the surface electrocardiogram, a P wave ≥ 120 ms (partial IAB) is observed or associated to the prolongation of the P wave with a biphasic (positive / negative) morphology in the inferior leads (advanced IAB). Bayes syndrome is defined as an advanced IAB associated with atrial arrhythmia, more specifically atrial fibrillation. Objective and Conclusion: The purpose of this review is to describe the latest evidence about an entity considered an anatomical and electrical substrate with its own name, which may be a predictor of supraventricular arrhythmia and cardioembolic cerebrovascular accidents, as well as the role of new imaging techniques, such as echocardiographic strain and cardiac magnetic resonance imaging, in characterizing atrial alterations associated with this syndrome and generally in the study of anatomy and atrial function.

Compression of the right coronary artery by an aortic pseudoaneurysm after infective endocarditis: an unusual case of myocardial ischemia

A 61-year-old male with a prosthetic St Jude aortic valve size 24 presented with heart failure symptoms and minimal-effort angina. Eleven months earlier, the patient had undergone cardiac surgery because of an aortic root dilatation and bicuspid aortic valve with severe regurgitation secondary to infectious endocarditis by Coxiela burnetii and coronary artery disease in the left circumflex coronary artery. Then, a prosthesis valve and a saphenous bypass graft to the left circumflex coronary artery were placed. The patient was admitted to the Cardiology Department of Hospital Universitario de Canarias, Tenerife, Spain and a transthoracic echocardiography was performed that showed severe paraprosthetic aortic regurgitation and an aortic pseudoaneurysm. The 64-slice multidetector computed tomography confirmed the pseudoaneurysm, originating from the right sinus of Valsalva, with a compression of the native right coronary artery and a normal saphenous bypass graft. On the basis of these findings, we performed surgical treatment with a favorable postoperative evolution. In our case, results from complementary cardiac imaging techniques were crucial for patient management. The multidetector computed tomography allowed for a confident diagnosis of an unusual mechanism of coronary ischemia.

WITHDRAWN: Pulmonary Hemorrhage in a Patient With ST-segment Elevation Acute Myocardial Infarction Treated With Ticagrelor: A Case Report.

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