José Luis Moya Mur

Resincronización cardíaca en la insuficiencia cardíaca: bases, métodos, indicaciones y resultados

98 La insuficiencia cardíaca es una de las enfermedades más prevalentes en los países desarrollados. El pronóstico de los pacientes con insuficiencia cardíaca avanzada es todavía malo, a pesar de que en las últimas décadas se han investigado nuevas terapias para mejorar la calidad de vida y la supervivencia de estos enfermos. Por otra parte, hasta el 30% de los pacientes con insuficiencia cardíaca avanzada presenta alteraciones de la conducción intraventricular, lo que condiciona una asincronía en la contractilidad normal del ventrículo que deteriorará la función cardíaca. Mediante la terapia de estimulación cardíaca con resincronización se puede conseguir una mayor sincronía en la contractilidad ventricular. Numerosos estudios han demostrado el beneficio que produce la terapia de estimulación biventricular en la mejora de los parámetros hemodinámicos, la calidad de vida, el test de los 6 min y la clase funcional en pacientes con insuficiencia cardíaca, disfunción sistólica ventricular y retraso de la conducción intraventricular. Algunos estudios han demostrado una mayor supervivencia en los pacientes tratados con resincronización y desfibrilador. Todavía quedan bastantes interrogantes por resolver sobre los efectos de la terapia de resincronización cardíaca, el lugar de estimulación y el tipo de dispositivo a implantar (desfibrilador o marcapasos).

Usefulness of Brain Natriuretic Peptide to Evaluate Patients With Heart Failure Treated With Cardiac Resynchronization

INTRODUCTION AND OBJECTIVES The aim of the present study was to document the evolution of the blood levels of brain natriuretic peptide (BNP) in patients with heart failure and their correlation with the clinical course after implantation of a biventricular pacemaker. PATIENTS AND METHOD Twenty-eight patients with heart failure associated to left bundle branch block and left ventricular systolic dysfunction were included in the study. In each patient we performed laboratory tests, chest X-ray, electrocardiogram and echocardiogram, and measured blood levels of BNP. RESULTS During follow-up (10 [6] months) functional capacity improved, decreasing from 3.3 (0.6) to 2.10 (0.4) (P=.03). The rate of hospitalizations for heart failure decreased from an average of 1.8 (0.7) (6 months before the procedure) to 0.8 (0.3) (6 months after the procedure; P=.04). The basal value of BNP decreased from 193 (98) pg/mL to 52 (14) at the end of the follow-up in the responder group (22 patients) and increased from 564 (380) to 650 (80) pg/mL in the nonresponder group (6 patients). Patients who responded showed significant clinical improvement and decreasing levels of BNP, which reached a plateau an average of 6 months after implantation. Multivariate logistic regression analysis identified lower levels of BNP, idiopathic dilated cardiomyopathy, and functional class as independent predictors of response to therapy. Age, QRS width and left ventricular ejection fraction were not predictors of response. CONCLUSIONS Brain natriuretic peptide concentrations allowed us to monitor, in an objective manner, the clinical course of patients with biventricular resynchronization therapy.

Left ventricular vortices as observed by vector flow mapping: main determinants and their relation to left ventricular filling.

Swirling flow, organized in vortices, contributes to adequate left ventricular function. In this study, we apply a novel echocardiographic flow‐mapping technique, vector flow mapping (VFM), to evaluate the main characteristics of left ventricular vortices and its relation to filling parameters.

Rendimiento de la ecocardiografía transtorácica con sonda de alta frecuencia en el estudio de la descendente anterior

Introduccion y objetivos Se realizo este estudio conel objetivo de valorar el rendimiento y la utilidad de laecocardiografia transtoracica (ETT) con sonda de altafrecuencia para detectar y analizar el flujo de la descendenteanterior en pacientes con lesiones de la misma yen pacientes con infarto anterior. Material y metodos Se estudiaron 11 pacientes conlesiones mayores del 75% y 10 pacientes con infarto anteriorprevio. Los resultados se compararon con un grupocontrol de 18 sujetos. Se intento localizar la descendenteanterior en el surco interventricular anterior partiendo deuna proyeccion apical de 4 camaras. Se considero quese detectaba la descendente anterior cuando se registrabacon Doppler pulsado un flujo predominante diastolico. Resultados La arteria fue detectada en 37/39 (94,9%)pacientes. Los pacientes con lesiones coronarias presentaronuna disminucion en el limite de la significacion delcociente velocidad pico diastolica/sistolica: 2,5 (desviacionestandar [DE], 0,7) frente a 1,8 (DE, 0,3) (p = 0,024).Los pacientes con infarto anterior presentaron un cocientevelocidad pico diastolica/sistolica mas disminuido respectoa los controles: 2,5 (DE, 0,7) frente a 1,4 (DE, 0,3)(p = 0,001). Conclusiones El flujo de la descendente anterior sepuede analizar con ETT y sonda de alta frecuencia enmas del 90% de los casos. Los pacientes con lesionescoronarias y aquellos con infarto tienen disminucion delcociente de velocidad pico diastolica/sistolica.

Flow collision in early aortic ejection: an additional source of kinetic energy loss in patients with mitral prosthetic valves.

Echocardiographic left ventricular (LV) flow analysis was performed with vector flow mapping (VFM) in a 48-year-old asymptomatic patient with prior mitral valve replacement by bi-leaflet prosthesis in 2013. Streamlines in Panel A show the consequence of trans-prosthetic mitral inflow directed towards the septum: the development of a dominant posterior vortex showing counter-clockwise …

Closure of an Iatrogenic Coronary Artery Fistula With a PTFE-Coated Stent

Acquired coronary-cameral fistula is an uncommon disorder. We describe a 50-year-old man with rheumatic valvular disease who required emergency mitral and aortic valve replacement due to Staphylococcus aureus acute infective endocarditis. He underwent further surgical interventions due to bleeding and prosthetic dehiscence. During follow-up, a continuous parasternal murmur was noted. Echocardiography showed continuous coronary fistula flow from the left anterior descending artery to the right ventricle. Elective closure of the ostium was achieved with direct implantation of a 3.5 × 16 mm PTFE-coated stent (Jostent Coronary System Graft ® , Jomed, Germany).

Flow Mapping Inside a Left Ventricular Aneurism: A Potential Tool to Demonstrate Thrombogenicity

We describe the use of vector flow mapping (VFM), a novel echocardiographic technique allowing intracardiac flow visualization, to quantify flow intensity inside a left ventricular aneurysm in a 68‐year‐old man. VFM successfully identified areas of stagnant flow corresponding to the wall region where a thrombus had been formed.

Cor triatriatum sinister

A 25-year-old asymptomatic woman showed, in two-dimensional (2D) transthoracic echocardiogram (TTE), a membrane in the left atrium (LA) diagnostic of cor triatriatum sinister. A three-dimensional (3D) TTE (view from the left ventricle; Panel A and Supplementary …

Use of left ventricular flow mapping in echocardiographic optimization of atrioventricular delay

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Clinical Implications from Three-dimensional Echocardiographic Analysis in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a complex and the most common inheritable cardiovascular disease. Echocardiography has numerous clinical advantages, including its availability, time and cost-efficiency, and ease of use in most patients and clinical settings. 3-dimensional echocardiography, by addressing the limitations of 2-dimensional imaging, may become the technique of choice for clinical evaluation of cardiac chambers and function in this clinical scenario. This review summarizes the role of 3D echocardiography in HCM with a focus on its diagnostic features, improving the quantification of left ventricular mass and left atrial function and the identification of the common intrinsic abnormalities of the mitral apparatus. Recent implications from 3D echocardiographic assessment and deformation analysis are also discussed including their role in the clinical diagnosis, the identification of preclinical disease in carriers of HCM mutations, and the utility in the planning and monitoring therapeutic strategies.