Juan Delgado Jiménez

Conferencia de Consenso de los Grupos Españoles de Trasplante Cardiaco

La Seccion de Insuficiencia Cardiaca, Trasplante Cardiaco y otras Alternativas Terapeuticas de la Sociedad Espanola de Cardiologia desarrollo en Sevilla, en junio de 2005, una Conferencia de Consenso sobre trasplante cardiaco (TC) a la que fueron invitados a participar todos los grupos espanoles de TC. El objetivo fue determinar, discutir y consensuar los aspectos mas relevantes y/o controvertidos de diferentes areas del TC en la actualidad: organizacion, seleccion del receptor, donantes, rechazo, inmunosupresion, enfermedad vascular del injerto, complicaciones a largo plazo y TC pediatrico. Este documento reune las recomendaciones del grupo de trabajo incluyendo el grado de evidencia con que se respalda cada una.

Guías de práctica clínica de la Sociedad Española de Cardiología en tromboembolismo e hipertensión pulmonar

La hipertension pulmonar primaria es una enfermedad de caracter progresivo, mas frecuente en mujeres jovenes y de mediana edad. Su etiologia se desconoce, aunque existe una predisposicion familiar hasta en un 6% de los casos. Las teorias patogenicas actuales se centran en la existencia de disfuncion endotelial y fallos en los canales ionicos de las fibras musculares lisas del vaso. Las pruebas diagnosticas se dirigen a descartar las causas secundarias y a evaluar la gravedad de la enfermedad. El test vasodilatador agudo es imprescindible para la eleccion del tratamiento mas adecuado. La anticoagulacion oral esta indicada en todos los pacientes. El trasplante de pulmon queda reservado a aquellos casos en los que fracasa el tratamiento medico. La septostomia auricular es un procedimiento paliativo util en casos seleccionados. La hipertension pulmonar tromboembolica cronica es una forma especial de hipertension pulmonar secundaria; aunque indistinguible clinicamente de la hipertension pulmonar primaria, su diagnostico resulta crucial, ya que es posible su curacion mediante la realizacion de tromboendarterectomia pulmonar. El tromboembolismo pulmonar es frecuente en pacientes hospitalizados, presentando elevadas tasas de mortalidad (el 30% en pacientes no tratados). El diagnostico es dificil, ya que puede acompanar o simular otras enfermedades cardiopulmonares. Las pruebas diagnosticas no invasivas tienen una baja sensibilidad y especificidad. Nuevas alternativas como la determinacion de dimero D o la TAC helicoidal incrementan la precision diagnostica. El tratamiento estandar consiste en la administracion de heparina durante 5-10 dias y posteriormente anticoagulantes orales durante 3-6 meses. La prevencion con heparinas o dextranos en los pacientes de alto riesgo ha demostrado claros beneficios.

Mid-range Ejection Fraction Does Not Permit Risk Stratification Among Patients Hospitalized for Heart Failure.

INTRODUCTION AND OBJECTIVES European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). METHODS A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups. RESULTS Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts. CONCLUSIONS The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission.

Management of Primary Pulmonary Artery Sarcoma: Experience of a Single Center

Primary sarcoma of the pulmonary artery (PSPA) is extremely rare. Many cases are misdiagnosed as pulmonary arterial hypertension (PAH) because of chronic thromboembolic disease (CTD). Four cases of PSPA with the initial misdiagnosis are reported. The presence of a unique mass in the main pulmonary artery or proximal branches, rapidly progressive dyspnea, and constitutional symptoms should raise the suspicion of PSPA. The pathological diagnosis is usually confirmed during surgery, which is done along with adjuvant chemotherapy, the treatment of choice.

Experiencia de 10 años en el tratamiento con epoprostenol en perfusión intravenosa continua en hipertensión pulmonar arterial grave

Introduction. Primary pulmonary hypertension and its associated forms is a progressive and often fatal disease, the course of which has been favourably modified by prostacyclin therapy in the last decade. Objective. The aim of this study is to analize retrospectively the efficacy of continuous intravenous epoprostenol (synthetic prostacyclin) therapy in pulmonary arterial hypertension, and to compare it with conventional therapy (anticoagulants, digoxin and diuretics). Methods. Between 1990-2000, 31 patients with severe precapillary pulmonary hypertension in functional class III or IV went on continuous intravenous epoprostenol therapy, administered by a portable infusion pump through a Hickman catheter. We compared their survival with a group of 16 patients treated with conventional therapy alone. Results. Time of follow-up was 33.25 months in the prostacyclin group and 20 months in the conventional group. The one- three- and five- year survival rates were 86%, 50% and 38% respectively for patients treated with epoprostenol compared with 40%, 40% and 8% survival rates at idetical periods for patients treated conventionally (p = 0,02). Functional class and the mean distance walked in the 6 minutes test were improved in patients treated with prostacyclin (p < 0,01). Serious complications attributable to the delivery system included 3 deaths, mainly due to infection. Conclusion. Continuous intravenous epoprostenol therapy improves survival and exercise capacity in patients with severe pulmonary arterial hypertension despite potentially serious complications attributable to the delivery system.

Transición de prostaciclina a bosentán en 5 pacientes con hipertensión pulmonar severa: el cambio es posible

La prostaciclina mejora los sintomas, la capacidad de ejercicio y la supervivencia en los pacientes con hipertension arterial pulmonar. Sin embargo, sus complejas vias de administracion (intravenosa, inhalada, subcutanea) ocasionan frecuentes efectos adversos que disminuyen la calidad de vida y pueden ser graves. Bosentan, un antagonista oral de los receptores de la endotelina, mejora la clase funcional y la capacidad de ejercicio en estos pacientes. Describimos la transicion de prostaciclina a bosentan en 5 pacientes con hipertension arterial pulmonary severa e importantes complicaciones secundarias al tratamiento con prostaciclina.

Prognostic Implications of Functional Mitral Regurgitation in Patients With Heart Failure and Reduced Ejection Fraction

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Transition From Prostacyclin to Bosentan in Five Patients With Severe Pulmonary Hypertension: the Switch Is Possible

Prostacyclin improves symptoms, exercise tolerance, and survival in patients with pulmonary arterial hypertension. However, the difficulty of administration (whether intravenous, subcutaneous, or by inhalation) often causes side effects that can reduce the patient’s quality of life and which may sometimes be serious. Bosentan, an orally active endothelin receptor antagonist, improves functional class and exercise tolerance in these patients. We describe the successful transition from prostacyclin to bosentan in five patients with severe pulmonary arterial hypertension who suffered serious side effects with prostacyclin treatment.

I Informe del Registro Español de Tumores Postrasplante Cardiaco

Neoplasia is a common and serious complication that occurs after heart transplantation and is one of the most important causes of death over the long term. The Spanish Post-Heart-Transplant Tumor Registry, which began in 2004, is an on-line record of all patients who have undergone heart transplantation in Spain. It includes continually updated information on post-transplantation tumors. The most common neoplasias are skin tumors (54%), followed by noncutaneous, nonlymphoid tumors (39%) and lymphomas (7%). Their incidence increases with age and time from transplantation and is higher in males. After 15 years, only 62% of patients are tumor-free. Prognosis varies according to the type of tumor. The incidence of lymphomas has decreased by half in the last decade. The Registry provides useful information on the incidence, risk factors and prognosis of tumors that occur after transplantation and can help in devising better management strategies.