Manel Morales

Plasma tissue inhibitor of matrix metalloproteinase-1 (TIMP-1): an independent predictor of poor response to cardiac resynchronization therapy

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a role in left ventricular structural remodelling. The aim of our study was to analyse MMP‐2 and TIMP‐1 levels as predictors of poor response to cardiac resynchronization therapy (CRT).

Specialized Care Program for End-Stage Heart Failure Patients. Initial Experience in a Heart Failure Unit

INTRODUCTION AND OBJECTIVES End-stage heart failure is associated with very high morbidity and mortality. Palliative care has been little studied in affected patients. PATIENTS AND METHOD Between January 1998 and December 2004, 61 patients with end-stage heart failure participated in a specialized advanced heart failure care program. The program included patient education on advanced heart failure, with day-care and home-care elements, and involved intravenous drug administration when necessary. RESULTS The mean age of the study population was 64 (13) years (range 32-87 years), with 92% being male. Their mean ejection fraction was 23 (6%), mean systolic blood pressure 100 (16) mm Hg, mean blood sodium level 137 (4) mEq, mean creatinine level 1.7 (0.8) mg/dL, and mean hemoglobin level 12 (2) mg/dL. The number of hospitalizations, number of days in hospital per admission, and number of emergency room visits in the year before inclusion in the specialized heart failure care program were 5.7 (0.5), 53 (5), and 8.3 (1.1), respectively. After inclusion, these figures decreased significantly to 1.9 (0.2) (P=.0001), 19 (3) (P=.0001), and 1.2 (0.2) (P=.0001), respectively. During a mean follow-up period of 11 (10) months, 28 patients died (47%) and 23 (38%) underwent heart transplantation. In addition, use of the program led to a reduction in healthcare costs. CONCLUSIONS Although mortality in end-stage heart failure patients remained very high, use of a specialized advanced heart failure care program decreased the number of hospitalizations, days per hospitalization, and emergency room visits, and reduced the cost of care.

Impaired Endothelium-Dependent Forearm Vasodilation in Idiopathic Dilated Cardiomyopathy Is Related to Severe Left Ventricular Dysfunction and Elevated Serum Tumor Necrosis Factor Levels

INTRODUCTION AND OBJECTIVES Endothelial dysfunction has been found in patients with idiopathic dilated cardiomyopathy (IDC), but its mechanism remains unknown. Our aim was to investigate whether forearm endothelium-dependent vasoreactivity correlates with cardiac disease severity or neurohormonal activation. PATIENTS AND METHOD We studied 23 patients with IDC and 10 healthy sex- and age-matched controls using brachial artery ultrasound to assess flow-mediated dilation (FMD) and nitroglycerin-induced vasodilation (NIV). In the IDC group, we determined plasma neurohormone and cytokine levels at the same time. RESULTS FMD was significantly less in the IDC group compared with the control group [--0.06 (2.8)% vs 4.4 (4.6)%, respectively; P<.01], whereas NIV was similar in both groups [15.0 (6.4)% vs 14.0 (7.4)%, respectively; P=NS]. FMD was significantly less in patients with poorer left ventricular (LV) function and more severe LV dilatation, and in those with a higher tumor necrosis factor-alpha (TNF-alpha) level. NIV was similar in all patient subgroups. There was a significant inverse correlation between the TNF-alpha plasma level and FMD (r=-0.75; P<.01). No correlation was found between the plasma levels of other neurohormones and FMD. CONCLUSIONS FMD, but not NIV, was impaired in patients with IDC compared with control subjects. In patients, there were significant associations between FMD impairment and the severity of LV dilatation, the severity of LV systolic dysfunction, and the plasma TNF-alpha level. The strongest correlation was observed between TNF-alpha plasma level and FMD. These data suggest that TNF-alpha may be implicated in endothelial dysfunction in patients with IDC.

Insuficiencia cardiaca en un paciente con Wolff-Parkinson-White

angioplastia no era técnicamente factible, tras un intenso debate del equipo tratante y debido a los deseos de la paciente, se realizó la reducción quirúrgica de la masa tumoral como última opción terapéutica para paliar los sı́ntomas progresivos. Falleció 3 dı́as después tras múltiples complicaciones postoperatorias. Los angiosarcomas primarios de la arteria pulmonar son excepcionales, y sólo se han descrito unos pocos casos. La similitud de los sı́ntomas iniciales con el TEP agudo o crónico, y la incapacidad de las técnicas de imágenes para realizar un diagnóstico de certeza (aunque pueden ser útiles en el diagnóstico diferencial) causan demoras en el diagnóstico definitivo. Este sólo se consigue mediante la toma de muestra de tejido, o durante la autopsia (el 60% de los casos). La biopsia endomiocárdica percutánea es un procedimiento seguro, fácilmente realizable y con escasa morbimortalidad. Para aumentar el rédito diagnóstico,

Multiple aorto-right cavitary fistula: a rare complication of prosthetic valvular endocarditis in intravenous drug users

Aorto-cavitary fistula is an infrequent complication in infective endocarditis as well as multiple fistula, being the most rare among intracardiac fistulas. The prognosis of infective endocarditis worsens if there are fistulas associated, exceeding the mortality over 40% despite aggressive surgical treatment. Although transoesophageal echocardiography offers a better sensitivity and specificity, sometimes transthoracic echocardiography is enough to obtain these infrequent pictures that we present.