Manel Sabaté Tenas

Effectiveness and Safety Beyond 10 Years of Percutaneous Transluminal Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

INTRODUCTION AND OBJECTIVES Percutaneous transluminal septal ablation is an alternative treatment in patients with hypertrophic obstructive cardiomyopathy. However, due to the relatively new introduction of this technique, there is no information on its very long term results (>10 years). METHODS The present study included consecutive patients treated in 5 centers between 1998 and 2003. We analyzed clinical, hemodynamic, and echocardiographic data at baseline and follow-up. RESULTS A total of 45 patients were included; there were 31 (69%) women, the mean age was 62.4 (14) years, and 39 patients (86.6%) showed functional class III or IV. Septal thickness was 21.8 (3.5) mm, the peak resting gradient on echocardiography was 77 (39) mmHg, and mitral regurgitation was at least moderate in 22 patients (48.8%). During hospitalization, permanent pacemaker implantation was required in 3 patients and ventricular perforation (by pacing lead) occurred in 1 patient, requiring surgery. After a follow-up of 12.3 years (11.0-13.5 years), 2 patients (4.4%) died from cardiac causes (heart failure and posttransplantation), 3 patients required an implantable cardioverter-defibrillator (1 for primary prevention and 2 due to sustained ventricular tachycardia after cardiac surgery), and 2 underwent cardiac surgery (due to endocarditis and mitral regurgitation). In the last clinical review, functional class was I-II in 39 patients (86.6%) (P<.0001), the peak resting gradient was 16 (23) mmHg (P<.0001), and mitral regurgitation was absent or mild in 34 patients (75.5%) (P<.03). CONCLUSIONS The results of this study suggest that septal ablation is safe and effective in the very long term. The procedure was not associated with a significant incidence of sudden death or symptomatic ventricular arrhythmias.

2015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases.

Full text available at: http://eurheartj.oxfordjournals.org/content/early/2015/08/28/eurheartj.ehv318.

Función endotelial en segmentos arteriales previamente sometidos a angioplastia coronaria

Introduccion y objetivo . La angioplastia coronaria comporta una denudacion endotelial y una posterior reendotelizacion. El objetivo de nuestro estudio ha sido determinar el estado de la funcion endotelial en segmentos coronarios sometidos a angioplastia y sin reestenosis. Metodos . Se analizo la respuesta vasodilatadora dependiente del endotelio en 12 pacientes con enfermedad de un vaso a los 6 meses de practicada la angioplastia mediante la infusion intracoronaria selectiva a dosis crecientes de acetilcolina (10–6, 10–5, 10–4 M) en la arteria previamente tratada. Siete pacientes con arterias coronarias normales o con minimas irregularidades y sin factores de riesgo constituyeron el grupo control. La respuesta vasomotora a las diferentes dosis de acetilcolina se analizo mediante angiografia coronaria cuantitativa. Resultados . El estudio de la funcion endotelial demostro una respuesta global vasodilatadora en el segmento dilatado a la maxima dosis de acetilcolina (incremento del diametro del 3,6 ± 3,5%), similar a la respuesta observada en el grupo control (incremento del diametro del 3 ± 6%; p = NS). En particular, se observo una funcion endotelial normal en 8 pacientes (67%) y una respuesta vasoconstrictora en 4 enfermos (33%). Se ha detectado una correlacion positiva entre la respuesta a la maxima dosis de acetilcolina y la lesion residual a los 6 meses de evolucion (r = 0,67; p = 0,02). Conclusiones . En pacientes que han sido tratados mediante angioplastia y que no presentan reestenosis, los segmentos dilatados muestran frecuentemente una funcion endotelial normal. Un mayor grado de estenosis residual en las zonas dilatadas se asocia a una menor alteracion de la funcion endotelial.

РЕКОМЕНДАЦИИ ESC ПО ДИАГНОСТИКЕ И ВЕДЕНИЮ ПАЦИЕНТОВ С ЗАБОЛЕВАНИЯМИ ПЕРИКАРДА 2015

The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS)

Update on Interventional Cardiology

This article provides a detailed review of the most important studies on interventional cardiology reported in publications or presentations during the year 2012. With regard to coronary interventions, ST-elevation myocardial infarction is extensively addressed in studies focusing on the relevance of reducing the reperfusion time and the utility of various devices and pharmacological strategies in primary angioplasty. Multiple comparative studies involving different generations of drug-eluting stents are available and indicate a favorable progression in terms of safety and efficacy. The risk of late thrombosis with the new generations of drug-eluting stents seems to be equivalent to that observed with bare-metal stents. The clinical outcomes with these stents in the elderly, in left main coronary artery, or in multivessel disease have also been the subject of important trials. Among the studies on intracoronary diagnostic techniques, those correlating imaging and pressure-based techniques are of special interest. The percutaneous treatment of structural heart disease, particularly transcatheter aortic valve implantation, followed by mitral repair, continues to be the subject of a great number of publications. Finally, renal denervation is currently being widely discussed in the literature.