Rosa Rábago

Asociación del síndrome tako-tsubo con la arteria coronaria descendente anterior con extensa distribución por el segmento diafragmático

Introduccion y objetivos. El sindrome de disfuncion ventricular transitoria tako-tsubo ha sido descrito en Japon y se han publicado casos aislados en Occidente. Mostramos una de las primeras series descritas fuera de Japon y presentamos nueva informacion sobre su anatomia coronaria. Pacientes y metodo. Entre enero de 1998 y abril de 2003 identificamos a 11 pacientes con sospecha de infarto agudo de miocardio, arterias coronarias normales y disfuncion ventricular transitoria tipo tako-tsubo. Estudiamos la anatomia coronaria de estos 11 pacientes, asi como de 44 controles ajustados por edad y sexo: 22 con coronarias normales y 22 con infarto agudo de miocardio en relacion con oclusion en la arteria coronaria descendente anterior. Resultados. Al igual que en los pacientes japoneses, el sindrome tako-tsubo en pacientes caucasicos generalmente ocurre en mujeres en la septima u octava decadas de la vida y con frecuencia se precede de estres emocional o fisico. La arteria coronaria descendente anterior de nuestros pacientes con sindrome tako-tsubo tiene mayor longitud y un segmento diafragmatico (recurrente) mas largo que la de los controles. Para compararlos disenamos un indice de recurrencia ([segmento recurrente de descendente anterior/longitud total de la descendente anterior] x 100). En los pacientes con sindrome tako-tsubo, este indice fue del 22,3 ± 1,5%, en controles normales fue del 10,9 ± 6,7% (p < 0,001) y en los pacientes de control con infarto del 11,3 ± 7,7% (p < 0,001). Los pacientes de control con infarto presentaban una ventriculografia identica a la de los enfermos con sindrome tako-tsubo cuando su indice de recurrencia era alto (= 16%). Conclusiones. Todos nuestros pacientes con sindrome tako-tsubo presentan una descendente anterior con un gran segmento recurrente. La morfologia identica de la ventriculografia de los pacientes con sindrome tako-tsubo y los controles con infarto con un elevado indice de recurrencia de la descendente anterior puede deberse a una etiopatogenia comun.

Parathormone levels are independently associated with the presence of left ventricular hypertrophy in patients with coronary artery disease

BackgroundAbnormalities of mineral metabolism and inflammation may affect the cardiovascular system. We have assessed the relationship of left ventricular hypertrophy (LVH) with inflammation and mineral metabolism.MethodsLVH was measured in 146 outpatients with stable coronary artery disease (SCAD) using echocardiography. Calcidiol (a vitamin D metabolite), parathyroid hormone (PTH), fibroblast growth factor-23, high-sensitivity C-reactive protein, MCP-1 (monocyte chemoattractant protein-1), galectin-3, NGAL (neutrophil gelatinase-associated lipocalin), and sTWEAK (soluble TNF-related weak inducer of apoptosis) plasma levels were studied.ResultsLVH, defined as septal thickness ≥11 mm, was present in 19.9% of cases. These patients were older [75.0 (61.0-81.0) vs 64.0 (51.0-76.0) years; p=0.002], had higher prevalence of left ventricular ejection fraction (LVEF)>40%, and had higher PTH [84.7 (59.6-104.7) vs 63.2 (49.2-85.2) pg/ml; p=0.007], galectin-3 [9.6 (8.0-11.1) vs 8.3 (6.9-9.9) ng/ml; p=0.037], and NGAL (208.5±87.6 vs 173.9±73.4 ng/ml; p=0.031) plasma levels than those without LVH. Glomerular filtration rate was lower in patients with LVH than in those without it (65.1±20.0 vs 74.7±19.9 mL/min/1.73 m2; p=0.021). There were no significant differences in hypertension (79.3 vs 68.4%; p=0.363) or sex between both groups. Variables showing differences based on univariate analysis and hypertension were entered into a logistic regression analysis. Only age [odds ratio (OR) =1.052 (1.011-1.096); p=0.013], PTH plasma levels [OR=1.017 (1.003-1.031); p=0.021], and LVEF>40% [OR=7.595 (1.463-39.429); p=0.016] were independent predictors of LVH.ConclusionsIn patients with SCAD, elevated PTH levels are independently associated with the presence of LVH. Further studies are needed to elucidate the role of PTH in the development of myocardial hypertrophy.

Tako-Tsubo Transient Left Ventricular Apical Ballooning Is Associated With a Left Anterior Descendig Coronary Artery With a Long Course Along the Apical Diaphragmatic Surface of the Left Ventricle

Introduction and objectives Tako-tsubo-like transient left ventricular apical ballooning has been described in Japan, but few cases have been reported in Western countries. We report one of the first series outside Japan, which provides new information on the coronary anatomy of this disorder. Patients and Methods From January 1998 to February 2003 we observed 11 patients with a clinical suspicion of acute myocardial infarction, normal coronary arteries, and transient tako-tsubo-like systolic left ventricular apical ballooning. We compared the coronary artery anatomy in these 11 patients with that in 44 controls matched for age and sex: 22 with normal coronary arteries and 22 with acute myocardial infarction related with an obstructive thrombus in the left anterior descending coronary artery. Results As in Japanese patients, tako-tsubo syndrome in Caucasian patients frequently occurs in women in their seventh or eighth decades of life, and is usually preceded by emotional or physical stress. The left anterior descending in our patients with tako-tsubo syndrome was longer overall, and its recurrent diaphragmatic segment was longer, than in controls. To compare these groups we designed a measure termed recurrent segment index (left anterior descending recurrent segment length/total left anterior descending length x 100). In tako-tsubo syndrome this index was 22.3 (1.5)%, vs 10.9 (6.7)% in normal controls (P Conclusions All our patients with tako-tsubo syndrome had a left anterior descending with a long recurrent segment. The identical ventriculographic findings in patients with tako-tsubo syndrome and those with acute myocardial infarction with a long recurrent segment may be due to a common etiology.

The Physiological Basis of Coronary Circulation

The high prevalence of cardiovascular diseases in developed countries, particularly coronary heart disease, has resulted in an increasing interest in the physiological basis of the circulatory system and coronary flow [1–4]. The study of the physiology helps us understand cardiovascular pathologic disorders and their clinical manifestations better. But it also allows us to learn about some aspects of the diagnostic tools applied in cardiovascular disease, since most of them aim to disclose abnormalities in coronary flow. These techniques use some type of tracer, a substance that travels through the coronary circulation and interacts with the cells of the vascular wall and the myocytes, reflecting the state, normal or abnormal, of the blood flow. This is the case of isotopic diagnostic techniques (SPECT, PET), the most recent technologies of cardiac magnetic resonance imaging or myocardial contrast-enhanced echocardiography—the topic of this book [5–7].