Samuel Córdova

Assessment of Left Atrial Function in Hypertrophic Cardiomyopathy and Athlete's Heart: A Left Atrial Myocardial Deformation Study

Background: Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and differentiating this condition from the nonpathological “athletes heart” remains a challenge. The development of pathological left ventricular hypertrophy (LVH) is associated with left atrial (LA) dilatation and dysfunction. LA strain and strain rate by two‐dimensional (2D) speckle tracking are novel indices of LA function and might contribute to differentiate physiological from pathological LVH among athletes with underdiagnosed HCM. Methods: We evaluated 20 patients with nonobstructive HCM, 20 highly trained athletes and 20 healthy controls matched for age, gender, and body surface area. All patients underwent a transthoracic echocardiogram with evaluation of LA strain: s‐wave (LASs); and strain rate: s‐wave (LASRs) and a‐wave (LASRa). Results: LV mass index, LA volume index, and ejection fraction were comparable between patients with HCM and athletes. Patients with HCM had a significantly lower LASs (19 + 8% vs. 43 + 8%, P < 0.01), LASRs (0.7 + 0.2 s‐1 vs. 1.6 + 0.2 s‐1, P < 0.01), and LASRa (–0.8 + 0.1 s‐1 vs. –1.4 + 0.3 s‐1, P < 0.01) compared to athletes. Among hypertrophic subjects, independent predictors of hypertrophy related to HCM were LASs and E/é ratio. Conclusions: LA myocardial deformation is significantly impaired in patients with HCM compared to athletes and healthy controls. LA strain and strain rate assessed by 2D speckle tracking should be incorporated in the evaluation of trained athletes with LVH and LA dilatation.

Prevalence of the angiotensin I converting enzyme insertion/deletion polymorphism, plasma angiotensin converting enzyme activity, and left ventricular mass in a normotensive Chilean population*

The aim of this study was to estimate the prevalence of the different alleles of the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and associated plasma ACE activity, as well as cardiac echocardiographic structure, in a healthy Chilean population. We selected 117 healthy normotensive subjects (aged 45 to 60 years, middle socioeconomic status, nonobese, and nondiabetic) from a population-based study concerning the prevalence of risk factors for chronic diseases (Conjunto de Acciones Para la Reducción Multifactorial de las Enfermedades no Transmisibles [CARMEN]). The frequencies of the I and D alleles were 0.57 and 0.43, respectively. Mean plasma ACE activity was 15.3 +/- 3.9 U/mL. Compared with subjects with the II genotype, plasma ACE activity was significantly higher in subjects with the ID and DD genotypes with no difference between them. No correlation was observed between blood pressure and plasma ACE activity. Among the three different genotypes there was no difference in left ventricular (LV) dimensions or in LV mass. No correlation between plasma ACE activity and LV mass was observed for either gender or different genotypes. Multivariate linear regression analysis using LV mass and LV mass index as dependent variables showed independent effects (P < .05) for gender (higher LV mass in men) and diastolic blood pressure, but not for the DD genotype. In conclusion, in this population, the presence of the D allele on the ACE gene determined higher circulating ACE activity. However, in this normotensive healthy population, male gender and diastolic blood pressure, but not the presence of the D allele, were associated with increased LV mass.

Markedly increased Rho-kinase activity in circulating leukocytes in patients with chronic heart failure

BACKGROUND The small guanosine triphosphatase Rho and its target Rho-kinase have significant roles in experimental remodeling and ventricular dysfunction, but no data are available on Rho-kinase activation in patients with heart failure (HF). We hypothesized that, in patients with chronic HF, Rho-kinase in circulating leukocytes is activated and related to left ventricular (LV) remodeling and dysfunction. METHODS Accordingly, Rho-kinase activity, assessed by the levels of phosphorylated to total myosin light chain phosphatase 1 (MYPT1-P/T) in circulating leukocytes, and echocardiographic LV function data were compared between patients with HF New York Heart Association functional class II or III due to systolic dysfunction (n = 17), healthy controls (n = 17), and hypertensive patients without HF (n = 17). RESULTS In the control subjects, mean MYPT1-P/T ratio was 1.2 ± 0.2 (it was similar in the hypertensive patients without HF), whereas in patients with HF, it was significantly increased by >100-fold (P < .001). Both MYPT1-P/T and log MYPT1-P/T ratios were inversely correlated with ejection fraction (r = -0.54, P < .03 and r = -0.86, P < .001, respectively). Furthermore, in patients with HF with LV end-diastolic diameter <60 mm, MYPT1-P/T ratio was 35.8 ± 18.1, whereas it was significantly higher in patients with LV diameter ≥60 mm (P < .05). CONCLUSIONS Rho-Kinase activity is markedly increased in patients with stable chronic HF under optimal medical treatment, and it is associated with pathologic LV remodeling and systolic dysfunction. Mechanisms of Rho-kinase activation in patients with HF, its role in the progression of the disease, and the direct effect of Rho-kinase inhibition need further investigation.

Acute Necrotizing Eosinophilic Myocarditis Presenting as ST-Elevation Myocardial Infarction: A Case Report

Eosinophilic myocarditis (EM) is a rare disease. The spectrum of clinical presentation is wide and it is often fatal if left untreated. We report a case of eosinophilic myocarditis manifesting as ST-elevation myocardial infarction (STEMI) with cardiogenic shock treated successfully with steroids. This diagnosis should always be considered in patients with an acute coronary syndrome and normal coronary arteries, especially in the presence of a history of allergies, asthma or peripheral eosinophilia.

Intrapulmonary shunting associated with sildenafil treatment in a patient with idiopathic pulmonary arterial hypertension

We reported a case of a 30-year-old Hispanic patient with a history of idiopathic pulmonary arterial hypertension (PAH). A baseline catheterisation showed a mean pulmonary artery pressure (PAP) of 58 mm Hg, capillary wedge pressure of 14 mm Hg, cardiac index of 2.7 l/min/m2 and pulmonary vascular resistance of 7.5 WU, with no response to adenosine. A pulmonary CT scan ruled out thromboembolism or significant abnormalities (such as glass opacities, septal lines or mediastinal node enlargement commonly seen in venocclusive disease1); albumin macroaggregate lung perfusion scan showed normal perfusion without significant intrapulmonary shunt (IPS). He was started on diuretics, oxygen and sildenafil 25 mg three times a day. Despite treatment, dyspnoea worsened and 2 months later the patient was referred …

Niveles de péptido natriurético cerebral y su relación con capacidad funcional y hemodinamia pulmonar en pacientes con hipertensión pulmonar primaria: Correlation with functional capacity and hemodynamic parameters

Background: Primary pulmonary hipertension (PPH) is a progressive disease leading to right heart failure and death. Right heart catherization and maximal or submaximal tests are employed to assess the course of the disease. A neurohormonal parameter such as pro-brain natriuretic peptide (BNP) would be helpful in the assessment of these patients. Aim: To study the correlation of BNP with functional status and non-invasive hemodynamic determinations in patients with PPH. Material and methods: Twelve patients (mean age: 48 years; 58% female) were evaluated with 6 minutes walk distance test (6-min WT), plasma BNP, systolic pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and cardiac output (CO) determined by echocardiogram. Plasma BNP levels were compared with normal subjects. Results: BNP levels were increased in PPH patients (1270±547 vs 48±8 pg/ml, p-value <0.01). Mean PAPs was 82±27 mmHg and the mean distance walked in 6 minutes was 407±113 meters. BNP levels were positively correlated with PVR (r=0.58, p-value=0.006) and negatively correlated with 6-min WT (r=-0.83, p-value <0.001). No correlation was found between BNP levels, PAPs and CO. Conclusions: In PPH patients, BNP levels are increased and correlate with functional class and PVR. Follow-up studies are needed to evaluate the role of BNP as a marker of progression and therapeutic response in PPH patients

Spontaneous rupture of tricuspid valve papillary muscle in pulmonary hypertension secondary to HIV infection. Report of one case

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42 years old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who developed an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilators. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully managed with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a live saving and useful approach in this condition.

Rotura espontánea de válvula tricúspide en un paciente con hipertensión pulmonar secundaria a VIH

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42 years old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who developed an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilators. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully managed with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a live saving and useful approach in this condition.

Endocarditis infecciosa por Listeria monocytogenes: revisión de la literatura a partir de un caso clínico

La endocarditis infecciosa por Listeria monocytogenes es una enfermedad extremadamente infrecuente, pero usualmente agresiva. Se ha observado en los ultimos anos un aumento en la edad de presentacion y una predileccion por pacientes con enfermedad valvular, especialmente valvula protesica. El tratamiento de eleccion es ampicilina combinada con un aminoglucosido para obtener sinergismo. Aun con un tratamiento adecuado, la mortalidad es elevada y mayor que en otros tipos de endocarditis bacteriana. Con una terapia optima, incluyendo la resolucion quirurgica, la mortalidad ha disminuido significativamente en los ultimos anos. Se presenta una revision de la literatura cientifica a partir de un caso clinico de un paciente con un sindrome febril en el que se diagnostico una endocarditis por L. monocytogenesque fue tratada en forma medica con un resultado exitoso.

Edad mayor a sesenta años y tabaquismo son predictores de la presencia ecocardiográfica de placa aórtica complicada en pacientes con accidente cerebrovascular isquémico sin cardiopatía

El ACV es la segunda causa es-pecifica de muerte en nuestro pais, siendo el origen cardioembolico responsable del 20% al 40% de los casos. En pacientes sin patologia cardiovascular eviden-te, clinica o por ecocardiografia transtoracica (ETT), la identificacion de la fuente embolica requiere la realiza-cion de ecocardiografia transesofagica (ETE), que puede confirmar la presencia de una placa aortica complicada (PAC) como agente causal de este fenomeno.