Sara Castaño

Left ventricular pacing site in cardiac resynchronization therapy: clinical follow-up and predictors of failed lateral implant.

The effects of the left ventricular (LV) pacing site on the clinical results of resynchronization therapy (CRT) are not well characterized. The aim of this study was to define the effect of LV lead location on clinical response and LV remodelling, and to identify predictors of failure to implant the LV lead in a lateral location.

New Strategies for Echocardiographic Evaluation of Left Ventricular Function in a Mouse Model of Long-Term Myocardial Infarction

Background The aim of this article is to present an optimized acquisition and analysis protocol for the echocardiographic evaluation of left ventricle (LV) remodeling in a mouse model of myocardial infarction (MI). Methodology 13 female DBA/2J mice underwent permanent occlusion of the left anterior descending (LAD) coronary artery leading to MI. Mice echocardiography was performed using a Vevo 770 (Visualsonics, Canada) before infarction, and 7, 14, 30, 60, 90 and 120 days after LAD ligation. LV systolic function was evaluated using different parameters, including the fractional area change (FAC%) computed in four high-temporal resolution B-mode short axis images taken at different ventricular levels, and in one parasternal long axis. Pulsed wave and tissue Doppler modes were used to evaluate the diastolic function and Tei Index for global cardiac function. The echocardiographic measurements of infarct size were validated histologically using collagen deposition labeled by Sirius red staining. All data was analyzed using Shapiro-Wilk and Students t-tests. Principal Findings Our results reveal LV dilation resulting in marked remodeling an severe systolic dysfunction, starting seven days after MI (LV internal apical diameter, basal = 2.82±0.24, 7d = 3.49±0.42; p<0.001. End-diastolic area, basal = 18.98±1.81, 7d = 22.04±2.11; p<0.001). A strong statistically significant negative correlation exists between the infarct size and long-axis FAC% (r = −0.946; R2 = 0.90; p<0.05). Moreover, the measured Tei Index values confirmed significant post-infarction impairment of the global cardiac function (basal = 0.46±0.07, 7d = 0.55±0.08, 14 d = 0.57±0.06, 30 d = 0.54±0.06, 60 d = 0.54±0.07, 90 d = 0.57±0.08; p<0.01). Conclusions/Significance In summary, we have performed a complete characterization of LV post-infarction remodeling in a DBA/2J mouse model of MI, using parameters adapted to the particular characteristics of the model In the future, this well characterized model will be used in both investigative and pharmacological studies that require accurate quantitative monitoring of cardiac recovery after myocardial infarction.

Dual-source CT coronary angiogram in heart transplant recipients in comparison with dobutamine stress echocardiography for detection of cardiac allograft vasculopathy.

Conventional coronary angiography (CCA) is the gold standard in the diagnosis of cardiac allograft vasculopathy (CAV) in heart transplant recipients. Dobutamine stress echocardiography (DSE) is a useful technique for screening. Dual-source computed tomography (DSCT) is the last generation of computed tomography scanners, which could be useful to noninvasively assess CAV. Thirty cardiac transplant recipients underwent DSE and DSCT coronary angiogram. Exclusion criteria were as follows: renal insufficiency, iodinated contrast media allergy, less than 12 months since transplant, and unstable clinical conditions. DSE showed ischemia in two patients. At DSCT scan 13 patients had a normal angiogram, 13 ones wall thickening and four significant diseases. DSCT showed a sensitivity of 100% with a specificity of 92%. DSCT allowed detection of more patients with CAV than DSE. Four patients showed significant CAV at DSCT compared with two at DSE. Thirteen patients showed initial signs of disease at DSCT despite a normal DSE.

Terapia de resincronización cardiaca y miocardiopatía valvular tras cirugía correctora

La terapia de resincronizacion cardiaca (TRC) ha mostrado utilidad terapeutica en un determinado grupo de pacientes con insuficiencia cardiaca avanzada. Sin embargo, los pacientes con diagnostico de miocardiopatia de origen valvular estan infrarrepresentados en los estudios clinicos aleatorizados. El objetivo del estudio fue evaluar el efecto de la TRC en pacientes con insuficiencia cardiaca de etiologia exclusivamente valvular a medio plazo (6 meses). Se incluyo a 40 pacientes consecutivos a quienes se implanto un dispositivo de resincronizacion cardiaca. A los 6 meses de seguimiento, se produjo una mejora de la clase funcional, el remodelado ventricular izquierdo y los parametros de asincronia intraventricular en los pacientes tratados. En este subgrupo de pacientes, la TRC muestra un beneficio similar al obtenido en pacientes con insuficiencia cardiaca de otra etiologia.

Cardiac Resynchronization Therapy and Valvular Cardiomyopathy After Corrective Surgery

Cardiac resynchronization therapy (CRT) has been shown to have clinical benefits in certain groups of patients with advanced heart failure (HF). However, patients with valvular cardiomyopathy are underrepresented in randomized clinical studies. The aim of this study was to assess the medium-term (i.e., at 6 months) effects of CRT in patients with HF exclusively due to valvular disease. The study included 40 consecutive patients who underwent CRT device implantation. At 6 months, there were improvements in functional class, left ventricular remodeling, and intraventricular dyssynchrony parameters in treated patients. In this particular subgroup of patients, the benefits of CRT were similar to those observed in patients with HF due to other etiologies.

Miocarditis aguda: diagnóstico mediante resonancia magnética cardiaca

Cardiomyopathies are a common cause of morbidity and mortality. Myocarditis, which is included among specific cardiomyopathies, frequently presents non-specific clinical manifestations and thus may be difficult to diagnose, or even be misdiagnosed. Traditionally employed diagnostic techniques, including endomyocardial biopsy, have been shown to be of limited value. Following its overall implantation in clinical practice, cardiac magnetic resonance imaging (MRI) is nowadays widely considered to be the best non-invasive diagnostic tool available for diagnosing myocarditis.

Prosthetic aortic valve thrombosis after left ventricular assist device implantation

Rev Esp Cardiol. 2005;58(7):863 863 A 54-year-old man had undergone aortic valve replacement with a valve graft according to the Bentall-Bono technique because of severe stenosis and aneurysm of the ascending aorta 14 years ago. He had been hospitalized several times over the past 2 years for congestive heart failure and progressive worsening of left ventricular (LV) ejection fraction, clinically classified as New York Heart Association functional class III-IV. After meeting the specific requirements, he was included on the heart transplantation (HT) waiting list. During his last hospitalization for heart failure, the patient presented various episodes of hemodynamic decompensation despite intravenous inotropic and vasodilator treatment. Implantation of an LV assist device (Thoratec®) was used as a bridge until HT could be performed. An apical cannula was placed to drain the LV and the outlet cannula was anastomosed to the ascending aorta valve graft, without complications. Anticoagulation initially consisted of low molecular weight heparin, and later acenocoumarol. IM A G E S I N CA R D I O L O G Y