Pericarditis constrictiva en paciente postrasplante cardíaco

We present a case of a 63-year-old patient with a history of orthotopic heart transplantation who evolved within a few months with heart failure to a right predominance secondary to constrictive pericarditis. The diagnosis was made through clinical and imaging methods, mainly Doppler echocardiography. Once diagnosed and taking into account the ominous prognosis of this entity, a radical pericardiectomy was performed with resolution of the clinical problem.A continuación se presenta el caso de un paciente de 63 años con antecedentes de trasplante cardíaco ortotópico, que evolucionó a los pocos meses con insuficiencia cardíaca con predominio derecho secundario a pericarditis constrictiva. El diagnóstico se realizó a través de la clínica y los métodos de imágenes, principalmente la ecocardiografía Doppler. Una vez diagnosticado y teniendo en cuenta el pronóstico ominoso de esta entidad fue sometido a pericardiectomía radical con resolución del cuadro clínico

Effects of serelaxin in patients with acute heart failure

Background: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. Methods: In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 μg per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. Results: A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P=0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P=0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. Conclusions: In this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778. opens in new tab.

Prevalencia de hallazgos electrocardiográficos anormales en deportistas amateur: comparación de los criterios de Seattle 2013 con los criterios de Seattle 2017

Introduction: The specificity of the electrocardiogram as a diagnostic method of causes of sudden cardiac death in athletesdepends on the criteria used to discern between physiological and pathological alterations.Objectives: To assess the prevalence of abnormal electrocardiographic findings in amateur athletes when comparing theSeattle 2013 and 2017 Criteria.Material and methods: 853 athletes were evaluated. Gender and age were evaluated as independent predictor variables.Follow-up was carried out by means of complementary diagnostic methods.Results: 29 athletes presented abnormal electrocardiograms according to 2013 criteria, and 17 athletes according to 2017criteria, constituting 3.4% and 2% respectively. No significant differences were found between genders or by age.Conclusions: Of the electrocardiograms considered abnormal according to the 2013 criteria, 41.4% came to be considerednormal when applying the criteria redefined in 2017. Neither gender nor age are independent predictor variables. In none ofthe patients, heart disease could be demonstrated during follow-up.Introducción: La especificidad del electrocardiograma como método diagnóstico de causas de muerte súbita cardíaca en deportistasdepende de los criterios utilizados para discernir entre alteraciones fisiológicas y patológicas.Objetivos: Evaluar la prevalencia de hallazgos electrocardiográficos anormales en deportistas amateur al comparar los Criteriosde Seattle 2013 y 2017.Material y métodos: Fueron evaluados 853 deportistas. Se evaluaron género y edad como variables predictoras independientes.Se realizó un seguimiento mediante métodos complementarios de diagnóstico.Resultados: Presentaron electrocardiogramas anormales según criterios 2013 29 deportistas y 17, según criterios 2017, lo queconstituyó el 3,4% y el 2%, respectivamente. No se encontraron diferencias significativas entre géneros ni por edad.Conclusiones: De los electrocardiogramas considerados anormales según los criterios 2013, el 41,4% pasó a considerarse normalal aplicarse los criterios redefinidos en 2017. Ni el género ni la edad constituyen variables predictoras independientes. Enningún evaluado, se pudo demostrar cardiopatía en el seguimiento

Changes in cardiac Aquaporin expression during aortic valve replacement surgery with cardiopulmonary bypass

OBJECTIVES: Cardiopulmonary bypass (CPB) use is an essential strategy for many cardiovascular surgeries. However, its use and duration have been associated with a higher rate of postoperative complications, such as low cardiac output syndrome due to myocardial oedema and dysfunction. Though Aquaporin water channels have been implicated in myocardial water balance, their specific role in this clinical scenario has not been established. METHODS: In a consecutive study of 17 patients with severe aortic stenosis undergoing aortic valve replacement surgery, 2 myocardial biopsies of the left ventricle were taken: 1 before and 1 after CPB use. Sociodemographic, clinical and laboratory data were collected. Western blot and immunohistochemistry studies were performed. RESULTS: After CPB use, there was a mean increase of ∼62% in Aquaporin 1 protein levels (P = 0.001) and a mean reduction of ∼38% in Aquaporin 4 protein levels (P = 0.030). In immunohistochemistry assays, Aquaporin 1 was found lining small blood vessels, while Aquaporin 4 formed a circular label in cardiomyocytes. There were no changes in the localization of either protein following CPB use. During the observed on-pump time interval, there was a 1.7%/min mean increase in Aquaporin 1 (P = 0.021) and a 2.5%/min mean decrease in Aquaporin 4 (P = 0.018). Myocardial interstitial oedema increased by 42% (95% confidence interval 31-54%) after CPB use. Patients who developed low cardiac output syndrome were in the upper half of the median percentage change of Aquaporin expression. CONCLUSION: Time-dependent changes in cardiac Aquaporin expression may be associated with myocardial oedema and dysfunction related to CPB use.Fil: Politi, María Teresa. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Ochoa, Federico Claudio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Netti, Vanina Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Ferreyra, Raúl. No especifíca;Fil: Bortman, Guillermo. No especifíca;Fil: Sanjuan, Norberto Aníbal. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Morales, Celina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiopatología Cardiovascular; ArgentinaFil: Piazza, Antonio. No especifíca;Fil: Capurro, Claudia Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; Argentin

A multifactorial approach employing melatonin to accelerate resynchronization of sleep-wake cycle after a 12 time-zone westerly transmeridian flight in elite soccer athletes

Rapid transmeridian translocation through multiple time zones has a negative impact on athletic performance. The aim of the present study was to test the timely use of three factors (melatonin treatment, exposure to light, physical exercise) to hasten the resynchronization of a group of elite sports competitors and their coaches to a westerly transmeridian flight comprising of 12 time-zones. Twenty-two male subjects were included in the study. They were professional soccer players and their coaches who travelled to Tokyo to play the final game of the Intercontinental Coup. The day prior to departure, urine was collected from each subject from 18:00 to 06:00 hrs to measure the melatonin metabolite 6-sulphatoxymelatonin. Participants were asked to complete sleep log diaries from day 0 (preflight) to the day before returning to Buenos Aires (day 8). All subjects received 3 mg of melatonin p.o. daily at expected bedtime at Tokyo immediately after leaving Buenos Aires. Upon arrival at Tokyo the subjects performed a daily physical exercise routine outdoors at two restricted times of the day (from 08:00 to 11:00 hrs in the morning and from 13:00 to 16:00 hrs in the afternoon). Exposure to sunlight or physical exercise at other times of the day was avoided. Except for the number of awakenings (which increased on days 1 and 3) and sleep latency (which decreased on days 2, 6 and 8), there was an absence of significant changes in subjective sleep parameters as compared with preflight assessment. Sleep quality and morning alertness at Tokyo correlated significantly with preflight 6-sulphatoxymelatonin excretion. Mean resynchronization rate of sleep-wake cycle to the 12 hr-time shift was 2.13 ± 0.88 days, significantly different from the minimal resynchronization rate of 6 days expected after a 12-time-zones flight. The results indicate that the combination of melatonin treatment, an appropriate environmental light schedule and timely applied physical exercise can be useful to help elite athletes to overcome the consequences of jet lag.Fil: Cardinali, Daniel Pedro. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Bortman, Guillermo. No especifíca;Fil: Liotta, G.. No especifíca;Fil: Perez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Albornoz Britos, Laura Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Cutrera, Rodolfo Angel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Batista, Julián Alberto. No especifíca;Fil: Ortega Gallo, P.. No especifíca