Diabetes Mellitus and Its Implications in Aortic Stenosis Patients

Aortic stenosis (AS) and diabetes mellitus (DM) are both progressive diseases that if left untreated, result in significant morbidity and mortality. Several studies revealed that the prevalence of DM is substantially higher in patients with AS and, thus, the progression from mild to severe AS is greater in those patients with DM. DM and common comorbidities associated with both diseases, DM and AS, increase patient management complexity and make aortic valve replacement the only effective treatment. For that reason, a better understanding of the pathogenesis underlying both these diseases and the relationships between them is necessary to design more appropriate preventive and therapeutic approaches. In this review, we provided an overview of the main aspects of the relationship between AS and DM, including common comorbidities and risk factors. We also discuss the established treatments/therapies in patients with AS and DM

Prioritization of Candidate Biomarkers for Degenerative Aortic Stenosis through a Systems Biology-Based In-Silico Approach

Degenerative aortic stenosis is the most common valve disease in the elderly and is usually confirmed at an advanced stage when the only treatment is surgery. This work is focused on the study of previously defined biomarkers through systems biology and artificial neuronal networks to understand their potential role within aortic stenosis. The goal was generating a molecular panel of biomarkers to ensure an accurate diagnosis, risk stratification, and follow-up of aortic stenosis patients. We used in silico studies to combine and re-analyze the results of our previous studies and, with information from multiple databases, established a mathematical model. After this, we prioritized two proteins related to endoplasmic reticulum stress, thrombospondin-1 and endoplasmin, which have not been previously validated as markers for aortic stenosis, and analyzed them in a cell model and in plasma from human subjects. Large-scale bioinformatics tools allow us to extract the most significant results after using high throughput analytical techniques. Our results could help to prevent the development of aortic stenosis and open the possibility of a future strategy based on more specific therapies

Miocardiopatía no compactada asociada a anomalía de Ebstein: Importancia de la imagen cardiaca multimodal en las cardiopatías congénitas

El diagnóstico causal de insuficiencia cardiaca en pacientes afectos de cardiopatías congénitas puede ser complejo. Estos pacientes con frecuencia asocian múltiples anomalías que pueden pasar desapercibidas tras un primer diagnóstico. Las recientes técnicas de imagen cardiaca son útiles en este contexto al caracterizarse por una mejor definición de la morfología y función cardiacas. Presentamos un caso donde se demuestra la utilidad de la imagen cardiaca multimodal en el estudio de la poco frecuente asociación de anomalía de Ebstein con no compactación ventricular izquierda

Estratificación de la estenosis aórtica: en la integración juiciosa de datos está el éxito

La estenosis aórtica es la valvulopatía más frecuente en nuestro medio. El envejecimiento de la población y la mayor esperanza de vida la convierten en un problema de salud pública relevante. Aunque los criterios diagnósticos de severidad están claramente establecidos, en ocasiones, la cuantificación de la estenosis no es tan sencilla, existiendo diferentes escenarios clínicos y ecocardiográficos llenos de matices en los que otras técnicas diagnósticas de imagen pueden desempeñar un papel fundamental. En este manuscrito de revisión se evalúan estos escenarios y, de acuerdo con trabajos previos, se propone un algoritmo diagnóstico que facilite la toma de decisiones

Arteria coronaria única con origen en seno de Valsalva derecho: Utilidad de la angiotomografía coronaria con tomografía multicorte

La arteria coronaria única con origen en el seno de Valsalva derecho es una anomalía coronaria congénita poco frecuente. Presentamos el caso de un hombre de 77 años remitido para coronariografía invasiva con diagnóstico de síndrome coronario agudo sin elevación del segmento ST de localización ínfero-lateral. En el estudio se demostró enfermedad significativa en el tercio proximal de la coronaria derecha. Durante el procedimiento no se logró cateterizar el ostium de la coronaria izquierda que aparentemente se rellenaba desde la coronaria derecha. Ante la sospecha de un origen anómalo de la misma, se realizó coronariografía no invasiva mediante tomografía multicorte de 64 cortes que confirmó la existencia de una arteria coronaria única con origen en el seno de Valsalva derecho

Assessment of left atrial volume in resistant hypertension by cardiac magnetic resonance imaging

Introduction: Increased left atrial (LA) volumes are associated with impaired diastolic properties of the left ventricle (LV) and have been shown to predict cardiovascular events in a wide spectrum of patients. A relation between LA volume and aldosterone has been reported in idiopathic dilated cardiomyopathy, but this relationship has not been evaluated in resistant hypertensive subjects. Hypothesis: We hypothesized that patients with elevated plasma aldosterone concentration (PAC) have greater LA volumes. We compared LA volumes in normal subjects and mildly hypertensive patients (Controls) and patients with resistant hypertension. Methods: 71 patients (55 resistant hypertensive (51% male, age 57±12 y) and 16 Controls (62% men, age 54±11 y, p=ns) were studied. Clinic blood pressure (BP), plasma levels of B-type natriuretic peptide (BNP), PAC, plasma renin activity (PRA), serum cortisol, and 24 hour urinary aldosterone and sodium excretion were determined. Cardiac magnetic resonance imaging was performed in all patients and LA volumes were measured using a biplane length-area method and indexed for the body surface area. Results: Results are summarized in the Table. Resistant hypertensives had significantly higher systolic and diastolic BP compared to Controls. There was a trend towards higher PAC in hypertensives that did not reach statistical significance. BNP levels also were not different between the groups but we found a relationship between BNP and LA volume index (r=0.43, p=0.003). Hypertensives also exhibited increased LV mass and LA volume index compared to Controls. No relation between LA volume index and PAC was found. PRA, cortisol, and 24 hour urinary aldosterone and sodium excretion also had no relation to LA volume index. Conclusions: LA volume index is higher in resistant hypertension and shows positive correlation with BNP levels in all subjects but is not related to PAC in either the Control or Resistant hypertension groups