Do the spatial characteristics of myocardial scar tissue determine the risk of ventricular arrhythmias?

Sudden cardiac death is one of the main causes of mortality in patients with structural heart disease. Although an implantable cardioverter de?brillator signi?cantly reduces the mortality rate, many patients never receive a shock. Identi?cation of high-risk patients would reduce the costs associated with this therapy and prevent the deleterious effect of inappropriate discharges. As scar tissue is the substrate of ventricular arrhythmias in patients with structural heart disease, scar characterization could allow strati?cation of the risk. The objective of this article is to review the role of scar characteristics in the pathogenesis of ventricular arrhythmias in patients with structural heart disease

Secretory phospholipase A2 elicits proinflammatory changes and upregulates the surface expression of fas ligand in monocytic cells: potential relevance for atherogenesis

Producción CientíficaType IIA secretory phospholipase A2 (sPLA2) is an acute-phase reactant that plays a role in atherogenesis and is expressed in atherosclerotic arterial walls displaying inflammatory features. This generates a relevant question addressing the biological effects of this enzyme on monocytic cells, in view of the role of these cells in the inflammatory process associated with atherosclerosis. sPLA2 produced a mild activation of the p42 mitogen-activated protein module of the mitogen-activated protein kinase (MAPK) cascade and a prominent activation of c-Jun N-terminal kinase in THP-1 monocytes. This activation showed both an early and a late peak, different from that elicited by tumor necrosis factor-α (TNF-α), which only showed the first peak. This was accompanied by activation of arachidonate metabolism, as judged from both the activation of the cytosolic phospholipase A2 (cPLA2) and the induction of cyclooxygenase-2 (COX-2) expression. sPLA2 also elicited the production of monocyte chemoattractant protein-1 (MCP-1) and showed a synergistic effect with TNF-α on both COX-2 induction and MCP-1 production. sPLA2 upregulated the expression of Fas ligand at the cell surface, but it did not influence Fas expression nor cell survival of monocytes. In summary, these data indicate that some of the atherogenic effects of sPLA2 can be exerted by engagement of an sPLA2-binding structure on monocytic cells, most probably the M-type receptor for sPLA2, which produces the activation of the MAPK cascade, induces a proinflammatory phenotype, and upregulates the cell surface expression of Fas ligand.Plan Nacional de Salud y Farmacia (grant SAF98/0176)Comisión Interministerial de Ciencia y Tecnología - Comisión Europea (grant 1FD97-0590)Fondo de Investigación Sanitaria (grant FIS00/0393

Diferencias en el sustrato endo y epicárdico de las taquicardias ventriculares posinfarto analizado mediante resonancia magnética cardiaca con realce tardío

Algunas taquicardias ventriculares (TV) posinfarto se localizan en el epicardio. La identificación de diferencias en el sustrato de las TV endocárdicas y epicárdicas permitiría definir una mejor estrategia de ablación

A measurement scale to assess children's satisfaction with hospitalization in the Andalusian population

Background: Patient satisfaction is a principal indicator in the evaluation of the stay of pediatric patients in hospitals, since its consequences can emotionally interfere with health treatment. The aim of this study was to obtain a valid scale to assess children’s satisfaction with their time spent as a patient in an Andalusian hospital. Method: The Children’s Satisfaction with Hospitalization Questionnaire (CSHQ) was applied to 623 pediatric patients hospitalized in Andalusia. An exploratory factor analysis (EFA) showed one dimension underlying the children’s satisfaction with their hospitalization. After that, we developed a depuration analysis process to achieve a valid and unidimensional scale to assess children’s satisfaction. Results: The eleven-item one-dimension solution showed suitable consistency and goodness-of-fit indices. The final scale addresses hosting aspects as the main dimension of a minor’s satisfaction in Andalusian hospitals. Conclusion: A unidimensional scale has been determined for the assessment of children’s satisfaction with their stay in Andalusian hospitals based on hosting aspects. Nonetheless, other dimensions underlying the satisfaction of patients should also be considered

Evolución temporal de las características de la escara isquémica en un modelo experimental de infarto agudo de miocardio: estudio basado en resonancia magnética

En los pacientes con infarto de miocardio, las características de la escara isquémica, incluyendo la extensión de tejido heterogéneo (TH) y los canales intraescara, se relacionan con la mortalidad arrítmica. Sin embargo, aún no se conoce bien la evolución temporal de la estructura de la escara en los primeros meses tras el infarto agudo de miocardio (IAM)

Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

[Abstract] Aims. The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods. We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results. The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024–1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115–1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction. Conclusions. In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction.

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.This research was funded by CIBERCV I and supported by the Instituto de Salud Carlos III. L.V. is funded by the Instituto de Salud Carlos III, Spain (CM20/00104 and ).S

Assessment of diastolic chamber properties of the right ventricle by global fitting of pressure-volume data and conformational analysis of 3D + T echocardiographic sequences

Assessment of diastolic chamber properties of the right ventricle by global fitting of pressure-volume data and conformational analysis of 3D + T echocardiographic sequence

Utilidad de los mapas de intensidad de señal basados en secuencias de realce tardía 3D para caracterizar el sustrato arritmogénico en pacientes con taquicardía ventricular isquémica

La escara miocárdica constituye el sustrato arritmogénico de los pacientes con TV isquémica. Los mapas de intensidad de señal (IS) obtenidos a partir de mágenes de realce tardío (RT) pueden ser una alternativa no invasiva a los mapas electroanatómicos para estudiar la arquitectura de la escara. El objetivo de este trabajo es describir las características de las escaras observadas en los pacientes (p) con TV isquémicas