Seguimiento a largo plazo de pacientes con miocardiopatía dilatada idiopática tras infusión intracoronaria de células de médula ósea

Las enfermedades cardiovasculares, y dentro de ellas la insuficiencia cardíaca (IC), son unas de las causas más frecuentes de morbimortalidad en el primer mundo. La principal causa de IC sigue siendo la cardiopatía isquémica, aunque el origen idiopático supone un número no despreciable de casos. A pesar de disponer de un tratamiento médico junto con otras medidas no farmacológicas que han conseguido un incremento de la supervivencia a corto-medio plazo, no en todos los casos se consigue, terminando algunos casos muy seleccionados en trasplante cardíaco, con las implicaciones que éste supone en cuanto a calidad de vida, enfermedades asociadas y un pronóstico incierto. Por todo esto parece razonable buscar alternativas terapéuticas a una enfermedad que hoy por hoy está desbancando a la cardiopatía isquémica como causa principal de trasplante cardíaco y esta es la miocardiopatía dilatada (MD) idiopática. Con ello nos referimos a la terapia regenerativa con células madre, que tras llevar dos décadas empleándose en casos de cardiopatía isquémica, se ha empezado a utilizar también en casos de origen idiopático, con resultados alentadores. Se ha relacionado con incrementos significativos de la función ventricular y reducción de volúmenes ventriculares así como mejoría de la clase funcional, entre otros efectos beneficiosos, sin apenas haberse descrito eventos adversos relacionados con dicha terapia. Con este trabajo pretendemos comprobar la aplicabilidad de la terapia regenerativa con células madre a largo plazo en casos de MD idiopática en nuestro medio así como conocer aquellos factores predictores de una buena respuesta tardía a la misma, un tema que ha sido poco estudiado hasta el momento

Practical Echocardiographic Approach of the Regurgitant Mitral Valve Assessment

Mitral regurgitation is the second-most frequent valvular heart disease in Europe after degenerative aortic stenosis. It is associated with significant morbidity and mortality, and its prevalence is expected to increase with population aging. Echocardiography is the first diagnostic approach to assess its severity, constituting a challenging process in which a multimodality evaluation, integrating quantitative, semiquantitative and qualitative methods, as well as a detailed evaluation of the morphology and function of both left ventricle and atria is the key. In this review, we would like to provide a practical diagnosis approach on the mitral valve regurgitation mechanism, severity quantification, and planning of future therapeutic options

Constrictive pericarditis heart failure in a patient with atrial fibrillation: A diagnostic challenge

Abstract Constrictive pericarditis is an infrequent cause of heart failure. Diagnosis is challenging and requires a high level of suspicion. Subtle echocardiographic findings, as the pericardial bounce, could be the clue to diagnosis

Randomised, double-blind, placebo-controlled clinical trial for evaluating the efficacy of intracoronary injection of autologous bone marrow mononuclear cells in the improvement of the ventricular function in patients with idiopathic dilated myocardiopathy: a study protocol

Background Cellular therapies have been increasingly applied to diverse human diseases. Intracoronary infusion of bone marrow-derived mononuclear cells (BMMNC) has demonstrated to improve ventricular function after acute myocardial infarction. However, less information is available about the role of BMMNC therapy for the treatment of dilated myocardiopathies (DCs) of non-ischemic origin. This article presents the methodological description of a study aimed at investigating the efficacy of intracoronary injection of autologous BMMNCs in the improvement of the ventricular function of patients with DC. Methods This randomised, placebo-controlled, double-blinded phase IIb clinical trial compares the improvement on ventricular function (measured by the changes on the ejection fraction) of patients receiving the conventional treatment for DC in combination with a single dose of an intracoronary infusion of BMMNCs, with the functional recovery of patients receiving placebo plus conventional treatment. Patients assigned to both treatment groups are monitored for 24 months. This clinical trial is powered enough to detect a change in Left Ventricular Ejection Fraction (LVEF) equal to or greater than 9%, although an interim analysis is planned to re-calculate sample size. Discussion The study protocol was approved by the Andalusian Coordinating Ethics Committee for Biomedical Research (Comité Coordinador de Ética en Investigación Biomédica de Andalucia), the Spanish Medicines and Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), and is registered at the EU Clinical Trials Register (EudraCT: 2013–002015-98). The publication of the trial results in scientific journals will be performed in accordance with the applicable regulations and guidelines to clinical trials. Trial registration ClinicalTrials.gov Identifier NCT02033278 (First Posted January 10, 2014): https://clinicaltrials.gov/ct2/show/NCT02033278; EudraCT number: 2013–002015-98, EU CT Register: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-002015-98. Trial results will also be published according to the CONSORT statement at conferences and reported peer-reviewed journals.This paper presents an investigator-driven Clinical trial partially funded by research grant provided by the Regional Ministry of Health of Andalusia (Grant Reference Number salud-201600073587-tra).Ye