Análisis de la interacción ventrículo-valvulo-arterial en pacientes con estenosis aórtica

La estenosis aórtica es probablemente la valvulopatía más importante en el mundo occidental, debido a su alta prevalencia y al grave impacto que tiene sobre la calidad y esperanza de vida de las personas que la padecen, de modo que la supervivencia en los pacientes sintomáticos es de aproximadamente un 50% a dos años. Durante décadas, la sustitución valvular quirúrgica ha sido la única opción de tratamiento con capacidad para modificar el pronóstico de la estenosis aórtica, y sin embargo, un 30% de los pacientes con estenosis aórtica severa sintomática no son operados por diversos motivos. En los últimos años, la sustitución valvular aórtica con catéter (TAVI) ha surgido como una opción de tratamiento para pacientes inoperables y de alto riesgo quirúrgico. La TAVI es superior al tratamiento farmacológico, reduciendo la mortalidad y mejorando los síntomas; además, en pacientes de alto riesgo quirúrgico, la TAVI tiene resultados al menos tan buenos como la cirugía. En la última década se ha producido un gran avance en los dispositivos y técnicas disponibles para TAVI, lo que ha contribuido a mejorar los resultados y reducir las complicaciones. La oposición al flujo sistólico en la estenosis aórtica viene determinada por la suma de la obstrucción valvular y la carga vascular. Esta última a menudo se encuentra anormalmente alta en la estenosis aórtica, debido a la hipertensión arterial y a la alta prevalencia de enfermedad vascular sistémica que presentan estos pacientes, lo que contribuye de forma importante a la postcarga total del ventrículo izquierdo. Además, entre la obstrucción valvular y la carga vascular existe un fenómeno de interdependencia, de forma que al reducir uno de los componentes aumenta el otro, y a la inversa..

Functional disorders in non-culprit coronary arteries and their implications in patients with acute myocardial infarction

Approximately 30-50% of patients with ST-segment elevation acute myocardial infarction have multivessel disease. The physiology of the non-culprit artery (NCA) is complex and represents a challenge to physicians as, while these plaques are presumably stable, clinical data show that they frequently lead to major adverse cardiovascular events. In addition the presence of microvascular and endothelial dysfunction may have prognostic implications and interfere with current physiological indices for stenosis severity assessment. In this review we aim to summarize current methods to study the microcirculation, discuss the evidence available regarding the endothelium and the microvascular compartment of the NCA; the best strategies to perform a complete revascularization based on proven ischemia; real limitations associated to hyperemic stenosis indices; and the potential role of novel resting-indices in this specific acute context

Phases I–III Clinical Trials Using Adult Stem Cells

First randomized clinical trials have demonstrated that stem cell therapy can improve cardiac recovery after the acute phase of myocardial ischemia and in patients with chronic ischemic heart disease. Nevertheless, some trials have shown that conflicting results and uncertainties remain in the case of mechanisms of action and possible ways to improve clinical impact of stem cells in cardiac repair. In this paper we will examine the evidence available, analyze the main phase I and II randomized clinical trials and their limitations, discuss the key points in the design of future trials, and depict new directions of research in this fascinating field

Pulmonary Vascular Remodeling and Prognosis in Patients Evaluated for Heart Transplantation: Insights from the OCTOPUS-CHF Study

Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 +/- 0.5 mm vs. 0.2 +/- 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients

Pulmonary vascular remodeling and prognosis in patients evaluated for heart transplantation: insights from the OCTOPUS-CHF study

[Abstract] Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 ± 0.5 mm vs. 0.2 ± 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients.Instituto de Salud Carlos III; PI18/00254European Regional Development Fund; CB16/11/0050

Reanimación cardiopulmonar con ECMO percutáneo en parada cardiaca refractaria hospitalaria: experiencia de un centro

Sin financiación4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems0.473 SJR (2019) Q3, 196/364 Cardiology and Cardiovascular MedicineNo data IDR 2019UE

Cardiopulmonary resuscitation with percutaneous ECMO in refractory in-hospital cardiac arrest: a single-center experience

Sin financiación4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems0.473 SJR (2019) Q3, 196/362 Cardiology and Cardiovascular MedicineNo data IDR 2019UE