Miocarditis aguda: diagnóstico mediante resonancia magnética cardiaca

Cardiomyopathies are a common cause of morbidity and mortality. Myocarditis, which is included among specific cardiomyopathies, frequently presents non-specific clinical manifestations and thus may be difficult to diagnose, or even be misdiagnosed. Traditionally employed diagnostic techniques, including endomyocardial biopsy, have been shown to be of limited value. Following its overall implantation in clinical practice, cardiac magnetic resonance imaging (MRI) is nowadays widely considered to be the best non-invasive diagnostic tool available for diagnosing myocarditi

Protein crystallization in short-peptide supramolecular hydrogels: A versatile strategy towards biotechnological composite materials

Protein crystallization in hydrogels has been explored with the main purpose of facilitating the growth of high quality crystals while increasing their size to enhance their manipulation. New avenues are currently being built for the use of protein crystals as source materials to create sensors and drug delivery vehicles, to name just a few. In this sense, short-peptide supramolecular hydrogels may play a crucial role in integrating protein crystals within a wider range of applications. In this article, we show that protein crystallization in short-peptide supramolecular hydrogels is feasible and independent of the type of peptide that forms the hydrogel and/or the protein, although the output is not always the same. As a general trend, it is confirmed that hydrogel fibers are always incorporated within crystals so that novel composite materials for biotechnological applications with enhanced properties are produced.This research was funded by the MICINN (Spain) projects BIO2010-6800 (JAG), CTQ2012-34778 (JJDM), and “Factoría Española de Cristalización” Consolider-Ingenio 2010 (JAG & MCM), and by Junta de Andalucía (Spain) project P12-FQM- 2721 (LAC). EDRF funds JAG, LAC & JMC. JJDM thanks MICINN for a Ramon y Cajal Fellowship and MCM thanks CSIC for her JAE Fellowshi

Cardiac resynchronization therapy and valvular cardiomyopathy after corrective surgery

Cardiac resynchronization therapy (CRT) has been shown to have clinical benefits in certain groups of patients with advanced heart failure (HF). However, patients with valvular cardiomyopathy are underrepresented in randomized clinical studies. The aim of this study was to assess the medium-term (i.e., at 6 months) effects of CRT in patients with HF exclusively due to valvular disease. The study included 40 consecutive patients who underwent CRT device implantation. At 6 months, there were improvements in functional class, left ventricular remodeling, and intraventricular dyssynchrony parameters in treated patients. In this particular subgroup of patients, the benefits of CRT were similar to those observed in patients with HF due to other etiologies

Efecto de la localización del electrodo ventricular izquierdo sobre los parámetros ecocardiográficos de asincronía en pacientes sometidos a terapia de resincronización cardíaca

Introduction and objectives. Cardiac resynchronization therapy has been shown to be an option in the treatment of patients with congestive heart failure. The current indication for this treatment is based on clinical and electrocardiographic criteria, although echocardiography has also been shown to be a useful tool for the diagnosis of ventricular dyssynchrony. The aim of this study was to assess left ventricular dyssynchrony by echocardiography and to evaluate the effect of the stimulation site on the magnitude of resynchronization. Patients and method. We studied 25 patients with biventricular stimulation (left ventricular lead located in a lateral position in 13 patients, and in an anterior position in 12). A complete echo-Doppler evaluation, including left ventricular ejection fraction, ventricular diameters and parameters of inter- and intraventricular dyssynchrony, was performed before implantation and 3 months after the procedure, with the device connected and disconnected. Results. Left ventricular ejection fraction increased significantly from 23.7 (6.5) to 27.8 (5.5) (P=.007) at 3 months. In the group as a whole, biventricular pacing was associated with a significant decrease in all intraventricular dyssynchrony parameters (septal-to-lateral wall motion delay and septal-to-posterior wall motion delay). This decrease in septal-to-posterior wall motion delay and septalto- lateral wall motion delay was significantly greater in patients with the electrode implanted in the lateral position (58.1 ms vs 118 ms; P=.02) than with the lead in the anterior position (39.5 ms vs 86.5 ms; P=.04). Three patients, all with the electrode in an anterior location, were considered non-responders. Conclusions. Left lateral free wall stimulation provided significantly better intraventricular resynchronization compared to stimulation at an anterior site. Echocardiography is a useful tool to evaluate changes in intra- and interventricular synchrony related to the pacing site

Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos

Recent data suggest that biventricular pacing may play an important role in treating advanced heart failure in the presence of a significant interventricular and/or intraventricular conduction disorder by correcting cardiac dysynchrony. In this article, we review the initial technical and clinical experience with cardiac resynchronization therapy in an electrophysiology laboratory. METHODS: The first 22 consecutive patients with severe congestive heart failure, ejection fraction < 0.35, NYHA functional class III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers were studied. Clinical, electrocardiographic, and echocardiographic evaluations were made before and three months after pacemaker implantation. Acute functional capacity testing with peak oxygen uptake was measured during biventricular pacing and during intrinsic rhythm or right ventricular pacing three months after the implantation procedure. RESULTS: The success rate of pacemaker implantation was 95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039) from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure decreased from an average of 3.12 (0.58) three months before the procedure to 1.38 (0.34) three months after the procedure. Peak oxygen uptake was significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1) ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3) ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely and with a high success rate in the electrophysiology laboratory. Biventricular pacing seems to improve the symptoms of congestive heart failure in patients with evidence of atrioventricular and/or interventricular/intraventricular dysynchrony. An acute benefit in peak oxygen uptake was associated with biventricular pacing after the implantation procedure

Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR

Owing to its pharmacodynamics and posology, the use of regadenoson for stress cardiac magnetic resonance (CMR) has potential advantages over other vasodilators. We sought to evaluate the safety, hemodynamic response and diagnostic performance of regadenoson stress-CMR in routine clinical practice. All regadenoson stress-CMR examinations performed between May 2017 and July 2020 at our institution were retrospectively reviewed. A total of 698 studies were included for the final analysis. A conventional stress/rest protocol was performed using a 1.5T MRI scanner (Magnetom Aera, Siemens Healthineers, Erlangen, Germany). Adverse events, clinical symptoms, and hemodynamic response were assessed. Diagnostic accuracy of the test was evaluated in patients who underwent invasive coronary angiography. Nearly half of patients (48.5%) remained asymptomatic. Most common clinical symptoms included dyspnea (137, 19.6%), chest pain (116, 16.6%) and flushing (44, 6.3%). Two patients (0.28%) could not complete the examination due to severe hypotension or unbearable chest pain. Overall, an increase in heart rate (HR) response (36.2% [IQR: 22.5–50.9]) and a decrease in systolic and diastolic blood pressure (BP) (median systolic BP response of -5% [IQR: -11.5-0.6]; median diastolic BP response of -6.3 mmHg [IQR: -13.4-0]) was observed. Patients with symptoms induced by regadenoson showed higher HR response (40.3%, IQR: 26.4–56.1 vs. 32.4%, IQR: 19-45.6, p<0.001), whereas a blunted HR response was observed in diabetic (29.6%, IQR: 18.4–42 p<0.001), obese (31.7%, IQR: 20.7–46.2 p=0.005) and patients aged 70 years or older (32.9%, IQR: 22.6–43.1 p<0.001). Overall, regadenoson stress-CMR showed 95.65% (IQ 91.49–99.81) sensitivity, 54.84% (IQ 35.71–73.97) specificity, 86.99% (IQ 82.74–94.68) positive predictive value, and 77.27% (IQ 57.49–97.06) negative predictive value for detecting significant coronary stenosis as compared with invasive coronary angiography. Regadenoson is a well-tolerated vasodilator that can be safely employed for stress perfusion CMR, with high diagnostic performanc

Play-in (Plataforma de Ayuda a la Investigación)

En septiembre de 2009, formando parte de la estructura organizativa y de gestión del IUACC, se ha creado una Plataforma de Ayuda a la Investigación, que tiene como objetivo ofrecer apoyo a los investigadores de los grupos adscritos al IUACC, para impulsar su actividad de investigación e innovación y para estimular la transferencia de conocimientos. Esta iniciativa es consecuencia de la ejecución del actual del Plan Estratégico del IUACC elaborado para el apoyo e impulso de la actividad de sus grupos. La plataforma se crea convencidos de que, en el escenario actual de investigación, son importantes estos soportes para la aplicación de estrategias que mejoren la labor investigadora y de gestión del PDI, y para el impulso de la formación avanzada y doctoral de jóvenes investigadores a través de los másteres y doctorado. Los grupos son los que, en función de sus necesidades específicas, diseñan su interacción con esta plataforma

Trasplante celular y terapia regenerativa con células madre

Uno de los campos de la medicina que más expectativas ha levantado en los últimos años es la terapia celular con células madre. El aislamiento de células embrionarias humanas, la aparente e inesperada potencialidad de las células madre adultas y el desarrollo de la terapia génica nos lleva a imaginar un futuro esperanzador para un importante número de enfermedades actualmente incurables. A lo largo de las siguientes páginas vamos a tratar de dibujar el panorama de la investigación con células madre, describiendo los principales logros en este campo así como algunas de las preguntas pendientes de responder. A pesar de las grandes expectativas, es fundamental que mantengamos un espíritu crítico y realista a la hora de analizar los avances científicos en este área

Trasplante cardíaco

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced