Prognostic role of stress cardiac magnetic resonance in the elderly.

Introduction And Objectives: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly.

Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease?

Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease.

Material And Methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease).

Results: We included 295 patients followed up for a median of 28 (19-36) months.

[Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels].

Background: Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography.

[Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?].

Objective: The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions.

Method: We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model.

Association of low GLP-1 with oxidative stress is related to cardiac disease and outcome in patients with type 2 diabetes mellitus: a pilot study.

Oxidative stress (OS) contributes to cardiovascular damage in type 2 diabetes mellitus (T2DM). The peptide glucagon-like peptide-1 (GLP-1) inhibits OS and exerts cardiovascular protective actions. Our aim was to investigate whether cardiac remodeling (CR) and cardiovascular events (CVE) are associated with circulating GLP-1 and biomarkers of OS in T2DM patients.

The activity of circulating dipeptidyl peptidase-4 is associated with subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus.

Background: Patients with type 2 diabetes mellitus (T2DM) present subclinical left ventricular systolic and/or diastolic dysfunction (LVD). Dipeptidyl peptidase-4 (DPP4) inactivates peptides that possess cardioprotective actions. Our aim was to analyze whether the activity of circulating DPP4 is associated with echocardiographically defined LVD in asymptomatic patients with T2DM.

Characterization of coronary plaques with combined use of intravascular ultrasound, virtual histology and optical coherence tomography.

According to post-mortem studies, luminal thrombosis occurs from plaque rupture, erosion and calcified nodules. In vivo studies have found thin cap fibroatheroma (TCFA) as the main vulnerable lesion, prone to rupture. Few data about other post-mortem lesions have been reported in vivo.

Randomized clinical trial on acute effects of i.v. iron sucrose during haemodialysis.

Aim: Haemodialysis induces endothelial dysfunction by oxidation and inflammation. Intravenous iron administration during haemodialysis could worsen endothelial dysfunction. The aim of this study was to ascertain if iron produces endothelial dysfunction and the possible neutralizing effect of N-acetylcysteine when infused before iron.

Echocardiographic findings and NT-proBNP level in type-2 diabetic patients with and without ischemic heart disease.

The aim of this study was to determine whether there are differences in echocardiographic findings or in the level of a biochemical marker (i.e. N-terminal probrain natriuretic peptide [NT-proBNP]) between controls and type-2 diabetic patients with or without ischemic heart disease.

Increased thrombin generation after acute versus chronic coronary disease as assessed by the thrombin generation test.

Atherosclerosis is the most common pathophysiologic substrate of coronary artery disease (CAD). Whereas plaque progression and arterial remodeling are critical components in chronic CAD, intracoronary thrombosis over plaque disruption is causally related to acute CAD. It was the objective of this study to investigate the differences between prior acute CAD and chronic CAD by a simple global coagulation assay measuring thrombin generation.

Variability in individual responsiveness to aspirin: clinical implications and treatment.

Aspirin protects from cardiovascular events because of its antiaggregant effect. The occurrence of new events in patients who take aspirin has been called clinical aspirin resistance. Many authors believe that aspirin resistance must be detected by biochemical tests, although there is no agreement on which is the best.

A case of capecitabine-induced coronary microspasm in a patient with rectal cancer.

5-Fluorouracil (5-FU) is the most frequently used chemotherapy agent concomitant with radiotherapy in the management of patients with rectal cancer. Capecitabine is an oral fluoropyrimidine that mimics the pharmaconkinetics of infusional 5-FU. This new drug is replacing 5-FU as a part of the combined-modality treatment of a number of gastrointestinal cancers.

Myocardial perfusion imaging with adenosine triphosphate predicts the rate of cardiovascular events.

Background: Adenosine triphosphate (ATP) has effects similar to adenosine, including a very short half-life, with the advantage of a much lower cost. Our aim was to evaluate whether myocardial single photon emission computed tomography (SPECT) with ATP can predict the rate of hard events.

Methods And Results: We studied 299 patients (188 men; mean age, 64 +/- 10 years) with known or suspected coronary disease with thallium 201 SPECT during ATP infusion and at rest.

Ergonovine test in angina with normal coronary arteries. Is it worth doing it?

Background: Patients with angina and normal coronary arteries are often misdiagnosed with having non-cardiac pain. Although vasospasm is a well-known entity, spasm provocation is not routinely done in the majority of hospitals at present.

Materials And Methods: One hundred and sixty two consecutive patients with thoracic pain and normal coronary arteries were retrospectively studied.

[Heart failure. Current pharmacologic treatment].

Treatment of heart failure (HF) has changed in recent years, despite the paucity of new approved drugs. Current treatment is directed not only towards improving symptoms, but also to preventing the development from asymptomatic systolic dysfunction to symptomatic heart failure, to preventing cardiac remodelling, renal dysfunction and to reducing mortality. The main families of drugs currently used are: cardiac glycosides, diuretics, angiotensin-converting enzyme inhibitors (ACEI), beta-blocking drugs (BB), angiotensin-II receptor blockers (ARB) and aldosterone receptor antagonists.

[Neurohormones and cytokines in heart failure. Correlation with coronary flow reserve].

Introduction And Objectives: In heart failure, the coronary flow reserve (CFR) measured by positron-emission tomography (PET) is reduced. As neurohormone and cytokine levels are also altered in patients with the condition, our aim was to determine whether there is a correlation between CFR and neurohormone and cytokine levels.

Patients And Method: The study included 40 patients with heart failure but without ischemic heart disease.

Prevalence of aspirin resistance measured by PFA-100.

Background: Aspirin protects from cardiovascular events. However, a number of patients who take this drug suffer events, probably due to aspirin resistance. Our objective was to determine the prevalence of aspirin resistance in patients taking this drug and to test if resistance is related to different variables.

[Impaired coronary flow reserve in patients with non-ischemic heart failure].

Introduction And Objectives: Coronary flow reserve (CFR) is impaired not only in ischemic heart disease, but also in cardiac diseases that may or may not course with heart failure. The aim of the present study was to determine if the severity of heart failure can influence CFR impairment.

Methods: Forty patients with non-ischemic heart disease and heart failure were studied 41 times.

Safety and feasibility of atropine added to submaximal exercise stress testing with Tl-201 SPECT for the diagnosis of myocardial ischemia.

Background: We aimed to assess whether atropine administration is safe and feasible in patients unable to reach the minimal heart rate (HR) required (80% of age-predicted HR) in myocardial scintigraphic studies after exercise stress testing (EST).

Methods And Results: We studied 108 patients who underwent myocardial perfusion scintigraphy after EST; 0.5 mg of atropine was administered to those showing signs of fatigue before reaching minimal HR (group A, n = 44).

Prognostic value of myocardial perfusion imaging with adenosine triphosphate.

Background: Pharmacologic stress with scintigraphy can predict prognosis in patients with coronary disease. Adenosine triphosphate (ATP) has been used in stress testing, but its efficacy in assessing prognosis has not been studied.

Methods And Results: A total of 150 patients (95 men, aged 64 +/- 10 years) were studied with thallium 201 during intravenous infusion of ATP and at rest.

[2002 Update of the Guidelines of the Spanish Society of Cardiology for Unstable Angina/Without ST-Segment Elevation Myocardial Infarction].

Since the Spanish Society of Cardiology Clinical Practice Guidelines on Unstable Angina/Non-Q-Wave Myocardial Infarction were released in 1999, the conclusions of several studies that have been published make it advisable to update current clinical recommendations. The main findings are related to the developing role of Chest Pain Units in the management and early risk stratification of acute coronary syndromes in the emergency department; new information concerning the efficacy of glycoprotein IIb/IIIa inhibitors, clopidogrel and low-molecular-weight heparins in the pharmacological treatment of acute coronary syndromes without ST-segment elevation; and the role of early invasive strategy in improving the prognosis of these patients. The published evidence is reviewed and the corresponding clinical recommendations for the management of acute coronary syndromes without persistent ST-segment elevation are updated.