Prognostic stratification of patients with left-sided endocarditis determined at admission.

Background: The prognosis of patients with left-sided endocarditis remains poor despite the progress of surgical techniques. Identification of high-risk patients within the first days after admission to the hospital would permit a more aggressive therapeutic approach.

Methods: We designed a prospective multicenter study to find out the clinical, microbiologic, and echocardiographic characteristics available within 72 hours of admission that might define the profile of high-risk patients.

[Trends and contexts in European cardiology practice for the next 15 years. The Madrid Declaration: a report from the European Conference on the Future of Cardiology, Madrid, 2-3 June 2006].

In the near future, the practice of the cardiology in Europe will be strongly influenced by a complex interplay of epidemiological, social, economical, professional, and technological evolving factors. The present report summarizes the conclusions of an expert conference organized by the European Society of Cardiology to discuss the interactions between these phenomena, in an attempt to foresee the potential scenario in which cardiovascular healthcare and research will develop in the near future, and to anticipate solutions to the identified problems.

Trends and contexts in European cardiology practice for the next 15 years: the Madrid Declaration: a report from the European Conference on the Future of Cardiology, Madrid, 2-3 June 2006.

In the near future, the practice of cardiology in Europe will be strongly influenced by a complex interplay of epidemiological, social, economical, professional, and technological evolving factors. The present report summarizes the conclusions of an expert conference organized by the European Society of Cardiology to discuss the interactions between these phenomena, in an attempt to foresee the potential scenario in which cardiovascular healthcare and research will develop in the near future, and to anticipate solutions to the identified problems.

Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial.

Aims: In patients with acute myocardial infarction and ST-segment elevation (STEMI), primary angioplasty is frequently not available or performed beyond the recommended time limit. We designed a non-inferiority, randomized, controlled study to evaluate whether lytic-based early routine angioplasty represents a reasonable reperfusion option for victims of STEMI irrespective of geographic or logistical barriers.

Methods And Results: A total of 212 STEMI patients were randomized to full tenecteplase followed by stenting within 3-12 h of randomization (early routine post-fibrinolysis angioplasty; 104 patients), or to undergo primary stenting with abciximab within 3 h of randomization (primary angioplasty; 108 patients).

Launching a clinical program of stem cell therapy for cardiovascular repair.

Since the feasibility of stem cell therapy has been recognized, enthusiasm for this therapy has grown exponentially. Nevertheless, as professionals we must realize that this enthusiasm should relate not only to our scientific interest but also to the care of our patients. Within the next decade, patients' demand for the latest therapies is likely to rise because of changes in health care systems that will broaden availability.

Bone-marrow-derived cells for cardiac stem cell therapy: safe or still under scrutiny?

Cardiac stem cell therapy with bone-marrow-derived stem cells is a promising approach to facilitate myocardial regeneration after acute myocardial infarction or in congestive heart failure. The clinical data currently available seem to indicate that this approach is safe and is not associated with an increase in the number of adverse clinical events; nevertheless, the level of safety confidence is limited because of the small number of patients who have been treated and the absence of long-term clinical follow-up data. In order to establish the clinical safety of cardiac stem cell therapy, it will be necessary to collect additional data from both previous and ongoing clinical trials in subsets of patients relative to their background risk.

[Safety of early cardiac magnetic resonance imaging in acute myocardial infarction patients with stents].

Introduction And Objectives: In general, magnetic resonance imaging is contraindicated when the patient has a ferromagnetic prosthesis or implant. With coronary stents, there is a theoretical concern that use of magnetic resonance imaging shortly after implantation will dislodge the stent, thereby increasing the risk of thrombosis. However, the risk may be overestimated because modern coronary stents are not ferromagnetic or are only weakly so.

[Efficacy of sirolimus-eluting stent implantation in diabetic patients with very small vessels (< or = 2.25 mm). Insights from the DIABETES trial].

Introduction And Objectives: Diabetic patients frequently have small-diameter vessels, which increases their risk of restenosis. The aim of this study was to determine the efficacy of sirolimus-eluting stent implantation in these high-risk patients following percutaneous coronary intervention.

Methods: Our study population comprised a subset of 85 diabetic patients from the DIABETES (DIABETes and sirolimus Eluting Stent) trial who had very small vessels, defined as those with a reference diameter < or =2.

Effect of NOD2/CARD15 variants in T-cell depleted allogeneic stem cell transplantation.

Background And Objectives: Three single nucleotide polymorphisms (SNP) in the NOD2/CARD15 gene have been associated with the incidence and the severity of acute graft-versus-host disease (GVHD) following allogeneic stem cell transplantation (SCT). We hypothesized that the clinical effect of SNP in NOD2/CARD15 might be different in patients submitted to T-cell-depleted allogeneic SCT, in which donor T cells, the main effectors of GVHD, are eliminated.

Design And Methods: SNP 8, 12 and 13 in NOD2/CARD15 were studied using a Taqman protocol in 85 patients undergoing HLA-identical, T-cell-depleted SCT and in 71 of their sibling donors.

Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematologic malignancies.

Purpose: One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate.

Patients And Methods: Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy.

Mannan-binding lectin pathway deficiencies and invasive fungal infections following allogeneic stem cell transplantation.

Objective: The Mannan-binding lectin (MBL) pathway involves recognition of fungal surfaces by MBL and cleavage of C2 and C4 by MBL-associated serine protease (namely, MASP-2). Recent data show that MBL pathway deficiency might result not only from polymorphisms of the MBL2 gene but also of MASP2. The aim of the study was to assess whether polymorphisms of these genes are associated with invasive fungal infections (IFIs) following allogeneic stem cell transplantation (allo-SCT).

[Imbalance between the supply and demand for cardiologists in Spain. Analysis of the current situation, future prospects, and possible solutions].

Planning cardiology provision in Spain requires knowledge of the resources available and the demand, both now and in the future. In this report, we present the results of a study carried out by the Spanish Society of Cardiology on the availability of and demand for cardiologists in the country. The current situation is characterized by an imbalance of around 14% between the number of active cardiologists and the estimated number required.

Severe infections after unrelated donor allogeneic hematopoietic stem cell transplantation in adults: comparison of cord blood transplantation with peripheral blood and bone marrow transplantation.

We evaluated the occurrence of severe infections in 192 consecutive adult recipients of volunteer unrelated donor allogeneic hematopoietic stem cell transplants, with a detailed analysis of severe infections after receipt of cord blood transplants (CBTs; n = 48) or bone marrow transplants (BMTs)/peripheral blood stem cell transplants (PBSCTs; n = 144). At a 3-year median follow-up, CBT recipients had a higher risk of developing any severe infection (85% versus 69% in BMT/PBSCT recipients, P < .01).

Vascular effects of sirolimus-eluting versus bare-metal stents in diabetic patients: three-dimensional ultrasound results of the Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial.

Objectives: A predefined intravascular ultrasound (IVUS) substudy was performed to evaluate the vascular effects of sirolimus-eluting stent (SES) versus bare-metal stent (BMS).

Background: The Diabetes and Sirolimus-Eluting Stent (DIABETES) trial is a prospective, multicenter, randomized, controlled trial aimed at demonstrating the efficacy of the SES compared with BMS in diabetic patients.

Methods: Serial intravascular ultrasound analyses were performed in 140 lesions (SES = 75; BMS = 65) immediately after stent implantation and at nine-month follow-up.

[Kinetics of C-reactive protein release in different forms of acute coronary syndrome].

Introduction And Objectives: Better knowledge of C-reactive protein (CRP) kinetics could lead to improved clinical application of this biomarker.

Methods: We studied 110 patients: 42 had ST-elevation acute myocardial infarction (STEMI), 35 had non-ST-elevation acute myocardial infarction (NSTEMI), and 33 had unstable angina. Patients were admitted to our institution within 6 hours of symptom onset.

Clinical factors influencing T-cell receptor excision circle (TRECs) counts following allogeneic stem cell transplantation in adults.

To ascertain the clinical factors involved in T-cell reconstitution after allogeneic stem cell transplantation (SCT), we evaluated serial assessments of lymphocyte subsets by flow cytometry and TRECs levels by quantitative PCR in 83 adult patients. Patient age >25 years, unrelated donor, CMV infection and acute graft-versus-host disease (GVHD) adversely affected CD3(+) and CD8(+) T-cell recovery after SCT (p < 0.05).

G-CSF increases the number of peripheral blood dendritic cells CD16+ and modifies the expression of the costimulatory molecule CD86+.

Dendritic cells (DC) play a key role in initiating immune reactions after allogeneic stem cell transplantation. The two main peripheral blood DC populations are myeloid (DC1) and lymphoplasmacytoid (DC2). A new subset of myeloid DC, expressing CD16, has been identified.

The consensus of the task force of the European Society of Cardiology concerning the clinical investigation of the use of autologous adult stem cells for repair of the heart.

A task force has been established by the European Society of Cardiology to investigate the role of progenitor/stem cell therapy in the treatment of cardiovascular disease. This article is the consensus of this group, of what clinical studies are needed in this field, and the challenges to be addressed in the translation of progenitor/stem cell biology to repair of the heart.

The role of noninvasive imaging techniques in the assessment of stem cell therapy after acute myocardial infarction.

Stem cell therapy after acute myocardial infarction is a promising therapeutic strategy. Intermediate-sized clinical trials to answer many unanswered questions must be carefully designed and surrogate end points carefully chosen. Moreover, imaging techniques accurate enough to measure surrogate parameters and to make it possible to reduce sample size are needed.

Contemplating the bright future of stem cell therapy for cardiovascular disease.

Not long ago, it was assumed that mammalian hearts were so differentiated that regeneration of cardiac tissue was not possible, but now an increasing amount of information suggests that the intrinsic regenerative capacity of the heart can be encouraged by stimulating resident stem cells or transplanting extracardiac progenitor cells. In the future, cardiovascular stem cell therapy may be administered to all patients. Here, we review what has happened and look at where we are going.

Anti-D alloimmunization after D-mismatched allogeneic hematopoietic stem cell transplantation in patients with hematologic diseases.

Background: The de novo development of anti-D after D-mismatched allogeneic hematopoietic stem cell transplantation (AHSCT) is a possibility that must be considered. The transfusion of D- blood components after AHSCT has been recommended but anti-D alloimmunization in this setting has been studied little. Thus, the aim of this study was to analyze anti-D formation after D-mismatched AHSCT.

Appropriate invasive and conservative treatment strategies for patients with ST elevation myocardial infarction.

Purpose Of Review: The goal of treatment strategies for patients with ST elevation myocardial infarction is to reperfuse the occluded coronary artery, as rapidly and safely as possible. This review discusses evidence regarding the appropriate treatment strategy for patients with ST elevation myocardial infarction taking into consideration geographical and logistical barriers.

Recent Findings: Primary percutaneous coronary intervention is considered the gold standard of myocardial reperfusion.