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Introduction

Guidelines underline the importance of assessment of aortic flow waveform morphology to estimate aortic stenosis (AS) severity. Our aim was to evaluate acceleration time/ejection time ratio (AT/ET) as prognostic value in this disease.

Methods

Between January 2013 and July 2016, patients with severe AS (aortic valve area < 1 cm²) who came to our echocardiography laboratory were included. We analyzed in the aortic flow in continuos Doppler wave the time between the onset and the peak velocity (acceleration time), and total ejection time, and then acceleration time/ejection time ratio was calculated. The primary end-point was a combined one of cardiovascular death or aortic valve replacement.

Results

One hundred and ninety-seven patients with severe AS were included (55% women, mean age 76 ± 8 years). Complete follow-up was achieved in 190 patients (96%): during a mean follow-up of 223 ± 156 days, 110 patients (58%) reached the primary endpoint; 70 patients (37%) were surgically operated, 8 patients (4%) percutaneous replacement, 33 patients (17%) suffered from cardiovascular death. Patients with AT/ET higher than 0.35 had more cardiovascular events (66% vs. 41%, P = .008). There was a non-significant trend to lower free-events survival by Kaplan-Meier method in patients with AT/ET higher than 0.35 (284 ± 25 vs. 350 ± 32 days, P = .07). In multivariate analysis by Cox regression, only aortic valve area (P = .03), atrial fibrillation (P = .02), symptomatic status (P < .001) and AT/ET (P = .04) were independent predictors of combined end-point.

Conclusion

AT/ET ratio could help to identify patients with more severe AS. Higher values of AT/ET ratio were associated with higher incidence of aortic valve replacement and/or cardiovascular death.

We describe the case of a 72-year-old patient with an ICD in primary prevention due to ischemic dilated myocardiopathy with T-wave oversensing in relation to the development of right bundle branch block, which caused inappropriate therapies of the device, and subsequently inhibition of pacing due to the oversensing after the appearance of complete AV block. We highlight the importance of this situation and the knowledge of each of the programmability options or algorithms offered by each manufacturer to deal with this phenomenon.

Patients with heart failure still have a reduced life expectancy, poor quality of life and frequent hospital admissions, although specific care units, new drugs and devices have been developed in the last years. For that reason, novel strategies are needed to treat the growing population of heart failure patients. Better understanding of many of the basic molecular mechanisms involved in the heart failure disease has allowed the development of gene therapy models using different vectors, including viral vectors specifically directed to these molecular targets. In spite of the promising results from animal studies, the clinical translation by randomized clinical trials has been unsuccessful. This review briefly reviews the principles underlying gene transfer therapy and its application in the field of heart failure, as well as the recent trials carried out in patients with heart failure.

Introduction and objetives

The cell saver is an alternative to blood transfusions according to the existing evidence. However, there is no evidence to determine the time of reinfusion of red blood cells in line with transfusions. Our objective was to analyze the evidence on the effectiveness of the cell saver to reduce blood transfusions.

Methods

Randomized clinical trial with 91 patients in a non-exposed group (reinfusion of autologous blood with the cell saver was performed at the end of surgery) and 80 patients exposed group (reinfusion of autologous blood was performed continuously during surgery). Variables were collected at three moments (preoperative, intraoperative and postoperative).

Results

Both haemoglobin and haematocrit were lower in the unexposed group when compared to the exposed group, both during after surgery (p=.011 and.018, respectively), and blood transfusions were higher in the unexposed group both during, and after surgery (p=.001).

Conclusions

In order to reduce the transfusion rate of cardiac patients as much as possible, the optimal time to reinfuse autologous blood from the cell saver should be during the surgery, according to a continuous reinfusion protocol.

Introduction and objectives

Electrocardiogram plays a fundamental role in the differential diagnosis of chest pain. It is sometimes difficult to differentiate these 2 entities: acute pericarditis and early repolarization. The aim of this study was to establish electrocardiographic characteristic to allow their differentiation.

Method

We included retrospectively a sample of patients who were hospitalized due to a non ischemic chest pain who showed ST segment elevation on the electrocardiogram between January 2010-December 2015. The patients were classified according to the electrocardiographic evolution and presence/absence of other pericarditis criteria in 2 groups: acute pericarditis and chest pain with a pattern of early repolarization.

Results

The study included 93 patients (76 patients with acute pericarditis and 17 patients with early repolarization) and they had a mean age of 35 ± 15 years, whom 80% were male. The patients with acute pericarditis showed higher ST segment elevation and a bigger ST/T ratio in V5 and V6, being the result statistically significant (P < .001). ST/T ratio in V5 with a cut-off point of 0.19 appears to be the most discriminative parameter in a significant way.

Conclusions

ST segment elevation and fundamentally ST/T ratio in V5 and V6 are useful for the differential diagnostic between acute pericarditis and early repolarization.

We present the case of a 29-year-old pregnant woman that consults in the emergency department because of a stabbing chest pain episode with the diagnosis of type A aortic dissection and with a successful final result for the mother and the newborn due to the multidisciplinary approach finished. Subsequent follow-up was performed in our specialized clinics, being diagnosed the patient of Marfan syndrome. We want to highlight the need and importance of multidisciplinary management of patients with this syndrome, both in diagnosis and in treatment and follow-up.

Introduction

Mitral regurgitation is the second most common cause of valvular heart disease, and even though it involves so bad prognosis, almost a half of patients are rejected from surgical treatment. For this cohort of patients, it has treated with MitraClip^® with promising outcomes in both functional and degenerative etiology of mitral regurgitation.

Material and methods

Retrosprective observational study about features and outcomes of 72 patients underwent MitraClip^® implantation from November 2011 to October 2016.

Results

Mitral regurgitation etiology was functional (61.1%), degenerative (26.4%) or mixed (12.5%). The functional etiology was associated with lower age (67.9 ± 8.74 vs 74.6 ± 13.06 years old, P = .21) and lower left ventricular ejection fraction (34 ± 8.5% vs 57 ± 15%; P < .001). The median EuroSCORE-II was 3.84 (Q1-Q3 quartile: 2.21-8.10). There was no differences about the number of clips used (1.55 ± 0.68 functional and 1.64 ± 0.55 degenerative, P = .53) or the number of days in hospitalary admission after intervention (3.36 functional vs 3.7 degenerative; p = .56). Regurgitation reduction was partial (more than grade 2) in 4.5% of functional etiology and 14.3% of degenerative etiology (P = .145). No cases of in-hospital mortality or during the first month after discharge were reported. During an average follow up of 24 months it was reported 9 deaths (20.45%) in functional etiology and 2 deaths (7.14%) in degenerative/mixed etiology (P = .13).

Conclusion

MitraClip® treatment is safe and effective in patients with both functional and degenerative etiology of mitral regugitation, even though the last one seems to be associated with a lower late mortality rate.