Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction

Little information is currently available from the various societies of cardiology on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Since primary PCI is the main method of reperfusion in AMI in many centres, and since of all cardiac emergencies AMI represents the most urgent situation for PCI, recommendations based on scientific evidence and expert experience would be useful for centres practising primary PCI, or those looking to establish a primary PCI programme. To this aim, a task force for primary PCI in AMI was formed to develop a set of recommendations to complement and assist clinical judgment. This paper represents the product of their recommendations.

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 912 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. PassingBablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis

Association of early repolarization with risk of cardiac mortality in the general population

Early repolarization, which is characterized by an elevation of the J-point on 12-lead electrocardiography, is a common finding that has been considered as benign for decades. However, in the last years, it has been related with vulnerability to idiopathic ventricular fibrillation and with cardiac mortality in the general population. Recently, 4 potential ECG predictors that could differentiate the benign from the malignant form of early repolarization have been suggested. Any previous study about early repolarization has been done in Spain. Aim. To ascertain whether the presence of early repolarization pattern in a resting electrocardiogram is associated with a major risk of cardiac death in a Spanish general population and to determine whether the presence of potential predictors of malignancy in a resting electrocardiogram increases the risk of cardiac mortality in patients with early repolarization pattern. Methods. We will analyse the presence of early repolarization and the occurrence of cardiac mortality in a retrospective cohort study of 4,279 participants aged 25 to 74 years in the province of Girona. This cohort has been followed during a mean of 9.8 years. Early repolarization will be stratified according to the degree of J-point elevation (≥0.1 mV or ≥0.2 mV), the morphology of the J-wave (slurring, notching or any of these two), the ST-segment pattern (ascending or descending) and the localization (inferior leads, lateral leads, or both). Association of early repolarization with cardiac death will be assessed by adjusted Cox-proportional hazards models

Microwave spectrometry for the Evaluation of the structural integrity of metallic stents

Purpose: To assess the feasibility of a method based on microwave spectrometry to detect structural distortions of metallic stents in open air conditions and envisage the prospects of this approach toward possible medical applicability for the evaluation of implanted stents. Methods: Microwave absorbance spectra between 2.0 and 18.0 GHz were acquired in open air for the characterization of a set of commercial stents using a specifically design setup. Rotating each sample over 360º, 2D absorbance diagrams were generated as a function of frequency and rotation angle. To check our approach for detecting changes in stent length (fracture) and diameter (recoil), two specific tests were performed in open air. Finally, with a few adjustments, this same system provides 2D absorbance diagrams of stents immersed in a water-based phantom, this time over a bandwidth ranging from 0.2 to 1.8 GHz. Results: The authors show that metallic stents exhibit characteristic resonant frequencies in their microwave absorbance spectra in open air which depend on their length and, as a result, may reflect the occurrence of structural distortions. These resonances can be understood considering that such devices behave like dipole antennas in terms of microwave scattering. From fracture tests, the authors infer that microwave spectrometry provides signs of presence of Type I to Type IV stent fractures and allows in particular a quantitative evaluation of Type III and Type IV fractures. Recoil tests show that microwave spectrometry seems able to provide some quantitative assessment of diametrical shrinkage, but only if it involves longitudinal shortening. Finally, the authors observe that the resonant frequencies of stents placed inside the phantom shift down with respect to the corresponding open air frequencies, as it should be expected considering the increase of dielectric permittivity from air to water. Conclusions: The evaluation of stent resonant frequencies provided by microwave spectrometry allows detection and some quantitative assessment of stent fracture and recoil in open air conditions. Resonances of stents immersed in water can be also detected and their characteristic frequencies are in good agreement with theoretical estimates. Although these are promising results, further verifica tion in a more relevant phantom is required in order to foresee the real potential of this approach.

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 9-12 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. Passing-Bablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis

Microwave spectrometry for the Evaluation of the structural integrity of metallic stents

Purpose: To assess the feasibility of a method based on microwave spectrometry to detect structural distortions of metallic stents in open air conditions and envisage the prospects of this approach toward possible medical applicability for the evaluation of implanted stents. Methods: Microwave absorbance spectra between 2.0 and 18.0 GHz were acquired in open air for the characterization of a set of commercial stents using a specifically design setup. Rotating each sample over 360º, 2D absorbance diagrams were generated as a function of frequency and rotation angle. To check our approach for detecting changes in stent length (fracture) and diameter (recoil), two specific tests were performed in open air. Finally, with a few adjustments, this same system provides 2D absorbance diagrams of stents immersed in a water-based phantom, this time over a bandwidth ranging from 0.2 to 1.8 GHz. Results: The authors show that metallic stents exhibit characteristic resonant frequencies in their microwave absorbance spectra in open air which depend on their length and, as a result, may reflect the occurrence of structural distortions. These resonances can be understood considering that such devices behave like dipole antennas in terms of microwave scattering. From fracture tests, the authors infer that microwave spectrometry provides signs of presence of Type I to Type IV stent fractures and allows in particular a quantitative evaluation of Type III and Type IV fractures. Recoil tests show that microwave spectrometry seems able to provide some quantitative assessment of diametrical shrinkage, but only if it involves longitudinal shortening. Finally, the authors observe that the resonant frequencies of stents placed inside the phantom shift down with respect to the corresponding open air frequencies, as it should be expected considering the increase of dielectric permittivity from air to water. Conclusions: The evaluation of stent resonant frequencies provided by microwave spectrometry allows detection and some quantitative assessment of stent fracture and recoil in open air conditions. Resonances of stents immersed in water can be also detected and their characteristic frequencies are in good agreement with theoretical estimates. Although these are promising results, further verifica tion in a more relevant phantom is required in order to foresee the real potential of this approach.

Orofacial pain of cardiac origin, serial of clinical cases

Objective: To determine the clinical characteristics of the orofacial pain of cardiac origin in patients visited when doing a treadmill exercise test, at the cardiology service of the Can Ruti Hospital in Badalona (Barcelona, Spain). Study design: The sample of that study included thirty patients visiteding when doing a treadmill exercise test, at the cardiology service. The questionnaire has been asked to a sample of 30 patients. Results: Eleven of the 30 patients included in this study presented craniofacial pain before or during the cardiac seizure. The location of the pain was bilateral, non-irradiated at the mandible in all cases. The intensity of the pain was from slight to severe. The frequency of the appearance of the pain was paroxysmal in 8 cases and constant in three cases, and the duration was from a few hours to a maximum of 14 days. Discussion: The cardiac pain in craniofacial structures is usually bilateral, compared to odontogenic pain which is always unilateral. The pain of cardiac origin is considered atypical because of its location, but about the 10 % of the cases, the cardiac ischemia has its primary manifestation in orofacial structures. Conclusions: Eleven patients referred a bilateral non-irradiated mandibular pain, with intensity from slight to severe, and with a paroxystic frequency in eight cases and a constant frequency in three cases. Just one patient referred pain during the treadmill exercise test. In all cases the pain disappeared after the cardiac surgery or the administration of vasodilators.

Association of early repolarization with risk of cardiac mortality in the general population

Early repolarization, which is characterized by an elevation of the J-point on 12-lead electrocardiography, is a common finding that has been considered as benign for decades. However, in the last years, it has been related with vulnerability to idiopathic ventricular fibrillation and with cardiac mortality in the general population. Recently, 4 potential ECG predictors that could differentiate the benign from the malignant form of early repolarization have been suggested. Any previous study about early repolarization has been done in Spain. Aim. To ascertain whether the presence of early repolarization pattern in a resting electrocardiogram is associated with a major risk of cardiac death in a Spanish general population and to determine whether the presence of potential predictors of malignancy in a resting electrocardiogram increases the risk of cardiac mortality in patients with early repolarization pattern. Methods. We will analyse the presence of early repolarization and the occurrence of cardiac mortality in a retrospective cohort study of 4,279 participants aged 25 to 74 years in the province of Girona. This cohort has been followed during a mean of 9.8 years. Early repolarization will be stratified according to the degree of J-point elevation (≥0.1 mV or ≥0.2 mV), the morphology of the J-wave (slurring, notching or any of these two), the ST-segment pattern (ascending or descending) and the localization (inferior leads, lateral leads, or both). Association of early repolarization with cardiac death will be assessed by adjusted Cox-proportional hazards models

Complicacions en la fase aguda del iamest derivades de la hiperglicèmia : revisió bibliogràfica

La hiperglicèmia elevada en la fase aguda de l’Infart Agut de Miocardi amb Elevació del segment ST, està estretament relacionada amb l’elevat risc de complicacions i mal pronòstic dels pacients, independentment que presentin Diabetis Mellitus prèviament coneguda. Hi ha evidències que en pacients que han rebut teràpia de reperfusió coronària, la hiperglicèmia major de 140mg/dL en el moment de l’ingrés està associada a esdeveniments tant perjudicials com és el desenvolupament d’una Diabetis Mellitus post Infart Agut de Miocardi. El control glicèmic a llarg termini s’associa a millores en els resultats cardiovasculars. L’objectiu d’aquesta revisió ésdeterminar la influència de la hiperglicèmia en les complicacions d’un malaltamb Infart Agut de Miocardi

Història natural dels pacients amb arteriopatia perifèrica

Introducció: Estudiar la història natural de la malaltia arterial perifèrica. Pacients i mètode: Registre observacional, multicèntric, prospectiu de pacients amb malaltia arterial perifèrica (FRENA) Resultats: Es registren 1205 pacients, 604 grau IIa de Fontaine; 336 grau IIb; 121 grau III i 144 grau IV. Durant el seguiment, 172 desenvolupen episodis isquèmics i 83 moren. En l’anàlisi multivariant pacients amb altres patologies, estadis III-IV, PAS&130mmHg i anticoagulats tenen risc de mort augmentat. Conclusions: Quan avança la malaltia augmenten episodis isquèmics i mortalitat. En l’estadi IIa, la incidència d’isquèmia crítica és com la d’infart de miocardi o d’ictus. Els pacients amb PAS &130mmHg tenen 3 vegades més risc de morir.

Trastorns respiratoris del son i infart cerebral agut: Mecanismes patogènics, prevalença, evolució i rellevància pronòstica

Estudi prospectiu en 41 pacients amb ictus agut mitjançant poligrafia respiratòria i repetició als 3 mesos (29) per avaluar el paper de la SAHS en l’ictus agut i la relació amb les CPEs. En fase estable va disminuir significativament l’IAH total i la prevalença de SAHS greu, sense relació amb el pronòstic. L’estudi de la SAHS en l’ictus agut pot sobreestimar la prevalença de SAHS greu, dada rellevant front la decisió d’iniciar tractament amb CPAP. Les CPEs mostren un pic als 7 dies post-ictus i els pacients SAHS presenten uns valors basals menors, possible reflex de la seva disfunció endotelial.

Determinació de diferents compostos bioactius en ingredients naturals per a l'elaboració de bombons funcionals amb beneficis cardiovasculars

Durant les darreres dècades, i degut, principalment, a un canvi en els hàbits alimentaris, hi ha hagut un augment a nivell mundial de malalties cròniques (l’obesitat, malalties cardiovasculars, etc.). En els països mediterranis hi ha menys incidència d’aquestes malalties i sembla ser que això es deu a l’anomenada dieta mediterrània. La dieta mediterrània es caracteritza per una combinació d’oli d’oliva com a grassa principal, verdures, hortalisses i fruites en abundància, lleguminoses, fruits secs, formatges i iogurt, peix, pa, pasta, cereals i els seus derivats i un consum moderat de vi i carns. Aquest model alimentari, ric en tocoferols, fitosterols i fitoestanols que ajuden a reduir el contingut de colesterol en sang, fa que en les poblacions mediterrànies hi hagi menys incidència de malalties cardiovasculars. Aquests compostos inhibeixen el deteriorament oxidatiu dels olis, actuen com agent antipolimerització per olis de fregir. Tenen capacitat de reduir els nivells de colesterol, evitant la incidència de malalties cardiovasculars. Els fitoesterols y fitoestanols es poden trobar en forma lliure o esterificada amb àcids grassos, àcids fenòlics i glucosa. Els objectius d’ aquest treball han estat, primer en el desenvolupament de mètodes d'anàlisi ràpids, fiables i robusts dels tocoferols, fitoesterols i fitoestanols i la seva aplicació en fruits sec, oli de segó, oli de pinyol de raïm i productes que els continguin. El primer mètode va estar basat en la cromatografía líquida (HPLC-DAD) amb extracció en fase sòlida (SPE) com tècnica alternativa a la saponificació para la determinació de fitoesterols lliures. Aquest mètode va estar aplicada a mostres de bombons que contenia fitoesterols. El segon mètode va estar basat en la cromatografia de gasos (GCFID) amb aponificació i SPE per quantificar fitoesterols i fitoestanols lliures, esterificats i totals. En els documents annexos es descriuen a profunditat els mètodes desenvolupats.

Influencia de la altura, la distancia de los tubos a la calle, la anchura de la calle, el tráfico y la densidad de vehículos sobre la concentración de NO2

Durante las primeras décadas del s. XX se contempló un importante aumento de las enfermedades coronarias, este hecho estimuló la investigación sobre las causas de dichas enfermedades. En 1978, y para investigar este fenómeno se inició el estudio REGICOR en el Hospital Josep Trueta de Girona. En el s. XX también se contempló un creciente problema de contaminación de las atmósferas urbanas, esto hizo que diferentes científicos estudiaran las relaciones entre las enfermedades coronarias y la contaminación atmosférica en áreas urbanas (Godish, 1997; Krupa & Legge, 2000; Brook et al., 2004 y Krewski et al., 2004). El proyecto realizado está situado en el contexto del primer estudio realizado en España que investiga los efectos sobre la salud de la contaminación atmosférica (REGICOR 2000-AIR). En el proyecto se pretende investigar la influencia de diferentes factores (distancia de los tubos a la calle, altura de los tubos, anchura de la calle, tráfico y densidad de tráfico) sobre la contaminación atmosférica de las ciudades de Girona y Salt, con el fin de poder caracterizar lo mejor posible la exposición a contaminación atmosférica. Para este fin se utilizará el NO2 como marcador de contaminación atmosférica y se seleccionaran varios puntos de muestreo en las dos ciudades dónde se pondrán captadores de NO2 para la medición de dicha contaminación. Después, y mediante un análisis estadístico, se podrá determinar la influencia de los factores en la variación de concentración de NO2 en el área seleccionada.

Risc cardiovascular dels fitoesterols

Els fitoesterols són components importants de la dieta Mediterrània. La seva ingesta augmenta les concentracions en sang i les concentracions elevades s’han relacionat amb un augment de risc cardiovascular. Però el síndrome metabòlic (SMet) s’associa a concentracions baixes de fitoesterols. S’ha investigat la relació entre fitoesterols del plasma i la dieta amb la presència de factors de risc cardiovascular, incloent el SMet, i malaltia cardiovascular. També s’han avaluat factors socioeconòmics que influencien els hàbits dietètics. Per dur-ho a terme s’ha realitzat un anàlisi retrospectiu en l’estudi Prevención con Dieta Mediterránea (PREDIMED) amb dades basals i a l’any d’una intervenció dietètica per avaluar la influència dels fitosterols de la dieta en el perfil lipídic dels participants. En l’estudi European Prospective Investigation into Cancer and Nutrition (EPIC) d’Espanya s’ha realitzat una anàlisi transversal per analitzar factors socials i dieta, i un estudi cas-control per avaluar el risc de desenvolupar malaltia cardiovascular segons les concentracions plasmàtiques de fitoesterols. Resultats: el consum de fitoesterols amb la dieta habitual s’ha relacionat amb la ingesta d’aliments saludables, amb una millora del perfil lipídic en els participants del PREDIMED i amb un increment dels fitoesterols plasmàtics. Aquest increment es va associar en l’estudi EPIC amb una millora dels factors de risc cardiovascular, una disminució del risc de patir malaltia cardiovascular o qualsevol component del SMet o el propi síndrome. Fa 10 anys la població espanyola seguia un patró de dieta mediterrània i era accessible a tothom independentment de la posició socioeconòmica. Conclusions. Les concentracions de fitoesterols plasmàtics semblen ser marcadors fiables d’un risc cardiometabòlic menor i un menor risc de patir malaltia cardiovascular. Ja que aquests elements són abundants en els aliments que característicament es consumeixen a Espanya, és necessari evitar que siguin difícils d’aconseguir per un encariment en el mercat i es generin desigualtats en salut a causa de l’alimentació.