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valorar la seguridad y la eficacia del implante de células madre mononucleadas autólogas (CMMA) combinado con cirugía de revascularización coronaria en pacientes que han tenido un infarto agudo de miocardio. Material y métodos: ensayo clínico prospectivo, aleatorizado, controlado, en el que se incluirán 20 pacientes. Se han aleatorizado 14 pacientes con infarto agudo de miocardio e indicación de cirugía a tratamiento de revascularización quirúrgica e implante de CMMA en la zona periinfar-to frente a cirugía aislada. Las CMMA se obtuvieron con punción de la médula ósea y centrifugación de Ficoll. Se realizó una resonancia magnética antes y 9 meses después de la cirugía. Se recogieron 80 variables en ambos grupos. Resultados: doce pacientes han finalizado el estudio. Ambos grupos fueron homogéneos en las características basales. No hubo complicaciones relacionadas con el implante celular. Los resultados se muestran en la tabla 1. Se han analizado los 39 segmentos infartados. No se obser-varon diferencias estadísticamente significativas en la mejoría del índice de motilidad global ni de la fracción de eyección, pero sí en la contractilidad regional (grupo Ce: 0,65 ± 0,26 vs grupo Co: 0,25 ± 0,29; p < 0,001). Conclusiones: el trasplante de CMMA puede llevarse a cabo de forma segura. La mejoría en la contractilidad de los segmentos infartados es significativamente mayor con el implante de células madre.

En este artículo se analiza el comportamiento de los grupos de generación eléctrica que toman decisiones sobre inversión y producción en un escenario de mercado liberalizado introduciendo contratos de largo plazo, en un contexto donde hay alto nivel de concentración de mercado. Para ello, se emplea un modelo determinístico dinámico de competencia imperfecta (con estrategias open loop) que se resuelve utilizando un sistema de ecuaciones complementarias mediante el software GAMS, a fin de proveer simulaciones que muestren los impactos de las diferentes estructuras de mercado (monopolio, oligopolio con franja competitiva, oligopolio (Cournot) y competencia perfecta) sobre las decisiones de inversión y producción, asumiendo la existencia de dos bloques horarios (base y pico) y considerando la existencia de dos tecnologías a utilizarse para el despacho eléctrico (hidráulica y térmica) con datos del año base 2011 para un horizonte temporal de 10 años. Los resultados muestran que a pesar de que en los diferentes escenarios de análisis puedan existir indicios de poder de mercado, existe un efecto positivo importante sobre la inversión en capacidad, la producción por tecnología, y precios por bloque de horario. || We analyze the behavior of electricity generation groups that make investment and production decisions in a liberalized market scenario by introducing long-term contracts, in a context where there is a high level of market concentration. In this way, a dynamic deterministic model of imperfect competition (with open loop strategies) is used, which is solved using a system of complementary equations through GAMS software, in order to provide simulations that show the impacts of the different market structures (monopoly, oligopoly with competitive fringe, oligopoly (Cournot) and perfect competition) on the decisions of investment and production, assuming the existence of two segment loads (base and peak) and considering the existence of two technologies to be used for the electric power dispatch (hydraulic and thermal) with 2011 data for 10-year planning horizon. The results show us that although there may be indications of market power in the different analysis scenarios, there is a significant positive effect on investment in capacity, production by technology, and prices per segment loads.

Introduction and Objectives: The aims of this study were to determine the dose-response association of carotid arterial stiffness with vascular outcomes and overall mortality, and to assess their added predictive capacity., Methods: Population-based cohort study including 6468 individuals, with a median follow-up of 6.5 years. Six carotid artery stiffness indices were assessed: strain, stiffness, Peterson elasticity coefficient, compliance coefficient, distensibility coefficient, and pulse wave velocity (PWV). Incident coronary, cerebrovascular, global vascular, and total fatal events were identified., Results: Carotid compliance and distensibility coefficients were not associated with any of the outcomes. Carotid stiffness, Peterson elasticity coefficient, and PWV showed a direct linear relationship to cerebrovascular disease: the risk increased by 8% (95%CI, 1-16) per stiffness unit increase, by 7% (95%CI, 2-13) per 10-unit Peterson elasticity coefficient increase, and by 26% (95%CI, 8-48) per PWV unit increase. Carotid strain showed a nonlinear association with ischemic heart disease. When strain was ≤ 0.09 units, each 0.01-unit increase was associated with a 15% lower risk of coronary events (95%CI,-33 to 6); above 0.09 units, each 0.01 increase in strain was associated with a 16% higher risk of coronary events (95%CI, 6-27). The addition of the stiffness indices did not improve the predictive capacity of validated risk functions., Conclusions: Carotid stiffness, Peterson elasticity coefficient, and PWV have a direct linear association with cerebrovascular disease risk. Carotid strain is not linearly related to U-shaped ischemic heart disease risk. The inclusion of these indexes does not improve the predictive capacity of risk functions., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Aortic self-expandable (SE) transcatheter aortic valve implantation (TAVI) devices are particularly useful for patients with aortic stenosis and small/tortuous vessels, small aortic annuli, or low coronary ostia. However, it is unclear whether the growing range of SE devices shows comparable hemodynamic and clinical outcomes. We aimed to determine the differential hemodynamic (residual valve area and regurgitation) and clinical outcomes of these devices in comparable scenarios., Methods: All patients were enrolled from 4 institutions and were managed with 4 different SE TAVI devices. Baseline and follow-up clinical data were collected and echocardiographic tests blindly and centrally analyzed. Patients were compared according to valve type and a 1:1 matched comparison was performed according to degree of calcification, aortic annulus dimensions, left ventricular ejection fraction, and body surface area., Results: In total, 514 patients were included (Evolut R/PRO, 217; ACURATE neo, 107; ALLEGRA, 102; Portico, 88). Surgical risk scores were comparable in the unmatched population. No differences were observed in the post-TAVI regurgitation rate and in in-hospital mortality (2.7%). The rate of pacemaker implantation at discharge was significantly different among devices (P=.049), with Portico showing the highest rate (23%) and ACURATE neo the lowest (9.5%); Evolut R/PRO and ALLEGRA had rates of 15.9% and 21.2%, respectively. The adjusted comparison showed worse residual TAVI gradients and aortic valve area with ACURATE neo vs ALLEGRA (P=.001) but the latter had higher risk of valve embolization and a tendency for more cerebrovascular events., Conclusions: A matched comparison of 4 SE TAVI devices showed no differences regarding residual aortic regurgitation and in-hospital mortality., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis., Methods: Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed., Results: The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10mmHg; P<.001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6mmHg; P<.001), and Doppler velocity index (EVR 0.65±0.15 vs S3 0.51±0.16; P<.001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P <.05, respectively), with a larger number of paravalvular jets (P <.001)., Conclusions: In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Bioresorbable vascular scaffolds (BVS) have the potential to restore vasomotion but the clinical implications are unknown. We sought to evaluate angina and ischemia in the long-term in patients treated with BVS and metallic drug-eluting stents (mDES)., Methods: Multicenter study including patients with 24 ± 6 months of uneventful follow-up, in which stress echocardiography was performed and functional status was assessed by the Seattle Angina Questionnaire (SAQ). The primary endpoint was a positive result in stress echocardiography., Results: The study included 102 patients treated with BVS and 106 with mDES. There were no differences in the patients' baseline characteristics. Recurrent angina was found in 18 patients (17.6%) in the BVS group vs 25 (23.5%) in the mDES group (P = .37), but SAQ results were significantly better in the BVS group (angina frequency 96.0 ± 8.0 vs 89.2 ± 29.7; P = .02). Stress echocardiography was positive in 11/92 (11.9%) of BVS patients vs 9/96 (9.4%) of mDES patients in the (P = .71) and angina was induced in 2/102 (1.9%) vs 7/106 (6.6%) (P = .18), respectively, but exercise performance was better in the BVS group even in those with positive tests (exercise duration 9.0 ± 2.0minutes vs 7.7 ± 1.8minutes; P = .02). A propensity score matching analysis yielded similar results., Conclusions: The primary endpoint was similar in both groups. In addition, recurrent angina was similar in patients with BVS and mDES. The better functional status, assessed by means of SAQ and exercise performance, detected in patients receiving BVS should be confirmed in further studies., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Controversy surrounds the long-term effects of intracoronary bone marrow stem cell transplantation after ST-elevation acute myocardial infarction (STEAMI). We report on the long-term changes in left ventricular function observed in 29 patients with STEAMI who were treated using this technique. Cardiac magnetic resonance imaging was performed at baseline, 6 months after transplantation, and long-term follow-up (median 27 months, interquartile range 24-35 months). The left ventricular ejection fraction had improved significantly by 6 months (from 47.6 ± 8.9% to 52.7 ± 11.6%; P = .001) and this improvement was maintained long-term, at 52.4 ± 11.8% (P = .01 vs. baseline and P = .999 vs. 6 months). There was no significant change from baseline in end-diastolic or end-systolic ventricular volume. Our findings indicate the improvement in injection fraction occurs soon after stem cell transplantation, within the first 6 months, and remains unchanged at long-term follow-up., (Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Echocardiographic evaluation of right ventricular systolic function remains subject to debate because of the anatomic peculiarities of the right ventricle. Several methods have been developed for quantifying right ventricular systolic function. The aim of this study was to determine the reliability and reproducibility of a number of echocardiographic parameters by evaluating their inter-observer and intra-observer variability., Methods: The study included 30 patients with isolated mitral valvulopathy scheduled for heart surgery. All underwent echocardiography, which was performed independently by two echocardiographers within 24 hours. The intra-observer analysis was carried out using the recorded images at least 1 month after they had been obtained. The parameters studied were the tricuspid annular plane systolic excursion (TAPSE), the tricuspid annular peak systolic velocity on tissue Doppler imaging, right ventricular outflow tract fractional shortening, fractional shortening of right ventricular diameters, and fractional shortening of right ventricular areas. Variability was analyzed using the intraclass correlation coefficient., Results: The degree of concordance on TAPSE and tricuspid annular peak systolic velocity measurement was good in the inter-observer analysis and excellent in the intra-observer analysis. However, concordance was poor on measurements of the fractional shortening of the right ventricular outflow tract, areas and diameters on both inter-observer and intra-observer analyses., Conclusions: The most reliable and reproducible echocardiographic parameters for evaluating right ventricular systolic function in patients with isolated mitral valvulopathy were the TAPSE and the tricuspid annular peak systolic velocity.

The usefulness the left ventricular ejection fraction as a surrogate endpoint in clinical trials has been confirmed by numerous studies. However, if this approach is to be applied successfully, images must be acquired in a rigorously controlled manner, and it is advisable to use measurement units that have been specifically developed for quantitative analysis of the imaging parameters obtained with current imaging techniques. This review summarizes what is now known about the left ventricular ejection fraction and left ventricular volumes, discusses the importance of measurement units in image analysis, and describes the different imaging techniques available. Finally, there is a discussion of how to select the best imaging technique for specific clinical applications.

Optical coherence tomography is a new intracoronary diagnostic technique that has a higher resolution than other techniques, such as intravascular ultrasound. We used optical coherence tomography to study outcomes after stent implantation in six patients who had undergone percutaneous coronary intervention, and in whom angiography showed normal results after revascularization. Material was observed to protrude through the stent struts in all patients, small dissections were seen at the stent edges in four patients, and there was incomplete stent apposition in four patients. In two patients, small amounts of thrombus were observed to form around the tomography catheter. With optical coherence tomography, it was possible to detect areas in which the results of percutaneous coronary intervention were suboptimal, despite a satisfactory appearance on angiography.

Introduction and Objectives: Late contrast-enhanced cardiac magnetic resonance (CMR) enables areas of persistent microvascular obstruction (PMO) to be detected early after acute myocardial infarction. Our aim was to evaluate the impact of PMO on subsequent ventricular remodeling in a cohort of patients with acute ST-elevation myocardial infarction (STEMI) who underwent intracoronary autologous bone-marrow mononuclear cell (ABMMC) transplantation., Methods: In total, 14 patients underwent intracoronary transplantation of 66+/-39 x 10(6) ABMMCs 8+/-2 days following successful revascularization of a STEMI (i.e., TIMI flow grade 3 in the affected artery). Serial CMR studies with gadolinium-DTPA enhancement were performed at baseline and 10 months after infarction. Left ventricular volume and ejection fraction, regional contractility and the infarct size were measured and the presence of PMO (defined as hypoenhanced areas within the infarcted zone) was investigated., Results: Overall, PMO was detected in five of the 14 patients (36%). Those with PMO tended to have a larger infarct size, larger ventricular volumes, and poorer regional and global left ventricular systolic function in baseline studies than those without PMO. At follow-up, there were significant associations between PMO and an increase in end-diastolic volume (25+/-24 mL vs. -2+/-19 mL; P=.037), the absence of an increase in end-diastolic parietal thickness (P=.027), and a smaller reduction in the number of akinetic or dyskinetic segments., Conclusions: The detection of PMO by CMR early after successful revascularization of a STEMI in patients who underwent intracoronary ABMMC transplantation was associated with adverse left ventricular remodeling.