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Energy storage systems are expected to play a fundamental part in the integration of increasing renewable energy sources into the electric system. They are already used in power plants for different purposes, such as absorbing the effect of intermittent energy sources or providing ancillary services. For this reason, it is imperative to research managing and sizing methods that make power plants with storage viable and profitable projects. In this paper, a managing method is presented, where particle swarm optimisation is used to reach maximum profits. This method is compared to expert systems, proving that the former achieves better results, while respecting similar rules. The paper further presents a sizing method which uses the previous one to make the power plant as profitable as possible. Finally, both methods are tested through simulations to show their potential.

A doubly three-phase fed synchronous reluctance machine (SynRM) is designed for electrical vehicle powertrain application. SynRM aims to deliver instant power and high power density, high torque at low speeds and high power at high speeds, wide speed range, high efficiency throughout its range of operation, ruggedness, high safety at a reasonable cost. Under these requirements, a 60 kW, 9000 rpm and 400 Nm SynRM has been designed. The main objective is to demonstrate the SynRM powertrain operation behaviour and determinate the operation points electrically and thermally. To reach the proposed SynRM goal, a new direct torque control algorithm based on output regulation subspace theory control is presented. The winding motor topology is galvanic isolated, so it is possible to operate with the six phases directly to the load and because of that, the combination with a back-to-back (B2B) converter becomes so profitable. To validate the system, two B2B full-converters and two motors (SynRM and induction machine) were used in a real test bench. Finally, a simulated and real efficiency map is obtained covering different drive cycles range. Some remarks about normal and failure mode of operation are presented.

A six-phase synchronous reluctance machine (SynRM) is designed for electrical vehicle (EV) powertrain applications. The SynRM in the charger mode is able to provide instantaneous power and high power density, high efficiency with two modes of charge, robust reliability, high safety and fault tolerance. The properties of the SynRM are 60 kW, 9000 rpm and 400 N m. The main objective of the SynRM powertrain used as a charger is proved electrically, thermically and to be fault tolerant using a specific test bench. The winding motor topology is galvanic isolated, making it possible to load directly from the single-phase and three-phase grid, enabling two ways of charging, which increases the reliability. For this reason, the back-to-back full-converter and the SynRM as a charger are used. The main goal is to prove the utility as a charger and the great efficiency derived from the SynRM plus inverter topology for electric cars. This SynRM + inverter topology offers redundancy for all load modes.

Resumen Introduccion y objetivos Comparar la estrategia de revascularizacion percutanea de lesiones graves en ramas coronarias secundarias (RS) (diametro ≥ 2 mm) de arterias epicardicas mayores frente al tratamiento conservador. Metodos Estudio de cohortes retrospectivo en el que se compara a pacientes con lesiones graves en RS de arterias epicardicas principales tratados con revascularizacion percutanea o con un tratamiento farmacologico a criterio del operador. Se analizo el porcentaje de eventos relacionados con la rama (muerte cardiovascular, infarto de miocardio atribuible a RS o necesidad de revascularizacion de la RS). Resultados Se analizaron 679 lesiones en RS (662 pacientes). Tras un seguimiento medio de 22,2 ± 10,5 meses, no hubo diferencias significativas entre ambos grupos de tratamiento en mortalidad de causa cardiovascular (el 1,7 frente al 0,4%; p = 0,14), infarto agudo de miocardio (IAM) no fatal (el 1,7 frente al 1,7%; p = 0,96) o necesidad de revascularizacion de la RS (el 4,1 frente al 5,4%; p = 0,45) ni en el porcentaje total de eventos (el 5,1 frente al 6,3%; p = 0,54). Las variables que mostraron asociacion con la ocurrencia de eventos en el analisis multivariable fueron la diabetes (sHR = 2,87; IC95%, 1,37-5,47; p = 0,004), IAM previo (sHR = 3,54; IC95%, 1,77-7,30; p Conclusiones En el seguimiento, el porcentaje de eventos relacionados con la RS fue bajo respecto al total de pacientes, sin diferencias significativas entre una y otra estrategia de tratamiento. Las variables que se asociaron con la ocurrencia de eventos en el analisis multivariable fueron la diabetes mellitus, el antecedente de IAM y la mayor longitud de la lesion.

Resumen Introduccion y objetivos La miocardiopatia arritmogenica del ventriculo derecho (MCAVD) es una cardiopatia hereditaria definida por la sustitucion progresiva de miocardio ventricular derecho por tejido fibroadiposo. Es causa frecuente de la muerte subita de jovenes atletas. El objetivo del presente estudio es conocer la incidencia de variantes desmosomicas patogenicas o probablemente patogenicas en pacientes con MCAVD definitiva de alto riesgo. Metodos El estudio de cohortes retrospectivo observacional incluyo a 36 pacientes diagnosticados de MCAVD definitiva de alto riesgo en nuestro hospital entre enero de 1998 y enero de 2015. El analisis genetico se realizo con next-generation sequencing. Resultados La mayoria eran varones (28 pacientes, 78%) con una media de edad al diagnostico de 45 ± 18 anos. Se detecto al menos 1 variante desmosomica patogenica o probablemente patogenica en 26 de los 35 casos indice (74%): 5 nonsense, 14 frameshift, 1 splice y 6 missense. En 15 pacientes (71%) se encontraron mutaciones nuevas. La presencia o la ausencia de mutaciones desmosomicas o la naturaleza de estas no se asociaron con caracteristicas electrocardiograficas, clinicas, arritmicas, anatomicas o pronosticas especificas. Conclusiones La incidencia de variantes desmosomicas patogenicas o probablemente patogenicas en MCAVD definitiva de alto riesgo fue muy alta, con mayoria de mutaciones que causan truncamiento. La presencia de mutaciones desmosomicas no se asocio con el pronostico.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

This paper focusses on a hybrid topology for a CHB, where some or the modules are equipped with energy storage systems. In addition to the well-known capabilities of the CHB as a STATCOM, the hybrid topology has new advantages as a grid stabilizer. However, the current ripple on the energy storage systems has negative effects which tends to result in expensive solutions. To overcome this inconvenient, a previously known balance strategy is modified to prevent the ripple without compromising the DC-Link balance. This new control method is demonstrated through simulations.

Aim: To evaluate the possible relationship between high levels of CA-125 and long-term prognosis in chronic heart failure patients after they undergo a cardiac transplantation (CT). Materials & methods: We retrospectively studied all patients who underwent a CT and had a previous determination of CA-125. Congestive patients and those whose survival was 35 U/ml). After CT, survival was significantly inferior in this group (96.3 vs 81%, 84.9 vs 64%, 70.7 vs 32.9% at 2, 5 and 8 years, p = 0.014). CA-125 >35 U/ml was the only factor independently associated to long-term mortality (OR: 3.94; 95% CI: 1.2–12.82; p = 0.023). Conclusion: Noncongestive patients with high levels of CA-125 had inferior long-term survival after CT.

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

Objectives Bicuspid aortic valve (BAV) is the most prevalent congenital cardiac malformation, frequently associated with aortic dilatation (AD). The molecular mechanisms involved in AD and its aetiological link with BAV formation are poorly understood. Altered fibrillin-1 (FBN1) and metalloprotease-2, -9 (MMP2,9) protein activities have been suggested to be involved in BAV aortopathy. In addition, FBN2 participates in embryonic valve formation, but its possible involvement in BAV-associated AD has never been explored. In this report, we evaluate the expression levels of MMP2,9 and FBN1,2 in the ascending aorta of patients with normal or dilated aortas and with tricuspid aortic valve (TAV) or BAV, using appropriate tissue-specific reference genes. Methods Gene expression was quantified by real-time quantitative polymerase chain reaction in 52 patients, using one or three reference genes previously validated in the same patient population. Results FBN2 expression was significantly increased in the aortas of patients with BAV compared with individuals with TAV (0.178 ± 0.042 vs 0.096 ± 0.021, P = 0.015), whereas differences in FBN1 did not reach statistical significance (1.946 ± 0.228 vs 1.430 ± 0.114, P = 0.090). When four groups of samples were considered, FBN2 expression was significantly higher in patients with BAV and AD compared with patients with TAV and AD (0.164 ± 0.035 vs 0.074 ± 0.027, P = 0.040). No significant differences were found when FBN1/FBN2 ratio, and MMP2 and MMP9 expression levels were analysed. No linear relationship between aortic diameter and gene expression levels were found. Conclusions BAV patients have an increased FBN (especially FBN2) gene expression level in the ascending aorta, irrespective of dilatation, whereas MMP expression does not change significantly. These results add a new piece of information to the pathophysiology of BAV disease and point to FBN2 as a new molecular player.

The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100&ndash, 140 mg/dL (standardized difference = 0.017) and &gt, 200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies.

Background Marfan syndrome (MFS) is a disorder of autosomal dominant inheritance, in which aortic root dilation is the main cause of morbidity and mortality. Fibrillin-1 (FBN-1) gene mutations are found in more than 90% of MFS cases. The aim of our study was to summarise variants in FBN-1 and establish the genotype-phenotype correlation, with particular interest in the onset of aortic events, in a broad population of patients with an initial clinical suspicion of MFS. Material and methods This single centre prospective cohort study included all patients presenting variants in the FBN-1 gene who visited a Hereditary Aortopathy clinic between September 2010 and October 2016. Results The study included 90 patients with FBN-1 variants corresponding to 58 non-interrelated families. Of the 57 FBN-1 variants found, 25 (43.9%) had previously been described, 23 of which had been identified as associated with MFS, while the the remainder are described for the first time. For 84 patients (93.3%), it was possible to give a definite diagnosis of Marfan syndrome in accordance with Ghent criteria. 44 of them had missense mutations, 6 of whom had suffered an aortic event (with either prophylactic surgery for aneurysm or dissection), whereas 20 of the 35 patients with truncating mutations had suffered an event (13.6% vs. 57.1%, p

BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve® (Medtronic, Minneapolis, MN, USA) prosthesis.MethodsA total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure.ResultsAKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53–41.9); p

Aims Hypertrophic cardiomyopathy is one of the main causes of sudden death in young people. Recent clinical practice guidelines include a risk prediction model for sudden death (HCM Risk-SCD), which facilitates the decision of whether to implant a defibrillator. The aim of our study was to ascertain the percentage of events in our series of primary prevention implantable cardioverter-defibrillator recipients with hypertrophic cardiomyopathy and whether HCM Risk-SCD predicts the onset of arrhythmic events. Methods and results This was an observational, retrospective cohort study, which included 48 primary prevention defibrillator recipient patients with HCM. We compiled their demographic and clinical characteristics, estimated 5-year risk using HCM Risk-SCD, and collected the documentation on arrhythmias during follow-up. The majority was male (66.7%) and mean age at implantation was 44.44 ± 14.46 years. Non-sustained ventricular tachycardia was the most prevalent risk factor (66.67%), followed by a family history of sudden death (47.92%). Mean HCM Risk-SCD was 6.15 ± 5.01%. HCM Risk-SCD was the only factor independently associated with the onset of ventricular tachyarrhythmia, above any other classic risk factor or association [odds ratio = 1.46 (95% confidence interval 1.051–2.013); P = 0.02]. None of the 11 patients estimated as low risk using HCM Risk-SCD suffered any appropriate events ( P < 0.05). Conclusions During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.

Aims We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P

This study analyzed the potential associations of 7 myocardial fibrosis-related microRNAs with the quality of the collagen network (e.g., the degree of collagen fibril cross-linking or CCL) and the enzyme lysyl oxidase (LOX) responsible for CCL in 28 patients with severe aortic stenosis (AS) of whom 46% had a diagnosis of chronic heart failure (HF). MicroRNA expression was analyzed in myocardial and blood samples. From the studied microRNAs only miR-19b presented a direct correlation (p in vitro studies miR-19b inhibition increased (p

IntroductionCardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial.Study designThe AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days.Ethics and disseminationThe institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings.Trial registration numberClinicalTrials.gov:NCT02798276, pre-results.

[Abstract] Epicardial adipose tissue has been proposed to participate in the pathogenesis of heart failure. The aim of our study was to assess the expression of thermogenic genes (Uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), and PR-domain-missing 16 (PRDM16) in epicardial adipose tissue in patients with heart failure, stablishing the difference according to left ventricular ejection fraction (reduced or preserved). Among the 75 patients in our study, 42.7% (n=32) had reduced left ventricular ejection fraction. UCP1, PGC1α and PRDM16 mRNA in EAT were significantly lower in patients with reduced left ventricular ejection fraction. Multiple regression analysis showed that age, male gender, body max index, presence of obesity, type-2-diabetes mellitus, hypertension and coronary artery disease and left ventricular ejection fraction were associated with the expression levels of UCP1, PGC1α and PRDM16 mRNA. Thermogenic genes expressions in epicardial adipose tissue (UCP1: OR 0.617, 95%CI 0.103-0.989, p=0.042; PGC1α: OR 0.416, 95%CI 0.171-0.912, p=0.031; PRDM16: OR 0.643, 95%CI 0.116-0.997, p=0.044) were showed as protective factors against the presence of heart failure with reduced left ventricular ejection fraction, and age (OR 1.643, 95%CI 1.001-3.143, p=0.026), presence of coronary artery disease (OR 6.743, 95%CI 1.932-15.301, p

ResumenIntroduccion y objetivos La mortalidad por endocarditis infecciosa izquierda continua siendo muy elevada. El objetivo de este estudio es valorar el impacto en la mortalidad precoz de la endocarditis infecciosa izquierda de una estrategia de alerta multidisciplinaria (AMULTEI, basada en la alerta clinica, ecocardiografica y microbiologica) iniciada en 2008 en un centro hospitalario de tercer nivel. Metodos Estudio de cohortes que compara nuestra serie historica (1996-2007) con la serie de pacientes de 2008-2011 diagnosticada de endocarditis izquierda (AMULTEI). Resultados La cohorte AMULTEI incluye a 72 pacientes, frente a los 155 de la cohorte historica. Los pacientes AMULTEI presentaron significativamente mas edad (62,5 frente a 57,9 anos en la cohorte historica; p = 0,047) y mas comorbilidad (indice de Charlson, 3,33 frente a 2,58 en la cohorte historica; p = 0,023). Se observo una tendencia a mas etiologia enterococica (el 20,8% del grupo AMULTEI frente al 11,6% de la cohorte historica; p = 0,067). Se realizo cirugia sin demora durante el ingreso hospitalario mas frecuentemente (el 48,6 frente al 23,2%; p

Resumen Introduccion y objetivos En nuestro medio hay pocos datos sobre los resultados del tratamiento quirurgico de la insuficiencia tricuspidea grave. Nuestro objetivo es analizar los resultados clinicos y ecocardiograficos de nuestra poblacion con insuficiencia tricuspidea grave sometida a cirugia comparandolos segun el tipo de reparacion o de sustitucion valvular. Metodos Realizamos un estudio retrospectivo incluyendo a 119 pacientes consecutivos con insuficiencia tricuspidea grave sometidos a cirugia de dicha valvula entre abril de 1996 y febrero de 2010. Resultados Se realizaron 61 anuloplastias sin anillo y 23 con anillo, y se implantaron 11 protesis biologicas y 24 mecanicas. La mortalidad perioperatoria fue del 18,5%, y se asociaron a ella la edad y el tiempo de circulacion extracorporea. Durante el seguimiento clinico (mediana, 41 [intervalo intercuartilico, 24-89] meses), el grupo anuloplastia con anillo preciso dos reoperaciones, al igual que el grupo de protesis mecanica, en el que se diagnostico trombosis protesica a 4 pacientes. La mortalidad total tras seguimiento fue del 29,9%, y se asociaron a ella la edad > 70 anos y el tiempo de circulacion extracorporea. La aparicion de nueva insuficiencia tricuspidea grave se asocio a la edad y la anuloplastia sin anillo (p = 0,04). Conclusiones La reparacion sin anillo se asocio significativamente con recurrencia de insuficiencia tricuspidea grave. El implante de protesis mecanica se asocio a una elevada tasa de trombosis en el seguimiento. No se encontraron diferencias significativas en la mortalidad perioperatoria o total segun el tipo de reparacion o sustitucion valvular.

Background Although recent studies indicate that epicardial adipose tissue expresses brown fat-like genes, such as PGC1α, UCP1 and PRDM16, the association of these genes with type 2 diabetes mellitus (DM2) in coronary artery disease (CAD) remains unknown. Methods PGC1α, UCP1, and PRDM16 mRNAs expression levels were measured by real-time PCR in epicardial and thoracic subcutaneous adipose tissue from 44 CAD patients (22 with DM2 [CAD-DM2] and 22 without DM2 [CAD-NDM2]) and 23 non-CAD patients (NCAD). Results The CAD-DM2 patients had significantly lower PGC1α and UCP1 expression in epicardial adipose tissue than the CAD-NDM2 and NCAD patients. However, PGC1α and UCP1 mRNA trended upward in subcutaneous adipose tissue from CAD-DM2 patients. At multiple regression analysis, age, body mass index, left ventricular ejection fraction, UCP1 expression of epicardial adipose tissue and diabetes came out to be independent predictors of PGC1α levels. Epicardial adipose tissue PGC1α expression was dependent on the number of injured coronary arteries and logistic regression analysis showed that PGC1α expression in epicardial adipose tissue could exert a protective effect against coronary lesions. Conclusions DM2 is associated with decreased expression of PGC1α and UCP1 mRNA in epicardial adipose tissue of patients with CAD, likely reflecting a loss of brown-like fat features. Decreased expression of PGC1α in human epicardial adipose tissue is associated with higher prevalence of coronary lesions.

Aims Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. Methods and results Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16–74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study. All tracings were classified by the same cardiologist, according to the Minnesota Code criteria. The mean age of the sample was 40 years, and 73.4% were male. Frequencies of complete right bundle branch block, complete left bundle branch block, and left ventricular hypertrophy were 1.1, 0.2, and 3.6%, respectively. Major Q wave abnormalities were observed in 1.7% of the subjects, T wave abnormalities in 0.7%, early repolarization in 2.4%, and other ST segment abnormalities in 0.2%. Atrial fibrillation was present in 0.08% of the workers and atrial flutter in 0.02%. Frequencies of the Wolff–Parkinson–White pattern, Brugada pattern, long QT pattern, and short QT pattern were 0.2, 0.068, 0.038, and 0.015%, respectively. Conclusion This study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low.

[ES] Fundamentos y objetivo: La leptina es una hormona plasmática que ha sido relacionada con la homeostasis cardiovascular y la aterosclerosis, pero no existen datos concluyentes sobre su asociación con la patogénesis de la enfermedad coronaria. El objetivo de este estudio fue evaluar el valor de la leptina sérica en pacientes con angina estable y su relación con la gravedad de la enfermedad coronaria., Pacientes y método: Se incluyeron 204 pacientes, 152 con angina estable (grupo con enfermedad coronaria) y 52 sin enfermedad coronaria, excluida por tomografía computarizada cardíaca (grupo control). El grupo con enfermedad coronaria fue dividido en 2 subgrupos atendiendo a la gravedad de la afectación (enfermedad monovaso o multivaso, 46 y 106 pacientes respectivamente). Los niveles de leptina sérica fueron determinados mediante Enzyme-Linked Inmunosorbent Assay., Resultados: Los niveles de leptina fueron significativamente superiores en los pacientes con enfermedad multivaso y se asociaron de forma independiente con una mayor gravedad de la enfermedad coronaria en comparación con los controles (OR 1,14; IC95% 1,03-1,27; p = 0,014) y con pacientes con enfermedad monovaso (OR 1,12; IC95% 1,01-1,25; p = 0,036). Se testó el valor diagnóstico de la leptina sérica para el diagnóstico enfermedad multivaso, obteniendo un área bajo la curva en la curva Receiver Operating Characteristic de 0,6764 (IC95% 0,5765-0,7657)., Conclusiones: La leptina sérica se asoció en pacientes con angina estable con la mayor gravedad de la enfermedad coronaria, mostrando su implicación en el desarrollo de la enfermedad coronaria y como futuro objetivo terapéutico., [EN] Background and objectives: Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease., Patients and methods: 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay., Results: Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03-1.27; p = 0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01-1.25; p = 0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765-0.7657)., Conclusions: Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target.

The purpose of this study was to evaluate the need for a permanent pacemaker after transcatheter aortic valve implantation with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) using the new Accutrak delivery system (Medtronic, Inc.).The need for a permanent pacemaker is a recognized complication after transcatheter aortic valve implantation with the CoreValve prosthesis.Between April 23, 2008 and May 31, 2011, 195 consecutive patients with symptomatic aortic valve stenosis underwent transcatheter aortic valve implantation using the self-expanding CoreValve prosthesis. In 124 patients, the traditional delivery system was used, and in 71 patients, the Accutrak delivery system was used.There were no significant differences in baseline electrocardiographic characteristics between the traditional system and the Accutrak patients: PR interval: 153 ± 46 mm versus 165 ± 30 mm, p = 0.12; left bundle branch block: 22 (20.2%) versus 8 (12.7%), p = 0.21; right bundle branch block: 21 (19.3%) versus 8 (12.7%), p = 0.26. The depth of the prosthesis in the left ventricular outflow tract was greater with the traditional system than with the Accutrak system (9.6 ± 3.2 mm vs. 6.4 ± 3 mm, p0.001) and the need for a permanent pacemaker was higher with traditional system than with Accutrak (35.1% vs. 14.3%, p = 0.003). The predictors of the need for a pacemaker were the depth of the prosthesis in the left ventricular outflow tract (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.08 to 1.34, p0.001), pre-existing right bundle branch block (HR: 3.5, 95% CI: 1.68 to 7.29, p = 0.001), and use of the traditional system (HR: 27, 95% CI: 2.81 to 257, p = 0.004).The new Accutrak delivery system was associated with less deep prosthesis implantation in the left ventricular outflow tract, which could be related to the lower rate of permanent pacemaker requirement.

Introduccion y objetivos La mayoria de los trabajos han puesto de manifiesto que el pronostico de la insuficiencia cardiaca con funcion sistolica conservada es tan malo como el de la insuficiencia cardiaca con funcion sistolica deprimida, aunque estos resultados pueden estar sesgados debido a que estos dos tipos de insuficiencia cardiaca tienen caracteristicas distintas (edad, comorbilidades, tratamiento) que pueden influir en el pronostico. Nuestro objetivo es evaluar si la morbimortalidad a corto plazo es distinta en estos dos subgrupos de insuficiencia cardiaca, con pacientes homogeneos en cuanto a edad, comorbilidad y tratamiento recibido. Metodos Analizamos dos grupos de pacientes mayores de 70 anos y que pudieran recibir bloqueadores beta, dados de alta consecutivamente tras un ingreso por insuficiencia cardiaca en 53 hospitales espanoles (funcion sistolica deprimida, 245; funcion sistolica conservada, 374), y se comparo la morbimortalidad cardiovascular a los 3 meses del alta. Resultados Las medias de edad fueron similares (77,5±4,8 frente a 78,2±5,5 anos). La fraccion de eyeccion ventricular izquierda fue de 56,2±8,1% frente a 33±6,9% (p

Resumen Introduccion y objetivos La enfermedad coronaria multivaso es un importante factor pronostico postinfarto a pesar de nuevas formas de reperfusion como la angioplastia primaria. El objetivo del presente estudio es determinar la secuencia de variacion de diferentes poblaciones de celulas progenitoras endoteliales y factores angiogenicos (factor de crecimiento endotelial vascular, factor de crecimiento hepatocitario) segun el grado de extension de la enfermedad coronaria. Metodos Estudiamos la cinetica de liberacion en 32 pacientes ingresados por un primer infarto, agrupados segun tuvieran enfermedad coronaria monovaso o multivaso y 26 sujetos que constituyen el grupo control. Resultados Los pacientes presentaban un mayor numero de celulas progenitoras endoteliales y citocinas angiogenicas que los controles en las tres determinaciones realizadas (al ingreso, dia 3 y dia 7) de las siguientes subpoblaciones: CD34, CD34+CD133+, CD34+KDR+ y CD34+CD133+KDR+CD45+ (debil); este ultimo era mayor el dia 7. Los valores de las tres poblaciones analizadas eran mayores en los pacientes con enfermedad coronaria monovaso en las tres determinaciones. Las cifras del factor de crecimiento endotelial vascular subian durante la primera semana y las del factor de crecimiento hepatocitario mostraron un pico precoz al ingreso. No apreciamos diferencias significativas en las variaciones de citocinas segun el grado de extension de la enfermedad coronaria. Conclusiones Aunque las cineticas de liberacion de diferentes poblaciones de celulas progenitoras endoteliales en pacientes con un primer infarto agudo de miocardio con enfermedad monovaso con enfermedad multivaso fueron similares, su numero fue mayor en los pacientes con enfermedad coronaria monovaso. Las cifras del factor de crecimiento endotelial vascular ascendieron durante la primera semana y las del factor de crecimiento hepatocitario muestran un pico precoz al ingreso.

Resumen El implante valvular aortico percutaneo ha surgido recientemente como alternativa terapeutica para pacientes con estenosis aortica severa sintomatica y alto riesgo quirurgico. Se presenta la experiencia inicial en el tratamiento de la disfuncion de la bioprotesis aortica mediante el implante percutaneo de protesis aortica CoreValve en 4 pacientes, tanto con estenosis como con insuficiencia aortica, y se analiza los resultados hospitalarios y a medio plazo. El procedimiento se realizo con anestesia local y guiado por angiografia. Se implantaron con exito en todos los casos, si bien uno preciso una segunda protesis por posicionamiento alto de la primera. No hubo complicaciones mayores. Tras un seguimiento medio de 7 ± 4,7 meses, todos los pacientes se encuentran asintomaticos.

Introduccion y objetivos Los cambios en la conduccion auriculoventricular son frecuentes tras el implante percutaneo de la protesis aortica, pero se desconoce que mecanismos estan implicados y su evolucion. Analizamos las alteraciones electrocardiograficas y los predictores de la necesidad de marcapasos tras el implante percutaneo con la protesis aortica CoreValve®. Metodos Entre abril de 2008 y octubre de 2009 se ha tratado a 65 pacientes con estenosis aortica grave sintomatica mediante la protesis aortica CoreValve®. Se analizaron caracteristicas clinicas y electrocardiograficas y predictores de la necesidad de marcapasos por bloqueo auriculoventricular avanzado. Del analisis se excluyo a 3 pacientes por tener marcapasos y a un cuarto paciente que fallecio durante el procedimiento. Resultados La media de edad era 79 ± 7,8 anos y el EuroSCORE logistico, 20% ± 14%. El exito del implante fue del 98,4%. Tras el implante de la protesis, el 47,5% tenia bloqueo de rama izquierda y 21 pacientes (34,4%) precisaron de marcapasos definitivo. La necesidad de marcapasos se relaciono con la mayor profundidad de la protesis en el tracto de salida del ventriculo izquierdo (TSVI) (13 ± 2,5 frente a 8,8 ± 2,8 mm; p Conclusiones Tras el implante de la protesis aortica CoreValve®, un alto porcentaje de pacientes precisan de marcapasos definitivo por bloqueo auriculoventricular avanzado. El unico predictor independiente es la profundidad de la protesis en el TSVI y podria detectar precozmente la necesidad de marcapasos.

Energy storage systems (ESSs) are enabling technologies for well-established and new applications such as power peak shaving, electric vehicles, integration of renewable energies, etc. This paper presents a review of ESSs for transport and grid applications, covering several aspects as the storage technology, the main applications, and the power converters used to operate some of the energy storage technologies. Special attention is given to the different applications, providing a deep description of the system and addressing the most suitable storage technology. The main objective of this paper is to introduce the subject and to give an updated reference to nonspecialist, academic, and engineers in the field of power electronics.

El analisis de la deformacion o strain y la tasa de deformacion o strain rate podrian valorar cuantitativamente la contractilidad segmentaria. Esto es factible con Doppler tisular y, mas recientemente, tambien con ecografia bidimensional mediante el rastreo de senales miocardicas (speckle tracking). Este trabajo se diseno para conocer el valor de estos parametros en sujetos sanos y su reproducibilidad. Se estudio a 105 sujetos sanos —55 mujeres (52,45%); edad, 38,8 ± 9,5 (20-59) anos— mediante speckle tracking con la aplicacion Vector Velocity Imaging. Se obtuvieron los valores medios de strain y strain rate de cada segmento, asi como el tiempo hasta el pico maximo, normalizado con la longitud del ciclo (TpN). Los valores medios fueron: strain circunferencial, 22,2 ± 4,81% con TpN 0,39 ± 0,06; strain longitudinal, 19,84 ± 4,59% con TpN 0,42 ± 0,06; strain rate circunferencial, 1,64 ± 0,48 1/s con TpN 0,23 ± 0,06; strain rate longitudinal, 1,3 ± 0,49 1/s con TpN 0,21 ± 0,09. Las variabilidades del observador y entre observadores fueron moderadas.

Multilevel cascaded H-bridge (CHB) converters have been presented as a good solution for high-power applications. In this way, several control and modulation techniques have been proposed for this power converter topology. In this paper, the steady-state power balance in the cells of a single-phase two-cell CHB is studied. The capability to be supplied with active power from the grid or to deliver active power to the grid in each cell is analyzed according to the dc-link voltages and the desired ac output voltage value. The limits of the maximum and minimum input active powers for a stable operation of the CHB are addressed. Simulation results are shown to validate the presented analysis.

Introduccion y objetivos La infrautilizacion de bloqueadores beta puede influir en la elevada mortalidad de la insuficiencia cardiaca. El objetivo de nuestro estudio es evaluar si un programa especifico de intervencion sobre medicos de atencion primaria permite optimizar el uso de bloqueadores beta en pacientes ancianos con insuficiencia cardiaca. Metodos Se diseno un estudio aleatorizado y comparativo en el que se incluyo a 627 pacientes de 70 o mas anos, dados de alta de forma consecutiva con el diagnostico principal de insuficiencia cardiaca en 53 hospitales espanoles. Se realizo una asignacion aleatoria de los 292 centros de salud de las areas de esos hospitales a dos grupos (formacion, 146 centros, y control, 146 centros), para impartir un programa de intervencion y formacion sobre bloqueadores beta a los medicos pertenecientes a los centros del grupo formacion. La variable principal fue el porcentaje de pacientes que recibian la dosis maxima o maxima tolerada de bloqueadores beta a los 3 meses del alta. Resultados La edad de los pacientes era de 78 ± 5 anos; el 42% eran mujeres. No hubo diferencias entre ambos grupos en sus caracteristicas demograficas, clinicas o en el tratamiento al alta. El porcentaje de pacientes que recibian la dosis maxima tolerada de bloqueadores beta a los 3 meses del alta fue mayor en el grupo formacion (el 49 frente al 38%; p = 0,014); pertenecer al grupo formacion fue predictor independiente de recibir la dosis maxima tolerada de bloqueadores beta (odds ratio = 2,46; intervalo de confianza del 95%, 1,29-4,69; p Conclusiones Un programa de formacion sobre bloqueadores beta en atencion primaria mejora su uso en pacientes ancianos con insuficiencia cardiaca.

Background aims. The goal was to induce the transdifferentiation (or conversion) of human adipose-derived stem cells to cardiomyocytes using an intracellular extract obtained from adult human heart tissue. Methods. Human adult stem cells from lipoaspirates were transiently permeabilized, exposed to human atrial extracts and allowed to recover in culture. Results. After 21 days, the cells acquired a cardiomyocyte phenotype, as demonstrated by morphologic changes (appearance of binucleate, striated cells and branching fi bers), immunofl uorescence detection of cardiac-specifi c markers (connexin-43, sarcomeric a-actinin, cardiac troponin I and T, and desmin) and the presence of cardiomyocyte-related genes analyzed by reverse transcription – polymerase chain reaction (cardiac myosin light chain 1, a -cardiac actin, cardiac troponin T and cardiac b -myosin). Conclusions. We have demonstrated for the fi rst time that adult cardiomyocytes obtained from human donors retain the capacity to induce cardiomyocyte differentiation of mesenchymal stromal cells. The use of autologous extracts for reprogramming adult stem cells may have potential therapeutic implications for treating heart disease.

Introduccion y objetivos El tratamiento quirurgico de la estenosis aortica severa es el unico efectivo recomendado actualmente para esta patologia, pero el riesgo quirurgico aumenta con la disfuncion ventricular izquierda. Nuestro objetivo fue identificar predictores de mortalidad y mejoria funcional en el postoperatorio y a largo plazo tras reemplazo valvular en pacientes con estenosis aortica y disfuncion ventricular severa. Metodos Entre 1996 y 2008, 635 pacientes con estenosis aortica severa fueron intervenidos, 82 con fraccion de eyeccion Resultados Tras seguimiento medio de 42,59 ± 40,83 meses, la mortalidad global fue del 18,8% y la cardiovascular, del 11,3%. Solo el bajo gasto cardiaco postoperatorio (OR = 4,40; IC del 95%, 1,20-15,50; p = 0,02) se relaciono con mayor mortalidad en el seguimiento. El 70,5% presento mejoria precoz de la funcion ventricular, siendo predictores de ausencia de mejoria el infarto previo (p = 0,04), las lesiones coronarias no revascularizadas (p = 0,04) y un gradiente aortico reducido (p = 0,02). El 93,4% mejoro su grado funcional significativamente durante el seguimiento. Conclusiones Pese a la considerable mortalidad postoperatoria precoz de los pacientes con estenosis aortica y disfuncion ventricular izquierda, a largo plazo se observa una supervivencia elevada junto a mejora de la funcion ventricular y del grado funcional.

Aims Cardiac resynchronization therapy (CRT) improves survival and quality of life in advanced heart failure (HF). Although mitral regurgitation (MR) reduction has been reported, its presence has been associated with non-response to CRT. This study was undertaken to assess the potential role of significant mitral regurgitation (SMR) persistence after CRT on clinical outcome, major arrhythmic events, and echocardiographic response in the mid-long term. Methods and results Seventy-six patients (28.9% women, 63 ± 11 years) with dilated cardiomyopathy in advanced HF were included. SMR, defined as regurgitant orifice area ≥0.20 cm2, was assessed at baseline and its evolution 6 months after CRT. Clinical outcome (cardiovascular death/HF readmission), major arrhythmic events, and echocardiographic response (reverse remodelling) were recorded on follow-up. Thirty-two patients (42.1%) presented baseline SMR, becoming non-significant in 11 of the 32 patients (34.3%) 6 months after CRT. Its persistence was associated with higher rates of clinical events (46.4 vs. 18.7%, P = 0.011), arrhythmic events (35.7 vs. 14.5%, P = 0.034), and less reverse remodelling (28.5 vs. 83.3%, P < 0.001). Conclusion CRT can reduce moderate or severe baseline MR to non-significant in one-third of patients. However, its persistence was associated with worse clinical evolution, greater incidence of arrhythmic events, and less reverse remodelling.

BACKGROUND AND HYPOTHESIS: Although prodromal angina occurring shortly before an acute myocardial infarction (MI) has protective effects against in‐hospital complications, this effect has not been well documented after initial hospitalization, especially in older or diabetic patients. We examined whether angina 1 week before a first MI provides protection in these patients. METHODS: A total of 290 consecutive patients, 143 elderly (>64 years of age) and 147 adults (

Introduccion y objetivos. La estrategia de revascularizacion en el paciente diabetico con enfermedad multivaso en la era actual de los stents farmacoactivos es controvertida. Metodos. Comparamos a 270 pacientes diabeticos consecutivos (2000-2004) con enfermedad multivaso (al menos 2 vasos con estenosis > 70% de novo y afeccion de la descendente anterior proximal) a los que se practico cirugia de revascularizacion coronaria (n = 142) o se implanto stents farmacoactivos (rapamicina/paclitaxel) (n = 128) mediante analisis de regresion logistica multivariable con propensity score. Analizamos los resultados clinicos (eventos cardiacos y cerebrovasculares mayores): muerte, infarto no fatal, ictus y necesidad de revascularizacion a 24 meses. Resultados. Los pacientes que recibieron stents farmacoactivos tuvieron mayor edad (67,5 ± 7 frente a 65,3 ± 8 anos; p = 0,05) y mas infarto previo (el 49,2 frente al 28,2%; p < 0,01), aunque no hubo diferencias en la presencia de disfuncion ventricular significativa (? 45%): el 32,4 frente al 28,1%. En los pacientes quirurgicos, la anatomia coronaria fue mas compleja: score SYNTAX (25,9 ± 7 frente a 18,5 ± 6; p < 0,001) y la calidad de la revascularizacion fue superior (revascularizacion anatomica completa, el 52,8 frente al 28,1%; p < 0,01). La incidencia total del evento combinado fue del 18,7% en el grupo quirurgico y el 21,8% en el grupo percutaneo (odds ratio [OR] ajustada = 0,93; intervalo de confianza [IC] del 95%, 0,47-1,86). El evento combinado de muerte, infarto e ictus fue del 15,8% en el grupo quirurgico, frente al 12,9% en el grupo de stent farmacoactivo (OR ajustada = 1,19; IC del 95%, 0,72-1,88). Los pacientes quirurgicos tuvieron menor necesidad de revascularizacion (el 4,3 frente al 12,1%; OR ajustada = 0,42; IC del 95%, 0,16-1,14; p = 0,09). Conclusiones. En una poblacion no seleccionada de diabeticos multivaso, la ventaja de la cirugia de revascularizacion coronaria se centro en reducir las revascularizaciones. No encontramos diferencias en muerte, infarto o ictus.

La reintervencion de los pacientes con fugas perivalvulares por insuficiencia cardiaca o hemolisis esta asociada a una elevada morbimortalidad. La utilizacion percutanea de los dispositivos Amplatzer supone una alternativa atractiva. Presentamos nuestra experiencia inicial: entre 2004 y 2006 realizamos cierre percutaneo con dispositivo Amplatzer a 8 pacientes con fugas perivalvulares (4 aorticas y 4 mitrales), sintomaticos y con alto riesgo quirurgico. La implantacion del dispositivo fue posible en todas las mitrales y en 3 aorticas. No hubo complicaciones durante el procedimiento. En 4 (57%) de los 7 implantes se logro una reduccion significativa del grado de regurgitacion y, tras 12 meses de seguimiento, solamente estos pacientes mejoraron clinicamente. De los 3 restantes, 1 paciente preciso reintervencion y 2 fallecieron por causa no cardiovascular. El tratamiento percutaneo de las fugas perivalvulares es factible y seguro y puede considerarse como una opcion terapeutica en subgrupos de alto riesgo quirurgico.

Introduccion y objetivos La influencia pronostica del sexo de los pacientes sometidos a sustitucion valvular aortica por estenosis severa tiene un papel controvertido, y algunos estudios le atribuyen un papel relevante como marcador de riesgo independiente. El objetivo del estudio es valorar la influencia pronostica perioperatoria del sexo de los pacientes sometidos a sustitucion valvular por estenosis aortica severa. Metodos Estudio retrospectivo en el que se analizo una cohorte de 577 pacientes sometidos a cirugia de reemplazo valvular aortico por estenosis aortica entre 1996 y abril de 2007. Resultados Las mujeres (44%) tenian mayor edad (70,3 ± 7,9 frente a 66,8 ± 9,8 anos; p Conclusiones La mortalidad perioperatoria de las mujeres con estenosis aortica severa sometidas a sustitucion valvular es alta. Al ajustar por potenciales factores de confusion, especialmente superficie corporal, el sexo femenino no se comporta como factor independiente de mortalidad.

Introduccion y objetivos La insuficiencia cardiaca congestiva (ICC) tiene elevadas incidencia, morbilidad y mortalidad y una gran prevalencia. Sin embargo, no hay datos directos sobre este aspecto en nuestro pais. El objetivo de nuestro estudio es evaluar la prevalencia de ICC en Espana. Metodos Se diseno un estudio poblacional en el que participaron 15 centros repartidos por toda Espana. Se selecciono de forma aleatoria una muestra de la poblacion de 45 o mas anos de edad atendida en cada area de salud, que fue estudiada por sus medicos de atencion primaria. Se utilizaron los criterios de Framingham para el diagnostico. Las personas con criterios de ICC fueron remitidas a una consulta de cardiologia para confirmacion diagnostica y realizacion de ecocardiograma. Resultados Se evaluo a 1.776 personas, con una media ± desviacion estandar (intervalo) de edad de 64 ± 12 (45-100) anos; eran varones el 44%. Se remitio a cardiologia a 242 pacientes. La prevalencia ponderada de ICC fue del 6,8% (intervalo de confianza [IC] del 95%, 4%- 8,7%). La prevalencia fue similar en varones (6,5%; IC del 95%, 4,7%-8,4%) y en mujeres (7%; IC del 95%, 4,4%-9,6%). Por edades, la prevalencia fue del 1,3% (0,4%-2,1%) entre los 45 y 54 anos; el 5,5% (2,4%-8,5%) entre 55 y 64 anos; el 8% (4,2%-11,8%) entre 65 y 74 anos, y el 16,1% (11%-21,1%) en personas de 75 o mas anos. Conclusiones La prevalencia de ICC en Espana es alta, en torno a un 7-8%. La prevalencia es similar varones y mujeres, y parece aumentar con la edad.

Journal Article The occurrence of angina in the week preceding myocardial infarction is associated with a reduction in cardiovascular complications in the acute phase. However, little is known about it relationship with prognosis after hospitalization (e.g., cardiovascular death and the development of heart failure or ischemic cardiomyopathy). The study included 290 consecutive patients admitted for a first myocardial infarction: 107 (36.9%) had preceding angina while 183 did not. Those with a history of ischemic cardiomyopathy of more than 1 week or structural cardiopathy were excluded. There was no difference in baseline characteristics between the two groups. Moreover, there was no difference in the rates of cardiovascular complications after hospital discharge: cardiovascular death (7% vs. 12.6%; P=.3), heart failure (7.4% vs. 11.6%; P=.2), and myocardial ischemia, including myocardial infarction and unstable angina, requiring hospitalization (41.2% vs. 31.3%; P=.3). The occurrence of angina in the week before a first myocardial infarction did not influence cardiovascular complications after hospital discharge (odds ratio = 0.75 [0.51-1.11]; P=.15). Yes La angina preinfarto precoz (semana previa) se asocia a una reducción de las complicaciones cardiovasculares en la fase aguda del infarto, pero es escasa la información sobre su relación con el pronóstico tras la fase hospitalaria (muerte cardiovascular y desarrollo de insuficiencia cardiaca e isquemia miocárdica). Estudiamos a 290 pacientes consecutivos ingresados con un primer infarto, 107 con angina precoz (36,9%) y 183 sin ella. Se excluyó a los pacientes con antecedentes de cardiopatía isquémica de más de 1 semana o cardiopatía estructural de base. No se aprecian diferencias en las características basales de ambos grupos. No hay diferencias en las complicaciones cardiovasculares tras el alta hospitalaria (mortalidad cardiovascular, 7 frente a 12,6%; p = 0,3), insuficiencia cardiaca (7,4 frente a 11,6%; p = 0,2) o isquemia miocárdica (infarto o angina inestable, 41,2 frente a 31,3%; p = 0,3) que motiven ingreso hospitalario. La angina precoz no es un factor asociado a complicaciones cardiovasculares tras el alta hospitalaria (odds ratio = 0,75; intervalo de confianza del 95%, 0,51-1,11; p = 0,15).

El objetivo fue comparar el efecto de la terapia de resincronizacion cardiaca en la funcion ventricular y el remodelado inverso en pacientes en ritmo sinusal y fibrilacion auricular sin ablacion del nodulo auriculoventricular. Se analizaron parametros clinicos y ecocardiograficos antes y 6 meses tras la resincronizacion de 55 pacientes: 15 en fibrilacion auricular y 40 en ritmo sinusal. La programacion del dispositivo, el estrechamiento del QRS y la asincronia ecocardiografica tras el implante fueron similares en ambos grupos. Sin embargo, aunque en ambos grupos se observo mejoria significativa del volumen telesistolico y la fraccion de eyeccion, los pacientes en ritmo sinusal presentaron mayor remodelado inverso (reduccion del volumen telesistolico del 30,9% ± 24,6% contra el 12,5% ± 18,6%; p = 0,024) y aumento relativo en la fraccion de eyeccion (el 15,4% ± 12,6% y el 5% ± 7,2%; p = 0,010). La terapia de resincronizacion en pacientes con fibrilacion auricular sin ablacion del nodulo mejora significativamente la fraccion de eyeccion y el remodelado inverso, pero menos que en ritmo sinusal.

Background Drug-eluting stents (DES) have been shown in randomized trials to reduce clinical events in diabetic patients. Our aim was to determine whether these clinical results are applicable in an unselected population of patients with non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). Methods We studied 440 consecutive patients (271 NIDDM and 169 IDDM) who underwent percutaneous coronary intervention, divided into 2 cohorts: Group A (1998–2000): 220 patients with bare metal stents, and Group B (2002–2004): 220 patients with drug-eluting stents. We analyzed major coronary adverse events (death, nonfatal acute myocardial infarction, and target lesion revascularization) over a mean follow-up of 18 ± 15 months. Results Group B had more patients who were insulin-dependent (44.5 versus 32.3% p

Introduccion y objetivos El calculo de la reserva fraccional de flujo (RFF) es una herramienta util y validada en la aproximacion funcional de estenosis coronarias de severidad intermedia. Nuestro objetivo fue conocer su utilidad en diabeticos, cuya disfuncion microvascular puede afectar a dicho calculo. Metodos Entre 1997 y 2004, se evaluaron mediante RFF 222 lesiones coronarias consecutivas de severidad intermedia (40-70%) a criterio del hemodinamista. Se utilizo adenosina intravenosa para alcanzar hiperemia maxima (140 μg/kg/min). Comparamos los eventos clinicos cardiacos (muerte, infarto de miocardio no fatal, revascularizacion de la lesion evaluada) en diabeticos y no diabeticos en los que la RFF fue negativa y no se intervino. El seguimiento medio fue de 30 ± 21 meses. Resultados La revascularizacion no se indico en 144 lesiones (136 pacientes) con RFF ≥ 0,75. Habia 42 lesiones de 40 pacientes diabeticos (29,2%). Hubo mas mujeres e hipertensos, dislipemicos y con enfermedad multivaso en el grupo de diabeticos. No hubo diferencias en la indicacion de la coronariografia. En ambos grupos, la arteria descendente anterior fue el vaso mas estudiado. El valor medio de la RFF fue 0,87 ± 0,06 y no hubo diferencias entre grupos. En el seguimiento a largo plazo, no encontramos diferencias en muerte o infarto de miocardio. El 8,8% de los no diabeticos frente al 14,3% de los diabeticos con RFF negativa precisaron revascularizacion de la lesion inicialmente evaluada (p = 0,32). Conclusiones Nuestros resultados indican que diferir la intervencion coronaria en diabeticos con estenosis coronaries intermedias y RFF ≥ 0,75 parece una estrategia segura.