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Introduction and objectives: Late functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. Methods: We prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. Results: Optimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC = 0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P = .03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P < .0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P = .01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. Conclusions: The current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery. Full English text available from:www.revespcardiol.org/en

En el programa de la asignatura de Física y Química de superficies se contemplan los fenómenos electrocinéticos, donde figura la electroforesis; la cual es una técnica útil para caracterizar cambios atribuidos a la transformación de biomoléculas como es el caso de las proteínas. Por ello, en el presente trabajo se evaluó la modificación del perfil proteico de lactosuero tratado en un sistema biolectroquímico, haciendo uso de la electroforesis en gel de poliacrilamida (SDS-PAGE). El sistema bioelectroquímico consistió en un electrodo de grafito con una superficie modificada con bacterias (electrodo microbiano), el cual fue puesto en marcha utilizando una técnica cronoamperométrica realizada en un período de 12 horas. Los resultados obtenidos a partir de los perfiles electroforéticos del estado inicial y final del lactosuero indican la presencia de 7 proteínas con pesos moleculares promedio entre 11.83 y 126.50 kDa en ambas muestras. Posteriormente, el análisis estadístico realizado a dichos resultados permitió determinar la transformación de 2 de las 7 proteínas identificadas en el lactosuero.

Introduccion y objetivos La incidencia por infarto de miocardio en Espana es baja y la mortalidad esta disminuyendo en las ultimas decadas. Hemos analizado las tendencies en las tasas de mortalidad, incidencia y ataque, y en la letalidad a 28 dias por infarto de miocardio entre 1990 y 1999 en la poblacion de 35 a 74 anos de Girona. Metodos Se incluyeron todos los casos de infarto de miocardio de Girona clasificados segun el algoritmo MONICA. Se calcularon las tasas de ataque, incidencia y mortalidad, y la letalidad, asi como el porcentaje de cambio annual en cada uno de los indicadores durante el periodo analizado. Resultados La tasa anual media de ataque fue de 258 (intervalo de confianza [IC] del 95%, 249-267) y 55 (IC del 95%, 51-59) por 100.000 habitantes para varones y mujeres, respectivamente, y la de mortalidad de 99 (IC del 95%, 93-104) por 100.000 en varones y de 25 (IC del 95%, 22-28) por 100.000 en mujeres. Las tasas de ataque, incidencia y recurrencia disminuyeron significativamente en varones de 35 a 64 anos durante el periodo 1990-1999, pero no en los de 65 a 74 anos ni en las mujeres. Conclusiones La incidencia y la mortalidad por IAM fueron bajas en la poblacion de 35 a 64 anos, y mejoraron en los varones de 35 a 64 anos durante el periodo 1990-1999, pero no en los de 65 a 74 anos, lo que indica que la combinacion de prevencion primaria y secundaria ha retrasado la edad de aparicion del infarto de miocardio o de las recurrencias. Las tasas en mujeres fueron inferiors y no cambiaron durante el periodo estudiado.

Introduction and objectives The incidence of myocardial infarction in Spain is low, and mortality has been decreasing over the last few decades. The objective of this study was to analyze trends in myocardial infarction mortality, incidence, attack rates, and 28-day case-fatality attack rates between 1990 and 1999 in the general population aged 35-74 years in Girona, Spain. Methods The study included all myocardial infarction cases in Girona classified according to the MONICA algorithm. Attack, incidence, mortality rates and case- fatality were calculated. In addition, the annual percentage change in each of these indicators during the study period was also calculated. Results The mean attack rate per 100,000 inhabitants was 258 (95% CI, 249-267) in men and 55 (95% CI, 51- 59) in women. The mean mortality rate per 100,000 was 99 (95% CI, 93-104) in men and 25 (95% CI, 22-28) in women. Significant reductions in attack, incidence and recurrence rates were observed in men aged 35-64 years during the period 1990-1999, but not in men aged 65-74 years, nor in women. Conclusions Myocardial infarction incidence and mortality rates were low in the general population aged 35- 64 years. Rates improved in men aged 35-64 years during the period 1990-1999, but not in those aged 65-74 years, which indicates that a combination of primary and secondary prevention has increased the age at which a myocardial infarction or its recurrence is observed. Rates in women were lower and did not change during the study period.

To assess the value of colour M-mode Doppler of the mitral valve in patients with acute myocardial infarction complicated by pulmonary edema.Case-control, clinical.Coronary care unit in a university hospital.28 patients admitted because of acute myocardial infarction, and who developed pulmonary edema (group P, cases); 39 patients with uncomplicated myocardial infarction (group C, controls).Patients in group P showed higher E wave (77+/-20 vs. 64+/-16 cm/s, p=0.007), E/A ratio (1.5+/-1.0 vs. 1.0+/-0.4, p=0.014), lower time of deceleration of the E wave (153+/-40 vs. 196+/-53 ms, p=0.001) and lower Ejection Fraction (35+/-10 vs. 49+/-11, p0.001). There were no differences in the velocity of the colour M-mode Doppler of the mitral valve (Vp: 36.2+/-11 vs. 34.0+/-12 cm/s). Excluding patients with abnormal relaxation or restrictive pattern of the pulsed Doppler, Vp was identical (group P 34+/-10, group C 34+/-12).M-mode colour Doppler of the mitral valve was not useful to differentiate patients with acute pulmonary edema complicating myocardial infarction. Measurement of Vp is not warranted as a routine in these patients.

Certain chemotherapy drugs for breast cancer may induce cardiotoxicity and these patients should be echocardiographically monitored. The performance of a focused echocardiographic evaluation (echoscopy) at the patient's location by a non-cardiologist appears to be feasible. The aim of the present study was to assess the accuracy of echoscopy performed by medical oncologists in an outpatient clinic using hand-held echocardiography devices. The study cohort comprised consecutive unselected patients who attended an oncology outpatient clinic. Two medical oncologists attended a one-week training period, which included theoretical and practical teaching by an expert cardiologist. Every subject underwent two echo examinations. The first examination was performed by an oncologist using a hand-held echo device and the second was performed by a cardiologist using a ‘premium’ device. Out of the 101 enrolled patients, 32 were men (31.7%) and the mean age was 56.03±16.88 years. There was a good global agreement [intra-class correlation coefficient (ICC): 0.65 for left ventricular ejection fraction (LVEF)]. When the results were analyzed depending on the period of time when the echo studies were performed, a clear and short learning curve was observed: LVEF started at ICC=0.58 and increased to 0.66 and 0.77 in the second and third period, respectively. There were extremely few clinically significant differences and a learning curve was also evident. In conclusion, cardiac echoscopy performed by an oncologist with a hand-held device may lead to a similar clinical management as a study performed by an expert cardiologist with a ‘premium’ system in patients under chemotherapy following a short training period.

Aim: The hypothesis that patients with hyperglycaemia during admission, regardless of previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. The objective was to assess the role of hyperglycaemia on short-term mortality after myocardial infarction (MI). Methods and Results: A cohort study nested in a prospective registry of MI patients in the reference hospital of Gerona, Spain was performed. All consecutive MI patients under 75 were registered between 1993 and 1996. Patient and clinical characteristics, including previous diagnosis of diabetes, glycaemia on admission and in the next four days, were recorded. Patients with glycaemia on admission or four day mean glycaemia >6.67 mmol/l were considered hyperglycaemic. The main outcome measure was mortality at 28 days. Of 662 patients with MI included, 195 (29.7%) had previously known diabetes mellitus, but 457 (69.0%) had glycaemia >6.67 mmol/l on admission. Patients with hyperglycaemia on admission were older, more often female, more frequently had a previous diagnosis of diabetes, developed more complications, and had higher 28 day mortality. The effect of admission glycaemia >6.67 mmol/l on 28 day mortality was independent of major confounding factors, particularly previous diagnosis of diabetes (OR=4.20, 95% confidence intervals 1.18 to 14.96). Conclusions: Higher 28 day mortality was observed among MI patients with glycaemia on admission >6.67 mmol/l compared with patients with lower levels, independently of major confounding variables and, particularly, previous diagnosis of diabetes. This early, simple, and inexpensive marker of bad prognosis after MI should prompt the application of more aggressive treatment of MI and risk factors and, probably, of glycaemia during admission.

STUDY OBJECTIVE—The objective of this study was to analyse whether the risk of death within 28 days and three years after a first Q wave myocardial infarction was higher in hospitalised women than in men. DESIGN—Follow up study. PATIENTS AND SETTING—All consecutive first Q wave myocardial infarction patients aged 25 to 74 years (447 women and 2322 men) admitted to a tertiary hospital in Gerona, Spain, from 1978 to 1997 were registered and followed up for three years. MAIN RESULTS—Women were older, presented more comorbidity and developed more severe myocardial infarctions than men. A significant interaction was found between sex and age. Women aged 65-74 had higher early mortality risk than men of the same age (OR 1.62; 95% CI 1.01, 2.66) after adjusting for age, comorbidity and acute complications including heart failure. Women under 65 tended to be at lower risk of early mortality than men (0.45 (95% CI 0.19, 1.04). Three year mortality of 28 day survivors did not differ between sexes. CONCLUSIONS—These data support the idea that the higher 28 day mortality in hospitalised women with a first Q wave myocardial infarction is mainly attributable to the large number of patients aged 65 to 74 years in whom the risk is higher than that in men. Women under 65 with myocardial infarction do not seem to be a special group of risk. Keywords: age factors; heart failure; mortality; myocardial infarction; sex factors; prognosis

Background —The aim of this study was to analyze 28-day case fatality trends between 1978 and 1993 among hospitalized acute myocardial infarction (AMI) patients in the REGICOR registry, Gerona, Spain, and relate them to thrombolytic and antiplatelet drug use and changes in patient characteristics. Methods and Results —A total of 2053 consecutive patients 25 to 74 years of age with a first Q-wave AMI admitted to the reference hospital between 1978 and 1993 were registered. Clinical characteristics and patient management were recorded. Four 4-year periods were considered: 1978 to 1981, 1982 to 1985 (prethrombolytic therapy), 1986 to 1989 (thrombolytic and antiplatelet drugs introduced), and 1990 to 1993 (thrombolytic and antiplatelet drugs used routinely). The end point was death at 28 days. Case fatality at 28 days decreased 6% per year between 1978 and 1993. A logistic model adjusted for comorbidity and severity showed the last 3 periods to present a steep decrease in the OR of death at 28 days: 0.86 (95% CI, 0.52 to 1.41), 0.59 (95% CI, 0.35 to 0.99), and 0.40 (95% CI, 0.24 to 0.69), respectively, compared with the first period. After 1986, 85.7% of the 112 lives saved could be attributed to the use of antiplatelet and thrombolytic drugs. Adjusted relative risk reduction was 56.0% for antiplatelet drugs, 34.1% for thrombolytic drugs, and 77.9% for the 2 combined. Conclusions —Our results strongly suggest that new therapies introduced since 1986 have contributed to the decrease in 28-day case fatality of patients admitted with a first Q-wave AMI. This decrease could be attributable mainly to the use of antiplatelet and thrombolytic drugs. These findings should encourage the routine use of thrombolytic and antiplatelet drugs and particularly their combination in the acute phase of AMI.

En Espana, la muerte subita cardiaca constituye un importante problema de salud publica a pesar de que su incidencia es de las mas bajas de los paises industrializados. Actualmente, se calcula que el 12% de las defunciones que se producen de forma natural son subitas y, de estas, el 88% son de origen cardiaco. Ademas, en los pacientes con cardiopatia isquemica es la forma mas frecuente de fallecimiento ( mas del 50% ) , siendo ademas el primer sintoma en el 1926% de los casos. Esta estrecha relacion con la cardiopatia isquemica hace que los factores de riesgo de presentarla se asocien tambien con la aparicion de muerte cardiaca subita. Diversos factores, como la actividad fisica o determinados farmacos y drogas, pueden desencadenar su aparicion. La estrategia mas efectiva para prevenir la muerte cardiaca subita incluye la identificacion de subgrupos de alto riesgo ( pacientes con antecedentes de cardiopatia isquemica, insuficiencia cardiaca, supervivientes a un paro cardiaco extrahospitalario o pacientes que presentan fibrilacion o taquicardia ventricular tras un infarto agudo de miocardio) , asi como el desarrollo de intervencione s terapeuticas eficaces. Dado que la mayoria de las muertes cardiacas subitas estan relacionadas con la cardiopatia isquemica, las medidas de prevencion primaria dirigidas a disminuir las tasas de incidencia y mortalidad por esta causa tambien deberian reducir las primeras. El desarrollo de programas comunitarios basados en la rapida respuesta de un servicio de emergencias o programas de educacion en reanimacion cardiopulmonar en el ambito poblacional ha demostrado tambien ser eficaz debido a que la mayor parte de las muertes subitas cardiacas son extrahospitalarias.

To the Editor: The article by Fosbol et al1 documents an interesting investigation of the fate of abstracts presented at the main cardiology meetings in the 2006 to 2008 period. They found that fewer than half of the abstracts were translated to formal peer-reviewed scientific articles, with the abstracts presented at the …

The objective of this study was to determine the influence of the inclusion of chestnuts and sugar beet pulp in pigs’ diets on the lipid composition of the external and internal muscles of dry-cured pork forelegs. This inclusion did not modify the lipid content and the glycerides, phospholipids and free fatty acid proportions of the internal and external muscles of dry-cured pork forelegs; however, it caused a significant decrease in the values of oxidation index TBA. No important changes were observed in fatty acid composition of glycerides. The dry-cured pork forelegs from pigs who received a diet with chestnuts and sugar beet pulp showed higher proportions of polyunsaturated fatty acids in phospholipid and free fatty acid fractions than dry-cured pork forelegs from pigs fed a conventional diet; this could be due to a decrease in the oxidation levels. El objetivo del presente trabajo fue determinar el efecto de la inclusión de castañas y pulpa de remolacha en la alimentación del cerdo sobre diferentes aspectos lipídicos de los músculos externos e internos de los lacones gallegos. Dicha inclusión no modificó el contenido de lípidos, ni la proporción de glicéridos, fosfolípidos y ácidos grasos libres; sin embargo, sí causó un descenso de los valores del índice de oxidación TBA. No se observaron cambios importantes en la composición de ácidos grasos de los glicéridos. Los lacones de cerdos alimentados con castaña y pulpa de remolacha presentaron un significativo mayor contenido de ácidos grasos poliinsaturados en las fracciones de fosfolípidos y, sobre todo, en la de ácidos grasos libres, lo cual podría atribuirse a un descenso de los niveles de oxidación.

Las malformaciones congenitas de la valvula mitral son poco frecuentes y su presentacion en adultos es excepcional. La ecocardiografia transtoracica es fundamental en su diagnostico. En este trabajo se presentan dos pacientes adultos con valvula mitral en paracaidas y uno con hendidura mitral aislada en los que el examen ecocardiografico fue decisivo para establecer un diagnostico correcto. Se comentan los aspectos clinicos, los hallazgos ecocardiograficos tipicos y el planteamiento terapeutico de estas entidades.

The left ventricular (LV) flow velocity propagation measured by colour M-mode Doppler ( V p) is a useful function diastolic index, with some advantages over pulsed Doppler. It might be used to differentiate a normal from a pseudonormal LV filling pattern.1,2 We have observed that the opening of the anterior leaflet of the mitral valve closely …

As Bazett’s actual role in the elaboration of this formula was quite minor, it seems fitting to present a brief historical review of the subject, identifying the contributions of those principally involved. Mechanical systole duration was a topic of great interest to 19th century pioneers in cardiovascular physiology, and in 1891 A.D. Waller, famous today for his contributions to the development of the electrocardiograph,2 proposed the following expression3 for normal systolic duration

Objective To describe the incidence and clinical manifestations of long-term cardiac complications of endocarditis. Design Cohort study. Setting University-affiliated tertiary medical center. Patients One hundred twelve consecutive patients, survivors from a series of 140 non-addicted patients with a first episode of infective endocarditis on native valves hospitalized from 1975 to 1990. Thirty-two patients had had valve replacement during the active phase of the infection, and the remaining 80 patients received medical treatment alone. Measurements Relapse, recurrence, need for late cardiac surgery, and cardiac mortality. Results Relapses occurred in three patients (2.7%) and recurrences in five patients (4.5%, incidence density at 15 years, 0.0030 per patient-year). Late cardiac surgery was needed by 47% of the patients treated medically during the active phase, and most had surgery in the first 2 years of follow-up (incidence density, 0.25 per patient-year at 2 years). Aortic valve involvement (relative risk, 2.66; 95% CI, 1.15 to 6.17) and end-diastolic diameter greater than 60 mm (relative risk, 1.04; 95% CI, 1.03 to 2.43) were associated with the need for late surgery in univariate analysis. Multiple logistic regression analysis showed aortic valve involvement to be an independent predictor of the need for late surgery (relative risk, 3.04; CI, 1.23 to 7.54). Only 2 of the 32 patients who had surgery during the active infection needed a second operation during follow-up. At the end of follow-up, the number of patients who had surgery after the onset of the infection was 86 (60% of the whole series). Cardiac death occurred in 16 patients; most deaths were sudden or postoperative and occurred in the first 2 years of follow-up (incidence density, 0.047 per patient-year at 2 years). Independent predictors of death were not found. Survival was 90% at 2 years, 88% at 5 years, 81% at 10 years, and 61% at 15 years. Conclusions Survival after infective endocarditis is fair (81% probability of survival at 10 years), and the most common types of cardiac death are sudden and postoperative. Aortic valve involvement is an independent predictor of the need for late cardiac surgery. The rate of recurrences is not negligible (incidence density at 15 years, 0.0030 per patient-year).

We report a patient with a mitral insufficiency due to myxomatous valve change, with a regurgitation murmur heard principally at aortic area and radiating to the neck base. Even though the topography of the murmur seemed to suggest aortic stenosis, the other auscultation findings and the initial clinical tests clearly supported its source in a mitral insufficiency. The echocardiography allowed us not only to confirm our suspicion, but also to explain this auscultation finding mechanism, to show a severe mitral insufficiency with a anterior and medial jet, which struck the aorta and atrial septum. The surgery found a clear aortic vibration, which disappeared after implanting the mitral protheses. Our case illustrates the value of new diagnostic image techniques to complement the semiologic findings.