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La fibrilación auricular aumenta hasta en 5 veces el riesgo de ictus. Los ictus cardioembólicos habitualmente son más graves y tienen altas tasas de recurrencias y discapacidad permanente en comparación con los ictus de otras etiologías. En consecuencia, la reducción del riesgo de ictus mediante una adecuada anticoagulación es uno de los principales objetivos en el tratamiento de los pacientes con fibrilación auricular. Los antagonistas de la vitamina K han sido ampliamente superados por los anticoagulantes orales de acción directa, ya que tanto los resultados de los ensayos clínicos como los de los estudios de práctica clínica y, últimamente, estudios poblacionales han demostrado que los anticoagulantes orales de acción directa tienen mayores eficacia (menos ictus y muerte) y seguridad (menos hemorragias intracraneales) que los antagonistas de la vitamina K. Además, durante la pandemia de COVID-19, el empleo preferente de anticoagulantes orales de acción directa frente a los antagonistas de la vitamina K constituye una estrategia clave para garantizar una calidad óptima de la anticoagulación y una mejor protección del paciente contra el SARS-CoV-2, al no precisarse control de la razón internacional normalizada.

Resumen La fibrilacion auricular aumenta de manera marcada el riesgo de ictus. Multiples ensayos clinicos y estudios en practica clinica han demostrado que el tratamiento anticoagulante disminuye el riesgo de complicaciones tromboembolicas. Para este tratamiento, los anticoagulantes orales de accion directa (ACOD) ofrecen un mejor perfil de eficacia y seguridad que los antagonistas de la vitamina K. Estudios realizados en paises de nuestro entorno han objetivado en los ultimos anos una reduccion en la incidencia de ictus isquemico, lo que podria estar en relacion con una mayor prescripcion de anticoagulantes orales, sobre todo ACOD. En Espana hay muy poca informacion sobre este tema. Sin embargo, los datos disponibles indican que parece que tambien la mayor prescripcion de anticoagulantes orales, sobre todo ACOD, se asociaria con una significativa reduccion de las incidencias tanto de ictus isquemico como de hemorragias intracraneales. En consecuencia, se deberia recomendar un mayor empleo de los ACOD para los pacientes con fibrilacion auricular, lo que contribuiria no solo a reducir la incidencia de ictus isquemico y de hemorragias intracraneales, sino tambien la carga economica que esto conlleva.

Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare heritable heart-muscle disorder characterized by a progressive loss of left ventricular myocardium and its replacement by fibrofatty tissue. Myocarditis is an inflammatory disease of the heart that may occur secondary to infections, immune system activation or exposure to drugs. Hot phases of ALVC present with chest pain and troponin rise, mimicking acute viral myocarditis and indicate a progression of the disease. Recently, myocarditis has also been described as an infrequent complication of coronavirus disease 2019 (Covid-19) mRNA vaccines. We herein report for the first time a case of probable myocarditis induced by Covid-19 vaccine in a patient with previous medical history of ALVC. We aim to highlight the common characteristics of ALVC and Covid-19 vaccine myocarditis and work through the differential diagnosis of these two entities.

Resumen La coexistencia de insuficiencia cardiaca (IC) con fraccion de eyeccion del ventriculo izquierdo (FEVI) reducida y diabetes es muy frecuente. En los ultimos anos, el sacubitrilo-valsartan (SV) y la familia de los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) han pasado a formar parte del arsenal terapeutico habitual del profesional dedicado a la IC. Comparado con el enalapril, se ha demostrado con el SV en pacientes con IC y FEVI reducida una clara mejoria a nivel pronostico y de calidad de vida; la familia de farmacos glucosuricos ha mostrado beneficios significativos en proteccion renal y hospitalizacion por IC en una poblacion mas variada, donde la prevalencia de IC basal es baja. Se revisa la evidencia actual de los 2 farmacos y el uso combinado de ambos. Informacion sobre el suplemento: este articulo forma parte del suplemento titulado «Controversias para una nueva era en el tratamiento de la insuficiencia cardiaca», que ha sido patrocinado por Novartis.

Aim: To analyze the impact of sacubitril/valsartan on functional class, surrogate parameters and clinical outcomes in clinical practice. Methods: Retrospective study of patients with heart failure and reduced ejection fraction that started treatment with sacubitril/valsartan. Results: 149 patients (70.7 ± 9.6 years) were included. At baseline, 83.9, 15.4 and 0.7% were taking sacubitril/valsartan 24/26, 49/51 and 97/103 mg, respectively. After 316.1 ± 155.9 days, these numbers moved to 38.9, 39.6, 12.8% (8.7% discontinued). Sacubitril/valsartan improved functional class (from 2.3 ± 0.6 to 1.8 ± 0.5; p Conclusion: Sacubitril/valsartan is effective and safe in routine practice.

et al., [ES]: [Introduction and objectives]: Peroxisome proliferator-activated receptor gamma coactivator 1a (PGC-1a) is a metabolic regulator induced during ischemia that prevents cardiac remodeling in animal models. The activity of PGC-1a can be estimated in patients with ST-segment elevation acute myocardial infarction. The aim of the present study was to evaluate the value of plasma PGC-1a levels in predicting the extent of necrosis and ventricular remodeling after infarction. [Methods]: In this prospective study of 31 patients with a first myocardial infarction in an anterior location and successful reperfusion, PGC-1a expression in peripheral blood on admission and at 72 hours was correlated with myocardial injury, ventricular volume, and systolic function at 6 months. Edema and myocardial necrosis were estimated using cardiac magnetic resonance imaging during thefirst week. At 6 months, infarct size and ventricular remodeling, defined as an increase > 10% of the left ventricular end-diastolic volume, was evaluated by follow-up magnetic resonance imaging. Myocardial salvage was defined as the difference between the edema and necrosis areas. [Results]: Greater myocardial salvage was seen in patients with detectable PGC-1a levels at admission (mean [standard deviation (SD)], 18.3% [5.3%] vs 4.5% [3.9%]; P = .04). Induction of PGC-1a at 72 hours correlated with greater ventricular remodeling (change in left ventricular end-diastolic volume at 6 months, 29.7% [11.2%] vs 1.2% [5.8%]; P = .04). Conclusions: Baseline PGC-1a expression and an attenuated systemic response after acute myocardial infarction are associated with greater myocardial salvage and predict less ventricular remodeling., [EN]: [Introducción y objetivos]: El coactivador 1a del receptor activado gamma del proliferador de peroxisoma (PGC-1a) es un regulador metabólico que se induce durante la isquemia y previene el remodelado cardiaco en modelos animales. Su actividad puede estimarse en pacientes con infarto agudo de miocardio con elevación del segmento ST. Nuestro objetivo es evaluar el valor predictivo de los valores plasmáticos de PGC-1a en la extensión del área necrótica y el remodelado ventricular tras infarto. [Métodos]: Estudio prospectivo de 31 pacientes con primer infarto de miocardio de localización anterior y reperfusión exitosa. Se determinó la expresión de PGC-1a en sangre periférica al ingreso y a las 72 h, evaluando su correlación con el daño miocárdico y el volumen ventricular y la función sistólica a los 6 meses. El edema y la necrosis miocárdica se estimaron mediante resonancia magnética cardiaca durante la primera semana. A los 6 meses, una resonancia de control evaluó tamaño del infarto y remodelado ventricular, definido como el incremento > 10% del volumen telediastólico del ventrículo izquierdo. Se definió miocardio salvado como la diferencia entre las áreas de edema y de necrosis. [Resultados]: Se observó más miocardio salvado en los pacientes con expresión de PGC-1a detectable al ingreso (el 18.3% [5.3%] vs 4.5% [3.9%]; P = .04). La inducción de PGC-1a a las 72 h se correlacionó con mayor remodelado ventricular (variación del volumen telediastólico del ventrículo izquierdo a los 6 meses, 29.7% [11.2%] vs 1.2% [5.8%]; P = .04). [Conclusiones]: El grado de expresión basal de PGC–1a y una respuesta atenuada del sistema tras infarto agudo de miocardio se asocian con más miocardio salvado y predicen menos remodelado ventricular., This work was financed by the Spanish Society of Cardiology through a grant for Proyectos de Investigación Básica en Cardiología, 2010; the Programa I3 de Intensificación Investigadora 2010 and 2012 from the Instituto de Salud Carlos III and the Generalitat Valenciana; the Fundación para la Investigación del Hospital General Universitario de Valencia through the Becas de Investigación Intramural, 2008 and 2010; the Spanish Ministry of Science and Innovation through projects SAF 2009-07599 and CSD 2007-00020; SAF2012-37693 from MINECO (Ministerio de Economía y Competitividad); and S2010/BMD-2361 from the Community of Madrid.

Resumen Introduccion y objetivos La terapia de resincronizacion cardiaca con desfibrilador aumenta la supervivencia y mejora la calidad de vida en insuficiencia cardiaca avanzada. Tradicionalmente, se ha excluido a los pacientes con fraccion de eyeccion > 35% calculada por ecocardiografia. Evaluamos el impacto pronostico de dicha terapia en un grupo de pacientes con disfuncion sistolica grave por ecocardiografia pero con fraccion de eyeccion > 35% por resonancia magnetica cardiaca. Metodos Se analizaron los ingresos por insuficiencia cardiaca entre 2004 y 2011 en clase funcional II - IV , QRS ≥ 120 ms, fraccion de eyeccion por ecocardiografia ≤ 35% y estudio de resonancia magnetica cardiaca segun protocolo local. Se incluyo a los pacientes (n = 103) con implante de dispositivo en prevencion primaria. Se registro la incidencia de arritmias ventriculares, reingreso por insuficiencia cardiaca y mortalidad total. La muestra se dividio segun la funcion sistolica por resonancia magnetica fuera ≤ 35% o > 35%. Resultados Ambos grupos mostraron mejoras comparables en clase funcional y fraccion de eyeccion a los 6 meses. Se encontro una tendencia no significativa hacia mayor mortalidad total entre los pacientes con fraccion de eyeccion ≤ 35% en el seguimiento a largo plazo. Al dividir la muestra por funcion sistolica y patron de realce, encontramos que la presencia de necrosis identificaba a los pacientes con peor pronostico de arritmias ventriculares y mortalidad total. Conclusiones La terapia de resincronizacion cardiaca con desfibrilador proporciono un beneficio clinico similar a los pacientes con funcion sistolica por resonancia resonancia magnetica cardiaca ≤ 35% y > 35%. El patron de realce tardio de gadolinio aporta informacion adicional sobre riesgo arritmico y pronostico a largo plazo de estos pacientes.

A B S T R A C T Introduction and objectives: Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35 estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance. Methods: We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS to 120 ms, ejection fraction 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n=103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance. Results: The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups. Conclusions: We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.

Background Venous thromboembolism (VTE) is a common complication in cancer patients. Non-adherence to anticoagulation therapy can lead to unsatisfactory health outcomes, and increase overall healthcare costs. Purpose To assess the Delphi technique as a method for achieving convergence of opinion concerning adherence to anticoagulation therapy and quality of life in cancer patients with VTE. Material and methods The Delphi technique was used to collect data from a panel of selected healthcare professionals, a multidisciplinary team of 27 experts (oncologists, haematologists, internal medicine experts, pulmonologists, emergency room physicians and hospital pharmacists). All were invited to answer an electronic questionnaire of 31 questions using a Likert scale (1, strongly disagree—4, strongly agree) in two rounds. A consensus was considered to have been reached when at least 70% of the panellists answered strongly agree/disagree on a recommendation. Any recommendation that did not obtain ≥70% agreement/disagreement was regarded. Results According to the experts’ opinions based on clinical daily practice, a positive Delphi consensus was reached on the following statements: a VTE diagnosis has an impact on quality of life (75%), adherence to anticoagulant treatment of VTE in cancer patients is critical (96%) and lack of adherence increases the recurrence of VTE (89%). A majority agreement was achieved for two statements: no instruments to measure quality of life in cancer patients with VTE are used (67%) and adherence to anticoagulant treatment of cancer patients with VTE is evaluated in clinical practice (56%). The experts agreed that low molecular weight heparin (LMWH) offered better compliance (33%). Conclusion Expert consensus was reached about a VTE diagnosis having a negative impact on quality of life, adherence to treatment is important (because lack of adherence increases recurrence of VTE in cancer patients) and treatment with LMWH could increase adherence to treatment in patients with cancer associated thrombosis. No conflict of interest

Introduction and objectives Although the diagnostic accuracy of CT in the non-invasive assessment of coronary arteries and grafts is known to be high, only a few studies have investigated the technique's reliability for the combined assessment of native coronary arteries, grafts, and vessels lying distal to anastomoses. The aim of this study was to evaluate the diagnostic accuracy of 64-slice CT for assessing coronary grafts and native coronary arteries. Methods In the study, 64-slice CT was used to evaluate 36 patients who had undergone coronary artery bypass graft surgery and had a clinical indication for angiographic graft assessment. The diagnostic accuracy of CT for identifying significant lesions in grafts and native coronary arteries was determined and compared with that of invasive coronary angiography. Results Of the 103 grafts studied (49 arterial and 54 venous), 96 (93.2%) could be visualized by angiography and 98 (95.1%) by CT. The sensitivity and specificity of CT for detecting significant lesions in grafts were 100% (30/30) and 97% (64/66), respectively, and the positive predictive value (PPV) and negative predictive value (NPV) were 94% and 100%, respectively. For non-revascularized coronary arteries (258 segments), the sensitivity, specificity, PPV and NPV were 94%, 95%, 80%, and 99%, respectively, and for distal vessels, 86%, 97%, 67%, and 99%, respectively. Conclusions The diagnostic accuracy of 64-slice CT for evaluating both coronary grafts and native coronary arteries was high.

Introduccion y objetivos Aunque la tomografia computarizada (TC) multidetector muestra una elevada exactitud diagnostica en la valoracion no invasiva de las arterias coronarias e injertos, son escasos los trabajos que valoren su fiabilidad en el estudio conjunto de vasos nativos, injertos y vasos distales a las anastomosis. El objetivo de este estudio es valorar la exactitud diagnostica de la TC de 64 detectores en la valoracion de injertos coronarios y arterias coronarias nativas. Metodos Se estudia con TC de 64 detectores a 36 pacientes revascularizados quirurgicamente e indicacion clinica de evaluacion angiografica de sus injertos. Se analizo la exactitud diagnostica de la TC para la deteccion de lesiones significativas en los injertos y coronarias nativas comparando sus resultados con los de la coronariografia invasiva. Resultados De los 103 injertos referidos (49 arteriales y 54 venosos) se visualizaron 96 (93,2%) por coronariografia y 98 (95,1%) por TC. Los valores diagnosticos para los injertos mostraron una sensibilidad del 100% (30/30) y especificidad del 97% (64/66) y valores predictivos positivo (VPP) y negativo (VPN) del 94 y el 100%, respectivamente. Respecto a los vasos nativos no revascularizados (258 segmentos), se obtuvo sensibilidad del 94%, especificidad del 95%, VPP del 80% y VPN del 99%. La sensibilidad y la especificidad de la valoracion de vasos distales fueron del 86 y el 97% respectivamente, con VPP del 67% y VPN del 99%. Conclusiones La TC de 64 detectores presenta una alta exactitud diagnostica en la valoracion de los injertos coronarios y arterias coronarias nativas.

Aims We evaluated the ability of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) to identify acute new-onset heart failure (HF) with left ventricular systolic dysfunction (LVSD), whether or not in relation to underlying coronary artery disease (CAD), in patients with no clinical evidence of associated ischaemic cardiomyopathy. Methods and results Hundred consecutive patients admitted with acute new-onset decompensated HF and EF ,40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis � 70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80‐91) and specificity of 92.4% (95% CI, 87‐96), respectively, with a negative predictive value of 96% (95% CI, 90‐99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814‐0.998). Conclusion In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.

Objetivo: Comparar la evolución durante el ingreso y a largo plazo de pacientes con choque cardiogénico de origen isquémico. Método: Estudio observacional prospectivo unicéntrico llevado a cabo en la unidad coronaria de un hospital terciario manejada por cardiólogos. Se incluyen pacientes con choque cardiogénico de origen isquémico que recibieron revascularización coronaria precoz. Dividimos a los pacientes en 2 grupos: mayores de 75 anos (grupo A) y menores (grupo B), y comparamos la evolución durante el ingreso y en un seguimiento máximo de 4 años. El objetivo principal fue estimar la mortalidad a los 4 años. El objetivo secundario se definió como la mortalidad intrahospitalaria. Resultados: Incluimos a 97 pacientes, 44 del grupo A (45%). Los pacientes del grupo B eran con más frecuencia varones (81 vs. 57%, p = 0.014), diabéticos (49 vs. 21%, p: 0.006) y fumadores (39.6 vs. 4.5%, p < 0.05). La mortalidad hospitalaria fue superior en el grupo A (54.5 vs. 30.2%, p = 0.022). El objetivo principal ocurrió en 32 pacientes del grupo A frente a 20 del grupo B (73 vs. 38%, p = 0.007). Conclusión: El choque cardiogénico de origen isquémico en paciente mayores de 75 anos presenta una alta mortalidad durante la estancia hospitalaria y en el seguimiento a largo plazo.

A previously healthy 36-year-old male was admitted with acute onset chest pain and elevated levels of cardiac enzymes (CK/MB 248/25ng/dl and TnI 7.16ng/dl). He denied use of cocaine or other illicit drugs. Clinical history was negative for recent flu-like syndrome. Physical examination is unremarkable. ECG showed Q wave in lead III with T wave inversion (Figure 1A). An echocardiogram showed a structurally normal heart with no wall motion abnormalities. He had the abrupt recurrence of severe chest discomfort 12 hours later associated with ST segment elevation in I and aVL (Figure 1B). Symptoms were relieved after administration of intravenous nitroglycerin and ECG changes suddenly resolved. Urgent coronary angiography revealed normal coronary arteries, despite slow flow in the left anterior descending artery. The patient was diagnosed with AMI type 2 secondary to probably coronary artery spasm. Cardiac enzymes peaked at CK/MB 2107/147 and TnI 71. On day 4 a cardiac magnetic resonance (CMR) showed normal first pass and areas of subepicardial contrast enhancement in all segments except in the lateral wall at basal level and septal midventricular consistent with extensive myocarditis (Figure 1C).

To compare the prognosis during hospitalization and maximum follow-up of 4 years in patients with myocardial infarction complicated with cardiogenic shock.Prospective observational study practiced in a coronary Care Unit managed by cardiologists. We included patients with myocardial infarction complicated with cardiogenic shock who received early coronary revascularization. Patients were divided into two groups: older than 75 years (group A) and lower (group B), and we compared the evolution during hospitalization and maximum follow-up of 4 years. Primary end point was mortality rate in the maximum follow-up of 4years. Secondary end point was mortality rate during hospitalization.Ninety-seven patients were included, 45% Group A. Patients of Group B were mostly men (81% vs. 57%; P=.014), diabetics (48% vs. 21%; P=0.006), and smokers (39.6% vs. 5%). Mortality rate during hospitalization was higher in Group A (54.5%) vs. 30.2% in Group B (P=.022). Mortality rate during follow-up (primary variable) was 73% in Group A vs. 38% in Group B (P=.007).Myocardial infarction complicated with cardiogenic shock in elderly patients is an entity with high mortality during hospitalization and continues to worsen during long term follow-up.

[EN] Introduction and objectives: To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. Methods: Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. Results: The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. Conclusions: Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance. © 2012 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved., [ES] Introducción y objetivos Evaluar la capacidad de la tomografía computarizada con multidetectores en el diagnóstico de la disfunción ventricular izquierda de origen coronario y valorar su exactitud diagnóstica comparándola con la combinación de coronariografía invasiva y resonancia magnética. Métodos Se estudió a 40 pacientes consecutivos con disfunción ventricular izquierda de origen no filiado mediante coronariografía invasiva y resonancia con contraste. A todos ellos se les realizó además un estudio de tomografía computarizada con multidetectores incluyendo presencia de calcio coronario y su cuantificación, coronariografía y valoración tisular del miocardio. Resultados La sensibilidad y la especificidad de la presencia de calcio coronario para identificar la disfunción ventricular izquierda de origen coronario fueron del 100 y el 31% respectivamente. Si se considera un score de calcio por Agatston > 100, la especificidad sube al 58% manteniendo la sensibilidad del 100%. Los valores de sensibilidad y especificidad de la coronariografía por tomografía computarizada con multidetectores fueron del 100 y el 96% respectivamente; para la identificación de áreas de necrosis en la adquisición precoz, del 57 y el 100% y en la adquisición tardía, del 84 y el 96%. Para identificar a los pacientes coronarios con necrosis, la sensibilidad y la especificidad fueron del 92 y el 100% respectivamente. Conclusiones De todas las herramientas diagnósticas disponibles en tomografía computarizada con multidetectores, la coronariografía es la que muestra mayor exactitud diagnóstica para determinar el origen coronario de la disfunción ventricular. La combinación del estudio coronariográfico y el estudio tisular del miocardio tras el contraste permite obtener en un solo examen información similar a la de la combinación de cateterismo y resonancia con contraste.

[EN] Introduction and objectives To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. Methods Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. Results The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. Conclusions Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance., [ES] Introducción y objetivos Evaluar la capacidad de la tomografía computarizada con multidetectores en el diagnóstico de la disfunción ventricular izquierda de origen coronario y valorar su exactitud diagnóstica comparándola con la combinación de coronariografía invasiva y resonancia magnética. Métodos Se estudió a 40 pacientes consecutivos con disfunción ventricular izquierda de origen no filiado mediante coronariografía invasiva y resonancia con contraste. A todos ellos se les realizó además un estudio de tomografía computarizada con multidetectores incluyendo presencia de calcio coronario y su cuantificación, coronariografía y valoración tisular del miocardio. Resultados La sensibilidad y la especificidad de la presencia de calcio coronario para identificar la disfunción ventricular izquierda de origen coronario fueron del 100 y el 31% respectivamente. Si se considera un score de calcio por Agatston >100, la especificidad sube al 58% manteniendo la sensibilidad del 100%. Los valores de sensibilidad y especificidad de la coronariografía por tomografía computarizada con multidetectores fueron del 100 y el 96% respectivamente; para la identificación de áreas de necrosis en la adquisición precoz, del 57 y el 100% y en la adquisición tardía, del 84 y el 96%. Para identificar a los pacientes coronarios con necrosis, la sensibilidad y la especificidad fueron del 92 y el 100% respectivamente. Conclusiones De todas las herramientas diagnósticas disponibles en tomografía computarizada con multidetectores, la coronariografía es la que muestra mayor exactitud diagnóstica para determinar el origen coronario de la disfunción ventricular. La combinación del estudio coronariográfico y el estudio tisular del miocardio tras el contraste permite obtener en un solo examen información similar a la de la combinación de cateterismo y resonancia con contraste., This work was supported in part by a grant from the Fundacion Espanola del Corazon and Fuente Liviana 2009 of Sociedad Espanola de Cardiologia. F. Ridocci received assistance from the Instituto de Salud Carlos III Research Activity Intensification Programme 2010.

A 78-year-old man was referred to our hospital because of new onset weakness and distended jugular veins; as background, history of valvular rheumatic disease with mitral and tricuspid valve replacement by mechanical prostheses in 2002 (in revisions at outpatient department of cardiology the patient had remained stable and with correct levels of …