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Prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) assays have been assessed in selected populations in different studies and in registries of members of the general population with low cardiovascular risk. The aim of this study was to determine the prognostic value of hs-cTnT in an asymptomatic very-high cardiovascular risk Spanish population.From a previous prospective cohort of the TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow-up was conducted in 602 patients (93.18%). The association of high hs-cTnT (≥99th percentile value) and incidence of primary event was studied. A primary event was defined as a combined major cardiovascular event (incidence of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction, or coronary revascularization). The association between high hs-cTnT and incidence of secondary events was studied as well.In patients with high hs-cTnT, the incidence of primary event during follow-up was significantly higher (18.30% vs 3.67% P.001): heart failure (6.25% vs 0.73% P.001), cardiovascular death (7.29% vs 0.00% P.001), and death from any cause (7.81% vs 0.98% P.001).In an asymptomatic very-high cardiovascular risk Spanish population, elevated hs-cTnT was significantly associated with incident major cardiovascular combined end point and incidence of heart failure, cardiovascular death, and death from any cause.

High-sensitivity troponin T assays (Hs-TnT) have been carried out in selected populations in clinical trials and in registries of the general population with low cardiovascular risk (CVR). The aim of this study was to determine the proportion of individuals with detectable Hs-TnT and the proportion of individuals with elevated Hs-TnT in a Spanish population of asymptomatic individuals with very high CVR, as well as the parameters associated with Hs-TnT elevation.The study included 690 patients. Hs-TnT detection and Hs-TnT elevation (≥99th percentile value), as well the association of elevated Hs-TnT and clinical, analytical, and treatment data were analyzed.Hs-TnT was analyzed in 646 patients and was detected in 645. Elevated TnT was detected in 212 patients (32.9%). On multivariate analysis, elevated TnT was independently associated with male sex (OR, 2.81; 95%CI, 1.67-4.73; P .001), older age (OR, 1.06; 95%CI, 1.04-1.09; P .001), a higher body mass index (OR, 1.07; 95%CI, 1.02-1.12; P .002), insulin therapy (OR, 1.99; 95%CI, 1.15-3.46; P = .01), history of heart failure (OR, 3.92; 95%CI, 1.24-12.39; P = .02), and estimated glomerular filtration rate calculated by CKD-EPI (OR, 0.96; 95%CI, 0.95-0.97; P .001).In a Spanish population of asymptomatic individuals at very high CVR, Hs-TnT was associated with older age, male sex, higher body mass index, insulin therapy, history of heart failure, and lower glomerular filtration rate.

Resumen Introduccion y objetivos La troponina T ultrasensible (TnT-us) se ha cuantificado en poblaciones de ensayos clinicos y en registros poblacionales de bajo riesgo cardiovascular (RCV). El objetivo del estudio es determinar en que proporcion de la poblacion espanola asintomatica de muy alto RCV se puede cuantificar la TnT-us, que proporcion presenta TnT-us elevada y que variables se asocian con la presencia de TnT-us elevada. Metodos Se incluyo a 690 pacientes. Se analizo la deteccion de la TnT-us y de la TnT-us elevada (≥ percentil 99 de referencia) y su asociacion con las diferentes variables recogidas. Resultados Se analizo la TnT-us en 646 pacientes y se detecto en 645. Presentaron TnT-us elevada 212 pacientes (32,9%). En el analisis multivariable, la TnT-us elevada se asocio al sexo masculino (OR = 2,81; IC95%, 1,67-4,73; p Conclusiones En una poblacion espanola asintomatica de muy alto RCV, la TnT-us se detecto practicamente en todos los pacientes, y estaba elevada en un tercio de ellos. La TnT-us elevada se asocio a mayor edad, el sexo masculino, el indice de masa corporal, la insuficiencia cardiaca previa, el tratamiento con insulina y un menor filtrado glomerular.

Fundamento y objetivo Aunque la hipertension arterial se suele asociar con alteraciones del llenado del ventriculo izquierdo (VI), el diagnostico de cardiopatia hipertensiva se basa en la demostracion del crecimiento del VI. El objetivo del presente trabajo ha sido analizar la relacion existente entre la funcion diastolica y el crecimiento del VI en la hipertension. Pacientes y metodo En 116 pacientes con hipertension arterial esencial nunca tratados se efectuo un estudio ecocardiografico (modo M, Doppler transmitral, Doppler tisular y M color). El diagnostico de disfuncion diastolica (DD) se baso en alteraciones de la velocidad del flujo transmitral, de la velocidad tisular del anillo mitral y de la velocidad de propagacion del flujo ventricular. El diagnostico de crecimiento del VI se baso en alteraciones del indice de masa ventricular izquierda y/o del grosor relativo de la pared. Resultados Noventa y cuatro pacientes (81%) presentaban DD y 22 (19%) presentaban una funcion diastolica normal. De los pacientes con DD, 79 (84%) presentaban un patron de relajacion retrasada y 15 (16%) un patron de llenado seudonormal. El crecimiento del VI estaba presente en el 41% de los pacientes sin DD y en el 75% de los pacientes con DD, diferencia que fue significativa (p Conclusiones Estos resultados indican que la DD esta presente en una gran proporcion de pacientes hipertensos. Una cuarta parte de los hipertensos presentan DD en ausencia de crecimiento del VI. Se apunta que el diagnostico de la cardiopatia hipertensiva no puede basarse exclusivamente en criterios morfologicos y ha de incluir tambien las alteraciones del llenado ventricular.

J Thorac Cardiovasc Surg Jesus Herreros Gonzalez Palazuelos Molinero, Jose Daniel Saenz de Buruaga, Alejandro Martin Trenor and Diego Martin Raymondi, Sergio Mejia Viana, Alejandro Berenguel Senen, Jorge anomalous coronary origin Supravalvular pulmonary stenosis as a late complication of surgery for http://jtcs.ctsnetjournals.org/cgi/content/full/123/6/1218 located on the World Wide Web at: The online version of this article, along with updated information and services, is

Introduction Glucose and lipid metabolism abnormalities of hypertensive patients are highly relevant due to its increase in cardiovascular risk; moreover, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) have a high risk of new-onset diabetes mellitus (DM) development. The objective of the study was to describe glucose metabolism abnormalities and the impact of mid-term weight loss. Methods A six-month prospective, observational and multicentre study of patients with hypertension was conducted. Clinical antecedents, physical examination, blood test and treatments were collected in two separated visits; conventional advice was the only intervention planned. Results A total of 1957 patients were included, mean age 66.3 (10.9) years and 59.9% males. A previous diagnosis of glucose metabolism alteration was present in 43.9% (25.5% type-2 DM, 14.8% IFG, 1.6% IFG and IGT, 1.0% IGT and 1.0% type-1 DM). An increasing pattern of cardiovascular risk and target organ damage was observed according to the categories of fasting glucose. Oral glucose tolerance test (OGTT) was carried out in 234 patients (11.9%) patients and yielded the diagnosis of IGT in 44.7% or DM in 22.4% of patients with fasting glucose >100mg/dl. Six months follow-up was achieved in 85.9% patients. A slight reduction in fasting glucose was observed in the whole cohort and patients who achieved ≥5% weight loss experienced the highest reduction in fasting glucose, LDL-c and triglycerides; moreover, 15.8% normalized their IFG. Conclusions Glucose and lipid metabolism abnormalities are highly prevalent in hypertensive patients and improve with 5% of weight lost at 6 months follow-up. OGTT is not currently extended in daily clinical practise .

Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension.One hundred and sixteen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness.Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction.These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling.

La insuficiencia cardiaca es un problema de salud pública creciente. Afecta a un 2-3% de la población mayor de 65 años y genera un gran costo sanitario. En el presente artículo, revisamos los ensayos prospectivos aleatorios que sirven como evidencia científica al tratamiento beta-bloqueante en pacientes afectos de insuficiencia cardiaca. También valoramos los diferentes beneficios que estos fármacos aportan a los parámetros hemodinámicos, así como las recomendaciones y precauciones de su uso.

Clinical Summary A 116-year-old woman came to the emergency department 36 hours after a closed thoracic trauma that had occurred when she was dropped from her horse and then was trodden on by her horse. Acute dyspnea and concomitant hemoptysis were her reasons for seeking treatment. Physical examination showed a pulse of 130 beats/min and blood pressure of 95/45 mm Hg, paleness, and erosions over the skin in the image of a horseshoe. The heart had a normal S1 and S2 sounds and grade 6/6 holosystolic murmur at the left bottom sternal border irradiating to the right bottom sternal border. There was bibasal hypoventilation with a tubaric murmur on the right thorax. Electrocardiography demonstrated elevation of the ST segment in the right leads. Biochemical testing showed a hemoglobin level of 10.3 g/dL, total creatine kinase of 222 IU/L, MB isoenzyme of creatine kinase of 7.8 (index 3.5%), and cardiac troponin I level of 13.10 ng/mL. Chest radiography (Figure 1) showed a normal cardiac size, Kerley B lines, pulmonary congestion, and bilateral pleural effusion. Computed tomographic scan showed multiple rib fractures, pulmonary contusion, and pericardial effusion. These data were compatible with a ventricular septal defect. An echocardiogram was therefore performed (Figure 2). On transthoracic apical 4-chamber view, the ventricles appeared dilated and dysfunctional and demonstrated a ventricular septal

OBJECTIVE: We investigated whether regression of left ventricular hypertrophy (LVH) in response to antihypertensive treatment is associated with plasma cardiotrophin-1 (CT-1) in hypertensive patients. METHODS: The study was performed in 47 patients with mild to moderate essential hypertension, and LVH was assessed echocardiographically. The family doctor gave antihypertensive treatment and followed all patients. LVH regression was diagnosed if the baseline left ventricular mass index (LVMI) decreased to normal values after 1 year of treatment. Plasma CT-1 was determined by an enzyme-linked immunosorbent assay. RESULTS: The LVMI was normalized in 23 patients (49%) and persisted at an abnormally increased level in 24 patients (51%) after 1 year of treatment, whereas the reduction in clinic and home blood pressure was similar in the two groups: CT-1 decreased (-48%, P < 0.005) and increased (+35%, P < 0.05) in patients in whom LVH regressed and LVH persisted, respectively. Final values of CT-1 were inversely correlated (r = 0.534, P < 0.001) with the decrease in LVMI after treatment in all patients. A significant association (chi2 = 16.87, P < 0.001) was found between normalization of CT-1 and regression of LVH with treatment. A cut-off value of 41 fmol/ml for CT-1 provided a relative risk of 43.13 (95% confidence interval, 4.88-380.48) for detecting LVH regression. CONCLUSION: These results show an association between treatment-induced decrease of plasma CT-1 and LVH regression in essential hypertension. Although preliminary, these findings suggest that the determination of plasma CT-1 may be useful for the follow-up of hypertensive heart disease in routine clinical practice.