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Objective: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia., Material and Methods: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug., Results: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p=0.001). No severe adverse effects were observed., Conclusion: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests., (Copyright © 2019 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Objective: To compare the accuracy of two cine-gradient-echo sequences to quantify left ventricular function, volumes, and mass in an animal model., Material and Methods: We studied ten Gottingen miniature pigs (seven male, three female; mean weight 49.8+/-10.65kg; range: 35-65kg) with a 1.5 Tesla MRI scanner using free-breathing SSFP and FLASH sequences. We used 8-mm short-axis images to estimate left ventricular ejection fraction (EF), volumes (end-diastolic (EDV), end-systolic (ESV), and stroke volume (SV)), mass, and signal-to-noise ratio (SNR) on SSFP and FLASH sequences. We analyzed the correlation and concordance of the two sequences for each variable., Results: Using the SSFP sequence, the mean estimated EF was 77.35+/-3.13%; mean EDV 61.55+/-8.64ml; mean ESV 13.83+/-1.92ml; mean SV 47.72+/-7.78ml; and mean myocardial mass 75.87+/-11.44g. Using the FLASH sequence, the mean EF was 81.87+/-2.22%; mean EDV 55.4+/-8.08ml; mean ESV 10.03+/-1.87ml; mean SV 45.38+/-6.83ml; and mean myocardial mass 87.74+/-15.21g. The correlation between SSFP and FLASH to quantify EDV, SV, and myocardial mass was excellent (r>0.8) and moderate (r>0.4) for quantifying ESV and EF. The SNR in the SSFP sequence was significantly higher than in the FLASH sequence (mean difference 120.94+/-42.94)., Conclusions: In the SSFP sequence, ventricular volumes are slightly higher and ventricular mass is slightly lower than in the FLASH sequence, probably because of the higher SNR on SSFP sequences.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

One of the fields of medicine that has raised the most expectations in recent years is cell therapy with stem cells. The isolation of human embryo cells, the apparent and unexpected potentiality of adult stem cells and the development of gene therapy lead us to imagine a hopeful future for a significant number of diseases that are at present incurable. In this article we will sketch out the panorama of stem cell research, describing the main achievements in this field as well as some of the questions that await an answer. In spite of the great expectations, it is essential that we maintain a critical and realistic spirit when it comes to analysing the scientific advances in this area.

The aim of this study was to assess the relationship between total plasma homocysteine (tHC) and several markers of endothelial function, coagulation, and pro-inflammatory status in renal transplant recipients. Our own previous study demonstrated the efficacy of folic acid (FA) and vitamin B(12) (B(12)) treatment to reduce tHC. Using 70 stable recipients, 56 of whom showed hyperhomocisteinemia (HHC) (tHC > or = 14 micromol/L) and a control group (n = 14, tHC < 14 micromol/L), we treated 29 patients in the HHC group (10 mg FA and 500 mg B(12) daily) and determined their endothelial function, inflammatory activity, and coagulation status. We assessed plasma levels of von Willebrand Factor and fibrinogen as the prothrombotic profile and C-reactive protein and plasma albumin as inflammation markers. We performed Doppler sonography of the brachial artery to assess endothelial function. The mean value of plasma tHC of 19.05 +/- 3.70 micromol/L before treatment decreased to 13.45 +/- 3.25 micromol/L after 3 months of treatment (P < .001). The vWF was significantly correlated with tHC (P < .05) and was higher in the HHC patients (P < .05). The fibrinogen mean level was also significantly higher in HHC patients (P < .05). The C-reactive protein level was significantly higher and the albumin level was lower among patients with HHC. The endothelium-dependent dilation (EDD) correlated with baseline tHC (P < .05). In preliminary data we observed that homocysteine-lowering therapy may provide cardiovascular protection by enhancing endothelial function, limiting oxidative stress, and reducing procoagulation status.

Atrial fibrillation, atrial flutter, paroxistical supraventricular tachycardias and atrial tachycardias are the main supraventricular arrhythmias. Atrial fibrillation is the most common. In this review we comment their physiopathology, clinical manifestations, and treatments, paying special attention to the possible esmolol applications.