Biomedical subjects
Publications and source records attributed to Luis Alonso-Pulpón.
Cardiac Magnetic Resonance (CMR) imaging has recently become a very useful tool in the diagnosis of myocarditis. We describe a patient in whom acute myocarditis was presented as an acute myocardial infarction and had an atypical course with rapid normalization of ECG abnormalities. In this case CMR imaging was essential to confirm the diagnosis of myocarditis.
BACKGROUND: Antilymphocytic antibodies have been long used for the prevention of acute rejection early after heart transplantation (HTx), but their adverse effects have limited their widespread use. Our aim was to evaluate the safety, tolerability, and efficacy of the novel anti-CD25 antibody basiliximab (BAS) compared with muromonab (OKT3). PATIENTS AND METHODS: In this multicenter study, 99 patients were randomly assigned to receive either BAS or OKT3 in the early post-HTx period. The primary endpoint was safety and tolerability. Specific safety variables were predefined for a better comparison of adverse effects. Secondary endpoints concerning anti-rejection efficacy were also evaluated. RESULTS: No adverse events related to study medication were found in the BAS group, whereas 23 were observed among patients receiving OKT3 (P<0.0001). The proportion of patients with predefined adverse events day 4 post-HTx was much higher with OKT3 than with BAS (43% vs. 4%; P<0.0001). Fever, acute pulmonary edema, hypotension, and other complications accounted for most of the difference. At 1-year follow-up, biopsy-proven rejection episodes grade>or=3A had occurred in 39.6% of BAS patients versus 40.4% of OKT3 patients (P=0.87). There were no differences in terms of severity and timing of acute rejection episodes. The number of infectious episodes, complications not related to study medication, and actuarial survival were similar in both groups. CONCLUSION: In this HTx study, induction therapy with BAS was safer and better tolerated than OKT3, without significant differences in efficacy outcomes.
Cardiac allograft vasculopathy remains one of the main causes of morbidity and mortality after heart transplantation, although its impact is becoming somewhat smaller as prophylactic measures are implemented. Advances in the understanding of the molecular and cellular mechanisms involved in the genesis and development of cardiac allograft vasculopathy are opening ways for new diagnostic and therapeutic strategies. Successful prophylaxis of the early stages of the disease has been demonstrated with the use of newer immunosuppressive agents, such as sirolimus and everolimus, that will probably be included in future protocols. For most patients with established cardiac allograft vasculopathy, currently available revascularisation methods and retransplantation are not appropriate options. Antiproliferative agents could provide significant improvement in terms of symptom relief and prognosis, but their definite value must be proven in well-designed trials.
INTRODUCTION AND OBJECTIVES: Ectopic activity originating inside the pulmonary veins has been associated with paroxysmal atrial fibrillation in some patients. However, the roles played by the pulmonary veins and the posterior wall of the left atrium in maintaining atrial fibrillation are not well understood. METHODS: Our aim was to determine whether there is a correlation between the refractory period of either the lateral wall of the right atrium, the lateral wall of the left atrium, the posterior wall of the left atrium, or the pulmonary veins, and the inducibility of atrial fibrillation in an experimental swine model. We assessed atrial fibrillation inducibility using programmed atrial stimulation before and after intravenous administration of a high dose of methacholine in 20 pigs. RESULTS: Atrial fibrillation was induced in 17 out of the 20 pigs. Univariate analysis showed that there were negative correlations between all refractory periods and atrial fibrillation inducibility. A short refractory period was associated with greater inducibility. In the multivariate analysis, only the refractory periods of the posterior wall of the left atrium and the pulmonary veins were associated with inducibility. We also investigated the relationship between the local atrial fibrillation cycle length and refractory period; the only significant correlation was with the refractory period of the lateral wall of the right atrium (Pearson correlation coefficient 0.97). CONCLUSIONS: In an experimental swine model, the inducibility of atrial fibrillation was found to be associated with the refractory periods of both the pulmonary veins and the posterior wall of the left atrium.
Planning cardiology provision in Spain requires knowledge of the resources available and the demand, both now and in the future. In this report, we present the results of a study carried out by the Spanish Society of Cardiology on the availability of and demand for cardiologists in the country. The current situation is characterized by an imbalance of around 14% between the number of active cardiologists and the estimated number required. The demographic distribution of cardiologists shows that they are predominantly male and middle-aged. Expectations are that the situation will get worse until the year 2020. To correct this imbalance, alternative forms of training or clinical department organization, or both, are required. Some possible alternatives are presented in the final part of this document, as proposals for open discussion.
BACKGROUND: Several authors have demonstrated the existence and implications of re-innervation in the transplanted heart. Our aim was to study this phenomenon using 3 different techniques and to analyze the correlation among them. METHODS: The study population consisted of 55 patients who had undergone heart transplantation 0.5 to 160 months earlier. We used a control group of 10 healthy individuals for comparison. To detect re-innervation, we used 1) planar and single photon emission computed tomography (SPECT) scintigraphic imaging of cardiac sympathetic activity with 123I-metaiodobenzylguanidine (MIBG), 2) analysis of heart-rate variability based on 24-hour Holter recordings; and 3) immunohistochemical study of endomyocardial biopsy specimens with anti-S100 antibody. RESULTS: The SPECT images showed evidence of sympathetic re-innervation in 17 patients (31%), predominantly in the anterior and in the septal regions of the left ventricle. Sympathetic activity increased during the post-transplant time course (r = 0.32; p = 0.017), although it did not reach normal values. We found a correlation between the low-frequency component of heart-rate variability (a marker of sympathetic activity) and the degree of MIBG uptake according to scintigraphy (r = 0.32; p = 0.015). Immunostaining study demonstrated the existence of nerve fibers in 36 patients (65%) who had greater values of heart-rate variability parameters reflecting parasympathetic activity. CONCLUSIONS: The 3 techniques evidenced re-innervation after heart transplantation. A correlation exists between sympathetic activity detected using MIBG scintigraphy and analysis of heart-rate variability. Patients in whom endomyocardial biopsy specimen reveals the presence of nerve fibers show more parasympathetic activity in the heart-rate variability analysis.
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