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Diabetes is a source of significant morbidity and mortality resulting from long-term micro- and macrovascular complications after coronary angioplasty in patients with ACS. Optimal pre-procedural glycaemic control and inhibition of intimal hyperplasia would reduce or impede re-stenosis, resulting in better clinical results.

Available data from controlled clinical trials comparing different drug classes seem to indicate a similar benefit in preventing cardiovascular morbidity and mortality in hypertensive patients. Although some differences in secondary end-points were detected, the overall benefit of various antihypertensive regimens seems to be linked to the extent of BP reduction. The cost of antihypertensive drugs (cost minimisation) is not an overwhelming consideration until cost-benefit analyses are correctly performed. Moreover, although the cost of drugs should be taken into account both for individual patients and for the health provider, cost considerations should not predominate over those of efficacy and tolerability in individual patients.

We therefore believe that liberality of choice among various antihypertensive drugs could offer an appropriate possibility of selecting the right drug for the right patient in order to achieve BP control, a goal which often requires rational combinations of antihypertensive drugs.

In November 2003 the American College of Cardiology (ACC) and the European Society of Cardiology (ESC) published in the an expert consensus document on hypertrophic cardiomyopathy (HCM) to inform practitioners about the state of the art in managing this particular disease [1]. HCM is a genetic disease which can cause sudden cardiac death (SCD), particularly in young people (including athletes). As HCM is uncommon (1:500 in the general population) [2], many cardiologists do not see many patients with this disease, and may therefore have some difficulty in managing the cases of the patients they do see.

This document has been written by specialists with extensive experience of managing HCM. However, the statements and treatment strategies put forward by the panel are very cautious owing to the considerable difficulties involved in reaching conclusions: (1) because the disease is uncommon, the available data are relatively limited; (2) HCM has a broad disease spectrum, so individual patients may have very different risk profiles; (3) large-scale controlled and randomised study designs (as in coronary artery disease) are not available. Consequently most information derives from non-randomised and retrospective studies.

Although rare and uncommon, sudden cardiac death (SCD) in young competitive athletes is a devastating event [1–18]. The identification of potential mechanisms precipitating SCD may help to prevent future events in athletes with similar conditions [1, 3, 13, 16].

ARVD is part of the group of cardiomyopathies characterised pathologically by fibrofatty replacement of the right ventricular myocardium and clinically by right ventricular arrhythmias of the LBBB pattern. Pathogenesis, prevalence, and aetiology are yet not fully known. The diagnosis of ARVD is based on the presence of structural, histological, electrocardiographic, and genetic factors. Therapeutic options include antiarrhythmic medication, catheter ablation, implantable cardioverter defibrillation, and surgery. Angiography and echocardiography lack sensitivity and specificity in the diagnosis of ARVD. MR imaging allows a three-dimensional evaluation of especially the right ventricle, and provides the most important anatomical, functional, and morphological criteria for diagnosis of ARVD within one single study. Although demonstration of morphological/functional abnormalities of the right ventricle, especially fat in the right ventricular myocardium, shows high specificity but low sensitivity, MR imaging appears to be the optimal imaging technique for detection and follow-up of clinically suspected ARVD. Positive MR imaging findings, based on the criteria of McKenna et al. [16], should be used as important additional criteria in the clinical diagnosis of ARVD, although negative MR imaging findings do not rule out ARVD.

Patients with SSS should be implanted with a dual-chamber pacemaker. Alternative sites appear superior to the traditional right appendage site since they improve atrial synchrony and may reduce AF recurrences. The hig percentage of ventricular pacing in DDD mode in all studies is a common pitfall comparing physiological pacing and VVI mode is characteristic of a common pitfall: ventricular pacing has a deleterious effect on both atrial and ventricular function that may mask the real beneficial entity of atrial pacing. New pacing site in the right ventricle and use of algorithms to minimise ventricular pacing is likely to lead to more consistent positive results. In conclusion, data from the literature suggest that in patients with SSS atrial pacing from an alternative site should be used, employing algorithms to attain the highest possible percentage of atrial pacing and to reduce ventricular pacing as much as possible.

L’angiografia coronarica costituisce ancora oggi la metodica diagnostica di riferimento nello studio del circolo coronarico nativo e dei controlli degli interventi di rivascolarizzazione coronarica, sia chirurgica (confezionamento di bypass) che tramite procedure interventistiche (angioplastica percutanea-PTCA e ).

The decision to implant a pacemaker needs to be kept in the clinical context of a benign condition which frequently affects young patients. Thus, cardiac pacing should be limited as the last-resort choice to a very selected small proportion of patients affected by severe vasovagal syncope. How to select these patients still remains partly uncertain.

In November 2003 the American College of Cardiology (ACC) and the European Society of Cardiology (ESC) published in the an expert consensus document on hypertrophic cardiomyopathy (HCM) to inform practitioners about the state of the art in managing this particular disease [1]. HCM is a genetic disease which can cause sudden cardiac death (SCD), particularly in young people (including athletes). As HCM is uncommon (1:500 in the general population) [2], many cardiologists do not see many patients with this disease, and may therefore have some difficulty in managing the cases of the patients they do see.

This document has been written by specialists with extensive experience of managing HCM. However, the statements and treatment strategies put forward by the panel are very cautious owing to the considerable difficulties involved in reaching conclusions: (1) because the disease is uncommon, the available data are relatively limited; (2) HCM has a broad disease spectrum, so individual patients may have very different risk profiles; (3) large-scale controlled and randomised study designs (as in coronary artery disease) are not available. Consequently most information derives from non-randomised and retrospective studies.

Effective haemodynamic sensing would open the way to the autoregulation of a number of pacemaker functions, which could thus be integrated into a single control system. The TVI sensor can be proposed to play this crucial role, allowing the assessment of systolic and diastolic modifications in ventricular volume by means of conventional pacing leads.