The significance of the high-sensitivity C-reactive protein (hs-CRP) level in percutaneous coronary interventions (PCIs) is unclear. Troponin-T and hs-CRP levels were measured before PCI, after stenting, and 8 h, 24 h, and 30 days after the procedure in 68 consecutive patients who received bare-metal stents. The study endpoints were death, nonfatal myocardial infarction, and the need for revascularization. The mean follow-up time after PCI was 16.6 months. Patients who experienced an event had higher hs-CRP levels 24 h (P=.05) and 30 days (P<.02) after stenting. The area under the receiver operating characteristic (ROC) curve at 30 days had the highest sensitivity (i.e., 80%) and specificity (i.e., 72%) for predicting an event. The 12-month event-free survival rate (Kaplan-Meier) was greater when the hs-CRP level at 30 days was <= 2.5 mg/L than when it was above this value (P=.04). Consequently, measuring the hs-CRP level 30 days after stenting may be useful for predicting late events.

La proteina C reactiva de alta sensibilidad (PCR-as) tiene un valor incierto en el intervencionismo coronario percutaneo (ICP). En 68 pacientes consecutivos tratados con stents metalicos, se determinaron PCR-as y troponina T pre-ICP, post-stent, a las 8 h, a las 24 h y a los 30 dias. Los objetivos finales fueron muerte, infarto de miocardio y nueva revascularizacion. El seguimiento medio post-ICP fue 16,6 meses. Los pacientes con eventos tuvieron PCR-as mas alta a las 24 h (p = 0,05) y a los 30 dias (p

Cardiac transplantation is the definitive treatment for eligible patients with end-stage cardiomyopathy. Post-transplant survival rates have improved with the use of new immunosuppression protocols, based on the use of calcineurin inhibitors (CI), cyclosporine A (CsA) or FK506. Cardiac allograft rejection is no longer the limiting factor for early survival, however nephrotoxicity limits their therapeutic benefit. It has been suggested that the nephrotoxic effects of these drugs are mediated via inhibition of phosphatase calcineurin. Sirolimus (SRL) is a new immunosuppressant and antiproliferative drug which is structurally related to FK506. While it retains a pharmacokinetic and drug interaction profile similar to that of CI, it has no effect on calcineurin and does not alter glomerular filtration rate produced with CI [1]. Information on the use of SRL in cardiac transplantation is limited to a few published cases in which it has been used to control refractory rejection [2] or advanced renal failure associated to CI, showing that its use makes it possible to decrease CI dosage [3]. We present a case in which SRL was used during the early postoperative course of a cardiac transplantation as an alternative to CI because of renal failure, thus avoiding a combined heart–renal transplantation (HRT) in the patient. A 58-year-old man was referred to our hospital for evaluation of a cardiac transplantation because of hypertensive dilated cardiomyopathy in advanced clinical status [New York Heart Association (NYHA) functional class III–IV] refractory to medical treatment. The pretransplantation study showed moderate chronic renal failure with creatinine plasma levels around 2 mg/dl (creatinine clearance: 35 ml/min). The renal biopsy established the diagnosis of nephroangiosclerosis. The nephrologist did not consider combined HRT indicated, thus an orthotopic cardiac transplantation was performed. Immunosuppressive induction treatment was performed with daclizumab (1 mg/kg i.v., 5 doses) and steroids (500 mg i.v. intraoperative, 3 i.v. doses of 125 mg in the first 24 h) and the maintenance immunosuppressive treatment was performed with mycophenolate mofetil (2 g/day p.o., target level: 4.5 μg/ml), steroids (0.8 mg/kg/day p.o.) and FK506 (0.075 mg/kg/day p.o., target level: 12–15 ng/ml). After FK506 was initiated on the fifth day, with plasma levels of 17.5 ng/ml for a dose of 3 mg/day and a baseline creatinine of 2,2 mg/dl the patient developed oligoanuric renal failure, requiring replacement renal therapy and discontinuation of FK506 5 days later, recovering renal parameters progressively (creatinine of 2 mg/dl). Sirolimus was introduced on the 14th day (5 mg/day, target level: 8–12 ng/ml) as first line immunosuppressant agent. During the 6-month follow-up, the patient maintained renal function with creatinine levels similar to baseline (<2 mg/dl) and the cardiac biopsy results were: 0 (at 15 days), 3A (at 1 month), 0 (at 2 months), 0 (at 3 months), 1B (at 5 months), 0 (at 6 months) with SRL plasma levels of 11, 8.9, 22, 24.5, 4.9 and 10.8 ng/ml respectively. The patient did not present any infectious symptoms and cytomegalovirus antigenemias was negative. The present case demonstrates that SRL is an effective and safe immunosuppressant agent. This strategy made it possible to avoid a combined HRT.

BACKGROUND AND OBJECTIVE:The prevalence and morbidity of the vaso-vagal syncope are well-known. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure.PATIENTS AND METHOD:All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test.RESULTS:Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients.CONCLUSIONS:In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Son conocidas la prevalencia del síncope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administración de la versión española del Cuestionario de Salud SF-36 en esta población con los valores de la población general y de pacientes con insuficiencia cardíaca. Además se ha analizado la influencia de diversos parámetros clínicos. Se incluyó consecutivamente a todos los pacientes con síncope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contestó previamente a la realización del test. Se calcularon los valores utilizando estadísticos apropiados a la distribución de la muestra, se analizaron según la edad y el sexo, y se correlacionaron con diversos parámetros clínicos. Se incluyó a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardíaca. En el varón sólo 4 dimensiones del SF-36 fueron inferiores a la población general, y en la mujer lo fueron las 8. La mujer tuvo peor percepción de su CVRS que el varón (p < 0,05). La edad influyó negativamente en todas las dimensiones del SF-36, sobre todo en la mujer. El número de síncopes fue el parámetro clínico que más se relacionó con la CVRS. En nuestra serie, los pacientes con síncope vasovagal tienen peor CVRS respecto a la población general de referencia y similar a la que sufre insuficiencia cardíaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el número de síncopes es el parámetro clínico que mejor se correlaciona con la CVRS. The prevalence and morbidity of the vaso-vagal syncope are wellknown. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure. All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test. Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients. In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Ante la ausencia de un protocolo estandarizado y único, presentamos un análisis de 1.661 pacientes consecutivos remitidos para estudio con test de tabla basculante (TTB) desde septiembre de 1990 y analizamos la influencia de la edad y el sexo en sus resultados utilizando 3 protocolos: Westminster, isoproterenol y nitroglicerina (grupos A, B y C). La proporción de mujeres es mayor en el grupo de menor edad. El TTB fue positivo en 592 pacientes. El porcentaje de respuestas positivas (RP) fue más bajo en el grupo A que en los grupos B y C. En los grupos A y C, éste se redujo con la edad a expensas de las RP mixtas, pero no en el grupo B. Los porcentajes de cada tipo de RP son similares en los grupos A y C, y diferentes en el grupo B, sin que el sexo influya en este resultado. Existe una gran similitud entre los protocolos A y C, pero este último obtiene un mayor porcentaje de RP. Because of the absence of a uniform protocol for the head-up tilt table test (HUT), we compared 1,661 consecutive patients with syncope referred for HUT. The influence of age and gender on the results (positive response rate and patterns) obtained with three different protocols, Westminster, isoprenaline and nitroglycerin (groups A, B and C) was analyzed. The proportion of women was larger in the youngest age group. A positive response to HUT was observed in 592 patients. The positive response rate to the HUT was higher in groups B and C than in group A, and the rate diminished with age in groups A and C, because of the decrease in mixed-positive responses, but not in group B. The rate of positive responses was similar in groups A and C, but different in group B; no influence of gender on these results was observed. The results with the Westminster and nitroglycerin protocols were similar, but the rate of positive responses was higher in the latter.