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Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC/D) is an inherited cardiomyopathy characterized by ventricular arrhythmias and heart failure. The aim of our study was to analyze the impact of the ICD indication in the prognosis of patients with high-risk ARVC/D according to the consensus document. Methods The high-risk category includes patients who experienced cardiac arrest due to sustained ventricular tachycardia or ventricular fibrillation and patients with severe right or left ventricular dysfunction. We included 41 patients with high-risk ARVC/D: 33 in secondary prevention and 8 in primary prevention. Results We followed 41 patients during 6.37 ± 4.88 years. Twenty-six patients (63.4%) had at least one appropriate arrhythmic event: 24 p (72.7%) in secondary prevention and 2 p (25%) in primary prevention; p=0.02. Twenty-four patients (72.7%) in secondary prevention and five (62.5%) in primary prevention had a cardiovascular event such as arrhythmias, admission due to heart failure, heart transplantation or cardiovascular death. Conclusions High-risk ARVC/D patients had a high number of cardiovascular events, but their nature and treatment were different. Arrhythmic prognosis was worse in secondary prevention and most of the events found in primary prevention were related to heart failure and, therefore, without benefit of the ICD.

Resumen La influencia del genero en el manejo y pronostico del sindrome coronario agudo sin elevacion del segmento ST (SCASEST) es un tema debatido. El objetivo del estudio fue analizar la repercusion del genero en el pronostico del SCASEST, y la influencia en los resultados de una estrategia intervencionista precoz. Para ello se realizo un analisis retrospectivo de 715 pacientes ingresados consecutivamente por SCASEST entre enero de 2004 y diciembre de 2005, con una mediana de seguimiento de 24 meses. Se estudiaron variables pronosticas, realizandose un analisis ajustado de repercusion del genero y del intervencionismo precoz (

Thepresenceoflategadoliniumenhancement(LGE)incardiacmag-netic resonance (CMR), that enables quantification of myocardialfibro-sis[1],iscommoninpatientswithnonischemicdilatedcardiomyopathy(NIDC). LGE has been related to adverse clinical outcomes in patientswith NIDC, mainly in those with idiopathic dilated cardiomyopathy[1,2]. This study pretends to assess the long-term prognostic signifi-cance of LGE in an unselected population of patients with NIDC. Everyunderlying possible cause was included.Weperformed aretrospective cohortstudyinwhich64consecutiveoutpatients with heart failure secondary to NIDC were included. Allunderwent a CMR between August 2005 and November 2011. Thepresence and location of LGE were evaluated.Diagnosis was established according to the World HealthOrganization/International Society and Federation of Cardiology'sdefinition [3]. None of the patients presented previous history ofsignificant valvular disease, hypertrophic cardiomyopathy, restrictivecardiomyopathy, congenital heart disease, or coronary artery disease.PatientsunderwentCMRjustafterthediagnosisofNIDCtocompletethe diagnostic evaluation. Exclusion criteria were: cardiac pacemaker/implantable cardioverter defibrillator (ICD)/cardiac resynchronizationtherapy, renal insufficiency and severe obesity or claustrophobia.Patientswerefollowedviaclinicalvisits.Theprimaryoutcomewasacomposite endpoint of three events: cardiac death, hospitalization forheart failure and appropriate ICD firing. ICD devices were implanted insome patients after they underwent CMR.CMRimagingwasperformedona1.5Teslascanner(PhilipsMRSys-tem Achieva Release 2.6.3.7). Delayed contrast-enhanced images wereacquired 10 min after intravenous administration of 0.2 mmol/kg ofgadolinium-diethylenetriaminepentaacetate, using inversion-recoveryfast gradient-echo pulse sequences in sequential short- and long-axisslices of the left ventricle.Allstudies were analyzedby aradiologistand acardiologist usinga workstation (Extended MR Work Space 2.6.2.4.). The presence andlocation of LGE were visually assessed.Qualitativevariableswereexpressedaspercentagesandquantitativeasmean±SD.Qualitativevariableswerecomparedwiththeχ

a Seccion de Cardiologia, Unidad de Medicina Interna, Hospital de Poniente, Carretera de Almerimar s/n, 04700 El Ejido, Almeria, Spain b Area del Corazon, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Malaga, Spain c Seccion de Cardiologia, Unidad de Medicina Interna, Fundacion Hospital Calahorra, Carretera de Logrono s/n, 26500 Calahorra, La Rioja, Spain d Unidad de Cardiologia, Hospital Parque San Antonio, Avenida Pintor Joaquin Sorolla n°2, 29016, Malaga, Spain

Introduccion y objetivos La indicacion de coronariografia en pacientes valvulares es recomendada de forma rutinaria previa a la realizacion de cirugia. La seleccion se hace en funcion de la edad, sexo y presencia de angina pero no suele estar basada en los factores de riesgo. El objetivo de este estudio es valorar marcadores que permitan predecir la probabilidad de lesion coronaria en este grupo de pacientes. Pacientes y metodos Se estudio retrospectivamente una poblacion de 541 pacientes con enfermedad valvular a los que se realizo coronariografia durante el periodo 1989-1994. De ellos, 301 eran varones y 240 mujeres con una edad media de 61,8 anos (rango, 34-82). Se relaciono la presencia de lesion coronaria con las variables edad, sexo, angina, hipertension, diabetes, hipercolesterolemia, tabaco, antecedentes familiares y la presencia de angina mediante analisis de regresion logistica. Resultados En 73 pacientes existia lesion coronaria superior al 50% (13,4%). La presencia de angina se aprecio en el 34,6% de los casos. El riesgo de lesion coronaria fue definido como odds ratio: angina 3,3, tabaco 2,6, diabetes 2,2, hipertension 1,8 y edad 1,4. El resto de variables no fueron predictoras de enfermedad coronaria. La probabilidad de lesion coronaria en pacientes sin angina y ausencia de los factores de riesgo descritos como predictores es del 4%. Si ademas analizamos la edad la probabilidad de enfermedad coronaria en pacientes menores de 65 anos era del 3% para los pacientes sin angina ni factores de riesgo, en cambio la probabilidad en el mismo grupo de pacientes > 65 anos fue del 6%. Conclusiones La ausencia de angina y de al menos los tres factores de riesgo descritos como predictores (tabaquismo, hipertension y diabetes) en pacientes menores de 65 anos permite descartar la enfermedad coronaria asociada en pacientes valvulares que van a ser intervenidos quirurgicamente lo que permite obviar la coronariografia en este grupo de pacientes.

Pneumopericardium is an uncommon but potentially serious condition of which leading cause is mechanical ventilation in infants suffering respiratory distress syndrome. In adults, however, the most common causes are iatrogenic in diagnostic and therapeutic procedures, as well as traumatic lesions. We describe a case of pneumopericardium in a teenager suffering an asthma crisis. A review of the literature is presented, stressing the most relevant findings of the physical examination and habitual laboratory tests.