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 3,232 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the last decade there has been a change in the clinical evolution of patients with unstable angina. A better knowledge of his pathophysiology has improved the progress in their treatment and prognosis. Aspirin and heparin have played an important role in this change. Nowadays, the rates of death and acute myocardial infarction at 6 weeks are about 2% and 5% respectively. Nevertheless, the debate about the stratification risk and the best therapeutic options persist. Part of this debate corresponds to the classification differences and to the heterogeneity of variables considered to be end points. On the other hand, the clinical importance conferred to variables identified as predictor of worse prognosis is not valued enough, forgetting that the low prevalence of events results in a low positive predictive value.
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PMID:[Current prognosis of unstable angina. The results of clinical studies]. 1036 15

Ischemic mitral regurgitation (IMR) is a frequent complication after acute myocardial infarction (AMI) associated with a worse prognosis. The pathophysiological mechanisms of IMR are not fully understood, but it is known to be a complex process in which ventricular remodelling is the main causal factor. The various imaging techniques in cardiology and echocardiography fundamentally have contributed significantly to clarify the mechanisms that cause and progressively aggravate IMR. At present, different therapeutic options, the most important of which are cardio-surgical, address this problem. Nowadays the improvement in cardiac surgery and transcatheter therapies, have shown a therapeutic advance in IMR management. IMR is a predictor of poor prognosis in patients with heart failure and depressed left ventricular (LV) systolic function. However, it remains controversial whether mitral regurgitation (MR) in these patients is a consequence of dilation and dysfunction of the LV, or whether it contributes to worsening the prognosis of the ventricular dysfunction. Given that echocardiography has a fundamental reference role in the identification, graduation of severity and evaluation of the therapeutics used in the treatment of MR, we are going to focus on it over the rest of the imaging techniques. In contrast to primary MR the benefits of mitral surgery in patients with secondary MR are uncertain. Therefore, we will comment fundamentally on the role of mitral surgery in patients with IMR, with an update of the different surgical interventions available, without forgetting to mention the other therapeutic options currently available.
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PMID:Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: a review. 3074 43