Grupos Investigadores

Líneas de Investigación

  • Marcadores genéticos, bioquímicos y de imagen del remodelado miocárdico en la insuficiencia cardiaca
  • Marcadores genéticos, bioquímicos y de imagen del remodelado miocárdico en la fibrilación auricular

Palabras Clave

  • Remodelado miocárdico
  • Insuficiencia cardiaca
  • Fibrilación auricular
  • Biomarcador

Publicaciones Científicas desde 2018

  • Autores: Ortiz, A.; Navarro-González, J. F.; Núñez, J.; et al.
    Revista: CLINICAL KIDNEY JOURNAL
    ISSN 2048-8505 Vol.15 N° 5 2022 págs. 865 - 872
    Resumen
    Despite the high prevalence of chronic kidney disease (CKD) and its high cardiovascular risk, patients with CKD, especially those with advanced CKD (stages 4-5 and patients on kidney replacement therapy), are excluded from most cardiovascular clinical trials. It is particularly relevant in patients with advanced CKD and heart failure (HF) who have been underrepresented in many pivotal randomized trials that have modified the management of HF. For this reason, there is little or no direct evidence for HF therapies in patients with advanced CKD and treatment is extrapolated from patients without CKD or patients with earlier CKD stages. The major consequence of the lack of direct evidence is the under-prescription of HF drugs to this patient population. As patients with advanced CKD and HF represent probably the highest cardiovascular risk population, the exclusion of these patients from HF trials is a serious deontological fault that must be solved. There is an urgent need to generate evidence on how to treat HF in patients with advanced CKD. This article briefly reviews the management challenges posed by HF in patients with CKD and proposes a road map to address them.
  • Autores: Mendoza Ferradas, Francisco Javier (Autor de correspondencia); Ezponda Casajús, Ana; Rabago Juan Aracil, Gregorio; et al.
    Revista: ARCHIVOS DE BRONCONEUMOLOGIA
    ISSN 0300-2896 Vol.58 N° 7 2022 págs. 565 - 565
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); De Boer, R. A.
    Revista: CARDIOVASCULAR RESEARCH
    ISSN 0008-6363 Vol.118 N° 2 2022 págs. e20 - e22
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); de Boer, R. A.
    Revista: CARDIOVASCULAR RESEARCH
    ISSN 0008-6363 Vol.118 N° 2 2022 págs. E20 - E22
  • Autores: Solimene, F. (Autor de correspondencia); Stabile, G.; Ramos Ardanáz, Pablo; et al.
    Revista: CLINICAL CARDIOLOGY
    ISSN 0160-9289 Vol.45 N° 6 2022 págs. 597 - 604
    Resumen
    Background The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. Methods The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single-arm, international post-market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post-ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post-ablation to proactively detect and manage any recurrences within the 90-day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post-ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. Discussion The DELETE AF trial will provide additional knowledge on long-term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at (NCT05005143).
  • Autores: de By, T. M. M. H. (Autor de correspondencia); Schoenrath, F.; Veen, K. M.; et al.
    Revista: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
    ISSN 1010-7940 Vol.62 N° 1 2022 págs. ezac032
    Resumen
    OBJECTIVES In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with <60% follow-ups completed were excluded. Outcomes were stratified into 3 eras (2011-2013, 2014-2017 and 2018-2020). Adverse event rates (AERs) were calculated and stratified into early phase (<3 months) and late phase (>3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER(3 months): 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent. As a registry of the European Association for Cardio-Thoracic Surgery, the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) offers a robust repository of clinical data on long-term mechanical circulatory support (MCS) from a large international community.
  • Autores: Wise, B.; Albarran Rincon, R.; De Lossada Juste, A. ; et al.
    Revista: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
    ISSN 1383-875X Vol.63 N° 1 2022 págs. 103 - 108
    Resumen
    Purpose Advanced non-fluoroscopic mapping systems for radiofrequency ablation (RFA) have shown to be an effective treatment of atrial fibrillation. This study analyzes the resource usage and subsequent costs associated with the implementation of an ultra-high density mapping system (UHDMS) compared to non-ultra-high density mapping systems (NUHDMS). Methods This retrospective observational study included 120 patients (18 years or older) with paroxysmal or persistent atrial fibrillation who underwent RFA for de novo pulmonary vein isolation guided either by an UHDMS (n=63) or NUHDMS (n=57) for their index procedure. We compared patient characteristics, short- and long-term procedural outcomes, resource usage, and clinical outcomes followed up to 16 months between the two treatment groups. The cost analysis was conducted from the perspective of a single center in Spain (Clinica Universidad de Navarra). Results Neither baseline patient characteristics nor complication rate differed between groups. Repeat RFAs following recurrent arrhythmia at 16 months was lower in the UHDMS patient group than in the NUHDMS group (6 vs. 14, respectively; P=0.027). The average total cost per patient was euro1,600 lower in the UHDMS group, compared to the NUHDMS group (euro11,061 and euro12,661, respectively; P=0.03). Conclusion In patients treated with an NUHDMS, 25% had a repeat ablation for recurrent arrhythmia, whereas only 9% of patients treated with a UHDMS had one (61% relative risk reduction), resulting in an average cost saving per patient of euro1,600.
  • Autores: Rivera-Caravaca, J. M.; Piot, O.; Roldán-Rabadán, I.; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.24 N° 2 2022 págs. 202 - 210
    Resumen
    Aims The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients. Methods and results The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included. The baseline 4S-AF scheme was calculated and related to the primary management strategy (rhythm or rate control). Follow-up was performed at 1-year with all-cause mortality and the composite of ischaemic stroke/transient ischaemic attack/systemic embolism, major bleeding, and all-cause death, as primary endpoints. A total of 1479 patients [36.9% females, median age 72 interquartile range (IQR 64-80) years] were included. The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both P < 0.001). The predictive performances of the 4S-AF scheme for the actual management strategy were appropriate in its continuous [c-index 0.77, 95% confidence interval (CI) 0.75-0.80] and categorical (c-index 0.75, 95% CI 0.72-0.78) forms. Cox regression analyses showed that 'red category' classified patients in the 4S-AF scheme had a higher risk of all-cause death (aHR 1.75, 95% CI 1.02-2.99) and composite outcomes (aHR 1.60, 95% CI 1.05-2.44). Conclusion Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control and could also help in identifying high-risk AF patients for worse clinical outcomes in a 'real-world' setting.
  • Autores: Solla-Buceta, M.; González-Vilchez, F.; Almenar-Bonet, L.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.75 N° 2 2022 págs. 141 - 149
    Resumen
    Introduction and objectives - Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. Methods: Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. Results: We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n = 47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n = 58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P = .009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P= .025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P= .471). Conclusions: Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Salterain González, Nahikari (Autor de correspondencia); Rabago Juan Aracil, Gregorio; Gómez-Bueno, M.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.75 N° 1 2022 págs. 60 - 66
    Resumen
    Introduction and objectives: Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain. Methods: We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT. Results: A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT > 5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P < .001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P < .001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P < .001). Conclusions: ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
  • Autores: Ravassa Albéniz, Susana; López Salazar, Begoña; Ferreira, J. P.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.24 N° 2 2022 págs. 321 - 331
    Resumen
    Aims: The HOMAGE randomized trial found that spironolactone reduced left atrial volume index (LAVI), E:A ratio, and a marker of collagen type I synthesis (procollagen type I C-terminal propeptide) in patients at risk of heart failure (HF). Previous trials showed that patients with HF, preserved ejection fraction and low serum collagen type I C-terminal telopeptide to matrix metalloproteinase-1 ratio (CITP:MMP-1), associated with high collagen cross-linking, had less improvement in diastolic function with spironolactone. We evaluated the interaction between serum CITP:MMP-1 and spironolactone on cardiac function in the HOMAGE trial. Methods and results: Patients at risk of HF were randomized to spironolactone (n = 260) or not (n = 255). Blood sampling and echocardiography were done at baseline, one and nine months. CITP:MMP-1 was used as an indirect measure of collagen cross-linking. Higher baseline CITP:MMP-1 (i.e. lower collagen cross-linking) was associated with greater reductions in LAVI with spironolactone at both one (p = 0.003) and nine (p = 0.01) months, but no interaction was observed for E:A ratio. Spironolactone reduced LAVI after one and nine months only for those patients in the third tertile of CITP:MMP-1 (estimated lowest collagen cross-linking) [mean differencesspiro/control : -1.77 (95% confidence interval, CI -2.94 to -0.59) and -2.52 (95% CI -4.46 to -0.58) mL/m2 ; interaction pacross-tertiles = 0.005; interaction pthird tertile = 0.008] with a similar trend for N-terminal pro-B-type natriuretic peptide which was consistently reduced by spironolactone only in the lowest collagen cross-linking tertile [mean differencesspiro/control : -0.47 (95% CI -0.66 to -0.28) and -0.31 (95% CI -0.59 to -0.04) ng/L; interaction pacross-tertiles = 0.09; interaction pthird tertile < 0.001]. Conclusions: These findings suggest that, for patients at risk of HF, the effects of spironolactone on left atrial remodelling may be more prominent in patients with less collagen cross-linking (indirectly assessed by serum CITP:MMP-1).
  • Autores: Romero González, Gregorio Aramid; González Miqueo, Aránzazu; López Salazar, Begoña; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN 0931-0509 Vol.37 N° 5 2022 págs. 817 - 824
    Resumen
    Heart failure (HF) is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD). Decreased glomerular filtration rate is associated with diffuse deposition of fibrotic tissue in the myocardial interstitium [i.e. myocardial interstitial fibrosis (MIF)] and loss of cardiac function. MIF results from cardiac fibroblast-mediated alterations in the turnover of fibrillary collagen that lead to the excessive synthesis and deposition of collagen fibres. The accumulation of stiff fibrotic tissue alters the mechanical properties of the myocardium, thus contributing to the development of HF. Accumulating evidence suggests that several mechanisms are operative along the different stages of CKD that may converge to alter fibroblasts and collagen turnover in the heart. Therefore, focusing on MIF might enable the identification of fibrosis-related biomarkers and targets that could potentially lead to a new strategy for the prevention and treatment of HF in patients with CKD. This article summarizes current knowledge on the mechanisms and detrimental consequences of MIF in CKD and discusses the validity and usefulness of available biomarkers to recognize the clinical-pathological variability of MIF and track its clinical evolution in CKD patients. Finally, the currently available and potential future therapeutic strategies aimed at personalizing prevention and reversal of MIF in CKD patients, especially those with HF, will be also discussed.
  • Autores: de La Fuente Villena, Ana; Santisteban Eslava, Marta; Lupón, J.; et al.
    Revista: CANCERS
    ISSN 2072-6694 Vol.14 N° 12 2022 págs. 2941
    Resumen
    Simple Summary Left ventricular dysfunction (LVD) induced by anthracycline-based cancer chemotherapy (ACC) is becoming an urgent healthcare concern. Myocardial fibrosis (MF) may contribute to LVD after ACC. We show that elevated circulating levels of procollagen type I C-terminal propeptide (PICP, biomarker of MF) are associated with early subclinical LVD and predict later development of cardiotoxicity in patients treated with ACC. In addition, an association between PICP and LVD in patients with ACC-induced heart failure is observed. These results provide novel insights into MF as a mechanism underlying LVD after ACC, with PICP emerging as a promising tool to monitor cardiotoxicity in patients treated with ACC. Anthracycline-based cancer chemotherapy (ACC) causes myocardial fibrosis, a lesion contributing to left ventricular dysfunction (LVD). We investigated whether the procollagen-derived type-I C-terminal-propeptide (PICP): (1) associates with subclinical LVD (sLVD) at 3-months after ACC (3m-post-ACC); (2) predicts cardiotoxicity 1-year after ACC (12m-post-ACC) in breast cancer patients (BC-patients); and (3) associates with LVD in ACC-induced heart failure patients (ACC-HF-patients). Echocardiography, serum PICP and biomarkers of cardiomyocyte damage were assessed in two independent cohorts of BC-patients: CUN (n = 87) at baseline, post-ACC, and 3m and 12m (n = 65)-post-ACC; and HULAFE (n = 70) at baseline, 3m and 12m-post-ACC. Thirty-seven ACC-HF-patients were also studied. Global longitudinal strain (GLS)-based sLVD (3m-post-ACC) and LV ejection fraction (LVEF)-based cardiotoxicity (12m-post-ACC) were defined according to guidelines. BC-patients: all biomarkers increased at 3m-post-ACC versus baseline. PICP was particularly increased in patients with sLVD (interaction-p < 0.001) and was associated with GLS (p < 0.001). PICP increase at 3m-post-ACC predicted cardiotoxicity at 12m-post-ACC (odds-ratio >= 2.95 per doubling PICP, p <= 0.025) in both BC-cohorts, adding prognostic value to the early assessment of GLS and LVEF. ACC-HF-patients: PICP was inversely associated with LVEF (p = 0.004). In ACC-treated BC-patients, an early increase in PICP is associated with early sLVD and predicts cardiotoxicity 1 year after ACC. PICP is also associated with LVD in ACC-HF-patients.
  • Autores: Pérez Cabeza, A. I.; Rivera-Caravaca, J. M.; Roldán-Rabadán, I.; et al.
    Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
    ISSN 0014-2972 Vol.52 N° 4 2022 págs. e13709
    Resumen
    Background Atrial fibrillation (AF) increases the risk of thromboembolism. We investigate the efficacy and safety of oral anticoagulation (OAC) therapy and explored the number needed to treat for net effect (NNTnet) of OAC in the Spanish cohort of the EURObservational Research Programme-AF (EORP-AF) Long-term General Registry. Methods The EORP-AF General Registry is a prospective, multicentre registry conducted in ESC countries, including consecutive AF patients. For the present analysis, we used the Spanish cohort, and the primary outcome was any thromboembolism (TE)/acute coronary syndrome (ACS)/cardiovascular death during the first year of follow-up. Results 729 AF patients were included (57.1% male, median age 75 [IQR 67-81] years, median CHA(2)DS(2)-VASc and HAS-BLED of 3 [IQR 2-5] and 2 [IQR 1-2], respectively). 548 (75.2%) patients received OAC alone (318 [43.6%] on VKAs and 230 [31.6%] on DOACs). After 1 year, the use of OAC alone showed lower rates of any TE/ACS/cardiovascular death (3.0%/year; p < 0.001) compared to other regimens, and non-use of OAC alone (HR 4.18, 95% CI 2.12-8.27) was independently associated with any TE/ACS/cardiovascular death. Balancing the effects of treatment, the NNTnet to provide an overall benefit of OAC therapy was 24. The proportion of patients on OAC increased at 1 year (87% to 88.1%), particularly on DOACs (33.6% to 39.9%) (p = 0.015), with low discontinuation rates. Conclusions In this contemporary cohort of AF patients, OAC therapy was associated with better clinical outcomes at 1 year and positive NNTnet. OAC use slightly increased during the follow-up, with low discontinuation rates and higher prescription of DOACs.
  • Autores: Ferreira, J. P. (Autor de correspondencia); Collier, T.; Clark, A. L.; et al.
    Revista: EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY
    ISSN 2055-6837 Vol.8 N° 2 2022 págs. 149 - 156
    Resumen
    Aims: Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on BP of patients at risk of developing HF is yet to be determined. To evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone's effect. Methods and results: HOMAGE (Heart OMics in Aging) was a prospective multicentre randomized open-label blinded endpoint (PROBE) trial including 527 patients at risk for developing HF randomly assigned to either spironolactone (25-50 mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, Months 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed effects models, and structural modelling equations was used. The median (percentile25-75) age was 73 (69-79) years, 26% were female, and >75% had history of hypertension. Overall, the baseline BP was 142/78 mmHg. Patients with higher BP were older, more likely to have diabetes and less likely to have coronary artery disease, had greater left ventricular mass (LVM), and left atrial volume (LAV). Compared with usual care, by last visit, spironolactone changed SBP by -10.3 (-13.0 to -7.5) mmHg and DBP by -3.2 (-4.8 to -1.7) mmHg (P < 0.001 for both). A higher proportion of patients on spironolactone had controlled BP <130/80 mmHg (36 vs. 26%; P = 0.014). Lower baseline renin levels predicted a greater response to spironolactone (interactionP = 0.041). Conclusion: Spironolactone had a clinically important BP-lowering effect. Spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.
  • Autores: Midya, V.; Colicino, E.; Conti, D. V.; et al.
    Revista: JAMA NETWORK OPEN
    ISSN 2574-3805 Vol.5 N° 7 2022 págs. e2220176
    Resumen
    IMPORTANCE Prenatal exposures to endocrine-disrupting chemicals (EDCs) may increase the risk for liver injury in children; however, human evidence is scarce, and previous studies have not considered potential EDC-mixture effects. Furthermore, the association between prenatal EDC exposure and hepatocellular apoptosis in children has not been studied previously. OBJECTIVE To investigate associations of prenatal exposure to EDC mixtures with liver injury risk and hepatocellular apoptosis in childhood. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used data collected from April 1, 2003, to February 26, 2016, from mother-child pairs from the Human Early-Life Exposome project, a collaborative network of 6 ongoing, population-based prospective birth cohort studies from 6 European countries (France, Greece, Lithuania, Norway, Spain, and the UK). Data were analyzed from April 1, 2021, to January 31, 2022. EXPOSURES Three organochlorine pesticides, 5 polychlorinated biphenyls, 2 polybrominated diphenyl ethers (PBDEs), 3 phenols, 4 parabens, 10 phthalates, 4 organophosphate pesticides, 5 perfluoroalkyl substances, and 9 metals. MAIN OUTCOMES AND MEASURES Child serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and CK-18 were measured at 6 to 11 years of age. Risk for liver injury was defined as having ALT, AST, and/or GGT levels above the 90th percentile. Associations of liver injury or cytokeratin 18 (CK-18) levels with each chemical group among the 45 EDCs measured in maternal blood or urine samples collected in pregnancy were estimated using 2 complimentary exposure-mixture methods: bayesian weighted quantile sum (BWQS) and bayesian kernel machine regression. RESULTS The study included 1108 mothers (mean [SD] age at birth, 31.0 [4.7] years) and their singleton children (mean [SD] age at liver assessment, 8.2 [1.6] years; 598 [54.0%] boys). Results of the BWQS method indicated increased odds of liver injury per exposure-mixture quartile increase for organochlorine pesticides (odds ratio [OR], 1.44 [95% credible interval (CrI), 1.21-1.71]), PBDEs (OR, 1.57 [95% CrI, 1.34-1.84]), perfluoroalkyl substances (OR, 1.73 [95% CrI, 1.45-2.09]), and metals (OR, 2.21 [95% CrI, 1.65-3.02]). Decreased odds of liver injury were associated with high-molecular-weight phthalates (OR, 0.74 [95% CrI, 0.60-0.91]) and phenols (OR, 0.66 [95% CrI, 0.54-0.78]). Higher CK-18 levels were associated with a 1-quartile increase in polychlorinated biphenyls (beta, 5.84 [95% CrI, 1.69-10.08] IU/L) and PBDEs (beta, 6.46 [95% CrI, 3.09-9.92] IU/L). Bayesian kernel machine regression showed associations in a similar direction as BWQS for all EDCs and a nonlinear association between phenols and CK-18 levels. CONCLUSIONS AND RELEVANCE With a combination of 2 state-of-the-art exposure-mixture approaches, consistent evidence suggests that prenatal exposures to EDCs are associated with higher risk for liver injury and CK-18 levels and constitute a potential risk factor for pediatric nonalcoholic fatty liver disease.
  • Autores: González-Vilchez, F. (Autor de correspondencia); Crespo-Leiro, M. G.; Delgado-Jiménez, J.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.75 N° 2 2022 págs. 129 - 140
    Resumen
    Introduction and objectives: Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. Methods: We retrospectively studied patients aged >= 18 years, with a first heart transplant performed between 2000 and 2014 and surviving >= 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. Results: The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation > 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P = .056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P = .065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P = .011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. Conclusions: IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients.
  • Autores: Ezponda Casajús, Ana; Casanova, C.; Divo, M.; et al.
    Revista: RESPIROLOGY
    ISSN 1323-7799 Vol.27 N° 4 2022 págs. 286 - 293
    Resumen
    Background and objective The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic identification and relationship with all-cause mortality have not been explored. Furthermore, whether their CT-detected prevalence differs from clinical diagnosis is unknown. Methods The prevalence of 10 CT-assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT-determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all-cause mortality was analysed. A 'CT-comorbidome' graphically expressed the strength of their association with mortality risk. Results Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio [HR] 2.09; 95% CI 1.03-4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05-4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23-5.57, p = 0.010) were independently associated with all-cause mortality and helped define the 'CT-comorbidome'. Conclusion This study of COPD patients shows that systematic detection of 10 CT-diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them.
  • Autores: Rodríguez-Mañero, M. (Autor de correspondencia); Baluja, A.; Hernández, J.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN 1885-5857 Vol.75 N° 7 2022 págs. 559 - 567
    Resumen
    Introducción y objetivos Se han desarrollado puntuaciones multiparamétricas para una mejor estratificación del riesgo en el síndrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparamétricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con síndrome de Brugada y estudio electrofisiológico (EEF). Métodos Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron análisis mediante estadístico C y modelos de regresión de riesgos proporcionales de Cox. Resultados Se incluyó en total a 831 pacientes con una media de edad de 42,8 ± 13,1 años; 623 (75%) eran varones; 386 (46,5%) tenían patrón electrocardiográfico (ECG) tipo 1; 677 (81,5%) estaban asintomáticos y 319 (38,4%) tenían un desfibrilador automático implantable. Durante un seguimiento de 10,2 ± 4,7 años, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y síncope fueron predictivos de eventos arrítmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomáticos). La evaluación de las puntuaciones de Delise y Sieira con diferente número de extraestímulos (1 o 2 frente a 3) no mejoró sustancialmente el índice c de predicción de eventos. Conclusiones En el SBr, los factores de riesgo clásicos como el ECG y el síncope previo predicen eventos arrítmicos. El número de extraestímulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clínico con EEF ayudan a identificar las poblaciones con más riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en población general con SBr como en pacientes asintomáticos.
  • Autores: Arasanz, H. (Autor de correspondencia); Zuazo, M.; Bocanegra, A.; et al.
    Revista: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
    ISSN 1422-0067 Vol.22 N° 7 2021 págs. 3736
    Resumen
    Along with the positioning of immunotherapy as a preferential treatment for a wide variety of neoplasms, a new pattern of response consisting in a sudden acceleration of tumor growth has been described. This phenomenon has received the name of "hyperprogressive disease", and several definitions have been proposed for its identification, most of them relying on radiological criteria. However, due to the fact that the cellular and molecular mechanisms have not been elucidated yet, there is still some debate regarding whether this fast progression is induced by immunotherapy or only reflects the natural course of some highly aggressive neoplasms. Moreover, contradictory results of trials including patients with different cancer types suggest that both the incidence, the associated factors and the implications regarding prognosis might differ depending on tumor histology. This article intends to review the main publications regarding this matter and critically approach the most controversial aspects.
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); Navarro-González, J. F.; Ortiz, A.; et al.
    Revista: NEFROLOGIA
    ISSN 0211-6995 Vol.41 N° 4 2021 págs. 391 - 402
    Resumen
    Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner.
  • Autores: López Salazar, Begoña; Ravassa Albéniz, Susana; Moreno Zulategui, María de Ujue; et al.
    Revista: NATURE REVIEWS CARDIOLOGY
    ISSN 1759-5002 Vol.18 N° 7 2021 págs. 479 - 498
    Resumen
    Diffuse myocardial fibrosis resulting from the excessive deposition of collagen fibres through the entire myocardium is encountered in a number of chronic cardiac diseases. This lesion results from alterations in the regulation of fibrillary collagen turnover by fibroblasts, facilitating the excessive deposition of type I and type III collagen fibres within the myocardial interstitium and around intramyocardial vessels. The available evidence suggests that, beyond the extent of fibrous deposits, collagen composition and the physicochemical properties of the fibres are also relevant in the detrimental effects of diffuse myocardial fibrosis on cardiac function and clinical outcomes in patients with heart failure. In this regard, findings from the past 20 years suggest that various clinicopathological phenotypes of diffuse myocardial fibrosis exist in patients with heart failure. In this Review, we summarize the current knowledge on the mechanisms and detrimental consequences of diffuse myocardial fibrosis in heart failure. Furthermore, we discuss the validity and usefulness of available imaging techniques and circulating biomarkers to assess the clinicopathological variation in this lesion and to track its clinical evolution. Finally, we highlight the currently available and potential future therapeutic strategies aimed at personalizing the prevention and reversal of diffuse myocardial fibrosis in patients with heart failure. In this Review, Diez and colleagues summarize the mechanisms of diffuse myocardial fibrosis in heart failure, discuss imaging techniques and circulating biomarkers to characterize the variability of this lesion in patients, and highlight the available and potential future therapeutic strategies for personalizing the prevention and reversal of diffuse myocardial fibrosis.
  • Autores: Pascual-Figal, D. (Autor de correspondencia); Bayes-Genis, A.; Beltrán-Troncoso, P.; et al.
    Revista: FRONTIERS IN CARDIOVASCULAR MEDICINE
    ISSN 2297-055X Vol.8 2021 págs. 754499
    Resumen
    Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
  • Autores: Bermejo, J.; Díez Martínez, Domingo Francisco Javier; Fernández-Avilés, F. (Autor de correspondencia)
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.74 N° 11 2021 págs. 898 - 900
  • Autores: Latasa, I.; Ramírez-Vélez, R.; Izquierdo, M.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN 1885-5857 Vol.74 N° 12 2021 págs. 1008 - 1012
  • Autores: Albarrán-Rincón, R.; Ramos Ardanáz, Pablo; Shanhutov Kulichok, Oleksandr; et al.
    Revista: JOURNAL OF ELECTROCARDIOLOGY
    ISSN 0022-0736 Vol.64 2021 págs. 1 - 2
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); Ortiz, A.
    Revista: CLINICAL KIDNEY JOURNAL
    ISSN 2048-8505 Vol.14 N° 6 2021 págs. 1491-1494
    Resumen
    Chronic kidney disease (CKD) has structural and functional repercussions for the cardiovascular system that facilitate the development of cardiovascular disease (CVD). In fact, cardiovascular complications are frequent in the CKD population and thus cause a great clinical, public health and economic burden. Despite this challenge, the prevention and management of cardiovascular complications is one among several aspects of CKD that meets the criteria of an unmet medical need. This probably has to do with the misperception by the nephrologist of the global relevance of CVD in the CKD patient which, in turn, may be due to insufficient cardiovascular training during nephrology specialization. Therefore a change in approach is necessary to understand CKD as a disease in which the manifestations and complications related to CVD become so frequent and important that they require dedicated multidisciplinary clinical management. From this perspective, it makes sense to consider training in the subspecialty of cardionephrology to provide adequate cardiovascular care for CKD patients by the nephrologist. In addition, the cardionephrology subspecialist would be better able to interact with other specialists in multidisciplinary care settings created to achieve a deeper understanding and more effective clinical handling of the interactions between CKD and CVD.
  • Autores: Lau, E. S.; Liu, E.; Paniagua, S. M.; et al.
    Revista: JACC. BASIC TO TRANSLATIONAL SCIENCE
    ISSN 2452-302X Vol.6 N° 1 2021 págs. 12 - 21
    Resumen
    We investigated the effect of galectin-3 (Gal-3) inhibition with modified citrus pectin on markers of collagen metabolism in a proof-of-concept randomized placebo-controlled trial of participants with elevated Gal-3 levels and hypertension. Although higher Gal-3 levels were associated with female sex, diabetes, and reduced glomerular filtration rate in cross-sectional analyses, treatment with modified citrus pectin did not change collagen markers. The effect of Gal-3 inhibition among individuals with heart failure warrants further investigation. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
  • Autores: Sankarankutty, A. C.; Greiner, J.; Bragard Monier, Jean; et al.
    Revista: FRONTIERS IN PHYSIOLOGY
    ISSN 1664-042X Vol.12 2021 págs. 730933
    Resumen
    With an estimated 64.3 million cases worldwide, heart failure (HF) imposes an enormous burden on healthcare systems. Sudden death from arrhythmia is the major cause of mortality in HF patients. Computational modeling of the failing heart provides insights into mechanisms of arrhythmogenesis, risk stratification of patients, and clinical treatment. However, the lack of a clinically informed approach to model cardiac tissues in HF hinders progress in developing patient-specific strategies. Here, we provide a microscopy-based foundation for modeling conduction in HF tissues. We acquired 2D images of left ventricular tissues from HF patients (n = 16) and donors (n = 5). The composition and heterogeneity of fibrosis were quantified at a sub-micrometer resolution over an area of 1 mm(2). From the images, we constructed computational bidomain models of tissue electrophysiology. We computed local upstroke velocities of the membrane voltage and anisotropic conduction velocities (CV). The non-myocyte volume fraction was higher in HF than donors (39.68 +/- 14.23 vs. 22.09 +/- 2.72%, p < 0.01), and higher in ischemic (IC) than nonischemic (NIC) cardiomyopathy (47.2 +/- 16.18 vs. 32.16 +/- 6.55%, p < 0.05). The heterogeneity of fibrosis within each subject was highest for IC (27.1 +/- 6.03%) and lowest for donors (7.47 +/- 1.37%) with NIC (15.69 +/- 5.76%) in between. K-means clustering of this heterogeneity discriminated IC and NIC with an accuracy of 81.25%. The heterogeneity in CV increased from donor to NIC to IC tissues. CV decreased with increasing fibrosis for longitudinal (R-2 = 0.28, p < 0.05) and transverse conduction (R-2 = 0.46, p < 0.01). The tilt angle of the CV vectors increased 2.1 degrees for longitudinal and 0.91 degrees for transverse conduction per 1% increase in fibrosis. Our study suggests that conduction fundamentally differs in the two etiologies due to the characteristics of fibrosis. Our study highlights the importance of the etiology-specific modeling of HF tissues and integration of medical history into electrophysiology models for personalized risk stratification and treatment planning.</p>
  • Autores: Bragard Monier, Jean (Autor de correspondencia); Witt, A.; Laroze, D.; et al.
    Revista: CHAOS (EEUU)
    ISSN 1054-1500 Vol.31 N° 7 2021 págs. 073144
    Resumen
    In this paper, we study the propagation of the cardiac action potential in a one-dimensional fiber, where cells are electrically coupled through gap junctions (GJs). We consider gap junctional gate dynamics that depend on the intercellular potential. We find that different GJs in the tissue can end up in two different states: a low conducting state and a high conducting state. We first present evidence of the dynamical multistability that occurs by setting specific parameters of the GJ dynamics. Subsequently, we explain how the multistability is a direct consequence of the GJ stability problem by reducing the dynamical system's dimensions. The conductance dispersion usually occurs on a large time scale, i.e., thousands of heartbeats. The full cardiac model simulations are computationally demanding, and we derive a simplified model that allows for a reduction in the computational cost of four orders of magnitude. This simplified model reproduces nearly quantitatively the results provided by the original full model. We explain the discrepancies between the two models due to the simplified model's lack of spatial correlations. This simplified model provides a valuable tool to explore cardiac dynamics over very long time scales. That is highly relevant in studying diseases that develop on a large time scale compared to the basic heartbeat. As in the brain, plasticity and tissue remodeling are crucial parameters in determining the action potential wave propagation's stability. (C) 2021 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
  • Autores: Gardner, R. S. (Autor de correspondencia); D'Onofrio, A.; Mark, G.; et al.
    Revista: ESC HEAR FAILURE
    ISSN 2055-5822 Vol.8 N° 2 2021 págs. 1675 - 1680
    Resumen
    Aims The SMART (Strategic MAnagement to optimize response to cardiac Resynchronization Therapy) Registry was designed to assess real-world outcomes for patients receiving a cardiac resynchronization therapy defibrillator (CRT-D) and to better understand which programming and optimization techniques are used and how effective they are. Methods and results The SMART Registry is a global, multicentre, prospective, observational, post-market CRT-D registry with a planned enrolment of 2000 subjects from a maximum of 200 sites in Europe, North America, and Asia-Pacific region. Each subject will be followed up for a minimum of 12 months. The primary endpoint of CRT response rate at 12 months is defined by a clinical composite score of all-cause mortality, heart failure events, New York Heart Association Class, and quality of life as assessed by a patient global assessment instrument. A subgroup composed of the first 103 consecutive European subjects implanted with an NG4 device will have left ventricular multisite pacing feature enabled at any time during the initial 12 months of follow-up. The primary endpoint for this sub-analysis will be the NG4 PG-related complication-free rate at 36 months. Conclusions The SMART Registry achieved its recruitment target in August 2019, with 2014 patients enrolled. The baseline demographics demonstrated that patients were generally older, with greater co-morbidity, and on more contemporary medical therapy than in the key CRT trials. The results of the SMART Registry will determine which programming and optimization techniques are effective in this real-world population.
  • Autores: Cleland, J. G. F. (Autor de correspondencia); Ferreira, J. P.; Mariottoni, B.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.42 N° 6 2021 págs. 684 - +
    Resumen
    Aims To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure. Methods and results Randomized, open-Label, blinded-endpoint trial comparing spironolactone (50mg/day) or control for up to 9 months in people with, or at high risk of, coronary disease and raised plasma &type natriuretic peptides. The primary endpoint was the interaction between baseline serum galectin-3 and changes in serum procollagen type-III N-terminal pro-peptide (PIIINP) in participants assigned to spironolactone or control. Procollagen type-1 C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), reflecting synthesis and degradation of type-I collagen, were also measured. In 527 participants (median age 73 years, 26% women), changes in PIIINP were similar for spironolactone and control [mean difference (mdiff): -0.15; 95% confidence interval (CI) -0.44 to 0.15 mu g/L; P=0.32] but those receiving spironolactone had greater reductions in PICP (mdiff: -8.1; 95% CI -11.9 to -4.3 mu g/L; P< 0.0001) and PICP/CITP ratio (mdiff: -2.9; 95% CI -4.3 to -1.5; <0.0001). No interactions with serum galectin were observed. Systolic blood pressure (mdiff: -10; 95% CI -13 to -7 mmHg; P<0.0001), left atrial volume (mdiff: -1; 95% CI -2 to 0 mL/m(2); P = 0.010), and NT-proBNP (mdiff: -57; 95% CI -81 to -33 ng/L; P< 0.0001) were reduced in those assigned spironolactone. Conclusion Galectin-3 did not identify greater reductions in serum concentrations of collagen biomarkers in response to spironolactone. However, spironolactone may influence type-I collagen metabolism. Whether spironolactone can delay or prevent progression to symptomatic heart failure should be investigated.
  • Autores: Rosano, G.; Jankowska, E. A. (Autor de correspondencia); Ray, R.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.23 N° 11 2021 págs. 1806 - 1818
    Resumen
    Patients with heart failure (HF) who contract SARS-CoV-2 infection are at a higher risk of cardiovascular and non-cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID-19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID-19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID-19 vaccination scheme in patients with HF. COVID-19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID-19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID-19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS-CoV-2 infection (including the COVID-19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF.
  • Autores: Garcia-Cosio, M. D. (Autor de correspondencia); Gonzalez-Vilchez, F.; Lopez-Vilella, R.; et al.
    Revista: FRONTIERS IN CARDIOVASCULAR MEDICINE
    ISSN 2297-055X Vol.8 2021 págs. 630113
    Resumen
    Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.
  • Autores: Ezponda Casajús, Ana; Casanova, C.; Cabrera, C.; et al.
    Revista: ARCHIVOS DE BRONCONEUMOLOGIA
    ISSN 0300-2896 Vol.57 N° 8 2021 págs. 533 - 539
    Resumen
    Rationale: Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. Methods: At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65 +/- 8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. Results: PsD was lower in COPD patients than in controls (40.5 vs 42.5, p = 0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p = 0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p = 0.023) were the variables independently associated with all-cause mortality. Conclusions: In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD. (C) 2021 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: López-Vilella, R. (Autor de correspondencia); González-Vílchez, F.; Crespo-Leiro, M. G.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.74 N° 5 2021 págs. 393 - 401
    Resumen
    Introduction and objectives: The age of heart transplant recipients and donors is progressively increasing. It is likely that not all donor-recipient age combinations have the same impact on mortality. The objective of this work was to compare survival in transplant recipients according to donor-recipient age combinations. Methods: We performed a retrospective analysis of transplants performed between 1 January 1993 and 31 December 2017 in the Spanish Heart Transplant Registry. Pediatric transplants, retransplants and combined transplants were excluded (6505 transplants included). Four groups were considered: a) donor < 50 years for recipient < 65 years; b) donor < 50 years for recipient >= 65 years; c) donor >= 50 years for recipient >= 65 years, and d) donor >= 50 years for recipient < 65 years. Results: The most frequent group was young donor for young recipient (73%). There were differences in the median survival between the groups (P<.001): a) younger-younger: 12.1 years, 95%CI, 11.5-12.6; b) younger-older: 9.1 years, 95%CI, 8.0-10.5; c) older-older: 7.5 years, 95%CI, 2.8-11.0; d) older-younger: 10.5 years, 95%CI, 9.6-12.1. On multivariate analysis, independent predictors of mortality were the age of the donor and the recipient (0.008 and 0.001, respectively). The worst combinations were older-older vs younger-younger (HR, 1.57; 95%CI, 1.22-2.01; P<.001) and younger-older vs younger-younger (HR, 1.33; 95%CI, 1.12-1.58; P=.001). Conclusions: Age (of the donor and recipient) is a relevant prognostic factor in heart transplant. The donor-recipient age combination has prognostic implications that should be identified when accepting an organ for transplant. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: He, T.; Mischak, M.; Clark, A. L.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.23 N° 11 2021 págs. 1875 - 1887
    Resumen
    Aims Heart failure (HF) is a major public health concern worldwide. The diversity of HF makes it challenging to decipher the underlying complex pathological processes using single biomarkers. We examined the association between urinary peptides and HF with reduced (HFrEF), mid-range (HFmrEF) and preserved (HFpEF) ejection fraction, defined based on the European Society of Cardiology guidelines, and the links between these peptide biomarkers and molecular pathophysiology. Methods and results Analysable data from 5608 participants were available in the Human Urinary Proteome database. The urinary peptide profiles from participants diagnosed with HFrEF, HFmrEF, HFpEF and controls matched for sex, age, estimated glomerular filtration rate, systolic and diastolic blood pressure, diabetes and hypertension were compared applying the Mann-Whitney test, followed by correction for multiple testing. Unsupervised learning algorithms were applied to investigate groups of similar urinary profiles. A total of 577 urinary peptides significantly associated with HF were sequenced, 447 of which (77%) were collagen fragments. In silico analysis suggested that urinary biomarker abnormalities in HF principally reflect changes in collagen turnover and immune response, both associated with fibrosis. Unsupervised clustering separated study participants into two clusters, with 83% of non-HF controls allocated to cluster 1, while 65% of patients with HF were allocated to cluster 2 (P < 0.0001). No separation based on HF subtype was detectable. Conclusions Heart failure, irrespective of ejection fraction subtype, was associated with differences in abundance of urinary peptides reflecting collagen turnover and inflammation. These peptides should be studied as tools in early detection, prognostication, and prediction of therapeutic response.
  • Autores: Minguito-Carazo, C. (Autor de correspondencia); Gómez-Bueno, M.; Almenar-Bonet, L.; et al.
    Revista: TRANSPLANT INTERNATIONAL
    ISSN 0934-0874 Vol.34 N° 5 2021 págs. 882 - 893
    Resumen
    Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.
  • Autores: Esteban-Fernández, A. (Autor de correspondencia); Carvajal Estupiñán, J. F.; Gavira Gómez, Juan José; et al.
    Revista: FRONTIERS IN CARDIOVASCULAR MEDICINE
    ISSN 2297-055X Vol.8 2021 págs. 721080
    Resumen
    Introduction and Objectives: Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of cancer treatment withdrawal, related to the poor outcomes. The cardiac-specific treatment could recover the left ventricular ejection fraction (LVEF). We analyzed the clinical profile and prognosis of patients with CTRCD in a real-world scenario. Methods: A retrospective study that include all the cancer patients diagnosed with CTRCD, defined as LVEF < 50%. We analyzed the cardiac and oncologic treatments, the predictors of mortality and LVEF recovery, hospital admission, and the causes of mortality (cardiovascular (CV), non-CV, and cancer-related). Results: We included 113 patients (82.3% women, age 49.2 +/- 12.1 years). Breast cancer (72.6%) and anthracyclines (72.6%) were the most frequent cancer and treatment. Meantime to CTRCD was 8 months, with mean LVEF of 39.4 +/- 9.2%. At diagnosis, 27.4% of the patients were asymptomatic. Cardiac-specific treatment was started in 66.4% of patients, with LVEF recovery-rate of 54.8%. Higher LVEF at the time of CTRCD, shorter time from cancer treatment to diagnosis of CTRCD, and younger age were the predictors of LVEF recovery. The hospitalization rate was 20.4% (8.8% linked to heart failure). Treatment with trastuzumab and lower LVEF at diagnosis of CTRCD were the predictors of mortality. Thirty point nine percent of patients died during the 26 months follow-up. The non-CV causes and cancer-related were more frequent than CV ones. Co
  • Autores: de Torres Tajes, Juan Pablo (Autor de correspondencia); Wisnivesky, J. P.; Bastarrika Alemañ, Gorka; et al.
    Revista: ARCHIVOS DE BRONCONEUMOLOGÍA
    ISSN 2173-5751 Vol.57 N° 1 2021 págs. 36 - 41
    Resumen
    Background: Lung Cancer (LC) screening with low dose chest computed tomography (LDCT) in smokers reduces LC mortality. Patients with Obstructive Lung Disease (OLD) are at high risk for LC. The potential effect of LC screening in this population is unknown. Objective: To determine if screening with LDCT reduces LC mortality in smokers with spirometrically defined OLD. Methods: The National Lung Screening Trial-American College of Radiology Imaging Network (NLST-ACRIN) study included 13,831 subjects (55-74 years of age with >= 30 pack-year history of smoking) that had a baseline spirometry. Randomly assigned to LDCT or Chest X-ray, all had 3 annual rounds of screening. LC mortality was compared between the LDCT and chest X-ray arms during the 1st year and at 6 years of follow up. Landmark analysis explored LC mortality differences between arms after the first year. Results: From the 4584 subjects with OLD (FEV1/FVC <0.7), 152 (3.3%) died from LC. Multivariable analysis showed that screening trended to decrease LC mortality at 6 years (HR, 95%CI: 0.75, 0.55-1.04, p = 0.09). During the 1st year no differences were found between arms (p = 0.65). However, after this year, LDCT significantly decreased LC mortality (HR, 95%CI: 0.63, 0.44-0.91, p = 0.01). The number needed to screen to avoid one LC death in these subjects was 108 while in those without OLD was 218. Conclusions: LC screening with LDCT in smokers with spirometrically diagnosed OLD, showed a trend to reduce lung cancer mortality but a study with a larger number of patients and with a more robust design would be needed to confirm these findings.
  • Autores: Recalde Zamacona, Borja (Autor de correspondencia); Tomás Velázquez, Alejandra; Campo Ezquibela, Aránzazu; et al.
    Revista: JOURNAL OF INTERNAL MEDICINE
    ISSN 1365-2796 Vol.289 N° 6 2021 págs. 921 - 925
    Resumen
    BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding among patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between March 1 and July 1. We have selected all 18 patients with prolonged viral shedding, and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n=54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhino-sinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (p<0.001 and p=0,003). The use of inhaled corticosteroids was also more frequent in case group (p=0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI],3.89 - 90.59; p<0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhino-sinusitis and atopy might be ass
  • Autores: Sansilvestri-Morel, P. (Autor de correspondencia); Harouki-Crochemore, N.; Bertin, F.; et al.
    Revista: JOURNAL OF CARDIOVASCULAR PHARMACOLOGY
    ISSN 0160-2446 Vol.78 N° 5 2021 págs. e703 - e713
    Resumen
    Maturation of fibrillar collagen is known to play a crucial role in the pathophysiology of myocardial fibrosis. Procollagen C-proteinase enhancer 1 (PCPE1) has a key role in procollagen maturation and collagen fibril formation. The phenotype of both male and female PCPE1 knock-out mice was investigated under basal conditions to explore the potential of PCPE1 as a therapeutic target in heart failure. Global constitutive PCPE1(-/-) mice were generated. Serum procollagen I C-terminal propeptide, organ histology, and cutaneous wound healing were assessed in both wild type (WT) and PCPE1(-/-) mice. In addition, the cardiac expression of genes involved in collagen metabolism was investigated and the total and insoluble cardiac collagen contents determined. Cardiac function was evaluated by echocardiography. No differences in survival, clinical chemistry, or organ histology were observed in PCPE1(-/-) mice compared with WT. Serum procollagen I C-terminal propeptide was lower in PCPE1(-/-) mice. Cardiac mRNA expression of Bmp1, Col1a1, Col3a1, and Loxl2 was similar, whereas Tgfb and Loxl1 mRNA levels were decreased in PCPE1(-/-) mice compared with sex-matched WT. No modification of total or insoluble cardiac collagen content was observed between the 2 strains. Ejection fraction was slightly decreased in PCPE1(-/-) male mice, but not in females. Finally, wound healing was not altered in PCPE1(-/-) mice. PCPE1 deficiency does not trigger any major liabilities and does not affect cardiac collagen content nor its function under basal conditions. Further studies are required to evaluate its role under stressed conditions and determine its suitability as a therapeutic target for heart failure.
  • Autores: García Baizán, Alejandra; Caballeros Lam, Fanny Meylin; Ezponda Casajús, Ana; et al.
    Revista: AMERICAN JOURNAL OF ROENTGENOLOGY
    ISSN 0361-803X Vol.216 N° 5 2021 págs. 1216 - 1221
    Resumen
    OBJECTIVE. This study aimed to evaluate the long-term prognostic value of coronary CT angiography (CCTA) in heart transplant recipients. MATERIALS AND METHODS. The records of 114 patients who had undergone a heart transplant (mean age, 61.7 ± 11.1 [SD] years; 83.3% men) and who underwent CCTA for the surveillance of coronary allograft vasculopathy (CAV) from June 2007 to December 2017 were retrospectively evaluated for the occurrence of major adverse cardiovascular events (MACEs) (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, coronary revascularization, cardiac arrhythmias, stroke, and retransplant). Patients were classified according to the presence of nonobstructive CAV (lumen reduction < 50%) or obstructive disease (lumen reduction ¿ 50%) and using a coronary segment involvement score (SIS). Differences in MACE rate between groups were compared. RESULTS. Obstructive CAV was observed in 12 heart transplant recipients (10.5%). During a mean follow-up of 67.5 ± 41.4 months the overall rates of MACE were 50% and 14.7% in patients with obstructive and nonobstructive CAV, respectively (p < .05), resulting in an odds ratio for MACE of 6 (95% CI, 1.7-21.2). Comparison of event-free survival showed a hazard ratio (HR) of 5 (95% CI, 1.95-13; p =. 004) for patients with obstructive disease. The presence of four or more stenotic coronary segments (SIS ¿ 4) was associated with a higher rate of events (HR, 3.46; 95% CI, 1.46-8.23). CONCLUSION. In patients who have undergone a heart transplant, CCTA offers a significant long-term prognostic impact on the prediction of MACEs.
  • Autores: García Bolao, José Ignacio (Autor de correspondencia); Moñino, D.; Marsal, R.; et al.
    Revista: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
    ISSN 1383-875X Vol.62 N° 2 2021 págs. 357 - 362
    Resumen
    Purpose Remote system operation technology was developed and applied to a non-fluoroscopic navigation system in order to overcome Spanish mobility restrictions caused by Covid-19 pandemic infection and subsequently used routinely. Methods and results Fifty consecutive complex ablations were performed in different days using this technology. All these procedures were assisted remotely with the only intervention of a field clinical specialist located at his home who took full control of the navigation system (keyboard, mouse, and screen) and had bidirectional real-time audio/video feedback with the operating physician. Once the connection was established, the remote field clinical specialist replicated the Rhythmia screen at the remote location with all its features, and interacted identically with the physician, essentially with no perceptible differences from being physically present. There were neither interruptions nor perceptible delays in the bidirectional communications between the remote field clinical specialist and the operating physician during the procedures. Video signal delay ranged from 265 to 325 ms. All the procedures were uneventful. Conclusions Remote system operation allowed full teleoperation of a non-fluoroscopic navigation system (keyboard, mouse, and screen) as well as bidirectional real-time audio/video feedback with the operating physician, providing a fully autonomous remote assistance in 50 complex ablation procedures. This technology ensures workflow continuity and optimal workforce flexibility and has relevant and promising implications in the field of training, teaching, and resource optimization that deserves further development.
  • Autores: Jujic, A. (Autor de correspondencia); Nilsson, P. M. ; Atabaki Pasdar, N.; et al.
    Revista: DIABETES CARE
    ISSN 0149-5992 Vol.44 N° 1 2021 págs. 224 - 230
    Resumen
    OBJECTIVE While existing evidence supports beneficial cardiovascular effects of glucagon-like peptide 1 (GLP-1), emerging studies suggest that glucose-dependent insulinotropic peptide (GIP) and/or signaling via the GIP receptor may have untoward cardiovascular effects. Indeed, recent studies show that fasting physiological GIP levels are associated with total mortality and cardiovascular mortality, and it was suggested that GIP plays a role in pathogenesis of coronary artery disease. We investigated the associations between fasting and postchallenge GIP and GLP-1 concentrations and subclinical atherosclerosis as measured by mean intima-media thickness in the common carotid artery (IMT(mean)CCA) and maximal intima-media thickness in the carotid bifurcation (IMT(max)Bulb). RESEARCH DESIGN AND METHODS Participants at reexamination within the Malmo Diet and Cancer-Cardiovascular Cohort study (n = 3,734, mean age 72.5 years, 59.3% women, 10.8% subjects with diabetes, fasting GIP available for 3,342 subjects, fasting GLP-1 available for 3,299 subjects) underwent oral glucose tolerance testing and carotid ultrasound. RESULTS In linear regression analyses, each 1-SD increment of fasting GIP was associated with increased (per mm) IMT(mean)CCA (beta = 0.010, P = 0.010) and IMT(max)Bulb (beta = 0.014; P = 0.040) in models adjusted for known risk factors and glucose metabolism. In contrast, each 1-SD increment of fasting GLP-1 was associated with decreased IMT(max)Bulb (per mm, beta = -0.016, P = 0.014). These associations remained significant when subjects with diabetes were excluded from analyses. CONCLUSIONS In a Swedish elderly population, physiologically elevated levels of fasting GIP are associated with increased IMT(mean)CCA, while GLP-1 is associated with decreased IMT(max)Bulb, further emphasizing diverging cardiovascular effects of these two incretin hormones.
  • Autores: Mortani Barbosa, E. J. (Jr.) (Autor de correspondencia); Georgescu, B.; Chaganti, S.; et al.
    Revista: EUROPEAN RADIOLOGY
    ISSN 0938-7994 Vol.31 N° 11 2021 págs. 8775 - 8785
    Resumen
    Objectives To investigate machine learning classifiers and interpretable models using chest CT for detection of COVID-19 and differentiation from other pneumonias, interstitial lung disease (ILD) and normal CTs. Methods Our retrospective multi-institutional study obtained 2446 chest CTs from 16 institutions (including 1161 COVID-19 patients). Training/validation/testing cohorts included 1011/50/100 COVID-19, 388/16/33 ILD, 189/16/33 other pneumonias, and 559/17/34 normal (no pathologies) CTs. A metric-based approach for the classification of COVID-19 used interpretable features, relying on logistic regression and random forests. A deep learning-based classifier differentiated COVID-19 via 3D features extracted directly from CT attenuation and probability distribution of airspace opacities. Results Most discriminative features of COVID-19 are the percentage of airspace opacity and peripheral and basal predominant opacities, concordant with the typical characterization of COVID-19 in the literature. Unsupervised hierarchical clustering compares feature distribution across COVID-19 and control cohorts. The metrics-based classifier achieved AUC = 0.83, sensitivity = 0.74, and specificity = 0.79 versus respectively 0.93, 0.90, and 0.83 for the DL-based classifier. Most of ambiguity comes from non-COVID-19 pneumonia with manifestations that overlap with COVID-19, as well as mild COVID-19 cases. Non-COVID-19 classification performance is 91% for ILD, 64% for other pneumonias, and 94% for no pathologies, which demonstrates the robustness of our method against different compositions of control groups. Conclusions Our new method accurately discriminates COVID-19 from other types of pneumonia, ILD, and CTs with no pathologies, using quantitative imaging features derived from chest CT, while balancing interpretability of results and classification performance and, therefore, may be useful to facilitate diagnosis of COVID-19.
  • Autores: Raafs, A. G.; Verdonschot, J. A. J.; Henkens, M. T. H. M.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.23 N° 6 2021 págs. 933 - 944
    Resumen
    Aims To determine the prognostic value of multilevel assessment of fibrosis in dilated cardiomyopathy (DCM) patients. Methods and results We quantified fibrosis in 209 DCM patients at three levels: (i) non-invasive late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR); (ii) blood biomarkers [amino-terminal propeptide of procollagen type III (PIIINP) and carboxy-terminal propeptide of procollagen type I (PICP)], (iii) invasive endomyocardial biopsy (EMB) (collagen volume fraction, CVF). Both LGE and elevated blood PICP levels, but neither PIIINP nor CVF predicted a worse outcome defined as death, heart transplantation, heart failure hospitalization, or life-threatening arrhythmias, after adjusting for known clinical predictors [adjusted hazard ratios: LGE 3.54, 95% confidence interval (CI) 1.90-6.60; P < 0.001 and PICP 1.02, 95% CI 1.01-1.03; P = 0.001]. The combination of LGE and PICP provided the highest prognostic benefit in prediction (likelihood ratio test P = 0.007) and reclassification (net reclassification index: 0.28, P = 0.02; and integrated discrimination improvement index: 0.139, P = 0.01) when added to the clinical prediction model. Moreover, patients with a combination of LGE and elevated PICP (LGE+/PICP+) had the worst prognosis (log-rank P < 0.001). RNA-sequencing and gene enrichment analysis of EMB showed an increased expression of pro-fibrotic and pro-inflammatory pathways in patients with high levels of fibrosis (LGE+/PICP+) compared to patients with low levels of fibrosis (LGE-/PICP-). This would suggest the validity of myocardial fibrosis detection by LGE and PICP, as the subsequent generated fibrotic risk profiles are associated with distinct cardiac transcriptomic profiles. Conclusion The combination of myocardial fibrosis at CMR and circulating PICP levels provides additive prognostic value accompanied by a pro-fibrotic and pro-inflammatory transcriptomic profile in DCM patients with LGE and elevated PICP.
  • Autores: Maarse, M. (Autor de correspondencia); Wintgens, L. I. S.; Ponomarenko, A.; et al.
    Revista: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
    ISSN 1045-3873 Vol.32 N° 3 2021 págs. 737 - 744
    Resumen
    Introduction Current guidelines recommend adequate anticoagulation for at least 3 weeks pre- and 4 weeks post-direct current cardioversion (DCCV) to reduce thrombo-embolic risk in patients with atrial fibrillation (AF) lasting greater than 48 h. No specific recommendations exist for DCCV in patients that have undergone left atrial appendage occlusion (LAAO), many of whom are ineligible for anticoagulation. This study aims to observe the efficacy and safety of DCCV post-LAAO in everyday clinical practice. Methods This prospective multicenter registry included DCCVs in patients post-LAAO. Imaging strategy or anticoagulation treatment around DCCV were analyzed. Complications during 30-day follow-up were registered. DCCVs performed in accordance with current guidelines for the general AF population were compared to DCCVs performed deviating from these guidelines. Results In 93 patients (age 65 +/- 17 years, CHA(2)DS(2)-VASC 3.0 +/- 1.3) 284 DCCVs were performed between 2010 and 2018, in 271 sinus rhythm was restored. A wide variety of imaging or anticoagulation strategies around DCCV was observed; in 128 episodes strategies deviated from current guidelines. No thrombo-embolic events were observed after any DCCV during 30-day follow-up. In 34 DCCVs trans-esophageal echocardiography (TOE) was performed before DCCV to exclude cardiac thrombi and/or (re-)verify adequate device positioning. In two patients without post-LAAO imaging before DCCV, a device rotation or embolization was observed during scheduled TOE after LAAO. Conclusion DCCV in AF patients after LAAO is highly effective. No thrombo-embolic events were observed in any patient in this observational cohort, regardless of the periprocedural anticoagulation or imaging strategy. Confirmation of adequate device positioning at least once before DCCV seems recommendable.
  • Autores: Ferreira, J. P. (Autor de correspondencia); Verdonschot, J.; Wang, P.; et al.
    Revista: JACC : HEART FAILURE
    ISSN 2213-1779 Vol.9 N° 4 2021 págs. 268 - 277
    Resumen
    OBJECTIVES This study sought to further understand the mechanisms underlying effect of spironolactone and assessed its impact on multiple plasma protein biomarkers and their respective underlying biologic pathways. BACKGROUND In addition to their beneficial effects in established heart failure (HF), mineralocorticoid receptor antagonists may act upstream on mechanisms, preventing incident HF. In people at risk for developing HF, the HOMAGE (Heart OMics in AGEing) trial showed that spironolactone treatment could provide antifibrotic and antiremodeling effects, potentially slowing the progression to HF. METHODS Baseline, 1-month, and 9-month (or last visit) plasma samples of HOMAGE participants were measured for protein biomarkers (n = 276) by using Olink Proseek-Multiplex cardiovascular and inflammation panels (Olink, Uppsala, Sweden). The effect of spironolactone on biomarkers was assessed by analysis of covariance and explored by knowledgebased network analysis. RESULTS A total of 527 participants were enrolled; 265 were randomized to spironolactone (25 to 50 mg/day) and 262 to standard care ("control"). The median (interquartile range) age was 73 years (69 to 79 years), and 26% were female. Spironolactone reduced biomarkers of collagen metabolism (e.g., COL1A1, MMP-2); brain natriuretic peptide; and biomarkers related to metabolic processes (e.g., PAPPA), inflammation, and thrombosis (e.g., IL17A, VEGF, and urokinase). Spironolactone increased biomarkers that reflect the blockade of the mineralocorticoid receptor (e.g., renin) and increased the levels of adipokines involved in the anti-inflammatory response (e.g., RARRES2) and biomarkers of hemostasis maintenance (e.g., tPA, UPAR), myelosuppressive activity (e.g., CCL16), insulin suppression (e.g., RETN), and inflammatory regulation (e.g., IL-12B). CONCLUSIONS Proteomic analyses suggest that spironolactone exerts pleiotropic effects including reduction in fibrosis, inflammation, thrombosis, congestion, and vascular function improvement, all of which may mediate cardiovascular protective effects, potentially slowing progression toward heart failure. (HOMAGE [Bioprofiling Response to Mineralocorticoid Receptor Antagonists for the Prevention of Heart Failure]; NCT02556450)
  • Autores: de la Espriella, R.; González, M.; Górriz, J. L.; et al.
    Revista: REC, CARDIOCLINICS
    ISSN 2605-1575 Vol.56 N° 4 2021 págs. 284 - 295
    Resumen
    La enfermedad renal es una de las comorbilidades halladas con mayor frecuencia en los pacientes con insuficiencia cardiaca. Su presencia se asocia a peor pronóstico y genera gran incertidumbre sobre la monitorización y abordaje terapéutico. De este modo, las unidades cardiorrenales han surgido como elementos integradores, que desde un punto de vista multidisciplinar pretenden vehiculizar la asistencia, docencia e investigación de este amplio espectro de pacientes. En el presente documento de consenso elaborado por el Grupo de Trabajo de Síndrome Cardiorrenal y Tratamiento de la Congestión en la Insuficiencia Cardiaca de la Sociedad Española de Cardiología y el Grupo de Trabajo de Medicina Cardiorrenal de la Sociedad Española de Nefrología, pretendemos definir las características organizativas que deberían tener las unidades cardiorrenales con la finalidad de garantizar la calidad y seguridad de las actuaciones y resultados obtenidos.
  • Autores: Cleland, J. G. F.; Pellicori, P.; González Miqueo, Aránzazu
    Revista: NATURE MEDICINE
    ISSN 1078-8956 Vol.27 N° 8 2021 págs. 1343 - 1344
    Resumen
    A new trial suggests that pirfenidone, an approved treatment for idiopathic pulmonary fibrosis, may also reduce myocardial fibrosis in patients with heart failure who have a preserved left ventricular ejection fraction.
  • Autores: García Baizán, Alejandra; Caballeros Lam, Fanny Meylin; Ezponda Casajús, Ana; et al.
    Revista: AMERICAN JOURNAL OF ROENTGENOLOGY
    ISSN 0361-803X Vol.216 N° 5 2021 págs. 1216 - 1221
    Resumen
    OBJECTIVE. This study aimed to evaluate the long-term prognostic value of coronary CTA (CCTA) in heart transplant recipients. MATERIALS AND METHODS. The records of 114 patients who had undergone a heart transplant (mean age, 61.7 +/- 11.1 [SD] years; 83.3% men) and who underwent CCTA for the surveillance of coronary allograft vasculopathy (CAV) from June 2007 to December 2017 were retrospectively evaluated for the occurrence of major adverse cardiovascular events (MACEs) (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, coronary revascularization, cardiac arrhythmias, stroke, and retransplant). Patients were classified according to the presence of nonobstructive CAV (lumen reduction < 50%) or obstructive disease (lumen reduction >= 50%) and using a coronary segment involvement score (SIS). Differences in MACE rate between groups were compared. RESULTS. Obstructive CAV was observed in 12 heart transplant recipients (10.5%). During a mean follow-up of 67.5 +/- 41.4 months the overall rates of MACE were 50% and 14.7% in patients with obstructive and nonobstructive CAV, respectively (p < .05), resulting in an odds ratio for MACE of 6 (95% CI, 1.7-21.2). Comparison of event-free survival showed a hazard ratio (HR) of 5 (95% CI, 1.95-13; p =. 004) for patients with obstructive disease. The presence of four or more stenotic coronary segments (SIS = 4) was associated with a higher rate of events (HR, 3.46; 95% CI, 1.46-8.23). CONCLUSION. In patients who have undergone a heart transplant, CCTA offers a significant long-term prognostic impact on the prediction of MACEs.
  • Autores: Marin Oto, Marta (Autor de correspondencia); Seijo Maceiras, Luis Miguel; Divo, M.; et al.
    Revista: JOURNAL OF CLINICAL MEDICINE
    ISSN 2077-0383 Vol.10 N° 3 2021 págs. 489
    Resumen
    Background: Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). It is unknown whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnoea (OSA) or their overlap, may be associated with PAE assessed by chest CT. Methods: We analysed data from two prospective cohort studies that enrolled 284 smokers in lung cancer screening programs and completing baseline home sleep studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD >= 29 mm in men and >= 27 mm in women or as a PA:Ao ratio > 0.9. We evaluated the association of PAE with baseline characteristics using multivariate logistic models. Results: PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index >= 30 kg/m(2) (OR 2.01; 95%CI 1.06-3.78), lower % predicted of forced expiratory volume in one second (FEV1) (OR 1.03; 95%CI 1.02-1.05) and higher % of sleep time with O-2 saturation < 90% (T90) (OR 1.02; 95%CI 1.00-1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02; 95%CI 1.01-1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02; 95%CI 1.01-1.03) or PA:Ao ratio (OR 1.04; 95%CI 1.01-1.07). Conclusions: In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence.
  • Autores: Fernández Ros, Nerea; Alegre Garrido, Félix; Huerta González, Ana; et al.
    Revista: MEDICINE (BALTIMORE)
    ISSN 0025-7974 Vol.100 N° 5 2021 págs. e24483
    Resumen
    Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU. A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0¿10), oxygenation (0¿5), antibiotic therapy (0¿9), organic injury (0¿5), and miscellaneous (0¿4). ...
  • Autores: Soriano Aguadero, Ignacio (Autor de correspondencia); Ezponda Casajús, Ana; Mendoza Ferradas, Francisco Javier; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.63 N° 3 2021 págs. 218 - 227
    Resumen
    Objective: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement. Methods: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (>= 10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume. Results: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score. Conclusion: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia. (C) 2021 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Pujol, C.; Varo Cenarruzabeitia, Nerea; Manero, M. R.; et al.
    Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
    ISSN 1137-6627 Vol.44 N° 2 2021 págs. 205 - 214
    Resumen
    Background. The aim of this paper is to analyze the role of the biomarkers Interleukin 6, Tumoral Necrosis Factor a, sCD40L, high sensitive Troponin T, high sensitive C-Reactive Protein and Galectin-3 in predicting super response (SR) to Cardiac Resynchronization Therapy (CRT), as they have not been studied in this field before. Methods. Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year. SR was defined as reduction in LVESV = 30% at one year follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. Results. 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p = 0.04), suffering from less ischemic cardiomyopathy (13 vs. 63%, p < 0.0001) and lateral (0 vs. 18%, p = 0.03), inferior (4 vs. 33%, p = 0.01) and posterior infarction (0 vs. 22%, p =0.01); absence of mitral regurgitation (47% vs. 22%, p = 0.04), wider QRS width (157.7 +/- 22.9 vs. 140.8 +/- 19.2 ms, p =0.01), higher concentrations of sCD40L (6.9 +/- 5.1 vs. 4.4 +/- 3.3 ng/mL, p= 0.02), and left ventricular lead more frequent in lateral medial position (69 vs. 26%, p = 0.002). QRS width, lateral medial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showed a moderate direct correlation with SR (r = 0.39, p = 0.02) and with the reduction of LVESV (r = 0.44, p = 0.02). Conclusion. sCD40L correlates significantly with SR to CRT. QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SR in this cohort.
  • Autores: Landecho Acha, Manuel Fortún (Autor de correspondencia); Yuste Ara, José Ramón; Gándara Rodríguez de Campoamor, Elsa Pilar; et al.
    Revista: INTERNAL MEDICINE JOURNAL (ONLINE)
    ISSN 1445-5994 Vol.289 N° 1 2021 págs. 116-120
    Resumen
    Importance: COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. Objective: To assess whether there is any retinal disease associated with COVID-19. Design: We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. Results: Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.
  • Autores: Raafs, A.; Verdonschot, J.; Ferreira, J. P.; et al.
    Revista: ESC HEAR FAILURE
    ISSN 2055-5822 Vol.8 N° 5 2021 págs. 3512 - 3520
    Resumen
    Aims Heart failure (HF) is common in both men and women, yet disease pathophysiology, presentation, and progression differ between sexes. Studies addressing whether biomarkers predict new onset HF sex-specifically are scarce. This study therefore aims to test the sex-specificity of 252 protein biomarkers for new-onset HF. Methods and results A matched case-control design in patients selected from cohorts within the HOMAGE consortium was used. Cases (new-onset HF, n = 562) and controls (n = 780) were matched for cohort (PREDICTOR, HEALTH-ABC, & PROSPER), follow-up time (defined as time from entry to incident HF), and age. Incident HF was defined as first hospitalization for HF. Targeted plasma proteins (n = 252) were measured using Proximity Extension Assay technology from O-link. To look for sex differences for new onset HF, we adjusted for cohort, age, and baseline clinical parameters. At baseline, women had a biomarker profile reflecting activated metabolism and immune responses. However, none of the biomarkers had a significant interaction with sex in predicting new onset HF, but four biomarkers had a trend towards sex-specificity (P < 0.013). E-selectin and interleukin 1 receptor antagonist were more female-specific, whereas IL17A and CHIT1 tended to be male sex-specific for incident HF. Conclusions The majority of biomarkers associated with incident HF did not significantly differ between women and men, despite clear differences in biomarkers at baseline.
  • Autores: Martinez Urabayena, U.; Caballeros Lam, Fanny Meylin; Soriano Aguadero, Ignacio; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.63 N° 5 2021 págs. 391 - 399
    Resumen
    Objective: To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. Material and methods: We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 +/- 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. Results: In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 +/- 2.6 mm vs. 16.7 +/- 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 +/- 2 mm vs. 13.8 +/- 2.2 mm, p = 0.009) and larger left atrial volume (91.9 +/- 24.9 cm(3) vs. 70.7 +/- 20.3 mm(3), p = 0.001). After 22.1 +/- 12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 +/- 23.0 mm(3) vs. 71.1 +/- 23.2 mm(3), p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. Conclusion: The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.
  • Autores: García, E. (Autor de correspondencia); Stratakis, N.; Valvi, D.; et al.
    Revista: ENVIRONMENTAL EPIDEMIOLOGY
    ISSN 2474-7882 Vol.5 N° 3 2021 págs. e153
    Resumen
    Background: Nonalcoholic fatty liver disease is the most prevalent pediatric chronic liver disease. Experimental studies suggest effects of air pollution and traffic exposure on liver injury. We present the first large-scale human study to evaluate associations of prenatal and childhood air pollution and traffic exposure with liver injury. Methods: Study population included 1,102 children from the Human Early Life Exposome project. Established liver injury biomarkers, including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and cytokeratin-18, were measured in serum between ages 6-10 years. Air pollutant exposures included nitrogen dioxide, particulate matter <10 <mu>m (PM10), and <2.5 <mu>m. Traffic measures included traffic density on nearest road, traffic load in 100-m buffer, and inverse distance to nearest road. Exposure assignments were made to residential address during pregnancy (prenatal) and residential and school addresses in year preceding follow-up (childhood). Childhood indoor air pollutant exposures were also examined. Generalized additive models were fitted adjusting for confounders. Interactions by sex and overweight/obese status were examined. Results: Prenatal and childhood exposures to air pollution and traffic were not associated with child liver injury biomarkers. There was a significant interaction between prenatal ambient PM10 and overweight/obese status for alanine aminotransferase, with stronger associations among children who were overweight/obese. There was no evidence of interaction with sex. Conclusion: This study found no evidence for associations between prenatal or childhood air pollution or traffic exposure with liver injury biomarkers in children. Findings suggest PM10 associations maybe higher in children who are overweight/obese, consistent with the multiple-hits hypothesis for nonalcoholic fatty liver disease pathogenesis.
  • Autores: Thavendiranathan, P.; Zhang, L. L.; Zafar, A.; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.77 N° 12 2021 págs. 1503 - 1516
    Resumen
    BACKGROUND Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. OBJECTIVES This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. METHODS In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. RESULTS Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 +/- 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across alt patients, mean z-scores for T1 and T2 values were 2.9 +/- 1.9 (p < 0.001) and 2.2 +/- 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1(1,079.0 +/- 55.5 ms vs. 1,000.3 +/- 221 ms; p < 0.001) and 12 (56.2 +/- 4.9 ms vs. 49.8 +/- 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91(95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE. CONCLUSIONS The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis. (C) 2021 by the American College of Cardiology Foundation.
  • Autores: Manrique Antón, Rebeca (Autor de correspondencia); Salterain González, Nahikari; Mendez Martínez, Elena; et al.
    Revista: CIRUGIA CARDIOVASCULAR
    ISSN 1134-0096 Vol.28 N° 6 2021 págs. 353 - 356
    Resumen
    El tratamiento percutáneo de la estenosis aórtica severa es una opción terapéutica para paciente inoperables y para aquellos de moderado o elevado riesgo quirúrgico. Presentamos el caso de un paciente joven inicialmente considerado inoperable, sometido a una implantación transcatéter de válvula aórtica, que comenzó a mostrar signos de degeneración tras seis años, que evolucionaron hasta requerir tratamiento quirúrgico a los ocho años del implante. Durante este tiempo, su estado de salud mejoró, por lo que fue presentado en sesión médico quirúrgica para la resección de la válvula previamente implantada y sustitución por otra bioprótesis. El procedimiento transcurrió sin complicaciones. No obstante, la resección de estas válvulas no es un procedimiento exento de riesgo, por las densas adherencias del marco a la raíz aórtica. Por este motivo, la expansión de esta tecnología a pacientes jóvenes y de bajo riesgo, no estaría justificada.
  • Autores: Bayes-Genis, A. (Autor de correspondencia); Januzzi, J. L.; Richards, A. M.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.23 N° 9 2021 págs. 1432 - 1436
  • Autores: Das, M. (Autor de correspondencia); Luik, A.; Shepherd, E.; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.23 N° 7 2021 págs. 1042 - 1051
    Resumen
    Aims Radiofrequency ablation creates irreversible cardiac damage through resistive heating and this temperature change results in a generator impedance drop. Evaluation of a novel local impedance (LI) technology measured exclusively at the tip of the ablation catheter found that larger LI drops were indicative of more effective lesion formation. We aimed to evaluate whether LI drop is associated with conduction block in patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI). Methods and results Sixty patients underwent LI-blinded de novo PVI using a point-by-point ablation workflow. Pulmonary vein rings were divided into 16 anatomical segments. After a 20-min waiting period, gaps were identified on electroanatomic maps. Median LI drop within segments with inter-lesion distance <= 6 mm was calculated offline. The diagnostic accuracy of LI drop for predicting segment block was assessed using receiver operating characteristic analysis. For segments with inter-lesion distance <= 6 mm, acutely blocked segments had a significantly larger LI drop [19.8 (14.1-27.1) Omega] compared with segments with gaps [10.6 (7.8-14.7) Omega, P < 0.001). In view of left atrial wall thickness differences, the association between LI drop and block was further evaluated for anterior/roof and posterior/inferior segments. The optimal LI cut-off value for anterior/roof segments was 16.1 Omega (positive predictive value for block: 96.3%) and for posterior/inferior segments was 12.3 Omega (positive predictive value for block 98.1%) where inter-lesion distances were <= 6 mm. Conclusion The magnitude of LI drop was predictive of acute PVI segment conduction block in patients with paroxysmal AF. The thinner posterior wall required smaller LI drops for block compared with the thicker anterior wall.
  • Autores: Romero-González, G.; Díaz Dorronsoro, Inés; Ravassa Albéniz, Susana; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.42 N° Supl. 1 2021 págs. 2911
  • Autores: Romero González, Gregorio Aramid; Ravassa Albéniz, Susana; Díaz Dorronsoro, Inés; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN 0931-0509 Vol.36 2021
  • Autores: Reese-Petersen, A. L.; González Miqueo, Aránzazu; López Salazar, Begoña; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.42 2021 págs. 732 - 732
  • Autores: Muñiz Sáenz-Diez, Javier; Ezponda Casajús, Ana; Gavira Gómez, Juan José; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.42 N° Supl. 1 2021 págs. 212
  • Autores: De Juan Baguda, J.; Pachón Iglesias, M.; Gavira Gómez, Juan José; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.23 N° Supl. 2 2021 págs. 297 - 298
  • Autores: Bayes-Genis, A.; Liu, P. P.; Lanfear, D. E.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.41 N° 36 2020 págs. 3477 - 3484
    Resumen
    This state-of-the-art review aims to provide an up-to-date look at breakthrough omic technologies that are helping to unravel heart failure (HF) disease mechanisms and heterogeneity. Genomics, transcriptomics, proteomics, and metabolomics in HF are reviewed in depth. In addition, there is a thorough, expert discussion regarding the value of omics in identifying novel disease pathways, advancing understanding of disease mechanisms, differentiating HF phenotypes, yielding biomarkers for diagnosis or prognosis, or identifying new therapeutic targets in HF. The combination of multiple omics technologies may create a more comprehensive picture of the factors and physiology involved in HF than achieved by either one alone and provides a rich resource for predictive phenotype modelling. However, the successful translation of omics tools as solutions to clinical HF requires that the observations are robust and reproducible and can be validated across multiple independent populations to ensure confidence in clinical decision-making.
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); González Miqueo, Aránzazu; Kovacic, J. C.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.75 N° 17 2020 págs. 2204 - 2218
  • Autores: González Miqueo, Aránzazu (Autor de correspondencia); López Salazar, Begoña; Ravassa Albéniz, Susana; et al.
    Revista: BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH
    ISSN 0167-4889 Vol.1867 N° 3 2020
    Resumen
    Myocardial interstitial fibrosis (MIF) is a common finding in heart failure (HF) patients, both with preserved and reduced ejection fraction, as well as in HF animal models. MIF is associated with impaired cardiac function and worse clinical outcome. The impact of MIF is influenced not only by the quantity but also by changes in the quality of collagen fibers and in the extracellular matrix components, such as a shift in collagen types proportion, increased fibronectin polymerization and increased degree of collagen cross-linking (CCL). In particular, CCL, a process that renders collagen fibers stiffer and more resistant to degradation, is increased both in patients and animal models of HF. Importantly, in HF patients increased cardiac CCL is directly associated with increased left ventricular stiffness and a higher risk of hospitalization for HF. The aim of this review is to address the complexity of MIF in HF, focusing on CCL.
  • Autores: Brakenhielm, E.; González Miqueo, Aránzazu; Díez Martínez, Domingo Francisco Javier (Autor de correspondencia)
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.76 N° 6 2020 págs. 735 - 744
    Resumen
    The cardiac lymphatic network plays a key role in regulation of myocardial extracellular volume and immune cell homeostasis. In different pathological conditions cardiac lymphatics undergo significant remodeling, with insufficient lymphatic function and/or lymphangiogenesis leading to fluid accumulation and development of edema. Additionally, by modulating the reuptake of tissue-infiltrating immune cells, lymphatics regulate immune responses. Available evidence suggests that both edema and inadequate immune response resolution may contribute to extracellular matrix remodeling and interstitial myocardial fibrosis. Interestingly, stimulation of lymphangiogenesis has been shown to improve cardiac function and reduce the progression of myocardial fibrosis during heart failure development after myocardial infarction. This review goes through the available clinical and experimental data supporting a role for cardiac lymphatics in cardiac disease, focusing on the current evidence linking poor cardiac lymphatic transport to the fibrogenic process and discussing potential avenues for novel biomarkers and therapeutic targets to limit cardiac fibrosis and dysfunction. (C) 2020 by the American College of Cardiology Foundation.
  • Autores: Romero González, Gregorio Aramid; Ravassa Albéniz, Susana; González Arostegui, Omar Jose; et al.
    Revista: NEFROLOGIA
    ISSN 0211-6995 Vol.40 N° 3 2020 págs. 223 - 236
    Resumen
    Patients with the dual burden of chronic kidney disease (CKD) and chronic congestive heart failure (HF) experience unacceptably high rates of symptom load, hospitalization, and mortality. Currently, concerted efforts to identify, prevent and treat HF in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this review paper endorse the need for a dedicated cardiorenal interdisciplinary team that includes nephrologists and renal nurses and jointly manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients. The implementation of cross-specialty educational programs across all levels in cardiology and nephrology will help train future specialists and nurses who have the ability to diagnose, treat, and prevent HF in CKD patients in a precise, clinically effective, and cost-favorable manner.
  • Autores: Caballeros Lam, Fanny Meylin (Autor de correspondencia); de La Fuente Villena, Ana; Hernández Hernández, Aitor; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA
    ISSN 0300-8932 Vol.73 N° 10 2020 págs. 863-864
  • Autores: Mendoza Ferradas, Francisco Javier; García del Barrio, Loreto; Bastarrika Alemañ, Gorka (Autor de correspondencia)
    Revista: ARCHIVOS DE BRONCONEUMOLOGIA
    ISSN 0300-2896 Vol.56 2020 págs. 31 - 32
  • Autores: Paternain Nuin, Alberto (Autor de correspondencia); Malmierca Ordoqui, Patricia; Igual Rouilleault, Alba Cristina; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.62 N° 4 2020 págs. 306 - 312
    Resumen
    Objectives: To evaluate the effectiveness of practical ultrasound workshops for the acquisition and consolidation of conceptual learning about the basic physics and semiology of ultrasonography aimed at third-year medical school students doing the physical examination module of their studies. Material and methods: We carried out practical ultrasound workshops with two groups of 177 and 175 students in two consecutive academic years. All students had taken a class in basic radiology in the previous year. Students examined each other with ultrasonography under instructors' supervision in a two-hour session. Before and after the workshop, students did a seven-question multiple-choice test about basic semiology and answered two questions evaluating their degree of confidence in interpreting ultrasonographic images and handling the ultrasound scanner on a scale from 1 to 10. Results: No significant differences were found between the scores obtained in the two groups. Overall, the mean score on the multiple-choice test improved from 59.71% on the initial assessment to 88.29% on the post-workshop assessment (p <0.01). Confidence in interpreting images improved from 3.39/10 to 6.28/10 (p <0.01), and confidence in handling the equipment improved from 3.73/10 to 6.51/10 (p <0.01). Conclusion: Practical workshops were useful for learning basic concepts about ultrasound imaging, allowing students to significantly improve their scores on the multiple-choice test. Students had a low level of confidence in their ability to interpret ultrasound images and handle the equipment before starting the workshop, but their confidence improved significantly after completing the workshop.
  • Autores: Schimmel, K.; Jung, M.; Foinquinos, A.; et al.
    Revista: CIRCULATION
    ISSN 0009-7322 Vol.141 N° 9 2020 págs. 751 - 767
    Resumen
    Background: Myocardial fibrosis is a hallmark of cardiac remodeling and functionally involved in heart failure development, a leading cause of deaths worldwide. Clinically, no therapeutic strategy is available that specifically attenuates maladaptive responses of cardiac fibroblasts, the effector cells of fibrosis in the heart. Therefore, our aim was to develop novel antifibrotic therapeutics based on naturally derived substance library screens for the treatment of cardiac fibrosis. Methods: Antifibrotic drug candidates were identified by functional screening of 480 chemically diverse natural compounds in primary human cardiac fibroblasts, subsequent validation, and mechanistic in vitro and in vivo studies. Hits were analyzed for dose-dependent inhibition of proliferation of human cardiac fibroblasts, modulation of apoptosis, and extracellular matrix expression. In vitro findings were confirmed in vivo with an angiotensin II-mediated murine model of cardiac fibrosis in both preventive and therapeutic settings, as well as in the Dahl salt-sensitive rat model. To investigate the mechanism underlying the antifibrotic potential of the lead compounds, treatment-dependent changes in the noncoding RNAome in primary human cardiac fibroblasts were analyzed by RNA deep sequencing. Results: High-throughput natural compound library screening identified 15 substances with antiproliferative effects in human cardiac fibroblasts. Using multiple in vitro fibrosis assays and stringent selection algorithms, we identified the steroid bufalin (from Chinese toad venom) and the alkaloid lycorine (from Amaryllidaceae species) to be effective antifibrotic molecules both in vitro and in vivo, leading to improvement in diastolic function in 2 hypertension-dependent rodent models of cardiac fibrosis. Administration at effective doses did not change plasma damage markers or the morphology of kidney and liver, providing the first toxicological safety data. Using next-generation sequencing, we identified the conserved microRNA 671-5p and downstream the antifibrotic selenoprotein P1 as common effectors of the antifibrotic compounds. Conclusions: We identified the molecules bufalin and lycorine as drug candidates for therapeutic applications in cardiac fibrosis and diastolic dysfunction.
  • Autores: Gutiérrez Jimeno, Miriam; Ibañez Sada, Adriana; Gavira Gómez, Juan José; et al.
    Revista: INTERNATIONAL JOURNAL OF CLINICAL PEDIATRICS
    ISSN 1927-1255 Vol.9 N° 3 2020 págs. 92 - 97
    Resumen
    Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic, affecting humans of all ages. Clinical features of the pediatric population have been published, but there is not yet enough information to make a definitive description. Fever is typical, as it is respiratory symptom. Rarely are the infection and complications severe, and, when they are, it is almost always in a patient with another underlying disease. However, some otherwise healthy children with COVID-19 do suffer critical organ injury, such as acute myocarditis, heart failure and gastrointestinal inflammation. The mechanism of these organ damages remains unclear. An otherwise normally healthy 13-year-old male was admitted to the pediatric intensive care unit with acute abdomen pain, possible myocarditis and a suspected diagnosis of COVID-19. Noteworthy basal findings were ventricular extrasystoles in the electrocardiogram (EKG) and moderate left ventricular systolic dysfunction. Chest X-ray was normal. Blood tests revealed altered levels of inflammation factors (C-reactive protein (CRP), D-dimer, fibrinogen, interleukin 6 (IL-6)), lymphopenia and elevated cardiac enzymes. The first test for polymerase chain reaction (PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. The patient¿s condition worsened, and he entered cardiogenic shock (hypotension, tachycardia and oliguria). He was vomiting continuously, which made pain control difficult; imaging of his abdomen was ...
  • Autores: Tschiderer, L.; Seekircher, L.; Klingenschmid, G.; et al.
    Revista: GERONTOLOGY
    ISSN 0304-324X Vol.66 N° 5 2020 págs. 447 - 459
    Resumen
    Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, -ankle-brachial index, pulse wave velocity, and coronary -artery calcium. The Prospective Studies of Atherosclerosis -(Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. In summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. The consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences.
  • Autores: Ravassa Albéniz, Susana; Beaumont Ezcurra, Francisco Javier; Cediel G; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN 1885-5857 Vol.S1885 - 5857 N° 19 2020 págs. 30366 - 4
  • Autores: Carnero González, Elena María; Bragard Monier, Jean; Urrestarazu Bolumburu, Elena; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.15 N° 3 2020 págs. e0229856
    Resumen
    Purpose To analyse nocturnal intraocular pressure (IOP) fluctuations in patients with obstructive sleep apnea syndrome (OSAS) using a contact lens sensor (CLS) and to identify associations between the OSAS parameters determined by polysomnographic study (PSG) and IOP changes. Method Prospective, observational study. Twenty participants suspected of having OSAS were recruited. During PSG study, IOP was monitored using a CLS placed in the eye of the patient. The patients were classified according to the apnea-hypopnea index (AHI) in two categories, severe (> 30) or mild/moderate (< 30) OSAS. We evaluated several parameters determined by the IOP curves, including nocturnal elevations (acrophase) and plateau times in acrophase (PTs) defined by mathematical and visual methods. Results The IOP curves exhibited a nocturnal acrophase followed by PTs of varying extents at which the IOP remained higher than daytime measurement with small variations. We found significant differences in the length of the PTs in patients with severe OSAS compared to those with mild/moderate disease (P = 0.032/P = 0.028). We found a positive correlation between PTs and OSAS severity measured by the total number of apneic events (r = 0.681/ 0.751 P = 0.004/0.001) and AHI (r = 0.674/0.710, P = 0.004/0.002). Respiratory-related arousal and oxygen saturation also were associated significantly with the IOP PT length. Conclusions Periods of nocturnal IOP elevation lasted longer in severe OSAS patients than those with mild/moderate OSAS and correlate with the severity of the disease. The length of the nocturnal PT is also associated to respiratory parameters altered in patients with OSAS.
  • Autores: Sánchez-Carpintero Abad, María (Autor de correspondencia); Sanchez-Salcedo, P.; de Torres Tajes, Juan Pablo; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.15 N° 4 2020 págs. e0231204
    Resumen
    Introduction: The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program. Methods: 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period. Results: The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62). Conclusions: Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence of new nodules and false positives on baseline and follow-up screening rounds. This leads to an increase need of diagnostic tests, although the lung cancer occurrence is not different.
  • Autores: Barrio-Lopez, M. T.; Ruiz-Canela, Miguel; Ramos Ardanáz, Pablo; et al.
    Revista: AMERICAN HEART JOURNAL
    ISSN 0002-8703 Vol.220 2020 págs. 127 - 136
    Resumen
    Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. Catheter ablation aims to restore sinus rhythm. However, relapses occur in up to 30% of patients. A Mediterranean diet (MedDiet) enriched with extra-virgin olive oil (EVOO) substantially reduced the incidence of AF in the PREDIMED trial. The PREDIMAR will test a similar intervention in secondary prevention. Methods PREDIMAR is a multicenter, randomized, single-blind trial testing the effect of a MedDiet enriched with EVOO to reduce tachyarrhythmia relapses after AF ablation. The primary outcome is the recurrence of any sustained atrial tachyarrhythmia after ablation (excluding those occurring only during the first 3 months after ablation). The target final sample size is 720 patients (360 per group) recruited from 4 Spanish hospitals. A remote intervention, maintained for 2 years, is delivered to the active intervention group including periodic phone calls by a dietitian and free provision of EVOO. The control group will receive delayed intervention after trial completion. Routine electrocardiogram (ECG) and Holter ECG are performed, and a portable cardiac rhythm monitoring device is provided to be worn by participants during 15 months. Results Recruitment started in March 2017. Up to July 2019, 609 patients were randomized (average inclusion rate: 5.3 patients/wk). Retention rates after 18 months are >94%. Conclusions If our hypothesis is confirmed, the utility of the MedDiet enriched with EVOO in slowing the progression of AF will be proven, preventing recurrences and potentially reducing complications.
  • Autores: Bastarrika Alemañ, Gorka (Autor de correspondencia); Ezponda Casajús, Ana; García Baizán, Alejandra; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.62 N° 3 2020 págs. 213 - 221
    Resumen
    Objective: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. Material and methods: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67 11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5 ml, 0.4 mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. Results: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9 + 11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1+18.8 mmHg and 5.3 9.2 mmHg, respectively (p '0.O01). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4 11.2 bpm vs. 20.6 + 10.7 bpm in asymptomatic patients, p =0.001). No severe adverse effects were observed. Conclusion: Regadenoson is welt tolerated and can be safety used for cardiac MRI stress tests. 0Z0/9 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Adalsteinsdottir, B. (Autor de correspondencia); Burke, M. ; Maron, B. J. ; et al.
    Revista: OPEN HEART
    ISSN 2053-3624 Vol.7 N° 1 2020
    Resumen
    Objective The myosin-binding protein C (MYBPC3) c.927-2A>G founder mutation accounts for >90% of sarcomeric hypertrophic cardiomyopathy (HCM) in Iceland. This cross-sectional observational study explored the penetrance and phenotypic burden among carriers of this single, prevalent founder mutation. Methods We studied 60 probands with HCM caused by MYBPC3 c.927-2A>G and 225 first-degree relatives. All participants underwent comprehensive clinical evaluation and relatives were genotyped. Results Genetic and clinical evaluation of relatives identified 49 genotype-positive (G+) relatives with left ventricular hypertrophy (G+/ LVH+), 59 G+without LVH (G+/LVH-) and 117 genotype-negative relatives (unaffected). Compared with HCM probands, G+/ LVH+ relatives were older at HCM diagnosis, had less LVH, a less prevalent diastolic dysfunction, fewer ECG abnormalities, lower serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I levels, and fewer symptoms. The penetrance of HCM was influenced by age and sex; specifically, LVH was present in 39% of G+males but only 9% of G+females under age 40 years (p=0.015), versus 86% and 83%, respectively, after age 60 (p=0.89). G+/LVH- subjects had normal wall thicknesses, diastolic function and NT-proBNP levels, but subtle changes in LV geometry and more ECG abnormalities than their unaffected relatives. Conclusions Phenotypic expression of the Icelandic MYBPC3 founder mutation varies by age, sex and proband status. Men are more likely to have LVH at a younger age, and disease manifestations were more prominent in probands than in relatives identified via family screening. G+/LVH- individuals had subtle clinical differences from unaffected relatives well into adulthood, indicating subclinical phenotypic expression of the pathogenic mutation.
  • Autores: Recalde Zamacona, Borja; García Tobar, Laura; Argueta Morales, Allan; et al.
    Revista: THORAX
    ISSN 0040-6376 Vol.75 N° 12 2020 págs. 1116 - 1118
    Resumen
    In December 2019, an outbreak of severe acute respiratory syndrome associated to SARS-CoV2 was reported in Wuhan, China. To date, little is known on histopathological findings in patients infected with the new SARS-CoV2. Lung histopathology shows features of acute and organising diffuse alveolar damage. Subtle cellular inflammatory infiltrate has been found in line with the cytokine storm theory. Medium-size vessel thrombi were frequent, but capillary thrombi were not present. Despite the elevation of biochemical markers of cardiac injury, little histopathological damage could be confirmed. Viral RNA from paraffin sections was detected at least in one organ in 90% patients.
  • Autores: Vázquez García, Blanca (Autor de correspondencia); Villas Tomé, Carlos; Pueyo Villoslada, Jesús; et al.
    Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
    ISSN 1137-6627 Vol.43 N° 3 2020 págs. 323 - 331
    Resumen
    Background: To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population. Methods: One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle. Results: The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º. Conclusion: A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique.
  • Autores: De-Simone, A.; Anselmino, M.; Scaglione, M.; et al.
    Revista: JOURNAL OF CARDIOVASCULAR MEDICINE
    ISSN 1558-2027 Vol.21 N° 2 2020 págs. 113 - 122
    Resumen
    Aims We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry. Methods A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs. Results In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66). Conclusion Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.
  • Autores: Ferreira JP (Autor de correspondencia); Pizard A; Machu JL; et al.
    Revista: CLINICAL RESEARCH IN CARDIOLOGY
    ISSN 1861-0684 Vol.109 N° 1 2020 págs. 22 - 23
    Resumen
    Background Hypertension, obesity and diabetes are major and potentially modifiable "risk factors" for cardiovascular diseases. Identification of biomarkers specific to these risk factors may help understanding the underlying pathophysiological pathways, and developing individual treatment. Methods The FIBRO-TARGETS (targeting cardiac fibrosis for heart failure treatment) consortium has merged data from 12 patient cohorts in 1 common database of > 12,000 patients. Three mutually exclusive main phenotypic groups were identified ("cases"): (1) "hypertensive"; (2) "obese"; and (3) "diabetic"; age-sex matched in a 1:2 proportion with "healthy controls" without any of these phenotypes. Proteomic associations were studied using a biostatistical method based on LASSO and confronted with machine-learning and complex network approaches. Results The case:control distribution by each cardiovascular phenotype was hypertension (50:100), obesity (50:98), and diabetes (36:72). Of the 86 studied proteins, 4 were found to be independently associated with hypertension: GDF-15, LEP, SORT-1 and FABP-2; 3 with obesity: CEACAM-8, LEP and PRELP; and 4 with diabetes: GDF-15, REN, CXCL-1 and SCF. GDF-15 (hypertension + diabetes) and LEP (hypertension + obesity) are shared by 2 different phenotypes. A machine-learning approach confirmed GDF-15, LEP and SORT-1 as discriminant biomarkers for the hypertension group, and LEP plus PRELP for the obesity group. Complex network analyses provided insight on the
  • Autores: Pellicori, P. (Autor de correspondencia); Ferreira, J. P.; Mariottoni, B. ; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.22 N° 9 2020 págs. 1711 - 1723
    Resumen
    AimsAsymptomatic patients with coronary artery disease (CAD), hypertension and/or type 2 diabetes mellitus (T2DM) are at greater risk of developing heart failure (HF). Fibrosis, leading to myocardial and vascular dysfunction, might be an important pathway of progression. The Heart OMics in AGing (HOMAGE) trial aims to investigate the effects of spironolactone on serum markers of collagen metabolism and on cardiovascular structure and function in people at risk of developing HF and potential interactions with a marker of fibrogenic activity, galectin-3. Methods and resultsThe HOMAGE trial is a prospective, randomised, open-label, blinded endpoint (PROBE) study comparing spironolactone (up to 50mg/day) and standard care over 9months in people with clinical risk factors for developing HF, including hypertension, CAD and T2DM, and elevated plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP, 125 to 1000ng/L) or B-type natriuretic peptide (BNP, 35 to 280ng/L). Exclusion criteria included left ventricular ejection fraction <45%, atrial fibrillation, severe renal dysfunction, or treatment with loop diuretics. The primary endpoint was the interaction between change in serum concentrations of procollagen type III N-terminal propeptide (PIIINP) and treatment with spironolactone according to median plasma concentrations of galectin-3 at baseline. For the 527 participants enrolled, median (interquartile range) age was 73 (69-79) years, 135 (26%) were women, 412 (78%) had hypertension, 377 (72%) CAD, and 212 (40%) T2DM. At baseline, medians (interquartile ranges) were for left ventricular ejection fraction 63 (58-67)%, for left atrial volume index 31 (26-37)mL/m(2), for plasma NT-proBNP 214 (137-356)ng/L, for serum PIIINP 3.9 (3.1-5.0)ng/mL, and for galectin-3 16.1 (13.5-19.7)ng/mL. ConclusionsThe HOMAGE trial will provide insights on the effect of spironolactone on pathways that might drive progression to HF. Clinical Trial Registration: ClinicalTrials.gov NCT02556450.
  • Autores: Valero-Masa, M. J.; Gonzalez-Vilchez, F. ; Almenar-Bonet, L. ; et al.
    Revista: INTERNATIONAL JOURNAL OF CARDIOLOGY
    ISSN 0167-5273 Vol.319 2020 págs. 14 - 19
    Resumen
    Background: Cold ischemia time (CIT) has been associated to heart transplantation (HT) prognosis. However, there is still uncertainty regarding the CIT cutoff value that might have relevant clinical implications. Methods: We analyzed all adults that received a first HT during the period 2008-2018. CIT was defined as the time between the cross-clamp of the donor aorta and the reperfusion of the heart. Primary outcome was 1-month mortality. Results: We included 2629 patients, mean age was 53.3 +/- 12.1 years and 655 (24.9%) were female. Mean CIT was 202 +/- 67 min (minimum 20 min, maximum 600 min). One-month mortality per CIT quartile was 9, 12, 13, and 19%. One-year mortality per CIT quartile was 16, 19, 21, and 28%. CIT was an independent predictor of 1-month mortality, but only in the last quartile of CIT >246 min (odds ratio 2.1, 95% confidence interval 1.49-3.08, p < .001). We found no relevant differences in CIT during the study period. However, the impact of CIT in 1-month and 1-year mortality decreased with time (p value for the distribution of ischemic time by year 0.01), particularly during the last 5 years. Conclusions: Although the impact of CIT in HT prognosis seems to be decreasing in the last years, CIT in the last quartile (>246 min) is associated with 1-month and 1-year mortality. Our findings suggest the need to limit HT with CIT > 246 min or to use different myocardial preservation systems if the expected CIT is >4 h.
  • Autores: Jiménez Jaso, Juana María; Ezponda Casajús, Ana; Muñiz Sáenz-Diez, Javier; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.62 N° 6 2020 págs. 493 - 501
    Resumen
    Objective: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. Material and methods: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac alto graft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. Results: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3 +/- 15.2 ml/m(2) vs. 71.4 +/- 15.9 ml/m(2) in those without transplants, p = 0.03), lower MPRI (1.35 +/- 0.19 vs. 1.6 +/- 0.28 in those without transplants, p = 0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1 +/- 5.4 bpm vs. 28.5 +/- 8.9 bpm in those without transplants, p<0.001). Conclusion: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants. (C) 2020 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Divo, M. J. (Autor de correspondencia); Marin Oto, Marta; Macario, C. C.; et al.
    Revista: ERJ OPEN RESEARCH
    ISSN 2312-0541 Vol.6 N° 3 2020 págs. 00122-2020
    Resumen
    Rationale: Chronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation. Objectives: We hypothesised that somatotype changes - as a surrogate of adiposity - from early adulthood follow different trajectories to reach distinct phenotypes. Methods: Using the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory. Measurements and main results: At 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg.m(-2)) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg.m(-2)). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI and D-LCO (diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1), D-LCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype. Conclusions: COPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.
  • Autores: Ravassa Albéniz, Susana; González Miqueo, Aránzazu; Bayés-Genís A; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN 1885-5857 Vol.S1885 - 5857 N° 19 2020 págs. 30300 - 7
    Resumen
    Myocardial interstitial fibrosis is a constant pathological finding in structural heart diseases of various etiologies that evolve with heart failure. Although fibrosis facilitates heart failure progression, until now no therapeutic strategy has been developed that ensures its reversal. A possible explanation for this may lie in the vision of myocardial interstitial fibrosis as a homogeneous lesion instead of a heterogeneous lesion in which different phenotypes can be distinguished using appropriate criteria. In addition, the notion that the heterogeneity of myocardial interstitial fibrosis may be cardiac disease-specific must be also considered when approaching this entity. Therefore, we propose that myocardial interstitial fibrosis represents a true challenge for transitioning from usual care to biomarker-based personalized treatment and precision medicine in heart failure. As a proof-of-concept, in this review we discuss the phenotyping of myocardial interstitial fibrosis in patients with heart failure attributable to hypertensive heart disease based on its histomolecular alterations and provide evidence of the prognostic relevance of the resulting stratification. Furthermore, we discuss the available information on some circulating biomarkers and certain pharmacological agents useful for noninvasive identification and personalized treatment, respectively, of those phenotypes. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U.
  • Autores: González Gutiérrez, Jessica; Rivera-Ortega, P.; Rodríguez-Fraile, M.; et al.
    Revista: THE INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (PRINT)
    ISSN 1176-9106 Vol.15 2020 págs. 1823 - 1829
    Resumen
    Rationale: Emphysema and osteoporosis are tobacco-related diseases. Many studies have shown that emphysema is a strong and independent predictor of low bone mineral density (BMD) in smokers; however, none of them explored its association with different emphysema subtypes. Objective: To explore the association between the different emphysema subtypes and the presence of low bone mineral density in a population of active or former smokers with and without chronic obstructive pulmonary disease (COPD). Methods: One hundred and fifty-three active and former smokers from a pulmonary clinic completed clinical questionnaires, pulmonary function tests, a low-dose chest computed tomography (LDCT) and a dual-energy absorptiometry (DXA) scans. Subjects were classified as having normal BMD or low BMD (osteopenia or osteoporosis). Emphysema was classified visually for its subtype and severity. Logistic regression analysis explored the relationship between the different emphysema subtypes and the presence of low BMD adjusting for other important factors. Results: Seventy-five percent of the patients had low BMD (78 had osteopenia and 37 had osteoporosis). Emphysema was more frequent (66.1 vs 26.3%, p=<0.001) and severe in those with low BMD. Multivariable analysis adjusting for other significant cofactors (age, sex, FEVi, and severity of emphysema) showed that BMI (OR=0.91, 95% CI: 0.76-0.92) and centrilobular emphysema (OR=26.19, 95% CI: 1.71 to 399.44) were associated with low BMD. Conclusion: Low BMD is highly prevalent in current and former smokers. BMI and centrilobular emphysema are strong and independent predictors of its presence, which suggests that they should be considered when evaluating smokers at risk for low BMD.
  • Autores: Jujic, A. ; Atabaki-Pasdar, N; Nilsson, P. M. ; et al.
    Revista: DIABETOLOGIA
    ISSN 0012-186X Vol.63 N° 5 2020 págs. 1043 - 1054
    Resumen
    Aims/hypothesis Evidence that glucose-dependent insulinotropic peptide (GIP) and/or the GIP receptor (GIPR) are involved in cardiovascular biology is emerging. We hypothesised that GIP has untoward effects on cardiovascular biology, in contrast to glucagon-like peptide 1 (GLP-1), and therefore investigated the effects of GIP and GLP-1 concentrations on cardiovascular disease (CVD) and mortality risk. Methods GIP concentrations were successfully measured during OGTTs in two independent populations (Malmo Diet Cancer-Cardiovascular Cohort [MDC-CC] and Prevalence, Prediction and Prevention of Diabetes in Botnia [PPP-Botnia]) in a total of 8044 subjects. GLP-1 (n = 3625) was measured in MDC-CC. The incidence of CVD and mortality was assessed via national/regional registers or questionnaires. Further, a two-sample Mendelian randomisation (2SMR) analysis between the GIP pathway and outcomes (coronary artery disease [CAD] and myocardial infarction) was carried out using a GIP-associated genetic variant, rs1800437, as instrumental variable. An additional reverse 2SMR was performed with CAD as exposure variable and GIP as outcome variable, with the instrumental variables constructed from 114 known genetic risk variants for CAD. Results In meta-analyses, higher fasting levels of GIP were associated with risk of higher total mortality (HR[95% CI] = 1.22 [1.11, 1.35]; p = 4.5 x 10(-5)) and death from CVD (HR[95% CI] 1.30 [1.11, 1.52]; p = 0.001). In accordance, 2SMR analysis revealed that increasing GIP concentrations were associated with CAD and myocardial infarction, and an additional reverse 2SMR revealed no significant effect of CAD on GIP levels, thus confirming a possible effect solely of GIP on CAD. Conclusions/interpretation In two prospective, community-based studies, elevated levels of GIP were associated with greater risk of all-cause and cardiovascular mortality within 5-9 years of follow-up, whereas GLP-1 levels were not associated with excess risk. Further studies are warranted to determine the cardiovascular effects of GIP per se.
  • Autores: Garcia-Cosio, M. D. (Autor de correspondencia); Gonzalez-Vilchez, F. ; Lopez-Vilella, R.; et al.
    Revista: CLINICAL TRANSPLANTATION
    ISSN 0902-0063 Vol.34 N° 12 2020 págs. e14096
    Resumen
    The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993-2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25-year study period. HT rate was higher in men, although this decreased over the 25-year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1%p < .001), hypertensives (33.1% vs. 24%p < .001), and smokers (21.7% vs. 12.9%p < .001), respectively. Women had more pre-HT malignancies (7.1% vs. 2.8%p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality-related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1%p < .001) and primary failure (18.2% vs. 12.5%p < .001) and in men due to malignancies (15.1% vs. 6.6%p < .001).
  • Autores: Álvarez-Cienfuegos Suárez, Francisco Javier (Autor de correspondencia); Hurtado-Pardo, L.; Valentí Azcarate, Víctor; et al.
    Revista: WORLD JOURNAL OF SURGERY
    ISSN 0364-2313 Vol.44 N° 6 2020 págs. 1798 - 1806
    Resumen
    BACKGROUND: Latero-lateral duodenojejunostomy is the treatment of choice for superior mesenteric artery syndrome (SMAS). The present study analyzes the long-term outcomes in 13 patients undergoing laparoscopic surgery for SMAS. MATERIALS AND METHODS: A retrospective study of 10 females and three males undergoing surgery between 2001 and 2013 was performed. Demographic, clinical and radiologic data and long-term surgical outcomes were recorded. In 12 patients latero-lateral duodenojejunostomy and in one patient distal laparoscopic gastrectomy with Roux-en-Y reconstruction were performed. The median age was 24 years (20-28), and the median duration of symptoms was 24 months (5-24). The most frequent symptoms were abdominal pain (n¿=¿11; 92.3%), nausea and vomiting (n¿=¿10; 77%) and weight loss (n¿=¿9; 69.2%). The median operating time was 98 min (86-138) and hospital stay was 3 days (1-14). RESULTS: No reconversions occurred, and one patient experienced gastric emptying delay in the immediate postoperative period with spontaneous resolution. In four patients, SMAS was associated with severe stenosis of the celiac trunk which was treated in the same operation, and four patients presented stenosis of the left renal vein (the "nutcracker" phenomenon). With a median follow-up of 94 months (SD 65.3), eight patients (61.5%) had excellent results. One patient had a relapse of symptoms 4 years after surgery requiring distal gastrectomy, two patients presented delay in gastric emptying following temporary improvement and one patient experienced no improvement. CONCLUSIONS: Latero-lateral duodenojejunostomy yields good results in SMAS although it requires other gastric motility disorders to be ruled out for appropriate treatment to be established.
  • Autores: Bartolomé Leal, Pablo; Caballeros Lam, Fanny Meylin; Quilez Larragán, Almudena; et al.
    Revista: JOURNAL OF THORACIC IMAGING
    ISSN 0883-5993 Vol.35 N° 1 2020 págs. 64 - 70
    Resumen
    Purpose: Routine manual tracing of cardiac contours is time-consuming and subject to variability. A fully automated software tool may improve reading efficiency. This study was performed to assess the accuracy, reliability, and time-efficiency of a fully automated left ventricular (LV) segmentation software tool to calculate LV volumes and function compared with conventional manual contouring. Materials and Methods: Sixty-seven consecutive patients (53 male, mean age 62.5 +/- 10.9 y) underwent adenosine stress/rest perfusion cardiac magnetic resonance examination to rule out myocardial ischemia. Double-oblique short-axis 6-mm slice thickness steady-state free precession cine images were acquired to assess LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) using manual contour tracing and a recently developed fully automated software tool. The length of time needed to obtain LV volumes with each segmentation method was also compared. Results: Compared with manual contouring, the fully automated software tool minimally underestimated LV-EF (mean difference of 2.9%+/- 3.9%) and SV (mean difference of 4.4 +/- 8.5 mL) and slightly overestimated ESV (mean difference of -6.4 +/- 10.8 mL) and LV mass (mean difference of -14 +/- 20.4 g). EDV quantification did not statistically differ. Reliability for EF (concordance correlation coefficient [CCC]=0.92, 95% confidence interval [CI], 0.88-0.95), EDV (CCC=0.98, 95% CI, 0.97-0.99), ESV (CCC=0.96, 95% CI, 0.94-0.97), SV (CCC=0.93, 95% CI, 0.89-0.95), and LV mass (CCC=0.84, 95% CI, 0.76-0.89) was very good. The evaluated software allowed to quantify LV parameters with a 79% reduction in the time required for manual contouring (414.7 +/- 91 s vs. 85 +/- 16.1 s, respectively, P<0.001). Conclusion: Quantification of LV volumes using the evaluated fully automated segmentation software is accurate and time-efficient.
  • Autores: González Gutiérrez, Jessica (Autor de correspondencia); Rivera Ortega, Pilar; Rodríguez Fraile, María Macarena; et al.
    Revista: THE INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (ONLINE)
    ISSN 1178-2005 Vol.15 2020 págs. 1823 - 1829
    Resumen
    Rationale: Emphysema and osteoporosis are tobacco-related diseases. Many studies have shown that emphysema is a strong and independent predictor of low bone mineral density (BMD) in smokers; however, none of them explored its association with different emphysema subtypes. Objective: To explore the association between the different emphysema subtypes and the presence of low bone mineral density in a population of active or former smokers with and without chronic obstructive pulmonary disease (COPD). Methods: One hundred and fifty-three active and former smokers from a pulmonary clinic completed clinical questionnaires, pulmonary function tests, a low-dose chest computed tomography (LDCT) and a dual-energy absorptiometry (DXA) scans. Subjects were classified as having normal BMD or low BMD (osteopenia or osteoporosis). Emphysema was classified visually for its subtype and severity. Logistic regression analysis explored the relationship between the different emphysema subtypes and the presence of low BMD adjusting for other important factors. Results: Seventy-five percent of the patients had low BMD (78 had osteopenia and 37 had osteoporosis). Emphysema was more frequent (66.1 vs 26.3%, p=<0.001) and severe in those with low BMD. Multivariable analysis adjusting for other significant cofactors (age, sex, FEVi, and severity of emphysema) showed that BMI (OR=0.91, 95% CI: 0.76-0.92) and centrilobular emphysema (OR=26.19, 95% CI: 1.71 to 399.44) were associated with low BMD...
  • Autores: Elosua-Bayés, I. (Autor de correspondencia); Beloqui Ruiz, Óscar María
    Revista: CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS
    ISSN 0214-9168 Vol.32 N° 5 2020 págs. 200 - 205
    Resumen
    Background: Hepatic steatosis is a public health problem with increased incidence and prevalence Objective: To determine whether the liver steatosis, as measured by the Fatty Liver Index (FLI), is related to metabolic risk and vascular factors and, if so, to identify the clinical -metabolic factor that explains the higher vascular risk. Methods: Cross-sectional study including a sample of 531 men who came to the University of Navarra Clinic Check-up Unit. The degree of steatosis was determined by the FLI. The metabolic risk was assessed using a scale based on determinations of HDL. LDL, triglycerides, blood glucose. HOMA-IR, neutrophil/lymphocyte index, and systolic blood pressure. The vascular risk was assessed by the presence of carotid and/or femoral atheromatous plaques. The dose -response association between FLI and both risks was analysed using non -parametric models (splines) and logistic regression. Results: The sample studied had a mean age of 52.70 years, with 49.3% having an FLI >= 60, as well as 33.6% with metabolic syndrome, and 43.9% with carotid and/or femoral atheromatous plaques. The relationship between FLI and metabolic risk and vascular was linear (metabolic: non-linear P=.097; linear P<.001; vascular: non-linear P=1.000; linear P=.028). For every 10 units of increase in FLI, the odds of presenting with atheroma plaques increased by 9.7% (OR = 1.097; 95% confidence interval 1.010-1.191). When adjusting for triglyceridaemia, the association disappeared (OR - 1.001). Conclusions: Patients with fatty liver disease had an increased metabolic and vascular risk. The increased vascular risk is associated with the triglyceride level. On a clinical level, this study suggests that these patients could benefit from treatment of hypertriglyceridaemia.
  • Autores: Esteban Fernández, Alberto (Autor de correspondencia); Bastarrika Alemañ, Gorka; Castañón Álvarez, Eduardo; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.73 N° 3 2020 págs. 241 - 247
    Resumen
    Introduction and objectives: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. Methods: We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. Results: Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). Conclusions: Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
  • Autores: Bastarrika Alemañ, Gorka (Autor de correspondencia); Calvo Imirizaldu, Marta; Ezponda Casajús, Ana; et al.
    Revista: AMERICAN JOURNAL OF ROENTGENOLOGY
    ISSN 0361-803X Vol.215 N° 4 2020 págs. 828 - 833
    Resumen
    OBJECTIVE. The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients. SUBJECTS AND METHODS. Twenty-two consecutive OHT recipients (16 men, six women; median age, 66.5 years [interquartile range, 51.3-70.3 years]; median heart rate, 91 beats/min [interquartile range, 79.3-97.3 beats/min]) underwent CCTA with a third-generation dual-source CT scanner in high-pitch mode to rule out coronary allograft vasculopathy. Data acquisition was triggered at 30% of the R-R interval. Two independent observers blindly assessed image quality on a per-segment, per-vessel, and per-patient basis using a 4-point scale (4, excellent; 1, not evaluative). Scores 2-4 indicated diagnostic quality. Studies were compared with previously performed retrospective ECG-gated examinations, when available. Interobserver agreement on the image quality was assessed with kappa statistics. Radiation dose was recorded. RESULTS. A total of 322 coronary segments were evaluated. Diagnostic image quality was observed in 97.5% of the segments. Interobserver agreement for image quality assessment was very good on a per-patient (kappa = 0.82), per-vessel (kappa = 0.83), and per-segment basis (kappa = 0.89). The median per-patient image quality score was 4.0 (3.0-4.0) for the entire coronary tree. A comparison of image quality scores between high-pitch and retrospective ECG-gated CCTA examinations showed no significant differences, but the estimated mean radiation dose was significantly lower for the high-pitch mode (median dose-length product, 31.6 mGy x cm [interquartile range, 23.1-38.8 mGy x cm] vs 736.5 mGy x cm [interquartile range, 655.5-845.7 mGy x cm], p < 0.001). CONCLUSION. Performing single-heartbeat high-pitch CCTA during the systolic phase of the cardiac cycle in OHT recipients results in diagnostic image quality in coronary angiograms at very low radiation dose.
  • Autores: Pichler G (Autor de correspondencia); Redon J; Martinez F; et al.
    Revista: JOURNAL OF HYPERTENSION
    ISSN 1473-5598 Vol.38 N° 10 2020 págs. 2036-2042
  • Autores: Eiros Bachiller, Rocío; Romero González, Gregorio Aramid; Gavira Gómez, Juan José; et al.
    Revista: JOURNAL OF CLINICAL MEDICINE
    ISSN 2077-0383 Vol.9 N° 2 2020 págs. 404
    Resumen
    In hypertensive patients with heart failure (HF) a serum biomarker combination of high carboxy-terminal propeptide of procollagen type-I (PICP) and low carboxy-terminal telopeptide of collagen type-I to matrix metalloproteinase-1 (CITP:MMP-1) ratio identifies a histomolecular phenotype of malignant myocardial fibrosis (mMF) associated with severe diastolic dysfunction (DD) and poor outcomes. As chronic kidney disease (CKD) facilitates MF and DD, we investigated the influence of CKD on the mMF biomarker combination in HF patients with preserved ejection fraction (HFpEF). Hypertensives (n = 365), 232 non-HF and 133 HFpEF, were studied, and 35% non-HF and 46% HFpEF patients had CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio ¿ 30 mg/g). Specific immunoassays were performed to determine biomarkers. Medians were used to establish the high PICP and low CITP:MMP-1 combination. A comparison with non-HF showed that the biomarker combination presence was increased in HFpEF patients, being associated with CKD in all patients. CKD influenced the association of the biomarker combination and HFpEF (p for interaction ¿ 0.019). The E:e' ratio was associated with the biomarker combination in CKD patients. Among CKD patients with HFpEF, those with the biomarker combination exhibited higher (p = 0.016) E:e' ratio than those without the pattern. These findings suggest that CKD facilitates the development of biomarker-assessed mMF and DD in hypertensive HFpEF patients.
  • Autores: Liu, B. Y. ; Neil, D. A. H. ; Premchand, M. ; et al.
    Revista: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
    ISSN 1097-6647 Vol.22 N° 1 2020
    Resumen
    Background: Myocardial fibrosis occurs in end-stage heart failure secondary to mitral regurgitation (MR), but it is not known whether this is present before onset of symptoms or myocardial dysfunction. This study aimed to characterise myocardial fibrosis in chronic severe primary MR on histology, compare this to tissue characterisation on cardiovascular magnetic resonance (CMR) imaging, and investigate associations with symptoms, left ventricular (LV) function, and exercise capacity. Methods: Patients with class I or IIa indications for surgery underwent CMR and cardiopulmonary exercise testing. LV biopsies were taken at surgery and the extent of fibrosis was quantified on histology using collagen volume fraction (CVFmean) compared to autopsy controls without cardiac pathology. Results: 120 consecutive patients (64 +/- 13 years; 71% male) were recruited; 105 patients underwent MV repair while 15 chose conservative management. LV biopsies were obtained in 86 patients (234 biopsy samples in total). MR patients had more fibrosis compared to 8 autopsy controls (median: 14.6% [interquartile range 7.4-20.3] vs. 3.3% [2.6-6.1], P < 0.001); this difference persisted in the asymptomatic patients (CVFmean 13.6% [6.3-18.8], P < 0.001), but severity of fibrosis was not significantly higher in NYHA II-III symptomatic MR (CVFmean 15.7% [9.9-23.1] (P = 0.083). Fibrosis was patchy across biopsy sites (intraclass correlation 0.23, 95% CI 0.08-0.39, P = 0.001). No significant relationships were identified between CVFmean and CMR tissue characterisation [native T1, extracellular volume (ECV) or late gadolinium enhancement] or measures of LV function [LV ejection fraction (LVEF), global longitudinal strain (GLS)]. Although the range of ECV was small (27.3 +/- 3.2%), ECV correlated with multiple measures of LV function (LVEF: Rho = - 0.22, P = 0.029, GLS: Rho = 0.29, P = 0.003), as well as NTproBNP (Rho = 0.54, P < 0.001) and exercise capacity (%PredVO(2)max: R = - 0.22, P = 0.030). Conclusions: Patients with chronic primary MR have increased fibrosis before the onset of symptoms. Due to the patchy nature of fibrosis, CMR derived ECV may be a better marker of global myocardial status.
  • Autores: Sanchez-Carpintero Abad, M.; Zulueta Frances, Javier Joseph; de Torres Tajes, Juan Pablo; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.56 N° Suppl. 64 2020
  • Autores: Liu, B. ; Khin, K. L. S. ; Neil, D. A. H.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.41 2020 págs. 2004 - 2004
  • Autores: Marín, F.; Rivera-Caravaca, J.; Roldán-Rabadán, I.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.41 N° Suppl. 2 2020 págs. 675 - 675
  • Autores: Muñiz Sáenz-Diez, Javier; Luque Gonzalez, M.; Martínez León, A.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.41 N° Suppl. 2 2020 págs. 250 - 250
  • Autores: Marin Oto, Marta; Divo, M. J.; Seijo Maceiras, Luis Miguel; et al.
    Revista: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
    ISSN 1073-449X Vol.201 2020
  • Autores: Divo, M.; Marin Oto, Marta; Casanova, C.; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.56 N° Suppl. 64 2020
  • Autores: Baguda, J. D. ; Gavira Gómez, Juan José; Iglesias, M. F. ; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.41 2020 págs. 3465 - 3465
  • Autores: Romero González, Gregorio Aramid; Díaz Dorronsoro, Inés; de La Fuente Villena, Ana; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN 0931-0509 Vol.35 N° Supl. 3 2020 págs. 1632
  • Autores: Robinson, E. L.; Hamdani, N. ; González Miqueo, Aránzazu; et al.
    Revista: CARDIOVASCULAR DRUGS AND THERAPY
    ISSN 0920-3206 Vol.34 N° 2 2020 págs. 285 - 285
  • Autores: García Bolao, José Ignacio (Autor de correspondencia); Ballesteros Derbenti, Gabriel Alejandro; Ramos Ardanáz, Pablo; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.21 N° Supl. 1 2019 págs. i4 - i11
    Resumen
    Despite the emerging technical evolution of the last two decades, the primary success rate of single-procedure pulmonary vein isolation (PVI), the cornerstone for any atrial fibrillation ablation procedure, is highly variable ranging from 53% to 92%. The recent development of ultra-high-density electroanatomic mapping systems, capable of acquiring and annotating multiple electrograms, with high spatiotemporal precision, which are processed by automated algorithms to generate activation and substrate maps to support and guide ablation procedures, has opened a new stage in cardiac electrophysiology. In this article, we review the existing evidence on the utility of high-density mapping on catheter-based PVI, the possibility to detect pulmonary vein potentials that remain undetected when using a standard approach and its potential relevance to the clinical outcome, and how this new technology is providing novel pathophysiological insights on complete PVI and atrial fibrillation ablation outcomes.
  • Autores: Rodriguez-Granillo, G. A. (Autor de correspondencia); Martinez-Ferro, M. ; Capunay, C. ; et al.
    Revista: EUROPEAN JOURNAL OF RADIOLOGY
    ISSN 0720-048X Vol.117 2019 págs. 140 - 148
    Resumen
    Purpose: Image acquisition protocols and reports in patients with pectus excavatum (PEX) differ significantly from routine examinations, and no imaging modality can enable a comprehensive assessment of PEX severity and cardiac impact within a single examination. We therefore attempt to establish recommendations about preoperative imaging in patients with PEX. Method: Chest computed tomography (CT), stress echocardiography (Echo), and cardiac magnetic resonance (CMR) allow the evaluation of specific information regarding structural and functional characteristics of vital importance to assess surgical candidacy and define surgical strategies. We sought to provide a multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists; to establish recommendations about the variables to be included in the reports of the imaging examinations performed in patients with PEX. Results: We provide recommendations for preoperative image acquisition and analysis, aimed at the assessment of the severity of the chest wall deformity (CT); the site of maximum cardiac compression, extent of increased interventricular dependence, and presence of pericardial effusion (CMR); and the effect of PEX on the functional capacity and exercise-related systolic and/or diastolic function, and tricuspid annulus compression (Echo). Conclusions: This multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists provides recommendations about preoperative imaging for patients with PEX.
  • Autores: González Miqueo, Aránzazu (Autor de correspondencia); López Salazar, Begoña; Ravassa Albéniz, Susana; et al.
    Revista: BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH
    ISSN 0167-4889 Vol.1866 N° 9 2019 págs. 1421 - 1432
    Resumen
    Myocardial interstitial fibrosis (MIF) is a common finding in heart failure (HF) patients, both with preserved and reduced ejection fraction, as well as in HF animal models. MIF is associated with impaired cardiac function and worse clinical outcome. The impact of MIF is influenced not only by the quantity but also by changes in the quality of collagen fibers and in the extracellular matrix components, such as a shift in collagen types proportion, increased fibronectin polymerization and increased degree of collagen cross-linking (CCL). In particular, CCL, a process that renders collagen fibers stiffer and more resistant to degradation, is increased both in patients and animal models of HF. Importantly, in HF patients increased cardiac CCL is directly associated with increased left ventricular stiffness and a higher risk of hospitalization for HF. The aim of this review is to address the complexity of MIF in HF, focusing on CCL.
  • Autores: Schelbert, E. B. (Autor de correspondencia); Butler, J. ; Díez Martínez, Domingo Francisco Javier
    Revista: JACC-CARDIOVASCULAR IMAGING
    ISSN 1936-878X Vol.12 N° 11 2019 págs. 2305 - 2318
    Resumen
    Interstitial heart disease, whether primarily from myocardial fibrosis or cardiac amyloidosis, indicates excess protein accumulation in the interstitium and constitutes a major source of heart failure with excess cardiac morbidity and mortality. Myocardial fibrosis (defined as excess myocardial collagen concentration that distorts myocardial architecture) is prevalent and causes cardiac symptoms and ultimately adverse cardiac events, such as heart failure, arrhythmia, and death. Conversely, cardiac amyloidosis is far less prevalent than myocardial fibrosis but represents a more extreme form of interstitial heart disease with marked interstitial expansion, profound architectural distortion, and then rapid clinical decline. Myocardial extracellular volume measures fundamentally advance the understanding of myocardium and specifically highlights the role of the interstitium. Rather than conceptualizing myocardium as a homogenous tissue, dichotomizing the myocardium into its interstitial (including the microvasculature) and cardiomyocyte phenotypes promotes additional understanding of heart failure pathophysiology that may spur the development of more effective therapies. (C) 2019 by the American College of Cardiology Foundation.
  • Autores: de Torres Tajes, Juan Pablo (Autor de correspondencia); Wisnivesky, J. P. ; Bastarrika Alemañ, Gorka; et al.
    Revista: PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY
    ISSN 1546-3222 Vol.16 N° 5 2019 págs. 641 - 644
  • Autores: Sullivan, J. L.; Bagevalu, B.; Glass, C.; et al.
    Revista: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
    ISSN 1073-449X Vol.200 N° 11 2019 págs. 1434 - 1439
  • Autores: Tschöpe D; Díez Martínez, Domingo Francisco Javier
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.40 N° 12 2019 págs. 979 - 981
  • Autores: Scaglione, M. (Autor de correspondencia); Adragao, P. ; García Bolao, José Ignacio
    Revista: EUROPACE
    ISSN 1099-5129 Vol.21 N° Supl. 3 2019 págs. 1 - 1
  • Autores: García Bolao, José Ignacio (Autor de correspondencia); Ramos Ardanáz, Pablo; Ballesteros Derbenti, Gabriel Alejandro; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.21 N° Supl. 3 2019 págs. 2 - 4
  • Autores: García Fernández, Nuria; Beaumont Ezcurra, Francisco Javier; Moreno Zulategui, María de Ujue; et al.
    Revista: CARDIOVASCULAR RESEARCH
    ISSN 0008-6363 Vol.115 N° 4 2019 págs. 696 - 698
  • Autores: Ravassa Albéniz, Susana; Ballesteros Derbenti, Gabriel Alejandro; Díez Martínez, Domingo Francisco Javier (Autor de correspondencia)
    Revista: AGING-US
    ISSN 1945-4589 Vol.11 N° 22 2019 págs. 9965 - 9966
  • Autores: Solimene, F. (Autor de correspondencia); Maddaluno, F. ; Schillaci, V. ; et al.
    Revista: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
    ISSN 1045-3873 Vol.30 N° 11 2019 págs. 2518 - 2519
  • Autores: García Fernández, Nuria; Lavilla Royo, Francisco Javier; Martín Moreno, Paloma Leticia; et al.
    Revista: AMERICAN JOURNAL OF HYPERTENSION
    ISSN 0895-7061 Vol.32 N° 1 2019 págs. 15 - 17
  • Autores: Beyens, A.; Albuisson, J.; Boel, A.; et al.
    Revista: GENETICS IN MEDICINE
    ISSN 1098-3600 Vol.21 N° 8 2019 págs. 1894 - 1895
  • Autores: A de Boer R; De Keulenaer G; Bauersachs J; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.21 N° 3 2019 págs. 272 - 285
  • Autores: Beunza, J. J. (Autor de correspondencia); Puertas, E.; Garcia-Ovejero, E. ; et al.
    Revista: JOURNAL OF BIOMEDICAL INFORMATICS
    ISSN 1532-0464 Vol.97 2019 págs. 103257
    Resumen
    Aim: The aim of this study is to compare the utility of several supervised machine learning (ML) algorithms for predicting clinical events in terms of their internal validity and accuracy. The results, which were obtained using two statistical software platforms, were also compared. Materials and methods: The data used in this research come from the open database of the Framingham Heart Study, which originated in 1948 in Framingham, Massachusetts as a prospective study of risk factors for cardiovascular disease. Through data mining processes, three data models were elaborated and a comparative methodological study between the different ML algorithms - decision tree, random forest, support vector machines, neural networks, and logistic regression - was carried out. The global selection criterium for choosing the right set of hyperparameters and the type of data manipulation was the area under a curve (AUC). The software tools used to analyze the data were R-Studio (R) and RapidMiner (R). Results: The Framingham study open database contains 4240 observations. The algorithm that yielded the greatest AUC when analyzing the data in R-Studio was neural network applied to a model that excluded all observations in which there was at least one missing value (AUC = 0.71); when analyzing the data in RapidMiner and applying the same model, the best algorithm was support vector machines (AUC = 0.75). Conclusions: ML algorithms can reinforce the diagnostic and prognostic capacity of traditional regression techniques. Differences between the applicability of those algorithms and the results obtained with them were a function of the software platforms used in the data analysis.
  • Autores: García Baizán, Alejandra; Millor Muruzábal, Maite; Bartolomé Leal, Pablo; et al.
    Revista: INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
    ISSN 1569-5794 Vol.35 N° 4 2019 págs. 675 - 682
    Resumen
    Abstract To evaluate the vasodilator effect of adenosine triphosphate (ATP) compared with adenosine in stress perfusion cardiac magnetic resonance (CMR) examinations. A total of thirty-three patients underwent clinically indicated stress/rest perfusion CMR examination following intravenous injection of a total dose of 0.2 mmol/kg of gadobutrol. Individuals were randomly assigned to ATP (160 mcg/kg/min) or adenosine (140 mcg/kg/min). The vasodilator effect of both drugs was analyzed by comparing differences in heart rate, symptoms during stress, and semiquantitative myocardial and splenic perfusion parameters, including time, time to peak, upslope, myocardial perfusion reserve index, tissue perfusion values, splenic and myocardial signal intensity ratios, and splenic-to-myocardial signal intensity ratios. No significant difference was found in heart rate variation between the stressors (26.1¿±¿19.1 bpm for ATP vs. 21.7¿±¿17.3 bpm for adenosine, p¿=¿0.52). Patients receiving ATP referred less pronounced clinical symptoms. Semiquantitative myocardial perfusion parameters were comparable, and patients in the adenosine and ATP groups showed similar myocardial perfusion reserve index values (2.34 [1.62-2.73] vs 1.63 [1.29-2.10], p¿=¿0.07). Splenic switch off was visually confirmed in all patients and estimated spleen to myocardium ratio was similar (0.92 [0.53-1.09] vs 0.81 [0.53-0.86] with ATP and adenosine, respectively, p¿=¿0.12). Both ATP and adenosine are potent coronary vasodilators that can be safely employed in stress-CMR. Both stressor cause similar hyperemic response. Splenic switch-off can be used to assess stress adequacy in patients undergoing stress-CMR with either adenosine or ATP.
  • Autores: Ballesteros Derbenti, Gabriel Alejandro; Ravassa Albéniz, Susana; Bragard Monier, Jean; et al.
    Revista: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
    ISSN 1045-3873 Vol.30 N° 8 2019 págs. 1231 - 1240
    Resumen
    Introduction Ultrahigh-density-voltage mapping (uHD(V)M) is a new tool that can add new insights into the pathophysiology of atrial fibrillation (AF). The aim of this study was to evaluate the performance of uHD(V)M in predicting postablation AF recurrence (AFR). Methods and Results We included 98 consecutive patients undergoing pulmonary vein isolation for AF (40.8% persistent) using an uHD(V)M system and followed for 1 year. The left atrium (LA) mean voltage (V-m) and the V-slope (slope of the voltage histogram calculated by linear interpolation, with the relative frequency on the vertical axis and the bipolar potential on the horizontal axis) were calculated from 12 567 +/- 5486 points per map. Patients with AFR (N = 29) had lower V-m and higher V-slope as compared with patients without AFR (N = 69). Receiver operating characteristic curves identified V-m as the strongest predictor of AFR, with a higher incidence of AFR in patients with V-m 0.758 mV (57.6%) or lower than patients with V-m higher than 0.758 mV (15.4%; P < .0001). Among patients with V-m higher than 0.758 mV, patients with V-slope 0.637 or higher exhibited higher (P = .043) AFR incidence (31.3%) than patients with V-slope lower than 0.637 (10.2%). This classification showed incremental predictive value over relevant covariables. V-m values were lower and V-slope values were higher in patients that progressed from paroxysmal to persistent AF. Patients with V-slope 0.637 or higher had a 14.2% incidence of postablation atypical atrial flutter, whereas patients with V-slope lower than 0.637 did not present this outcome. Conclusions The risk of AFR, atrial flutter, and progression from paroxysmal to persistent AF can be detected by quantitative analysis of LA uHD(V)M identifying diverse patterns of atrial substrate alterations.
  • Autores: Cauwenberghs, N.; Ravassa Albéniz, Susana; Thijs, L. ; et al.
    Revista: JOURNAL OF THE AMERICAN HEART ASSOCIATION. CARDIOVASCULAR AND CEREBROVASCULAR DISEASE
    ISSN 2047-9980 Vol.8 N° 2 2019 págs. e010430
    Resumen
    Background Serial imaging studies in the general population remain important to evaluate the usefulness of pathophysiologically relevant biomarkers in predicting progression of left ventricular (LV) remodeling and dysfunction. Here, we assessed in a general population whether these circulating biomarkers at baseline predict longitudinal changes in LV structure and function. Methods and Results In 592 participants (mean age, 50.8 years; 51.4% women; 40.5% hypertensive), we derived echocardiographic indexes reflecting LV structure and function at baseline and after 4.7 years. At baseline, we measured alkaline phosphatase, markers of collagen turnover (procollagen type I, C-terminal telopeptide, matrix metalloproteinase-1) and high-sensitivity cardiac troponin T. We regressed longitudinal changes in LV indexes on baseline biomarker levels and reported standardized effect sizes as a fraction of the standard deviation of LV change. After full adjustment, a decline in LV longitudinal strain (-14.2%) and increase in E/e' ratio over time (+18.9%; P¿0.019) was associated with higher alkaline phosphatase activity at baseline. Furthermore, longitudinal strain decreased with higher levels of collagen I production and degradation at baseline (procollagen type I, -14.2%; C-terminal telopeptide, -16.4%; P¿0.029). An increase in E/e' ratio over time was borderline associated with lower matrix metalloproteinase-1 (+9.8%) and lower matrix metalloproteinase-1/tissue inhibitor of metalloproteinase-1 ratio (+11.9%; P¿0.041). Higher high-sensitivity cardiac troponin T levels at baseline correlated significantly with an increase in relative wall thickness (+23.1%) and LV mass index (+18.3%) during follow-up ( P¿0.035). Conclusions We identified a set of biomarkers predicting adverse changes in LV structure and function over time. Circulating biomarkers reflecting LV stiffness, injury, and collagen composition might improve the identification of subjects at risk for subclinical cardiac maladaptation.
  • Autores: Ravassa Albéniz, Susana; Ballesteros Derbenti, Gabriel Alejandro; López Salazar, Begoña; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.73 N° 12 2019 págs. 1398 - 1410
    Resumen
    Background A combination of circulating biomarkers associated with excessive myocardial collagen type-I cross-linking or CCL+ (i.e., decreased carboxy-terminal telopeptide of collagen type-I to matrix metalloproteinase-1 ratio) and with excessive myocardial collagen type-I deposition or CD+ (i.e., increased carboxy-terminal propeptide of procollagen type-I) has been described in heart failure (HF) patients and associates with poor outcomes. Objectives The purpose of this study was to investigate whether the CCL+CD+ combination of biomarkers associates with atrial fibrillation (AF). Methods Biomarkers were analyzed in serum samples from 242 HF patients (study 1) and 150 patients referred for AF ablation (study 2). Patients were classified into 3 groups (CCL¿CD¿, CCL+CD¿ or CCL¿CD+, and CCL+CD+) in accordance to biomarker threshold values. Left atrial electroanatomic high-density mapping was performed in 71 patients from study 2. Results In study 1, 53.7% patients had AF at baseline and 19.6% developed AF (median follow-up 5.5 years). Adjusted odds and hazard ratios associated with baseline and new-onset AF, respectively, were both ¿3.3 (p ¿ 0.050) in CCL+CD+ patients compared with CCL¿CD¿ patients, with nonsignificant changes in the other group. In study 2, 29.3% patients had AF recurrence during 1-year post-ablation.
  • Autores: Rodriguez-Manero, M.; Azcarate-Aguero, P. (Autor de correspondencia); Kreidieh, B. ; et al.
    Revista: ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
    ISSN 0742-2822 Vol.36 N° 2 2019 págs. 306 - 311
    Resumen
    Introduction: We evaluate the ability of 2D non-contrast-enhanced echocardiography (CE-echo), 2DCE-echo, 3D-echo, 3D non-CE-echo, and 3DCE-echo to evaluate allograft function and dimensions in orthotropic heart transplantation (OHT). Cardiac resonance (CMR) was used as reference. Methods: Twenty six consecutive OHT-recipients were prospectively recruited. Bland-Altman, Spearman rank, and concordance-correlation coefficients (CCC) were determined. Results: Good CCCs were found between the four modalities and CMR for ejection fraction (r >= 0.72/P < 0.001; r >= 0.77/ P < 0.001; r >= 0.51/ P < 0.23; r >= 0.75/P < 0.001, respectively). Highest intraclass correlation coefficient (ICC) was for 2D CE-echo(CCC = 0.77). End-diastolic volume(EDV) measurements statistically differed when 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo were compared with the cross-sectional imaging modalities, but they did not differ significantly from 3DCE-echo. End-systolic volume (ESV) and stroke volume (SV) differed statistically between the four modalities; however, SV measured by CMR and 3DCE-echo were comparable. Overall, 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo showed lower mean EDV, ESV, and SV than CMR. ICC was that of the ESV variable in the 4 techniques, with the values of the ICC of the 3DCE-echo technique superior to the rest. Overall, the best CCC were found for 3DCE(r = 0.88, 0.92 and 0.76 for EDV, ESV and SV, respectively). Conclusion: Routine use of 3DCE-echo may allow more comprehensive cardiac assessment in cardiac transplant recipients.
  • Autores: Barge-Caballero, G. (Autor de correspondencia); Castel-Lavilla, M. A.; Almenar-Bonet, L.; et al.
    Revista: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
    ISSN 1569-9293 Vol.29 N° 5 2019 págs. 670 - 677
    Resumen
    OBJECTIVES: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS: We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n=73) were compared to a control group of patients without IABP support (n=96). RESULTS: There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P=0.17), death during VA-ECMO support (20.6% vs 14.6%, P=0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P=0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P=0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P=0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P=0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P=0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). CONCLUSIONS: In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
  • Autores: Millor Muruzábal, Maite (Autor de correspondencia); Bartolomé Leal, Pablo; Pons Renedo, María José; et al.
    Revista: RADIOLOGIA MEDICA
    ISSN 0033-8362 Vol.124 2019 págs. 1199 - 1211
    Resumen
    Background There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. Aim To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. Materials and methods We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. Results WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mai
  • Autores: Gutierrez Buey, Gala; Restituto Aranguibel, Patricia; Botella Martínez, María Sonsoles; et al.
    Revista: CLINICAL ENDOCRINOLOGY
    ISSN 0300-0664 Vol.91 N° 3 2019 págs. 391 - 399
    Resumen
    Context Bone loss is accelerated in the late perimenopause and early menopause. The date of the final menstrual period cannot be stated until 1 year after it has ended, and at that time, most of the rapid bone loss phase will have elapsed. Therefore, early detection of bone loss is crucial. Objectives To evaluate the utility of bone turnover markers (BTM) to identify the women who are more likely to lose more bone mass during the transition to menopause and quantify the loss of bone quality measured by trabecular bone score (TBS). Design, patients and setting Sixty-four healthy premenopausal women, mean age between 44 and 57 years old, were enrolled and followed up for 5 years. Clinical features, lifestyle, bone densitometry, TBS and BTM (CTX, P1NP and osteocalcin) were measured at baseline and follow-up. Results All women had densitometrically normal bone at the time of enrolment. After 5 years, 48.4% had normal bone mineral density, 45.8% low bone mass and 6.3% osteoporosis. Women with osteopenia/osteoporosis at follow-up had higher CTX and P1NP at enrolment compared with women with densitometrically normal bone. The areas under the curve for the prediction of low bone mass or osteoporosis were 0.69 (P = 0.011) for P1NP, 0.69 for CTX (P = 0.013) and 0.77 (P 0.001) for OC. A significant correlation was found between P1NP increase after 5 years and the decrease in lumbar bone density (r = -0.383, P = 0.002). At baseline, 7 (10.9%) women had deteriorated microarchitecture (TBS < 1.3). Three of these women developed osteoporosis and four osteopenia at follow-up. Conclusions Women with higher P1NP and CTX and lower TBS at baseline had lower BMD in the transition to menopause suggesting these novel tools could have potential use in identifying women at high risk of rapidly decreasing bone mass.
  • Autores: Miranda-Silva D; Gonçalves-Rodrigues P; Almeida-Coelho J; et al.
    Revista: SCIENTIFIC REPORTS
    ISSN 2045-2322 Vol.9 2019 págs. 1 - 14
  • Autores: Ferreira JP; Rossignol P; Pizard A; et al.
    Revista: HEART
    ISSN 1355-6037 Vol.105 N° 4 2019 págs. 307-314
  • Autores: Smyrnias, I. (Autor de correspondencia); Gray, S. P. ; Okonko, D. O. ; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.73 N° 14 2019 págs. 1795 - 1806
    Resumen
    BACKGROUND The mitochondrial unfolded protein response (UPRmt) is activated when misfolded proteins accumulate within mitochondria and leads to increased expression of mitochondrial chaperones and proteases to maintain protein quality and mitochondrial function. Cardiac mitochondria are essential for contractile function and regulation of cell viability, while mitochondrial dysfunction characterizes heart failure. The role of the UPRmt in the heart is unclear. OBJECTIVES The purpose of this study was to: 1) identify conditions that activate the UPRmt in the heart; and 2) study the relationship among the UPRmt, mitochondrial function, and cardiac contractile function. METHODS Cultured cardiac myocytes were subjected to different stresses in vitro. Mice were subjected to chronic pressure overload. Tissues and blood biomarkers were studied in patients with aortic stenosis. RESULTS Diverse neurohumoral or mitochondrial stresses transiently induced the UPRmt in cultured cardiomyocytes. The UPRmt was also induced in the hearts of mice subjected to chronic hemodynamic overload. Boosting the UPRmt with nicotinamide riboside (which augments NAD(+) pools) in cardiomyocytes in vitro or hearts in vivo significantly mitigated the reductions in mitochondrial oxygen consumption induced by these stresses. In mice subjected to pressure overload, nicotinamide riboside reduced cardiomyocyte death and contractile dysfunction. Myocardial tissue from patients with aortic stenosis also showed evidence of UPRmt activation, which correlated with reduced tissue cardiomyocyte death and fibrosis and lower plasma levels of biomarkers of cardiac damage (high-sensitivity troponin T) and dysfunction (N-terminal pro-B-type natriuretic peptide). CONCLUSIONS These results identify the induction of the UPRmt in the mammalian (including human) heart exposed to pathological stresses. Enhancement of the UPRmt ameliorates mitochondrial and contractile dysfunction, suggesting that it may serve an important protective role in the stressed heart. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
  • Autores: González Gutiérrez, Jessica; Henschke, C. I.; Yankelevitz, D. F. ; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.14 N° 7 2019
    Resumen
    Background To assess the relationship between lung cancer and emphysema subtypes. Objective Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment. Methods Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clinica Universidad de Navarra's lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes. Results Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6). Conclusions Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
  • Autores: Ferreira, J. P. ; Verdonschot, J. ; Collier, T. ; et al.
    Revista: CIRCULATION-HEART FAILURE
    ISSN 1941-3289 Vol.12 N° 5 2019 págs. e005897
    Resumen
    BACKGROUND: Identifying the mechanistic pathways potentially associated with incident heart failure (HF) may provide a basis for novel preventive strategies. METHODS AND RESULTS: To identify proteomic biomarkers and the potential underlying mechanistic pathways that may be associated with incident HF defined as the first hospitalization for HF, a nested-matched case-control design was used with cases (incident HF) and controls (without HF) selected from 3 cohorts (> 20 000 individuals). Controls were matched on cohort, follow-up time, age, and sex. Two independent sample sets (a discovery set with 286 cases and 591 controls and a replication set with 276 cases and 280 controls) were used to discover and replicate the findings. Two hundred fifty-two circulating proteins in the plasma were studied. Adjusting for the matching variables age, sex, and follow-up time (and correcting for multiplicity of tests), 89 proteins were found to be associated with incident HF in the discovery phase, of which 38 were also associated with incident HF in the replication phase. These 38 proteins pointed to 4 main network clusters underlying incident HF: (1) inflammation and apoptosis, indicated by the expression of the TNF (tumor necrosis factor)-family members; (2) extracellular matrix remodeling, angiogenesis and growth, indicated by the expression of proteins associated with collagen metabolism, endothelial function, and vascular homeostasis; (3) blood pressure regulation, indicated by the expression of natriuretic peptides and proteins related to the reninangiotensin- aldosterone system; and (4) metabolism, associated with cholesterol and atherosclerosis. CONCLUSIONS: Clusters of biomarkers associated with mechanistic pathways leading to HF were identified linking inflammation, apoptosis, vascular function, matrix remodeling, blood pressure control, and metabolism. These findings provide important insight on the pathophysiological mechanisms leading to HF.
  • Autores: Pascual-Figal A; Bayes-Genis A; López A; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.73 N° 9 2019 págs. 1016 - 1025
  • Autores: Couto-Mallon, D.; Gonzalez-Vilchez, F.; Almenar-Bonet, L.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.72 N° 3 2019 págs. 208 - 214
    Resumen
    Introduction and objectives: To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant. Methods: We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels. The main study outcome was 1-year survival after transplant. Results: A total of 177 heart transplant recipients were studied; preoperatively, 90 were supported on venoarterial extracorporeal membrane oxygenation, 51 on temporary left ventricular assist devices, and 36 on temporary biventricular assist devices. Preoperative hyperlactatemia (¿ 2 mmol/L) was present in 44 (25%) patients. On multivariable analysis, pretransplant serum lactate was identified as an independent predictor of 1-year posttransplant survival (adjusted HR per 0.1 mmol/L, 1.02; 95%CI, 1.01-1.03; P = .007). One-year posttransplant survival was 53.1% (95%CI, 45.3-60.9) in patients with preoperative hyperlactatemia and 75.6% (95%CI, 71.8-79.4) in those without preoperative hyperlactatemia (adjusted HR, 1.94; 95%CI, 1.04-3.63; P = .039). Preoperative hyperlactatemia correlated with adverse outcomes in patients supported with extracorporeal membrane oxygenation, but not in patients supported
  • Autores: Hindricks, G. (Autor de correspondencia); Weiner, S.; McElderry, T.; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.21 N° 4 2019 págs. 655 - 661
    Resumen
    Aims The objective of this study was to verify acute safety, performance, and usage of a novel ultra-high density mapping system in patients undergoing ablation procedure in a real-world clinical setting. Methods and results The TRUE HD study enrolled patients undergoing catheter ablation with mapping for all arrhythmias (excluding de novo atrial fibrillation) who were followed for 1month. Safety was determined by collecting all serious adverse events and adverse events associated with the study devices. Performance was determined as the composite of: ability to map the arrhythmia/substrate, complete the ablation applications, arrhythmia termination (where applicable), and ablation validation. Use of mapping system in the ablation validation workflow was also evaluated. Among the 519 patients who underwent a complete (504) or attempted (15) procedure, 21 (4%) serious ablation-related complications were collected, with 3 (0.57%) potentially related to the mapping catheter. Four hundred and twenty treated patients resulted in a successful procedure confirmed by arrhythmia-specific validation techniques (83.3%; 95% confidence interval: 79.8-86.5%). A total of 1419 electroanatomical maps were created with a median acquisition time of 9:23min per map. Of these, 372 maps in 222 (44%) patients were collected for ablation validation purposes. Following validation mapping, 162/222 (73%) patients required additional ablation. Conclusion In the TRUE HD study mapping was associated with rates of acute success and complications consistent with previously published reports. Importantly, a low percentage of events (0.57%) was attributed to the mapping catheter. When performed, validation mapping was useful for identifying additional targets for ablation in the majority of patients.
  • Autores: Santer, L.; López Salazar, Begoña; Ravassa Albéniz, Susana; et al.
    Revista: HYPERTENSION
    ISSN 0194-911X Vol.73 N° 4 2019 págs. 820 - 828
    Resumen
    The plasma levels of long noncoding RNA LIPCAR are elevated in heart failure (HF) patients with reduced ejection fraction and associated with left ventricular remodeling and poor outcomes. We studied whether the presence of chronic kidney disease (CKD), as defined by an estimated glomerular filtration rate value <60mL/(min·1.73m2) modified the associations of plasma LIPCAR with left ventricular remodeling and outcomes in HF patients. Two hundred and thirty-four patients (mean age 74 [9.14] years, 50% male) were enrolled and followed for 4.73 (0.24-7.25) years. Plasma LIPCAR was detected by real-time quantitative polymerase chain reaction. LIPCAR was increased ( P=0.005) in patients compared with 17 age- and sex-matched controls, directly correlated with age ( P=0.001) and with the maximal early transmitral flow velocity to the mean peak early diastolic velocity of the mitral annulus displacement ratio ( P=0.001) and inversely correlated with estimated glomerular filtration rate ( P<0.001). LIPCAR was associated with hospitalization for HF, cardiovascular death, and a composite of hospitalization for HF or cardiovascular death ( P¿0.010), these associations being dependent of estimated glomerular filtration rate. The interactions between estimated glomerular filtration rate and LIPCAR with respect to these outcomes were statistically significant or of borderline significance ( P¿0.060). LIPCAR was increased in CKD patients compared with non-CKD patients ( P=0.021). LIPCAR was independently associated with hospitalization for HF ( P¿0.039) only in non-CKD patients, but its addition to traditional risk factors did not improve risk prediction in these patients. In conclusion, plasma LIPCAR prognosticates outcomes in elderly HF patients without CKD. Thus, there is an effect modification of CKD on the association of circulating LIPCAR with outcomes in HF patients.
  • Autores: Martinez-Martinez, E.; Brugnolaro, C. ; Ibarrola, J.; et al.
    Revista: HYPERTENSION
    ISSN 0194-911X Vol.73 N° 3 2019 págs. 602 - 611
    Resumen
    Myocardial fibrosis is a main contributor to the development of heart failure (HF). CT-1 (cardiotrophin-1) and Gal-3 (galectin-3) are increased in HF and associated with myocardial fibrosis. The aim of this study is to analyze whether CT-1 regulates Gal-3. Proteomic analysis revealed that Gal-3 was upregulated by CT-1 in human cardiac fibroblasts in parallel with other profibrotic and proinflammatory markers. CT-1 upregulation of Gal-3 was mediated by ERK (extracellular signal-regulated kinase) 1/2 and Stat-3 (signal transducer and activator of transcription 3) pathways. Male Wistar rats and B6CBAF1 mice treated with CT-1 (20 mu g/kg per day) presented higher cardiac Gal-3 levels and myocardial fibrosis. In CT-1-treated rats, direct correlations were found between cardiac CT-1 and Gal-3 levels, as well as between Gal-3 and perivascular fibrosis. Gal-3 genetic disruption in human cardiac fibroblasts and pharmacological Gal-3 inhibition in mice prevented the profibrotic and proinflammatory effects of CT-1. Dahl salt-sensitive hypertensive rats with diastolic dysfunction showed increased cardiac CT-1 and Gal-3 expression together with cardiac fibrosis and inflammation. CT-1 and Gal-3 directly correlated with myocardial fibrosis. In HF patients, myocardial and plasma CT-1 and Gal-3 were increased and directly correlated. In addition, HF patients with high CT-1 and Gal-3 plasma levels presented an increased risk of cardiovascular death. Our data suggest that CT-1 upregulates Gal-3 which, in turn, mediates the proinflammatory and profibrotic myocardial effects of CT-1. The elevation of both molecules in HF patients identifies a subgroup of patients with a higher risk of cardiovascular mortality. The CT-1/Gal-3 axis emerges as a candidate therapeutic target and a potential prognostic biomarker in HF.
  • Autores: Ruiz-Granell, R. (Autor de correspondencia); Ballesteros Derbenti, Gabriel Alejandro; Andreu, D.; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.21 N° 2 2019 págs. 250 - 258
    Resumen
    Aims Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is usually associated to conduction gaps in pulmonary veins (PVs). Our objective was to characterize gaps in patients with recurrences after a first radiofrequency (RF) or cryoballoon (CB) PVI procedure, using a high-density mapping (HDM) system. Methods and results Fifty patients with AF recurrence after a first PVI procedure (pre-RF 25 patients; pre-CB 25 patients) were included at two centres. Activation map (AM) and voltage map (VM) of the left atrium and PVs were built using the HDM Rhythmia (R) system. Superior PVs were reconnected more frequently in both groups. Right PVs were reconnected more frequently in pre-RF patients. Pre-RF patients had more reconnected veins than pre-CB patients (meanstandard deviation: 3.00 +/- 0.96 vs. 1.88 +/- 1.13; P<0.001) and more gaps (4.84 +/- 2.06 vs. 2.16 +/- 1.49; P<0.001). Gaps in the VM were wider in pre-CB patients (16.5 +/- 9.5mm vs. 12.1 +/- 4.8mm; P=0.006). There was a gap in 179 of the 800 PV segments analysed (22%); 52% were identified in both AM and VM maps; 39% only in the AM and 8% only in the VM. The highest sensitivity and specificity for gap detection was obtained with VM in pre-CB patients and with AM in pre-RF patients. Conclusion In conclusion, HDM seems to be a useful and precise tool to detect conduction gaps after a first PVI procedure. The anatomical pattern and location of gaps depends on the technique used previously, usually being multiple, smaller, and better detected by AM after RF, and fewer, wider, and better detected by VM after CB.
  • Autores: Aramendia Vidaurreta, Verónica; Garcia-Oses, A.; Vidorreta, M. ; et al.
    Revista: NMR IN BIOMEDICINE
    ISSN 0952-3480 Vol.32 N° 5 2019 págs. e4077
    Resumen
    The aim of this study was to improve the scan efficiency of ASL in the myocardium. Free breathing FAIR-ASL scans with different TRs were compared, while keeping the acquisition time constant. Scans were named by the trigger pulse that started each acquisition: every two (TP1), four (TP2) and six (TP3) cardiac cycles. TP2 offered the best alternative with a coefficient of variation of 17.15% intrasession and 36.85% intersession. Mean MBF increased by 0.22 +/- 0.41 ml/g/min with mild stress.
  • Autores: Barge-Caballero, E. (Autor de correspondencia); Gonzalez-Vilchez, F.; Delgado, J. F.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.72 N° 10 2019 págs. 835 - 843
    Resumen
    Introduction and objectives: In Spain, intra-aortic balloon pump (IABP) has been used frequently as a bridge to urgent heart transplant (HT). We sought to analyze the clinical outcomes of this strategy. Methods: We conducted a case-by-case, retrospective review of clinical records of 281 adult patients listed for urgent HT under IABP support in 16 Spanish institutions from 2010 to 2015. Pre- and post-transplant survival and adverse clinical events were analyzed. Results: A total of 194 (69%, 95%CI, 63.3-74.4) patients were transplanted and 20 (7.1%, 95%CI, 4.4-10.8) died during a mean period of IABP support of 10.9 +/- 9.7 days. IABP support was withdrawn before an organ became available in 32 (11.4%) patients. Thirty-five (12.5%, 95%CI, 8.8-16.9) patients transitioned from IABP to full-support mechanical devices. Mean urgent waiting list time increased from 5.9 +/- 6.3 days in 2010 to 15 +/- 11.7 days in 2015 (P = .001). Post-transplant survival rates at 30-days, 1-year, and 5-years were 88.1% (95%CI, 85.7-90.5), 76% (95%CI, 72.9-79.1), and 67.8% (95%CI, 63.7-71.9), respectively. The incidence rate of major adverse clinical outcomes-device dysfunction, stroke, bleeding or infection-during IABP support was 26 (95%CI, 20.6-32.4) episodes per 1000 patient-days. The incidence rate of IABP explantation due to complications was 7.2 (95%CI, 4.5-10.8) cases per 1000 patient-days. Conclusions: In a setting of short waiting list times, IABP can be used to bridge candidates to urgent HT with acceptable postoperative results, but there were significant rates of adverse clinical events during support. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: González Gutiérrez, Jessica; Rodríguez Fraile, María Macarena; Rivera Ortega, Pilar; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.14 N° 2 2019 págs. e0209777
    Resumen
    BACKGROUND: Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. OBJECTIVE: To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. METHODS: Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. RESULTS: One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (ß = 0.005, 95% CI:0.000-0.011, p = 0.032; ß = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; ß = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; ß = 0.001, 95% CI:0.000-0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients.
  • Autores: Bragard Monier, Jean (Autor de correspondencia); Sankarankutty, A. C.; Sachse, F. B.
    Revista: FRONTIERS IN PSYCHOLOGY
    ISSN 1664-1078 Vol.10 2019 págs. 337
    Resumen
    Defibrillation is a well-established therapy for atrial and ventricular arrhythmia. Here, we shed light on defibrillation in the fibrotic heart. Using the extended bidomain model of electrical conduction in cardiac tissue, we assessed the influence of fibrosis on the strength of virtual electrodes caused by extracellular electrical current. We created one-dimensional models of rabbit ventricular tissue with a central patch of fibrosis. The fibrosis was incorporated by altering volume fractions for extracellular, myocyte and fibroblast domains. In our prior work, we calculated these volume fractions from microscopic images at the infarct border zone of rabbit hearts. An average and a large degree of fibrosis were modeled. We simulated defibrillation by application of an extracellular current for a short duration (5 ms). We explored the effects of myocyte-fibroblast coupling, intra-fibroblast conductivity and patch length on the strength of the virtual electrodes present at the borders of the normal and fibrotic tissue. We discriminated between effects on myocyte and fibroblast membranes at both borders of the patch. Similarly, we studied defibrillation in two-dimensional models of fibrotic tissue. Square and disk-like patches of fibrotic tissue were embedded in control tissue. We quantified the influence of the geometry and fibrosis composition on virtual electrode strength.
  • Autores: Cauwenberghs, N.; Ravassa Albéniz, Susana; Thijs, L.; et al.
    Revista: JOURNAL OF HYPERTENSION
    ISSN 0263-6352 Vol.37 2019 págs. E7 - E7
  • Autores: Gonzalez-Vilchez, F. J. F. J.; Crespo-Leiro, M. G.; Delgado-Jimenez, J. F.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.21 2019 págs. 141 - 141
  • Autores: Salterain González, Nahikari; Castañón Álvarez, Eduardo; Rodeiro, P.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.21 N° Supl. 1 2019 págs. 288 - 289
  • Autores: Campo Ezquibela, Aránzazu; Olmos, P. E. Y.; Ocón de Miguel, María del Mar; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.54 N° Supl. 63 2019
  • Autores: Carazo, C. M.; Bueno, M. G. ; Bonet, L. A. ; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.40 N° Supl. 1 2019 págs. 1889
  • Autores: Maack, C.; Lehrke, M.; Backs, J. ; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.39 N° 48 2018 págs. 4243 - +
  • Autores: Rodriguez-Manero, M. (Autor de correspondencia); Grigorian-Shamagian, L. ; Rabago Juan Aracil, Gregorio; et al.
    Revista: ARCHIVES OF MEDICAL RESEARCH
    ISSN 0188-4409 Vol.49 N° 8 2018 págs. 558 - 567
    Resumen
    Heart failure (HF) is a progressively debilitating disease that considerably decreases the life expectancy and quality of life. It has become an important area of focus since it remains one of the most common reasons for admission in patients over the age of 65. Importantly, the incidence of HF has not declined within the past 20 years, but the survival after onset has increased in younger patients and men. This has been in part due to the growing interest in therapies that may decrease morbidity, mortality, along with the substantial health care expenditures associated with the disease. It can be said that over the past 50 years, there have been three distinct eras relating to HF management; a) the non-pharmacologic era, focused its treatments on fluid restriction; b) the pharmacologic era, marked by the increased use of inotropes and diuretics and the discovery of vasodilators, and the posterior discovery of medications relating to neurohormonal pathways; c) the device era, with the discovery, acceptance, and increased use of implantable cardioverter defibrillators, cardiac resynchronization therapy (CRT), and left ventricular assist devices (LVADs) among others. A new forth era could be about to arrive, with the advent of regenerative therapies. In this review article will discuss new therapeutic discoveries as well as provide insight into future therapies. (C) 2019 IMSS. Published by Elsevier Inc. All rights reserved.
  • Autores: González Miqueo, Aránzazu; Schelbert, E. B.; Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.71 N° 15 2018 págs. 1696 - 1706
    Resumen
    Myocardial interstitial fibrosis contributes to left ventricular dysfunction leading to the development of heart failure. Basic research has provided abundant evidence for the cellular and molecular mechanisms behind this lesion and the pathways by which it imparts a detrimental impact on cardiac function. Translation of this knowledge, however, to improved diagnostics and therapeutics for patients with heart failure has not been as robust. This is partly related to the paucity of biomarkers to accurately identify myocardial interstitial fibrosis and to the lack of personalized antifibrotic strategies to treat it in an effective manner. This paper summarizes current knowledge of the mechanisms and detrimental consequences of myocardial interstitial fibrosis, discusses the potential of circulating and imaging biomarkers available to recognize different phenotypes of this lesion and track their clinical evolution, and reviews the currently available and potential future therapies that allow its individualized management in heart failure patients.
  • Autores: González Miqueo, Aránzazu; Ravassa Albéniz, Susana; López Salazar, Begoña; et al.
    Revista: HYPERTENSION
    ISSN 0194-911X Vol.72 N° 3 2018 págs. 549 - 558
  • Autores: Scully, P. R.; Bastarrika Alemañ, Gorka; Moon, J. C.; et al.
    Revista: CURRENT CARDIOLOGY REPORTS (PRINT)
    ISSN 1523-3782 Vol.20 N° 3 2018 págs. 15
    Resumen
    Purpose of review This review article discusses the evolution of extracellular volume (ECV) quantification using both cardiovascular magnetic resonance (CMR) and computed tomography (CT). Recent findings Visualizing diffuse myocardial fibrosis is challenging and until recently, was restricted to the domain of the pathologist. CMR and CT both use extravascular, extracellular contrast agents, permitting ECV measurement. The evidence base around ECV quantification by CMR is growing rapidly and just starting in CT. In conditions with high ECV (amyloid, oedema and fibrosis), this technique is already being used clinically and as a surrogate endpoint. Non-invasive diffuse fibrosis quantification is also generating new biological insights into key cardiac diseases. Summary CMR and CT can estimate ECV and in turn diffuse myocardial fibrosis, obviating the need for invasive endomyocardial biopsy. CT is an attractive alternative to CMR particularly in those individuals with contraindications to the latter. Further studies are needed, particularly in CT.
  • Autores: Ballesteros Derbenti, Gabriel Alejandro (Autor de correspondencia); Menendez Ramirez, Diego Ernesto; Ramos Ardanáz, Pablo; et al.
    Revista: CIRCULATION
    ISSN 0009-7322 Vol.138 N° 4 2018 págs. 439 - 440
  • Autores: López Salazar, Begoña; González Miqueo, Aránzazu; Díez Martínez, Domingo Francisco Javier; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.71 N° 25 2018 págs. 2984 - 2985
  • Autores: Ballesteros Derbenti, Gabriel Alejandro; Menendez Ramirez, Diego Ernesto; Ramos Ardanáz, Pablo; et al.
    Revista: CIRCULATION
    ISSN 0009-7322 Vol.137 N° 7 2018 págs. 743 - 746
  • Autores: Bayes-Genis, A. (Autor de correspondencia); González Miqueo, Aránzazu; Lupon, J.
    Revista: CIRCULATION-HEART FAILURE
    ISSN 1941-3289 Vol.11 N° 12 2018
  • Autores: Bastarrika Alemañ, Gorka (Autor de correspondencia); de Torres Tajes, Juan Pablo; Zulueta Frances, Javier Joseph
    Revista: ANNALS OF TRANSLATIONAL MEDICINE
    ISSN 2305-5839 Vol.6 N° Supl. 1 2018 págs. S51
  • Autores: Lorenz, M. W. (Autor de correspondencia); Gao, L.; Ziegelbauer, K.; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.13 N° 9 2018 págs.
    Resumen
    Aims Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. Methods and results From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C. Conclusions We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals.
  • Autores: Esteban Fernández, Alberto (Autor de correspondencia); Coma Canella, María Isabel; Bastarrika Alemañ, Gorka; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.60 N° 6 2018 págs. 493 - 495
    Resumen
    Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). Results: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). Conclusions: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: García Bolao, José Ignacio (Autor de correspondencia); Ballesteros Derbenti, Gabriel Alejandro; Ramos Ardanáz, Pablo; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.20 N° Supl. 3 2018 págs. F351 - F358
    Resumen
    Aims Maps obtained by means of electroanatomic high-density mapping (HDM) systems have shown their use in the identification of conduction gaps in experimental atrial linear lesion models. The objective of this study was to assess the use of HDM in the recognition of reconnection gaps in pulmonary veins (PV) in redo atrial fibrillation (AF) ablation procedures. Methods and results One hundred and eight patients were included in a non-randomized study that assessed the recognition of reconnection gaps in PV by means of HDM compared to a control group that received conventional non-fluoroscopic guidance with a circular multipolar catheter (CMC). Among the HDM group, adequate recognition of reconnection gaps was obtained in 60.99% of the reconnected PVs (86 of 141), a figure significantly higher than that achieved with analysis of CMC recorded signals (39.66%, 48 of 121; P = 0.001). The number of applications and total radiofrequency time were also significantly lower in the HDM group (12.46 +/- 6.1 vs. 15.63 +/- 7.7 and 7.61 +/- 3 vs. 9.29 +/- 5; P = 0.02, and P = 0.03, respectively). At the 6-month follow-up, no statistically significant differences were found in recurrence of AF or any other atrial tachycardia between the HDM group (8 patients, 14.8%) and the control group in (16 patients, 29.6%; P = 0.104). Conclusion An analysis of the high-density activation maps allows greater precision in the identification of reconnection gaps in PV, which results in lower radiofrequency time for the new isolation.
  • Autores: Bibiloni Lage, Ignacio (Autor de correspondencia); Bastarrika Alemañ, Gorka; Delgado Dominguez, Cristian; et al.
    Revista: INDIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
    ISSN 0970-9134 Vol.34 N° 2 2018 págs. 161 - 163
    Resumen
    Left main coronary artery aneurysm is an extremely uncommon coronary pathology that can present with angina, myocardial infarction, pericardial tamponade, or sudden death, and whose treatment still remains controversial. Here, we present a 64-year-old woman admitted due to angina with a previous mitral and aortic valve replacement. Transthoracic echocardiogram revealed an aortic prosthesis dysfunction and preoperative angiogram showed a large left main coronary artery aneurysm. Surgical aneurysm exclusion with concomitant coronary artery bypass grafting and aortic prosthesis replacement were performed after defining the aneurysm's anatomical details and relationship using contrast-enhanced computed tomography.
  • Autores: Trippel, T. D.; Van Linthout, S.; Westermann, D.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.20 N° 3 2018 págs. 460 - 470
    Resumen
    Aim Heart failure with preserved ejection fraction (HFpEF) is associated with myocardial remodelling including severe pro-fibrotic changes contributing to an increase in left ventricular stiffness and diastolic dysfunction. Serum C-terminal propeptide of procollagen type I (PIP) strongly correlates with the turnover of extracellular cardiac matrix proteins and fibrosis. Torasemide, but not furosemide, was described to reduce collagen type I synthesis in clinically unstable patients with heart failure with reduced ejection fraction. We evaluated whether its effect translated to HFpEF patients with type 2 diabetes mellitus (T2DM) and abnormal basal PIP levels. Methods and results We performed a relatively small, single-centre, randomised, double-blind, two-arm parallel-group, active controlled clinical trial in 35 HFpEF patients with T2DM to determine the effects of a 9-month treatment with torasemide vs. furosemide on changes of serum PIP levels. Patients with increased PIP levels (>= 110 ng/mL), or evidence of structural changes with a left atrial volume index (LAVI) > 29 mL/m(2) and abnormal PIP levels (>= 70 ng/mL), were eligible to participate. Fifteen patients were female (42%), mean age was 69 years, body mass index was 34.7 kg/m(2), 83% were in New York Heart Association class II/III. Echocardiographic characteristics showed a mean left ventricular ejection fraction of > 60%, a left ventricular mass index > 120 g/m(2), an E/e' ratio of 14, and a LAVI of 40 mL/m(2) ...
  • Autores: Ferreira, J. P.; Machu, J. L.; Girerd, N. ; et al.
    Revista: ESC HEAR FAILURE
    ISSN 2055-5822 Vol.5 N° 1 2018 págs. 139-148
    Resumen
    AIMS: Myocardial fibrosis alters the cardiac architecture favouring the development of cardiac dysfunction, including arrhythmias and heart failure. Reducing myocardial fibrosis may improve outcomes through the targeted diagnosis and treatment of emerging fibrotic pathways. The European-Commission-funded 'FIBROTARGETS' is a multinational academic and industrial consortium with the main aims of (i) characterizing novel key mechanistic pathways involved in the metabolism of fibrillary collagen that may serve as biotargets, (ii) evaluating the potential anti-fibrotic properties of novel or repurposed molecules interfering with the newly identified biotargets, and (iii) characterizing bioprofiles based on distinct mechanistic phenotypes involving the aforementioned biotargets. These pathways will be explored by performing a systematic and collaborative search for mechanisms and targets of myocardial fibrosis. These mechanisms will then be translated into individualized diagnostic tools and specific therapeutic pharmacological options for heart failure. METHODS AND RESULTS: The FIBROTARGETS consortium has merged data from 12 patient cohorts in a common database available to individual consortium partners. The database consists of >12 000 patients with a large spectrum of cardiovascular clinical phenotypes. It integrates community-based population cohorts, cardiovascular risk cohorts, and heart failure cohorts. CONCLUSIONS: The FIBROTARGETS biomarker programme is aimed at exploring fibrotic pathways allowing the bioprofiling of patients into specific 'fibrotic' phenotypes and identifying new therapeutic targets that will potentially enable the development of novel and tailored anti-fibrotic therapies for heart failure.
  • Autores: Lozano, I. F. (Autor de correspondencia); Osinalde, E. P.; García Bolao, José Ignacio; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN 0300-8932 Vol.71 N° 8 2018 págs. 643 - 655
    Resumen
    Adequate, updated and functional technology is essential in cardiology. In Spain, the economic scenario has strongly impacted technology renewal programs and obsolescence is a growing problem. The current report attempts to describe the current situation and the conditions that must concur to update, replace or adopt new technologies in the field of cardiology. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Barge-Caballero, E. (Autor de correspondencia); Almenar-Bonet, L.; Crespo-Leiro, M. G..; et al.
    Revista: INTERNATIONAL JOURNAL OF CARDIOLOGY
    ISSN 0167-5273 Vol.250 2018 págs. 183 - 187
    Resumen
    Background: It's unclear whether pre-transplant T. gondii seropositivity is associated with impaired survival in heart transplant recipients. Objectives: To test the above-mentioned hypothesis in the Spanish Heart Transplantation Registry. Methods: Post-transplant outcomes of 4048 patients aged >16 years who underwent first, single-organ heart transplantation in 17 Spanish institutions from 1984 to 2014 were studied. Long-term post-transplant survival and survival free of cardiac death or retransplantation of 2434 (60%) T. gondii seropositive recipients and 1614 (40%) T. gondii seronegative recipients were compared. Results: T. gondii seropositive recipients were older, had higher body mass index, and presented higher prevalence of hypertension, hypercholesterolemia, COPD and Cytomegalovirus seropositivity than T. gondii seronegative recipients. In univariable analysis, pre-transplant T. gondii seropositivity was associated with increased post-transplant all-cause mortality (non-adjusted HR 1.15; 95% CI 1.04-1.26). However, this effect was no longer statistically significant after multivariable adjustment by recipient's age and sex (adjusted HR 1.01, 95% CI 0.92-1.11). Extended multivariable adjustment by other potential confounders showed similar results (adjusted HR 0.99, 95% CI 0.89-1.11). T. gondii seropositivity had no significant effect on the composite outcome cardiac death or retransplantation (non-adjusted HR 1.08, 95% CI 0.95-1.24, p = 0.235). The distribution of the causes of death was comparable in T. gondii seropositive and T. gondii seronegative recipients. No statistically significant impact of donor's T. gondii serostatus or donor-recipient T. gondii serostatus matching on post-transplant survival was observed. Conclusions: Our analysis did not show a significant independent effect of preoperative T. gondii serostatus on long-term outcomes after heart transplantation. (C) 2017 Elsevier B.V. All rights reserved.
  • Autores: De Simone, A.; La Rocca, V.; Panella, A.; et al.
    Revista: CLINICAL CASE REPORTS
    ISSN 2050-0904 Vol.6 N° 6 2018 págs. 1060 - 1065
  • Autores: Ceniceros Paredes, Lucía; Chopitea Ortega, Ana; Pardo Sánchez, Fernando; et al.
    Revista: CLINICAL AND TRANSLATIONAL ONCOLOGY
    ISSN 1699-048X Vol.20 N° 5 2018 págs. 658 - 665
    Resumen
    Synchronous liver metastases (LM) from gastric (GC) or esophagogastric junction (EGJ) adenocarcinoma are a rare events. Several trials have evaluated the role of liver surgery in this setting, but the impact of preoperative therapy remains undetermined. Patients with synchronous LM from GC/EGJ adenocarcinoma who achieved disease control after induction chemotherapy (ICT) and were subsequently scheduled to chemoradiotherapy (CRT) to the primary tumor and surgery assessment were retrospectively analyzed. Pathological response, patterns of relapse, progression-free survival (PFS), and overall survival (OS) were calculated. From July 2002 to September 2012, 16 patients fulfilling the inclusion criteria were identified. Primary tumor site was GC (nine patients) or EGJ (seven patients). LM were considered technically unresectable in nine patients. Radiological response to the whole neoadjuvant program was achieved in 13 patients. Eight patients underwent surgical resection of the primary tumor; in five of these LM were resected. A complete pathological response in the primary or in the LM was found in four and three patients, respectively. The most frequent site of relapse/progression was systemic (eight patients). Local and liver-only relapses were observed in two patients each. After a median follow-up of 91 months, the median OS and PFS were 23.0 (95% CI 13.2-32.8) and 17.0 months (95% CI 11.7-22.3). 5-year actuarial PFS is 17.6%. Our results suggest that an intensified approach using ICT followed by CRT in synchronous LM from GC/EGJ adenocarcinoma is feasible and may translate into prolonged survival times in selected patients.
  • Autores: Verjans, R. ; Peters,T. ; Beaumont Ezcurra, Francisco Javier; et al.
    Revista: HYPERTENSION
    ISSN 0194-911X Vol.71 N° 2 2018 págs. 280 - 288
    Resumen
    Pressure overload causes cardiac fibroblast activation and transdifferentiation, leading to increased interstitial fibrosis formation and subsequently myocardial stiffness, diastolic and systolic dysfunction, and eventually heart failure. A better understanding of the molecular mechanisms underlying pressure overload-induced cardiac remodeling and fibrosis will have implications for heart failure treatment strategies. The microRNA (miRNA)-221/222 family, consisting of miR-221-3p and miR-222-3p, is differentially regulated in mouse and human cardiac pathology and inversely associated with kidney and liver fibrosis. We investigated the role of this miRNA family during pressure overload-induced cardiac remodeling. In myocardial biopsies of patients with severe fibrosis and dilated cardiomyopathy or aortic stenosis, we found significantly lower miRNA-221/222 levels as compared to matched patients with nonsevere fibrosis. In addition, miRNA-221/222 levels in aortic stenosis patients correlated negatively with the extent of myocardial fibrosis and with left ventricular stiffness. Inhibition of both miRNAs during AngII (angiotensin II)-mediated pressure overload in mice led to increased fibrosis and aggravated left ventricular dilation and dysfunction. In rat cardiac fibroblasts, inhibition of miRNA-221/222 derepressed TGF-ß (transforming growth factor-ß)-mediated profibrotic SMAD2 (mothers against decapentaplegic homolog 2) signaling and downstream gene expression, whereas overexpression of both miRNAs blunted TGF-ß-induced profibrotic signaling. We found that the miRNA-221/222 family may target several genes involved in TGF-ß signaling, including JNK1 (c-Jun N-terminal kinase 1), TGF-ß receptor 1 and TGF-ß receptor 2, and ETS-1 (ETS proto-oncogene 1). Our findings show that heart failure-associated downregulation of the miRNA-221/222 family enables profibrotic signaling in the pressure-overloaded heart.
  • Autores: Ravassa Albéniz, Susana (Autor de correspondencia); Trippel, T.; Bach, D. ; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.20 N° 9 2018 págs. 1290 - 1299
    Resumen
    Background Myocardial fibrosis is characterized by excessive cross-linking and deposition of collagen type I and is involved in left ventricular stiffening and left ventricular diastolic dysfunction (LVDD). We investigated whether the effect of spironolactone on LVDD in patients with heart failure with preserved ejection fraction (HFpEF) depends on its effects on collagen cross-linking and/or deposition. Methods and results We investigated 381 HFpEF patients from the multicentre, randomized, placebo-controlled Aldo-DHF trial with measures of the E:e' ratio. The ratio of serum carboxy-terminal telopeptide of collagen type I to serum matrix metalloproteinase-1 (CITP:MMP-1, an inverse index of myocardial collagen cross-linking) and serum carboxy-terminal propeptide of procollagen type I (PICP, a direct index of myocardial collagen deposition) were determined at baseline and after 1-year treatment with spironolactone 25 mg once daily or placebo. Patients were classified by CITP: MMP-1 and PICP tertiles at baseline. While CITP: MMP-1 tertiles at baseline interacted (P < 0.05) with spironolactone effect on E:e', PICP tertiles did not. In fact, while spironolactone treatment did not modify E:e' in patients with lower CITP: MMP-1 levels, this ratio was significantly reduced in the remaining spironolactone-treated patients. In addition, PICP was unchanged in patients with lower CITP: MMP-1 levels but was reduced in the remaining spironolactone-treated patients. Conclusions A biochemical phenotype of high collagen cross-linking identifies HFpEF patients resistant to the beneficial effects of spironolactone on LVDD. It is suggested that excessive collagen cross-linking, which stabilizes collagen type I fibres, diminishes the ability of spironolactone to reduce collagen deposition in these patients.
  • Autores: Barge-Caballero, E. (Autor de correspondencia); Almenar-Bonet, L.; Gonzalez-Vilchez, F. ; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.20 N° 1 2018 págs. 178 - 186
    Resumen
    Background In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy. Methods and results We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD). Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.112.6days. Mean time from listing to transplantation was 7.6 +/- 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008). Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30-0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS. Conclusion Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO.
  • Autores: González A; Ravassa S; López B; et al.
    Revista: HYPERTENSION
    ISSN 0194-911X Vol.72 N° 3 2018 págs. 549 - 558
  • Autores: de Torres Tajes, Juan Pablo; Ezponda Casajús, Ana; Alcaide Ocaña, Ana Belén; et al.
    Revista: PLOS ONE
    ISSN 1932-6203 Vol.13 N° 4 2018 págs. e0195640
    Resumen
    In this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.
  • Autores: Manrique Antón, Rebeca (Autor de correspondencia); Alzueta, A.; Ramirez, J. L.; et al.
    Revista: CIRUGIA CARDIOVASCULAR
    ISSN 1134-0096 Vol.25 N° 4 2018 págs. 208 - 211
    Resumen
    Mitral valve aneurysms are very rare complications of bacterial endocarditis. We present the case of an 88-year-old woman with moderate aortic insufficiency and an aneurysm in the anterior leaflet of the mitral valve secondary to endocarditis. After completing a full course of antibiotic, we performed though the aortotomy, mitral leaflet aneurysm resection, repairing the defect with an autologous pericardial patch, and aortic valve replacement by a bioprosthesis. The evolution of the patient was uneventful and was discharged on the ninth postoperative day. (C) 2018 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.
  • Autores: Treibel, T. A.; Kozor, R.; Schofield, R.; et al.
    Revista: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
    ISSN 0735-1097 Vol.71 N° 8 2018 págs. 860 - 871
    Resumen
    BACKGROUND Left ventricular (LV) hypertrophy, a key process in human cardiac disease, results from cellular (hypertrophy) and extracellular matrix expansion (interstitial fibrosis). OBJECTIVES This study sought to investigate whether human myocardial interstitial fibrosis in aortic stenosis (AS) is plastic and can regress. METHODS Patients with symptomatic, severe AS (n = 181; aortic valve area index 0.4 +/- 0.1 cm(2)/m(2)) were assessed pre-aortic valve replacement (AVR) by echocardiography (AS severity, diastology), cardiovascular magnetic resonance (CMR) (for volumes, function, and focal or diffuse fibrosis), biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T), and the 6-min walk test. CMR was used to measure the extracellular volume fraction (ECV), thereby deriving matrix volume (LV mass x ECV) and cell volume (LV mass x [1 - ECV]). Biopsy excluded occult bystander disease. Assessment was repeated at 1 year post-AVR. RESULTS At 1 year post-AVR in 116 pacemaker-free survivors (age 70 +/- 10 years; 54% male), mean valve gradient had improved (48 +/- 16 mm Hg to 12 +/- 6 mm Hg; p < 0.001), and indexed LV mass had regressed by 19% (88 +/- 26 g/m(2) to 71 +/- 19 g/m2; p < 0.001). Focal fibrosis by CMR late gadolinium enhancement did not change, but ECV increased (28.2 +/- 2.9% to 29.9 +/- 4.0%; p < 0.001): this was the result of a 16% reduction in matrix volume (25 +/- 9 ml/m(2) to 21 +/- 7 ml/m(2); p < 0.001) but a proportionally greater 22% reduction in cell volume (64 +/- 18 ml/m(2) to 50 +/- 13 ml/m(2); p < 0.001). These changes were accompanied by improvement in diastolic function, N-terminal pro-B-type natriuretic peptide, 6-min walk test results, and New York Heart Association functional class. CONCLUSIONS Post-AVR, focal fibrosis does not resolve, but diffuse fibrosis and myocardial cellular hypertrophy regress. Regression is accompanied by structural and functional improvements suggesting that human diffuse fibrosis is plastic, measurable by CMR and a potential therapeutic target. (Regression of Myocardial Fibrosis After Aortic Valve Replacement; NCT02174471) (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  • Autores: Treibel, T.; Kozor, R.; Fontana, M.; et al.
    Revista: JACC. CARDIOVASCULAR IMAGING
    ISSN 1936-878X Vol.11 N° 7 2018 págs. 962 - 973
    Resumen
    OBJECTIVES: The goal of this study was to explore sex differences in myocardial remodeling in aortic stenosis (AS) by using echocardiography, cardiac magnetic resonance (CMR), and biomarkers. BACKGROUND: AS is a disease of both valve and left ventricle (LV). Sex differences in LV remodeling are reported in AS and may play a role in disease phenotyping. METHODS: This study was a prospective assessment of patients awaiting surgical valve replacement for severe AS using echocardiography, the 6-min walking test, biomarkers (high-sensitivity troponin T and N-terminal pro-brain natriuretic peptide), and CMR with late gadolinium enhancement and extracellular volume fraction, which dichotomizes the myocardium into matrix and cell volumes. LV remodeling was categorized into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. RESULTS: In 168 patients (age 70 ± 10 years, 55% male, indexed aortic valve area 0.40 ± 0.13 cm2/m2, mean gradient 47 ± 4 mm Hg), no sex or age differences in AS severity or functional capacity (6-min walking test) were found. CMR captured sex dimorphism in LV remodeling not apparent by using 2-dimensional echocardiography. Normal geometry (82% female) and concentric remodeling (60% female) dominated in women; concentric hypertrophy (71% male) and eccentric hypertrophy (76% male) dominated in men. Men also had more evidence of LV decompensation (pleural effusions), lower left ventricular ejection fraction (67 ± 16% vs. 74 ± 13%; p < 0.001), and higher levels of N-terminal pro-brain natriuretic peptide (p = 0.04) and high-sensitivity troponin T (p = 0.01). Myocardial fibrosis was higher in men, with higher focal fibrosis (late gadolinium enhancement 16.5 ± 11.2 g vs. 10.5 ± 8.9 g; p < 0.001) and extracellular expansion (matrix volume 28.5 ± 8.8 ml/m2 vs. 21.4 ± 6.3 ml/m2; p < 0.001). CONCLUSIONS: CMR revealed sex differences in associations between AS and myocardial remodeling not evident from echocardiography. Given equal valve severity, the myocardial response to AS seems more maladaptive in men than previously reported. (Regression of Myocardial Fibrosis After Aortic Valve Replacement [RELIEF-AS]; NCT02174471).
  • Autores: Rodriguez-Manero, M. (Autor de correspondencia); Oloriz, T.; de Waroux, J. B. L.; et al.
    Revista: EUROPACE
    ISSN 1099-5129 Vol.20 N° 5 2018 págs. 851 - 858
    Resumen
    Aims Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
  • Autores: Pappritz, K.; Savvatis, K.; Miteva, K.; et al.
    Revista: FASEB JOURNAL
    ISSN 0892-6638 Vol.32 N° 11 2018 págs. 6066 - 6078
    Resumen
    Regulatory T (T-reg) cells offer new therapeutic options for controlling undesired systemic and local immune responses. The aim of the current study was to determine the impact of therapeutic T-reg administration on systemic and cardiac inflammation and remodeling in coxsackievirus B3 (CVB3) -induced myocarditis. Therefore, syngeneic T-reg cells were applied intravenously in CVB3-infected mice 3 d after infection. Compared with CVB3 + PBS mice, CVB3 + T-reg mice exhibited lower left ventricle (LV) chemokine expression, accompanied by reduced cardiac presence of proinflammatory Ly6C(high)CCR2(high)Cx3Cr1(low) monocytes and higher retention of proinflammatory Ly6C(mid)CCR2(high)Cx3Cr1(low) monocytes in the spleen. In addition, splenic myelopoiesis was reduced in CVB3 + T-reg compared with CVB3 + PBS mice. Coculture of T-reg cells with splenocytes isolated from mice 3 d post-CVB3 infection further demonstrated the ability of T-reg cells to modulate monocyte differentiation in favor of the anti-inflammatory Ly6C(low)CCR2(low)Cx3Cr1(high) subset. T-reg-mediated immunomodulation was paralleled by lower collagen 1 protein expression and decreased levels of soluble and insoluble collagen in LV of CVB3 + T-reg compared with CVB3 + PBS mice. In agreement with these findings, LV systolic and diastolic function was improved in CVB3 + T-reg mice compared with CVB3 + PBS mice. In summary, adoptive T-reg transfer in the inflammatory phase of viral-induced myocarditis protects the heart against inflammatory damage and fibrosis via modulation of monocyte subsets.Pappritz, K., Savvatis, K., Miteva, K., Kerim, B., Dong, F., Fechner, H., Muller, I., Brandt, C., Lopez, B., Gonzalez, A., Ravassa, S., Klingel, K., Diez, J., Reinke, P., Volk, H.-D., Van Linthout, S., Tschope, C. Immunomodulation by adoptive regulatory T-cell transfer improves Coxsackievirus B3-induced myocarditis.
  • Autores: Treibel, T. A.; López Salazar, Begoña; González Miqueo, Aránzazu; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.39 N° 8 2018 págs. 699 - 709
    Resumen
    Aims To investigate myocardial fibrosis (MF) in a large series of severe aortic stenosis (AS) patients using invasive biopsy and non-invasive imaging. Methods and results One hundred thirty-three patients with severe, symptomatic AS accepted for surgical aortic valve replacement underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) quantification. Intra-operative left ventricular (LV) biopsies were performed by needle or scalpel, yielding tissue with (n = 53) and without endocardium (n=80), and compared with 10 controls. Myocardial fibrosis occurred in three patterns: (i) thickened endocardium with a fibrotic layer; (ii) microscopic scars, with a subendomyo-cardial predominance; and (iii) diffuse interstitial fibrosis. Collagen volume fraction (CVF) was elevated (P<0.001) compared with controls, and higher (P<0.001) in endocardium-containing samples with a decreasing CVF gradient from the subendocardium (P = 0.001). Late gadolinium enhancement correlated with CVF (P<0.001) but not ECV. Both LGE and ECV correlated independently (P<0.001) with N-terminal pro-brain natriuretic peptide and high-sensitivity-troponin T. High ECV was also associated with worse LV remodelling, left ventricular ejection fraction and functional capacity. Combining high ECV and LGE better identified patients with more adverse LV remodelling, blood biomarkers and histological parameters, and worse functional capacity than each parameter alone. Conclusion Myocardial fibrosis in severe AS is complex, but three main patterns exist: endocardial fibrosis, microscars (mainly in the subendomyocardium), and diffuse interstitial fibrosis. Neither histological CVF nor the CMR parameters ECV and LGE capture fibrosis in its totality. A combined, multi-parametric approach with ECV and LGE allows best stratification of AS patients according to the response of the myocardial collagen matrix.
  • Autores: Bayes-Genis, A. (Autor de correspondencia); Voors, A. A.; Zannad, F. ; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.39 N° 30 2018 págs. 2793 - 2799
  • Autores: Bastarrika Alemañ, Gorka (Autor de correspondencia); González de la Huebra Rodríguez, Ignacio Javier; Calvo Imirizaldu, Marta; et al.
    Revista: RADIOLOGIA
    ISSN 0033-8338 Vol.60 N° 5 2018 págs. 387 - 393
    Resumen
    Objective: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. Conclusion: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: Marin Oto, Marta; Calvo Imirizaldu, Marta; González Gutiérrez, Jessica; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.52 N° Supl. 62 2018
  • Autores: González Miqueo, Aránzazu; Martinez-Martinez, E.; Brugnolaro, C. ; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.20 N° Supl. 1 2018 págs. 367 - 368
  • Autores: Eiros Bachiller, Rocío; Treibel, T. ; Scully, P.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.39 N° Supl. 1 2018 págs. 1378 - 1378
  • Autores: Díez Martínez, Domingo Francisco Javier
    Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
    ISSN 0014-2972 Vol.48 N° Supl. 1 2018 págs. 33 - 34
  • Autores: Salterain González, Nahikari; Manrique Antón, Rebeca; Ibero Valencia, Javier; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN 1388-9842 Vol.20 N° Supl 1 2018 págs. 158 - 158
  • Autores: Rivera Ortega, Pilar; González Gutiérrez, Jessica; Restituto Aranguibel, Patricia; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.52 N° Supl. 62 2018
  • Autores: Carbone, J.; Sousa, I.; Cifrian, J.; et al.
    Revista: JOURNAL OF HEART AND LUNG TRANSPLANTATION
    ISSN 1053-2498 Vol.37 N° 4 2018 págs. S156 - S157
  • Autores: Moreno Zulategui, María de Ujue; Ravassa Albéniz, Susana; Gallego, C.; et al.
    Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
    ISSN 0014-2972 Vol.48 N° Supl. 1 2018 págs. 125 - 126
  • Autores: de Torres Tajes, Juan Pablo; Wisnivesky, J. ; Wilson, D.; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN 0903-1936 Vol.52 N° Supl. 62 2018
  • Autores: Pichler, G.; Santamaria, J. M. V.; Garcia, F. M. ; et al.
    Revista: JOURNAL OF HYPERTENSION
    ISSN 0263-6352 Vol.36 N° Supl. 1 2018 págs. E110
  • Autores: Proietti, M. ; Laroche, C.; Popescu, M. I.; et al.
    Revista: EUROPEAN HEART JOURNAL
    ISSN 0195-668X Vol.39 N° Supl. 1 2018 págs. 694 - 695
  • Autores: Sunsundegui, P.; Santesteban-Moriones, V.; Landecho Acha, Manuel Fortún
    Libro: Endocrinology and systemic diseases
    ISSN 978-3-319-68728-5 2021 págs. 365 -3 98
  • Autores: Yuste Ara, José Ramón; López Olaondo, Luis Alberto; Aquerreta González, Irene; et al.
    Libro: Guía para la profilaxis y tratamiento de las infecciones y política antibiótica
    ISSN 978-84-09-02690-6 2018 págs. 7
  • Autores: Yuste Ara, José Ramón; del Pozo León, José Luis; Panizo Santos, Carlos Manuel; et al.
    Libro: Guía para la profilaxis y tratamiento de las infecciones y política antibiótica
    ISSN 978-84-09-02690-6 2018 págs. 155 - 240

Proyectos desde 2018

  • Título: RICORS2040
    Código de expediente: RD21/0005/0024
    Investigador principal: NURIA GARCIA FERNANDEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2021 AES Redes de Investigación cooperativa orientadas a resultados (RICORS)
    Fecha de inicio: 01-01-2022
    Fecha fin: 31-12-2024
    Importe concedido: 105.765,00 €
    Fondos FEDER: SI
  • Título: Estudio genómico para la personalización del diagnóstico y el tratamiento de los pacientes con insuficiencia Cardíaca crónica y enfermedad renal crónica (Medicina cardIoreNal pERsonalizada en NaVArra)-II (MINERVA-II)
    Código de expediente: 0011-1411-2021-000094
    Investigador principal: JUAN JOSE GAVIRA GOMEZ.
    Financiador: GOBIERNO DE NAVARRA
    Convocatoria: 2021 GN PROYECTOS ESTRATEGICOS DE I+D 2021-2024
    Fecha de inicio: 01-05-2021
    Fecha fin: 31-12-2023
    Importe concedido: 100.748,76 €
    Fondos FEDER: NO
  • Título: Papel de la MMP-10 y la perfusión tisular en el diagnóstico y seguimiento de la nefropatía y patología cardiovascular de pacientes con diabetes mellitus tipo 2.
    Código de expediente: PI20/01678
    Investigador principal: NURIA GARCIA FERNANDEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2020 AES Proyectos de investigación
    Fecha de inicio: 01-01-2021
    Fecha fin: 31-12-2023
    Importe concedido: 102.608,00 €
    Fondos FEDER: SI
  • Título: Caracterización de un perfil de biomarcadores no invasivos asociados a daño Cardiaco en pacientes infEctados por SARS-CoV-2. Implicaciones diagnósticas y pronósticas.
    Código de expediente: 0011-1383-2020-000010 PC057
    Investigador principal: INES DIAZ DORRONSORO.
    Financiador: GOBIERNO DE NAVARRA
    Convocatoria: 2020 GN Proyectos Colaborativos
    Fecha de inicio: 01-07-2020
    Fecha fin: 30-11-2022
    Importe concedido: 52.534,25 €
    Fondos FEDER: NO
  • Título: Implicación de guanilina y uroguanilina en el desarrollo de obesidad y resistencia a la insulina.
    Código de expediente: PI19/00990
    Investigador principal: AMAIA RODRIGUEZ MURUETA-GOYENA.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2019 AES Proyectos de investigación
    Fecha de inicio: 01-01-2020
    Fecha fin: 31-12-2022
    Importe concedido: 171.820,00 €
    Fondos FEDER: SI
  • Título: ESTUDIO MULTIDISCIPLINAR INTEGRADO DE LA FISIOPATOLOGIA Y EL ABORDAJE TERAPEUTICO DE LA INSUFICIENCIA CARDIACA
    Código de expediente: EIN2019-103130
    Investigador principal: ARANZAZU GONZALEZ MIQUEO.
    Financiador: MINISTERIO DE CIENCIA E INNOVACIÓN
    Convocatoria: 2019 AEI - MICIU Europa Investigación
    Fecha de inicio: 01-07-2019
    Fecha fin: 31-12-2020
    Importe concedido: 22.000,00 €
    Fondos FEDER: SI
  • Título: Metilación del ADN circulante como biomarcador para enfermedades
    Código de expediente: 55/2018
    Investigador principal: MARIA ARECHEDERRA CALDERON.
    Financiador: GOBIERNO DE NAVARRA. DEPARTAMENTO DE SALUD
    Convocatoria: 2018 PROYECTOS DE I+D EN SALUD
    Fecha de inicio: 31-12-2018
    Fecha fin: 30-12-2021
    Importe concedido: 77.050,00 €
    Fondos FEDER: SI
  • Título: MINERVA. Estudio genómico para la personalización del diagnóstico y el tratamiento de los pacientes con insuficiencia Cardíaca crónica y enfermedad renal crónica (Medicina cardIoreNal pERsonalizada en NaVArra)
    Código de expediente: 0011-1411-2018-000043
    Investigador principal: DOMINGO FRANCISCO JAVIER DIEZ MARTINEZ, DOMINGO FRANCISCO JAVIER DIEZ MARTINEZ.
    Financiador: GOBIERNO DE NAVARRA
    Convocatoria: 2018- GN PROY. ESTRATEGICOS DE I+D 2018-2020
    Fecha de inicio: 01-04-2018
    Fecha fin: 30-11-2020
    Importe concedido: 1.001.241,69 €
    Fondos FEDER: NO
  • Título: Estudio genómico para la personalización del diagnóstico y el tratamiento de los pacientes con insuficiencia cardiaca crónica y enfermedad renal crónica (Medicina cardIoreNal pERsonalizada en NaVArra) (MINERVA)
    Código de expediente: 0011-1411-2018-000036
    Investigador principal: JUAN JOSE GAVIRA GOMEZ.
    Financiador: GOBIERNO DE NAVARRA
    Convocatoria: 2018 GN PROYECTOS ESTRATEGICOS DE I+D 2018-2020
    Fecha de inicio: 01-04-2018
    Fecha fin: 30-11-2020
    Importe concedido: 97.237,60 €
    Fondos FEDER: NO
  • Título: Estudio de la fibrosis intersticial miocárdica en la toxicidad cardíaca asociada al tratamiento del cáncer de mama. Implicaciones diagnósticas y terapéuticas
    Código de expediente: PI17/01999
    Investigador principal: SUSANA RAVASSA ALBENIZ, DOMINGO FRANCISCO JAVIER DIEZ MARTINEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2017 - PROYECTOS DE I+D EN SALUD
    Fecha de inicio: 01-01-2018
    Fecha fin: 30-06-2022
    Importe concedido: 111.320,00 €
    Fondos FEDER: SI
  • Título: Papel del inflamasoma en la regulación del inmunometabolismo, estrés oxidativo y remodelado de la matriz en la expansión del tejido adiposo asociada a la obesidad y sus comorbilidades.
    Código de expediente: PI17/02188
    Investigador principal: VICTORIA CATALAN GOÑI.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2017 PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2018
    Fecha fin: 31-12-2020
    Importe concedido: 110.715,00 €
    Fondos FEDER: SI
  • Título: Papel de IL-1ß e IL-1RN en el desarrollo de alteraciones metabólicas mediadas por osteopontina en el contexto de la obesidad.
    Código de expediente: PI17/02183
    Investigador principal: JAVIER GOMEZ AMBROSI.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2017 PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2018
    Fecha fin: 31-12-2020
    Importe concedido: 159.720,00 €
    Fondos FEDER: SI
  • Título: Predimar
    Código de expediente: PI17/00718
    Investigador principal: MIGUEL RUIZ-CANELA LOPEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: AES2017 PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2018
    Fecha fin: 31-12-2021
    Importe concedido: 52.030,00 €
    Fondos FEDER: SI
  • Título: Tratamiento del infarto de miocardio y prevención del remodelado adverso mediante la aplicación de factores de crecimiento y microRNAs anti-fibróticos
    Código de expediente: PI16/00129
    Investigador principal: BEATRIZ PELACHO SAMPER, JUAN JOSE GAVIRA GOMEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2016 - PROYECTOS DE I+D EN SALUD
    Fecha de inicio: 01-01-2017
    Fecha fin: 30-06-2020
    Importe concedido: 98.615,00 €
    Fondos FEDER: SI
  • Título: Estudio de la interacción de adipoquinas y mioquinas en el desarrollo de obesidad y comorbilidades asociadas.
    Código de expediente: PI16/00221
    Investigador principal: AMAIA RODRIGUEZ MURUETA-GOYENA.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2016 AES PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2017
    Fecha fin: 31-12-2019
    Importe concedido: 92.565,00 €
    Fondos FEDER: SI
  • Título: Cribado de cáncer de pulmón en pacientes con EPOC con TAC de baja dosis de radiación: análisis de la cohorte del estudio National Lung cancer Screening Trial (NLST)-ACRIN
    Código de expediente: PI16/01149
    Investigador principal: JUAN PABLO DE TORRES TAJES.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2016 AES PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2017
    Fecha fin: 31-12-2020
    Importe concedido: 19.965,00 €
    Fondos FEDER: SI
  • Título: Ensayo aleatorizado de prevención con dieta mediterránea de arritmias recurrentes (estudio predimar) en pacientes con fibrilación auricular
    Código de expediente: 46/2016
    Investigador principal: MIGUEL RUIZ-CANELA LOPEZ.
    Financiador: GOBIERNO DE NAVARRA
    Convocatoria: 2016 GN SALUD
    Fecha de inicio: 08-12-2016
    Fecha fin: 08-12-2019
    Importe concedido: 47.385,16 €
    Fondos FEDER: NO
  • Título: Biomateriales y nanopartículas para la aplicación y liberación de células y proteínas terapéuticas para la reparación del corazón (EURONANOMED-036)
    Código de expediente: AC15/00050
    Investigador principal: FELIPE LUIS PROSPER CARDOSO, FELIPE LUIS PROSPER CARDOSO.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2015 AES ACCIONES COMPLEMENTARIAS
    Fecha de inicio: 01-01-2016
    Fecha fin: 30-06-2019
    Importe concedido: 149.435,00 €
    Fondos FEDER: NO
  • Título: Estudio clínico y experimental del papel de la MMP-10 en la nefropatía diabética tipo 2
    Código de expediente: PI15/02111
    Investigador principal: NURIA GARCIA FERNANDEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2015 AES PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2016
    Fecha fin: 30-11-2020
    Importe concedido: 116.765,00 €
    Fondos FEDER: SI
  • Título: Estudio de coste-efectividad y factibilidad del cribado de cáncer de pulmón en España
    Código de expediente: PI15/02157
    Investigador principal: JAVIER JOSEPH ZULUETA FRANCES.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2015 AES PROYECTOS DE INVESTIGACIÓN
    Fecha de inicio: 01-01-2016
    Fecha fin: 31-12-2018
    Importe concedido: 62.315,00 €
    Fondos FEDER: NO
  • Título: Implicación de las NADPH oxidasas en la fibrosis miocárdica intersticial en la insuficiencia cardiaca
    Código de expediente: PI14/00684
    Investigador principal: MARIA DE UJUE MORENO ZULATEGUI, GORKA SAN JOSE ENERIZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2014 - PROYECTOS DE I+D EN SALUD
    Fecha de inicio: 01-01-2015
    Fecha fin: 30-12-2018
    Importe concedido: 74.415,00 €
    Fondos FEDER: SI
  • Título: Estudio de exosomas tumorales como inductores de células mieloides supresoras y mensajeros transportadores de moléculas inmunosupresoras.
    Código de expediente: PI14/00274
    Investigador principal: ALVARO GONZALEZ HERNANDEZ.
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: 2014 ISCIII Proyectos de I+D
    Fecha de inicio: 01-01-2015
    Fecha fin: 31-12-2018
    Importe concedido: 55.055,00 €
    Fondos FEDER: NO
  • Título: MiCrovasculaR rarefaction in vascUlar Cognitive Impairement
    Código de expediente: 848109
    Investigador principal: ARANZAZU GONZALEZ MIQUEO
    Financiador: COMISIÓN EUROPEA
    Convocatoria: SC1-BHC-02-2019
    Fecha de inicio: 01-01-2020
    Fecha fin: 31-12-2023
    Importe concedido: 459.505,00 €
    Fondos FEDER: NO
  • Título: MiCrovasculaR rarefaction in vascUlar Cognitive Impairement and heArt faiLure
    Código de expediente:
    Investigador principal: GORKA BASTARRIKA ALEMAÑ
    Financiador: COMISIÓN EUROPEA
    Convocatoria: SC1-BHC-01-2019
    Fecha de inicio: 01-01-2020
    Fecha fin: 31-12-2023
    Importe concedido: 345.495,00 €
    Fondos FEDER: NO
  • Título: LIPCAR-HF: Lipcar, un marcador pronóstico de la insuficiencia cardíaca con fracción de eyección reducida.
    Código de expediente: AC16/00016
    Investigador principal: DOMINGO FRANCISCO JAVIER DIEZ MARTINEZ
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: ERA-CVD
    Fecha de inicio: 01-01-2017
    Fecha fin: 30-04-2020
    Importe concedido: 99.746,35 €
    Fondos FEDER: SI
  • Título: LYMIT-DIS: Targeted lymphatic and microvessel treatment in metabolic-disease HFpEF
    Código de expediente: AC16/00020
    Investigador principal: ARANZAZU GONZALEZ MIQUEO
    Financiador: INSTITUTO DE SALUD CARLOS III
    Convocatoria: ERA-CVD
    Fecha de inicio: 01-01-2017
    Fecha fin: 30-03-2021
    Importe concedido: 99.825,00 €
    Fondos FEDER: SI
  • Título: HOMAGE: Heart OMics in AGEing
    Código de expediente: 305507
    Investigador principal: DOMINGO FRANCISCO JAVIER DIEZ MARTINEZ ARANZAZU GONZALEZ MIQUEO
    Financiador: COMISIÓN EUROPEA
    Convocatoria: FP7-HEALTH FP7-HEALTH FP7-HEALTH FP7-HEALTH
    Fecha de inicio: 01-02-2013
    Fecha fin: 31-01-2019
    Importe concedido: 354.590,10 €
    Fondos FEDER: NO