Grupos Investigadores

Líneas de Investigación

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

Palabras Clave

  • Biomarcador
  • Fibrilación auricular
  • Insuficiencia cardiaca
  • Remodelado miocárdico

Publicaciones Científicas desde 2018

  • Autores: de Torres Tajes, Juan Pablo (Autor de correspondencia); Alcaide Ocaña, Ana Belén; Campo Ezquibela, Aránzazu; et al.
    Revista: ARCHIVOS DE BRONCONEUMOLOGIA
    ISSN: 0300-2896 Vol.60 N° 2 2024 págs. 95 - 100
    Resumen
    Introduction: The Global Initiative for Obstructive Lung Disease (GOLD) recommends lung cancer screening for patients with Chronic Obstructive Pulmonary Disease (COPD), but data is lacking regarding results of screening in this high-risk population. The main goal of the present work is to explore if lung cancer screening with Low Dose Chest Tomography (LDCT) in people with COPD, allows lung cancer (LC) diagnosis in early stages with survival compatible with curative state. Methods: This is a post hoc exploratory analysis. Pamplona International Early Lung Cancer Action Program (P-IELCAP) participants with a GOLD defined obstructive pattern (post bronchodilator FEV1/FVC<0.70) were selected for analysis. The characteristics of those who developed LC and their survival are described. A Cox proportional analysis explored the factors associated with LC diagnosis. Results: Eight hundred and sixty-five patients (77% male, 93% in spirometric GOLD stage 1+2) were followed for 102±63 months. LC prevalence was 2.6% at baseline, with an annual LC diagnosis rate of 0.68%. Early-stage tumors predominated (74%) with a median survival (25-75th percentiles) of 139 (76-185) months. Cumulative tobacco exposure, FEV1%, and emphysema were the main predictors of an LC diagnosis. Eight (11%) patients with COPD had a second LC, most of them in early stage (92%), and 6 (8%) had recurrence. Median survival (25-75th percentiles) in these patients was 168 (108-191) months.
  • Autores: Ramírez-Vélez, R.; González Miqueo, Aránzazu; García-Hermoso, A.; et al.
    Revista: METABOLISM-CLINICAL AND EXPERIMENTAL
    ISSN: 0026-0495 Vol.138 2023 págs. 155348
    Resumen
    Exercise intolerance remains a major unmet medical need in patients with heart failure (HF). Skeletal myopathy is currently considered as the major limiting factor for exercise capacity in HF patients. On the other hand, emerging evidence suggest that physical exercise can decrease morbidity and mortality in HF patients. Therefore, mechanistic insights into skeletal myopathy may uncover critical aspects for therapeutic interventions to improve exercise performance in HF. Emerging data reviewed in this Artículo suggest that the assessment of circulating myokines (molecules synthesized and secreted by skeletal muscle in response to contraction that display autocrine, paracrine and endocrine actions) may provide new insights into the pathophysiology, phe-notyping and prognostic stratification of HF-related skeletal myopathy. Further studies are required to determine whether myokines may also serve as biomarkers to personalize the modality and dose of physical training prescribed for patients with HF and exercise intolerance. In addition, the production and secretion of myokines in patients with HF may interact with systemic alterations (e.g., inflammation and metabolic disturbances), frequently present in patients with HF. Furthermore, myokines may exert beneficial or detrimental effects on cardiac structure and function, which may influence adverse cardiac remodelling and clinical outcomes in HF patients. Collectively, these data suggest that a deeper knowledge on myokines regulation and actions may lead to the identification of novel physical exercise-based therapeutic approaches for HF patients.
  • Autores: Ravassa Albéniz, Susana; López Salazar, Begoña; Treibel, T. A.; et al.
    Revista: MOLECULAR ASPECTS OF MEDICINE
    ISSN: 0098-2997 Vol.93 2023 págs. 101194
    Resumen
    Heart failure is a leading cause of mortality and hospitalization worldwide. Cardiac fibrosis, resulting from the excessive deposition of collagen fibers, is a common feature across the spectrum of conditions converging in heart failure. Eventually, either reparative or reactive in nature, in the long-term cardiac fibrosis contributes to heart failure development and progression and is associated with poor clinical outcomes. Despite this, specific cardiac antifibrotic therapies are lacking, making cardiac fibrosis an urgent unmet medical need. In this context, a better patient phenotyping is needed to characterize the heterogenous features of cardiac fibrosis to advance toward its personalized management. In this review, we will describe the different phenotypes associated with cardiac fibrosis in heart failure and we will focus on the potential usefulness of imaging techniques and circulating biomarkers for the non-invasive characterization and phenotyping of this condition and for tracking its clinical impact. We will also recapitulate the cardiac antifibrotic effects of existing heart failure and non-heart failure drugs and we will discuss potential strategies under preclinical development targeting the activation of cardiac fibroblasts at different levels, as well as targeting additional extracardiac processes.
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); Butler, J.
    Revista: HYPERTENSION
    ISSN: 0194-911X Vol.80 N° 1 2023 págs. 13 - 21
    Resumen
    Hypertensive heart disease (HHD) is currently the second leading cause of heart failure. The prevalence of HHD and its associated risk of heart failure have increased despite substantial improvement in arterial hypertension treatment and control in the recent decades. Therefore, the prevention of heart failure in patients with HHD represents an unmet medical need, due to its clinical, economic, and social impact. In this conceptual framework, we call to action because the time has come for diagnosis and treatment of patients with HHD not to be limited to assessment of morphological and functional left ventricular changes, blood pressure control, and left ventricular hypertrophy regression. We propose a further perspective incorporating also the detection and reversal of the histological changes that develop in the hypertensive heart and that lead to the structural remodeling of the myocardium. In particular, we focus on the diagnosis and treatment of myocardial interstitial fibrosis, likely the lesion most critically involved in the transition from subclinical HHD to clinically overt heart failure. In this context, it is worth considering whether the use of imaging and circulating biomarkers for the noninvasive diagnosis of myocardial interstitial fibrosis should be incorporated in the medical study of hypertensive patients, especially of those with HHD.
  • Autores: Rao, V. N. (Autor de correspondencia); Díez Martínez, Domingo Francisco Javier; Gustafsson, F.; et al.
    Revista: JOURNAL OF CARDIAC FAILURE
    ISSN: 1071-9164 Vol.29 N° 3 2023 págs. 389 - 402
    Resumen
    Vericiguat is a soluble guanylate cyclase stimulator approved by multiple global regulatory bodies and recommended in recently updated clinical practice guidelines to reduce morbidity and mortality in patients with worsening chronic heart failure (HF) with reduced ejection frac-tion (HFrEF). Despite the growing armaments of evidence-based medical therapy for HFrEF that have demonstrated clinical outcome benefits, there is a need to address residual risk following worsening HF events. When considering therapies aimed to mitigate postevent cardio-vascular risk, potential barriers preventing the prescription of vericiguat in eligible patients may include providers' lack of familiarity with it, clinical inertia, limited knowledge about monitoring response to therapy, and concerns about potential adverse effects as well as inte-gration of its routine use during an era of in-person and telehealth hybrid ambulatory care. This review provides an overview of vericiguat therapy and proposes an evidence-based and practical guidance strategy toward implementing its use in various clinical settings. This review additionally summarizes patient counseling points for its initiation and maintenance.
  • Autores: de la Espriella, R.; Cobo-Marcos, M.; Ronco, C.; et al.
    Revista: CLINICAL KIDNEY JOURNAL
    ISSN: 2048-8505 Vol.16 N° 5 2023 págs. 780 - 792
    Resumen
    The population with concomitant heart and kidney disease (often termed 'cardiorenal' disease) is expected to grow, significantly impacting public health and healthcare utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated and specialized care would be a positive shift towards improving patient outcomes and optimizing healthcare resources. This article aims to define the organizational aspects and key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.
  • Autores: Maroto Garcia, Julia (Autor de correspondencia); Martínez-Escribano, A. ; Delgado-Gil, V. ; et al.
    Revista: CLINICA CHIMICA ACTA
    ISSN: 0009-8981 Vol.548 N° 117471 2023
    Resumen
    Introduction: Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system. Although there is currently no definite cure for MS, new therapies have recently been developed based on a continuous search for new biomarkers. Development: MS diagnosis relies on the integration of clinical, imaging and laboratory findings as there is still no singlepathognomonicclinical feature or diagnostic laboratory biomarker. The most commonly laboratory test used is the presence of immunoglobulin G oligoclonal bands (OCB) in cerebrospinal fluid of MS patients. This test is now included in the 2017 McDonald criteria as a biomarker of dissemination in time. Nevertheless, there are other biomarkers currently in use such as kappa free light chain, which has shown higher sensitivity and specificity for MS diagnosis than OCB. In addition, other potential laboratory tests involved in neuronal damage, demyelination and/or inflammation could be used for detecting MS. Conclusions: CSF and serum biomarkers have been reviewed for their use in MS diagnosis and prognosis to stablish an accurate and prompt MS diagnosis, crucial to implement an adequate treatment and to optimize clinical outcomes over time.
  • Autores: Quiroga, B.; Ortiz, A.; Navarro-González, J. F.; et al.
    Revista: CLINICAL KIDNEY JOURNAL
    ISSN: 2048-8505 Vol.16 N° 1 2023 págs. 19 - 29
    Resumen
    Cardiorenal syndromes (CRS) are broadly defined as disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. CRS are currently classified into five categories, mostly based on disease-initiating events and their acuity or chronicity. CRS types 3 and 4 (also called renocardiac syndromes) refer to acute and chronic kidney dysfunction resulting in acute and chronic heart dysfunction, respectively. The notion of renocardiac syndromes has broadened interest in kidney-heart interactions but uncertainty remains in the nephrological community's understanding of the clinical diversity, pathophysiological mechanisms and optimal management approaches of these syndromes. This triple challenge that renocardiac syndromes (and likely other cardiorenal syndromes) pose to the nephrologist can only be faced through a specific and demanding training plan to enhance his/her cardiological scientific knowledge and through an appropriate clinical environment to develop his/her cardiological clinical skills. The first must be the objective of the subspecialty of cardionephrology (or nephrocardiology) and the second must be the result of collaboration with cardiologists (and other specialists) in cardiorenal care units. This review will first consider various aspects of the challenges that renocardiac syndromes pose to nephrologists and, then, will discuss those aspects of cardionephrology and cardiorenal units that can facilitate an effective response to the challenges.
  • Autores: Pudis, M. (Autor de correspondencia); Bastarrika Alemañ, Gorka
    Revista: MEDICINA CLINICA
    ISSN: 0025-7753 Vol.160 N° 3 2023 págs. 121 - 128
    Resumen
    Cardiac amyloidosis (CA) is an underdiagnosed disease and, if left untreated, rapidly fatal. Emerging therapies for CA increase the urgency of developing non-invasive diagnostic methods for its early detec-tion and for monitoring therapeutic response. Classic imaging features on echocardiography and cardiac magnetic resonance, although typical for cardiac amyloidosis, are not specific enough to distinguish light chain amyloidosis from transthyretin. Myocardial bone-avid radiotracer uptake is highly specific for transthyretin cardiac amyloidosis when plasma cell dyscrasia has been excluded; it is now replacing the need for biopsy in many patients. Detection of early cardiac amyloidosis, quantitation of its burden, and assessment of response to therapy are important next steps for imaging to advance the evaluation and management of cardiac amyloidosis.
  • Autores: García-Hermoso, A. (Autor de correspondencia); Ramírez-Velez, R.; Díez Martínez, Domingo Francisco Javier; et al.
    Revista: JOURNAL OF SPORT AND HEALTH SCIENCE
    ISSN: 2095-2546 Vol.12 N° 2 2023 págs. 147 - 157
    Resumen
    Background: This study investigates the effects of exercise training on exerkines in patients with type 2 diabetes mellitus to determine the opti-mal exercise prescription.Methods: A systematic search for relevant studies was performed in 3 databases. Randomized controlled trials investigating the effects of exer-cise training on at least one of the following exerkines were included: adiponectin, apelin, brain-derived neurotrophic factor, fetuin-A, fibroblast growth factor-21, follistatin, ghrelin, interleukin (IL)-6, IL-8, IL-10, IL-15, IL-18, leptin, myostatin, omentin, resistin, retinol-binding protein 4, tumor necrosis factor-a, and visfatin.Results: Forty randomized controlled trials were selected for data extraction (n = 2160). Exercise training induces changes in adiponectin, fetuin-A, fibroblast growth factor-21, IL-6, IL-10, leptin, resistin, and tumor necrosis factor-a levels but has no significant effects on apelin, IL-18, and ghrelin compared to controls. Physical exercise training favored large and positive changes in pooled exerkines (i.e., an overall effect size calculated from several exerkines) (Hedge's g = 1.02, 95% confidence interval (95%CI): 0.76-1.28), which in turn were related to changes in glycated hemoglobin (mean difference (MD) = -0.81%, 95%CI: -0.95% to-0.67%), fasting glucose (MD = -23.43 mg/dL, 95%CI: -30.07 mg/dL to -16.80 mg/dL), waist circumference (MD = -3.04 cm, 95%CI: -4.02 cm to -2.07 cm), and body mass (MD = -1.93 kg, 95%CI: -2.00 kg to -1.86 kg). Slightly stronger effects were observed with aerobic, resistance, or high-intensity interval protocols at moderate-to vigorous-intensity and with programs longer than 24 weeks that comprise at least 3 sessions per week and more than 60 min per session.Conclusion: Exercise training represents an anti-inflammatory therapy and metabolism-improving strategy with minimal side effects for patients with type 2 diabetes mellitus.
  • Autores: Sogbe Diaz, Miguel Eduardo; Blanco Di Matteo, Andrés Enrique (Autor de correspondencia); Di Frisco Ramírez, Isberling Madeleine; et al.
    Revista: GASTROENTEROLOGIA Y HEPATOLOGIA
    ISSN: 0210-5705 Vol.46 N° 6 2023 págs. 489 - 490
  • Autores: Sogbe Diaz, Miguel Eduardo; Ezponda Casajús, Ana; del Pozo León, José Luis (Autor de correspondencia)
    Revista: MEDICINA CLINICA
    ISSN: 0025-7753 Vol.160 N° 9 2023 págs. 416 - 417
  • Autores: Sánchez Vega, Juan Diego (Autor de correspondencia); Pascual Izco, Marina; Alonso Salinas, G. L.
    Revista: CARDIOLOGY
    ISSN: 0008-6312 Vol.148 N° 2 2023 págs. 114 - 116
  • Autores: Albarrán-Rincón, R.; Riesgo García, Álvaro; Ramos Ardanáz, Pablo; et al.
    Revista: JOURNAL OF ARRHYTHMIA
    ISSN: 1880-4276 Vol.39 N° 1 2023 págs. 82 - 83
  • Autores: Del Nido Recio, Pablo; Fernández-Ordoñez Pita, Pedro; Ezponda Casajús, Ana (Autor de correspondencia)
    Revista: MEDICINA CLINICA
    ISSN: 0025-7753 Vol.161 N° 12 2023 págs. 549 - 550
  • Autores: Quiroga, B. (Autor de correspondencia); Díez Martínez, Domingo Francisco Javier
    Revista: CLINICAL KIDNEY JOURNAL
    ISSN: 2048-8505 Vol.16 N° 7 2023 págs. 1049 - 1055
    Resumen
    The progressive reduction in estimated glomerular filtration rate (eGFR) resulting in chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD) (i.e., cardiorenal disease). Cardiorenal disease is associated with poor outcomes, mainly due to increased cardiovascular (CV) complications and CV death. Data from general population-based studies and studies of cohorts with CKD and/or CVD show that compared with creatinine-based eGFR, cystatin C-based eGFR and creatinine plus cystatin C-based eGFR detect higher risks of adverse CV outcomes and add predictive discrimination to current CVD risk scores. On the other hand, growing clinical evidence supports kidney and CV protective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors in cardiorenal patients. However, recent data suggest that some detrimental effects of SGLT2 inhibitors on skeletal muscle mass may lead to overestimation of creatinine-based eGFR and subsequent misinterpretation of associated CV risk in patients treated with these agents. Within this framework, we suggest the advisability of using cystatin C and/or creatinine plus cystatin C-based eGFR for routine clinical practice in cardiorenal patients to more accurately stratify CV risk and evaluate the kidney and CV protective effects of SGLT2 inhibitors. In this regard, we make a call to action to investigate the protective effects of these pharmacological agents using cystatin C-based eGFR.
  • Autores: Díez Martínez, Domingo Francisco Javier (Autor de correspondencia); Rosano, G. M. C.; Butler, J.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.25 N° 4 2023 págs. 450 - 453
  • Autores: Ferreira JP (Autor de correspondencia); Cleland JGF; Girerd N; et al.
    Revista: INTERNATIONAL JOURNAL OF CARDIOLOGY
    ISSN: 0167-5273 Vol.377 2023 págs. 86-88
    Resumen
    Background: Spironolactone might improve the prognosis of patients with heart failure with preserved left ventricular ejection fraction (HFpEF), but the mechanisms by which it acts are uncertain. Serum concentrations of procollagen type I carboxy-terminal propeptide (PICP) reflect the synthesis of type I collagen and correlate well with histologically proven cardiac fibrosis.Aims: To investigate the effect of spironolactone on serum PICP concentration in patients with stage B and C HFpEF across three trials (HOMAGE, ALDO-DHF, and TOPCAT) for which measurements of serum PICP were available.Methods: Random-effects meta-analysis.Results: A total of 1038 patients with PICP measurements available both at baseline and 9-12 months were included in this analysis: 488 (47.0%) from HOMAGE, 386 (37.2%) from ALDO-DHF, and 164 (15.8%) from TOPCAT. The median (percentile25-75) serum PICP was 98 (76-128) ng/mL. Compared to placebo or usual care, administration of spironolactone for 9 to 12 months reduced serum PICP by-7.4 ng/mL, 95%CI-13.9 to-0.9, P -value =0.02. The effect was moderately heterogeneous (I2 = 64%) with the most pronounced effect seen in TOPCAT where PICP was reduced by-27.0 ng/mL, followed by HOMAGE where PICP was reduced by-8.1 ng/ mL, and was least marked in ALDO-DHF where PICP changed by-2.9 ng/mL. The association between spi-ronolactone and serum PICP was not mediated substantially by blood pressure.Conclusions: Spironolactone reduced serum concentrations of PICP in patients with HFpEF with different severity and stages of disease. These findings are consistent with spironolactone having an anti-fibrotic effect.
  • Autores: Ravassa Albéniz, Susana (Autor de correspondencia); Lupón, J. ; López Salazar, Begoña; et al.
    Revista: JACC : HEART FAILURE
    ISSN: 2213-1779 Vol.11 N° 1 2023 págs. 58 - 72
    Resumen
    BACKGROUND Myocardial fibrosis may increase vulnerability to poor prognosis in patients with heart failure (HF), even in those patients exhibiting left ventricular reverse remodeling (LVRR) after guideline-based therapies.OBJECTIVES This study sought to characterize fibrosis at baseline in patients with HF with left ventricular ejection fraction (LVEF) <50% by determining serum collagen type I-derived peptides (procollagen type I C-terminal propeptide [PICP] and ratio of collagen type I C-terminal telopeptide to matrix metalloproteinase-1) and to evaluate their association with LVRR and prognosis.METHODS Peptides were determined in 1,034 patients with HF at baseline. One-year echocardiography was available in 665 patients. Associations of peptides with 1-year changes in echocardiographic variables were analyzed by multivariable linear mixed models. LVEF was considered improved if it increased by & GE;15% or to & GE;50% or if it increased by & GE;10% to >40% in patients with LVEF & LE;40%. Cardiovascular death and HF-related outcomes were analyzed in all patients ran-domized to derivation (n = 648) and validation (n = 386) cohorts.RESULTS Continuous associations with echocardiographic changes were observed only for PICP. Compared with high-PICP (& GE;108.1 ng/mL) patients, low-PICP (<108.1 ng/mL) patients exhibited enhanced LVRR and a lower risk of HF-related outcomes (P & LE; 0.018), with women and nonischemic patients with HF showing a stronger LVEF increase (interaction P & LE; 0.010). LVEF increase was associated with a better prognosis, particularly in low-PICP patients (interaction P & LE; 0.029). Only patients with both low PICP and improved LVEF exhibited a better clinical evolution than patients with nonimproved LVEF (P < 0.001).CONCLUSIONS Phenotyping with PICP, a peptide associated with myocardial fibrosis, may be useful to differentiate patients with HF who are more likely to experience clinical myocardial recovery from those with partial myocardial improvement. (J Am Coll Cardiol HF 2023;11:58-72) & COPY; 2023 by the American College of Cardiology Foundation.
  • Autores: Sagastagoitia-Fornie, M. (Autor de correspondencia); Morán-Fernández, L.; Blázquez-Bermejo, Z.; et al.
    Revista: TRANSPLANT INTERNATIONAL
    ISSN: 0934-0874 Vol.36 2023 págs. 11042
    Resumen
    In this observational and multicenter study, that included all patients who underwent a heart transplantation (HT) in Spain from 1984 to 2018, we analyzed the incidence, management, and prognosis of colorectal cancer (CRC) after HT. Of 6,244 patients with a HT and a median follow-up of 8.8 years since the procedure, 116 CRC cases (11.5% of noncutaneous solid cancers other than lymphoma registered) were diagnosed, mainly adenocarcinomas, after a mean of 9.3 years post-HT. The incidence of CRC increased with age at HT from 56.6 per 100,000 person-years among under 45 year olds to 436.4 per 100,000 person-years among over 64 year olds. The incidence rates for age-at-diagnosis groups were significantly greater than those estimated for the general Spanish population. Curative surgery, performed for 62 of 74 operable tumors, increased the probability of patient survival since a diagnosis of CRC, from 31.6% to 75.7% at 2 years, and from 15.8% to 48.6% at 5 years, compared to patients with inoperable tumors. Our results suggest that the incidence of CRC among HT patients is greater than in the general population, increasing with age at HT.
  • Autores: Refoyo Salicio, Elena (Autor de correspondencia); Troya, J.; de La Fuente Villena, Ana; et al.
    Revista: JOURNAL OF CLINICAL MEDICINE
    ISSN: 2077-0383 Vol.12 N° 9 2023 págs. 3059
    Resumen
    Background: The global myocardial work index (GWI), a novel, valid, and non-invasive method based on speckle-tracking echocardiography, could provide value for calculating left ventricular (LV) function and energy consumption in athletes. Materials and Methods: We prospectively analyzed a single-center cohort of Spanish First-Division football players who attended a pre-participation screening program from June 2020 to June 2021, compared to a control group. All the individuals underwent an electrocardiogram and echocardiography, including two-dimensional speckle tracking and 4D-echo. The study aimed to evaluate the feasibility of myocardial work in professional football players and its correlations with other echocardiographic parameters. Results: The study population comprised 97 individuals (49 professional players and 48 controls). The mean age was 30.48 +/- 7.20 years old. The professional football players had significantly higher values of LVEDV (p < 0.001), LVESV (p < 0.001), LV-mass index (p = 0.011), PWTd (p = 0.023), and EA (p < 0.001) compared with the control group. In addition, the professional players had lower GCW (p = 0.003) and a tendency to show lower GWI values (p < 0.001). These findings could suggest that professional football players have more remodeling and less MW, related to their adaptation to intensive training. Significant differences in GLS (p = 0.01) and GWE (p = 0.04) were observed as a function of the septal thickness of the athletes. Irrespective of the MW variable, the parameters with better correlations across all the populations were SBP, DBP, and GLS. Conclusions: The GWI is a novel index to assess cardiac performance, with less load dependency than strain measurements. Future GWI analyses are warranted to understand myocardial deformation and other pathological differential diagnoses.
  • Autores: Cau, R.; Muscogiuri, G.; Pisu, F.; et al.
    Revista: JOURNAL OF THORACIC IMAGING
    ISSN: 0883-5993 Vol.38 N° 6 2023 págs. 391 - 398
    Resumen
    Purpose: Takotsubo cardiomyopathy (TTC) is a transient but severe acute myocardial dysfunction with a wide range of outcomes from favorable to life-threatening. The current risk stratification scores of TTC patients do not include cardiac magnetic resonance (CMR) parameters. To date, it is still unknown whether and how clinical, trans-thoracic echocardiography (TTE), and CMR data can be integrated to improve risk stratification. Methods: EVOLUTION (Exploring the eVolution in prognOstic capabiLity of mUlti-sequence cardiac magneTIc resOnance in patieNts affected by Takotsubo cardiomyopathy) is a multicenter, international registry of TTC patients who will undergo a clinical, TTE, and CMR evaluation. Clinical data including demographics, risk factors, comorbidities, laboratory values, ECG, and results from TTE and CMR analysis will be collected, and each patient will be followed-up for in-hospital and long-term outcomes. Clinical outcome measures during hospitalization will include cardiovascular death, pulmonary edema, arrhythmias, stroke, or transient ischemic attack. Clinical long-term outcome measures will include cardiovascular death, pulmonary edema, heart failure, arrhythmias, sudden cardiac death, and major adverse cardiac and cerebrovascular events defined as a composite endpoint of death from any cause, myocardial infarction, recurrence of TTC, transient ischemic attack, and stroke. We will develop a comprehensive clinical and imaging score that predicts TTC outcomes and test the value of machine learning models, incorporating clinical and imaging parameters to predict prognosis. Conclusions: The main goal of the study is to develop a comprehensive clinical and imaging score, that includes TTE and CMR data, in a large cohort of TTC patients for risk stratification and outcome prediction as a basis for possible changes in patient management.
  • Autores: Raafs, A. G. (Autor de correspondencia); Adriaans, B. P.; Henkens, M. T. H. M.; et al.
    Revista: JOURNAL OF CLINICAL MEDICINE
    ISSN: 2077-0383 Vol.12 N° 17 2023 págs. 5695
    Resumen
    Background: Collagen cross-linking is a fundamental process in dilated cardiomyopathy (DCM) and occurs when collagen deposition exceeds degradation, leading to impaired prognosis. This study investigated the associations of collagen-metabolism biomarkers with left ventricular function and prognosis in DCM. Methods: DCM patients who underwent endomyocardial biopsy, blood sampling, and cardiac MRI were included. The primary endpoint included death, heart failure hospitalization, or life-threatening arrhythmias, with a follow-up of 6 years (5-8). Results: In total, 209 DCM patients were included (aged 54 & PLUSMN; 13 years, 65% male). No associations were observed between collagen volume fraction, circulating carboxy-terminal propeptide of procollagen type-I (PICP), or collagen type I carboxy-terminal telopeptide [CITP] and matrix metalloproteinase [MMP]-1 ratio and cardiac function parameters. However, CITP:MMP-1 was significantly correlated with global longitudinal strain (GLS) in the total study sample (R = -0.40, p < 0.0001; lower CITP:MMP-1 ratio was associated with impaired GLS), with even stronger correlations in patients with LVEF > 40% (R = -0.70, p < 0.0001). Forty-seven (22%) patients reached the primary endpoint. Higher MMP-1 levels were associated with a worse outcome, even after adjustment for clinical and imaging predictors (1.026, 95% CI 1.002-1.051, p = 0.037), but CITP and CITP:MMP-1 were not. Combining MMP-1 and PICP improved the goodness-of-fit (LHR36.67, p = 0.004). Conclusion: The degree of myocardial cross-linking (CITP:MMP-1) is associated with myocardial longitudinal contraction, and MMP-1 is an independent predictor of outcome in DCM patients.
  • Autores: Caballeros Lam, Fanny Meylin (Autor de correspondencia); Pujols, P.; Ezponda Casajús, Ana; et al.
    Revista: LIVER TRANSPLANTATION
    ISSN: 1527-6465 Vol.29 N° 10 2023 págs. 1100 - 1108
    Resumen
    To address the feasibility of implementing a lung cancer screening program in liver transplant recipients (LTR) targeted to detect early-stage lung cancer one hundred twenty-four LTR (89% male, 59.8+/-8.8 y old), who entered the lung cancer screening program at our hospital were reviewed. The results of the diagnostic algorithm using low-dose CT and F-18-fluorodeoxyglycose positron emission tomography (FDG-PET) were analyzed. Lung cancer was detected in 12 LTR (9.7%), most of which corresponded to the non-small cell subtype. Two of the 12 lung cancers were detected in the baseline study (prevalence of 1.6%), whereas 10 patients were diagnosed with lung cancer in the follow-up (incidence of 8.1%). Considering all cancers, 10 of 12 (83.3%) were diagnosed at stage I, one cancer was diagnosed at stage IIIA, and another one at stage IV. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of F-18-fluorodeoxyglycose positron emission tomography to detect malignancy in our cohort were 81.8%,100%, 99.3%, 100%, and 99.3%, respectively. A carefully followed multidisciplinary lung cancer screening algorithm in LTR that includes F-18-fluorodeoxyglycose positron emission tomography and low-dose CT allows lung cancer to be diagnosed at an early stage while reducing unnecessary invasive procedures.
  • Autores: Barge-Caballero, E. (Autor de correspondencia); González-Vílchez, F.; lmenar-Bonet, L.; et al.
    Revista: JOURNAL OF HEART AND LUNG TRANSPLANTATION
    ISSN: 1053-2498 Vol.42 N° 4 2023 págs. 488 - 502
    Resumen
    BACKGROUND: We aimed to describe recent trends in the use and outcomes of temporary mechanical circulatory support (MCS) as a bridge to heart transplantation (HTx) in Spain.METHODS: Retrospective case-by-case analysis of 1,036 patients listed for emergency HTx while on temporary MCS in 16 Spanish institutions from January 1st, 2010 to December 31st, 2020. Patients were classified in 3 eras according to changes in donor allocation criteria (Era 1: January 2010/May 2014; Era 2: June 2014/May 2017; Era 3: June 2017/December 2020).RESULTS: Over time, the proportion of candidates listed with intra-aortic balloon pumps decreased (Era 1= 55.9%, Era 2 = 32%, Era 3 = 0.9%; p < 0.001), while the proportion of candidates listed with surgi-cal continuous-flow temporary VADs (Era 1= 10.6%, Era 2 = 32%, Era 3 = 49.1%; p < 0.001) and per -cutaneous VADs (Era 1 = 0.3%, Era 2 = 6.3%; Era 3 = 17.2%; p < 0.001) increased. Rates of HTx increased from Era 1 (79.4%) to Era 2 (87.8%), and Era 3 (87%) (p = 0.004), while rates of death before HTx decreased (Era 1 = 17.7%; Era 2 = 11%, Era 3 = 12.4%; p = 0.037) Median time from list-ing to HTx increased in patients supported with intra-aortic balloon pumps (Era 1 = 8 days, Era 2 = 15 days; p < 0.001) but remained stable in other candidates (Era 1 = 6 days; Era 2 = 5 days; Era 3 = 6 days; p = 0.134). One-year post-transplant survival was 71.4% in Era 1, 79.3% in Era 2, and 76.5% in Era 3 (p = 0.112). Preoperative bridging with ECMO was associated with increased 1-year post -trans-plant mortality (adjusted HR=1.71; 95% CI 1.15-2.53; p = 0.008).CONCLUSIONS: During the period 2010 to 2020, successive changes in the Spanish organ allocation protocol were followed by a significant increase of the rate of HTx and a significant reduction of wait-ing list mortality in candidates supported with temporary MCS. One-year post-transplant survival rates remained acceptable. J Heart Lung Transplant 2023;42:488-502 (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.
  • Autores: Cau, R.; Pisu, F.; Suri, J. S.; et al.
    Revista: EUROPEAN JOURNAL OF RADIOLOGY
    ISSN: 0720-048X Vol.166 2023 págs. 110980
    Resumen
    Objective: The aims of our study were to investigate the sex differences in late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) in a single-centre cohort of consecutive patients with acute myocarditis (AM). Method: This retrospective study performed CMR scans in 135 consecutive patients with AM that met the Lake Louise criteria. On CMR, LV ventricular strain functions were performed on conventional cine SSFP sequences. Besides myocardial strain measurements, myocardial scar location, extension, and size were assigned and quantified by LGE imaging. Results: There was no difference in age (age 42.51 & PLUSMN; 19.64 years vs 40.92 & PLUSMN; 19.94 years; p = 0.74) and cardiovascular risk profile between women and men. Despite similar comorbidities, women were more like to present with dyspnea (p = 0.001). Women demonstrated higher prevalence of septal LGE (p = 0.004) and increased global circumferential strain parameters (p = 0.008) in comparison with men. In multivariate analysis, female sex remained an independent determinant of septal LGE (& beta; coefficient = -0.520, p = 0.001). Conclusion: This is the first study reporting sex differences in LGE localization in AM. Women have more septal LGE involvement independent of age, cardiovascular risk factors, and CMR parameters. These findings further emphasize the sex-based differences in cardiovascular diseases.
  • Autores: Amat-Santos, I. J. (Autor de correspondencia); Delgado-Arana, J. R.; Cruz-Gonzalez, I.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN: 1885-5857 Vol.76 N° 7 2023 págs. 503 - 510
    Resumen
    Introduction and objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA. Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA. Results: We studied a total of 1159 patients. Forty patients (3.5%) were diagnosed with ATTR-CA; these patients were older and had more comorbidities, higher HAS-BLED and CHA2DS2-VASc scores, and lower left ventricular function. Successful LAAC was achieved in 1137 patients (98.1%) with no differences between groups. Regarding in-hospital and follow-up complications, there were no differences between the groups in ischemic stroke (5% vs 2.5% in those without a known diagnosis of CA; P=.283), hemorrhagic stroke (2.5% and 0.8% in the control group; P=.284), major or minor bleeding. At the 2-year follow-up, there were no significant differences in mortality (ATTR-CA: 20% vs those without known CA: 13.6%, 0.248); however, the at 5-year follow-up, ATTR-CA patients had higher mortality (40% vs 19.2%; P <.001) but this difference was unrelated to hemorrhagic complications or ischemic stroke. Conclusions: LAAC could reduce the risk of bleeding complications and ischemic cerebrovascular events without increasing the rate of early or mid-term complications. Although long-term survival was impaired in ATTR-CA patients, it was comparable to that of patients without a known diagnosis of CA at the 2-year follow-up, suggesting that LAAC for patients with ATTR-CA might not be futile.
  • Autores: Girerd, N. (Autor de correspondencia); Levy, D.; Duarte, K.; et al.
    Revista: CIRCULATION-HEART FAILURE
    ISSN: 1941-3289 Vol.16 N° 5 2023 págs. e009694
    Resumen
    Background: We sought to identify protein biomarkers of new-onset heart failure (HF) in 3 independent cohorts (HOMAGE cohort [Heart Omics and Ageing], ARIC study [Atherosclerosis Risk in Communities], and FHS [Framingham Heart Study]) and assess if and to what extent they improve HF risk prediction compared to clinical risk factors alone. Methods: A nested case-control design was used with cases (incident HF) and controls (without HF) matched on age and sex within each cohort. Plasma concentrations of 276 proteins were measured at baseline in ARIC (250 cases/250 controls), FHS (191/191), and HOMAGE cohort (562/871). Results: In single protein analysis, after adjusting for matching variables and clinical risk factors (and correcting for multiple testing), 62 proteins were associated with incident HF in ARIC, 16 in FHS, and 116 in HOMAGE cohort. Proteins associated with incident HF in all cohorts were BNP (brain natriuretic peptide), NT-proBNP (N-terminal pro-B-type natriuretic peptide), eukaryotic translation initiation factor 4E-BP1 (4E-binding protein 1), hepatocyte growth factor (HGF), Gal-9 (galectin-9), TGF-alpha (transforming growth factor alpha), THBS2 (thrombospondin-2), and U-PAR (urokinase plasminogen activator surface receptor). The increment in C-index for incident HF based on a multiprotein biomarker approach, in addition to clinical risk factors and NT-proBNP, was 11.1% (7.5%-14.7%) in ARIC, 5.9% (2.6%-9.2%) in FHS, and 7.5% (5.4%-9.5%) in HOMAGE cohort, all P<0.001), each of which was a larger increase than that for NT-proBNP on top of clinical risk factors. Complex network analysis revealed a number of overrepresented pathways related to inflammation (eg, tumor necrosis factor and interleukin) and remodeling (eg, extracellular matrix and apoptosis). Conclusions: A multiprotein biomarker approach improves prediction of incident HF when added to natriuretic peptides and clinical risk factors.
  • Autores: Sogbe Diaz, Miguel Eduardo (Autor de correspondencia); Blanco Di Matteo, Andrés Enrique; Di Frisco Ramírez, Isberling Madeleine; et al.
    Revista: REUMATOLOGIA CLINICA
    ISSN: 1699-258x Vol.19 N° 2 2023 págs. 114 - 116
    Resumen
    Introduction: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine.Objective: Describe another possible mechanism of myocarditis after COVID-19 vaccination.Case presentation: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilu-tion, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex.Results and discussion: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affec-tion. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine.Conclusion: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.(c) 2022 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologi acute accent a y Colegio Mexicano de Reumatologi acute accent a. All rights reserved.
  • Autores: Buelga Suarez, M.; Pascual Izco, Marina; Pastor Pueyo, P.; et al.
    Revista: CARDIOLOGY
    ISSN: 0008-6312 Vol.148 N° 1 2023 págs. 78 - 82
    Resumen
    BACKGROUNDSmartwatches have become a widely used tool for health self-care. Its role in ischemic heart disease (IHD) has not been assessed. OBJETCIVESTo evaluate the usefulness of smartwatch ECG registry in IHD.METHODSWe present an observational study of 25 consecutive patients with acute IHD. Conventional ECG and smartwatch tracing were obtained simultaneously at admission. Waves of conventional and smartwatch ECGs were objectively compared. A survey on medical attitude was conducted among 12 physicians (3 cardiologists, 3 intensivists, 3 emergency physicians, and 3 general practitioners) and a score (1 to 5) of concordance between the records was requested.RESULTSThere were no differences in Q wave, R wave, ST segment, or T wave. There was a very strong correlation between ST segments, a strong correlation in Q waves and R waves, and a moderate correlation in T wave measurements.All specialists obtained a high level of agreement (4.45 +/- 0.45). Smartwatch tracings would lead to similar management compared to conventional ECG. There were only 6 (2%) discrepant cases due to differences in inferior repolarization, showing an almost perfect agreement (kappa=0.96).CONCLUSIONSIn most patients with acute IHD, smartwatch ECG tracing is a reliable tool to make the diagnosis and guide appropriate medical care. However, due to their intrinsic limitations, inferior myocardial infarctions may be missed and require a conventional 12-lead ECG to rule them out.
  • Autores: Oyarzun-Domeño, A. (Autor de correspondencia); Cia, I.; Echeverria-Chasco, R.; et al.
    Revista: MAGNETIC RESONANCE IMAGING
    ISSN: 0730-725X Vol.104 2023 págs. 39 - 51
    Resumen
    Accurate segmentation of renal tissues is an essential step for renal perfusion estimation and postoperative assessment of the allograft. Images are usually manually labeled, which is tedious and prone to human error. We present an image analysis method for the automatic estimation of renal perfusion based on perfusion magnetic resonance imaging. Specifically, non-contrasted pseudo-continuous arterial spin labeling (PCASL) images are used for kidney transplant evaluation and perfusion estimation, as a biomarker of the status of the allograft. The proposed method uses machine/deep learning tools for the segmentation and classification of renal cortical and medullary tissues and automates the estimation of perfusion values. Data from 16 transplant patients has been used for the experiments. The automatic analysis of differentiated tissues within the kidney, such as cortex and medulla, is performed by employing the time-intensity-curves of non-contrasted T1-weighted MRI series. Specifically, using the Dice similarity coefficient as a figure of merit, results above 93%, 92% and 82% are obtained for whole kidney, cortex, and medulla, respectively. Besides, estimated cortical and medullary perfusion values are considered to be within the acceptable ranges within clinical practice.
  • Autores: Lee, V.; Zheng, Q.; Toh, D. F.; et al.
    Revista: FRONTIERS IN CARDIOVASCULAR MEDICINE
    ISSN: 2297-055X Vol.10 2023 págs. 1248468
    Resumen
    BackgroundDiffuse interstitial myocardial fibrosis is a key common pathological manifestation in hypertensive heart disease (HHD) progressing to heart failure (HF). Angiotensin receptor-neprilysin inhibitors (ARNi), now a front-line treatment for HF, confer benefits independent of blood pressure, signifying a multifactorial mode of action beyond hemodynamic regulation. We aim to test the hypothesis that compared with angiotensin II receptor blockade (ARB) alone, ARNi is more effective in regressing diffuse interstitial myocardial fibrosis in HHD.MethodsRole of ARNi in Ventricular Remodeling in Hypertensive LVH (REVERSE-LVH) is a prospective, randomized, open-label, blinded endpoint (PROBE) clinical trial. Adults with hypertension and left ventricular hypertrophy (LVH) according to Asian sex- and age-specific thresholds on cardiovascular magnetic resonance (CMR) imaging are randomized to treatment with either sacubitril/valsartan (an ARNi) or valsartan (an ARB) in 1:1 ratio for a duration of 52 weeks, at the end of which a repeat CMR is performed to assess differential changes from baseline between the two groups. The primary endpoint is the change in CMR-derived diffuse interstitial fibrosis volume. Secondary endpoints include changes in CMR-derived left ventricular mass, volumes, and functional parameters. Serum samples are collected and stored to assess the effects of ARNi, compared with ARB, on circulating biomarkers of cardiac remodeling. The endpoints will be analyzed with reference to the corresponding baseline parameters to evaluate the therapeutic effect of sacubitril/valsartan vs. valsartan.DiscussionREVERSE-LVH will examine the anti-fibrotic potential of sacubitril/valsartan and will offer mechanistic insights into the clinical benefits of sacubitril/valsartan in hypertension in relation to cardiac remodeling. Advancing the knowledge of the pathophysiology of HHD will consolidate effective risk stratification and personalized treatment through a multimodal manner integrating complementary CMR and biomarkers into the conventional care approach.Clinical Trial Registration: ClinicalTrials.gov, identifier, NCT03553810.DiscussionREVERSE-LVH will examine the anti-fibrotic potential of sacubitril/valsartan and will offer mechanistic insights into the clinical benefits of sacubitril/valsartan in hypertension in relation to cardiac remodeling. Advancing the knowledge of the pathophysiology of HHD will consolidate effective risk stratification and personalized treatment through a multimodal manner integrating complementary CMR and biomarkers into the conventional care approach.Clinical Trial Registration: ClinicalTrials.gov, identifier, NCT03553810.
  • Autores: Barreiro-Pérez, M.; Cabeza, B.; Calvo, D.; et al.
    Revista: RADIOLOGIA
    ISSN: 0033-8338 Vol.65 N° 3 2023 págs. 269 - 284
    Resumen
    Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool. (c) 2022 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
  • Autores: van Dinther, M. (Autor de correspondencia); Bennett, J.; Thornton, G. D.; et al.
    Revista: CEREBROVASCULAR DISEASES. EXTRA
    ISSN: 1664-5456 Vol.13 2023 págs. 18 - 32
    Resumen
    Introduction: Microvascular rarefaction, the functional reduction in perfused microvessels and structural reduction of microvascular density, seems to be an important mechanism in the pathophysiology of small blood vessel related disorders including vascular cognitive impairment (VCI) due to cerebral small vessel disease and heart failure with preserved ejection fraction (HFpEF). Both diseases share common risk factors including hypertension, diabetes mellitus, obesity, and ageing; in turn, these co-morbidities are associated with microvascular rarefaction. Our consortium aims to investigate novel non-invasive tools to quantify microvascular health and rarefaction in both organs, as well as surrogate biomarkers for cerebral and/or cardiac rarefaction (via sublingual capillary health, vascular density of the retina, and RNA content of circulating extracellular vesicles), and to determine whether microvascular density relates to disease severity.Methods/design: The clinical research program of CRUCIAL consists of four observational cohort studies. We aim to recruit 75 VCI patients, 60 HFpEF patients, 60 patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement as a pressure overload HFpEF model, and 200 elderly participants with mixed comorbidities to serve as controls. Data collected will include medical history, physical examination, cognitive testing, advanced brain and cardiac MRI, ECG, echocardiography, sublingual capillary health, optical coherence tomography angiography (OCTa), extracellular vesicles RNA analysis and myocardial remodelling-related serum biomarkers. The AS cohort undergoing surgery will also have myocardial biopsy for histological microvascular assessment. Discussion: CRUCIAL will examine the pathophysiological role of microvascular rarefaction in VCI and HFpEF using advanced brain and cardiac MRI techniques. Furthermore, we will investigate surrogate biomarkers for non-invasive, faster, easier, and cheaper assessment of microvascular density since these are more likely to be disseminated into widespread clinical practice. If microvascular rarefaction is an early marker of developing small vessel diseases, then measuring rarefaction may allow pre-clinical diagnosis, with implications for screening, risk stratification, and prevention. Further knowledge of the relevance of microvascular rarefaction and its underlying mechanisms may provide new avenues for research and therapeutic targets.
  • Autores: Aghagolzadeh, P. (Autor de correspondencia); Plaisance, I.; Bernasconi, R.; et al.
    Revista: CIRCULATION
    ISSN: 0009-7322 Vol.148 N° 9 2023 págs. 778 - 797
    Resumen
    BACKGROUND: Cardiac fibroblasts have crucial roles in the heart. In particular, fibroblasts differentiate into myofibroblasts in the damaged myocardium, contributing to scar formation and interstitial fibrosis. Fibrosis is associated with heart dysfunction and failure. Myofibroblasts therefore represent attractive therapeutic targets. However, the lack of myofibroblast-specific markers has precluded the development of targeted therapies. In this context, most of the noncoding genome is transcribed into long noncoding RNAs (lncRNAs). A number of lncRNAs have pivotal functions in the cardiovascular system. lncRNAs are globally more cell-specific than protein-coding genes, supporting their importance as key determinants of cell identity.METHODS: In this study, we evaluated the value of the lncRNA transcriptome in very deep single-cell RNA sequencing. We profiled the lncRNA transcriptome in cardiac nonmyocyte cells after infarction and probed heterogeneity in the fibroblast and myofibroblast populations. In addition, we searched for subpopulation-specific markers that can constitute novel targets in therapy for heart disease.RESULTS: We demonstrated that cardiac cell identity can be defined by the sole expression of lncRNAs in single-cell experiments. In this analysis, we identified lncRNAs enriched in relevant myofibroblast subpopulations. Selecting 1 candidate we named FIXER (fibrogenic LOX-locus enhancer RNA), we showed that its silencing limits fibrosis and improves heart function after infarction. Mechanitically, FIXER interacts with CBX4, an E3 SUMO protein ligase and transcription factor, guiding CBX4 to the promoter of the transcription factor RUNX1 to control its expression and, consequently, the expression of a fibrogenic gene program.. FIXER is conserved in humans, supporting its translational value.CONCLUSIONS: Our results demonstrated that lncRNA expression is sufficient to identify the various cell types composing the mammalian heart. Focusing on cardiac fibroblasts and their derivatives, we identified lncRNAs uniquely expressed in myofibroblasts. In particular, the lncRNA FIXER represents a novel therapeutic target for cardiac fibrosis.
  • Autores: Barreiro-Pérez, M. (Autor de correspondencia); Cabeza, B.; Calvo, D.; et al.
    Revista: RADIOLOGÍA (ENGLISH ED.)
    ISSN: 2173-5107 Vol.76 N° 3 2023 págs. 183 - 196
    Resumen
    Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
  • Autores: Kobayashi, M.; Huttin, O.; Ferreira, J. P.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.25 N° 8 2023 págs. 1284 - 1289
    Resumen
    AimAn echocardiographic algorithm derived by machine learning (e ' VM) characterizes pre-clinical individuals with different cardiac structure and function, biomarkers, and long-term risk of heart failure (HF). Our aim was the external validation of the e ' VM algorithm and to explore whether it may identify subgroups who benefit from spironolactone. Methods and resultsThe HOMAGE (Heart OMics in AGEing) trial enrolled participants at high risk of developing HF randomly assigned to spironolactone or placebo over 9 months. The e ' VM algorithm was applied to 416 participants (mean age 74 +/- 7 years, 25% women) with available echocardiographic variables (i.e. e ' mean, left ventricular end-diastolic volume and mass indexed by body surface area [LVMi]). The effects of spironolactone on changes in echocardiographic and biomarker variables were assessed across e ' VM phenotypes. A majority (>80%) had either a 'diastolic changes' (D), or 'diastolic changes with structural remodelling' (D/S) phenotype. The D/S phenotype had the highest LVMi, left atrial volume, E/e', natriuretic peptide and troponin levels (all p < 0.05). Spironolactone significantly reduced E/e' and B-type natriuretic peptide (BNP) levels in the D/S phenotype (p < 0.01), but not in other phenotypes (p > 0.10; p(interaction) <0.05 for both). These interactions were not observed when considering guideline-recommended echocardiographic structural and functional abnormalities. The magnitude of effects of spironolactone on LVMi, left atrial volume and a type I collagen marker was numerically higher in the D/S phenotype than the D phenotype but the interaction test did not reach significance. ConclusionsIn the HOMAGE trial, the e ' VM algorithm identified echocardiographic phenotypes with distinct responses to spironolactone as assessed by changes in E/e' and BNP.
  • Autores: Buelga Suarez, M.; Rebolleda Sanchez, A.; Pascual Izco, Marina; et al.
    Revista: JOURNAL OF ELECTROCARDIOLOGY
    ISSN: 0022-0736 Vol.81 2023 págs. 51 - 59
    Resumen
    Background: The clinical utility of the Apple Inc.& REG; smartwatch in scenarios beyond detecting atrial fibrillation has been debated. Although the device has the capability to record electrocardiograms (ECG) and detect arrhythmias, voltage limitations hinder its accuracy in measuring real voltage when recording precordial leads. This limitation poses challenges for its clinical use in diagnosing ischemia and screening cardiomyopathies. This review aims to analyze the ECG recording capacity of the Apple Watch, investigate the reasons for voltage limitations, and explore alternative approaches for its use in these clinical scenarios. Methods: A comprehensive literature review was conducted to examine the ECG recording capacity of the Apple Watch and the limitations encountered when recording precordial leads. Data in CSV format files were analyzed to gain insights into the underlying causes of voltage limitations. Results: The Apple Watch demonstrates effectiveness in detecting cardiac arrhythmias such as atrial fibrillation using photoplethysmography and ECG recording. However, voltage limitations during precordial lead recordings impede accurate voltage measurement, thereby limiting its clinical utility. Analysis of the data stored in the CSV files revealed that these voltage limitations are primarily attributed to the presentation format. Exploring alternative approaches for data processing could potentially overcome this challenge. Conclusions: This review highlights the potential for addressing voltage limitations through alternative data processing approaches. Further research is necessary to identify suitable alternatives that enable the Apple Watch to be effectively utilized in these clinical scenarios.
  • Autores: Muñiz Sáenz-Diez, Javier (Autor de correspondencia); Ezponda Casajús, Ana; Caballeros Lam, Fanny Meylin; et al.
    Revista: INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
    ISSN: 1569-5794 Vol.39 N° 9 2023 págs. 1765 - 1774
    Resumen
    Owing to its pharmacodynamics and posology, the use of regadenoson for stress cardiac magnetic resonance (CMR) has potential advantages over other vasodilators. We sought to evaluate the safety, hemodynamic response and diagnostic performance of regadenoson stress-CMR in routine clinical practice. All regadenoson stress-CMR examinations performed between May 2017 and July 2020 at our institution were retrospectively reviewed. A total of 698 studies were included for the final analysis. A conventional stress/rest protocol was performed using a 1.5T MRI scanner (Magnetom Aera, Siemens Healthineers, Erlangen, Germany). Adverse events, clinical symptoms, and hemodynamic response were assessed. Diagnostic accuracy of the test was evaluated in patients who underwent invasive coronary angiography. Nearly half of patients (48.5%) remained asymptomatic. Most common clinical symptoms included dyspnea (137, 19.6%), chest pain (116, 16.6%) and flushing (44, 6.3%). Two patients (0.28%) could not complete the examination due to severe hypotension or unbearable chest pain. Overall, an increase in heart rate (HR) response (36.2% [IQR: 22.5?50.9]) and a decrease in systolic and diastolic blood pressure (BP) (median systolic BP response of -5% [IQR: -11.5-0.6]; median diastolic BP response of -6.3 mmHg [IQR: -13.4-0]) was observed. Patients with symptoms induced by regadenoson showed higher HR response (40.3%, IQR: 26.4?56.1 vs. 32.4%, IQR: 19-45.6, p < 0.001), whereas a blunted HR response was observed in diabetic (29.6%, IQR: 18.4?42 p < 0.001), obese (31.7%, IQR: 20.7?46.2 p = 0.005) and patients aged 70 years or older (32.9%, IQR: 22.6?43.1 p < 0.001). Overall, regadenoson stress-CMR showed 95.65% (IQ 91.49?99.81) sensitivity, 54.84% (IQ 35.71?73.97) specificity, 86.99% (IQ 82.74?94.68) positive predictive value, and 77.27% (IQ 57.49?97.06) negative predictive value for detecting significant coronary stenosis as compared with invasive coronary angiography. Regadenoson is a well-tolerated vasodilator that can be safely employed for stress perfusion CMR, with high diagnostic performance.
  • Autores: Solimene, F. (Autor de correspondencia); Speziale, G.; Schillaci, V.; et al.
    Revista: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
    ISSN: 1383-875X 2023
    Resumen
    Background: Criteria such as electrograms voltage or late potentials have been largely utilized in the past to help identify areas of substrate maps that are within the ventricular tachycardia (VT) isthmus; yet their specificity and positive predictive value are quite low. The Lumipoint fractionation tool of the Rhythmia system illuminates regions with fractionated electrograms irrespective of their timing and annotation. We aimed to ascertain whether the use of this tool can rapidly identify areas within VT isthmuses from substrate maps. Methods: Thirty patients with structural cardiomyopathy in whom a complete right ventricular-paced substrate map and a full reconstruction of the diastolic isthmus during VT could be obtained were enrolled. The VT isthmus border was projected on each substrate map to verify whether the areas illuminated by Lumipoint fell within those borders. The behavior of the electrograms detected at the illuminated areas of the substrate maps was studied during a right ventricular drive train and extra stimulus protocol: if the near field potentials showed a delayed conduction after a single extra stimulus, defined as a minimum of 10 ms increase of the time interval between the far field and the near field activation measured during the drive train, the electrogram was said to have a "decremental" behavior. Results: The logistic analysis showed that areas with fractionated electrograms illuminated by the Lumipoint software and showing the greatest decremental behavior fell within the VT isthmus borders (OR = 1.66, CI: 1.41-1.75, p<0.001; OR=1.57 CI: 1.32-1.72, p<0.001, respectively) with a sensitivity, specificity, and positive predictive value of 87%, 96%, and 97%, respectively. Conclusions: Fractionated electrograms illuminated by the automated Lumipoint software on right ventricular-paced substrate maps showing the greatest decremental behavior fall within the VT isthmus borders with a probability of 0.97, irrespective of their timing, annotation, or voltage, without any need for subjective assessment of their involvement in slow conduction areas.
  • Autores: Irazusta Olloquiegui, Xabier; Mora Gutiérrez, Jose María; Castañeda Infante, Laura Juliana; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN: 0931-0509 Vol.38 N° Supl. 1 2023 págs. I998 - I999
  • Autores: Salterain González, Nahikari; Manrique Antón, Rebeca; Gavira Gómez, Juan José; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.25 N° Supl. 2 2023 págs. 225 - 226
  • Autores: Aiello, A.; Ligotti, M. E.; Garnica, M.; et al.
    Revista: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
    ISSN: 1422-0067 Vol.23 N° 17 2022 págs. 9880
    Resumen
    Vaccination, being able to prevent millions of cases of infectious diseases around the world every year, is the most effective medical intervention ever introduced. However, immunosenescence makes vaccines less effective in providing protection to older people. Although most studies explain that this is mainly due to the immunosenescence of T and B cells, the immunosenescence of innate immunity can also be a significant contributing factor. Alterations in function, number, subset, and distribution of blood neutrophils, monocytes, and natural killer and dendritic cells are detected in aging, thus potentially reducing the efficacy of vaccines in older individuals. In this paper, we focus on the immunosenescence of the innate blood immune cells. We discuss possible strategies to counteract the immunosenescence of innate immunity in order to improve the response to vaccination. In particular, we focus on advances in understanding the role and the development of new adjuvants, such as TLR agonists, considered a promising strategy to increase vaccination efficiency in older individuals.
  • Autores: Garnica, M.; Aiello, A.; Ligotti, M. E.; et al.
    Revista: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
    ISSN: 1422-0067 Vol.23 N° 17 2022 págs. 9797
    Resumen
    The number of people that are 65 years old or older has been increasing due to the improvement in medicine and public health. However, this trend is not accompanied by an increase in quality of life, and this population is vulnerable to most illnesses, especially to infectious diseases. Vaccination is the best strategy to prevent this fact, but older people present a less efficient response, as their immune system is weaker due mainly to a phenomenon known as immunosenescence. The adaptive immune system is constituted by two types of lymphocytes, T and B cells, and the function and fitness of these cell populations are affected during ageing. Here, we review the impact of ageing on T and B cells and discuss the approaches that have been described or proposed to modulate and reverse the decline of the ageing adaptive immune system.
  • Autores: Bayes-Genis, A. (Autor de correspondencia); Aimo, A.; Jhund, P.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° 10 2022 págs. 1767 - 1777
    Resumen
    The approval of new heart failure (HF) therapies has slowed over the past two decades in part due to the high costs of conducting large randomized clinical trials that are needed to adequately power major clinical endpoint studies. Several biomarkers have been identified reflecting different elements of HF pathophysiology, with possible applications in diagnosis, risk stratification, treatment monitoring, and even in the design of clinical trials. Biomarkers could potentially be used to refine study inclusion criteria to enable enrolment of patients who are more likely to respond to a therapeutic intervention, despite being at sufficient risk to meet pre-determined study endpoint rates. When there is a close relationship between biomarker levels and clinical endpoints, changes in biomarker levels after a given treatment can act as a surrogate endpoint, potentially reducing the duration and cost of a clinical trial. Natriuretic peptides have been widely used in clinical trials with a variable amount of added value, which such variation being probably due to the absence of a close pathophysiological connection to the study drug. Notable exceptions to this include sacubitril/valsartan and vericiguat. Future studies should seek to adopt unbiased approaches for discovery of true companion diagnostics; with -omics-based tools, biomarkers might be more precisely selected for use in clinical trials to identify responses that closely reflect the biological effects of the drug under investigation. Finally, biomarkers associated with cardiac damage and remodelling, such as cardiac troponin, could be employed as safety endpoints provided that standardization between different assays is achieved.
  • 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: Rosano, G. M. C. (Autor de correspondencia); Seferovic, P.; Savarese, G.; et al.
    Revista: ESC HEAR FAILURE
    ISSN: 2055-5822 Vol.9 N° 5 2022 págs. 2767 - 2778
    Resumen
    Heart failure (HF) is a long-term clinical syndrome, with increasing prevalence and considerable healthcare costs that are further expected to increase dramatically. Despite significant advances in therapy and prevention, mortality and morbidity remain high and quality of life poor. Epidemiological data, that is, prevalence, incidence, mortality, and morbidity, show geographical variations across the European countries, depending on differences in aetiology, clinical characteristics, and treatment. However, data on the prevalence of the disease are scarce, as are those on quality of life. For these reasons, the ESC-HFA has developed a position paper to comprehensively assess our understanding of the burden of HF in Europe, in order to guide future policies for this syndrome. This manuscript will discuss the available epidemiological data on HF prevalence, outcomes, and human costs-in terms of quality of life-in European countries.
  • Autores: González Miqueo, Aránzazu (Autor de correspondencia); Richards, A. M.; de Boer, R. A.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° 6 2022 págs. 927 - 943
    Resumen
    Cardiac remodelling refers to changes in left ventricular structure and function over time, with a progressive deterioration that may lead to heart failure (HF) development (adverse remodelling) or vice versa a recovery (reverse remodelling) in response to HF treatment. Adverse remodelling predicts a worse outcome, whilst reverse remodelling predicts a better prognosis. The geometry, systolic and diastolic function and electric activity of the left ventricle are affected, as well as the left atrium and on the long term even right heart chambers. At a cellular and molecular level, remodelling involves all components of cardiac tissue: cardiomyocytes, fibroblasts, endothelial cells and leucocytes. The molecular, cellular and histological signatures of remodelling may differ according to the cause and severity of cardiac damage, and clearly to the global trend toward worsening or recovery. These processes cannot be routinely evaluated through endomyocardial biopsies, but may be reflected by circulating levels of several biomarkers. Different classes of biomarkers (e.g. proteins, non-coding RNAs, metabolites and/or epigenetic modifications) and several biomarkers of each class might inform on some aspects on HF development, progression and long-term outcomes, but most have failed to enter clinical practice. This may be due to the biological complexity of remodelling, so that no single biomarker could provide great insight on remodelling when assessed alone. Another possible reason is a still incomplete understanding of the role of biomarkers in the pathophysiology of cardiac remodelling. Such role will be investigated in the first part of this review paper on biomarkers of cardiac remodelling.
  • Autores: Aimo, A.; Vergaro, G.; González Miqueo, Aránzazu; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° 6 2022 págs. 944 - 958
    Resumen
    In patients with heart failure, the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with heart failure with reduced ejection fraction because most studies on cardiac remodelling focused on this setting.
  • 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: Bayés-Genís, A.; Díez Martínez, Domingo Francisco Javier (Autor de correspondencia)
    Revista: EUROPEAN HEART JOURNAL
    ISSN: 0195-668X Vol.43 N° 35 2022 págs. 3332 - 3334
  • Autores: Andrés, V.; Díez Martínez, Domingo Francisco Javier (Autor de correspondencia)
    Revista: HYPERTENSION
    ISSN: 0194-911X Vol.79 N° 10 2022 págs. 2185 - 2187
  • Autores: Barrio Piqueras, Miguel; Ezponda Casajús, Ana; Felgueroso Rodero, Carmen; et al.
    Revista: ARCHIVOS DE BRONCONEUMOLOGIA
    ISSN: 0300-2896 Vol.58 2022 págs. 53 - 54
  • 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: Sansilvestri-Morel, P. (Autor de correspondencia); Duvivier, V.; Bertin, F.; et al.
    Revista: PLOS ONE
    ISSN: 1932-6203 Vol.17 N° 2 2022 págs. e0263828
    Resumen
    Background and aims Nonalcoholic Steatohepatitis (NASH) is a major cause of end-stage liver diseases such as cirrhosis and hepatocellular carcinoma resulting ultimately in increased liver-related mortality. Fibrosis is the main driver of mortality in NASH. Procollagen C-Proteinase Enhancer-1 (PCPE-1) plays a key role in procollagen maturation and collagen fibril formation. To assess its role in liver fibrosis and NASH progression, knock-out mice were evaluated in a dietary NASH model. Methods Global constitutive Pcolce(-/-) and WT male mice were fed with a Choline Deficient Amino acid defined High Fat Diet (CDA HFD) for 8 weeks. Liver triglycerides, steatosis, inflammation and fibrosis were assessed at histological, biochemical and gene expression levels. In addition, human liver samples from control and NASH patients were used to evaluate the expression of PCPE-1 at both mRNA and protein levels. Results Pcolce gene deficiency prevented diet-induced liver enlargement but not liver dysfunction. Furthermore, liver triglycerides, steatosis and inflammation were not modified in Pcolce(-/-) male mice compared to WT under CDA HFD. However, a significant decrease in liver fibrosis was observed in Pcolce(-/-) mice compared to WT under NASH diet, associated with a decrease in total and insoluble collagen content without any significant modifications in the expression of genes involved in fibrosis and extracellular matrix remodeling. Finally, PCPE-1 protein expression was increased in cirrhotic liver samples from both NASH and Hepatitis C patients. Conclusions Pcolce deficiency limits fibrosis but not NASH progression in CDA HFD fed mice.
  • Autores: Monzo, L.; Ferreira, J.P.; Cleland, J. G. F.; et al.
    Revista: ESC HEAR FAILURE
    ISSN: 2055-5822 Vol.9 N° 6 2022 págs. 4352 - 4357
    Resumen
    Aims In people at risk of heart failure (HF) enrolled in the Heart 'OMics' in AGEing (HOMAGE) trial, spironolactone reduced circulating markers of collagen synthesis, natriuretic peptides, and blood pressure and improved cardiac structure and function. In the present report, we explored factors associated with dyskalaemia. Methods and results The HOMAGE trial was an open-label study comparing spironolactone (up to 50 mg/day) versus standard care in people at risk for HF. After randomization, serum potassium was assessed at 1 and 9 months and was defined as low when <= 3.5 mmol/L (hypokalaemia) and high when >= 5.5 mmol/L (hyperkalaemia). Multivariable logistic regression models were constructed to identify clinical predictors of dyskalaemia. A total of 513 participants (median age 74 years, 75% men, median estimated glomerular filtration rate 71 mL/min/1.73 m(2)) had serum potassium available and were included in this analysis. At randomization, 88 had potassium < 4.0 mmol/L, 367 had potassium 4.0-5.0 mmol/L, and 58 had potassium > 5.0 mmol/L. During follow-up, on at least one occasion, a serum potassium < 3.5 mmol/L was observed in 6 (1.2%) and <4.0 mmol/L in 46 (9%) participants, while a potassium > 5.0 mmol/L was observed in 38 (8%) and >5.5 mmol/L in 5 (1.0%) participants. The median (percentile(25-75)) increase in serum potassium with spironolactone during the study was 0.23 (0.16; 0.29) mmol/L. Because of the low incidence of dyskalaemia, for regression analysis, hypokalaemia and hyperkalaemia thresholds were set at 5.0 mmol/L, respectively. The occurrence of a serum potassium > 5.0 mmol/L during follow-up was positively associated with the presence of diabetes mellitus {odds ratio [OR]: 1.21 [95% confidence interval (CI) 2.14; 3.79]} and randomization to spironolactone (OR: 2.83 [95% CI 1.49; 5.37]). Conversely, the occurrence of a potassium concentration < 4.0 mmol/L was positively associated with the use of thiazides (OR: 2.39 [95% CI 1.32; 4.34]), blood urea concentration (OR: 2.15 [95% CI 1.34; 3.39] per 10 mg/dL), and history of hypertension (OR: 2.32 [95% CI 1.02; 5.29]) and negatively associated with randomization to spironolactone (OR: 0.30 [95% CI 0.18; 0.52]). Conclusions In people at risk for developing HF and with relatively normal renal function, spironolactone reduced the risk of hypokalaemia and, at the doses used, was not associated with the occurrence of clinically meaningful hyperkalaemia.
  • 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: de la Espriella, R.; Navarro, J.; Mollar, A.; et al.
    Revista: CARDIORENAL MEDICINE
    ISSN: 1664-3828 Vol.12 N° 4 2022 págs. 179 - 187
    Resumen
    Introduction: Although small-sample size studies have shown that basal alterations of estimated glomerular filtration rate (eGFR) are related to short- and mid-term higher mortality in acute heart failure (AHF), there is scarce information on the influence of an altered eGFR on long-term mortality and readmissions. Therefore, this multicenter study sought to investigate the relationship between eGFR on admission for AHF and both long-term mortality and readmissions in a large sample of patients. Methods: We retrospectively evaluated 4,595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 1, 2008, to January 1, 2020. To investigate the effect of eGFR on admission with long-term morbimortality, we stratified the patients according to four eGFR categories: <30 mL center dot min(-1)center dot 1.73 m(-2) (G4 and G5 patients, n = 534), 30-44 mL center dot min(-1)center dot 1.73 m(-2) (G3b patients, n = 882), 45-59 mL center dot min(-1)center dot 1.73 m(-2) (G3a patients, n = 1,080), and >= 60 mL center dot min(-1)center dot 1.73 m(-2) (G1 and G2 patients, n = 2,099). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation within the first 24 h following admission. Results: At a median follow-up of 2.20 years, multivariate analyses revealed that compared to G1 and G2 patients, G4 and G5 patients exhibited a higher risk of all-cause (HR = 1.15, 95% CI: 01.02-1.30, p = 0.020) and cardiovascular (CV) (HR = 1.20, 95% CI: 1.04-1.39, p = 0.013) mortality. Similarly, multivariate analyses also showed that the lower the eGFR, the higher the risk of readmissions. In fact, compared to G1 and G2 patients, G4 and G5 patients displayed significantly increased incident rate ratios of total all-cause (28%), CV (26%), and HF-related (30%) readmissions. Conclusion: Data from this large study provide evidence that an eGFR below 30 mL center dot min(-1)center dot 1.73 m(-2) on admission could be an independent predictor for long-term mortality and readmissions in patients with AHF.
  • Autores: Perdomo Zelaya, Carolina María (Autor de correspondencia); Núñez Córdoba, Jorge María; Ezponda Casajús, Ana; et al.
    Revista: FRONTIERS IN MEDICINE
    ISSN: 2296-858X Vol.9 2022 págs. 1023583
    Resumen
    BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting.
  • Autores: de Juan Bagudá, J. (Autor de correspondencia); Gavira Gómez, Juan José; Pachón Iglesias, M.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
    ISSN: 1885-5857 Vol.75 N° 9 2022 págs. 709 - 716
    Resumen
    Introduction and objectives: HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. Methods: We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). Results: We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). Conclusions: The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
  • Autores: Ramírez, A. (Autor de correspondencia); Sobrinos, E.; Girón, J. J.; et al.
    Revista: CIRUGIA CARDIOVASCULAR
    ISSN: 1134-0096 Vol.29 N° 2 2022 págs. 110 - 113
    Resumen
    An anomalous origin of the coronary artery is an uncommon congenital disorder. Even though the pathology is generally asymptomatic, it can present with life-threatening symptoms. Two cases with an anomalous origin of the right coronary artery are assessed. Though both patients' arterial anomalies were alike, the surgical procedure was different in each case. The unroofing technique and coronary artery bypass grafting are compared to evaluate different surgical approaches for a personalize treatment of the pathology.
  • Autores: Rypdal, K. B. (Autor de correspondencia); Melleby, A. O.; Robinson, E. L.; et al.
    Revista: COMMUNICATIONS BIOLOGY
    ISSN: 2399-3642 Vol.5 N° 1 2022 págs. 1392
    Resumen
    Heart failure is a major cause of morbidity and mortality worldwide, and can result from pressure overload, where cardiac remodelling is characterized by cardiomyocyte hypertrophy and death, fibrosis, and inflammation. In failing hearts, transforming growth factor (TGF)beta drives cardiac fibroblast (CFB) to myofibroblast differentiation causing excessive extracellular matrix production and cardiac remodelling. New strategies to target pathological TGF beta signalling in heart failure are needed. Here we show that the secreted glycoprotein ADAMTSL3 regulates TGF beta in the heart. We found that Adamtsl3 knock-out mice develop exacerbated cardiac dysfunction and dilatation with increased mortality, and hearts show increased TGF beta activity and CFB activation after pressure overload by aortic banding. Further, ADAMTSL3 overexpression in cultured CFBs inhibits TGF beta signalling, myofibroblast differentiation and collagen synthesis, suggesting a cardioprotective role for ADAMTSL3 by regulating TGF beta activity and CFB phenotype. These results warrant future investigation of the potential beneficial effects of ADAMTSL3 in heart failure.
  • 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: 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: Angleitner, P. (Autor de correspondencia); Kaider, A.; De By, T. M. M. H.; et al.
    Revista: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
    ISSN: 1010-7940 Vol.62 N° 3 2022 págs. ezac401
    Resumen
    OBJECTIVES: The objective was to analyse associations between obesity and outcomes after left ventricular assist device (LVAD) implantation. METHODS: A retrospective analysis of the EUROMACS Registry was performed. Adult patients undergoing primary implantation of a continuous-flow LVAD between 2006 and 2019 were included (Medtronic HeartWare((R)) HVAD((R)), Abbott HeartMate II (R), Abbott HeartMate 3 (TM)). Patients were classified into 4 different groups according to body mass index at the time of surgery (body mass index <20 kg/m(2): n = 254; 20-24.9 kg/m(2): n = 1281; 25-29.9 kg/m(2): n = 1238; >= 30 kg/m(2): n = 691). RESULTS: The study cohort was comprised of 3464 patients. Multivariable Cox proportional cause-specific hazards regression analysis demonstrated that obesity (body mass index >= 30 kg/m(2)) was independently associated with significantly increased risk of mortality (body mass index >= 30 vs 20-24.9 kg/m(2): hazard ratio 1.36, 95% confidence interval 1.18-1.57, overall P < 0.001). Moreover, obesity was associated with significantly increased risk of infection and driveline infection. The probability to undergo heart transplantation was significantly decreased in obese patients (body mass index >= 30 vs 20-24.9 kg/m(2): hazard ratio 0.59, 95% confidence interval 0.48-0.74, overall P < 0.001). CONCLUSIONS: Obesity at the time of LVAD implantation is associated with significantly higher mortality and increased risk of infection as well as driveline infection. The probability to undergo heart transplantation is significantly decreased. These aspects should be considered when devising a treatment strategy before surgery.
  • Autores: Sáenz de Pipaon Echarren, Goren; Ravassa Albéniz, Susana; Larsen, K. L.; et al.
    Revista: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
    ISSN: 1078-5884 Vol.63 N° 4 2022 págs. 648 - 656
    Resumen
    Objective: Peripheral arterial disease (PAD) is the most prevalent cardiovascular (CV) condition globally. Despite the high CV risk of PAD patients, no reliable predictors of adverse clinical evolution are yet available. In this regard, previous transcriptomic analyses revealed increased expression of calprotectin (S100A8/A9) and lipocalin-2 (LCN2) in circulating extracellular vesicles (EVs) of patients with PAD. The aim of this study was to determine the prognostic value of LCN2 and calprotectin for CV risk assessment in PAD. Methods: LCN2 and the S100A9 subunit of calprotectin were examined in human femoral plaques by immunohistochemistry and qPCR. LCN2 and calprotectin were determined by ELISA in PAD (CHN cohort, n = 331, Fontaine IIeIV, serum), and PAD diagnosed by population based screening (VIVA trial, n = 413, the majority Fontaine 0eI, plasma). Patients were followed up for a mean of four years, recording the primary outcomes; CV death or amputation in the CHN cohort and CV death or major lower limb events (MALE) in the VIVA population. Secondary outcomes were all cause death or amputation, and all cause death or MALE, respectively. Results: LCN2 and S100A9 were detected in human plaques in regions rich in inflammatory cells. LCN2 and calprotectin levels were 70% and 64% lower in plasma than in serum. In the CHN cohort, high serum levels of LCN2 and calprotectin increased the risk of primary and secondary outcomes 5.6 fold (p < .001) and 1.8 fold (p = .034), respectively, after covariable adjustment. Similarly, elevated plasma levels of LCN2 and calprotectin increased by three fold the risk of primary and secondary outcomes (p <.001) in the VIVA cohort. Moreover, addition of the combined variable to basal models, considering clinically relevant risk factors, improved reclassification for the primary outcome in both cohorts (p <= .024). Conclusion: Combined assessment of the inflammatory biomarkers LCN2 and calprotectin might be useful for risk stratification in advanced and early PAD.
  • Autores: Bragard Monier, Jean; Moriones Imirizaldu, Leire; Echebarria, B.; et al.
    Revista: COMPUTING IN CARDIOLOGY
    ISSN: 2325-8861 Vol.49 2022 págs. 1 - 4
    Resumen
    The aim of this work is to use biomarkers extracted from high-resolution voltage maps of atrial fibrillation (AF) patients in order to make predictions about future "redo" procedures. We collected maps of the left atrium of 122 patients, prior of being treated for AF The bipolar voltage maps were extracted with the Rythmia system from Boston Scientific and subsequently analyzed in the MATLAB environment. The present study focuses on three biomarkers extracted from those maps. Two are associated with the bipolar voltage measurements on the map, i.e., the mean voltage and the voltage dispersion on the map. The third indicator is the area of the atrium evaluated from the map. The data are used for feeding a supervised classification algorithm. The output variable is a binary variable that is set to 1 if the patient will need a "redo" procedure in the twelve months following the cardiac intervention and 0 otherwise. We show that the biomarkers have some statistical power in predicting future outcomes. Especially the mean voltage on the map is the best predictor of the future outcome. We determine the cutoff value for the mean voltage based on the best prediction accuracy of Vm=0.542 mV in agreement with previous studies. We discuss some extensions of this study that could allow improvements in predictive power.
  • Autores: Kobayashi, M.; Girerd, N.; Ferreira, J. P.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° 9 2022 págs. 1559 - 1568
    Resumen
    Aims Procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP) are markers reflecting collagen synthesis in cardiac fibrosis. However, they may be influenced by the presence of non-cardiac comorbidities (e.g. ageing, obesity, renal impairment). Understanding the associations between markers of collagen synthesis and abnormalities of cardiac structure and function is important to screen for myocardial fibrosis and monitor the antifibrotic effect of medications. Methods and results The HOMAGE (Heart 'OMics' in AGEing) trial showed that spironolactone decreased serum PICP concentrations and improved cardiac remodelling over 9 months in a population at risk of developing heart failure (HF). We evaluated the associations between echocardiographic variables, PICP, PIIINP and galectin-3 at baseline and during the course of the trial. Among 527 individuals (74 +/- 7 years, 26% women), median serum concentrations of PICP, PIIINP and galectin-3 were 80.6 mu g/L (65.1-97.0), 3.9 mu g/L (3.1-5.0), and 16.1 mu g/L (13.5-19.7), respectively. After adjustment for potential confounders, higher serum PICP was significantly associated with left ventricular hypertrophy, left atrial enlargement, and greater ventricular stiffness (all p < 0.05), whereas serum PIIINP and galectin-3 were not (all p > 0.05). In patients treated with spironolactone, a reduction in serum PICP during the trial was associated with a decrease in E/e ' (adjusted-beta = 0.93, 95% confidence interval 0.14-1.73; p = 0.022). Conclusions In individuals at high risk of developing HF, serum PICP was associated with cardiac structural and functional abnormalities, and a decrease in PICP with spironolactone was correlated with improved diastolic dysfunction as assessed by E/e '. In contrast, no such associations were present for serum PIIINP and galectin-3.
  • 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: Yang, C. X.; Tomchaney, M.; Landecho Acha, Manuel Fortún; et al.
    Revista: CELLS
    ISSN: 2073-4409 Vol.11 N° 12 2022 págs. 1864
    Resumen
    People with pre-existing lung diseases such as chronic obstructive pulmonary disease (COPD) are more likely to get very sick from SARS-CoV-2 disease 2019 (COVID-19). Still, an interrogation of the immune response to COVID-19 infection, spatially throughout the lung structure, is lacking in patients with COPD. For this study, we characterized the immune microenvironment of the lung parenchyma, airways, and vessels of never- and ever-smokers with or without COPD, all of whom died of COVID-19, using spatial transcriptomic and proteomic profiling. The parenchyma, airways, and vessels of COPD patients, compared to control lungs had (1) significant enrichment for lung-resident CD45RO(+) memory CD4(+) T cells; (2) downregulation of genes associated with T cell antigen priming and memory T cell differentiation; and (3) higher expression of proteins associated with SARS-CoV-2 entry and primary receptor ubiquitously across the ROIs and in particular the lung parenchyma, despite similar SARS-CoV-2 structural gene expression levels. In conclusion, the lung parenchyma, airways, and vessels of COPD patients have increased T-lymphocytes with a blunted memory CD4 T cell response and a more invasive SARS-CoV-2 infection pattern and may underlie the higher death toll observed with COVID-19.
  • 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: 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: 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: 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: Solimene, F. (Autor de correspondencia); Stabile, G.; Segreti, L.; et al.
    Revista: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
    ISSN: 1045-3873 Vol.33 N° 7 2022 págs. 1414 - 1424
    Resumen
    Introduction Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (residual antral potential [RAP]) within the antral scar by means of an ultra-high-density mapping (UHDM) system. Methods We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity. The Lumipoint (TM) (Boston Scientific) map-analysis tool was used sequentially on each PV component. The ablation endpoint was PV isolation (PVI) and electrical quiescence in the antral region. Results Fifty-eight cases of AF ablation were analyzed. A total of 86 PVGs in 34 (58.6%) patients and 44 RAPs in 34 patients (58.6%) were found. In 16 (27.6%) cases, we found at least one RAP in patients with complete absence of PV conduction. RAPs showed a lower mean voltage than PVG (0.3 +/- 0.2 mV vs. 0.7 +/- 0.5 mV, p < .0001), whereas the mean number of electrogram peaks was higher (8.4 +/- 1.4 vs. 3.2 +/- 1.5, p < .0001). The percentage of patients in whom RAPs were detected through Lumipoint (TM) was higher than through propagation map analysis (58.6% vs. 36.2%, p = .025). Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study patients. During a mean follow-up of 453 +/- 133 days, 6 patients (10.3%) suffered an AF/AT recurrence. Conclusion Local vulnerabilities in antral lesion sets were easily discernible by means of the UHDM system in both de novo and redo patients when no PV conduction was present.
  • Autores: Ferreira, J. P. (Autor de correspondencia); Verdonschot, J. A. J.; Girerd, N.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° 5 2022 págs. 771 - 778
    Resumen
    Aims Left ventricular ejection fraction (LVEF) can provide haemodynamic information and may influence the response to spironolactone and other heart failure (HF) therapies. We aimed to study patient characteristics and circulating protein associations with LVEF, and whether LVEF influenced the response to spironolactone. Methods and results HOMAGE enrolled patients aged >60 years at high risk of developing HF with a LVEF >= 45%. Overall, 527 patients were randomized to either spironolactone or standard of care for approximate to 9 months, and 276 circulating proteins were measured using Olink (R) technology. A total of 364 patients had available LVEF determined by the Simpson's biplane method. The respective LVEF tertiles were: tertile 1: <60% (n = 122), tertile 2: 60%- 65% (n = 121), and tertile 3: >65% (n = 121). Patients with a LVEF >65% had smaller left ventricular chamber size and volumes, and lower natriuretic peptide levels. Compared to patients with a LVEF <60%, those with LVEF >65% had higher levels of circulating c-c motif chemokine ligand-23 and interleukin-8, and lower levels of tissue plasminogen activator, brain natriuretic peptide (BNP), S100 calcium binding protein A12, and collagen type I alpha 1 chain (COL1A1). Spironolactone significantly reduced the circulating levels of BNP and COL1A1 without significant treatment-by-LVEF heterogeneity: BNP change beta = -0.36 log(2) and COL1A1 change beta=-0.16 log(2) (p<0.0001 for both; interaction p>0.1 for both). Spironolactone increased LVEF from baseline to month 9 by 1.1% (p = 0.007). Conclusion Patients with higher LVEF had higher circulating levels of chemokines and inflammatory markers and lower levels of stretch, injury, and fibrosis markers. Spironolactone reduced the circulating levels of natriuretic peptides and type 1 collagen, and increased LVEF.
  • Autores: Ortiz-Bautista, C. (Autor de correspondencia); Muniz, J.; Almenar-Bonet, L.; et al.
    Revista: CLINICAL TRANSPLANTATION
    ISSN: 0902-0063 Vol.36 N° 9 2022 págs. e14774
    Resumen
    Introduction and objectives The Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score was derived and validated as a predictor of mortality after heart transplantation (HT). The primary objective of this work is to externally validate the IMPACT score in a contemporary Spanish cohort. Methods Spanish Heart Transplant Registry data were used to identify adult (>16 years) HT patients between January 2000 and December 2015. Retransplantation, multiorgan transplantation and patients in whom at least one of the variables required to calculate the IMPACT score was missing were excluded from the analysis (N = 2810). Results Median value of the IMPACT score was five points (IQR: 3, 8). Overall, 1-year survival rate was 79.1%. Kaplan-Meier 1-year survival rates by IMPACT score categories (0-2, 3-5, 6-9, 10-14, >= 15) were 84.4%, 81.5%, 79.3%, 77.3%, and 58.5%, respectively (Log-Rank test: p < .001). Performance analysis showed a good calibration (Hosmer-Lemeshow chi-square for 1 year was 7.56; p = .47) and poor discrimination ability (AUC-ROC .59) of the IMPACT score as a predictive model. Conclusions In a contemporary Spanish cohort, the IMPACT score failed to accurately predict the risk of death after HT.
  • Autores: Barrio Piqueras, Miguel; Ezponda Casajús, Ana; Urtasun Iriarte, César; et al.
    Revista: RADIOLOGIA
    ISSN: 0033-8338 Vol.64 N° 4 2022 págs. 317 - 323
    Resumen
    Introducción El objetivo del presente estudio fue evaluar el papel de la tomografía computarizada (TC) de tórax complementaria a la prueba de la reacción en cadena de la polimerasa con transcripción inversa (RT-PCR) en pacientes asintomáticos candidatos a cirugía electiva en el contexto de la pandemia de COVID-19. Material y métodos Se incluyeron, de forma prospectiva, 464 pacientes asintomáticos que se sometieron a una triple estrategia de cribado de infección por SARS-CoV-2 (cuestionario de salud, prueba de RT-PCR y TC torácica de baja dosis) durante las 48 horas previas a la realización de una cirugía electiva. Un resultado positivo en la prueba de RT-PCR y/o la identificación de hallazgos tomográficos sugestivos de neumonía COVID-19 (categorías CO-RADS 4 y 5) fueron considerados criterios diagnósticos de infección por SARS-CoV-2. Resultados La mayor parte de los pacientes se sometieron a cirugías de otorrinolaringología (64,7%). Ningún paciente presentó un resultado positivo en la prueba de RT-PCR ni síntomas sugestivos de infección por SARS-CoV-2 en el cuestionario de salud. Únicamente 22 (4,7%) mostraron signos compatibles con infección pulmonar; 20 de ellos atípica o indeterminada para COVID-19 (CO-RADS 2, 3) y 2 compatibles con neumonía COVID-19 en resolución. Durante el postoperatorio inmediato no se confirmó ningún caso positivo para SARS-CoV-2. Conclusión En nuestra serie, la realización de una TC torácica de baja dosis de radiación en pacientes asintomáticos para el cribado preoperatorio de infección por SARS-CoV-2 no proporcionó un valor diagnóstico adicional a la RT-PCR y el cuestionario de salud.
  • 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: 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: 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: 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: Quinaglia, T. (Autor de correspondencia); Gongora, C.; Awadalla, M.; et al.
    Revista: JACC-CARDIOVASCULAR IMAGING
    ISSN: 1936-878X Vol.15 N° 11 2022 págs. 1883 - 1896
    Resumen
    BACKGROUND Global circumferential strain (GCS) and global radial strain (GRS) are reduced with cytotoxic chemotherapy. There are limited data on the effect of immune checkpoint inhibitor (ICI) myocarditis on GCS and GRS. OBJECTIVES This study aimed to detail the role of GCS and GRS in ICI myocarditis. METHODS In this retrospective study, GCS and GRS from 75 cases of patients with ICI myocarditis and 50 ICI-treated patients without myocarditis (controls) were compared. Pre-ICI GCS and GRS were available for 12 cases and 50 controls. Measurements were performed in a core laboratory blinded to group and time. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. RESULTS Cases and controls were similar in age (66 +/- 15 years vs 63 +/- 12 years; P = 0.20), sex (male: 73% vs 61%; P = 0.20) and cancer type (P = 0.08). Pre-ICI GCS and GRS were also similar (GCS: 22.6% +/- 3.4% vs 23.5% +/- 3.8%; P = 0.14; GRS: 45.5% +/- 6.2% vs 43.6% +/- 8.8%; P = 0.24). Overall, 56% (n = 42) of patients with myocarditis presented with preserved left ventricular ejection fraction (LVEF). GCS and GRS were lower in myocarditis compared with on-ICI controls (GCS: 17.5% +/- 4.2% vs 23.6% +/- 3.0%; P < 0.001; GRS: 28.6% +/- 6.7% vs 47.0% +/- 7.4%; P < 0.001). Over a median follow-up of 30 days, 28 cardiovascular events occurred. A GCS (HR: 4.9 [95% CI: 1.6-15.0]; P = 0.005) and GRS (HR: 3.9 [95% CI: 1.4-10.8]; P = 0.008) below the median was associated with an increased event rate. In receiveroperating characteristic (ROC) curves, GCS (AUC: 0.80 [95% CI: 0.70-0.91]) and GRS (AUC: 0.76 [95% CI: 0.64-0.88]) showed better performance than cardiac troponin T (cTnT) (AUC: 0.70 [95% CI: 0.58-0.82]), LVEF (AUC: 0.69 [95% CI: 0.56- 0.81]), and age (AUC: 0.54 [95% CI: 0.40-0.68]). Net reclassification index and integrated discrimination improvement demonstrated incremental prognostic utility of GRS over LVEF (P = 0.04) and GCS over cTnT (P = 0.002). CONCLUSIONS GCS and GRS are lower in ICI myocarditis, and the magnitude of reduction has prognostic significance. (J Am Coll Cardiol Img 2022;15:1883-1896) (c) 2022 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
  • Autores: García Bolao, José Ignacio (Autor de correspondencia); Ramos Ardanáz, Pablo; Luik, A.; et al.
    Revista: JACC-CLINICAL ELECTROPHYSIOLOGY
    ISSN: 2405-500X Vol.8 N° 5 2022 págs. 595 - 604
    Resumen
    Objectives: This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures. Background: A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure. Methods: Fifty-eight patients who had undergone LI-blinded de novo PVI returned for a 3-month mapping procedure. PVI ablation circles were divided into 16 anatomic segments for classification (durable block or gap), and the median LI drop within segments with an interlesion distance of ¿6 mm was compared. A total of 51 data sets met the criteria for segmental analysis of LI performance. Results: At the 3-month procedure, PV connection was confirmed in at least 1 PV segment in 35 of the included patients. LI drop outperformed generator impedance drop as a predictor of durable conduction block (area under the receiver-operating characteristic curve: 0.79 vs 0.68; P = 0.003). Optimal LI drops were identified by left atrial region (anterior/superior: 16.9 ¿ [sensitivity: 69.1%; specificity: 85.0%; positive predictive value for durable conduction block: 97.7%]; posterior/inferior:14.2 ¿ [sensitivity: 73.8%; specificity: 78.3%; positive predictive value: 96.9%]). Starting LI before radiofrequency (RF) application was significantly different among healthy, gap, and mature scar tissue and was also a contributing factor to achieving an optimal LI drop (85.2% of RF applications with a starting LI of ¿110 ¿ achieved the optimal regional drop or greater). Conclusions: LI drop is predictive of durable PV segment isolation. Preablation starting LI is associated with the magnitude of LI drop. These findings suggest that a regional approach to RF ablation guided by LI combined with careful interlesion distance control may be beneficial in patients with paroxysmal atrial fibrillation (Electrical Coupling Information From the Rhythmia HDx System and DirectSense Technology in Subjects With Paroxysmal Atrial Fibrillation [LOCALIZE]; NCT03232645).
  • Autores: Lange, T.; Backhaus, S. J.; Beuthner, B. E.; et al.
    Revista: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
    ISSN: 1097-6647 Vol.24 N° 1 2022
    Resumen
    Background: Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods: CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. Results: Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 +/- 16.9% to 65.4 +/- 14.5%, p= 0.002); LV global longitudinal (- 21.4 +/- 8.0% to -25.0 +/- 6.4%, p < 0.001) and circumferential strain (- 36.9 +/- 14.3% to - 42.6 +/- 11.8%, p = 0.001); left atrial reservoir (13.3 +/- 6.3% to 17.8 +/- 6.7%, p= 0.001), conduit (5.5 +/- 3.2% to 8.4 +/- 4.6%, p= 0.001) and boosterpump strain (8.2 +/- 4.6% to 9.9 +/- 4.2%, p= 0.027). This was paralleled by regression of total myocardial volume (90.3 +/- 21.0 ml/m(2) to 73.5 +/- 17.0 ml/m(2), p <0.001) including cellular (55.2 +/- 13.2 ml/ m(2) to 45.3 +/- 11.1 ml/m(2), p < 0.001) and matrix volumes (20.7 +/- 6.1 ml/m(2) to 18.8 +/- 5.3 ml/m(2), p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 +/- 3002 ng/L to 988 +/- 1222 ng/L, p = 0.001). Conclusion: CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients.
  • 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: Genovese, F.; Reese-Petersen, A.; Karsdal, M. A.; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN: 0931-0509 Vol.37 N° Supl. 3 2022 págs. I539
  • Autores: Bronte Viedma, Angela; Guillen Valderrama, Edgar Fernando; García Belaustegui, Laura; et al.
    Revista: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
    ISSN: 1619-7070 Vol.49 N° SUPPL 1 2022 págs. S274 - S274
  • Autores: De Juan Bagudá, J.; De Frutos, F.; Almenar, L.; et al.
    Revista: EUROPEAN JOURNAL OF HEART FAILURE
    ISSN: 1388-9842 Vol.24 N° Supl. 2 2022 págs. 100 - 101
  • 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: 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: 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: 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: 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: 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: 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 Amezqueta, I.; Ramírez-Vélez, R.; Izquierdo, M.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN: 0300-8932 Vol.74 N° 12 2021 págs. 1009 - 1013
  • 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: Romero González, Gregorio Aramid; Ravassa Albéniz, Susana; Díaz Dorronsoro, Inés; et al.
    Revista: NEPHROLOGY DIALYSIS TRANSPLANTATION
    ISSN: 0931-0509 Vol.36 2021
  • 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: Pei, J. Y.; Harakalova, M.; Treibel, T. A.; et al.
    Revista: CLINICAL EPIGENETICS (PRINT)
    ISSN: 1868-7075 Vol.12 N° 1 2020 págs. 106
    Resumen
    Background H3K27ac histone acetylome changes contribute to the phenotypic response in heart diseases, particularly in end-stage heart failure. However, such epigenetic alterations have not been systematically investigated in remodeled non-failing human hearts. Therefore, valuable insight into cardiac dysfunction in early remodeling is lacking. This study aimed to reveal the acetylation changes of chromatin regions in response to myocardial remodeling and their correlations to transcriptional changes of neighboring genes. Results We detected chromatin regions with differential acetylation activity (DARs;P-adj.< 0.05) between remodeled non-failing patient hearts and healthy donor hearts. The acetylation level of the chromatin region correlated with its RNA polymerase II occupancy level and the mRNA expression level of its adjacent gene per sample. Annotated genes from DARs were enriched in disease-related pathways, including fibrosis and cell metabolism regulation. DARs that change in the same direction have a tendency to cluster together, suggesting the well-reorganized chromatin architecture that facilitates the interactions of regulatory domains in response to myocardial remodeling. We further show the differences between the acetylation level and the mRNA expression level of cell-type-specific markers for cardiomyocytes and 11 non-myocyte cell types. Notably, we identified transcriptome factor (TF) binding motifs that were enriched in DARs and defined TFs that were predicted to bind to these motifs. We further showed 64 genes coding for these TFs that were differentially expressed in remodeled myocardium when compared with controls. Conclusions Our study reveals extensive novel insight on myocardial remodeling at the DNA regulatory level. Differences between the acetylation level and the transcriptional level of cell-type-specific markers suggest additional mechanism(s) between acetylome and transcriptome. By integrating these two layers of epigenetic profiles, we further provide promising TF-encoding genes that could serve as master regulators of myocardial remodeling. Combined, our findings highlight the important role of chromatin regulatory signatures in understanding disease etiology.
  • 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: 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: 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: 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: 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: 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: Ravassa Albéniz, Susana (Autor de correspondencia); Beaumont Ezcurra, Francisco Javier; Cediel, G.; et al.
    Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
    ISSN: 0300-8932 Vol.73 N° 10 2020 págs. 835 - 843
    Resumen
    Introduction and objectives: Preliminary results suggest that high circulating insulin-like growth factor binding protein 2 (IGFBP2) levels are associated with mortality risk in heart failure (HF) patients. As IGFBP2 levels are increased in patients with chronic kidney disease (CKD), which is associated with a higher mortality risk in HF patients, we examined whether IGFBP2 is associated with CKD in HF patients, and whether CKD modifies the prognostic value of this protein in HF patients. Methods: HF patients (n = 686, mean age 66.6 years, 32.7% women) were enrolled and followed up for a median of 3.5 (min-max range: 0.1-6) years. Patients were classified as having CKD with decreased estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m(2)) or as having CKD with nondecreased eGFR (similar to 60 mL/min/1.73 m(2)). Serum IGFBP2 was detected by ELISA. Results: IGFBP2 was increased (P <.001) in CKD patients with decreased eGFR (n = 290, 42.3%) compared with patients with nondecreased eGFR. IGFBP2 was directly associated with NT-proBNP (P <.001) and inversely associated with eGFR (P <.001), with both associations being independent of confounding factors. IGFBP2 was directly and independently associated with cardiovascular and all-cause death (P <.001) in the whole group of patients, but showed a stronger association with cardiovascular death in CKD patients with decreased eGFR (P for interaction <.05), improving risk prediction in these patients over clinically relevant risk factors. Conclusions: Serum IGFBP2 is associated with impaired renal function and prognosticates cardiovascular death in patients with HF and CKD with decreased eGFR. Thus, there is an effect modification of CKD on circulating IGFBP2 and on its association with cardiovascular mortality in HF patients. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
  • 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: Divo, M.; Marin Oto, Marta; Casanova, C.; et al.
    Revista: EUROPEAN RESPIRATORY JOURNAL
    ISSN: 0903-1936 Vol.56 N° Suppl. 64 2020
  • 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: 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: 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: 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: 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: 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: Beyens, A.; Albuisson, J.; Boel, A.; et al.
    Revista: GENETICS IN MEDICINE
    ISSN: 1098-3600 Vol.21 N° 8 2019 págs. 1894 - 1895
  • 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: 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: 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: Tschöpe D; Díez Martínez, Domingo Francisco Javier
    Revista: EUROPEAN HEART JOURNAL
    ISSN: 0195-668X Vol.40 N° 12 2019 págs. 979 - 981
  • 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: 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: 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: 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: 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: 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 recipie