Revista espanola de cardiologia最新文献

{"title":"Novedades en la endocarditis infecciosa","authors":"","doi":"10.1016/j.recesp.2024.03.011","DOIUrl":"10.1016/j.recesp.2024.03.011","url":null,"abstract":"<div><p>Infective endocarditis is a continually evolving disease. Present-day patients differ significantly from those treated a few decades ago: they tend to be older and have more comorbidities and health care-related episodes, while new groups of patients have emerged with new types of endocarditis, such as those affecting patients with percutaneous valve prostheses. There have also been changes in diagnostic techniques. Although transthoracic and transesophageal echocardiography are still the most commonly used imaging modalities, other techniques, such as 3-dimensional transesophageal ultrasound, cardiac computed tomography, and nuclear medicine tests (PET/CT and SPECT/CT), are increasingly used for diagnosing both the disease and its complications. In recent years, there have also been significant developments in antibiotic therapy. Currently, several treatment strategies are available to shorten the hospital phase of the disease in selected patients, which can reduce the complications associated with hospitalization, improve the quality of life of patients and their families, and reduce the health care costs of the disease. This review discusses the main recent epidemiological, diagnostic and therapeutic developments in infective endocarditis.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Análisis de la incidencia y la letalidad del infarto agudo de miocardio en la provincia de Girona durante las tres últimas décadas","authors":"Anna Camps-Vilaró ,&nbsp;Isaac Subirana ,&nbsp;Roberto Elosua ,&nbsp;Iván Palomo ,&nbsp;Juan Sanchis ,&nbsp;Helena Tizón-Marcos ,&nbsp;Miguel Cainzos-Achirica ,&nbsp;Joan Sala ,&nbsp;Rafael Masia ,&nbsp;Rafel Ramos ,&nbsp;Irene R. Dégano ,&nbsp;Jaume Marrugat","doi":"10.1016/j.recesp.2023.10.017","DOIUrl":"10.1016/j.recesp.2023.10.017","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019).</p></div><div><h3>Methods</h3><p>The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n<!--> <!-->=<!--> <!-->4 974 977) and mortality registry (n<!--> <!-->=<!--> <!-->70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression.</p></div><div><h3>Results</h3><p>MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%<span>C</span>I), –1.4 to –0.53) in women from 1990 to 2019 and –4.2% (95%CI, –5.5 to –3.0) in men from 1994 to 2019. The largest decrease in case fatality was –3.8% (95%CI, -5.1 to –2.5) from 1995 to 2003 in women and –2.4% (95%CI, –2.9 to –1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, –2.6 to –1.1) in men and –3.2% (95%CI, –4.6 to –1.8) in women.</p></div><div><h3>Conclusions</h3><p>In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diferencias regionales en la epidemiología y los resultados de la endocarditis infecciosa en España. Un estudio poblacional contemporáneo","authors":"","doi":"10.1016/j.recesp.2024.01.011","DOIUrl":"10.1016/j.recesp.2024.01.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Our aim was to describe the contemporary epidemiological profile of infective endocarditis (IE) in Spain, and to evaluate variations in IE incidence, characteristics, and outcomes among the different Spanish regions (autonomous communities [AC]).</p></div><div><h3>Methods</h3><p>We conducted a retrospective, population-based study, using data obtained from national in-patient hospital activity of all patients discharged with a diagnosis of IE from hospitals included in the Spanish National Health System, from January 2016 to December 2019. Differences in the IE profile between the 17 Spanish AC were analyzed.</p></div><div><h3>Results</h3><p>A total of 9008 hospitalization episodes were identified during the study period. Standardized incidence of IE was 5.77 (95%CI, 5.12-6.41) cases per 100 000 population. Regarding predisposing conditions, 26.8% of episodes occurred in prosthetic valve carriers, 36.8% had some kind of valve heart disease, and 10.6% had a cardiac implantable electronic device. Significant differences were found between AC in terms of incidence, predisposing conditions, and microbiological profile. Cardiac surgery was performed in 19.3% of episodes in the total cohort, and in 33.4% of the episodes treated in high-volume referral centers, with wide variations among AC. Overall in-hospital mortality was 27.2%. Risk-adjusted mortality rates also varied significantly among regions.</p></div><div><h3>Conclusions</h3><p>We found wide heterogeneity among Spanish AC in terms of incidence rates and the clinical and microbiological characteristics of IE episodes. The proportion of patients undergoing surgery was low and in-hospital mortality rates were high, with wide differences among regions. The development of regional networks with referral centers for IE could facilitate early surgery and improve outcomes.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto de prótesis valvular pulmonar en la función ventricular derecha y eventos cardiacos en pacientes con tetralogía de Fallot: análisis retrospectivo","authors":"Francisco Javier Ruperti-Repilado ,&nbsp;Nora Haag ,&nbsp;Thomas Fischer ,&nbsp;Bruno Santos Lopes ,&nbsp;Lukas Meier ,&nbsp;Kerstin Wustmann ,&nbsp;Francesca Bonassin ,&nbsp;Christine Attenhofer Jost ,&nbsp;Fabienne Schwitz ,&nbsp;Markus Schwerzmann ,&nbsp;Daniel Tobler ,&nbsp;Stefanie von Felten ,&nbsp;Matthias Greutmann","doi":"10.1016/j.recesp.2023.11.010","DOIUrl":"10.1016/j.recesp.2023.11.010","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Our aim was to assess the impact of prosthetic pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) on changes in biventricular volumes and function and on adverse cardiac events.</p></div><div><h3>Methods</h3><p>Adults with rTOF were identified from the SACHER-registry. Data from serial cardiac magnetic resonance imaging, echocardiography, exercise capacity and n-terminal pro b-type natriuretic peptide (NT-proBNP) were collected. The primary endpoint was right ventricular ejection fraction (RVEF) as measured by cardiac magnetic resonance. Secondary endpoints were biventricular volumes, left ventricular ejection fraction, exercise capacity and NT-proBNP levels, and time to adverse cardiac outcomes (atrial and ventricular arrhythmia, endocarditis). Associations between previous PVR and longitudinal changes in functional outcomes and time to adverse cardiac outcomes were analyzed using linear mixed-effects models and Cox proportional hazards models, respectively.</p></div><div><h3>Results</h3><p>A total of 308 patients (153 with and 155 without PVR) with 887 study visits were analyzed. Previous PVR was not significantly associated with changes in RVEF (CE, -<!--> <!-->1.33; 95%<span>C</span>I, -<!--> <!-->5.87 to 3.21; <em>P</em> <!-->=<!--> <!-->.566). Previous PVR was associated with lower right ventricular end-diastolic volume but had no significant effect on left ventricular ejection fraction, exercise capacity, or NT-proBNP-levels. Previous PVR was associated with an increased hazard of atrial arrhythmias (HR, 2.09; 95%CI, 1.17-3.72; <em>P</em> <!-->=<!--> <!-->.012) and infective endocarditis (HR, 12.72; 95%CI, 4.69-34.49; <em>P</em> <!-->&lt;<!--> <!-->.0001) but not with an increased hazard of sustained ventricular arrhythmias (HR, 0.64; 95%CI, 0.18-2.27; <em>P</em> <!-->=<!--> <!-->.490).</p></div><div><h3>Conclusions</h3><p>Previous PVR was not significantly associated with changes in RVEF but was associated with an increased risk of atrial arrhythmias and infective endocarditis.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ética en la investigación clínica: qué debe saber antes de iniciar un estudio","authors":"","doi":"10.1016/j.recesp.2024.03.004","DOIUrl":"10.1016/j.recesp.2024.03.004","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La endocarditis infecciosa en la España del siglo XXI: un reto terapéutico constante en un escenario cambiante","authors":"","doi":"10.1016/j.recesp.2024.03.003","DOIUrl":"10.1016/j.recesp.2024.03.003","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimización médica pre-TAVI guiado por el antígeno carbohidrato 125: impacto en la calidad de vida y resultados clínicos","authors":"","doi":"10.1016/j.recesp.2024.01.009","DOIUrl":"10.1016/j.recesp.2024.01.009","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Carbohydrate antigen 125 (CA125), a biomarker associated with fluid overload, has proven useful in managing diuretic therapy in heart failure. We aimed to evaluate the impact of diuretic optimization guided by CA125 before transcatheter aortic valve implantation (TAVI) on outcomes.</p></div><div><h3>Methods</h3><p>This prospective interventional study enrolled patients scheduled for TAVI, in whom baseline CA125 was measured 2 weeks before TAVI. Patients with CA125 ≥ 20 U/mL underwent diuretic up-titration before TAVI. Three groups were included: group I) baseline CA125 &lt;<!--> <!-->20 U/mL; IIa) CA125 ≥ 20 U/mL that decreased after treatment, and IIb) CA125 ≥ 20 U/mL that did not decrease. The primary outcome was changes in the Kansas City Cardiomyopathy Questionnaire at 3 and 12 months. The secondary endpoint was clinical events.</p></div><div><h3>Results</h3><p>The study included 184 patients (115 group I, 46 IIa, and 23 IIb). Groups I and IIa exhibited early and sustained improvements in the Kansas City Cardiomyopathy Questionnaire (group I: 18.9 points [95%CI, 15.7-22.1; <em>P</em> &lt;<!--> <!-->.001] at 90 days, and 18.1 [95%CI, 14.9-21.4, <em>P</em> &lt;<!--> <!-->.001] at 1 year; group IIa: 21.1 points [95%CI, 15.4-26.7; <em>P</em> &lt;<!--> <!-->.001] and 19.5 [95%CI, 13.9-25.1; <em>P</em> &lt;<!--> <!-->.001] respectively). In contrast, in group IIb there was no significant improvement at 90 days (<em>P</em> <!-->=<!--> <!-->.12), with improvement being significant only at 1 year (17.8 points, 95%CI, 5.9-29.6; <em>P</em> <!-->=<!--> <!-->.003). Over a median follow-up of 20.7 months, there were 63 (27.83%) deaths or heart failure admissions. Multivariate analysis showed a lower risk of events in group I vs IIb (HR, 0.28; 95%CI, 0.14-0.58; <em>P</em> &lt;<!--> <!-->.001), and IIa vs IIb (HR, 0.24; 95%CI, 0.11-0.55; <em>P</em> &lt;<!--> <!-->.001).</p></div><div><h3>Conclusions</h3><p>Patients with persistently high CA125 despite diuretic therapy pre-TAVI showed slower functional recovery and poorer clinical outcomes after TAVI.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amiloidosis por transtirretina diagnosticada en pacientes con una miocardiopatía previa - oportunidades y preguntas abiertas. Respuesta","authors":"Esteban Martín-Álvarez ,&nbsp;José María Larrañaga-Moreira ,&nbsp;María Generosa Crepo-Leiro ,&nbsp;Roberto Barriales-Villa","doi":"10.1016/j.recesp.2023.12.018","DOIUrl":"10.1016/j.recesp.2023.12.018","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cifras e impacto de la hipertensión arterial en España","authors":"","doi":"10.1016/j.recesp.2024.03.002","DOIUrl":"10.1016/j.recesp.2024.03.002","url":null,"abstract":"<div><p>In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: <em>a)</em> white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); <em>b)</em> inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and <em>c)</em> insufficient use of polytherapy (≈55%). The remaining challenges include: <em>a)</em> technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); <em>b)</em> clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and <em>c)</em> public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0300893224001076/pdfft?md5=68cf2c42fae107001f8d17b455f1b568&pid=1-s2.0-S0300893224001076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retirada del tratamiento farmacológico en pacientes respondedores a terapia de resincronización cardiaca: justificación y diseño del ensayo clínico REMOVE","authors":"","doi":"10.1016/j.recesp.2024.02.020","DOIUrl":"10.1016/j.recesp.2024.02.020","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiac resynchronization therapy (CRT) is an effective treatment for patients with nonischemic dilated cardiomyopathy associated with left bundle branch block (LBBB). In these patients, the device can normalize left ventricular ejection fraction (LVEF). Nevertheless, it remains unclear whether CRT responders still require neurohormonal blockers. The aim of this study is to determine the long-term safety of withdrawing drug therapy in these patients.</div></div><div><h3>Methods</h3><div>The REMOVE trial is a prospective, multicenter, open-label and randomized 1:1 study designed to assess the effect of withdrawing neurohormonal blockers in patients with nonischemic dilated cardiomyopathy associated with left bundle branch block who recovered LVEF after CRT. The study will include a 12-month follow-up with the option to continue into the follow-up extension phase for up to 24 months. The primary endpoint is the recurrence of cardiomyopathy defined as any of the following criteria: <em>a)</em> a reduction in LVEF &gt;<!--> <!-->10% (provided the LVEF is &lt;<!--> <!-->50%); <em>b)</em> a reduction in LVEF &gt;<!--> <!-->10% accompanied by an increase &gt;<!--> <!-->15% in the indexed end-systolic volume relative to the previous value and in a range higher than the normal values, or <em>c)</em> decompensated heart failure requiring intravenous diuretic administration. In patients meeting the primary endpoint, drug therapy will be restarted.</div></div><div><h3>Conclusions</h3><div>The results of this study will help to enhance our understanding of CRT superresponders, a specific group of patients. Registred at ClinicalTrials.gov (Identifier: <span><span>NCT05151861</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}