Revista espanola de cardiologia最新文献

{"title":"Importancia de la evaluación del riesgo de muerte súbita: el chaleco desfibrilador como puente a trasplante","authors":"Borja Guerrero Cervera , Raquel López-Vilella , Víctor Donoso Trenado , Maite Izquierdo , Joaquín Osca Asensi , Luis Almenar-Bonet","doi":"10.1016/j.recesp.2024.04.012","DOIUrl":"10.1016/j.recesp.2024.04.012","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 12","pages":"Pages 1055-1057"},"PeriodicalIF":5.9,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720691","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":"Situación de la rehabilitación cardiaca en España. Resultados del registro AULARC","authors":"Vicente Arrarte Esteban , Raquel Campuzano Ruiz , Carmen De Pablo Zarzosa , M. Rosa Fernández Olmo , en representación de los investigadores del registro AULARC","doi":"10.1016/j.recesp.2024.04.011","DOIUrl":"10.1016/j.recesp.2024.04.011","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 9","pages":"Pages 796-798"},"PeriodicalIF":5.9,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142076696","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":"Fisiología coronaria: una herramienta diagnóstica imprescindible más allá de la obtención de un punto de corte","authors":"","doi":"10.1016/j.recesp.2024.04.010","DOIUrl":"10.1016/j.recesp.2024.04.010","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 11","pages":"Pages 896-898"},"PeriodicalIF":5.9,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770076","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":"Utilidad de los biomarcadores en el trasplante cardiaco para predecir el pronóstico","authors":"Raquel López-Vilella ,&nbsp;Julia Martínez Solé ,&nbsp;Sara Huélamo Montoro ,&nbsp;Víctor Donoso Trenado ,&nbsp;Ignacio Sánchez-Lázaro ,&nbsp;Iratxe Zarragoikoetxea Jauregui ,&nbsp;Paula Carmona García ,&nbsp;Manuel Pérez Guillén ,&nbsp;Carlos Domínguez Massa ,&nbsp;Luis Martínez Dolz ,&nbsp;Luis Almenar Bonet","doi":"10.1016/j.recesp.2024.04.008","DOIUrl":"10.1016/j.recesp.2024.04.008","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Heart transplant (HT) represents a major physiological stress, resulting in elevated levels of analytical biomarkers. This study aimed to determine whether changes in biomarker levels after HT can identify patients with a poor prognosis.</div></div><div><h3>Methods</h3><div>A prospective longitudinal noninterventional study was conducted in 149 consecutive patients undergoing HT from July 2017 to July 2023. Biomarkers were assessed before HT and at 6, 24, 48, 72, and 96<!--> <!-->hours after HT. The biomarkers analyzed were high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and lactic acid. The primary outcome was a composite of death and severe primary graft failure (PGF).</div></div><div><h3>Results</h3><div>NT-proBNP and troponin levels remained highly elevated throughout the period and stabilized from the first 24<!--> <!-->hours post-HT. Lactate levels stabilized after the first 24<!--> <!-->hours, and creatinine from the second day onward. Exitus occurred in 23 (15%) of the patients, and severe PGF in 26 (17%). All biomarkers were significantly associated with the incidence of the combined event (<em>P</em> &lt;<!--> <!-->.0001). Receiver operating characteristic curve analysis at 24<!--> <!-->hours showed significant areas under the curve (<em>P</em> <!-->=<!--> <!-->.0001). The greatest discriminatory power was observed for the NT-proBNP curve. A value of 10 000 pg/mL had a sensitivity of 90% and specificity of 80%.</div></div><div><h3>Conclusions</h3><div>A significant elevation of post-HT analytical biomarkers was associated with mortality and/or severe PGF. Among the biomarkers analyzed, NT-proBNP was the most accurate in classifying patients.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 12","pages":"Pages 1018-1025"},"PeriodicalIF":5.9,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774650","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":"Evaluación dinámica de las escalas CHA2DS2-VASc y HAS-BLED para predecir ictus isquémico y hemorragia mayor en pacientes con fibrilación auricular","authors":"","doi":"10.1016/j.recesp.2024.02.013","DOIUrl":"10.1016/j.recesp.2024.02.013","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Stroke and bleeding risks in atrial fibrillation (AF) are often assessed at baseline to predict outcomes years later. We investigated whether dynamic changes in CHA₂DS₂-VASc and HAS-BLED scores over time modify risk prediction.</div></div><div><h3>Methods</h3><div>We included patients with AF who were stable while taking vitamin K antagonists. During a 6-year follow-up, all ischemic strokes/transient ischemic attacks (TIAs) and major bleeding events were recorded. CHA₂DS₂-VASc and HAS-BLED were recalculated every 2-years and tested for clinical outcomes at 2-year periods.</div></div><div><h3>Results</h3><div>We included 1361 patients (mean CHA₂DS₂-VASc and HAS-BLED 4.0<!--> <!-->±<!--> <!-->1.7 and 2.9<!--> <!-->±<!--> <!-->1.2). During the follow-up, 156 (11.5%) patients had an ischemic stroke/TIA and 269 (19.8%) had a major bleeding event. Compared with the baseline CHA₂DS₂-VASc, the CHA₂DS₂-VASc recalculated at 2 years had higher predictive ability for ischemic stroke/TIA during the period from 2 to 4 years. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) showed improvements in sensitivity and better reclassification. The CHA₂DS₂-VASc recalculated at 4 years had better predictive performance than the baseline CHA₂DS₂-VASc during the period from 4 to 6 years, with an improvement in IDI and an enhancement of the reclassification. The recalculated HAS-BLED at 2-years had higher predictive ability than the baseline score for major bleeding during the period from 2 to 4 years, with significant improvements in sensitivity and reclassification. A slight enhancement in sensitivity was observed with the HAS-BLED score recalculated at 4 years compared with the baseline score.</div></div><div><h3>Conclusions</h3><div>In AF patients, stroke and bleeding risks are dynamic and change over time. The CHA₂DS₂-VASc and HAS-BLED scores should be regularly reassessed, particularly for accurate stroke risk prediction.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 10","pages":"Pages 835-842"},"PeriodicalIF":5.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777948","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":"Superioridad de la planimetría 3D sobre el tiempo de hemipresión para evaluar el área valvular mitral tras la reparación mitral percutánea de borde a borde","authors":"","doi":"10.1016/j.recesp.2024.03.007","DOIUrl":"10.1016/j.recesp.2024.03.007","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient.</div></div><div><h3>Methods</h3><div>A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient.</div></div><div><h3>Results</h3><div>We analyzed data from 167 patients. The mean age was 76<!--> <!-->±<!--> <!-->10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89<!--> <!-->±<!--> <!-->0.60 cm² using pressure half-time (PHT), 2.87<!--> <!-->±<!--> <!-->0.83 cm² using 3D planimetry, and the mean gradient was 3<!--> <!-->±<!--> <!-->1.19<!--> <!-->mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (<em>r</em> <!-->=<!--> <!-->0.46, <em>P</em> <!-->&lt;<!--> <!-->.001) than MVA obtained by PHT (<em>r</em> <!-->=<!--> <!-->0.19, <em>P</em> <!-->=<!--> <!-->.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 11","pages":"Pages 919-925"},"PeriodicalIF":5.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140784795","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":"Revisión sistemática y metanálisis de estudios aleatorizados y no aleatorizados sobre revascularización guiada por reserva fraccional de flujo","authors":"","doi":"10.1016/j.recesp.2024.02.011","DOIUrl":"10.1016/j.recesp.2024.02.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization.</div></div><div><h3>Methods</h3><div>Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765).</div></div><div><h3>Results</h3><div>A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%<span>C</span>I, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (<em>P</em> <!-->=<!--> <!-->.012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (<em>P</em> <!-->=<!--> <!-->.039).</div></div><div><h3>Conclusions</h3><div>FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 11","pages":"Pages 885-895"},"PeriodicalIF":5.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771368","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":"Stents autoexpandibles SINUS XL para implante previo en el recambio valvular pulmonar","authors":"","doi":"10.1016/j.recesp.2024.02.021","DOIUrl":"10.1016/j.recesp.2024.02.021","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 9","pages":"Pages 788-790"},"PeriodicalIF":5.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796045","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":"Uso de los nuevos vasodilatadores pulmonares en pacientes con cortocircuitos sistémico-pulmonares: estrategia «tratar y reparar»","authors":"","doi":"10.1016/j.recesp.2024.04.005","DOIUrl":"10.1016/j.recesp.2024.04.005","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 9","pages":"Pages 793-796"},"PeriodicalIF":5.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792450","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 identificación subjetiva y ablación de impulsores auriculares mejora el control del ritmo en la fibrilación auricular persistente. Estudio CHAOS-AF","authors":"","doi":"10.1016/j.recesp.2024.01.010","DOIUrl":"10.1016/j.recesp.2024.01.010","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>The optimal approach for persistent atrial fibrillation (AF) ablation remains unknown. In patients with persistent AF, we compared an ablation strategy based on pulmonary vein isolation (PVI) plus ablation of drivers (PVI<!--> <!-->+<!--> <!-->D), with a conventional PVI-only approach performed in a 1:1 propensity score-matched cohort.</p></div><div><h3>Methods</h3><p>Drivers were subjectively identified using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid), without dedicated software, as fractionated continuous or quasicontinuous electrograms on 1 to 2 adjacent bipoles, which were ablated first; and as sites with spatiotemporal dispersion (the entire cycle length comprised within the mapping catheter) plus noncontinuous fractionation, which were only targeted in patients without fractionated continuous electrograms, or without AF conversion after ablation of fractionated continuous electrograms. Ablation included PVI plus focal or linear ablation targeting drivers.</p></div><div><h3>Results</h3><p>A total of 50 patients were included in each group (61<!--> <!-->±<!--> <!-->10 years, 25% women). Fractionated continuous electrograms were found and ablated in 21 patients from the PVI<!--> <!-->+<!--> <!-->D group (42%), leading to AF conversion in 7 patients. In the remaining 43 patients, 143 sites with spatiotemporal dispersion plus noncontinuous fractionation were targeted. Globally, AF conversion was achieved in 21 patients (42%). The PVI<!--> <!-->+<!--> <!-->D group showed lower atrial arrhythmia recurrences at 1 year of follow-up (30.6% vs 48%; <em>P</em> <!-->=<!--> <!-->.048) and at the last follow-up (46% vs 72%; <em>P</em> <!-->=<!--> <!-->.013), and less progression to permanent AF (10% vs 40%; <em>P</em> <!-->=<!--> <!-->.001).</p></div><div><h3>Conclusions</h3><p>Subjective identification and ablation of drivers, added to PVI, increased 1-year freedom from atrial arrhythmia and decreased long-term recurrences and progression to permanent AF.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 9","pages":"Pages 723-733"},"PeriodicalIF":5.9,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140784438","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}