Pub Date : 2026-03-01Epub Date: 2025-10-17DOI: 10.1016/j.recesp.2025.08.011
Álvaro Rodríguez-Pérez , Carlos Moliner-Abos , David Viladés-Medel , Juan Fernández-Martínez , Josep Mayol-Domingo , Adrián Ruíz-López , Mario Salido , Martín Descalzo , Sandra Pujadas-Olano , Irene Menduiña , Lidia Bos-Real , José A. Parada-Barcia , Manuel Barreiro-Pérez , Ilana Forado-Benatar , Andrea Arenas-Loriente , Rubén Leta-Petracca , Dabit Arzamendi , Chi Hion Pedro Li
Introduction and objectives
Hepatic, portal, and intrarenal venous flows are impaired in significant tricuspid regurgitation (TR), but the impact of massive and torrential TR remains unclear. This study assessed these venous flow patterns across the 5-grade TR classification and their potential as grading markers.
Methods
Patients with TR were prospectively included from 3 centers. Exclusion criteria were admission for heart failure, cirrhosis, and stage V renal disease. TR severity was classified using biplane vena contracta width and 2-dimensional effective regurgitant orifice area. Venous flow patterns (hepatic vein reverse systolic flow, portal pulsatility fraction, monophasic intrarenal flow, and reverse portal and intrarenal systolic flows) were analyzed for each TR grade.
Results
Of the 143 patients (52 grade III, 30 grade IV, 17 grade V TR), worsening TR was associated with progressively abnormal venous flow. Hepatic vein reverse flow had high sensitivity (96%) but lower specificity (73%) for grade III TR and was less useful for grades IV-V. Monophasic intrarenal flow had high specificity (97%) for grade III TR. Portal pulsatility fraction worsened with severity, with cutoffs of ≥ 40% for grade III, ≥ 80% for grade IV, and > 100% for grade V. Reverse portal and intrarenal systolic flows were highly specific for grade V (94% and 97%, respectively).
Conclusions
Increasing TR severity correlates with abnormal hepatic, portal, and intrarenal venous flow patterns, which can be assessed through routine echocardiography.
Full English text available from: www.revespcardiol.org/en
{"title":"Caracterización de los patrones de flujo venoso hepático, portal y renal mediante ecografía Doppler según los grados de insuficiencia tricuspídea","authors":"Álvaro Rodríguez-Pérez , Carlos Moliner-Abos , David Viladés-Medel , Juan Fernández-Martínez , Josep Mayol-Domingo , Adrián Ruíz-López , Mario Salido , Martín Descalzo , Sandra Pujadas-Olano , Irene Menduiña , Lidia Bos-Real , José A. Parada-Barcia , Manuel Barreiro-Pérez , Ilana Forado-Benatar , Andrea Arenas-Loriente , Rubén Leta-Petracca , Dabit Arzamendi , Chi Hion Pedro Li","doi":"10.1016/j.recesp.2025.08.011","DOIUrl":"10.1016/j.recesp.2025.08.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Hepatic, portal, and intrarenal venous flows are impaired in significant tricuspid regurgitation (TR), but the impact of massive and torrential TR remains unclear. This study assessed these venous flow patterns across the 5-grade TR classification and their potential as grading markers.</div></div><div><h3>Methods</h3><div>Patients with TR were prospectively included from 3 centers. Exclusion criteria were admission for heart failure, cirrhosis, and stage V renal disease. TR severity was classified using biplane vena contracta width and 2-dimensional effective regurgitant orifice area. Venous flow patterns (hepatic vein reverse systolic flow, portal pulsatility fraction, monophasic intrarenal flow, and reverse portal and intrarenal systolic flows) were analyzed for each TR grade.</div></div><div><h3>Results</h3><div>Of the 143 patients (52 grade III, 30 grade IV, 17 grade V TR), worsening TR was associated with progressively abnormal venous flow. Hepatic vein reverse flow had high sensitivity (96%) but lower specificity (73%) for grade III TR and was less useful for grades IV-V. Monophasic intrarenal flow had high specificity (97%) for grade III TR. Portal pulsatility fraction worsened with severity, with cutoffs of ≥ 40% for grade III, ≥ 80% for grade IV, and<!--> <!-->> 100% for grade V. Reverse portal and intrarenal systolic flows were highly specific for grade V (94% and 97%, respectively).</div></div><div><h3>Conclusions</h3><div>Increasing TR severity correlates with abnormal hepatic, portal, and intrarenal venous flow patterns, which can be assessed through routine echocardiography.</div><div><em>Full English text available from</em>: <span><span>www.revespcardiol.org/en</span><svg><path></path></svg></span></div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 226-236"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413519","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}
Pub Date : 2026-03-01Epub Date: 2025-05-17DOI: 10.1016/j.recesp.2025.05.003
César Jiménez-Méndez , Rafael Vázquez-García , William Delgado, Daniel Bartolome, Etel Silva
{"title":"Impacto a largo plazo de una estrategia intensiva basada en la telemedicina para el control lipídico","authors":"César Jiménez-Méndez , Rafael Vázquez-García , William Delgado, Daniel Bartolome, Etel Silva","doi":"10.1016/j.recesp.2025.05.003","DOIUrl":"10.1016/j.recesp.2025.05.003","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 273-275"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413524","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}
Pub Date : 2026-03-01Epub Date: 2025-11-22DOI: 10.1016/j.recesp.2025.09.001
Andrea Zito , Antonio Landi , Andrea Milzi , Enrico Frigoli , Sergio Leonardi , Pascal Vranckx , Arnoud W.J. Vant’Hof , José M. de la Torre Hernández , Gianluca Campo , Ferdinando Varbella , Paolo Calabrò , Giuseppe Andò , Giacomo Boccuzzi , Filippo Russo , Marco Valgimigli
Introduction and objectives
The prognostic role of platelet count dynamics in patients hospitalized with acute coronary syndromes (ACS) remains unclear. This study investigated the implications of platelet counts and their changes in ACS patients, using MATRIX trial data.
Methods
In-hospital relative changes in platelet count were analyzed continuously and were categorized into groups. Associations with 1-year risks of mortality and major or clinically relevant nonmajor bleeding were modelled using Cox regression.
Results
Among 7722 ACS patients, a platelet count drop > 10% occurred in 47.5% of the patients and a platelet count increase > 10% in 6.4%. Platelet count changes showed a U-shaped association with mortality and an L-shaped association with bleeding. Compared with the reference group (from 10% drop to 10% increase; rates: mortality 2.6%, bleeding 6.2%), platelet count drops were associated with an incremental mortality risk of approximately 30% (30%-50% drop: 9.5%; HR, 2.86; 95%CI, 1.93-4.23]; > 50% drop: 21.4% HR, 3.86; 95%CI, 2.21-6.74) and a bleeding risk of approximately 10% (10%-30% drop: 8.2%, HR, 1.34; 95%CI, 1.11-1.61; 30%-50% drop: 13.8%, HR, 2.01; 95%CI, 1.48-2.72; > 50% drop: 32.1%; HR, 4.59; 95%CI, 3.01-6.99). Platelet count increases were associated with an incremental mortality risk of approximately 10% (10%-30% increase: 5.8%; HR, 1.87; 95%CI, 1.18-2.98; 30%-50% increase: 8.5%; HR, 2.61; 95%CI, 1.05-6.44; > 50% increase: 9.7%; HR, 3.51; 95%CI, 1.10-11.22) but not with bleeding.
Conclusion
In ACS patients, platelet count drops were associated with incremental risks of mortality and bleeding, whereas platelet count increases were associated with an incremental risk of mortality but not bleeding.
Full English text available from: www.revespcardiol.org/en
{"title":"Dinámica del recuento plaquetario intrahospitalario en pacientes con síndrome coronario agudo","authors":"Andrea Zito , Antonio Landi , Andrea Milzi , Enrico Frigoli , Sergio Leonardi , Pascal Vranckx , Arnoud W.J. Vant’Hof , José M. de la Torre Hernández , Gianluca Campo , Ferdinando Varbella , Paolo Calabrò , Giuseppe Andò , Giacomo Boccuzzi , Filippo Russo , Marco Valgimigli","doi":"10.1016/j.recesp.2025.09.001","DOIUrl":"10.1016/j.recesp.2025.09.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The prognostic role of platelet count dynamics in patients hospitalized with acute coronary syndromes (ACS) remains unclear. This study investigated the implications of platelet counts and their changes in ACS patients, using MATRIX trial data.</div></div><div><h3>Methods</h3><div>In-hospital relative changes in platelet count were analyzed continuously and were categorized into groups. Associations with 1-year risks of mortality and major or clinically relevant nonmajor bleeding were modelled using Cox regression.</div></div><div><h3>Results</h3><div>Among 7722 ACS patients, a platelet count drop ><!--> <!-->10% occurred in 47.5% of the patients and a platelet count increase ><!--> <!-->10% in 6.4%. Platelet count changes showed a U-shaped association with mortality and an L-shaped association with bleeding. Compared with the reference group (from 10% drop to 10% increase; rates: mortality 2.6%, bleeding 6.2%), platelet count drops were associated with an incremental mortality risk of approximately 30% (30%-50% drop: 9.5%; HR, 2.86; 95%CI, 1.93-4.23]; ><!--> <!-->50% drop: 21.4% HR, 3.86; 95%CI, 2.21-6.74) and a bleeding risk of approximately 10% (10%-30% drop: 8.2%, HR, 1.34; 95%CI, 1.11-1.61; 30%-50% drop: 13.8%, HR, 2.01; 95%CI, 1.48-2.72; ><!--> <!-->50% drop: 32.1%; HR, 4.59; 95%CI, 3.01-6.99). Platelet count increases were associated with an incremental mortality risk of approximately 10% (10%-30% increase: 5.8%; HR, 1.87; 95%CI, 1.18-2.98; 30%-50% increase: 8.5%; HR, 2.61; 95%CI, 1.05-6.44; ><!--> <!-->50% increase: 9.7%; HR, 3.51; 95%CI, 1.10-11.22) but not with bleeding.</div></div><div><h3>Conclusion</h3><div>In ACS patients, platelet count drops were associated with incremental risks of mortality and bleeding, whereas platelet count increases were associated with an incremental risk of mortality but not bleeding.</div><div><em>Full English text available from</em>: <span><span>www.revespcardiol.org/en</span><svg><path></path></svg></span></div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 257-269"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413522","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}
Pub Date : 2026-03-01Epub Date: 2025-10-17DOI: 10.1016/j.recesp.2025.08.006
Xavier Rossello , Rafael Gonzalez-Manzanares , Ignacio Amat-Santos , Vicente Peral Disdier , Luis Nieto Roca , Diego López Otero , Luis Nombela Franco , Livia Gheorge , Jorge Sanz-Sánchez , Javier Gómez Herrero , Rocío González Ferreiro , Antonio Jesús Muñoz García , Victoria Vilalta , Soledad Ojeda , Gabriela Veiga Fernández , Juan Gabriel Córdoba Soriano , Ander Regueiro , Miriam Sandín Rollán , Xacobe Flores Ríos , Aitor Uribarri , Sergio Raposeiras-Roubín
Introduction and objectives
The win ratio (WR) approach is used to assess composite endpoints in a hierarchical fashion. This novel method offers an excellent opportunity to assess the robustness of the findings yielded by landmark trials, such as the DapaTAVI trial.
Methods
We applied the WR method to evaluate the treatment effect of dapagliflozin in hierarchically ordered clinical outcomes. Several combinations of outcomes were tested, including time-to-event, binary, and continuous endpoints.
Results
The WR of the original primary endpoint was 1.36 (95%CI, 1.03-1.78; P = .028), comparable to the reciprocal of the original hazard ratio (1/HR, 1.38; 95%CI, 1.06-1.81). The win difference was 4.84% (95%CI, 0.55-9.12), confirming consistent findings in terms of absolute effect. Alternative combinations of the primary outcome with different prioritization of its components yielded similar treatment effects and statistical significance. Ignoring a time-to-event approach and including recurrent events did not substantially affect treatment efficacy and its statistical significance. In contrast, the inclusion of the total length of stay for heart failure hospitalizations in the hierarchy shifted the point estimate toward the null. Including New York Heart Association functional class improved the precision of the estimate (WR = 1.31; 95%CI, 1.09-1.56; P = .003). Conversely, including quality of life through Kansas City Cardiomyopathy Questionnaire comparisons shifted the overall estimate toward the null (WR = 1.10; 95%CI, 0.94-1.30; P = .236).
Conclusions
The WR approach is a solid method to assess treatment efficacy. We observed consistent findings using this approach in the DapaTAVI trial.
介绍和目标胜率（WR）方法用于以分层方式评估复合端点。这种新方法提供了一个极好的机会来评估具有里程碑意义的试验（如DapaTAVI试验）所产生的结果的稳健性。方法采用WR法对达格列净的临床疗效进行分级评价。测试了几种结果组合，包括事件发生时间、二元终点和连续终点。结果原始主要终点的WR为1.36 (95%CI, 1.03 ~ 1.78; P = 0.028)，与原始危险比的倒数相当（1/HR, 1.38; 95%CI, 1.06 ~ 1.81）。差异为4.84% (95%CI, 0.55-9.12)，证实了绝对效果方面的一致发现。具有不同优先级的主要结局的替代组合产生了相似的治疗效果和统计学意义。忽略事件发生时间方法并包括复发事件并没有实质性地影响治疗效果及其统计学意义。相比之下，在层次结构中纳入心力衰竭住院总时间使点估计向零偏移。纳入纽约心脏协会功能分类提高了估计的精度（WR = 1.31; 95%CI, 1.09-1.56; P = 0.003）。相反，通过堪萨斯城心肌病问卷比较纳入生活质量使总体估计向零偏移（WR = 1.10; 95%CI, 0.94-1.30; P = 0.236）。结论WR法是评价治疗效果的可靠方法。我们在DapaTAVI试验中使用这种方法观察到一致的结果。
{"title":"Uso del enfoque win ratio para evaluar los resultados del ensayo clínico DapaTAVI","authors":"Xavier Rossello , Rafael Gonzalez-Manzanares , Ignacio Amat-Santos , Vicente Peral Disdier , Luis Nieto Roca , Diego López Otero , Luis Nombela Franco , Livia Gheorge , Jorge Sanz-Sánchez , Javier Gómez Herrero , Rocío González Ferreiro , Antonio Jesús Muñoz García , Victoria Vilalta , Soledad Ojeda , Gabriela Veiga Fernández , Juan Gabriel Córdoba Soriano , Ander Regueiro , Miriam Sandín Rollán , Xacobe Flores Ríos , Aitor Uribarri , Sergio Raposeiras-Roubín","doi":"10.1016/j.recesp.2025.08.006","DOIUrl":"10.1016/j.recesp.2025.08.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The win ratio (WR) approach is used to assess composite endpoints in a hierarchical fashion. This novel method offers an excellent opportunity to assess the robustness of the findings yielded by landmark trials, such as the DapaTAVI trial.</div></div><div><h3>Methods</h3><div>We applied the WR method to evaluate the treatment effect of dapagliflozin in hierarchically ordered clinical outcomes. Several combinations of outcomes were tested, including time-to-event, binary, and continuous endpoints.</div></div><div><h3>Results</h3><div>The WR of the original primary endpoint was 1.36 (95%CI, 1.03-1.78; <em>P</em> <!-->=<!--> <!-->.028), comparable to the reciprocal of the original hazard ratio (1/HR, 1.38; 95%CI, 1.06-1.81). The win difference was 4.84% (95%CI, 0.55-9.12), confirming consistent findings in terms of absolute effect. Alternative combinations of the primary outcome with different prioritization of its components yielded similar treatment effects and statistical significance. Ignoring a time-to-event approach and including recurrent events did not substantially affect treatment efficacy and its statistical significance. In contrast, the inclusion of the total length of stay for heart failure hospitalizations in the hierarchy shifted the point estimate toward the null. Including New York Heart Association functional class improved the precision of the estimate (WR<!--> <!-->=<!--> <!-->1.31; 95%CI, 1.09-1.56; <em>P</em> <!-->=<!--> <!-->.003). Conversely, including quality of life through Kansas City Cardiomyopathy Questionnaire comparisons shifted the overall estimate toward the null (WR<!--> <!-->=<!--> <!-->1.10; 95%CI, 0.94-1.30; <em>P</em> <!-->=<!--> <!-->.236).</div></div><div><h3>Conclusions</h3><div>The WR approach is a solid method to assess treatment efficacy. We observed consistent findings using this approach in the DapaTAVI trial.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 215-225"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413521","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}
Pub Date : 2026-03-01Epub Date: 2026-01-20DOI: 10.1016/j.recesp.2025.11.022
Grupo de Trabajo de la SEC sobre la actualización ESC 2025 sobre el tratamiento de las dislipemias y Comité de Guías de la SEC
{"title":"Reflexiones sobre la actualización ESC 2025 sobre el tratamiento de las dislipemias","authors":"Grupo de Trabajo de la SEC sobre la actualización ESC 2025 sobre el tratamiento de las dislipemias y Comité de Guías de la SEC","doi":"10.1016/j.recesp.2025.11.022","DOIUrl":"10.1016/j.recesp.2025.11.022","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 199-203"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413528","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}
Pub Date : 2026-03-01Epub Date: 2025-09-29DOI: 10.1016/j.recesp.2025.09.007
Fernando A. Navarro
{"title":"Constantes vitales","authors":"Fernando A. Navarro","doi":"10.1016/j.recesp.2025.09.007","DOIUrl":"10.1016/j.recesp.2025.09.007","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Page 193"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413526","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}
Pub Date : 2026-03-01Epub Date: 2025-10-24DOI: 10.1016/j.recesp.2025.07.012
Jun Hao , Jingyang Wang , Rui Shi , Qi Wang , Xiaohua Cheng , Jiayu Feng , Yanmin Yang , Yuxiao Hu , Tao Chen , Kangyu Chen
Introduction and objectives
Resting heart rate is a readily available vital sign with important prognostic significance. However, traditional measures overlook both the magnitude and duration of elevated heart rate over time. This study assessed the association between cumulative resting heart rate load and adverse outcomes in patients with chronic heart failure (HF) in sinus rhythm.
Methods
Data from 5 randomized controlled trials (BEST, GUIDE-IT, HF-ACTION, RELAX, and TOPCAT) were analyzed. Cumulative heart rate load was calculated as the area under the curve (AUC) for heart rate ≥70 beats per minute (bpm), relative to the total AUC prior to outcomes. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiovascular death and hospitalization for HF. Cox proportional hazards regression models were used to examine associations with outcomes.
Results
A total of 5428 patients were included. Higher cumulative resting heart rate load was significantly associated with increased risk of MACE (hazard ratio [HR], 1.31; 95% CI, 1.24-1.38), cardiovascular death (HR, 1.17; 95% CI, 1.08-1.27), hospitalization for HF (HR, 1.34; 95% CI, 1.26-1.43), all-cause death (HR, 1.20; 95% CI, 1.12-1.29), and any hospitalization (HR, 1.20; 95% CI, 1.15-1.25). Cumulative resting heart rate load demonstrated superior predictive value for all outcomes compared with baseline heart rate, mean heart rate, heart rate standard deviation, and heart rate time in the target range with improvements in C-statistics, net reclassification improvement, and integrated discrimination improvement when added to base models.
Conclusions
Cumulative resting heart rate load provides stronger prognostic value for adverse outcomes in chronic HF. Incorporating this parameter into clinical practice may improve risk stratification and help identify high-risk patients who could benefit from intensive monitoring or therapeutic interventions.
Full English text available from: www.revespcardiol.org/en
{"title":"Carga acumulativa de la frecuencia cardiaca en reposo y riesgo cardiovascular en pacientes con insuficiencia cardiaca en ritmo sinusal","authors":"Jun Hao , Jingyang Wang , Rui Shi , Qi Wang , Xiaohua Cheng , Jiayu Feng , Yanmin Yang , Yuxiao Hu , Tao Chen , Kangyu Chen","doi":"10.1016/j.recesp.2025.07.012","DOIUrl":"10.1016/j.recesp.2025.07.012","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Resting heart rate is a readily available vital sign with important prognostic significance. However, traditional measures overlook both the magnitude and duration of elevated heart rate over time. This study assessed the association between cumulative resting heart rate load and adverse outcomes in patients with chronic heart failure (HF) in sinus rhythm.</div></div><div><h3>Methods</h3><div>Data from 5 randomized controlled trials (BEST, GUIDE-IT, HF-ACTION, RELAX, and TOPCAT) were analyzed. Cumulative heart rate load was calculated as the area under the curve (AUC) for heart rate ≥70 beats per minute (bpm), relative to the total AUC prior to outcomes. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiovascular death and hospitalization for HF. Cox proportional hazards regression models were used to examine associations with outcomes.</div></div><div><h3>Results</h3><div>A total of 5428 patients were included. Higher cumulative resting heart rate load was significantly associated with increased risk of MACE (hazard ratio [HR], 1.31; 95% CI, 1.24-1.38), cardiovascular death (HR, 1.17; 95% CI, 1.08-1.27), hospitalization for HF (HR, 1.34; 95% CI, 1.26-1.43), all-cause death (HR, 1.20; 95% CI, 1.12-1.29), and any hospitalization (HR, 1.20; 95% CI, 1.15-1.25). Cumulative resting heart rate load demonstrated superior predictive value for all outcomes compared with baseline heart rate, mean heart rate, heart rate standard deviation, and heart rate time in the target range with improvements in C-statistics, net reclassification improvement, and integrated discrimination improvement when added to base models.</div></div><div><h3>Conclusions</h3><div>Cumulative resting heart rate load provides stronger prognostic value for adverse outcomes in chronic HF. Incorporating this parameter into clinical practice may improve risk stratification and help identify high-risk patients who could benefit from intensive monitoring or therapeutic interventions.</div><div><em>Full English text available from</em>: <span><span>www.revespcardiol.org/en</span><svg><path></path></svg></span></div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 3","pages":"Pages 204-214"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413527","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}
Pub Date : 2026-02-01Epub Date: 2025-09-16DOI: 10.1016/j.recesp.2025.07.002
Katarzyna Gendera , Stanimir Georgiev , Andreas Eicken , Andrea Amici , Alfred Hager , Maria von Stumm , Daniel Dilber , Peter Ewert , Pinar Bambul Heck
Introduction and objectives
Stent implantation has become the gold standard for the treatment of native coarctation of the aorta (CoA) and recurrent CoA in adolescents and adults. In smaller children, however, stent implantation remains technically challenging due to anatomical constraints and growth considerations. Furthermore, data on the optimal treatment strategy in this age group are still limited. This study retrospectively analyzed clinical outcomes in young children treated with stent implantation for recurrent aortic arch stenosis.
Methods
A total of 101 patients (63 male; 62%) with a body weight of less than 15 kg were treated with endovascular stent implantation for restenosis of the reconstructed aortic arch (n = 94; 93%) or native CoA (n = 7; 7%). The median age at the time of stent implantation was 4.8 months (IQR, 3.2-9.6 months) with a median body weight of 5.9 kg (IQR, 4.7-8.4 kg). The median follow-up period was 46.4 months (IQR, 11.0-76.6 months).
Results
All procedures were successful, and no serious complications occurred. The peak-to-peak gradient decreased significantly from a median of 32.5 mmHg (IQR, 17.3-46.0 mmHg) to 0.0 mmHg (IQR, 0.0-2.5 mmHg; P < .005). The diameter of the narrow segment increased from a median of 3.0 mm (IQR, 2.0-4.0 mm) to 6.9 mm (IQR, 6.0-8.0 mm; P < .005). During follow-up, none of the patients required reoperation
Conclusions
Stent implantation is a safe and feasible treatment option in patients with restenosis after complex aortic arch reconstruction or native CoA in whom surgical treatment would pose an elevated risk of complications. However, repeated dilatations and, ultimately, intentional stent fracture are required during follow-up.
简介与目的支架植入术已成为治疗青少年和成人先天性主动脉缩窄（CoA）和复发性CoA的金标准。然而，在较小的儿童中，由于解剖限制和生长考虑，支架植入在技术上仍然具有挑战性。此外，关于该年龄组最佳治疗策略的数据仍然有限。本研究回顾性分析了接受支架置入术治疗复发性主动脉弓狭窄的幼儿的临床结果。方法101例体重小于15 kg的主动脉弓再狭窄患者（男性63例，62%）分别采用血管内支架植入术（94例，93%）或天然辅酶a（7例，7%）治疗。支架植入时的中位年龄为4.8个月（IQR, 3.2-9.6个月），中位体重为5.9 kg （IQR, 4.7-8.4 kg）。中位随访时间为46.4个月（IQR, 11.0-76.6个月）。结果所有手术均成功，无严重并发症发生。峰间梯度从中位数32.5 mmHg （IQR, 17.3-46.0 mmHg）显著下降到0.0 mmHg （IQR, 0.0-2.5 mmHg; P < 0.005）。窄段直径中位数从3.0 mm （IQR, 2.0-4.0 mm）增加到6.9 mm （IQR, 6.0-8.0 mm; P < 0.005）。结论对于复杂主动脉弓重建后再狭窄或原发CoA术后手术治疗并发症风险较高的患者，支架植入术是一种安全可行的治疗方案。然而，在随访期间，需要反复扩张和最终故意支架断裂。
{"title":"Implante de stent para la estenosis recurrente tras la reparación del arco aórtico en niños pequeños: resultados a corto y medio plazo sin reintervenciones","authors":"Katarzyna Gendera , Stanimir Georgiev , Andreas Eicken , Andrea Amici , Alfred Hager , Maria von Stumm , Daniel Dilber , Peter Ewert , Pinar Bambul Heck","doi":"10.1016/j.recesp.2025.07.002","DOIUrl":"10.1016/j.recesp.2025.07.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Stent implantation has become the gold standard for the treatment of native coarctation of the aorta (CoA) and recurrent CoA in adolescents and adults. In smaller children, however, stent implantation remains technically challenging due to anatomical constraints and growth considerations. Furthermore, data on the optimal treatment strategy in this age group are still limited. This study retrospectively analyzed clinical outcomes in young children treated with <em>stent</em> implantation for recurrent aortic arch stenosis.</div></div><div><h3>Methods</h3><div>A total of 101 patients (63 male; 62%) with a body weight of less than 15<!--> <!-->kg were treated with endovascular <em>stent</em> implantation for restenosis of the reconstructed aortic arch (n<!--> <!-->=<!--> <!-->94; 93%) or native CoA (n<!--> <!-->=<!--> <!-->7; 7%). The median age at the time of stent implantation was 4.8 months (IQR, 3.2-9.6 months) with a median body weight of 5.9<!--> <!-->kg (IQR, 4.7-8.4<!--> <!-->kg). The median follow-up period was 46.4 months (IQR, 11.0-76.6 months).</div></div><div><h3>Results</h3><div>All procedures were successful, and no serious complications occurred. The peak-to-peak gradient decreased significantly from a median of 32.5<!--> <!-->mmHg (IQR, 17.3-46.0<!--> <!-->mmHg) to 0.0<!--> <!-->mmHg (IQR, 0.0-2.5<!--> <!-->mmHg; <em>P</em> <!--><<!--> <!-->.005). The diameter of the narrow segment increased from a median of 3.0<!--> <!-->mm (IQR, 2.0-4.0<!--> <!-->mm) to 6.9<!--> <!-->mm (IQR, 6.0-8.0<!--> <!-->mm; <em>P</em> <!--><<!--> <!-->.005). During follow-up, none of the patients required reoperation</div></div><div><h3>Conclusions</h3><div>Stent implantation is a safe and feasible treatment option in patients with restenosis after complex aortic arch reconstruction or native CoA in whom surgical treatment would pose an elevated risk of complications. However, repeated dilatations and, ultimately, intentional stent fracture are required during follow-up.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 2","pages":"Pages 142-150"},"PeriodicalIF":5.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039950","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}
Pub Date : 2026-02-01Epub Date: 2025-09-05DOI: 10.1016/j.recesp.2025.08.012
Ana Viana-Tejedor , Pedro Martínez Losas , Rut Andrea-Riba , Miguel Corbí-Pascual , Sandra Rosillo , Joaquín J. Alonso , Alessandro Sionís , Pablo Pastor , Pablo Jorge-Pérez , Cosme García-García
Intermediate cardiac care units (IMCU) provide a level of care between hospital wards and cardiac acute care units. They are designed for patients who require close monitoring or noncritical support, such as those with acute coronary syndromes, acute heart failure (HF), arrhythmias, monitoring after structural interventional cardiology or electrophysiology procedures, or postoperative care following cardiac surgery. IMCU help optimize resources and relieve pressure on cardiac acute care units, thereby improving specialized care. Two levels of IMCU are defined: level 1, which offers noninvasive monitoring and basic life support, and level 2, which incorporates invasive arterial pressure monitoring, noninvasive mechanical ventilation, and equipment for complex procedures. Their structure should be functional, with single-patient rooms, effective communication with other services, and dedicated areas for health care personnel. Care is led by cardiologists with specific training, supported by highly specialized nursing staff, and requires continuous medical coverage (24 hours a day, 7 days a week) based on well-defined clinical protocols. This model aims to provide efficient, safe, and excellence-driven care. The Spanish Society of Cardiology (SEC) promotes its development through this position statement of the SEC Ischemic Heart Disease and Acute Cardiovascular Care Association (SEC-ACICAC), intended to guide the implementation of IMCU in Spain.
{"title":"Unidades de cuidados intermedios cardiológicos: base racional, dotación e indicaciones de ingreso. Posicionamiento de la SEC-ACICAC","authors":"Ana Viana-Tejedor , Pedro Martínez Losas , Rut Andrea-Riba , Miguel Corbí-Pascual , Sandra Rosillo , Joaquín J. Alonso , Alessandro Sionís , Pablo Pastor , Pablo Jorge-Pérez , Cosme García-García","doi":"10.1016/j.recesp.2025.08.012","DOIUrl":"10.1016/j.recesp.2025.08.012","url":null,"abstract":"<div><div>Intermediate cardiac care units (IMCU) provide a level of care between hospital wards and cardiac acute care units. They are designed for patients who require close monitoring or noncritical support, such as those with acute coronary syndromes, acute heart failure (HF), arrhythmias, monitoring after structural interventional cardiology or electrophysiology procedures, or postoperative care following cardiac surgery. IMCU help optimize resources and relieve pressure on cardiac acute care units, thereby improving specialized care. Two levels of IMCU are defined: level 1, which offers noninvasive monitoring and basic life support, and level 2, which incorporates invasive arterial pressure monitoring, noninvasive mechanical ventilation, and equipment for complex procedures. Their structure should be functional, with single-patient rooms, effective communication with other services, and dedicated areas for health care personnel. Care is led by cardiologists with specific training, supported by highly specialized nursing staff, and requires continuous medical coverage (24<!--> <!-->hours a day, 7 days a week) based on well-defined clinical protocols. This model aims to provide efficient, safe, and excellence-driven care. The Spanish Society of Cardiology (SEC) promotes its development through this position statement of the SEC Ischemic Heart Disease and Acute Cardiovascular Care Association (SEC-ACICAC), intended to guide the implementation of IMCU in Spain.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"79 2","pages":"Pages 165-172"},"PeriodicalIF":5.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039952","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}
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