Revista espanola de cardiologia最新文献

英文中文

Impacto de la contaminación por partículas finas (PM2,5) en la frecuentación y mortalidad hospitalaria por infarto agudo de miocardio en España 细颗粒物污染（PM2.5）对西班牙急性心肌梗死住院率和死亡率的影响

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-07-02 DOI: 10.1016/j.recesp.2025.06.010

Raquel Campuzano , Julio Núñez , Violeta Sánchez , Juan José Gómez-Doblas , Vicente Arrarte , Ángel Cequier , Blanca Miranda , Cristina Fernández , Náyade Prado , Nicolás Rosillo , José Luis Bernal , Pablo Pérez , Sonia Gutiérrez , Jordi Bañeras

Introduction and objectives

Atherosclerotic vascular disease is the main cause of mortality attributable to air pollution. This study analyzes, for the first time, the association between levels of fine particulate matter (PM_2.5, particles ≤ 2.5 μm in diameter) and hospital admissions and in-hospital mortality due to acute myocardial infarction (AMI) in hospitals of the Spanish National Health System.

Methods

Data on air pollution, temperature, and humidity were obtained from the Ministry for the Ecological Transition and the Demographic Challenge, covering the period from 2016 to 2021. A total of 122 National Health System hospitals were geographically matched with environmental monitoring stations located within a 10 km radius. The study included 115 071 patients aged 18 years or older (mean age, 67 years; 28% women) who were discharged with a diagnosis of AMI during the study period. An autoregressive integrated moving average (ARIMA) model was applied to each hospital, and a meta-analysis was conducted to consolidate the estimates of the association between PM_2.5 levels and variations in AMI hospital admissions. The association between PM_2.5 pollution and in-hospital AMI mortality was analyzed using logistic regression models.

Results

Maximum 3-day average PM_2.5 levels exceeding 10 μg/m³ were associated with an additional 21.9 AMI hospital admissions per 1000 (95%CI, 9.1-34.8; P < .001). Furthermore, PM_2.5 levels above 25 μg/m³ (3-day moving average) were associated with an increased risk of in-hospital mortality due to AMI (OR, 1.14; 95%CI, 1.07-1.23; P < .001).

Conclusions

This study identifies a significant association between elevated PM_2.5 levels and increased hospital admissions and in-hospital mortality due to AMI in Spain, highlighting the importance of reducing air pollution as a critical factor in cardiovascular health.

简介与目的动脉粥样硬化性血管疾病是空气污染导致死亡的主要原因。本研究首次分析了西班牙国家卫生系统医院细颗粒物（PM2.5，直径≤2.5 μm的颗粒）水平与急性心肌梗死（AMI）住院率和住院死亡率之间的关系。方法从生态转型和人口挑战部获得2016年至2021年的空气污染、温度和湿度数据。共有122家国家卫生系统医院在地理上与10公里半径内的环境监测站相匹配。该研究纳入了115071例18岁及以上的患者（平均年龄67岁，28%为女性），这些患者在研究期间因AMI诊断出院。对每家医院应用自回归综合移动平均（ARIMA）模型，并进行荟萃分析，以巩固PM2.5水平与急性心肌梗死住院率变化之间的关联。采用logistic回归模型分析PM2.5污染与AMI住院死亡率之间的关系。结果最大3天平均PM2.5浓度超过10 μg/m3与每1000人额外21.9例AMI住院相关（95%CI, 9.1-34.8; P < .001）。此外，PM2.5浓度高于25 μg/m3（3天移动平均值）与AMI住院死亡风险增加相关（OR, 1.14; 95%CI, 1.07-1.23; P < .001）。本研究确定了PM2.5水平升高与西班牙AMI住院率和住院死亡率增加之间的显著关联，强调了减少空气污染作为心血管健康的关键因素的重要性。

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引用次数: 0

Congestión refractaria en la insuficiencia cardiaca: cuando lo convencional no basta 充血性心力衰竭：当常规方法不够时

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-26 DOI: 10.1016/j.recesp.2025.06.009

Rafael de la Espriella

引用次数: 0

Estrategia de seguridad en la extracción de electrodos de dispositivos cardiacos 心脏装置电极提取的安全策略

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-23 DOI: 10.1016/j.recesp.2025.06.006

Javier Miguelena Hycka , Victoria Cañadas-Godoy , Piercarmine Iorlano Mariano , Víctor Castro Urda , Diego Monzón Díaz , Jorge Rodríguez-Roda Stuart

引用次数: 0

Acoplamiento entre el ventrículo derecho y la arteria pulmonar como predictor de muerte o ingreso por IC en pacientes con insuficiencia tricuspídea grave 右心室与肺动脉的联接作为严重三联功能不全患者死亡或IC入院的预测因素

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-23 DOI: 10.1016/j.recesp.2025.04.012

Ana Fernández Ruiz , Martín Ruiz Ortiz , Consuelo Fernández-Avilés Irache , Ana María Rodríguez Almodóvar , Mónica Delgado Ortega , Fátima Esteban Martínez , Adriana Resúa Collazo , Gloria Heredia Campos , Rafael González Manzanares , José López Aguilera , Juan Carlos Castillo Domínguez , Manuel Anguita Sánchez , Manuel Pan Álvarez-Ossorio , Dolores Mesa Rubio

Introduction and objectives

The right ventricular-pulmonary arterial coupling, evaluated by tricuspid annular plane systolic excursion and pulmonary artery systolic pressure ratio (TAPSE/PASP), has been studied in the prognostic assessment of severe tricuspid regurgitation only in selected populations and mainly in relation to all-cause mortality.

Methods

We retrospectively included all adult patients with severe tricuspid regurgitation who underwent echocardiography at a tertiary care hospital between January 1, 2008, and December 31, 2017. We investigated the association of TAPSE/PASP, either as a continuous variable or dichotomized at < 0.31 mm/mmHg, with the combined endpoint of mortality and heart failure (HF) admission, as well as its usefulness in several subgroups of interest.

Results

A total of 474 patients (70 ± 13 years; 71% women) were included, with a median follow-up of 5 [p25-75, 2-7] years. During follow-up, 285 patients died and 192 experienced 481 HF admissions. Patients with TAPSE/PASP < 0.31 mm/mmHg had significantly worse HF admission-free survival at median follow-up (25% vs 53%, P < .0005). The discriminative ability of TAPSE/PASP was statistically significant (area under the curve, 0.69; 95%CI, 0.65-0.74; P < .0005). After multivariate adjustment, TAPSE/PASP remained an independent predictor of the combined endpoint (HR, 0.017; 95%CI, 0.004-0.075; P < .0005), with significant incremental prognostic value over clinical variables (P < .0005). The performance of the index was consistent in patients with pacemaker/defibrillator leads or prior cardiac surgery, but not in those with reduced ejection fraction.

Conclusions

In this cohort of patients with severe tricuspid regurgitation, TAPSE/PASP was a strong independent predictor of HF admission or mortality during long-term follow-up.

通过三尖瓣环平面收缩偏移和肺动脉收缩压比（TAPSE/PASP）评估的右心室-肺动脉耦合，仅在选定人群中研究了严重三尖瓣反流的预后评估，主要与全因死亡率有关。方法回顾性纳入2008年1月1日至2017年12月31日在三级医院接受超声心动图检查的所有严重三尖瓣反流成年患者。我们研究了TAPSE/PASP与死亡率和心力衰竭（HF）入院的联合终点的关联，无论是作为一个连续变量还是在0.31 mm/mmHg时进行二分类，以及它在几个感兴趣的亚组中的有效性。结果共纳入474例患者（70±13岁，71%为女性），中位随访时间为5年[p25- 75,2 -7]年。随访期间，285例患者死亡，192例有481例心衰入院。中位随访时，TAPSE/PASP <； 0.31 mm/mmHg的患者心衰无入院生存率明显较差（25% vs 53%, P < 0.0005）。TAPSE/PASP的判别能力有统计学意义（曲线下面积0.69;95%CI, 0.65 ~ 0.74; P < 0.0005）。多因素调整后，TAPSE/PASP仍然是联合终点的独立预测因子（HR, 0.017; 95%CI, 0.004-0.075; P < .0005），与临床变量相比，其预后价值显著增加（P < .0005）。该指数在使用起搏器/除颤器导联或既往心脏手术的患者中表现一致，但在射血分数降低的患者中则不一致。结论：在这组严重三尖瓣反流患者中，TAPSE/PASP是长期随访中心衰入院或死亡的一个强有力的独立预测因子。

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引用次数: 0

Congestión refractaria tras pericardiocentesis efectiva en un taponamiento cardiaco: pericarditis efusivoconstrictiva por Cutibacterium acnes 心肌梗塞有效心肌梗塞后的难治性梗塞：痤疮角膜杆菌引起的消化性收缩性心肌炎

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-23 DOI: 10.1016/j.recesp.2025.06.002

Meritxell Santaló-Corcoy , Laura Triguero-Llonch , Juan Fernández-Martínez , Jessica P. Arias-Pinilla , Miguel Ferrer-Menéndez , Ana Bonet-Basiero

引用次数: 0

Fracaso primario del injerto grave tras el trasplante cardiaco: tendencias y resultados en una cohorte española contemporánea 心脏移植后严重移植的主要失败：当代西班牙队列的趋势和结果

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-23 DOI: 10.1016/j.recesp.2025.04.006

Carlos Ortiz-Bautista , Luis Almenar-Bonet , David Couto-Mallón , José González-Costello , Javier Segovia-Cubero , Diego Rangel-Sousa , Joan Guzmán-Bofarull , Antonia Pomares-Varó , Juan F. Delgado-Jiménez , Beatriz Díaz-Molina , Iris P. Garrido-Bravo , Teresa Blasco-Peiró , María del Val Groba Marco , Javier Muñiz-García , Francisco González-Vílchez

Introduction and objectives

Severe primary graft dysfunction (PGD) is the leading cause of early mortality following heart transplant (HT). This study analyzed the temporal trends and mortality associated with severe PGD, identified risk factors, and developed a predictive model based on a contemporary cohort.

Methods

A total of 2029 HT performed between 2010 and 2020 in 14 Spanish centers were retrospectively analyzed. Patients with and without severe PGD were compared. Logistic regression was used to identify predictors of severe PGD and to generate a risk score. Model performance was assessed in terms of calibration and discrimination.

Results

The incidence of severe PGD was 10%, with an increase observed over the last 5 years (8% vs 11%). However, 30-day and 1-year mortality declined significantly (59.1% vs 38.8% and 69.7% vs 58.8%, respectively). Independent predictors of severe PGD included extracorporeal membrane oxygenation (OR, 2.79), pretransplant ventricular assist devices (OR, 2.11), donor-to-recipient weight ratio < 0.8 (OR, 2.11), and congenital heart disease (OR, 2.11). A risk score was created, showing good calibration but limited discriminative ability.

Conclusions

Despite a rising incidence of severe PGD, mortality showed a marked decrease. Predictors of severe PGD included congenital heart disease, a donor-to-recipient weight ratio < 0.8, and the use of extracorporeal membrane oxygenation or pretransplant ventricular assist devices. The predictive model showed good calibration but only moderate discriminative performance.

简介和目的严重的原发性移植物功能障碍（PGD）是心脏移植（HT）术后早期死亡的主要原因。本研究分析了与严重PGD相关的时间趋势和死亡率，确定了危险因素，并基于当代队列建立了预测模型。方法回顾性分析2010年至2020年西班牙14个中心共2029例HT。比较有和没有严重PGD的患者。使用逻辑回归来确定严重PGD的预测因素并生成风险评分。从校准和判别两方面对模型性能进行了评估。结果严重PGD的发生率为10%，在过去5年中观察到增加（8%对11%）。然而，30天和1年死亡率显著下降（分别为59.1%对38.8%和69.7%对58.8%）。严重PGD的独立预测因子包括体外膜氧合（OR, 2.79）、移植前心室辅助装置（OR, 2.11）、供体与受体体重比（OR, 2.11）和先天性心脏病（OR, 2.11）。建立了一个风险评分，显示出良好的校准，但区分能力有限。结论重度PGD发病率上升，但死亡率明显下降。严重PGD的预测因素包括先天性心脏病、供体与受体体重比0.8、体外膜氧合或移植前心室辅助装置的使用。该预测模型具有良好的校正性，但判别性能一般。

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引用次数: 0

Puente epicárdico de aleteo auricular. Al alcance del catéter 耳鳍桥。触手可及的导管

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-23 DOI: 10.1016/j.recesp.2025.04.007

Alejandro Carta-Bergaz , Ángel Arenal-Maíz

引用次数: 0

Miocarditis por vasculitis de vaso pequeño: una etiología infrecuente 小血管炎引起的心肌炎：罕见病因

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-11 DOI: 10.1016/j.recesp.2025.06.001

Alejandro Gullón de la Roza , María Salgado Barquinero , María Fernández García , Beatriz Nieves Ureña , Fernando López Iglesias , María Martín Fernández

引用次数: 0

Corrección en el artículo del Grupo de Trabajo de la SEC y el Comité de Guías de la SEC «Comentarios a la guía ESC 2024 sobre el tratamiento de la presión arterial elevada y de la hipertensión», Rev Esp Cardiol. 2025;78:296-300 对美国证券交易委员会工作组和美国证券交易委员会指导委员会文章《对ESC 2024年高血压和高血压治疗指南的评论》的更正，Rev Esp Cardiol. 2025;78:296-300

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-11 DOI: 10.1016/j.recesp.2025.05.011

引用次数: 0

Abordaje y consumo de recursos sanitarios en la miocardiopatía hipertrófica obstructiva en España: un estudio de la vida real 西班牙阻塞性肥厚性心肌病的卫生资源消耗和负担：一项现实生活研究

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-06-11 DOI: 10.1016/j.recesp.2025.04.004

Roberto Barriales-Villa , Luis Escobar-López , David Vilanova Larena , Joel Salazar-Mendiguchía , Ainara Echeto , Ignacio Hernández , Elena Rebollo-Gómez , Juan Ramón Gimeno

Introduction and objectives

Obstructive hypertrophic cardiomyopathy (oHCM), whose symptoms range from dyspnea to heart failure or sudden cardiac death, accounts for approximately 70% of all hypertrophic cardiomyopathy cases. This study aimed to analyze the lack of comprehensive data on oHCM management and determine its clinical and economic burden in Spain.

Methods

This retrospective observational study, based on electronic medical records (BIG-PAC), enrolled adults from 1 January 2014, to 31 October 2022, from the time of HCM diagnosis. The analysis focused on epidemiology, patient characteristics and management, transitions between New York Heart Association (NYHA) functional classes, healthcare resource utilization (HCRU), and associated costs.

Results

A total of 752 oHCM patients were included (mean age: 63 years; male: 57.6%). NYHA functional classification at diagnosis was as follows: 12% NYHA-I, 47.9% NYHA-II, 31.5% NYHA-III, and 8.6% NYHA-IV. The prevalence of HCM and oHCM was 28 and 7 per 10 000 individuals, respectively. Patients received a mean of 2.4 (SD 1.5) treatments, mainly beta-blockers. Only patients in NYHA classes III and IV underwent septal reduction therapies (SRT) (13.1% and 47.7%, respectively); 38.7% and 35.5% of NYHA-III and -IV patients who received SRT, respectively, improved to a lower NYHA class. Symptom severity, as measured by NYHA class, was associated with increased rates of hospitalization, cardiovascular events, mortality, and higher HCRU and costs. Mean annualized, direct, adjusted health care costs ranged from €4142 (95%CI: €3110-€5175) in NYHA-I to €16 677 (95%CI: €15 482-€17 872) in NYHA-IV.

Conclusions

This is the first Spanish study to evaluate oHCM patient management and to demonstrate its impact in terms of increased hospitalizations, mortality, HCRU, and healthcare costs, trends that parallel the progression of symptoms by NYHA functional class. Patients who underwent SRT showed partial symptom improvement.

梗阻性肥厚性心肌病（oHCM）的症状从呼吸困难到心力衰竭或心源性猝死，约占所有肥厚性心肌病病例的70%。本研究旨在分析西班牙缺乏全面的oHCM管理数据，并确定其临床和经济负担。方法本回顾性观察性研究基于电子病历（BIG-PAC），从2014年1月1日至2022年10月31日，从HCM诊断开始。分析的重点是流行病学、患者特征和管理、纽约心脏协会（NYHA）功能类别之间的转换、医疗资源利用率（HCRU）和相关成本。结果共纳入oHCM患者752例，平均年龄63岁，男性占57.6%。诊断时NYHA功能分类为：NYHA- i占12%，NYHA- ii占47.9%，NYHA- iii占31.5%，NYHA- iv占8.6%。HCM和oHCM的患病率分别为28 / 10000和7 / 10000。患者平均接受2.4次（SD 1.5）治疗，主要是β受体阻滞剂。只有NYHA III级和IV级患者接受了间隔缩小治疗（SRT）（分别为13.1%和47.7%）；接受SRT治疗的NYHA- iii和-IV患者分别有38.7%和35.5%改善到较低的NYHA级别。NYHA分级测量的症状严重程度与住院率、心血管事件、死亡率、HCRU和成本升高相关。NYHA-I的平均年化直接调整后医疗保健费用为4142欧元（95%置信区间：3110- 5175欧元），NYHA-IV的平均年化直接调整后医疗保健费用为16 677欧元（95%置信区间：15 482- 17 872欧元）。结论：这是西班牙第一个评估oHCM患者管理的研究，并证明其在增加住院率、死亡率、HCRU和医疗费用方面的影响，以及NYHA功能等级与症状进展平行的趋势。接受SRT的患者表现出部分症状改善。

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