Pub Date : 2025-04-15DOI: 10.1016/j.recesp.2024.11.018
Amaia Martínez León , David Testa Alonso , María Salgado , Minel Soroa , Daniel García-Iglesias , David Calvo
{"title":"Bloqueo de la conducción interauricular como consecuencia del aislamiento antral ampliado de las venas pulmonares","authors":"Amaia Martínez León , David Testa Alonso , María Salgado , Minel Soroa , Daniel García-Iglesias , David Calvo","doi":"10.1016/j.recesp.2024.11.018","DOIUrl":"10.1016/j.recesp.2024.11.018","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 6","pages":"Pages 571-573"},"PeriodicalIF":5.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134696","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 : 2025-04-15DOI: 10.1016/j.recesp.2025.02.011
David Hong, Minseok Hong, Onyou Kim, Heayoung Shin, Minjung Bak, Darae Kim, Jihoon Kim, Ki Hong Choi, Eun Kyoung Kim, Joo Myung Lee, Jeong Hoon Yang, Sung-A. Chang, Sung-Ji Park, Sang-Chol Lee, Seung Woo Park, Jin-Oh Choi
Introduction and objectives
This study aimed to evaluate the efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors throughout the spectrum of kidney function in patients with heart failure (HF).
Methods
This meta-analysis included randomized controlled trials comparing SGLT2 inhibitors with placebo in patients with HF stratified by renal function. Literature from inception to June 8, 2024 was searched. The primary outcome was a composite of cardiovascular death or HF events.
Results
Five trials were identified, comprising 21 204 patients (10 605 in the SGLT2 inhibitor group and 10 599 in the placebo group) who were randomized and followed up for a weighted median duration of 1.8 years. When patients were classified by estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2, SGLT2 inhibitors reduced the risk of the primary outcome irrespective of kidney function (RR, 0.81; 95%CI, 0.75-0.87; P < .01 for eGFR < 60 mL/min/1.73 m2; RR, 0.79; 95%CI, 0.72-0.87; P < .01 for eGFR≥ 60 mL/min/1.73 m2; test for subgroup differences P = .75). The beneficial impact of SGLT2 inhibitors was consistently observed when patients were further subclassified by eGFR values of 20-30, 30-45, 45-60, and > 60 mL/min/1.73 m2 (test for subgroup differences, P = .54). Early eGFR decline showed a differential impact with increased risk only in the placebo subgroup (RR, 1.30; 95%CI, 1.15-1.47; P < .01), but not in the SGLT2 inhibitor subgroup (RR, 0.99; 95%CI, 0.86-1.13; P = .84) (test for subgroup differences, P < .01).
Conclusions
SGLT2 inhibitor therapy is safe and effective throughout the spectrum of kidney function and regardless of the initial decline in kidney function in patients with chronic HF.
{"title":"Eficacia y seguridad de los inhibidores de SGLT2 en pacientes con insuficiencia cardiaca según la función renal: revisión sistemática y metanálisis","authors":"David Hong, Minseok Hong, Onyou Kim, Heayoung Shin, Minjung Bak, Darae Kim, Jihoon Kim, Ki Hong Choi, Eun Kyoung Kim, Joo Myung Lee, Jeong Hoon Yang, Sung-A. Chang, Sung-Ji Park, Sang-Chol Lee, Seung Woo Park, Jin-Oh Choi","doi":"10.1016/j.recesp.2025.02.011","DOIUrl":"10.1016/j.recesp.2025.02.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>This study aimed to evaluate the efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors throughout the spectrum of kidney function in patients with heart failure (HF).</div></div><div><h3>Methods</h3><div>This meta-analysis included randomized controlled trials comparing SGLT2 inhibitors with placebo in patients with HF stratified by renal function. Literature from inception to June 8, 2024 was searched. The primary outcome was a composite of cardiovascular death or HF events.</div></div><div><h3>Results</h3><div>Five trials were identified, comprising 21 204 patients (10 605 in the SGLT2 inhibitor group and 10 599 in the placebo group) who were randomized and followed up for a weighted median duration of 1.8 years. When patients were classified by estimated glomerular filtration rate (eGFR) of 60<!--> <!-->mL/min/1.73 m<sup>2</sup>, SGLT2 inhibitors reduced the risk of the primary outcome irrespective of kidney function (RR, 0.81; 95%CI, 0.75-0.87; <em>P</em> <!--><<!--> <!-->.01 for eGFR <<!--> <!-->60<!--> <!-->mL/min/1.73 m<sup>2</sup>; RR, 0.79; 95%CI, 0.72-0.87; <em>P</em> <!--><<!--> <!-->.01 for eGFR≥ 60<!--> <!-->mL/min/1.73 m<sup>2</sup>; test for subgroup differences <em>P</em> <!-->=<!--> <!-->.75). The beneficial impact of SGLT2 inhibitors was consistently observed when patients were further subclassified by eGFR values of 20-30, 30-45, 45-60, and ><!--> <!-->60<!--> <!-->mL/min/1.73 m<sup>2</sup> (test for subgroup differences, <em>P<!--> </em>=<!--> <!-->.54). Early eGFR decline showed a differential impact with increased risk only in the placebo subgroup (RR, 1.30; 95%CI, 1.15-1.47; <em>P</em> <!--><<!--> <!-->.01), but not in the SGLT2 inhibitor subgroup (RR, 0.99; 95%CI, 0.86-1.13; <em>P</em> <!-->=<!--> <!-->.84) (test for subgroup differences, <em>P</em> <!--><<!--> <!-->.01).</div></div><div><h3>Conclusions</h3><div>SGLT2 inhibitor therapy is safe and effective throughout the spectrum of kidney function and regardless of the initial decline in kidney function in patients with chronic HF.</div><div>Registered at PROSPERO: CRD42024565218.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 9","pages":"Pages 789-799"},"PeriodicalIF":5.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895209","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 : 2025-04-15DOI: 10.1016/j.recesp.2025.01.016
Andrea Ruberti , Pedro Cepas-Guillén , Julio Echarte-Morales , Dabit Arzamendi , Vanessa Moñivas , Fernando Carrasco-Chinchilla , Manuel Pan , Luis Nombela-Franco , Isaac Pascual , Claudio E. Guerreiro , Tomás Benito-González , Ruth Pérez , Iván Gómez-Blázquez , Ignacio J. Amat-Santos , Eduardo Flores-Umanzor , Ignacio Cruz-González , Ángel Sánchez-Recalde , Ana Belén Cid Álvarez , Manuel Barreiro-Pérez , Laura Sanchis , Xavier Freixa
Introduction and objectives
This study aimed to assess the effectiveness and clinical outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with cardiac implantable electronic devices (CIEDs).
Methods
This subanalysis of the Transcatheter Tricuspid Valve Repair in Spain (TRI-SPA) registry included patients with at least severe tricuspid regurgitation (TR) who were treated with T-TEER between June 2020 and May 2023 in Spain. Patients with CIEDs and no or mild tricuspid lead-leaflet interaction were compared with those without CIEDs. The primary composite endpoint was all-cause mortality, heart failure-related hospitalization, and tricuspid valve reintervention at 12 months.
Results
Among 310 patients (mean age 75.5 ± 9.1 years, 70% female) with significant TR treated with T-TEER, 35 (11%) had CIEDs. Device implantation success was high in both groups (97.1% in the CIED group vs 96.4% in the non-CIED group, P = .81), with a similar rate of ≤ 2+ residual TR (84.9% in the CIED group vs 91.0% in the non-CIED group, P = .26). Patients with CIEDs experienced comparable rates of the primary composite endpoint to the non-CIED group (23.8% vs 19.1%, respectively, HR, 1.40; 95%CI, 0.60-3.31; P = .44), sustained successful TR reduction (≤ 2+ in 55.0% vs 73.8%, P = .07), and functional improvement (NYHA class I/II 81.8% vs 79.9%, P = .79).
Conclusions
In a real-world setting, T-TEER seems to be an effective therapeutic option for selected patients with more than moderate TR and CIEDs with no or mild lead-leaflet interaction, offering comparable cardiovascular outcomes and clinical improvement to those without leads. However, the presence of CIEDs may represent an independent risk factor for TR recurrence.
本研究旨在评估三尖瓣经导管边缘到边缘修复（T-TEER）在心脏植入式电子装置（cied）患者中的有效性和临床结果。方法：对西班牙经导管三尖瓣修复（TRI-SPA）登记的患者进行亚分析，包括2020年6月至2023年5月在西班牙接受T-TEER治疗的至少严重三尖瓣反流（TR）患者。没有或轻度三尖瓣铅-小叶相互作用的cied患者与没有cied的患者进行比较。主要综合终点为全因死亡率、心力衰竭相关住院和12个月时三尖瓣再干预。结果在接受T-TEER治疗的310例明显TR患者中（平均年龄75.5±9.1岁，70%为女性），35例（11%）发生cied。两组植入术成功率均较高（CIED组为97.1%，非CIED组为96.4%,P = 0.81），残余TR≤2+的比例相似（CIED组为84.9%，非CIED组为91.0%,P = 0.26）。cied患者的主要综合终点率与非cied组相当（分别为23.8% vs 19.1%， HR为1.40；95%CI为0.60-3.31;P = 0.44），持续成功的TR降低（55.0% vs 73.8%, P = 0.07）和功能改善（NYHA I/II类81.8% vs 79.9%, P = 0.79）。结论：在现实环境中，T-TEER似乎是中度以上TR和cied患者的有效治疗选择，没有或轻微的铅叶相互作用，与没有铅叶的患者相比，T-TEER提供了相当的心血管结局和临床改善。然而，cied的存在可能是TR复发的独立危险因素。
{"title":"Eficacia de la reparación percutánea de borde a borde para la insuficiencia tricuspídea en pacientes portadores de dispositivos cardiacos implantables: resultados del registro TRI-SPA","authors":"Andrea Ruberti , Pedro Cepas-Guillén , Julio Echarte-Morales , Dabit Arzamendi , Vanessa Moñivas , Fernando Carrasco-Chinchilla , Manuel Pan , Luis Nombela-Franco , Isaac Pascual , Claudio E. Guerreiro , Tomás Benito-González , Ruth Pérez , Iván Gómez-Blázquez , Ignacio J. Amat-Santos , Eduardo Flores-Umanzor , Ignacio Cruz-González , Ángel Sánchez-Recalde , Ana Belén Cid Álvarez , Manuel Barreiro-Pérez , Laura Sanchis , Xavier Freixa","doi":"10.1016/j.recesp.2025.01.016","DOIUrl":"10.1016/j.recesp.2025.01.016","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>This study aimed to assess the effectiveness and clinical outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with cardiac implantable electronic devices (CIEDs).</div></div><div><h3>Methods</h3><div>This subanalysis of the Transcatheter Tricuspid Valve Repair in Spain (TRI-SPA) registry included patients with at least severe tricuspid regurgitation (TR) who were treated with T-TEER between June 2020 and May 2023 in Spain. Patients with CIEDs and no or mild tricuspid lead-leaflet interaction were compared with those without CIEDs. The primary composite endpoint was all-cause mortality, heart failure-related hospitalization, and tricuspid valve reintervention at 12 months.</div></div><div><h3>Results</h3><div>Among 310 patients (mean age 75.5<!--> <!-->±<!--> <!-->9.1 years, 70% female) with significant TR treated with T-TEER, 35 (11%) had CIEDs. Device implantation success was high in both groups (97.1% in the CIED group vs 96.4% in the non-CIED group, <em>P</em> <!-->=<!--> <!-->.81), with a similar rate of ≤<!--> <!-->2+ residual TR (84.9% in the CIED group vs 91.0% in the non-CIED group, <em>P</em> <!-->=<!--> <!-->.26). Patients with CIEDs experienced comparable rates of the primary composite endpoint to the non-CIED group (23.8% vs 19.1%, respectively, HR, 1.40; 95%CI, 0.60-3.31; <em>P</em> <!-->=<!--> <!-->.44), sustained successful TR reduction (≤<!--> <!-->2+ in 55.0% vs 73.8%, <em>P</em> <!-->=<!--> <!-->.07), and functional improvement (NYHA class I/II 81.8% vs 79.9%, <em>P</em> <!-->=<!--> <!-->.79).</div></div><div><h3>Conclusions</h3><div>In a real-world setting, T-TEER seems to be an effective therapeutic option for selected patients with more than moderate TR and CIEDs with no or mild lead-leaflet interaction, offering comparable cardiovascular outcomes and clinical improvement to those without leads. However, the presence of CIEDs may represent an independent risk factor for TR recurrence.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Pages 863-875"},"PeriodicalIF":5.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181344","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 : 2025-04-11DOI: 10.1016/j.recesp.2025.03.012
Covadonga Fernández-Golfín , Ana García-Martín
{"title":"Del estetoscopio a la inteligencia artificial: decodificando la enfermedad tricuspídea","authors":"Covadonga Fernández-Golfín , Ana García-Martín","doi":"10.1016/j.recesp.2025.03.012","DOIUrl":"10.1016/j.recesp.2025.03.012","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Pages 848-849"},"PeriodicalIF":5.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181400","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 : 2025-04-10DOI: 10.1016/j.recesp.2024.11.022
Héctor Bueno , Germán Seara , María Rosario Azcutia , María Jesús Rodríguez-García , Sonia Peláez , Yolanda Agra , Carla A. Dueñas , Pedro Gullón , Pilar Aparicio Azcárraga , en representación del Comité Asesor Multidisciplinar de la Estrategia en Salud Cardiovascular del Sistema Nacional de Salud (ESCAV)
Introduction and objectives
Cardiovascular disease (CVD) remains the leading cause of death in most countries; however, few specific political actions have been implemented to improve cardiovascular health at both national and international levels. We aimed to describe the methodology used for the development and initial rollout of Spain's Cardiovascular Health Strategy of the National Health System (ESCAV, Estrategia en Salud Cardiovascular del Sistema Nacional de Salud).
Methods
A multidisciplinary team comprising diverse stakeholders developed a national strategy to reduce the burden of CVD in Spain. The team used qualitative methodologies to identify and select priorities and design strategic map models.
Results
The strategy was structured around a matrix with 6 cross-cutting themes (citizen empowerment; health promotion, prevention, and early CVD detection; comprehensive management of acute and chronic CVD; health care coordination; equity; and knowledge management) and 4 longitudinal lines (ischemic heart disease, heart failure, arrhythmias, and valve disease). The framework was further supported by 3 overarching axes: continuity of care, patient safety, and leveraging of information systems. A total of 27 critical points were selected, leading to the definition of 99 strategic objectives (32 general and 67 specific) and 136 actions through iterative reviews and prioritization. Strategic maps were developed for the overall strategy and for each action line, incorporating 61 indicators to facilitate and monitor the development of the strategy.
Conclusions
ESCAV represents one of the most ambitious initiatives aimed at transforming a nation's cardiovascular health. The methods and steps undertaken in this process could serve as a valuable reference for other countries seeking to establish similar initiatives. Furthermore, it may act as a catalyst to advance efforts toward establishing a European plan for cardiovascular health.
简介和目的心血管疾病（CVD）仍然是大多数国家的主要死亡原因；然而，在国家和国际两级，为改善心血管健康而采取的具体政治行动很少。我们的目的是描述用于制定和初步推出西班牙国家卫生系统心血管健康战略（ESCAV, Estrategia en Salud Cardiovascular del Sistema Nacional de Salud）的方法。方法一个由不同利益相关者组成的多学科团队制定了一项减少西班牙心血管疾病负担的国家战略。该团队使用定性方法来确定和选择优先级，并设计战略地图模型。结果该战略是围绕6个交叉主题(公民赋权；促进健康、预防和早期发现心血管疾病；急慢性心血管疾病的综合管理；卫生保健协调；股本;（知识管理）和4条纵线（缺血性心脏病、心力衰竭、心律失常和瓣膜疾病）。该框架得到了三个总体轴的进一步支持：护理的连续性、患者安全和信息系统的利用。总共选择了27个关键点，通过反复审查和确定优先顺序，确定了99个战略目标（32个一般目标和67个具体目标）和136项行动。为整个战略和每项行动制定了战略地图，其中包括61项指标，以促进和监测战略的制定。sescav是旨在改变一个国家心血管健康状况的最雄心勃勃的举措之一。在这一进程中采取的方法和步骤可以作为寻求建立类似倡议的其他国家的宝贵参考。此外，它还可能成为推动建立欧洲心血管健康计划的催化剂。
{"title":"Desarrollo y puesta en marcha de un plan nacional de salud cardiovascular. Estrategia en salud cardiovascular (ESCAV) española","authors":"Héctor Bueno , Germán Seara , María Rosario Azcutia , María Jesús Rodríguez-García , Sonia Peláez , Yolanda Agra , Carla A. Dueñas , Pedro Gullón , Pilar Aparicio Azcárraga , en representación del Comité Asesor Multidisciplinar de la Estrategia en Salud Cardiovascular del Sistema Nacional de Salud (ESCAV)","doi":"10.1016/j.recesp.2024.11.022","DOIUrl":"10.1016/j.recesp.2024.11.022","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiovascular disease (CVD) remains the leading cause of death in most countries; however, few specific political actions have been implemented to improve cardiovascular health at both national and international levels. We aimed to describe the methodology used for the development and initial rollout of Spain's Cardiovascular Health Strategy of the National Health System (ESCAV, <em>Estrategia en Salud Cardiovascular del Sistema Nacional de Salud</em>).</div></div><div><h3>Methods</h3><div>A multidisciplinary team comprising diverse stakeholders developed a national strategy to reduce the burden of CVD in Spain. The team used qualitative methodologies to identify and select priorities and design strategic map models.</div></div><div><h3>Results</h3><div>The strategy was structured around a matrix with 6 cross-cutting themes (citizen empowerment; health promotion, prevention, and early CVD detection; comprehensive management of acute and chronic CVD; health care coordination; equity; and knowledge management) and 4 longitudinal lines (ischemic heart disease, heart failure, arrhythmias, and valve disease). The framework was further supported by 3 overarching axes: continuity of care, patient safety, and leveraging of information systems. A total of 27 critical points were selected, leading to the definition of 99 strategic objectives (32 general and 67 specific) and 136 actions through iterative reviews and prioritization. Strategic maps were developed for the overall strategy and for each action line, incorporating 61 indicators to facilitate and monitor the development of the strategy.</div></div><div><h3>Conclusions</h3><div>ESCAV represents one of the most ambitious initiatives aimed at transforming a nation's cardiovascular health. The methods and steps undertaken in this process could serve as a valuable reference for other countries seeking to establish similar initiatives. Furthermore, it may act as a catalyst to advance efforts toward establishing a European plan for cardiovascular health.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 7","pages":"Pages 628-636"},"PeriodicalIF":5.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481500","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 : 2025-04-10DOI: 10.1016/j.recesp.2025.02.012
Marcos Ferrández-Escarabajal, Gina LaRocca
{"title":"«Falso positivo» en CRM de estrés en un paciente con amiloidosis cardiaca","authors":"Marcos Ferrández-Escarabajal, Gina LaRocca","doi":"10.1016/j.recesp.2025.02.012","DOIUrl":"10.1016/j.recesp.2025.02.012","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Page 929"},"PeriodicalIF":5.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181348","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 : 2025-04-08DOI: 10.1016/j.recesp.2025.02.018
Juan Alfonso Zamorano-Vargas , Mikel Izquierdo , Robinson Ramírez-Vélez
{"title":"La cinética del consumo de oxígeno durante la recuperación posterior al ejercicio se ve afectada en pacientes con COVID-19 prolongada: un estudio transversal","authors":"Juan Alfonso Zamorano-Vargas , Mikel Izquierdo , Robinson Ramírez-Vélez","doi":"10.1016/j.recesp.2025.02.018","DOIUrl":"10.1016/j.recesp.2025.02.018","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 12","pages":"Pages 1120-1122"},"PeriodicalIF":5.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579135","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 : 2025-04-05DOI: 10.1016/j.recesp.2025.01.022
Woochan Kwon , Taek Kyu Park , Ki Hong Choi , Joo Myung Lee , Jeong Hoon Yang , Young Bin Song , Joo-Yong Hahn , Hyeon-Cheol Gwon , Seung-Hyuk Choi
Introduction and objectives
The clinical benefits of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remain controversial. This study aimed to investigate whether PCI for CTO located in the left anterior descending artery (LAD) could have beneficial effects on clinical outcomes.
Methods
Patients were retrospectively selected from a single-center CTO registry and followed up for approximately 10 years. The patients were grouped based on the presence of LAD CTO and whether the CTO was revascularized. Inverse probability weighting adjustment was also performed. The primary outcome was the composite of cardiac death or myocardial infarction at 10 years.
Results
Among 1323 patients with CTO, 1034 were male, and 417 had LAD CTO. PCI was attempted in 72.2% of participants in the LAD CTO group and in 49.9% of those in the non-LAD CTO group. In the non-LAD CTO group, PCI did not significantly affect the primary outcome (medical therapy vs PCI, 20.7% vs 13.4%, adjusted HR: 0.72, 95%CI, 0.47–1.10; P = .13). However, a significant difference in the incidence of the primary outcome between the treatment methods was observed in the LAD CTO group (30.8% vs 15.4%; adjusted HR: 0.44; 95%CI, 0.25-0.81; P = .007). A significant interaction was observed between LAD CTO and treatment method (P for interaction = .011).
Conclusions
The benefits of PCI compared with medical therapy for CTO might be more apparent when the CTO is located in the LAD.
简介和目的经皮冠状动脉介入治疗慢性全闭塞（CTO）的临床益处仍存在争议。本研究旨在探讨PCI治疗位于左前降支（LAD）的CTO是否会对临床结果产生有益影响。方法回顾性地从单中心CTO登记中选择患者，随访约10年。根据LAD CTO的存在和CTO是否血运重建对患者进行分组。还进行了逆概率加权调整。主要结局是10年时心脏死亡或心肌梗死的综合结果。结果1323例CTO中，男性1034例，LAD CTO 417例。在LAD CTO组中有72.2%的参与者尝试PCI，而在非LAD CTO组中有49.9%的参与者尝试PCI。在非lad CTO组中，PCI对主要结局没有显著影响（药物治疗vs PCI， 20.7% vs 13.4%，调整后风险比：0.72,95%CI, 0.47-1.10; P = 0.13）。然而，在LAD CTO组中，两种治疗方法的主要结局发生率有显著差异（30.8% vs 15.4%；调整后危险度：0.44;95%CI, 0.25-0.81; P = 0.007）。LAD CTO与治疗方法之间存在显著的交互作用（交互作用P = 0.011）。结论当CTO位于LAD时，PCI治疗CTO的优势比药物治疗更明显。
{"title":"Localización de la oclusión total crónica y resultados tras la intervención coronaria percutánea o el tratamiento médico: seguimiento a 10 años de un registro unicéntrico","authors":"Woochan Kwon , Taek Kyu Park , Ki Hong Choi , Joo Myung Lee , Jeong Hoon Yang , Young Bin Song , Joo-Yong Hahn , Hyeon-Cheol Gwon , Seung-Hyuk Choi","doi":"10.1016/j.recesp.2025.01.022","DOIUrl":"10.1016/j.recesp.2025.01.022","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The clinical benefits of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remain controversial. This study aimed to investigate whether PCI for CTO located in the left anterior descending artery (LAD) could have beneficial effects on clinical outcomes.</div></div><div><h3>Methods</h3><div>Patients were retrospectively selected from a single-center CTO registry and followed up for approximately 10 years. The patients were grouped based on the presence of LAD CTO and whether the CTO was revascularized. Inverse probability weighting adjustment was also performed. The primary outcome was the composite of cardiac death or myocardial infarction at 10 years.</div></div><div><h3>Results</h3><div>Among 1323 patients with CTO, 1034 were male, and 417 had LAD CTO. PCI was attempted in 72.2% of participants in the LAD CTO group and in 49.9% of those in the non-LAD CTO group. In the non-LAD CTO group, PCI did not significantly affect the primary outcome (medical therapy vs PCI, 20.7% vs 13.4%, adjusted HR: 0.72, 95%CI, 0.47–1.10; <em>P</em> <!-->=<!--> <!-->.13). However, a significant difference in the incidence of the primary outcome between the treatment methods was observed in the LAD CTO group (30.8% vs 15.4%; adjusted HR: 0.44; 95%CI, 0.25-0.81; <em>P</em> <!-->=<!--> <!-->.007). A significant interaction was observed between LAD CTO and treatment method (<em>P</em> for interaction<!--> <!-->=<!--> <!-->.011).</div></div><div><h3>Conclusions</h3><div>The benefits of PCI compared with medical therapy for CTO might be more apparent when the CTO is located in the LAD.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Pages 850-859"},"PeriodicalIF":5.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181345","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 : 2025-04-02DOI: 10.1016/j.recesp.2025.01.020
Daiana Ibarretxe-Guerediaga , Cristina Marimón , Albert Feliu , Cèlia Rodríguez-Borjabad , Núria Plana , Lluís Masana
{"title":"Muerte súbita en un niño con hipercolesterolemia familiar homocigota y cardiomiopatía no compactada. ¿Es solo una coincidencia?","authors":"Daiana Ibarretxe-Guerediaga , Cristina Marimón , Albert Feliu , Cèlia Rodríguez-Borjabad , Núria Plana , Lluís Masana","doi":"10.1016/j.recesp.2025.01.020","DOIUrl":"10.1016/j.recesp.2025.01.020","url":null,"abstract":"","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Pages 922-924"},"PeriodicalIF":5.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181395","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 : 2025-03-28DOI: 10.1016/j.recesp.2025.02.005
Luigi P. Badano , Marco Penso , Michele Tomaselli , Kyu Kim , Alexandra Clement , Noela Radu , Geu-Ru Hong , Diana R. Hădăreanu , Alexandra Buta , Caterina Delcea , Samantha Fisicaro , Gianfranco Parati , Chi Young Shim , Denisa Muraru
Introduction and objectives
Significant secondary tricuspid regurgitation (STR) is associated with poor prognosis, but its heterogeneity makes predicting patient outcomes challenging. Our objective was to identify STR prognostic phenogroups.
Methods
We analyzed 758 patients with moderate-to-severe STR: 558 (74 ± 14 years, 55% women) in the derivation cohort and 200 (73 ± 12 years, 60% women) in the external validation cohort. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality.
Results
We identified 3 phenogroups. The low-risk phenogroup (2-year event-free survival 80%, 95%CI, 74%-87%) had moderate STR, preserved right ventricular (RV) size and function, and a moderately dilated but normally functioning right atrium. The intermediate-risk phenogroup (HR, 2.20; 95%CI, 1.44-3.37; P < .001) included older patients with severe STR, and a mildly dilated but uncoupled RV. The high-risk phenogroup (HR, 4.67; 95%CI, 3.20-6.82; P < .001) included younger patients with massive-to-torrential tricuspid regurgitation, as well as severely dilated and dysfunctional RV and right atrium. Multivariable analysis confirmed the clustering as independently associated with the composite endpoint (HR, 1.40; 95%CI, 1.13-1.70; P = .002). A supervised machine learning model, developed to assist clinicians in assigning patients to the 3 phenogroups, demonstrated excellent performance both in the derivation cohort (accuracy = 0.91, precision = 0.91, recall = 0.91, and F1 score = 0.91) and in the validation cohort (accuracy = 0.80, precision = 0.78, recall = 0.78, and F1 score = 0.77).
Conclusions
The unsupervised cluster analysis identified 3 risk phenogroups, which could assist clinicians in developing more personalized treatment and follow-up strategies for STR patients.
重要的继发性三尖瓣反流（STR）与不良预后相关，但其异质性使得预测患者预后具有挑战性。我们的目的是确定STR预后表型。方法对758例中重度STR患者进行分析：衍生队列558例（74±14岁，55%为女性），外部验证队列200例（73±12岁，60%为女性）。主要终点是心力衰竭住院和全因死亡率的综合。结果共鉴定出3个表型组。低风险表型组（2年无事件生存率80%，95%CI, 74%-87%）有中度STR，保留右心室（RV）大小和功能，中度扩张但功能正常的右心房。中危表型组（HR, 2.20; 95%CI, 1.44-3.37; P < .001）包括严重STR的老年患者和轻度扩张但未耦合的RV。高危表型组（HR, 4.67; 95%CI, 3.20-6.82; P < .001）包括年轻的三尖瓣大量到剧烈反流的患者，以及严重扩张和功能不全的右心室和右心房。多变量分析证实聚类与复合终点独立相关（HR, 1.40; 95%CI, 1.13-1.70; P = 0.002）。为了帮助临床医生将患者分配到3个表型组，开发了一个监督机器学习模型，该模型在衍生队列（准确性= 0.91，精度= 0.91，召回率= 0.91，F1评分= 0.91）和验证队列（准确性= 0.80，精度= 0.78，召回率= 0.78，F1评分= 0.77）中都表现出色。结论无监督聚类分析确定了3个风险表型，有助于临床医生为STR患者制定更个性化的治疗和随访策略。
{"title":"Ecocardiografía avanzada y análisis de conglomerados para identificar fenogrupos de insuficiencia tricuspídea secundaria con diferente riesgo","authors":"Luigi P. Badano , Marco Penso , Michele Tomaselli , Kyu Kim , Alexandra Clement , Noela Radu , Geu-Ru Hong , Diana R. Hădăreanu , Alexandra Buta , Caterina Delcea , Samantha Fisicaro , Gianfranco Parati , Chi Young Shim , Denisa Muraru","doi":"10.1016/j.recesp.2025.02.005","DOIUrl":"10.1016/j.recesp.2025.02.005","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Significant secondary tricuspid regurgitation (STR) is associated with poor prognosis, but its heterogeneity makes predicting patient outcomes challenging. Our objective was to identify STR prognostic phenogroups.</div></div><div><h3>Methods</h3><div>We analyzed 758 patients with moderate-to-severe STR: 558 (74<!--> <!-->±<!--> <!-->14 years, 55% women) in the derivation cohort and 200 (73<!--> <!-->±<!--> <!-->12 years, 60% women) in the external validation cohort. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality.</div></div><div><h3>Results</h3><div>We identified 3 phenogroups. The low-risk phenogroup (2-year event-free survival 80%, 95%<span>C</span>I, 74%-87%) had moderate STR, preserved right ventricular (RV) size and function, and a moderately dilated but normally functioning right atrium. The intermediate-risk phenogroup (HR, 2.20; 95%CI, 1.44-3.37; <em>P</em> <!--><<!--> <!-->.001) included older patients with severe STR, and a mildly dilated but uncoupled RV. The high-risk phenogroup (HR, 4.67; 95%CI, 3.20-6.82; <em>P</em> <!--><<!--> <!-->.001) included younger patients with massive-to-torrential tricuspid regurgitation, as well as severely dilated and dysfunctional RV and right atrium. Multivariable analysis confirmed the clustering as independently associated with the composite endpoint (HR, 1.40; 95%CI, 1.13-1.70; <em>P</em> <!-->=<!--> <!-->.002). A supervised machine learning model, developed to assist clinicians in assigning patients to the 3 phenogroups, demonstrated excellent performance both in the derivation cohort (accuracy<!--> <!-->=<!--> <!-->0.91, precision<!--> <!-->=<!--> <!-->0.91, recall<!--> <!-->=<!--> <!-->0.91, and F1 score<!--> <!-->=<!--> <!-->0.91) and in the validation cohort (accuracy<!--> <!-->=<!--> <!-->0.80, precision<!--> <!-->=<!--> <!-->0.78, recall<!--> <!-->=<!--> <!-->0.78, and F1 score<!--> <!-->=<!--> <!-->0.77).</div></div><div><h3>Conclusions</h3><div>The unsupervised cluster analysis identified 3 risk phenogroups, which could assist clinicians in developing more personalized treatment and follow-up strategies for STR patients.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 10","pages":"Pages 838-847"},"PeriodicalIF":5.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181399","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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