Revista espanola de cardiologia最新文献

英文中文

Importancia de la evaluación del riesgo de muerte súbita: el chaleco desfibrilador como puente a trasplante 猝死风险评估的重要性：除颤器马甲作为移植的桥梁

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-27 DOI: 10.1016/j.recesp.2024.04.012

Borja Guerrero Cervera , Raquel López-Vilella , Víctor Donoso Trenado , Maite Izquierdo , Joaquín Osca Asensi , Luis Almenar-Bonet

引用次数: 0

Situación de la rehabilitación cardiaca en España. Resultados del registro AULARC 西班牙心脏康复情况。AULARC 登记结果

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-27 DOI: 10.1016/j.recesp.2024.04.011

Vicente Arrarte Esteban , Raquel Campuzano Ruiz , Carmen De Pablo Zarzosa , M. Rosa Fernández Olmo , en representación de los investigadores del registro AULARC

引用次数: 0

Fisiología coronaria: una herramienta diagnóstica imprescindible más allá de la obtención de un punto de corte 冠状动脉生理学：获取临界点之外的重要诊断工具

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-25 DOI: 10.1016/j.recesp.2024.04.010

引用次数: 0

Utilidad de los biomarcadores en el trasplante cardiaco para predecir el pronóstico 心脏移植中预测预后的生物标志物的效用

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-25 DOI: 10.1016/j.recesp.2024.04.008

Raquel López-Vilella , Julia Martínez Solé , Sara Huélamo Montoro , Víctor Donoso Trenado , Ignacio Sánchez-Lázaro , Iratxe Zarragoikoetxea Jauregui , Paula Carmona García , Manuel Pérez Guillén , Carlos Domínguez Massa , Luis Martínez Dolz , Luis Almenar Bonet

Introduction and objectives

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.

Methods

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).

Results

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 (P < .0001). Receiver operating characteristic curve analysis at 24 hours showed significant areas under the curve (P = .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%.

Conclusions

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.

导言和目的心脏移植（HT）是一种重大的生理压力，会导致分析性生物标志物水平升高。本研究旨在确定心脏移植术后生物标志物水平的变化是否能识别预后不良的患者。方法从 2017 年 7 月至 2023 年 7 月，对 149 名连续接受心脏移植术的患者进行了前瞻性纵向非干预研究。在 HT 前以及 HT 后 6、24、48、72 和 96 小时对生物标志物进行了评估。分析的生物标志物包括高敏肌钙蛋白 T、N-末端前 B 型钠尿肽（NT-proBNP）、肌酐和乳酸。结果NT-proBNP和肌钙蛋白水平在整个过程中一直高度升高，并在HT术后24小时内趋于稳定。乳酸水平在头 24 小时后趋于稳定，肌酐则从第二天起趋于稳定。有 23 名患者（15%）出现了呕吐，26 名患者（17%）出现了严重的 PGF。所有生物标志物都与合并事件的发生率有明显相关性（P < .0001）。24 小时的接收者操作特征曲线分析显示曲线下的面积很大（P = .0001）。NT-proBNP 曲线的判别能力最强。结论 HT 后分析生物标志物的显著升高与死亡率和/或严重 PGF 有关。在分析的生物标志物中，NT-proBNP 在对患者进行分类方面最为准确。

{"title":"Utilidad de los biomarcadores en el trasplante cardiaco para predecir el pronóstico","authors":"Raquel López-Vilella , Julia Martínez Solé , Sara Huélamo Montoro , Víctor Donoso Trenado , Ignacio Sánchez-Lázaro , Iratxe Zarragoikoetxea Jauregui , Paula Carmona García , Manuel Pérez Guillén , Carlos Domínguez Massa , Luis Martínez Dolz , 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 96hours 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 24hours post-HT. Lactate levels stabilized after the first 24hours, 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> <.0001). Receiver operating characteristic curve analysis at 24hours 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}

引用次数: 0

Evaluación dinámica de las escalas CHA2DS2-VASc y HAS-BLED para predecir ictus isquémico y hemorragia mayor en pacientes con fibrilación auricular 对 CHA2DS2-VASc 和 HAS-BLED 量表预测心房颤动患者缺血性中风和大出血的动态评估

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-24 DOI: 10.1016/j.recesp.2024.02.013

Introduction and objectives

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.

Methods

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.

Results

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.

Conclusions

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.

导言和目的心房颤动（AF）的卒中和出血风险通常在基线时进行评估，以预测数年后的结果。我们研究了 CHA2DS2-VASc 和 HAS-BLED 评分随着时间推移的动态变化是否会改变风险预测。在为期 6 年的随访中，记录了所有缺血性脑卒中/短暂性脑缺血发作（TIA）和大出血事件。每两年重新计算一次 CHA2DS2-VASc 和 HAS-BLED，并在两年期间检测临床结果。随访期间，156 名患者（11.5%）发生了缺血性中风/TIA，269 名患者（19.8%）发生了大出血。与基线 CHA2DS2-VASc 相比，在 2 年时重新计算的 CHA2DS2-VASc 对 2 至 4 年期间缺血性中风/TIA 的预测能力更高。综合辨别改进（IDI）和净再分类改进（NRI）显示灵敏度有所提高，再分类效果更好。与基线 CHA2DS2-VASc 相比，4 年后重新计算的 CHA2DS2-VASc 在 4 至 6 年期间具有更好的预测性能，IDI 有所提高，重新分类能力也有所增强。在 2 至 4 年期间，重新计算的 2 年期 HAS-BLED 对大出血的预测能力高于基线评分，灵敏度和再分类能力显著提高。与基线评分相比，4 年后重新计算的 HAS-BLED 评分的灵敏度略有提高。应定期重新评估 CHA2DS2-VASc 和 HAS-BLED 评分，尤其是为了准确预测卒中风险。

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引用次数: 0

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 在评估经皮二尖瓣边缘对边缘修复术后的二尖瓣面积时，三维平面测量法优于半压时间法

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-24 DOI: 10.1016/j.recesp.2024.03.007

Introduction and objectives

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.

Methods

A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient.

Results

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 (r = 0.46, P < .001) than MVA obtained by PHT (r = 0.19, P = .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).

Conclusions

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.

引言和目的目前，确定经皮二尖瓣边缘对边缘修复术后测量二尖瓣面积（MVA）最准确方法的证据有限。我们的目的是评估在这种情况下的最佳方法及其与平均二尖瓣传导阶差的相关性。方法对接受经皮二尖瓣修复术的患者进行登记，分析测量二尖瓣瓣口面积的不同方法及其与平均阶差的相关性。平均年龄为 76 ± 10.3 岁，54% 为男性，46% 为女性。病因为退行性病变的占 45%，功能性病变的占 39%，混合性病变的占 16%。使用压力半定时法（PHT）测量的夹板后MVA为（1.89 ± 0.60）平方厘米，使用三维平面测量法测量的MVA为（2.87 ± 0.83）平方厘米，平均梯度为（3 ± 1.19）毫米汞柱。使用三维平面测量法获得的 MVA 与平均阶差的相关性（r = 0.46，P <.001）高于 PHT 获得的 MVA（r = 0.19，P = .048）。结论我们的研究表明，与使用经食道三维平面测量法直接测量相比，PHT 法明显低估了夹片植入后的 MVA。后者与植入后梯度的相关性更好，观察者之间的变异性也更小。这些结果表明，三维平面测量法是评估夹片植入后二尖瓣狭窄的更合适的方法。

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引用次数: 0

Revisión sistemática y metanálisis de estudios aleatorizados y no aleatorizados sobre revascularización guiada por reserva fraccional de flujo 关于分数血流储备引导下血管再通的随机和非随机研究的系统回顾和荟萃分析

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-22 DOI: 10.1016/j.recesp.2024.02.011

Introduction and objectives

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.

Methods

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).

Results

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%CI, 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 (P = .012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P = .039).

Conclusions

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.

导言和目的有几项研究调查了分数血流储备（FFR）引导在改善心肌血管再通术后临床疗效方面的有效性，但结果相互矛盾。本研究旨在比较冠状动脉疾病患者在 FFR 引导或血管造影引导下接受血管再通术后的临床疗效。方法纳入了随机对照试验（RCT）和非随机干预研究。主要终点为全因死亡、心肌梗死和主要不良心血管事件（MACE）。该研究已在 PROSPERO 注册（CRD42022344765）。FFR引导下的血管再通术与较低的全因死亡率（OR，0.63；95%CI，0.53-0.73）、心肌梗死（OR，0.70；95%CI，0.59-0.84）和MACE（OR，0.77；95%CI，0.70-0.85）相关。如果仅考虑研究性临床试验，则未观察到两种策略在任何终点上存在显著差异。然而，FFR的使用与血管再通率和治疗病变率的降低有关。元回归结果表明，与血管造影术相比，血管再通率越高的患者，FFR指导对减少MACE的益处越低（P = .012）。结论与血管造影引导相比，FFR引导下的血管再通术与较低的全因死亡、心肌梗死和MACE发生率相关，但RCT和非随机干预研究得出的数据相互矛盾。在血管重建率高、急性冠脉综合征患者发病率高的研究中，FFR引导的益处似乎不那么明显。

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引用次数: 0

Stents autoexpandibles SINUS XL para implante previo en el recambio valvular pulmonar 用于肺动脉瓣置换术前植入的 SINUS XL 自扩张支架

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-16 DOI: 10.1016/j.recesp.2024.02.021

引用次数: 0

Uso de los nuevos vasodilatadores pulmonares en pacientes con cortocircuitos sistémico-pulmonares: estrategia «tratar y reparar» 在全身-肺分流患者中使用新型肺血管扩张剂："治疗和修复 "策略

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-16 DOI: 10.1016/j.recesp.2024.04.005

引用次数: 0

La identificación subjetiva y ablación de impulsores auriculares mejora el control del ritmo en la fibrilación auricular persistente. Estudio CHAOS-AF 主观识别和消融心房冲动可改善持续性心房颤动的节律控制。CHAOS-AF 研究

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2024-04-03 DOI: 10.1016/j.recesp.2024.01.010

Introduction and objectives

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.

Methods

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.

Results

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%; P = .048) and at the last follow-up (46% vs 72%; P = .013), and less progression to permanent AF (10% vs 40%; P = .001).

Conclusions

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.

导言和目的持续性心房颤动（房颤）消融的最佳方法仍然未知。在持续性房颤患者中，我们比较了基于肺静脉隔离（PVI）和驱动因素消融（PVI + D）的消融策略，以及在 1:1 倾向评分匹配队列中仅采用传统 PVI 的方法。方法使用传统的高密度绘图导管（IntellaMap ORION、PentaRay NAV 或 Advisor HD Grid），在不使用专用软件的情况下，根据 1 到 2 个相邻双极上的连续或类连续电图分段主观地识别驱动因素，并首先对其进行消融；以及具有时空弥散（整个周期长度包含在映射导管内）和非连续分馏的部位，仅针对无分馏连续电图或分馏连续电图消融后无房颤转换的患者。消融包括 PVI 加局灶或线性消融靶向驱动器。结果每组共纳入 50 名患者（61 ± 10 岁，25% 为女性）。PVI + D 组中有 21 名患者（42%）发现了分段连续电图并进行了消融，其中 7 名患者转为房颤。在其余 43 名患者中，143 个时空弥散加非连续分馏的部位成为目标。总体而言，21 名患者（42%）实现了房颤转复。PVI + D 组在随访 1 年（30.6% vs 48%；P = .048）和最后一次随访（46% vs 72%；P = .013）时的房性心律失常复发率较低，发展为永久性房颤的比例较低（10% vs 40%；P = .001）。

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