REC: CardioClinics最新文献

Introduction and objectives

Computed tomography of coronary arteries (CTCA) is emerging as the gold standard in the initial evaluation of chest pain. The aim of this study is to calculate the diagnostic performance and clinical usefulness of numerical models of arterial channels flow to assess non-invasive coronary fractional flow reserve by computed tomography (FFRct) compared to assessment by invasive angiography (FFR).

Methods

Computation of FFR from CTCA images was performed on 39 vessels in 32 patients who followed the usual clinical protocol including invasive coronary angiography and FFR following the usual clinical protocol. From the segmentation of the CTCA images, 3D geometry is obtained, and computational fluid dynamics techniques are applied to accurately reproduce the circulation of blood considering steady and unsteady circulatory conditions. Additional parameters as wall shear stress, stenosis resistance index and ΔFFRct were also calculated.

Results

The results obtained show a good correlation between FFRct and invasive FFR, without obtaining false positives values. In addition, no differences were observed between the simulations considering steady conditions or those considering the transient. Additional parameters as wall shear stress, stenosis resistance, and ΔFFRct also showed a good correlation with the invasive values.

Conclusions

This new model for calculating the FFRct from non-invasive 3D medical images of coronary tree has shown good agreement with those obtained using invasive techniques. Parameters as wall shear stress, stenosis resistance and ΔFFRct provide useful information that could be helpful in medical decision-making in those situations with FFR values close to the cut-off zone.

Introduction and objectives

Remote monitoring (RM) is a new tool in heart failure (HF) patients with cardiac implantable electronic devices but its effect in clinical outcomes is still uncertain. In remote regions as islands HF management is even more challenging and RM may have a different impact. We aimed to assess its impact in clinical outcomes in an insular reality.

Methods

This was a retrospective, non-randomized study conducted in our hospital, that is the reference center of a nine-island archipelago. Patients in the HF remote monitoring program were matched 1:1 with usual standard of care patients.

Results

From 307 patients, 96 with RM (group 1 – G1) were matched 1:1 according to age ±2 years and gender with 96 usual standard of care (group 2 – G2) (mean age 69 years, 76% males, mean follow-up period 55 months). Primary endpoint was cardiovascular (CV) mortality and secondary endpoints all-cause mortality, HF hospitalizations at 12 months and at FUP. CV mortality was lower in G1 (hazard ratio [HR] 6.7; 95% confidence interval [95% CI] 1.46–30.87; P = .004), as well as all-cause mortality (HR, 5.7; 95% CI, 1.85–17.39; P < .001) and HF hospitalizations at 12 months (P = .02) with a tendency toward less hospitalizations during follow-up.

Conclusions

RM in the management of HF patients with cardiac implantable electronic devices in a remote geographic location, as a nine-island archipelago, was effective in reducing CV mortality, all-cause mortality and HF hospitalizations.

Conduction system pacing is a cardiac pacing modality that seeks to maintain ventricular electromechanical activation synchrony through direct stimulation of the specific conduction system, generally the bundle of His or the left bundle branch. Although technically more complex than conventional right ventricular pacing, the advent of dedicated tools has favored its implementation in clinical practice as a more physiologic alternative to conventional right ventricular pacing and as a rescue strategy when conventional resynchronization therapy through biventricular pacing is not feasible. More recently, the growing scientific evidence that compares it to the latter would place it as a real alternative strategy in patients with heart failure and an indication for resynchronization. This text reviews the fundamentals of the main implant modalities and technique, the available scientific evidence, and future prospects.

The IV edition of the Congress of Young Cardiologists, CardioMIR, was held in the city of Madrid on September 22 and 23, 2023, bringing together around 550 young cardiologists to learn about the latest developments in the diagnostic approach and therapeutics of cardiovascular disease. The congress also aims to be a meeting point for young cardiologists from the Spanish Society of Cardiology, especially residents, where they can share experiences and concerns. The aim of this article is to summarize of the main topics addressed in the IV edition of CardioMIR.

Health Economics is an unfriendly topic for most clinical cardiologists. However, if we want to bridge the gap between patients and healthcare management, it is essential that decisions regarding new drugs, procedures, and technologies involve clinical professionals. Our unique position allows us to provide valuable insights and expertise in our fields and bring added value for decision making in the health system as a whole. Equipping clinical cardiologists with basic knowledge and tools in Health Economics and Economic Evaluation (such as cost-effectiveness or cost-utility studies) is crucial to develop studies that accurately reflect the clinical impact of diseases, both for patients and the healthcare system. By getting involved, clinicians can play a vital role in shaping the future of healthcare systems and influencing the allocation of (usually scarce) resources to ensure optimal care for our patients.

Tricuspid regurgitation is the most prevalent valvular disease in the general population. However, it has traditionally been largely forgotten. This article reviews anatomy, etiology (with special attention to atriogenic tricuspid regurgitation), prognostic involvement, diagnostic methods, and therapeutic indication of this valve disease. In addition, the literature is reviewed regarding the selection of candidates, the importance of early management, surgery, and recent percutaneous treatment options, which are undoubtedly revolutionizing the management of this entity.

Introduction and objectives

To determine the current situation about the clinical management of heart failure (HF) in primary care (PC) and cardiology, in order to identify potential areas for improvement in the healthcare continuity.

Methods

The program was implemented through joint work sessions between PC and cardiology in our country, in which possible deficiencies, difficulties, and areas for improvement were identified in the integrative management of patients with HF.

Results

66 sessions were performed throughout Spain, with a total of 1187 attendees. 61.8% of the participants indicated that the healthcare centers did not have a HF cardiology referrer, in 64.7% the relationship between both healthcare levels was isolated and communication was carried out predominantly through telematic tools. 88.2% of PC physicians could request natriuretic peptides directly, but in 75.8% the echocardiogram had to be requested through cardiology. In 61.8% of the cases there was a therapeutic plan to optimize the treatment with quadruple therapy, although in 82.4% the full doses were not attained. In most centers (60.3%) there was no expert nurse in the management of HF.

Conclusions

In Spain there are significant deficiencies in the integrative management of patients with HF. A higher education of PC physicians and nurses, a better coordination between both healthcare levels, and the development of local protocols that facilitates treatment optimization, could be helpful to improve this situation.