Revista española de cardiología (English ed.)最新文献

This consensus document on cardiovascular disease in women summarizes the views of a panel of experts organized by the Working Group on Women and Cardiovascular Disease of the Spanish Society of Cardiology (SEC-WG CVD in Women), and the Association of Preventive Cardiology of the SEC (SEC-ACP). The document was developed in collaboration with experts from various Spanish societies and associations: the Spanish Society of Gynecology and Obstetrics (SEGO), the Spanish Society of Endocrinology and Nutrition (SEEN), the Spanish Association for the Study of Menopause (AEEM), the Spanish Association of Pediatrics (AEP), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), and the Association of Spanish Midwives (AEM). The document received formal approval from the SEC. This consensus serves as a guide for the clinical community on the diagnostic approach and management of cardiovascular health during the stages or life cycles of women: adolescence, the menopausal transition, postpartum disorders, and other gynecologic conditions. It is based on current evidence and best available practices.

Introduction and objectives: Infective endocarditis (IE) is a serious public health problem both in Spain and worldwide. This study aimed to analyze the trends in the incidence of IE in Spain from 1992 to 2021.

Methods: We used IE incidence data from the Global Health Data Exchange and population data from the Spanish National Statistics Institute to analyze changes in age-standardized incidence rates. Joinpoint and Age-Period-Cohort (A-P-C) models were applied to identify significant trend changes and the effects of age, period, and birth cohort.

Results: The age-standardized incidence rates of IE increased from 17.5 cases per 100 000 population in 1992 to 30.8 per 100,000 in 2021 among men and from 16.8 per 100 000 in 1992 to 22.9 per 100 000 in 2021 among women. Joinpoint analysis revealed distinct trend changes, with men having a faster rate of increase (1.9%) compared with women (1.1%). The male-to-female incidence rate ratio peaked at 1.4, indicating a higher risk of IE among men. The incidence of IE was significantly influenced by age, period, and cohort. Both sexes showed increasing risk with age. Risk increased in women born in the late 20th and early 21st centuries compared with earlier cohorts. Men in these later cohorts showed a decreasing risk. Period effects increased from the 1990s to the mid-2000s and then declined, especially among men.

Conclusions: This study reveals a significant increase in the incidence of IE in Spain, especially among older adults and men. These trends reflect demographic changes, medical advances, and changing risk factors.

Introduction and objectives: Despite advances in mechanical circulatory support, mortality rates in cardiogenic shock (CS) remain high. A reliable risk stratification system could serve as a valuable guide in the clinical management of patients with CS. This study aimed to develop and externally validate a risk prediction model for in-hospital mortality in CS patients using machine learning (ML) algorithms.

Methods: Data from 1247 patients with all-cause CS in the RESCUE registry (January 2014-December 2018) were analyzed. Key predictive variables were identified using 4 ML algorithms. A risk prediction model, the RESCUE score, was developed using logistic regression based on the selected variables. Internal validation was conducted within the RESCUE registry, and external validation was performed using an independent CS registry of 750 patients.

Results: The 4 ML models identified 7 predictors: age, vasoactive inotropic score, left ventricular ejection fraction, lactic acid level, in-hospital cardiac arrest at presentation, need for continuous renal replacement therapy, and mechanical ventilation. The RESCUE score demonstrated strong predictive performance, with an AUC of 0.86 (95%CI, 0.83-0.88) for in-hospital mortality. Ten-fold internal cross-validation yielded an AUC of 0.86 (95%CI, 0.77-0.95). External validation showed an AUC of 0.80 (95%CI, 0.76-0.84).

Conclusions: Our ML-based risk-scoring system, the RESCUE score, demonstrated excellent predictive performance for in-hospital mortality in all patients with CS patients, regardless of cause. The system could be a useful and reliable tool to estimate risk stratification of CS in everyday clinical practice.

Clinical trial registration: NCT02985008.

Introduction and objectives: In recent years, several cases of hereditary transthyretin amyloidosis (ATTRv) due to the p.Val142Ile variant have been described in patients without African ancestry. The aim of this study was to analyze the impact of ATTRv caused by p.Val142Ile in Spain, focusing on its phenotypic characteristics and its population frequency.

Methods: Patients diagnosed with ATTRv caused by p.Val142Ile, as well as carriers irrespective of their phenotype, were recruited from 16 centers in Spain. Baseline characteristics and events during follow-up were retrieved. Population frequency was assessed using data from the Spanish National DNA Bank (N = 3569) and the Catalan Health Databank (N = 790).

Results: The cohort included 164 participants: 75 probands (45.7%) and 89 relatives (54.3%). Among the probands, the mean age was 73.9 ± 8.5 years, and 47 (62.7%) were male. Sixty-seven probands (89.3%) reported European ancestry, while only 6 (8%) reported African ancestry. Cardiac symptoms were the most frequent reason for ATTRv diagnosis (n = 64; 85.3%). The median follow-up was 2.6 years [Interquartile range, 1.5-4.1]. Overall penetrance at ages 65, 75, and 85 years was 12.8%, 44.3%, and 94.2%, respectively. Tafamidis therapy was initiated during follow-up in 38 patients: after 1 year of treatment, 14 patients (38.9%) met the combined endpoint (12 experienced disease progression and 2 died from cardiovascular causes). Population frequency was estimated to range between 0.0% and 0.12%, based on data from the Spanish and Catalan databases, respectively.

Conclusions: ATTRv caused by p.Val142Ile has a significant prevalence in Spain. Its phenotypic features are characterized by late onset, male predominance, and cardiac involvement.