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

Introduction and objectives: Left atrial remodeling is common in hypertrophic cardiomyopathy (HCM) and is associated with atrial fibrillation (AF) and thromboembolic events. However, currently available AF risk prediction models perform poorly in patients with HCM. The left atrioventricular coupling index (LACI) is a novel imaging marker that integrates left atrial size and left ventricular filling properties and has emerged as a potential indicator of atrial remodeling and AF risk. This study aimed to evaluate the association between LACI and new-onset AF, transient ischemic attack, or ischemic stroke in patients with HCM.

Methods: We retrospectively analyzed 287 patients with HCM without a prior history of AF, transient ischemic attack, or ischemic stroke who underwent cardiac magnetic resonance imaging between 2014 and 2022. Left atrial and left ventricular volumes were measured, and LACI was calculated as the ratio of minimum left atrial volume to left ventricular end-diastolic volume. Patients were categorized into tertiles according to LACI. Left atrial strain analysis was performed. Cox proportional hazards models assessed the association between LACI and a composite endpoint including AF, transient ischemic attack, or ischemic stroke.

Results: During a median follow-up of 60 months, 51 patients (17.9%) reached the composite endpoint. Patients in the highest LACI tertile (≥ 36%) had a significantly higher risk of AF or thromboembolic events (adjusted HR, 2.88; 95%CI, 1.27-6.51; P <.001). Left atrial booster strain was also independently associated with adverse outcomes.

Conclusions: LACI and left atrial booster strain are independently associated with new-onset AF and thromboembolic events in patients with HCM.

Introduction and objectives: Hereditary transthyretin amyloidosis (hATTR) is a rare, multisystemic, autosomal dominant disease. Cardiac involvement worsens prognosis. We aimed to characterize Spanish patients with hATTR cardiac amyloidosis (hATTR-CA) and to identify predictors of poor prognosis.

Methods: We conducted a retrospective, multicenter study in 39 Spanish hospitals, including adults with genetically confirmed hATTR and cardiac involvement (January 2000-September 2022). Independent predictors of poor prognosis (death, heart transplantation, heart failure, or cardiovascular hospitalization) were identified using multivariate logistic regression. Data were also collected on clinical and genetic characteristics, management patterns, and event-free survival.

Results: A total of 442 patients were included (67.6% male; median age at diagnosis, 65 years). Fifteen TTR variants were identified, with p.Val30Met being the most frequent (64.9%). The most common extracardiac manifestation was neuropathy (64.6%). At baseline, most patients were in New York Heart Association class I-II, with progressive worsening during follow-up. Overall, 48.9% of patients were hospitalized, and 21.9% died; 25.3% of deaths were heart failure-related. Five-year event-free survival was 80.2% from symptom onset and 66.9% from diagnosis. Disease-specific treatments (tafamidis, patisiran, inotersen, or liver transplant) were associated with improved survival (P < .001). In an exploratory analysis stratified by diagnosis before vs after 2018, event-free survival did not differ significantly (HR, 1.04; 95%CI, 0.63-1.72; P = .88). Independent predictors of poor prognosis included New York Heart Association class II-IV, lower left ventricular ejection fraction, elevated N-terminal pro-B-type natriuretic peptide, and the presence of neurological involvement.

Conclusions: This national cohort-the largest reported to date-highlights the clinical and genetic heterogeneity of hATTR -CA in Spain. Early diagnosis and disease-specific therapies are essential to improving prognosis.

Introduction and objectives: Clinical practice guidelines for heart failure (HF) recommend advance care planning and assessment of patients' end-of-life preferences. However, very few studies have captured these preferences or their relationship with prognosis.

Methods: Observational, multicenter, survey-style study of patients aged 75 or older admitted for HF to internal medicine department of 60 Spanish hospitals. Patients were followed for 6 months and mortality, emergency room visits and readmissions were recorded.

Results: A total of 673 patients were included. The median age was 86 years, and they had significant comorbidity, frailty (59%), and a predominance of HF with preserved left ventricular ejection fraction (75%). A total of 92% of patients prioritized quality of life over living longer. A total of 9% had spoken with their physician about cardiopulmonary resuscitation; 29% did not want cardiopulmonary resuscitation, and 37% had not yet decided. About 15% of patients were considering requesting euthanasia. Adequate symptom control, particularly dyspnea and pain, was the patients' major priority. None of the end-of-life preferences expressed by patients were shown to be an independent prognostic factor at 6 months of follow-up.

Conclusions: Elderly patients with multiple pathologies admitted for HF prioritize quality of life and symptom control over living longer. Advance care planning for them should be systematic and proactive.

Introduction and objectives: Metabolic syndrome (MetS) is associated with coronary microvascular dysfunction (CMD), both of which increase the risk of cardiovascular events after ST-segment elevation myocardial infarction (STEMI). However, the prognostic significance of CMD in STEMI patients with MetS remains unclear. This study aimed to evaluate the effects of CMD, assessed by the angiography-derived index of microcirculatory resistance, on cardiovascular outcomes in STEMI patients with and without MetS.

Methods: STEMI patients undergoing primary percutaneous coronary intervention were prospectively enrolled at 4 centers. MetS was defined as the presence of at least 3 out of 5 cardiometabolic abnormalities. CMD was defined as an angiography-derived index of microcirculatory resistance> 40 U.

Results: Among 497 included patients, 316 (63.8%) patients had MetS. During 2.8 years follow-up, the cumulative incidence of adverse outcomes was significantly higher in the CMD group than in the non-CMD group among patients with MetS (30.3% vs 18.4%; P=.034), but not among those without MetS (12.6% vs 13.0%; P=.937). Both the presence of CMD and the angiography-derived index of microcirculatory resistance as a continuous variable predicted adverse outcomes in patients with MetS, but not in those without MetS. CMD was also significantly associated with left ventricular dysfunction (OR, 3.909; 95%CI, 1.330-11.489; P=.013) and lack of left ventricular ejection fraction recovery (OR, 3.367; 95%CI, 1.099-10.318; P=.034) at follow-up, independently of baseline function.

Conclusions: CMD assessed by the angiography-derived index of microcirculatory resistance independently predicts adverse outcomes and lack of left ventricular functional recovery in STEMI patients with MetS, but not in those without MetS.