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

Introduction and objectives: Angina or myocardial ischemia with nonobstructive coronary artery disease (ANOCA/INOCA) is associated with an elevated risk of adverse outcomes. This study aimed to evaluate the prognosis of patients with ANOCA/INOCA who received tailored therapy according to their endotype, as defined by invasive coronary function testing (CFT).

Methods: This prospective, multicenter observational study included ANOCA/INOCA patients who underwent an invasive CFT. The primary outcome was a composite of total episodes of myocardial infarction, emergency department visits for chest pain, or hospital admissions for angina or heart failure that occurred during a long-term follow-up. Negative binomial regression was used to assess the association between endotypes and total events, with risk estimates expressed as incidence rate ratios (IRR).

Results: From January 2020 to November 2023, a total of 308 patients were enrolled. Patients were stratified into 4 endotypes: microvascular dysfunction (n=141), epicardial spasm (n=66), microvascular spasm (n=26), or negative-CFT (n=75). At a median follow-up of 1.8 years, the incidence rates of the composite outcome per 100 patient-years were 35.3, 12.9, 31.0, and 10.2 in microvascular dysfunction, epicardial spasm, microvascular spasm, and negative-CFT endotypes, respectively (P <.001). After multivariable adjustment, microvascular dysfunction emerged as the only independent predictor of the composite outcome (IRR, 3.24; 95%CI, 1.12-9.05; P=.029).

Conclusions: Despite tailored medical therapy, ANOCA/INOCA endotype classification revealed significant prognostic differences, with microvascular dysfunction being the endotype associated with the highest burden of recurrent events.

Introduction and objectives: A provegetarian (PVG) food pattern is reportedly cardioprotective in older adults from non-Mediterranean populations, but scarce evidence is available for Mediterranean populations. We assessed the association between 3 different PVG food patterns and the risk of cardiovascular disease (CVD) in the SUN (Seguimiento Universidad de Navarra) cohort.

Methods: The SUN Project is a Mediterranean cohort study of relatively young Spanish university graduates. A PVG food pattern was calculated by assigning positive scores to plant-based foods and reverse scores to animal-based foods. Two additional patterns, healthful (hPVG) and unhealthful (uPVG), were derived based on the quality of plant-based foods.

Results: The final analysis included 18 560 participants, with a mean±standard deviation baseline age of 38±12 years. During a median [interquartile range] follow-up of 16 [10-20] years, 227 cases of CVD were identified. Participants within the upper quartile of the PVG pattern had a 37% lower CVD risk (HR_Q4vsQ1, 0.63; 95%CI, 0.42-0.94) compared with the lowest quartile. This inverse association was similar for the hPVG (HR_Q4vsQ1, 0.60; 95%CI, 0.40-0.90), but not for the uPVG food pattern, which instead exhibited a 76% higher CVD risk between extreme quartiles (HR_Q4vsQ1, 1.76; 95%CI, 1.17-2.64).

Conclusions: Both a general PVG and hPVG food pattern were associated with a reduced CVD risk in a relatively young Mediterranean population. An uPVG food pattern was associated with an increased risk.

Introduction and objectives: The origin of emboli involved in patent foramen ovale (PFO)-related ischemic events remains poorly documented. Our objective was to evaluate venous thromboembolic (VTE) disease as a potential source of PFO-related embolic events.

Methods: Patients scheduled for PFO closure for secondary prevention of PFO-related arterial embolic events underwent a systematic VTE risk evaluation. This included: a) a detailed questionnaire on past VTE history to identify clinical situations associated with a high risk of VTE at the time of the embolic event, and b) abdominopelvic magnetic resonance imaging (MRI) with venography to identify abdominal or pelvic venous disease.

Results: From July 2020 to May 2023, 366 consecutive patients (median age 51 [range, 42-58] years; 42.9% female) were prospectively included. A prior VTE event, a high-risk VTE situation, a hyperthrombotic state, or an abdominal or pelvic venous anomaly on MRI were present in 8.5% (95%CI, 6.0-11.8), 22.7% (95%CI, 18.7-27.2), 7.1% (95%CI, 4.9-10.2), and 36.3% (95%CI, 31.6-41.4) of patients, respectively. Overall, 58.5% (95%CI, 53.4-63.4) of patients had at least 1 of these conditions. MRI identified several previously undiagnosed pelvic venous anomalies, including pelvic varices in 20.0%, May-Thurner/Cockett in 9.8%, and Nutcracker syndrome in 7.4%. Imaging abnormalities were more frequent among younger patients (aOR, 1.02; 95%CI, 1.00-1.04) and women (aOR, 1.94; 95%CI, 1.25-3.02).

Conclusions: A prior VTE event, a high-risk VTE situation, a hyperthrombotic state, or an abdominal or pelvic venous anomaly may be present in most patients with a history of a PFO-related arterial event.

Introduction and objectives: Previous studies have reported an inverse association between the extent of green space and the risk of cardiovascular disease (CVD). However, longitudinal research focusing on individuals residing within the same geographic area remains scarce. Moreover, comprehensive investigations evaluating the impact of urban green space (UGS) on both CVD incidence and cardiovascular mortality are limited.

Methods: This retrospective cohort study used data from the National Health Insurance Service National Sample Cohort. We included 74 925 individuals aged ≥ 20 years residing in 7 metropolitan cities in South Korea, who maintained consistent residential addresses throughout the study period. UGS exposure was quantified as the area of UGS per 1000 residents in 2010. Participants were followed up from January 1, 2011 to December 31, 2019. Cox proportional hazard regression analysis was conducted to evaluate the risk of CVD and mortality, adjusting for potential confounders, including lifestyle behaviors.

Results: The highest UGS coverage was associated with a reduced risk of CVD (aHR,0.84; 95%CI, 0.77-0.91), with a significant trend (P for trend<.001). These overall trends remained consistent among various CVD subtypes. A reduced cardiovascular mortality risk was observed in the highest UGS coverage group (aHR,0.74; 95%CI, 0.56-0.97).

Conclusions: This study identified an association between higher levels of UGS coverage and a reduced risk of both CVD and CVD-related mortality. The study holds significant value in focusing on individuals residing within the same area. Therefore, UGS should be considered as a key factor in future urban planning efforts to reduce the burden of CVD and associated mortality.