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

Introduction and objectives: Left atrial appendage closure (LAAC) has emerged as a viable stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. The objective of the study was to analyze temporal trends and outcomes of LAAC in a nationwide study.

Methods: This population-based study analyzed the incidence, epidemiological and clinical characteristics, and outcomes of all patients discharged with a diagnosis of percutaneous LAAC from hospitals included in the Spanish National Health System over a 7-year period (from January 2016 to December 2022).

Results: A total of 3786 patients undergoing percutaneous LAAC were identified. The rate of procedures significantly increased over the study period (annual growth of 23%; IRR, 1.23; 95%CI, 1.17-1.28; P <.001), both in men and in women. The in-hospital mortality rate was 1%, and the incidences of in-hospital concomitant adverse events (AE) and 30-day readmission were 14.0% and 3.5%, respectively. The most frequent AE was the need for blood transfusion (11.5%), followed by vascular complications (2.2%) and acute renal failure (1.9%). The HAS-BLED score was a predictor of in-hospital mortality (OR, 2.55; 95%CI, 1.73-3.74, P <.001) and AE (OR, 1.82, 95%CI, 1.58-2.10; P <.001). Periprocedural AE was less frequent in elective procedures (24.5% vs 11.2%; P <.001) and in high-volume (> 120 procedures) centers (OR, 0.76; 95%CI, 0.63-0.93; P=.008).

Conclusions: The rate of percutaneous LAAC procedures significantly increased over recent years, with a low in-hospital mortality rate. High volume centers and elective LAAC procedures were significantly associated with a lower risk of AE.

Intermediate cardiac care units (IMCU) provide a level of care between hospital wards and cardiac acute care units. They are designed for patients who require close monitoring or noncritical support, such as those with acute coronary syndromes, acute heart failure (HF), arrhythmias, monitoring after structural interventional cardiology or electrophysiology procedures, or postoperative care following cardiac surgery. IMCU help optimize resources and relieve pressure on cardiac acute care units, thereby improving specialized care. Two levels of IMCU are defined: level 1, which offers noninvasive monitoring and basic life support, and level 2, which incorporates invasive arterial pressure monitoring, noninvasive mechanical ventilation, and equipment for complex procedures. Their structure should be functional, with single-patient rooms, effective communication with other services, and dedicated areas for health care personnel. Care is led by cardiologists with specific training, supported by highly specialized nursing staff, and requires continuous medical coverage (24hours a day, 7 days a week) based on well-defined clinical protocols. This model aims to provide efficient, safe, and excellence-driven care. The Spanish Society of Cardiology (SEC) promotes its development through this position statement of the SEC Ischemic Heart Disease and Acute Cardiovascular Care Association (SEC-ACICAC), intended to guide the implementation of IMCU in Spain.

Introduction and objectives: Left ventricular reverse remodeling (LVRR) is a key therapeutic goal in dilated cardiomyopathy (DCM). However, its genetic predictors and prognostic impact remain uncertain.

Methods: We analyzed genotyped DCM patients with serial echocardiograms from the Spanish DCM study. The main objective was to assess the influence of genotype on LVRR, defined by improvement in ejection fraction within 12± 6 months. Secondary endpoints included major adverse cardiovascular events, end-stage heart failure (HF), and malignant ventricular arrhythmias.

Results: A total of 711 patients were included (67% male, mean age 50.8 years, baseline ejection fraction 31%, 44% genotype positive). LVRR occurred in 39% of genotype-positive vs 47% of genotype-negative patients (P=.036). Independent predictors of LVRR were TTN variants, lower baseline ejection fraction, and HF admission at diagnosis. In contrast, desmosomal, nuclear envelope and motor sarcomeric gene variants were associated with a lower likelihood of LVRR. During a median follow-up of 4.5 years, 26% of patients with initial LVRR showed subsequent deterioration, which was more frequent among genotype-positive individuals (32% vs 22%, P=.054). Compared with patients with sustained LVRR, those with deterioration had worse outcomes, including higher rates of major cardiovascular events (25% vs 7%), end-stage HF (18% vs 1%), and ventricular arrhythmia (12% vs 4%) (all P <.05).

Conclusions: Genotype is a major determinant of both initial and long-term LVRR. Loss of ejection fraction improvement is common and strongly associated with adverse outcomes.