Pub Date : 2024-07-01DOI: 10.1016/j.rec.2024.01.008
Pau Llàcer , Gregorio Romero , Joan Carles Trullàs , Rafael de la Espriella , Marta Cobo , Borja Quiroga , Jesús Casado , María F. Slon-Roblero , José Luis Morales-Rull , José Ignacio Morgado , Alberto Ortiz , Francesc Formiga , María Melendo-Viu , Patricia de Sequera , Alejandro Recio , Javier Díez , Luis Manzano , Julio Núñez
Most of the signs and symptoms of heart failure can be explained by fluid overload, which is also related to disease progression. Fluid overload is a complex phenomenon that extends beyond increased intravascular pressures and poses challenges for accurate diagnosis and effective treatment. Current recommendations advise a multiparametric approach, including clinical data (symptoms/signs), imaging tests, and biomarkers. This article proposes a practical therapeutic approach to managing hydrosaline overload in heart failure in both inpatient and outpatient settings. This document is an initiative of the Spanish Society of Internal Medicine (SEMI) in collaboration with the Spanish Society of Cardiology (SEC) and the Spanish Society of Nephrology (S.E.N.).
{"title":"Consensus on the approach to hydrosaline overload in acute heart failure. SEMI/SEC/S.E.N. recommendations","authors":"Pau Llàcer , Gregorio Romero , Joan Carles Trullàs , Rafael de la Espriella , Marta Cobo , Borja Quiroga , Jesús Casado , María F. Slon-Roblero , José Luis Morales-Rull , José Ignacio Morgado , Alberto Ortiz , Francesc Formiga , María Melendo-Viu , Patricia de Sequera , Alejandro Recio , Javier Díez , Luis Manzano , Julio Núñez","doi":"10.1016/j.rec.2024.01.008","DOIUrl":"10.1016/j.rec.2024.01.008","url":null,"abstract":"<div><p>Most of the signs and symptoms of heart failure can be explained by fluid overload, which is also related to disease progression. Fluid overload is a complex phenomenon that extends beyond increased intravascular pressures and poses challenges for accurate diagnosis and effective treatment. Current recommendations advise a multiparametric approach, including clinical data (symptoms/signs), imaging tests, and biomarkers. This article proposes a practical therapeutic approach to managing hydrosaline overload in heart failure in both inpatient and outpatient settings. This document is an initiative of the Spanish Society of Internal Medicine (SEMI) in collaboration with the Spanish Society of Cardiology (SEC) and the Spanish Society of Nephrology (S.E.N.).</p></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.rec.2023.12.002
Alain García-Olea Jurado , Iria Fernández de la Prieta , Lara Ruiz Gómez
{"title":"[18F]-fluorodeoxyglucose PET-CT in systemic amyloidosis with cardiac involvement","authors":"Alain García-Olea Jurado , Iria Fernández de la Prieta , Lara Ruiz Gómez","doi":"10.1016/j.rec.2023.12.002","DOIUrl":"10.1016/j.rec.2023.12.002","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1016/j.rec.2024.04.020
Moisés Rodríguez-Mañero, José R González-Juanatey
{"title":"Proposal for a model of care for emergency pacemaker implantation.","authors":"Moisés Rodríguez-Mañero, José R González-Juanatey","doi":"10.1016/j.rec.2024.04.020","DOIUrl":"10.1016/j.rec.2024.04.020","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25DOI: 10.1016/j.rec.2024.06.004
Minjung Bak, Junho Hyun, Hyukjin Park, Hyung Yoon Kim, Seonhwa Lee, In-Cheol Kim, So Ree Kim, Mi-Na Kim, Kyung-Hee Kim, Jeong Hoon Yang
Introduction and objectives: Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in patients with fulminant myocarditis, the most effective timing of venting is uncertain. We aimed to investigate the benefit of early venting among patients who underwent VA-ECMO for fulminant myocarditis.
Methods: Among 841 patients with acute myocarditis from 7 hospitals in the Republic of Korea, 217 patients with fulminant myocarditis who underwent VA-ECMO were included in this analysis. The patients were categorized into 2 groups: an early unloading group that underwent venting within 24hours of ECMO insertion, and the no or delayed unloading group. The primary outcome was a composite of death, cardiac replacement, or cardiovascular rehospitalization.
Results: Among 217 patients, 56 underwent early venting, 54 underwent delayed venting, and 107 did not undergo venting. On spline curves in 110 patients who underwent venting, rapid deterioration was observed as the timing of venting was delayed. The incidence of the primary outcome was lower in the early venting group than in the no or delayed unloading group (37.5% vs 58.4%; HR, 0.491; 95%CI, 0.279-0.863; P=.014). Among patients not experiencing the primary outcome within 6 months, clinical outcomes were similar after 6 months (P=.375).
Conclusions: Early left heart unloading within 24hours of ECMO insertion is associated with a lower risk of a composite of death, cardiac replacement therapy, and cardiovascular rehospitalization in patients with fulminant myocarditis undergoing VA-ECMO. Registered at ClinicalTrials.gov (NCT05933902).
{"title":"Early unloading and clinical outcomes in patients with fulminant myocarditis undergoing VA-ECMO: results of a multicenter retrospective study.","authors":"Minjung Bak, Junho Hyun, Hyukjin Park, Hyung Yoon Kim, Seonhwa Lee, In-Cheol Kim, So Ree Kim, Mi-Na Kim, Kyung-Hee Kim, Jeong Hoon Yang","doi":"10.1016/j.rec.2024.06.004","DOIUrl":"10.1016/j.rec.2024.06.004","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in patients with fulminant myocarditis, the most effective timing of venting is uncertain. We aimed to investigate the benefit of early venting among patients who underwent VA-ECMO for fulminant myocarditis.</p><p><strong>Methods: </strong>Among 841 patients with acute myocarditis from 7 hospitals in the Republic of Korea, 217 patients with fulminant myocarditis who underwent VA-ECMO were included in this analysis. The patients were categorized into 2 groups: an early unloading group that underwent venting within 24hours of ECMO insertion, and the no or delayed unloading group. The primary outcome was a composite of death, cardiac replacement, or cardiovascular rehospitalization.</p><p><strong>Results: </strong>Among 217 patients, 56 underwent early venting, 54 underwent delayed venting, and 107 did not undergo venting. On spline curves in 110 patients who underwent venting, rapid deterioration was observed as the timing of venting was delayed. The incidence of the primary outcome was lower in the early venting group than in the no or delayed unloading group (37.5% vs 58.4%; HR, 0.491; 95%CI, 0.279-0.863; P=.014). Among patients not experiencing the primary outcome within 6 months, clinical outcomes were similar after 6 months (P=.375).</p><p><strong>Conclusions: </strong>Early left heart unloading within 24hours of ECMO insertion is associated with a lower risk of a composite of death, cardiac replacement therapy, and cardiovascular rehospitalization in patients with fulminant myocarditis undergoing VA-ECMO. Registered at ClinicalTrials.gov (NCT05933902).</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25DOI: 10.1016/j.rec.2024.06.002
Felix Voll, Constantin Kuna, Maria Scalamogna, Thorsten Kessler, Sebastian Kufner, Tobias Rheude, Hendrik B Sager, Erion Xhepa, Jens Wiebe, Michael Joner, Robert A Byrne, Heribert Schunkert, Gjin Ndrepepa, Barbara E Stähli, Adnan Kastrati, Salvatore Cassese
Introduction and objectives: Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context.
Methods: We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization.
Results: Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n=1683; staged during the index hospitalization, n=3460; staged during a subsequent hospitalization within 45 days, n=3275) or to culprit vessel-only PCI (n=2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P=.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other.
Conclusions: In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death. This study is registered at PROSPERO (CRD42023457794).
{"title":"Timing of multivessel revascularization in stable patients with STEMI: a systematic review and network meta-analysis.","authors":"Felix Voll, Constantin Kuna, Maria Scalamogna, Thorsten Kessler, Sebastian Kufner, Tobias Rheude, Hendrik B Sager, Erion Xhepa, Jens Wiebe, Michael Joner, Robert A Byrne, Heribert Schunkert, Gjin Ndrepepa, Barbara E Stähli, Adnan Kastrati, Salvatore Cassese","doi":"10.1016/j.rec.2024.06.002","DOIUrl":"10.1016/j.rec.2024.06.002","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context.</p><p><strong>Methods: </strong>We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization.</p><p><strong>Results: </strong>Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n=1683; staged during the index hospitalization, n=3460; staged during a subsequent hospitalization within 45 days, n=3275) or to culprit vessel-only PCI (n=2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P=.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other.</p><p><strong>Conclusions: </strong>In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death. This study is registered at PROSPERO (CRD42023457794).</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction and objectives: This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).
Methods: We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).
Results: During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).
Conclusions: The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
{"title":"Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain.","authors":"Salud Santos, Nicolás Manito, Joaquín Sánchez-Covisa, Ignacio Hernández, Carmen Corregidor, Luciano Escudero, Kirsty Rhodes, Clementine Nordon","doi":"10.1016/j.rec.2024.06.003","DOIUrl":"10.1016/j.rec.2024.06.003","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>This real-world study-the first of its kind in a Spanish population-aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and >365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).</p><p><strong>Results: </strong>During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased >365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).</p><p><strong>Conclusions: </strong>The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24DOI: 10.1016/j.rec.2024.05.011
Diana Ladera Santos, Álvaro Roldán Guerra, Manuel Anguita-Sánchez
{"title":"NSTEMI in a 16-year-old male patient with ulcerative colitis.","authors":"Diana Ladera Santos, Álvaro Roldán Guerra, Manuel Anguita-Sánchez","doi":"10.1016/j.rec.2024.05.011","DOIUrl":"10.1016/j.rec.2024.05.011","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-18DOI: 10.1016/j.rec.2024.06.001
Gabriela Tirado-Conte, Ángel Sánchez-Recalde, José Luis Zamorano
{"title":"Is DOAC the preferred oral anticoagulation therapy after TAVI?","authors":"Gabriela Tirado-Conte, Ángel Sánchez-Recalde, José Luis Zamorano","doi":"10.1016/j.rec.2024.06.001","DOIUrl":"10.1016/j.rec.2024.06.001","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-13DOI: 10.1016/j.rec.2024.05.009
{"title":"Richard S. Cooper","authors":"","doi":"10.1016/j.rec.2024.05.009","DOIUrl":"10.1016/j.rec.2024.05.009","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1885585724001877/pdfft?md5=c5894e6daf0087e19b6bb58cc800ccb2&pid=1-s2.0-S1885585724001877-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}