Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial.

OBJECTIVES: We tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults. DESIGN: Secondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial. SETTING: Community-dwelling, free-living participants in PREDIMED-Plus trial. PARTICIPANTS: 6,874 Spanish older adults (55-75 years, 49% women) with overweight/obesity and metabolic syndrome. INTERVENTION: Participants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations. MEASUREMENTS: COVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk. RESULTS: Overall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)). CONCLUSIONS: There was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Health-related quality of life in individuals with metabolic syndrome: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

[What should nephrologists know about cardiac illnesses in patients on peritoneal dialysis?]. / ¿Qué debe conocer el nefrólogo de la afectación cardíaca en el paciente en diálisis peritoneal?

Patients on peritoneal dialysis account for approximately 10% of individuals on dialysis and are very variably distributed throughout Spain, with a national mean of 47 procedures per million inhabitants. The high incidence of cardiovascular disease in patients on peritoneal dialysis is determined by the almost universal presence of traditional cardiovascular risk factors (diabetes, hypertension) and other risk factors secondary to uremia and the inflammatory process associated to atherosclerotic disease. The concomitant presence in clinical practice of highly diverse heart diseases in these patients makes relevant a number of considerations from the cardiological viewpoint that may be of interest for specialists in nephrology. This review analyzes some aspects of four cardiological conditions that are very common in patients on peritoneal dialysis: heart failure, coronary heart disease, valve involvement, and atrial fibrillation.

[Giant-cell myocarditis simulating an apical myocardial infarct]. / Miocarditis de células gigantes simulando un infarto de miocardio apical.

We present a case of a 57-year-old man with a giant-cell myocarditis that made its debut as a sustained ventricular polymorphic tachycardia interpreted in the context of old apical myocardium infarct, with a posterior evolution towards refractory heart failure, which finally needed urgent cardiac transplantation. We explain the characteristics of this unusual myocarditis, which has a poor prognosis, and also the results of the laboratory techniques that led to an equivocal diagnosis in this patient.

[Usefulness of exercise Doppler in the diagnosis of severe mitral stenosis]. / Valor del Doppler de esfuerzo para el diagnóstico de la estenosis mitral severa.

BACKGROUND: Exercise in mitral stenosis produces an increase in cardiac output and heart rate which determines the increment in the transmitral gradient. However, it has not yet been established what level is reached by the gradients on exercise in severe mitral stenosis nor whether the rise in the gradient during such exercise is different to that occurring in non-severe stenosis. OBJECTIVE: To evaluate the effect of exercise in patients with severe mitral stenosis on the mitral valve gradients in absolute values and on the increment with respect to base values. METHODS: Forty-eight mitral stenosis patients (mean age: 48.8 +/- 11 years) underwent 50 exercise Doppler echocardiographic studies using supine bicycle ergometry in two stages with increases of 25 W every 3 minutes; from each of these we obtained the peak and mean mitral gradient using a non-imaging continuous-wave Doppler probe. We also conducted this procedure on 14 patients with a mean age of 50 +/- 6 who had Bjork mitral prostheses which were functioning normally. RESULTS: We defined a hemodynamic profile of severity based on the data from 18 patients whose basal mitral valve areas was < 1.2 cm2 (group I), and compared them with the data from the 32 studies of mitral stenosis patients with an area > 1.1 cm2 (group II) and with the patients with mitral prostheses (group III). The mean mitral gradient (mmHg) in group I was greater than in group II at rest (9.3 +/- 3.2 and 6.6 +/- 2.7; p < 0.001), at 25 W (20.6 +/- 4.8 and 14.1 +/- 5; p < 0.001) and at 50 W (25.9 +/- 5.4 and 17.3 +/- 5.8; p < 0.001). The increase in mean mitral gradient from the baseline to 50 watts was 16.7 +/- 4.5 mmHg in group I, which was greater than in group II and III (11.1 +/- 4.1 and 6.8 +/- 2.6 mmHg; p < 0.001). CONCLUSIONS: Exercise Doppler echocardiography enabled us to define a differential hemodynamic profile in patients with severe mitral stenosis which can be used in isolation as an indicator of severity in this condition.

[II. Role of Doppler echocardiography in the management of chronic ischemic cardiopathy]. / II. Papel de la ecocardiografía Doppler en el manejo de la cardiopatía isquémica crónica.

Doppler echocardiography is a simple, fast and non-invasive method to identify abnormal regional and global left ventricular function. One could consider this method the best application for this end within the techniques of imaging. This chapter reviews the role of Doppler echocardiography in the management of chronic coronary artery disease, as well as for studying the global and regional function at rest, as in the applications derived from their use during stress testing. Frequent techniques of stress echocardiography for the diagnosis of ischemic heart disease, their utility in the study of myocardial viability, and the establishment of recommendations for their use in clinical practice are analyzed.

[The prescription of physical exercise in the individual with aortic prostheses. The role of Doppler exercise study]. / Prescripción de ejercicio físico en el individuo con prótesis aórticas. Papel del Doppler de esfuerzo.

BACKGROUND AND OBJECTIVES: Exercise Doppler echocardiography allows measure valvular gradient during exercise, that could be useful in the prescription of physical activity in patients with a prosthetic aortic valve. METHODS: Exercise Doppler echocardiography was performed in 50 patients (mean age 53 +/- 12 years) with normally-functioning aortic prosthesis. Maximal exercise was performed by supine bicycle ergometry in 35 and modified Bruce protocol in 15. Continuous wave Doppler examinations were obtained at rest, during and at maximal exercise with a nonimaging transducer. RESULTS: The mean value of workload was 6.9 +/- 2 METS and there were no complications. Gradients at peak exercise were available in 43/50 patients. Exercise induced a statistic significant increase in the heart rate (76 +/- 14 to 136 +/- 26), systolic blood pressure (128 +/- 19 to 182 +/- 19 mmHg), peak gradient (29 +/- 9 to 61 +/- 17 mmHg) and mean gradient (16 +/- 5 to 32 +/- 9 mmHg). The gradient was greater than 59 mmHg in 18/43 patients, greater than 69 mmHg in 12/43 and greater than 79 mmHg in 5/43. CONCLUSIONS: Prescription of exercise in patients with aortic prosthesis requires perform an exercise Doppler echocardiography to measure the increase of valvular gradient with the exercise in each patient, since the stress testing could be normal, it can advise a rate of physical activity that determine very high prosthetic gradients.

[The role of Doppler of effort in the indications for percutaneous valvuloplasty and/or mitral surgery in patients with a preserved functional class]. / Papel del Doppler de esfuerzo en la indicación de valvuloplastia percutánea y/o cirugía mitral en pacientes con grado funcional conservado.

We have evaluated in this study the role of exercise Doppler echocardiography to establish the clinical indication of invasive procedures in patients with mitral stenosis and preserved functional class. Thirty-tree patients, mean age 45 +/- 9 years, underwent 35 exercise Doppler studies by supine bicycle ergometry with a 2 MHz nonimaging continuous wave Doppler probe. Sixteen patients were in N.Y.H.A. class I and 19 in class II. Peak and mean mitral gradient were obtained at rest, during, at maximal exercise and at recovery period, averaging at least 5 cardiac cycles. The data of 16 patients with mitral area at rest < 1.2 cm2 (group I) were compared with the data of 19 patients with mitral area at rest > 1.1 cm2 (group II). The mean gradient (mmHg) in the group I compared with respect group II was significantly higher at rest (9.5 +/- 3 vs 6 +/- 3, p < 0.01), step 1 (21 +/- 5 vs 14 +/- 6, p < 0.001), step 2 (26.4 +/- 5 vs 17.9 +/- 6, p < 0.001), step 3 (26.5 +/- 4 vs 20.7 +/- 6, p < 0.01), step 4 (29.8 +/- 5 vs 23.8 +/- 4, p < 0.05) and peak exercise (31.4 +/- 4 vs 21.9 +/- 6, p < 0.001). The functional capacity in mets was similar in both groups (6.7 +/- 1 vs 7.2 +/- 2, p = NS). Three patients of group I (15.7%) showed the same increase of gradient as group I. We conclude that exercise Doppler echocardiography allow identification of the haemodynamic severity of patients with mitral stenosis and preserved functional class. This technique could be a good tool in clinical indication of invasive procedures in these patients.

[Calculation of the mitral valve area using Hatle's method. Effect of the preload change induced by nitrates]. / Cálculo del área valvular mitral por el método de Hatle. Efecto de la modificación en la precarga inducida por nitritos.

The aim of the present study was to assess the effect of changes in preload induced by nitrates on calculated mitral valve area by Doppler pressure half-time. Forty patients (mean age 51 +/- 10 years), 23 with mitral stenosis, ten with mechanical prosthesis and seven with bioprosthesis were studied by Doppler echocardiography. Twelve were in sinus rhythm and 28 had atrial fibrillation. Mitral valve area by Doppler pressure half-time, peak and mean mitral gradient and pulmonary artery systolic pressure were measured before and after isosorbide dinitrate (5 mg) or nitroglycerin (0.4 mg). The nitrates produced a significant reduction of pre-load in total group (p less than 0.001) but did not change the mitral valve area (1.9 +/- 0.8 to 1.9 +/- 0.8). The subsets of patients with size valvular area (greater than 2 cm2, less than 2 cm2, less than 1.5 cm2, mechanical prosthesis, bioprosthesis, sinus rhythm and atrial fibrillation) had an insignificant change in mitral valve area after administration of nitrates. We conclude that the mitral valve area by Doppler pressure half-time method do not modify in different conditions of preload. These findings remain in patients with prosthesis, different sizes of mitral valve area and atrial fibrillation.