Revascularization of coronary chronic total occlusions in an infarct-related artery and recurrence of ventricular arrhythmias among patients with secondary prevention implantable cardioverter defibrillator.

OBJECTIVES: To evaluate whether the revascularization of a coronary chronic total occlusion in an infarct-related artery (IRACTO) may be associated with lower recurrence of ventricular arrhythmias (VA) among patients with a secondary prevention implantable cardioverter defibrillator (ICD). BACKGROUND: IRACTO is increasingly recognized as an independent predictor of VA. It is unknown whether IRACTO revascularization can reduce the burden of VA. METHODS: Multicenter observational cohort study that included consecutive patients with prior myocardial infarction and secondary prevention ICD. The primary endpoint was any appropriate ICD therapy. RESULTS: Among the 460 patients included, 269 (58%) had at least one IRACTO at the coronary angiogram performed before ICD implantation; of these, 20 (7%) had their IRACTO successfully revascularized (IRACTO-R) afterwards. During a median follow-up of 48 months, 229 patients (49%) had at least one appropriate ICD therapy. Patients with IRACTO not revascularized (IRACTO-NR) had the highest incidence of ICD therapies (65%) while patients with IRACTO-R had the lowest (10%, p < .001). In the entire cohort, IRACTO-NR was an independent predictor of appropriate ICD therapies (HR 2.85, p < .001) and appropriate ICD shocks (HR 2.94, p < .001). Among patients with IRACTO at baseline, IRACTO-R was independently associated with a marked reduction of appropriate ICD therapies (HR 0.12, p = .002) and appropriate ICD shocks (HR 0.21, p = .03). CONCLUSIONS: In patients with prior myocardial infarction and secondary prevention ICD, IRACTO revascularization was independently associated with a markedly lower incidence of appropriate ICD therapies and shocks. These results should be corroborated by larger prospective studies.

Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies.

INTRODUCTION: Risk stratification for ventricular arrhythmias in patients with ischemic cardiomyopathy needs to be improved. Coronary chronic total occlusions in an infarct-related artery (IRA-CTOs) have been associated with an increased arrhythmic risk. This study aimed to evaluate the association between IRA-CTOs and appropriate implantable cardioverter-defibrillator (ICD) therapies. METHODS AND RESULTS: Observational cohort study that included 342 patients with ischemic cardiomyopathy, an ICD implanted for primary or secondary prevention, and a coronary angiography performed shortly before ICD implantation. The ICD was implanted for primary prevention in 163 patients (48%). IRA-CTO was found in 161 patients (47%). During a median follow-up of 33 months, 41% of patients experienced at least one appropriate ICD therapy. Patients with IRA-CTO had higher proportions of appropriate ICD therapies (57% vs. 26%, P < 0.001) and appropriate ICD shocks (40% vs. 17%, P < 0.001). At multivariate Cox regression, IRA-CTO was the only variable that consistently resulted as independent predictor of appropriate ICD therapies and shocks both in the global population of the study (HR 2.3, P < 0.001 and HR 3, P < 0.001, respectively) and when analyzing separately patients with primary or secondary prevention ICD. CONCLUSIONS: IRA-CTO is an independent predictor of appropriate ICD therapies, including appropriate ICD shocks. This association is consistent across all the subgroups analyzed. Patients with IRA-CTO have a very high risk of appropriate ICD therapies. These findings may help improving risk stratification as well as the management of ventricular arrhythmias in patients with ischemic cardiomyopathy.

Chronic total occlusion of an infarct-related artery: a new predictor of ventricular arrhythmias in primary prevention implantable cardioverter defibrillator patients.

Aims: The aim of this article is to evaluate the impact of a coronary chronic total occlusion in an infarct-related artery (IRA-CTO) on the occurrence of ventricular arrhythmias (VAs) in patients implanted with an implantable cardioverter defibrillator (ICD) for primary prevention. Methods and Results: The study includes a prospective cohort of 108 consecutive patients with ischaemic cardiomyopathy, in whom an ICD was implanted for primary prevention and a coronary angiography performed before ICD implantation. About 49 patients (45%) had a CTO and 34 (31%) had an IRA-CTO. Patients with IRA-CTO did not differ from the rest of the population in terms of basal characteristics and severity of cardiac disease. Median follow-up was 33 months (interquartile range 46). Infarct-related artery-CTO was associated with higher rates of any VA (53 vs. 26%, P = 0.006) and fast ventricular tachycardia (fast VT, cycle length <300 ms) or ventricular fibrillation (VF) (47 vs. 19%, P = 0.002). At multivariate Cox regression, IRA-CTO was the only independent predictor of any VA [hazard ratio (HR) 3.64, P = 0.002] and fast VT/VF (HR 3.36, P = 0.008). On the contrary, CTO not associated with a prior infarction in their territory did not increase the risk of VA. Infract-related artery-CTO was also an independent predictor of cardiac mortality or heart transplantation (HR 3.46, P = 0.022). Conclusion: In ischaemic patients implanted with an ICD for primary prevention, a CTO associated with a previous infarction in its territory is an independent predictor of VA and, especially, of fast VT/VF, identifying a subgroup of patients with a very high rate of arrhythmic events at follow-up.

Functional differences between Andean oak (Quercus humboldtii Bonpl.) populations: The importance of intraspecific variation.

Monodominant tree communities can have phenotypic trait variation (intraspecific variation) as extreme as the trait variation across a forest with higher species diversity. An example of such forests is those composed of Quercus, an important genus of woody angiosperms in the montane neotropical forest. The Andean oak, or Quercus humboldtii Bonpl., is the sole member of this genus in South America and a characteristic component of montane ecosystems. Although there are several studies on the ecology and genetic structure of this species, there are few studies on the functional trait diversity among populations. Understanding functional traits can improve our comprehension of how organisms respond to various environmental conditions. In this study, we aimed to evaluate differences in six functional traits in individuals of the Andean oak, in two ontogenetic stages (juveniles and adults) from three populations with contrasting environmental conditions. Additionally, using T-statistics, we assessed the impact of external filters (e.g., climate, resource availability, large-scale biotic interactions) on population assembly. We found a remarkable level of functional differentiation among Andean oak forests, with all traits differing between populations and five traits differing between ontogenetic stages. External filters had a stronger influence in populations with more extreme environmental conditions. These findings emphasize the dynamic and context-dependent nature of functional traits in this species. However, given the limited exploration of functional diversity in Andean oak populations, further studies are needed to inform conservation efforts.

[Body mass index and prognosis in the elderly patients with acute coronary syndromes]. / Índice de masa corporal y pronóstico en pacientes ancianos con síndrome coronario agudo.

BACKGROUND AND OBJECTIVE: Little information exists about the prognostic impact of body mass index (BMI) in the elderly with acute coronary syndromes (ACS). We aimed to prospectively assess the association between BMI and midterm mortality in consecutive elderly patients with ACS. PATIENTS AND METHOD: We included consecutive ACS patients aged 75 years or older admitted to the Coronary Care Unit. Patients were stratified into 5 BMI subgroups (<20, 20-24.9, 25-29.9, 30-35, > 35 kg/m(2)). Primary endpoint was overall midterm mortality. Analyses were performed by Cox regression method. RESULTS: During the study period 600 patients were admitted, of whom 579 had known BMI values. Low weight patients (BMI<20 kg/m(2)) were older, with higher prevalence of vasculopathy and lower creatinine clearance. Median follow up was 315 days. Patients with BMI< 20 kg/m(2) had higher mortality as compared to the rest of groups. Adjusted analysis showed an attenuation of these differences, while maintaining significance for the groups of BMI 20-24.9 and 30-35 kg/m(2). CONCLUSIONS: The association between BMI and mortality was mainly due to worse prognosis in low weight patients. Prospective assessment of comorbidities and other variables linked to ageing should contribute to better understand the association between BMI and mortality.

Etiología del infarto renal: revisión sistemática de 1582 casos de la literatura / Etiology of renal infarction: a systematic review

Background: Renal infarction is a rare and usually underdiagnosed entity. Aim: To study the etiology of renal infarction in published series. Material and Methods: A systematic review was carried out selecting 28 series that included 1582 patients. Results: The proposed cause was cardiac or aortic embolism in 718 cases (45%), an arterial injury in 253 (16%), prothrombotic factors in 146 (9%) and other causes in 79 (5%). 291 cases were classified as idiopathic (18.4%). Atrial fibrillation was present in 542 of the 718 patients with cardiac or aortic embolism. Conclusions: The main cause of renal infarction is cardiac or aortic embolism and among this group, most cases are due to atrial fibrillation. One out of five cases is labeled as idiopathic.

Índice de masa corporal y pronóstico en pacientes ancianos con síndrome coronario agudo / Body mass index and prognosis in the elderly patients with acute coronary syndromes

Fundamento y objetivo: La información sobre el impacto pronóstico del índice de masa corporal (IMC) en el anciano con síndrome coronario agudo (SCA) es muy escasa. El objetivo fue analizar prospectivamente la asociación entre IMC y mortalidad a medio plazo en una serie de ancianos con SCA. Pacientes y método: Se incluyeron pacientes consecutivos con SCA de 75 años o más ingresados en la Unidad Coronaria, estratificándose en 5 categorías (IMC < 20, 20-24,9, 25-29,9, 30-35, > 35 kg/m2). El objetivo primario fue la mortalidad durante el seguimiento, analizándose mediante regresión de Cox. Resultados: Durante el período de estudio ingresaron 600 pacientes ancianos, de los cuales 579 tenían valores conocidos de IMC. Los pacientes con IMC < 20 kg/m2 presentaban mayor edad, mayor prevalencia de vasculopatía y peor aclaramiento de creatinina. La mediana de seguimiento fue de 315 días. Los pacientes con IMC < 20 kg/m2 presentaron una mortalidad superior al resto. El ajuste estadístico mostró atenuación de dichas diferencias, conservando significación para las categorías de IMC 20-24,9 y 30-35 kg/m2. Conclusiones: La asociación entre IMC y mortalidad se basó fundamentalmente en un peor pronóstico en pacientes de bajo peso. Un registro prospectivo de comorbilidades y otras variables vinculadas al envejecimiento podría contribuir al conocimiento de esta asociación (AU)

Background and objective: Little information exists about the prognostic impact of body mass index (BMI) in the elderly with acute coronary syndromes (ACS). We aimed to prospectively assess the association between BMI and midterm mortality in consecutive elderly patients with ACS. Patients and method: We included consecutive ACS patients aged 75 years or older admitted to the Coronary Care Unit. Patients were stratified into 5 BMI subgroups (< 20, 20-24.9, 25-29.9, 30-35, > 35 kg/m2). Primary endpoint was overall midterm mortality. Analyses were performed by Cox regression method. Results: During the study period 600 patients were admitted, of whom 579 had known BMI values. Low weight patients (BMI < 20 kg/m2) were older, with higher prevalence of vasculopathy and lower creatinine clearance. Median follow up was 315 days. Patients with BMI < 20 kg/m2 had higher mortality as compared to the rest of groups. Adjusted analysis showed an attenuation of these differences, while maintaining significance for the groups of BMI 20-24.9 and 30-35 kg/m2. Conclusions: The association between BMI and mortality was mainly due to worse prognosis in low weight patients. Prospective assessment of comorbidities and other variables linked to ageing should contribute to better understand the association between BMI and mortality (AU)