Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Mitral Valve Insufficiency , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Treatment Outcome
INTRODUCTION AND OBJECTIVES: Transcatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes. METHODS: The population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n=450) and b) TEER after the recommendation of ARNIs by European Guidelines (n=639), with further analysis according to intake (n=52) or not (n=587) of ARNIs. RESULTS: A total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82mL vs 100mL, P=.025), and better function (35% vs 38%, P=.011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P <.001) and heart failure readmissions (16.6% vs 27.8%, P <.001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission+mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P=.048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P=.011). CONCLUSIONS: Better patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.
Heart Failure , Mitral Valve Insufficiency , Neprilysin , Humans , Heart Failure/drug therapy , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/drug therapy , Mitral Valve Insufficiency/surgery , Neprilysin/antagonists & inhibitors , Receptors, Angiotensin , Treatment Outcome
BACKGROUND: Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR. METHODS: Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes. RESULTS: Overall, 1074 (69.1% male, 73.3 ± 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies. CONCLUSION: TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.
Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Aged , Aged, 80 and over , Cardiac Catheterization , Echocardiography , Female , Heart Atria , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Treatment Outcome
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Rheumatic Heart Disease/surgery , Transcatheter Aortic Valve Replacement/instrumentation , Aged , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Prosthesis Failure , Reoperation , Treatment Outcome
This article presents a cross-cultural study on perceived risk in the construction industry. Worker samples from three different countries were studied: Spain, Peru and Nicaragua. The main goal was to explain how construction workers perceive their occupational hazard and to analyze how this is related to their national culture. The model used to measure perceived risk was the psychometric paradigm. The results show three very similar profiles, indicating that risk perception is independent of nationality. A cultural analysis was conducted using the Hofstede model. The results of this analysis and the relation to perceived risk showed that risk perception in construction is independent of national culture. Finally, a multiple lineal regression analysis was conducted to determine what qualitative attributes could predict the global quantitative size of risk perception. All of the findings have important implications regarding the management of safety in the workplace.
Construction Industry , Perception , Risk-Taking , Work/psychology , Adult , Cross-Cultural Comparison , Female , Humans , Linear Models , Male , Nicaragua , Peru , Psychometrics , Risk , Spain , Surveys and Questionnaires
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Humans , Female , Middle Aged , Embolism , Aorta, Thoracic , Thrombosis/complications , Echocardiography, Transesophageal
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Humans , Female , Aged , Pericarditis/complications , Pericarditis/diagnosis , Cardiac Tamponade/complications , Echinococcosis/complications , Echinococcosis/diagnosis , Echocardiography , Echinococcosis/physiopathology , Echinococcosis , Pericardiocentesis , /methods
Coronary Disease/therapy , Coronary Restenosis/prevention & control , Paclitaxel/administration & dosage , Sirolimus/administration & dosage , Stents , Coronary Restenosis/epidemiology , Data Interpretation, Statistical , Diabetes Complications , Humans , Immunosuppressive Agents/administration & dosage
La fibrosis endomiocárdica es una miocardiopatía restrictiva, de etiología no muy clara, endémica en países tropicales y subtropicales. Los pacientes suelen ser jóvenes, y el inicio de la enfermedad, insidioso y con mal pronóstico. La cirugía puede lograr una mejoría clínica y prolongar las expectativas de vida; sin embargo, es solamente un tratamiento paliativo y no frena el progreso natural de la enfermedad. Presentamos un caso de fibrosis endomiocárdica procedente de Guinea Ecuatorial, con severa afectación clínica y franca mejoría tras la cirugía. Se comentan las hipótesis etiopatogénicas más actuales, los hallazgos encontrados y el tratamiento de estos pacientes, poco habituales en nuestro medio. También se comentan las diferencias con el síndrome de Loeffler, con el que ha sido relacionada históricamente según una de las hipótesis etiopatogénicas (AU)
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Adult , Female , Humans , Endomyocardial Fibrosis
