Analysis and prevention of falls among community-dwelling older adults in southern Thailand.

AIM: To analyse fall prevalence, risk factors and perceptions among Thai older adults to design a prevention model. DESIGN: Quantitative and qualitative data were collected using a convergent parallel mixed-methods design. METHODS: A cross-sectional analysis was conducted using secondary data from health screenings of older adults in 20 subdistrict hospitals in southern Thailand from January 2018 to September 2019 (n = 12,130). In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with purposively sampled participants who were representatives of older adults and stakeholders (n = 50). RESULTS: The quantitative analysis showed that the prevalence of falls was 12.1%. The independent risk factors were female gender, employment status, cognitive impairment, semi-dependent functional ability, balance problems, vision impairment, hearing difficulties, use of medications, reliance on assistive devices and access to outdoor toilets. The qualitative analysis revealed misconceptions on falls and fall prevention measures among older adults and community stakeholders. In Thailand, healthcare providers and community nurses play a crucial role in providing primary advice and conducting interventions, yet they encounter obstacles due to lack of personnel, time constraints, limited resources, inadequate support and unclear policies. Stakeholders stress the urgency of improving practice guidelines, developing evidence-based strategies and aligning with government policies. CONCLUSIONS: Fall risk factors and prevention challenges among older adults were identified. Effective fall prevention programmes are needed. IMPACT: The identified fall events may guide public health agencies and local administrations in planning fall prevention programmes. For implementation in Thai communities, teamwork among leaders and stakeholders is key. PATIENT OR PUBLIC CONTRIBUTION: IDIs and FGDs were conducted with older adults, village health volunteers, nurses, healthcare providers, local organization administrators and village headmen.

Circadian Variations and Associated Factors in Patients with Ischaemic Heart Disease.

Circadian rhythms have been identified in cardiovascular diseases, and cardiovascular risk factors can modify the circadian rhythm. The purpose of this study was to describe the onset of ischaemic heart disease symptomatology in relation to the date and time, the day of the week of presentation, the season, AMI location and severity and the level of influence of individual patient characteristics in a retrospective cross-sectional study involving 244 ischaemic heart disease patients from the intensive care unit of La Ribera Hospital (Spain). The onset of pain was more frequent in the morning, the season with the highest frequency of ischaemic events was winter, and the lowest incidence was during weekends. Regarding the severity of ischaemic heart disease, the circadian rhythm variables of weekdays vs. weekends and seasons did not show a significant association. The length of hospital stay was associated with the onset of pain in the afternoon. The onset of pain at night was associated with the subendocardial location of the infarction. In conclusion, living in a Mediterranean country, the Spanish population showed a circadian pattern of AMI, where the onset of pain has an influence on AMI location and on the length of hospital stay and is the same in patients with different individual risk factors.

Interleukin Inhibitors in Cytokine Release Syndrome and Neurotoxicity Secondary to CAR-T Therapy.

INTRODUCTION: Chimeric antigen receptor T-cell (CAR-T) therapy is an innovative therapeutic option for addressing certain recurrent or refractory hematological malignancies. However, CAR-T cells also cause the release of pro-inflammatory cytokines that lead to life-threatening cytokine release syndrome and neurotoxicity. OBJECTIVE: To study the efficacy of interleukin inhibitors in addressing cytokine release syndrome (CRS) and neurotoxicity secondary to CAR-T therapy. METHODOLOGY: The authors conducted a bibliographic review in which 10 articles were analyzed. These included cut-off studies, case reports, and clinical trials involving 11 cancer centers and up to 475 patients over 18 years of age. RESULTS: Tocilizumab is the only interleukin inhibitor approved to address CRS secondary to CAR-T therapy due to its efficacy and safety. Other inhibitors, such as siltuximab and anakinra, could be useful in combination with tocilizumab for preventing severe cytokine release and neurotoxicity. In addition, the new specific inhibitors could be effective in mitigating CRS without affecting the cytotoxic efficacy of CAR-T therapy. CONCLUSION: More lines of research should be opened to elucidate the true implications of these drugs in treating the side effects of CAR-T therapy.

Nurse-led and Interdisciplinary Secondary Cardiovascular Prevention Programmes: Spanish Cohort of the EUROACTION Project.

BACKGROUND: Cardiovascular prevention and rehabilitation programmes (CVPRP) are a preventive tool, which can reverse unhealthy behaviours and improve risk factor management. They have been successfully implemented in a variety of settings in patients with coronary heart disease (CHD). OBJECTIVE: The objective of this study is to evaluate an interdisciplinary and nurse-led cardiovascular prevention and rehabilitation programme in patients with coronary heart disease. METHODS: Six pairs of hospitals were randomised between intervention (INT) and usual care (UC) patients. The interdisciplinary team in the intervention hospital carried out a 16-week CVPRP to reach European risk factor goals. The trial is registered as ISRCTN 71715857. RESULTS: The proportion of patients achieving European cardiovascular recommendations in Spain increased in the intervention hospital, mainly regarding fruit and vegetable consumption (INT 98% vs. UC 53%, p<0.001), oily fish consumption (INT 42% vs. UC 19.5%, p<0.001), self-reported physical activity (INT 31% vs. UC 12.4%, p=0.04), blood pressure (INT 69% vs. UC 47.1%) p< 0.05) and LDL concentrations (INT 86.1% vs. UC 67.6%, p=0.04). CONCLUSION: The EUROACTION nurse-led model of CVPR programme has shown that therapeutic goals in cardiovascular disease prevention are affordable and sustainable in everyday clinical practice. EUROACTION model adapted in Spain has produced a healthier lifestyle.

Salivary IL-6 Concentration Is Associated with Frailty Syndrome in Older Individuals.

BACKGROUND: One of the physiological changes that is most closely associated with frailty is the increase in pro-inflammatory cytokines, and IL-6 in particular. Most studies have demonstrated this association using blood samples. We analyzed the relationship between frailty syndrome, individual frailty criteria, and IL-6 levels obtained by saliva tests. METHODS: A cross-sectional pilot study was performed among women institutionalized in nursing homes. Frailty was defined as having three or more of the following components: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those components. RESULTS: There was a significant and positive correlation between the frailty score and salivary IL-6 concentration. Regarding the associations between IL-6 and individual dichotomized frailty criteria, there were significant differences in salivary IL-6 concentration in two frailty criteria: weight loss (p = 0.002) and low physical activity (p = 0.007). Receiver operating characteristic curve analysis showed that IL-6 concentration significantly (p < 0.05) (although moderately) discriminated patients that progressed in the frailty syndrome (the area under the curve value was 0.697 with 95% CI 0.566-0.827). CONCLUSIONS: Salivary IL-6 concentration can be used as potential biomarker of frailty syndrome and as a tool to monitor the effects of interventions in frail individuals.

Evaluation of the Effectiveness of Breastfeeding as a Factor in the Prevention of Breast Cancer.

BACKGROUND & OBJECTIVE: As cancer is one of the main causes of fatal illnesses in the world, and breast cancer is responsible for an elevated number of deaths in women, it is important to implement measures to prevent this disease. METHOD: In order to assess the influence of breastfeeding in preventing breast cancer in women, forteen prospective cohort articles are included in this study, and their methodological quality has been assessed through the Newcastle Ottawa quality assessment scale cohort studies. After determining the risk of bias for each case study, those with fewer systematic errors and therefore greater validity, have been selected to demonstrate the relationship they propose exists between breastfeeding and breast cancer. RESULTS: 50% percent of the research included found that breastfeeding does not reduce the risk of breast cancer, while the other 50% argue that it is a protective factor. However, with regards to quality, the case studies that conclude that breastfeeding is not associated with breast cancer have more evidential support. CONCLUSION: It is difficult to establish whether or not breastfeeding prevents breast cancer, given the diversity of conclusions in the literature. Nevertheless, the findings of this study reinforce the importance of developing strategies to improve long-term women's health in the field of prevention.

Psycho-Social Factors in Patients with Cardiovascular Disease Attending a Family-Centred Prevention and Rehabilitation Programme: EUROACTION Model in Spain.

BACKGROUND: Coronary heart disease (CHD) persists as the leading cause of death worldwide. Cardiovascular prevention and rehabilitation (CVPR) has an interdisciplinary focus, and includes not only in physiological components, but it also addresses psycho-social factors. METHODS: The study analysed the Spanish psycho-social data collected during the EUROACTION study. In Spain, two hospitals were randomised in the Valencia community. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out a 16-week CVPR programme, which aimed to assess illness perceptions and establish healthy behaviours in patients and their partners. RESULTS: Illness perceptions were significantly and inversely associated with anxiety and depression. Low levels of anxiety were associated with better self-management of total cholesterol (p = 0.004) and low-density lipoprotein-cholesterol (p = 0.004). There was concordance at one year among patients and partners who participated in the programme related to anxiety (p < 0.001), fruit consumption (p < 0.001), and vegetable consumption (p < 0.001). CONCLUSIONS: The EUROACTION study emphasised the importance of assessing psycho-social factors in a CVPR programme and the inclusion of family as support in patients' changes in behaviour.

The Beneficial Effect of Physical Exercise on Inflammatory Makers in Older Individuals.

Old age is associated with a loss of motor functions and a general progressive decline in cognitive functions. Physical exercise is one of the ways in which inflammatory levels in general can be reduced, and therefore physical exercise can be considered a biological aging decelerator. In this article, we examine the relationships between physical exercise and inflammatory markers reported for the different physical exercise protocols that have been used in studies with older individuals, as well as the effects of these regimens. The different types of exercises programmed, and methods used to implement them were very heterogeneous in the articles we analysed. Both, the aerobic exercise and resistance training protocols produced a decrease in plasma levels of IL-6, CRP and TNF-α, and an increase of IL-10 plasma levels as a chronic effect. However, the acute-response of physical exercise appeared to be an initial increase in IL-6 expression and plasma IL-6 levels. Continuing with these exercise programs usually subsequently achieved a chronic response in which there was a decrease in both the basal levels of IL-6, CRP and TNF-α, and the IL-6 produced as acute responses. Regardless of the type of exercise performed, it seems that the exercise parameters, intensity, duration, subject variables, fitness, and level of inflammation are key factors in achieving the expected balance between proinflammatory and anti-inflammatory cytokines.

Lipid Profile Results after Cardiovascular Prevention Programme: Euroaction Model in Spain.

BACKGROUND: Cardiovascular prevention and rehabilitation programmes (CVPRP) are an established model of care designed to improve risk factor management. They have been successfully implemented in a variety of settings, in patients with coronary heart disease (CHD). OBJECTIVE: To assess the long term impact of a nurse-coordinated, multidisciplinary, CVPRP in patients with CHD in the reduction of lipid profile and medication prescription in clinical practice. METHODS: The study used an analytical, experimental, population based, prospective and longitudinal design. In Spain, the study was conducted in the Valencian Community, including two randomized hospitals. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out an 8-week CVPRP. RESULTS: The proportion of patients achieving improved standards of preventive care increased in the intervention hospital compared with the usual care hospital, mainly regarding LDL-C concentrations. Furthermore, an increased prescription of statins was found in the intervention group. However, there were no statistically significant differences in triglycerides and glucose levels. CONCLUSION: The EUROACTION nurse-led CVPRP enabled coronary patients to control lipid profile to the European targets. A large proportion of patients were prescribed statin therapy as cardioprotective medication with favorable changes in medication for coronary patients. To improve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to the health policy of individual countries.

The Effects of Exercise on IL-6 Levels and Cognitive Performance in Patients with Schizophrenia.

Exercise plays an important role in brain plasticity, leading to improvements in cognitive function and delaying the cognitive deterioration of healthy people. These effects can be observed in individuals with schizophrenia through improvements in their performance in cognitive tasks and a decrease in the symptomology of the disease. In this review we examine the current evidence for the roles that exercise and the immune system play in patients with schizophrenia, and specifically analyze the interleukin-6 (IL-6) pathway as a potential mechanism resulting in these positive effects. Inflammation and high levels of IL-6 are associated with both the severity of schizophrenia and the cognitive impairment suffered throughout the disease. Performing regular exercise can modulate IL-6 by lowering its basal levels and by causing lower acute increases in the plasma levels of this cytokine in response to exercise (an anti-inflammatory response to physical exertion). Although there is evidence for the positive effects of physical exercise on schizophrenia, more studies will be required to better understand how variation in different exercise parameters affects both the acute and chronic plasma levels of IL-6.

Apoptosis and Mobilization of Lymphocytes to Cardiac Tissue Is Associated with Myocardial Infarction in a Reperfused Porcine Model and Infarct Size in Post-PCI Patients.

ST-segment elevation myocardial infarction (STEMI) is the most severe outcome of coronary artery disease. Despite rapid reperfusion of the artery, acute irrigation of the cardiac tissue is associated with increased inflammation. While innate immune response in STEMI is well described, an in-depth characterization of adaptive immune cell dynamics and their potential role remains elusive. We performed a translational study using a controlled porcine reperfusion model of STEMI and the analysis of lymphocyte subsets in 116 STEMI patients undergoing percutaneous coronary intervention (PCI). In the animal model, a sharp drop in circulating T lymphocytes occurred within the first hours after reperfusion. Notably, increased apoptosis of circulating lymphocytes and infiltration of proinflammatory Th1 lymphocytes in the heart were observed 48 h after reperfusion. Similarly, in STEMI patients, a sharp drop in circulating T lymphocyte subsets occurred within the first 24 h post-PCI. A cardiac magnetic resonance (CMR) evaluation of these patients revealed an inverse association between 24 h circulating T lymphocyte numbers and infarction size at 1-week and 6-month post-PCI. Our translational approach revealed striking changes in the circulating and tissue-infiltrating T lymphocyte repertoire in response to ischemia-reperfusion. These findings may help in developing new diagnostic and therapeutic approaches for coronary diseases.

Estudio experimental de los efectos de EIPA, losartán y BQ-123 sobre las modificaciones electrofisiológicas inducidas por el estiramiento miocárdico / Experimental study of the effects of EIPA, Losartan, and BQ-123 on electrophysiological changes induced by myocardial stretch

Introducción y objetivos: Se han implicado diversos mecanismos en la respuesta mecánica al estiramiento miocárdico, que incluyen la activación del intercambiador Na+/H+ por acciones autocrinas y paracrinas. Se estudia la participación de estos mecanismos en las respuestas electrofisiológicas al estiramiento agudo miocárdico mediante el análisis de los cambios inducidos con fármacos. Métodos: Se analizan las modificaciones de la fibrilación ventricular inducidas por el estiramiento agudo miocárdico en corazones de conejo aislados y perfundidos utilizando electrodos múltiples epicárdicos y técnicas cartográficas. Se estudian 4 series: control (n = 9); durante la perfusión del antagonista de los receptores de la angiotensina II, losartán (1 miM, n = 8); durante la perfusión del bloqueador del receptor de la endotelina A, BQ-123 (0,1 miM, n = 9), y durante la perfusión del inhibidor del intercambiador Na+/H+, EIPA (5-[N-ethyl-N-isopropyl]-amiloride) (1 miM, n = 9). Resultados: EIPA atenuó el aumento de la frecuencia dominante de la fibrilación producido por el estiramiento (control = 40,4%; losartán = 36% [no significativo]; BQ-123 = 46% [no significativo], y EIPA = 22% [p < 0,001]). Durante el estiramiento, la complejidad de los mapas de activación fue menor en la serie con EIPA (p < 0,0001) y también en esta serie fue mayor la concentración espectral de la arritmia (mayor regularidad): control = 18 ± 3%; EIPA = 26 ± 9% (p < 0,02); losartán = 18 ± 5% (no significativo), y BQ-123 = 18 ± 4% (no significativo). Conclusiones: El inhibidor del intercambiador Na+/H+ EIPA atenúa los efectos electrofisiológicos responsables de la aceleración y del aumento de la complejidad de la fibrilación ventricular producidos por el estiramiento agudo miocárdico. Por el contrario, el antagonista de los receptores de la angiotensina II, losartán, y el del receptor A de la endotelina, BQ-123, no modifican estos efectos (AU)

Introduction and objectives: Mechanical response to myocardial stretch has been explained by various mechanisms, which include Na+ /H+ exchanger activation by autocrine-paracrine system activity. Drug-induced changes were analyzed to investigate the role of these mechanisms in the electrophysiological responses to acute myocardial stretch. Methods: Multiple epicardial electrodes and mapping techniques were used to analyze changes in ventricular fibrillation induced by acute myocardial stretch in isolated perfused rabbit hearts. Four series were studied: control (n = 9); during perfusion with the angiotensin receptor blocker losartan (1 mM, n = 8); during perfusion with the endothelin A receptor blocker BQ-123 (0.1 mM, n = 9), and during perfusion with the Na+ /H+ exchanger inhibitor EIPA (5-[N-ethyl-N-isopropyl]-amiloride) (1 mM, n = 9). Results: EIPA attenuated the increase in the dominant frequency of stretch-induced fibrillation (control = 40.4%; losartan = 36% [not significant]; BQ-123 = 46% [not significant]; and EIPA = 22% [P < .001]). During stretch, the activation maps were less complex (P < .0001) and the spectral concentration of the arrhythmia was greater (greater regularity) in the EIPA series: control = 18 (3%); EIPA = 26 (9%) (P < .02); losartan = 18 (5%) (not significant); and BQ-123 = 18 (4%) (not significant). Conclusions: The Na+ /H+ exchanger inhibitor EIPA attenuated the electrophysiological effects responsible for the acceleration and increased complexity of ventricular fibrillation induced by acute myocardial stretch. The angiotensin II receptor antagonist losartan and the endothelin A receptor blocker BQ-123 did not modify these effects (AU)

Ranolazine Attenuates the Electrophysiological Effects of Myocardial Stretch in Langendorff-Perfused Rabbit Hearts.

PURPOSE: Mechanical stretch is an arrhythmogenic factor found in situations of cardiac overload or dyssynchronic contraction. Ranolazine is an antianginal agent that inhibits the late Na (+) current and has been shown to exert a protective effect against arrhythmias. The present study aims to determine whether ranolazine modifies the electrophysiological responses induced by acute mechanical stretch. METHODS: The ventricular fibrillation modifications induced by acute stretch were studied in Langendorff-perfused rabbit hearts using epicardial multiple electrodes under control conditions (n = 9) or during perfusion of the late Na(+) current blocker ranolazine 5 µM (n = 9). Spectral and mapping techniques were used to establish the ventricular fibrillation dominant frequency, the spectral concentration and the complexity of myocardial activation in three situations: baseline, stretch and post-stretch. RESULTS: Ranolazine attenuated the increase in ventricular fibrillation dominant frequency produced by stretch (23.0 vs 40.4 %) (control: baseline =13.6 ± 2.6 Hz, stretch = 19.1 ± 3.1 Hz, p < 0.0001; ranolazine: baseline = 1.4 ± 1.8 Hz, stretch =14.0 ± 2.4 Hz, p < 0.05 vs baseline, p < 0.001 vs control). During stretch, ventricular fibrillation was less complex in the ranolazine than in the control series, as evaluated by the lesser percentage of complex maps and the greater spectral concentration of ventricular fibrillation. These changes were associated to an increase in the fifth percentile of VV intervals during ventricular fibrillation (50 ± 8 vs 38 ± 5 ms, p < .01) and in the wavelength of the activation (2.4 ± 0.3 vs 1.9 ± 0.2 cm, p < 0.001) under ranolazine. CONCLUSIONS: The late inward Na(+) current inhibitor ranolazine attenuates the electrophysiological effects responsible for the acceleration and increase in complexity of ventricular fibrillation produced by myocardial stretch.

Experimental Study of the Effects of EIPA, Losartan, and BQ-123 on Electrophysiological Changes Induced by Myocardial Stretch.

INTRODUCTION AND OBJECTIVES: Mechanical response to myocardial stretch has been explained by various mechanisms, which include Na(+)/H(+) exchanger activation by autocrine-paracrine system activity. Drug-induced changes were analyzed to investigate the role of these mechanisms in the electrophysiological responses to acute myocardial stretch. METHODS: Multiple epicardial electrodes and mapping techniques were used to analyze changes in ventricular fibrillation induced by acute myocardial stretch in isolated perfused rabbit hearts. Four series were studied: control (n = 9); during perfusion with the angiotensin receptor blocker losartan (1 µM, n = 8); during perfusion with the endothelin A receptor blocker BQ-123 (0.1 µM, n = 9), and during perfusion with the Na(+)/H(+) exchanger inhibitor EIPA (5-[N-ethyl-N-isopropyl]-amiloride) (1 µM, n = 9). RESULTS: EIPA attenuated the increase in the dominant frequency of stretch-induced fibrillation (control=40.4%; losartan=36% [not significant]; BQ-123=46% [not significant]; and EIPA=22% [P<.001]). During stretch, the activation maps were less complex (P<.0001) and the spectral concentration of the arrhythmia was greater (greater regularity) in the EIPA series: control=18 (3%); EIPA = 26 (9%) (P < .02); losartan=18 (5%) (not significant); and BQ-123=18 (4%) (not significant). CONCLUSIONS: The Na(+)/H(+) exchanger inhibitor EIPA attenuated the electrophysiological effects responsible for the acceleration and increased complexity of ventricular fibrillation induced by acute myocardial stretch. The angiotensin II receptor antagonist losartan and the endothelin A receptor blocker BQ-123 did not modify these effects.

Interleukin 6 and cognitive dysfunction.

The interleukin-6 (IL-6) is a pleiotropic cytokine that plays a key role in interaction between immune and nervous system. Although IL-6 has neurotrophic properties and beneficial effects in the CNS, its overexpression is generally detrimental, adding to the pathophysiology associated with CNS disorders. The source of the increase in peripheral IL-6 remains to be established and varies among different pathologies, but has been found to be associated with cognitive dysfunction in several pathologies. This comprehensive review provides an update summary of the studies performed in humans concerning the role of central and peripheral IL-6 in cognitive dysfunction in dementias and in other systemic diseases accompained by cognitive dysfuction such as cardiovascular, liver disease, Behçet's disease and systemic lupus erythematosus. Further research is needed to correlate specific deficits in IL-6 and its receptors in pathologies characterized by cognitive dysfunction and to understand how systemic IL-6 affects high cerebral function in order to open new directions in pharmacological treatments that modulate IL-6 signalling.

Dynamics of serum-induced endothelial cell apoptosis in patients with myocardial infarction.

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) reperfused with primary coronary intervention (PCI), the dynamics of endothelial cell (EC) viability, apoptosis and necrosis and its relationship with the structural consequences on the left ventricle have not been addressed so far. DESIGN: In 20 STEMI patients, we incubated human umbilical vein endothelial cells (HUVECs) with serum drawn before reperfusion and subsequently afterwards (24, 96 h, 30 days). Viability, apoptosis and necrosis percentages were evaluated by flow cytometry. Values were compared with 12 age- and sex-matched control subjects with normal coronary arteries. Cardiac magnetic resonance (CMR) was performed during the first week after infarction. RESULTS: Serum from STEMI patients induced a progressive loss of EC viability, with a nadir of 67.7 ± 10.2% at 96 h (baseline: 75 ± 6% and controls: 80.2 ± 3.9%, P < 0.001 in both cases). This is due to an increase in apoptosis that peaked at 96 h after reperfusion (15.2 ± 7.1% vs. 11 ± 6 at baseline and 5.8 ± 1.6% in controls, P < 0.001 in both cases). However, no significant dynamic changes in EC necrosis were detected. Extensive myocardial oedema (> 30%, median of left ventricular mass) was the only CMR variable significantly associated with a higher percentage of EC apoptosis at 96 h (extensive vs. nonextensive oedema: 18.3 ± 6.8% vs. 12.1 ± 6.3%, P < 0.05). CONCLUSIONS: Dynamic changes in EC viability occur in the setting of STEMI patients reperfused with PCI, these changes peak late after reperfusion, they are mainly the result of an increase of apoptosis and are associated with the presence of extensive myocardial oedema.

Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI.

Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.

Evaluación de la complejidad de la activación miocárdica durante la fibrilación ventricular. Estudio experimental / Evaluation of the complexity of myocardial activation during ventricular fibrillation. An experimental study

Introducción y objetivos. Analizar en un modelo experimental las características de la fibrilación ventricular en situaciones con distintos grados de complejidad y establecer la relación existente entre los datos aportados por distintos métodos de análisis de la arritmia. Métodos. En 27 preparaciones de corazón aislado de conejo estudiadas bajo la acción de fármacos (propranolol y KB-R7943) o procedimientos físicos (estiramiento) que causan distintos grados de variación de la complejidad de la activación miocárdica durante la arritmia, se han utilizado técnicas espectrales, morfológicas y cartográficas para procesar los registros obtenidos con multielectrodos epicárdicos. Resultados. La complejidad de la fibrilación ventricular objetivada mediante procedimientos cartográficos se ha relacionado con la frecuencia dominante, la energía normalizada del espectro, el índice de regularidad de las señales, sus coeficientes de variación y el área de las regiones de interés identificadas a partir de estos parámetros. En el análisis multivariable, se han aceptado como variables independientes el área de las regiones de interés relacionadas con la energía espectral y el coeficiente de variación de la energía (índice de complejidad = -0,005 × área de las regiones de la energía espectral -2,234 × coeficiente de variación de la energía +1,578; p = 0,0001; r = 0,68). Conclusiones. Los indicadores espectrales, morfológicos y, de manera independiente, los derivados del análisis de las regiones de interés de la energía normalizada permiten aproximarse de manera fiable a la evaluación de la complejidad de la fibrilación ventricular como una alternativa a los complejos procedimientos cartográficos (AU)

Introduction and objectives. An experimental model is used to analyze the characteristics of ventricular fibrillation in situations of variable complexity, establishing relationships among the data produced by different methods for analyzing the arrhythmia. Methods. In 27 isolated rabbit heart preparations studied under the action of drugs (propranolol and KB-R7943) or physical procedures (stretching) that produce different degrees of change in the complexity of myocardial activation during ventricular fibrillation, use was made of spectral, morphological, and mapping techniques to process the recordings obtained with epicardial multielectrodes. Results. The complexity of ventricular fibrillation assessed by mapping techniques was related to the dominant frequency, normalized spectral energy, signal regularity index, and their corresponding coefficients of variation, as well as the area of the regions of interest identified on the basis of these parameters. In the multivariate analysis, we used as independent variables the area of the regions of interest related to the spectral energy and the coefficient of variation of the energy (complexity index = -0.005 × area of the spectral energy regions -2.234 × coefficient of variation of the energy +1.578; P=.0001; r=0.68). Conclusions. The spectral and morphological indicators and, independently, those derived from the analysis of normalized energy regions of interest provide a reliable approach to the evaluation of the complexity of ventricular fibrillation as an alternative to complex mapping techniques (AU)