Impact of Sex in the Incidence of Heart Failure in Patients with Chronic Coronary Syndrome.

PURPOSE OF REVIEW: This review examines the available evidence concerning the incidence of heart failure in patients with chronic coronary syndrome, with a focus on gender differences. RECENT FINDINGS: The incidence of heart failure in the context of chronic coronary syndrome presents conflicting data. Most of the available information stems from studies involving stable patients' post-acute coronary syndrome, revealing a wide range of incidence rates, from less than 3% to over 20%, observed over 5 years of follow-up. Regarding the gender differences in heart failure incidence, there is no consensus about whether women exhibit a higher incidence, particularly in the presence of evidence of obstructive coronary artery disease. However, in cases where obstructive coronary artery disease is absent, women may face a more unfavourable prognosis due to a higher prevalence of microvascular disease and heart failure with preserved ventricular function. The different profile of ischaemic heart disease in women difficult to establish differences in prognosis independently associated with female sex. Targeted investigations are essential to discern the incidence of heart failure in chronic coronary syndrome and explore potential gender-specific associations.

Current status of fertility preservation in a Spanish tertiary public hospital: multidisciplinary approach and experience in over 1500 patients.

PURPOSE: Currently, 15% of gynaecological and 9% of haematological malignancies are diagnosed before the age of 40. The increased survival rates of cancer patients who are candidates for gonadotoxic treatments, the delay in childbearing to older ages, and the optimization of in vitro fertilisation techniques have all contributed to an increased interest in fertility preservation (FP) treatments. This study reviews the experience of the Fertility Preservation Programme (FPP) of a tertiary public hospital with a multidisciplinary approach. METHODS: This retrospective study included all the available (FP) treatments, performed in patients of childbearing age between 2006 and 2022. RESULTS: 1556 patients were referred to the FPP: 332 oocyte vitrification cycles, 115 ovarian cortex cryopreservation with 11 orthotopic autotransplantations, 175 gonadotropin-releasing hormone (GnRH) agonist treatments, 109 fertility-sparing treatments for gynaecological cancer, and 576 sperm cryopreservation were performed. Malignancy was the main indication for FP (the main indications being breast cancer in women and haematological malignancies in men), although non-oncological pathologies, such as endometriosis and autoimmune diseases, have increased in recent years. Currently, the most widely used FP technique is oocyte vitrification, the increase of which has been associated with a decrease in the use of cortex CP and GnRH agonists. CONCLUSIONS: The increase in FP treatment reflects the implementation of reproductive counselling in oncology programmes. A multidisciplinary approach in a tertiary public hospital allows individualised FP treatment for each patient. In recent years, there has been a change in trend with the introduction of new indications for FP and a change in techniques due to their optimisation.

Accuracy of the angiography-based quantitative flow ratio in intermediate left main coronary artery lesions and comparison with visual estimation.

BACKGROUND: Revascularization of left main coronary artery (LMCA) stenosis is mostly based on angiography. Indices based on angiography might increase accuracy of the decision, although they have been scarcely used in LMCA. The objective of this study is to study the diagnostic agreement of QFR (quantitative flow ratio) with wire-based fractional flow reserve (FFR) in LMCA lesions and to compare with visual severity assessment. METHODS: In a series of patients with invasive FFR assessment of intermediate LMCA stenoses we retrospectively compared the measured value of QFR with that of FFR and the estimate of significance from angiography. RESULTS: 107 QFR studies were included. The QFR intra-observer and inter-observer agreement was 87% and 82% respectively. The mean QFR-FFR difference was 0.047 ± 0.05 with a concordance of 90.7%, sensitivity 88.1%, specificity 92.3%, positive predictive value 88.1% and negative predictive value 92.3%. All these values were superior to those observed with the visual estimation which showed an intra- and inter-observer agreement of 73% and 72% respectively, besides 78% with the FFR value. The low diagnostic performance of the visual estimation and the acceptable performance of the QFR index measurement were observed in all subgroups analysed. CONCLUSIONS: QFR allows an acceptable estimate of the FFR obtained with intracoronary pressure guidewire in intermediate LMCA lesions, and clearly superior to the assessment based on angiography alone. The decision to revascularize patients with moderate LMCA lesions should not be based solely on the degree of angiographic stenosis.

Natural History of Anal HPV Infection in Women Treated for Cervical Intraepithelial Neoplasia.

Women with high-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (HSIL/CIN) are at high risk of anal human papillomavirus HPV infection, and it has also been suggested that self-inoculation of the virus from the anal canal to the cervix could explain HPV recurrence in the cervix after treatment of HSIL/CIN. We aimed to evaluate the bidirectional interactions of HPV infection between these two anatomical sites. We evaluated 68 immunocompetent women undergoing excisional treatment for HSIL/CIN. Immediately before treatment, samples from the anus and the cervix were obtained (baseline anal and cervical HPV status). Cervical HPV clearance after treatment was defined as treatment success. The first follow-up control was scheduled 4-6 months after treatment for cervical and anal samples. High resolution anoscopy (HRA) was performed on patients with persistent anal HPV infections or abnormal anal cytology in the first control. Baseline anal HPV was positive in 42/68 (61.8%) of the women. Anal HPV infection persisted after treatment in 29/68 (42.6%) of the women. One-third of these women (10/29; 34.5%) had HSIL/anal intraepithelial neoplasia (AIN). Among women achieving treatment success, cervical HPV in the first control was positive in 34.6% and 17.6% of the patients with positive and negative baseline anal HPV infection, respectively (p = 0.306). In conclusion, patients with persisting anal HPV after HSIL/CIN treatment are at high risk of HSIL/AIN, suggesting that these women would benefit from anal exploration. The study also suggests that women with anal HPV infection treated for HSIL/CIN might be at higher risk of recurrent cervical HPV even after successful treatment.

Changes in the Treatment Strategy Following Intracoronary Pressure Wire in a Contemporaneous Real-Life Cohort of Patients With Intermediate Coronary Stenosis. Results From a Nationwide Registry.

BACKGROUND: Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. AIMS: To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. METHODS: Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. RESULTS: 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). CONCLUSIONS: The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.

Aquaporin-4-Positive Triple-Negative Breast Cancer Presenting with Paraneoplastic Neuromyelitis Optica Spectrum Disorder.

INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory central nervous system disorder that preferentially affects the optic nerve and the spinal cord. Although NMOSD is more commonly an idiopathic autoimmune condition associated with antibodies against aquaporin-4 (AQP4)-IgG, the disease may also occur as a paraneoplastic syndrome in rare instances. In these cases, the expression of AQP4 by the tumor is likely the trigger of the autoimmune response. CASE PRESENTATION: We describe the case of a 32-year-old woman who presented with progressive tetraparesis, cranial involvement, respiratory failure, and spinal cord MRI compatible with longitudinally extensive transverse myelitis, few days after being diagnosed with a T3N1M0 triple-negative right breast cancer. Due to the history of concurrent breast cancer and after ruling out metastatic spinal cord involvement, the possibility of a paraneoplastic origin was raised. AQP4-IgG were found in the serum and CSF by cell-based assay, confirming the diagnosis of NMOSD. The patient was treated with corticosteroids, plasma exchange, and rituximab. Concomitantly, breast cancer therapy was started with an adapted neoadjuvant chemotherapy scheme based on carboplatin and paclitaxel. An initial slight improvement slowed down; so, a right mastectomy with lymphadenectomy was performed. Expression of AQP4 was demonstrated in the tumor. The patient presented a significant neurological improvement after combined treatment regaining muscular balance and strength in upper and lower extremities. CONCLUSION: NMOSD may have a paraneoplastic origin associated with breast cancer and the importance of its early detection since the combination of tumoral and immunosuppressive therapy may improve the patient's prognosis.

Descubriendo las novedades del marco de la AOTA / Discovering the novelties of AOTA framework

El trabajo de compilación de un documento de este calibre no deja de ser un reto. Con este número especial intentamos contribuir al desarrollo de la disciplina y establecer una base teórica para beneficio de los y las profesionales e terapia ocupacional. (AU)

The work of compiling a document of this caliber is always a challenge. In this special issue we attempt to contribute to the development of the discipline and establish a theoretical basis for the benefit of occupational therapy professionals. (AU)

Conocimiento, conducta y actitud ante el Código europeo contra el cáncer por parte de los profesionales sanitarios de atención primaria / Knowledge, conduct and attitude before the European Code against Cancer by health professionals of primary care

OBJETIVO: Determinar si los profesionales de atención primaria (AP) conocen el Código europeo contra el cáncer (CECC) y si ello se relaciona con que practiquen sus recomendaciones. DISEÑO: Observacional descriptivo. Emplazamiento: Centros de AP españoles. PARTICIPANTES: Profesionales de AP. INTERVENCIONES: Cuestionario autoadministrado. Mediciones principales: Factores de riesgo y protectores del cáncer, pruebas de cribado y conocimiento del CECC. RESULTADOS: Respondieron 1.734 profesionales (10,5%), edad media de 48,5 años (DT: 9,2), el 71,5% mujeres. El 50,0% desconoce el CECC; los tutores (OR = 1,61), adscritos al PAPPS (OR=1,51) y que llevan más tiempo trabajando en AP (OR = 2,62) son los que más lo conocen. El 7,2% fuma y el 79,1% bebe alcohol. El 64,1% presenta normopeso y el 19% realiza actividad física. Evita exponerse al sol el 52,7% y usa protectores el 53,8%. El 85,2% nunca se ha realizado un cribado colorrectal, el 11% nunca una citología y el 12% una mamografía. Existe relación entre conocer el CECC y el tabaquismo (p < 0,001), sobrepeso/obesidad (p = 0,024), actividad física (p = 0,003), ingesta de carnes (p < 0,001), mamografía (p < 0,001), citología (p = 0,022), PSA (p = 0,045), así como el fomento de sus consejos entre los pacientes. CONCLUSIONES: El CECC es desconocido por la mitad de los profesionales de AP. La práctica de sus recomendaciones es desigual, siendo la prevalencia de tabaquismo baja, y la protección solar una conducta poco extendida. Los que lo conocen son los que más practican sus recomendaciones

OBJECTIVE: To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients. DESIGN: descriptive, observational study. SETTING: Spanish Health Centers. PARTICIPANTS: Health professionals. Interventions self-administered questionnaire. MAIN MEASUREMENTS: cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC. RESULTS: 1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR = 1.61), assigned to the PAPPS (OR = 1.51) and who have been working in AP for more time (OR = 2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P < .001), overweight/obesity (P = .024), physical activity (P = .003), meat intake (P < .001), mammography (P < .001), cytology (P=.022), PSA (P = .045), as well as the promotion of their advice among patients. CONCLUSIONS: The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations

[Knowledge, conduct and attitude before the European Code against Cancer by health professionals of primary care]. / Conocimiento, conducta y actitud ante el Código europeo contra el cáncer por parte de los profesionales sanitarios de atención primaria.

OBJECTIVE: To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients. DESIGN: descriptive, observational study. SETTING: Spanish Health Centers. PARTICIPANTS: Health professionals. INTERVENTIONS: self-administered questionnaire. MAIN MEASUREMENTS: cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC. RESULTS: 1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR=1.61), assigned to the PAPPS (OR=1.51) and who have been working in AP for more time (OR=2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P<.001), overweight/obesity (P=.024), physical activity (P=.003), meat intake (P<.001), mammography (P<.001), cytology (P=.022), PSA (P=.045), as well as the promotion of their advice among patients. CONCLUSIONS: The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations.

Determinantes e impacto pronóstico de la insuficiencia cardiaca y la fracción de eyección del ventrículo izquierdo en el síndrome coronario agudo / Determinants and prognostic impact of heart failure and left ventricular ejection fraction in acute coronary syndrome settings

Introducción y objetivos: Actualmente existen pocos datos sobre la incidencia y el pronóstico de la insuficiencia cardiaca (IC) y la fracción de eyección del ventrículo izquierdo (FEVI) en el escenario del síndrome coronario agudo (SCA). El objetivo del estudio fue determinar la relación de la FEVI y la IC con el pronóstico a largo plazo en una cohorte de pacientes con SCA. Métodos: Se trata de un estudio retrospectivo observacional de 6.208 pacientes consecutivos ingresados por SCA en 2 hospitales españoles. Se determinaron las características clínicas y se consideró como objetivo primario la mortalidad y/o el reingreso por IC durante el seguimiento. Resultados: Entre los 5.064 participantes, presentaron SCA sin IC durante el ingreso: 290 (5,8%) con FEVI < 40%, 540 (10,6%) con FEVI 40-49% y 4.234 (83,6%) con FEVI ≥ 50%. De los 1.144 pacientes restantes 395 (34,6%) con FEVI < 40%, 251 (21,9%) FEVI 40-49% y 498 (43,5%) FEVI ≥ 50%. Los pacientes con FEVI del 40-49% tenían un perfil clínico y demográfico con características intermedias entre los pacientes presentaban FEVI < 40% y FEVI ≥ 50%. Las curvas de Kaplan-Meier mostraron que la mortalidad y el reingreso por IC eran significativamente distintos en función de la FEVI únicamente en los pacientes sin IC. En este grupo, la FEVI ≥ 50% fue un factor pronóstico independiente. Conclusiones: En el SCA, el pronóstico a largo plazo es considerablemente peor en los pacientes que desarrollan IC durante el ingreso, independientemente del valor de la FEVI. Este parámetro solo es en un factor pronóstico en los pacientes sin IC

Introduction and objectives: Contemporary data on the incidence and prognosis of heart failure (HF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scant. The aim of this study was to examine the relationship between LVEF and HF with long-term prognosis in a cohort of patients with ACS. Methods: This is a retrospective observational study of 6208 patients consecutively admitted for ACS to 2 different Spanish hospitals. Baseline characteristics were examined and a follow-up period was established for registration of death and HF rehospitalization as the primary endpoint. Results: Among the study participants, 5064 had ACS without HF during hospitalization: 290 (5.8%) had LVEF < 40%, 540 (10.6%) LVEF 40% to 49%, and 4234 (83.6%) LVEF ≥ 50%. The remaining 1144 patients developed HF in the acute phase: 395 (34.6%) had LVEF < 40%, 251 (21.9%) LVEF 40% to 49%, and 498 (43.5%) LVEF ≥ 50%. Patients with LVEF 40% to 49% had a demographic and clinical profile with intermediate features between the LVEF < 40% and LVEF ≥ 50% groups. Kaplan-Meier curves showed that mortality and HF readmissions were statistically different depending on LVEF in the non-HF group but not in the HF group. Left ventricular ejection fraction ≥ 50% was an independent prognostic factor in the non-HF group only. Conclusions: In ACS, long-term prognosis is considerably worse in patients who develop HF during hospitalization than in patients without HF, irrespective of LVEF. This parameter is a strong prognostic predictor only in patients without HF

Prevalencia e incidencia tras el alta hospitalaria de neoplasias en pacientes con síndrome coronario agudo / Prevalence and postdischarge incidence of malignancies in patients with acute coronary syndrome

Introducción y objetivos. Las neoplasias malignas son la segunda causa de muerte en los países desarrollados, por detrás de las enfermedades cardiovasculares, y ambas entidades tienen factores en común. Métodos. Estudio prospectivo de todos los pacientes ingresados por un síndrome coronario agudo en el que se evaluó la prevalencia de neoplasias y la incidencia tras el alta. Resultados. La prevalencia de neoplasias en los 1.819 pacientes incluidos fue del 3,4% y el 41,9% de los casos se consideraron libres de enfermedad. Entre los 1.731 pacientes dados de alta, la incidencia fue 3,1% (53 casos) y las localizaciones más frecuentes fueron colon, pulmón, vejiga y páncreas. Los pacientes con neoplasias prevalentes presentaron más edad, comorbilidades y complicaciones. No se observaron diferencias en el porcentaje de revascularización, pero sí menor uso de stents farmacoactivos en los pacientes con neoplasias prevalentes. Durante el seguimiento, la mediana de tiempo hasta el diagnóstico de nuevas neoplasias fue de 25 meses y el análisis multivariante identificó como factores independientes la edad y el ser fumador o exfumador. La mortalidad por cualquier causa tras el alta fue muy superior en los pacientes con neoplasias incidentes (64,2%) o prevalentes (40,0%). El análisis multivariante mostró que en las neoplasias prevalentes e incidentes se multiplicaba por 4 el riesgo de mortalidad por cualquier causa. Conclusiones. El 3,8% de los pacientes tuvieron neoplasias prevalentes y menos del 50% se consideraban curadas en el momento del ingreso. La incidencia de nuevas neoplasias fue del 3,4% y ambas formas de neoplasias empeoraron mucho el pronóstico a largo plazo (AU)

Introduction and objectives. Malignancies are the second cause of death in developed countries after cardiovascular disease and both share common risk factors. Methods. This prospective study assessed the prevalence and postdischarge incidence of malignancies in all consecutive patients admitted for an acute coronary syndrome. Results. A total of 1819 patients were included. On admission, the prevalence of malignancies was 3.4%, and 41.9% of the patients were considered disease-free; of the 1731 discharged patients, the incidence was 3.1% (53 cases) and the most common locations were the colon, lung, bladder, and pancreas. Patients with prevalent malignancies were older and had more comorbidities and complications. There were no differences in the revascularization rate, but implantation of drug-eluting stents was less frequent in patients with prevalent malignancies. During follow-up, the median time to diagnosis of incident malignancies was 25 months. On multivariate analysis, independent risk factors were age and current or former smoking. All-cause mortality was much higher in patients with incident (64.2%) or prevalent (40.0%) malignancies. Multivariate analysis showed that prevalent and incident malignancies increased the risk of all-cause mortality by 4-fold. Conclusions. Among patients admitted for an acute coronary syndrome, 3.8% had a history of malignancy, with less than 50% considered cured. The incidence of new malignancies was 3.4% and both types of malignancies substantially impaired the long-term prognosis (AU)

Adición de antianginosos y complicaciones cardiovasculares recurrentes asociadas a la revascularización incompleta en el síndrome coronario agudo / Addition of antiangina drugs and recurrent cardiovascular events associated with incomplete revascularization in acute coronary syndrome

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Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain: the MAMPA study.

OBJECTIVE: To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain. METHODS: Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate). RESULTS: Participants' mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases. CONCLUSION: Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines' recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.