Extended septal myectomy versus alcohol septal ablation: clinical results at a national referral centre.

OBJECTIVES: Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment. METHODS: It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II. RESULTS: A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg [P < 0.001, 95% confidence interval -30.7; -11.3], and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%-36% vs 59%-1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%-16% vs 15.4-3.8%; P = 0.054). CONCLUSIONS: After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.

Clinical profile and outcome of cardiac amyloidosis in a Spanish referral center.

INTRODUCTION AND OBJECTIVES: Cardiac amyloidosis (CA) is produced by amyloid fiber deposition in the myocardium. The most frequent forms are those caused by light chains (AL) and transthyretin (ATTR). Our objective was to describe the diagnosis, treatment and outcomes of CA in a specialized Spanish center. METHODS: We included all patients diagnosed with CA in Hospital Universitario Puerta de Hierro Majadahonda from May 2008 to September 2018. We analyzed their clinical characteristics, outcomes, and survival. RESULTS: We included 180 patients with CA, of whom 64 (36%) had AL (50% men; mean age, 65±11 years) and 116 had ATTR (72% men; mean age 79±11 years; 18 with hereditary ATTR). The most common presentation was heart failure in both groups (81% in AL and 45% in ATTR, P <.01). Other forms of presentation in ATTR patients were atrial arrhythmias (16%), conduction disorders (6%), and incidental finding (6%); 70 patients (40%), had a previous alternative cardiac diagnosis. Diagnosis was noninvasive in 75% of ATTR patients. Diagnostic delay was higher in ATTR (2.8±4.3 vs 0.6±0.7 years, P <.001), but mortality was greater in AL patients (48% vs 32%, P=.028). Independent predictors of mortality were AL subtype (HR, 6.16; 95%CI, 1.56-24.30; P=.01), female sex (HR, 2.35; 95%CI, 1.24-4.46; P=.01), and NYHA functional class III-IV (HR, 2.07; 95%CI, 1.11-3.89; P=.02). CONCLUSIONS: CA is a clinical challenge, with wide variability in its presentation depending on the subtype, leading to diagnostic delay and high mortality. Improvements are needed in the early diagnosis and treatment of these patients.

Predicción del rendimiento académico en alumnos de ESO y Bachillerato mediante el Inventario Clínico para Adolescentes de Millon (escala MACI) / Prediction of academic achievement in obligatory compulsory education and baccalaureate students through the Millon Adolescent Clinical Inventory

El aumento creciente de la conflictividad en las aulas, los problemas de comportamiento entre alumnos y profesores y la aparición progresiva y creciente de trastornos de personalidad, unido a un rendimiento académico cada vez menor en algunos grupos de alumnos, al que se unen aspectos familiares disfuncionales y cuestiones sociales e interpersonales en los jóvenes cada vez más heterogéneas ha hecho plantearnos desde una perspectiva psicopatológica y clínica (dada la insuficiencia explicativa de las variables únicamente organizativas y pedagógicas de los centros de enseñanza), un estudio preferentemente correlacional multivariante (diseño “ex post facto”), con técnicas de regresión logística binaria, que intente encontrar relaciones iniciales entre variables de personalidad y educativas (rendimiento) que ayuden a clarificar dichos problemas y que puedan servir, de forma complementaria, para el diseño y puesta en práctica de programas de salud mental en la escuela, su derivación a los servicios correspondientes de la red sanitaria o la puesta en práctica de medidas psicopedagógicas más idóneas. Alrededor de 380 alumnos de un instituto público de educación secundaria (ESO -12 a 16 años- y Bachillerato -16 a 19 años-), formaron parte de esta investigación, a los que se les administró la escala MACI (entre otras), así como medidas de rendimiento escolar

The progressive increase of the conflicting in the classrooms, the behavior problems among students and teachers and the increasing appearance of personality disorders, added to a bigger academic failure in some groups of adolescents joined to social and familiar dysfunctions have done posed us, from a clinical and psychopatological perspective, a research basically correlational multivariable with binary logistic regression techniques, intending to found initial relationships between personality and educational (achievement) variables. About 380 students of Compulsory Secondary Education (ESO – 12 to 16, and Baccalaureate –16 to 19 years) were administered the Millon Adolescents Clinical Inventory (and other materials) as well as academic performance measures