Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination.

INTRODUCTION AND OBJECTIVES: Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population. METHODS: The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented. RESULTS: From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality). CONCLUSIONS: In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.

Tromboembolia pulmonar en la COVID-19. Cuando nada es lo que parece / Pulmonary embolism in COVID-19. When nothing is what it seems

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Cirugía de revascularización aortocoronaria en España. Influencia del volumen de procedimientos en los resultados / Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes

INTRODUCCIÓN Y OBJETIVOS: Analizar la asociación entre volumen y resultados en cirugía de revascularización aortocoronaria (CABG) en el Sistema Nacional de Salud de España. MÉTODOS: Se analizaron los eventos de CABG entre 2013-2015. Las variables de resultado seleccionadas fueron la mortalidad hospitalaria en el evento índice, así como los reingresos por causa cardiaca a los 30 días y la mortalidad en el reingreso. Mediante regresión logística multinivel, se obtuvieron las tasas ajustadas a riesgo de mortalidad hospitalaria (RAMER) y de reingresos (RARER). Se discriminó entre centros de alto y bajo volumen mediante un análisis no condicionado (k-medias), utilizando también para CABG la recomendación de volumen de las guías de práctica clínica. RESULTADOS: Se incluyeron 17.335 eventos de CABG con una mortalidad bruta del 5,0%. Los eventos atendidos en centros de bajo volumen para CABG (< 155 CABG al año) mostraron una RAMER un 17% superior (5,81%±2,07 frente a 4,96%±1,76; p <0,001) y una correlación lineal negativa entre volumen y RARER (r=-0,318; p = 0,029), así como una mayor proporción de complicaciones durante el evento. La misma asociación entre volumen y mejores resultados se encontró en la CABG aislada. CONCLUSIONES: Los hospitales del Sistema Nacional de Salud tienen un bajo volumen promedio de CABG. Se ha hallado una asociación entre mayor volumen y mejores resultados en la CABG total y aislada. Los hallazgos de este estudio aconsejan una mayor concentración de CABG y la publicación de los resultados ajustados a riesgo de la intervención coronaria

INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMER) and 30-day readmissions (RARER) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07 vs 4.96±1.76; P <.001) and a negative linear correlation between volume and RARR (r=−0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention

Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes.

INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.

Role of Right Ventricular Strain Measured by Two-Dimensional Echocardiography in the Diagnosis of Cardiac Amyloidosis.

BACKGROUND: Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes. METHODS: Seventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value. RESULTS: LV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9 ± 2.9% in ALCA, 12.5 ± 3.8% in TTRwt, 14.9 ± 2.7% in TTRm, and 21.9 ± 2.6% in control subjects [P < .01]; free-wall RV longitudinal strain: 13.1 ± 6.8%, 14.9 ± 4.5%, 17.2 ± 3.4%, and 22.1 ± 3.1%, respectively [P < .01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1 ± 0.2, 0.8 ± 0.2, 0.9 ± 0.1, and 0.7 ± 0.1, respectively [P < .001]; RV AR: 1.1 ± 0.2, 0.6 ± 0.2, 0.6 ± 0.1, and 0.6 ± 0.1, respectively [P < .001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA. CONCLUSIONS: RV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.