Are valence and arousal related to the development of amodal representations of words? A computational study.

In this study, we analyzed the relationship between the amodal (semantic) development of words and two popular emotional norms (emotional valence and arousal) in English and Spanish languages. To do so, we combined the strengths of semantics from vector space models (vector length, semantic diversity, and word maturity measures), and feature-based models of emotions. First, we generated a common vector space representing the meaning of words at different developmental stages (five and four developmental stages for English and Spanish, respectively) using the Word Maturity methodology to align different vector spaces. Second, we analyzed the amodal development of words through mixed-effects models with crossed random effects for words and variables using a continuous time metric. Third, the emotional norms were included as covariates in the statistical models. We evaluated more than 23,000 words, whose emotional norms were available for more than 10,000 words, in each language separately. Results showed a curve of amodal development with an increasing linear effect and a small quadratic deceleration. A relevant influence on the amodal development of words was found only for emotional valence (not for arousal), suggesting that positive words have an earlier amodal development and a less pronounced semantic change across early lifespan.

Assessment of the Chronic Toxicity and Interactions between Arsenic and Riverbed Biofilms.

The toxic effect of exposure to arsenic, As(V), at concentrations of 0 to 30 mg L-1, for 49 days, on epipsammic biofilms, was evaluated in a microcosm experiment. The growth and composition of biofilms developed on sediments containing As concentrations of 31 mg kg-1 and 85 mg kg-1 were compared, using photosynthetic parameters and Live/Dead stains as end points. A toxic effect of arsenic could not be demonstrated; however, biofilm growth was higher over the sediment with higher arsenic concentrations, suggesting the development of pollution-induced community induced tolerance (PICT). Nevertheless, PICT was not observed after exposure to high arsenic concentration in the laboratory, as there were no differences in algal growth between the previous 0 and 30 mg L-1 systems exposed to new 30 mg As L-1 dissolution over 29 days. The algal composition was affected by the added arsenic, and brown algae were the most tolerant compared to green algae and cyanophyceae, as their percentage increased from 25 and 33% in the control samples to 57 and 47% in the samples with the highest added As concentration. In turn, the biofilm development influenced arsenic redistribution and speciation. Arsenic concentration in water decreased with time during the incubation experiment, retained by the sediment particles and the biofilm. In the biofilm, extracellular As was significantly higher (up to 11 times) than intracellular arsenic. As(V) was the predominant species in water and in the biofilm, but products of biotic transformation, namely As(III), DMA(V) and MMA(V), were also found in the solution and in the biofilm in some systems, demonstrating reduction and methylation by the organisms. As a conclusion, a toxic effect was not detected for the concentrations evaluated. Biofilms naturally exposed in the river system to high As concentrations acquire pollution-induced tolerance; however, tolerance was not acquired by exposure to 30 mg L-1 for 29 days in the laboratory.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome.

Background and aim: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome. Methods: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis. Results: A total of 200 patients (mean age 48.8 ± 14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8 ± 8.1 mL/min/kg vs. 28.8 ± 9.6 mL/min/kg, p = 0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p < 0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p = 0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders. Conclusion: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Antecedentes y objetivo: Varios informes han demostrado la persistencia de síntomas a largo plazo luego de la infección inicial por COVID-19 (síndrome post-COVID-19). El objetivo de este estudio fue analizar las características de la prueba de esfuerzo cardiopulmonar (PECP) realizada en pacientes con antecedentes de infección por COVID-19, comparando sujetos según la presencia de síndrome post-COVID-19. Métodos: se realizó un estudio transversal. Se incluyeron pacientes consecutivos >18 años con antecedentes de infección por SARS-CoV-2 confirmada por la prueba de reacción en cadena de la polimerasa y una PECP realizada entre 45 y 120 días luego del episodio viral. Se evaluó la asociación entre variables relacionadas con la PECP y síndrome post-COVID-19 mediante análisis univariante y multivariado. Resultados: Se incluyeron 200 pacientes (edad media 48,8 ± 14,3 años, 51% hombres). Los pacientes con síndrome post-COVID-19 mostraron un VO2 pico significativamente menor (25,8 ± 8,1 mL/min/kg frente a 28,8 ± 9,6 mL/min/kg, p = 0,017) en comparación con los sujetos asintomáticos. Además, los pacientes con síndrome post-COVID-19 desarrollaron síntomas con mayor frecuencia durante la PECP (52,7% vs. 13,7%, p < 0,001) y tenían menos probabilidades de alcanzar el umbral anaeróbico (50,9% vs. 72,7%, p = 0,002) en comparación con sujetos asintomáticos. Estos hallazgos no se modificaron al ajustar por factores de confusión. Conclusión: Nuestros datos sugieren que el síndrome post-COVID-19 se asoció con un menor VO2 pico, una menor probabilidad de alcanzar el umbral anaeróbico y una mayor probabilidad de presentar síntomas durante la PECP. Se necesitan estudios futuros para determinar si estas anomalías durante la PECP tendrían valor pronóstico.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome

Background and aimSeveral reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome.MethodsA cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis.ResultsA total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders.ConclusionOur data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value. (AU)

Antecedentes y objetivoVarios informes han demostrado la persistencia de síntomas a largo plazo luego de la infección inicial por COVID-19 (síndrome post-COVID-19). El objetivo de este estudio fue analizar las características de la prueba de esfuerzo cardiopulmonar (PECP) realizada en pacientes con antecedentes de infección por COVID-19, comparando sujetos según la presencia de síndrome post-COVID-19.Métodosse realizó un estudio transversal. Se incluyeron pacientes consecutivos >18 años con antecedentes de infección por SARS-CoV-2 confirmada por la prueba de reacción en cadena de la polimerasa y una PECP realizada entre 45 y 120 días luego del episodio viral. Se evaluó la asociación entre variables relacionadas con la PECP y síndrome post-COVID-19 mediante análisis univariante y multivariado.ResultadosSe incluyeron 200 pacientes (edad media 48,8±14,3 años, 51% hombres). Los pacientes con síndrome post-COVID-19 mostraron un VO2 pico significativamente menor (25,8±8,1mL/min/kg frente a 28,8±9,6mL/min/kg, p=0,017) en comparación con los sujetos asintomáticos. Además, los pacientes con síndrome post-COVID-19 desarrollaron síntomas con mayor frecuencia durante la PECP (52,7% vs. 13,7%, p<0,001) y tenían menos probabilidades de alcanzar el umbral anaeróbico (50,9% vs. 72,7%, p=0,002) en comparación con sujetos asintomáticos. Estos hallazgos no se modificaron al ajustar por factores de confusión.ConclusiónNuestros datos sugieren que el síndrome post-COVID-19 se asoció con un menor VO2 pico, una menor probabilidad de alcanzar el umbral anaeróbico y una mayor probabilidad de presentar síntomas durante la PECP. Se necesitan estudios futuros para determinar si estas anomalías durante la PECP tendrían valor pronóstico. (AU)

Frailty and prognosis of older patients with chronic heart failure.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS: Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS: We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS: In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.

Electrochemical Oscillatory Baffled Reactors Fabricated with Additive Manufacturing for Efficient Continuous-Flow Oxidations.

Electrochemical continuous-flow reactors offer a great opportunity for enhanced and sustainable chemical syntheses. Here, we present a novel application of electrochemical continuous-flow oscillatory baffled reactors (ECOBRs) that combines advanced mixing features with electrochemical transformations to enable efficient electrochemical oxidations under continuous flow at a millimeter distance between electrodes. Different additive manufacturing techniques have been employed to rapidly fabricate reactors. The electrochemical oxidation of NADH, a very sensitive substrate key for the regeneration of enzymes in biocatalytic transformations, has been employed as a benchmark reaction. The oscillatory conditions improved bulk mixing, facilitating the contact of reagents to electrodes. Under oscillatory conditions, the ECOBR demonstrated improved performance in the electrochemical oxidation of NADH, which is attributed to improved mass transfer associated with the oscillatory regime.

Prognostic role of cardiopulmonary exercise testing in pulmonary hypertension: a systematic review and meta-analysis.

INTRODUCTION: Several studies have evaluated the relation between variables of cardiopulmonary exercise testing (CPET) and major clinical events in pulmonary hypertension (PH) patients, although the results were conflicting. The main objective of this study was to investigate the prognostic value of the CPET derived parameters on all-cause mortality or urgent transplantation in PH patients. MATERIAL AND METHODS: A meta-analysis of time-to-event outcomes were performed from observational studies that evaluated the predictive value of CEPT-related variables [peak oxygen uptake (VO2) and the ventilation to CO2 production slope (VE/VCO2)] in PH patients, reporting data from mortality or urgent transplantation, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A random-effects meta-analysis model was then applied. RESULTS: Nine eligible studies, including 986 patients, were identified and considered eligible for the quantitative analyses. This meta-analysis showed that high peak VO2 was associated with a lower mortality or transplant occurrence (HR: 0.81; 95% CI: 0.78-0.85, I2 = 29%). In addition, high VE/VCO2 slope was associated with a higher incidence of the primary endpoint (HR: 1.04; 95% CI: 1.02-1.06, I2 = 78%). The sensitivity analysis showed that the results were robust. CONCLUSIONS: Our data suggest that in a population with PH the CPET-related variables have predictive capacity regarding mortality and the risk of transplantation. Future studies should establish the best cut-off points for these CPET-related variables.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome.

BACKGROUND AND AIM: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome. METHODS: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis. RESULTS: A total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders. CONCLUSION: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Prueba de ejercicio cardiopulmonar en receptores de trasplante cardíaco / Cardiopulmonary Exercise Test in Heart Transplant Recipients

RESUMEN Introducción: La capacidad de ejercicio de los pacientes con insuficiencia cardíaca avanzada mejora después del trasplante cardíaco (TXC). La prueba de ejercicio cardiopulmonar (PECP) es reconocida como el estudio "estándar de oro" para la evaluación de la capacidad de ejercicio aeróbico. El objetivo del estudio fue analizar las características de la PECP realizada en receptores de TXC. Material y métodos: Se realizó un estudio de corte transversal. Se incluyeron pacientes mayores de 18 años receptores de TXC desde el 1 de noviembre de 2013 hasta el 30 de junio de 2019, que hubieran realizado una PECP dentro del primer año posterior al trasplante. Se analizaron variables clínicas y de la PECP. Resultados: Se incluyeron 122 pacientes (edad media 50,1 ± 11,8 años, 77,0% hombres). El consumo de oxígeno (VO2) pico fue de 23,3 ± 5,3 mL/min/kg y el 45,9% alcanzó el umbral anaeróbico. El 68,0% y el 28,7% de la población mostró valores de pulso de oxígeno y de la pendiente de la eficiencia del VO2 (OUES) normales, respectivamente. El 46,7%, 23,0% y 3,3% presentaron una reducción leve, moderada o grave de la capacidad funcional, respectivamente. El valor de OUES fue bajo en el 80,0%, 71,4% y 92,9% de los pacientes con disminución de la capacidad funcional de origen cardiovascular, periférico y mixto, respectivamente. Conclusión: En esta población de receptores de TXC, la proporción de sujetos con capacidad funcional reducida o valores de OUES alterados fue considerable. La evaluación de estos pacientes a través de la PECP podría favorecer la derivación temprana a centros de rehabilitación cardiovascular.

ABSTRACT Background: Exercise capacity of patients with advanced heart failure improves after heart transplantation (HTX). Cardiopulmonary exercise test (CPET) is recognized as the "gold standard" study for the evaluation of aerobic exercise capacity. Objective: The aim of this study was to analyze the characteristics of CPET in HTX recipients. Methods: A cross-sectional study was performed in patients over 18 years of age undergoing HTX from November 1, 2013 to June 30, 2019, and with a CPET within the first year after transplantation. Clinical and CPET variables were analyzed. Results: A total of 122 patients with mean age of 50.1 ± 11.8 years and 77.0% men were included in the study. Peak oxygen consumption (VO2) was 23.3 ± 5.3 mL/min/kg and 45.9% of patients achieved the anaerobic threshold. In 68.0% and 28.7% of cases, the population presented normal oxygen pulse and oxygen uptake efficiency slope (OUES) values, respectively. Mild, moderate, or severe reduced functional capacity was found in 46.7%, 23.0%, and 3.3% of patients, respectively. Oxygen uptake efficiency slope was low in 80.0%, 71.4% and 92.9% of patients with decreased functional capacity of cardiovascular, peripheral, and mixed origin, respectively. Conclusion: In this population of HTX recipients, a considerable proportion of subjects showed reduced functional capacity or abnormal OUES values. The evaluation of these patients through CPET could favor early referral to cardiovascular rehabilitation centers.

Prognostic value of cardiopulmonary exercise test after heart transplantation.

BACKGROUND: The clinical utility of cardiopulmonary exercise testing (CPET) has not been extensively studied yet in heart transplantation (HTX) patients. OBJECTIVE: To analyze the predictive value of the CPET on hospitalizations and mortality in HTX recipients. METHODS: A retrospective cohort was performed from a secondary database. Patients > 18 years with HTX who underwent a CPET between 3 and 12 months after transplantation were included. Time to the first primary endpoint (HTX-related hospitalization) was analyzed and adjusted using Cox proportional hazards regression model. RESULTS: A total of 122 patients (mean age 50.1 years, 77.0% men) were included. Fifty-seven patients (46.7%) had the primary endpoint. Peak VO2 (HR .95; CI 95% .90-.99, P = .03), oxygen pulse (HR .57; CI 95% .34-.96, P = .03) and predicted VO2 (HR .97; CI 95% .96-.99, P = .002) were associated with the endpoint. We did not find a significant association between the other variables and the outcome. CONCLUSION: In HTX recipients, peak VO2 , oxygen pulse, and predicted VO2 were independently associated with hospitalizations at follow up.

¿Cómo recomendamos actividad física los médicos cardiólogos? / How do Cardiologists Recommend Physical Activity?

RESUMEN Introducción: Gran cantidad de estudios confirman los beneficios de la actividad física, pero existen escasas publicaciones sobre cómo se prescribe durante la consulta médica. El objetivo de este trabajo fue conocer el grado de conocimiento y la actitud de los cardiólogos respecto a las recomendaciones existentes sobre actividad física. Material y métodos: Estudio observacional y transversal (n = 299 cardiólogos), que respondieron una encuesta virtual. Se analizó el perfil del cardiólogo, grado de conocimiento, planificación y satisfacción. Se analizaron las respuestas según género, presencia de factores de riesgo cardiovascular y años de especialista. Resultados: El 70% de los participantes realiza actividad física según recomendaciones de la Organización Mundial de la Salud. El 98,99% recomienda actividad física y 80,74% la prescribe. Solo el 31,85% ha realizado formación de posgrado que incluyera conocimientos sobre prescripción. Los cardiólogos que presentan factores de riesgo cardiovascular son mayoritariamente varones y realizan menos actividad física que el resto. Los que tienen más años de especialista consideran con mayor frecuencia el sedentarismo como factor de riesgo y prescriben más actividad física. Conclusión: La encuesta realizada permitió conocer el perfil prescriptivo de los cardiólogos respecto de la actividad física. La falta de información parece ser el mayor obstáculo para la generalización de la prescripción.

ABSTRACT Background: A large number of studies confirm the benefits of physical activity, but only a few publications describe on how it is prescribed during the medical consultation. The purpose of this study was to determine the degree of knowledge and attitude of cardiologists about existing recommendations on physical activity. Methods: This was an observational, cross-sectional study performed on 229 cardiologists responding to a virtual survey. The profile, degree of knowledge, planning and satisfaction of each cardiologist were analyzed. Responses were evaluated according to gender, cardiovascular risk factors, and years as a specialist. Results: Seventy percent of participants met Health Organization recommendations for physical activity, 98.99% recommended physical activity and 80.74% prescribed it. Only 31.85% had completed postgraduate training that included knowledge on physical activity prescription. Cardiologists with cardiovascular risk factors were mostly men and were less engaged in physical activity than the rest. Those with more years as specialist were likely to consider sedentary lifestyle as a risk factor, and prescribed more physical activity. Conclusion: This survey provides knowledge on the prescription profile of cardiologists associated with physical activity. Lack of information seems to be the greatest obstacle to prescription generalization.

Estado actual de la rehabilitación cardiovascular en Argentina / Current Status of Cardiac Rehabilitation in Argentina

RESUMEN Introducción: La rehabilitación cardiovascular es una reconocida estrategia de prevención secundaria para el tratamiento de numerosas cardiopatías. Es una herramienta multicomponente donde se incluyen la educación en un estilo de vida saludable, control de los factores de riesgo, asesoramiento en aspectos psicosociales y la prescripción supervisada del ejercicio físico. Numerosos ensayos clínicos, revisiones sistemáticas y metaanálisis han demostrado su eficacia y seguridad. Sin embargo, sigue siendo una herramienta subutilizada. Existen datos descriptivos de cómo se lleva a cabo la rehabilitación cardiovascular y las características de los centros que la implementan de varios países europeos y de Norteamérica. A nivel sudamericano en su conjunto, contamos con datos reportados en el año 2014 y otros provenientes de Brasil, Colombia y Uruguay. Pero existen escasos datos provenientes de nuestro país, por ello el objetivo de este estudio se centró en conocer la situación actual de los programas de rehabilitación cardiovascular en Argentina. Material y métodos: Se trata de un estudio descriptivo, realizado por medio de un cuestionario virtual que evalúa la estructura y características de los programas de rehabilitación de nuestro país y las potenciales barreras para una rehabilitación eficiente. Resultados: Respondieron 72 centros. Los principales resultados muestran gran concentración de centros en áreas urbanas (69,23% en el AMBA), predominancia de centros privados (66,67%) inclusión de pacientes con patologías cardiovasculares denominadas como clásicas (enfermedad coronaria, insuficiencia cardíaca, posoperatorios valvulares, enfermedad vascular periférica, postrasplante cardíaco y poscolocación de dispositivos), y predominancia de centros con estrategia centrada en el ejercicio. La principal dificultad a la hora de la inclusión de pacientes a los centros es la escasa referencia de los candidatos. Conclusiones: Los datos de esta encuesta permiten hacer un diagnóstico de situación, y pueden ser el punto de partida para estrategias de mejora, que permitan implementar estándares de calidad y en un futuro establecer programas de acreditación de centros.

ABSTRACT Background: Cardiac rehabilitation is a well-known strategy for secondary prevention in several heart diseases and includes a set of strategies based on education of a healthy lifestyle, management of cardiovascular risk factors, psychosocial counseling, and prescription of supervised physical exercise. Several clinical trials, systematic reviews and meta-analyses have documented its efficacy and safety. Nevertheless, cardiac rehabilitation remains underused. There is information available describing the current status of cardiac rehabilitation and the characteristics of centers in some European countries and North America. There are pooled data from South America in 2014, along with reports from Brazil, Colombia, and Uruguay, but there are few data from our country. Therefore, the aim of this study was to determine the current status of cardiac rehabilitation programs in Argentina. Methods: We conducted a descriptive study using a virtual questionnaire to evaluate the structure and characteristics of rehabilitation programs in our country and the potential barriers to achieve efficient rehabilitation. Results: Seventy-two centers responded. The main results show a high concentration of centers in urban areas (69.23% in AMBA), predominance of private centers (66.67%), inclusion of patients with the so-called classic cardiovascular diseases (coronary artery disease, heart failure, postoperative heart valve surgery, peripheral vascular disease, and after cardiac transplantation and device implantation), and a majority of centers with an exercise-centered strategy. The main difficulty for the inclusion of patients in the centers was poor referral of candidates. Conclusions: The data from this survey allows for a diagnosis of the situation and can be the starting point for developing improvement strategies to implement quality standards and future accreditation programs for the centers.

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan.

BACKGROUND: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. METHODS: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). RESULTS: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). CONCLUSIONS: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

Sex Influence on the Efficacy and Safety of Sacubitril/Valsartan.

BACKGROUND: Women are underrepresented in sacubitril/valsartan (SV) clinical trials. The aim of this study was to assess sex-specific differences in efficacy, tolerability, and safety of SV in real-world heart failure with reduced ejection fraction (HFrEF) patients. METHODS: A prospective registry in 10 centers including all patients who started SV during the last 6 months was analyzed in this study. RESULTS: A total of 427 patients were included, 126 (29.5%) were women. There were no substantial differences in HFrEF treatment before SV initiation, although fewer women than men carried an implantable cardioverter defibrillator (57 [45.2%] vs. 173 [58.1%], p = 0.02). SV starting dose was 24/26 mg b.i.d. in 206 patients (48.2%), 49/51 mg b.i.d. in 184 (43.1%), and 97/103 mg b.i.d. in 34 (8.2%), without relevant differences associated to sex. There were no losses during a mean follow-up of 7.0 ± 0.1 months. The proportion of patients who discontinued the drug (16 [12.7%] women vs. 33 [11.0%] men, p = 0.66) or presented SV-related adverse effects (31 [24.6%] women vs. 79 [26.5%] men, p = 0.72) was also similar in both sexes. However, female sex was an independent predictor of functional class improvement in the multivariate analysis (odds ratio 2.33, 95% confidence interval: 1.24-4.38, p = 0.04). CONCLUSIONS: SV in women with HFrEF has a similar tolerability as in men. Females seem to have a more frequent functional class improvement than males.

Sacubitril/Valsartan in Daily Clinical Practice: Data From a Prospective Registry.

Sacubitril/valsartan (SV) is a new therapy in heart failure with reduced ejection fraction. Our aim was to determine the efficacy and safety of this drug daily clinical practice. We performed a multicenter registry in 10 hospitals. All patients who started SV from October 2016 to March 2017 on an outpatient basis were included. A total of 427 patients started treatment with SV. Mean follow-up was 7.0 ± 0.1 months. Forty-nine patients (11.5%) discontinued SV, and 12 (2.8%) died. SV discontinuation was associated with higher cardiovascular (hazard ratio 13.22, 95% confidence interval, 6.71-15.73, P < 0.001) and all-cause mortality (hazard ratio 13.51, 95% confidence interval 3.22-56.13, P < 0.001). Symptomatic hypotension occurred in 71 patients (16.6%). Baseline N-terminal pro-B-type natriuretic peptide levels, functional class, and left ventricular ejection fraction improved at the end of follow-up in patients who continued with SV (all P values ≤0.001). This improvement was not significant in patients with SV discontinuation. SV has a good tolerability in patients from daily clinical practice. SV withdrawal in patients with heart failure and reduced ejection fraction was independently associated with increased all-cause mortality. Patients who continued with SV presented an improvement in functional class left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide levels.

Clinical Profile of a Nonselected Population Treated With Sacubitril/Valsartan Is Different From PARADIGM-HF Trial.

Our aim is to describe the characteristics of the patients receiving sacubitril/valsartan (SV) in daily clinical practice. This is a prospective registry in 10 hospitals including all patients who started SV in everyday clinical practice. From October 2016 to March 2017, 427 patients started treatment with SV. The mean age was 68.1 ± 12.4 years, and 30.5% were women (22.0% in PARADIGM-HF, P < 0.001). Comparing our cohort with patients included in PARADIGM-HF, baseline treatment was different, with a lower ratio of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (2.7 vs. 3.5, P < 0.001), and a higher proportion of patients with implantable cardioverter defibrillator (53.8% vs. 15%, P < 0.001), and cardiac resynchronization therapy (25.8% vs. 5%, P < 0.001). Treatment with mineralocorticoid receptor antagonists was more frequent (76.7% vs. 60.0%, P < 0.001), and the use of beta-blockers was similar (94.6% vs. 93.0%, P = 0.43). We observed more patients in functional class III-IV (30.4 vs. 24.8, P = 0.015), higher levels of Nt pro-BNP [3421 (904-4161) vs. 1631 (885-3154) pg/mL] and worse renal function (creatinine level 1.3 ± 0.7 vs. 1.1 ± 0.3 mg/dL, P < 0.001). In real life, patients receiving SV have a higher risk profile than in the pivotal trial, poorer functional class, higher levels of natriuretic peptides, and worse renal function.

Proposal of a novel clinical score to predict heart failure incidence in long-term survivors of acute coronary syndromes.

INTRODUCTION: HF remains a frequent complication following MI and adversely affects prognosis. The objective of this study was to identify predictors of HF following MI and to design a risk score for its prediction. METHODS: Retrospective study of all consecutive patients admitted for MI. Primary end point was time to incident HF. Patients with previous history of HF were excluded. Death was modelled as competing risk. RESULTS: 5737 patients were included. Mean age was 66.32±12.80. During a median follow-up of 47.0months (23.0-73.0), 686 patients (12%) developed HF. Age, diabetes mellitus, peripheral artery disease, renal insufficiency, chronic obstructive pulmonary disease, persistent atrial fibrillation, haemoglobin, troponin peak, diuretic at admission, ventricular function, and revascularization were independent predictors for HF development. According to this multivariate regression analysis, we developed a novel score that allows for the identification of patients at high (≥16), medium (9-15) and low risk (<9) for HF development, with an AUC of 0.77 (IC 95%, 0.76-0.78; p=0.008). CONCLUSIONS: Clinical comorbidities were determinant for the development of HF following MI. A simple score effectively categorize patients into low, intermediate, and high-risk. This could be important in order to intensify medical treatment or consider additional interventions.