Clinical outcomes of TAVI with the Myval balloon-expandable valve for non-calcified aortic regurgitation.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) in non-calcified aortic regurgitation (NCAR) is an off-label procedure. The balloon-expandable Myval includes extra-large sizes (30.5 mm and 32 mm) of interest in this setting. AIMS: We aimed to evaluate the safety and feasibility of Myval in NCAR. METHODS: This was an international, multicentre, observational study that enrolled all consecutive patients with symptomatic severe NCAR undergoing TAVR with the Myval device. The images were centrally analysed. RESULTS: A total of 113 patients were recruited, 64.6% were men, the mean age was 78.4±7.5 years, and the Society of Thoracic Surgeons score was 2.7±1.7%. Aortic root dilatation was present in 59.3% of patients, 7.1% were bicuspid, and the mean annular area was 638.6±106.0 mm2. The annular area was beyond the recommended range for extra-large sizes in 2.6% of cases, and additional volume was added in 92% (median 4 cc, up to 9 cc). The extra-large sizes were used in 95 patients (84.1%), and the mean oversizing was 17.9±11.0%. The technical success rate was 94.7%; the rate of residual ≥moderate aortic regurgitation was 8.9%, and the pacemaker rate was 22.2%. There were no cases of annular rupture, cardiac tamponade, or aortic dissection, but in 4 patients (3.5%) valve embolisation occurred (1 antegrade and 3 ventricular), all in cases with a tapered left ventricle outflow tract (p=0.007). Thirty-day and 1-year mortality were 5.3% and 9.7%, respectively. Technical success was associated with better survival (97.1% vs 72.7%; p=0.012), and valve embolisation was the main determinant of mortality (p=0.047). CONCLUSIONS: Myval is a feasible and safe option for selected non-operable patients with NCAR and demonstrated good midterm outcomes and lack of impact of oversizing on device durability.

Comparison of central corneal thickness measurements obtained by OrbscanIIz® and ultrasound pachymetry: A concordance study in the usual clinical practice.

PURPOSE: The objective of this study was to assess the concordance between the values obtained in measuring central corneal thickness using the OrbscanIIz® and the contact ultrasonic pachymeter available in our public ophthalmology service. METHODS: Measurements were taken from 88 eyes of 44 patients using the two instruments. The data obtained were statistically analyzed using version 22 of the IBM SPSS® program. RESULTS: The mean of central corneal thickness measurements obtained from OrbscanIIz® was significantly higher than that obtained from ultrasound pachymetry. However, the mean of differences between both instruments was only 7.22 µ, which could be considered a clinically insignificant result when considering the good concordance obtained between both systems. CONCLUSION: OrbscanIIz® and ultrasound pachymetry can be interchangeable in the usual public clinical practice when measuring central corneal thickness. This is the first research found in the literature that uses a concordance study to compare the data resulting from central corneal thickness measurements obtained by an OrbscanIIz® and an OcuScan® pachymeter in our environment.

Choroidal thickness and granulocyte colony-stimulating factor in tears improve the prediction model for coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) detection in asymptomatic patients still remains controversial. The aim of our study was to evaluate the usefulness of ophthalmologic findings as predictors of the presence of CAD when added to cardiovascular classic risk factors (CRF) in patients with acute coronary cardiopathy suspicion. METHODS: After clinical stabilization, 96 patients with acute coronary cardiopathy suspicion were selected and divided in two groups: 69 patients with coronary lesions and 27 patients without coronary lesions. Their 192 eyes were subjected to a complete routine ophthalmologic examination. Samples of tear fluid were also collected to be used in the detection of cytokines and inflammatory mediators. Logistic regression models, receiver operating characteristic curves and their area under the curve (AUC) were analysed. RESULTS: Suggestive predictors were choroidal thickness (CT) (OR: 1.02, 95% CI 1.01-1.03) and tear granulocyte colony-stimulating factor (G-CSF) (OR: 0.97, 95% CI 0.95-0.99). We obtained an AUC of 0.9646 (95% CI 0.928-0.999) when CT and tear G-CSF were added as independent variables to the logistic regression model with cardiovascular CRF: sex, age, diabetes, high blood pressure, hypercholesterolemia, smoking habit and obesity. This AUC was significantly higher (p = 0.003) than the prediction derived from the same logistic regression model without CT and tear G-CSF (AUC = 0.828, 95% CI 0.729-0.927). CONCLUSIONS: CT and tear G-CSF improved the predictive model for CAD when added to cardiovascular CRF in our sample of symptomatic patients. Subsequent studies are needed for validation of these findings in asymptomatic patients.

Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings.

The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20-50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23-2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40-3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10-2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25-3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.

Síndrome coronario agudo y shock en el contexto de infección aguda por COVID-19 / Acute coronary syndrome and shock in the context of acute COVID-19 infection

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Desfibrilador subcutáneo: papel en la prevención de la muerte súbita en presencia de una prótesis mecánica tricúspide / Subcutaneous defibrillator: role in the prevention of sudden cardiac death in the setting of mechanical tricuspid prosthesis

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Fibrilación auricular en pacientes con dispositivos cardiacos electrónicos implantables / Atrial fibrillation in patients with cardiac implantable electronic devices

La fibrilación auricular es la arritmia más frecuente en la práctica clínica. Su prevalencia está aumentando considerablemente debido al envejecimiento de la población de los países desarrollados. La fibrilación auricular es la causa principal del ictus cardioembólico, y el tratamiento anticoagulante oral es una terapia eficaz para disminuir su riesgo de manera considerable. También es creciente el número de pacientes portadores de dispositivos cardiacos electrónicos implantables que, por su capacidad para detectar alteraciones del ritmo y almacenar electrogramas, son una herramienta de alto rendimiento en la detección de episodios de alta frecuencia auricular, que corresponden normalmente a episodios de fibrilación auricular (en menor medida, flutter auricular y taquicardia auricular) en gran número de pacientes. Diversos estudios han demostrado que los episodios de fibrilación auricular subclínica se asocian con un aumento del riesgo de eventos tromboembólicos, aunque no se ha podido demostrar una relación temporal entre ambas circunstancias. Sin embargo, la evaluación de la eficacia del tratamiento con anticoagulantes orales en pacientes con fibrilación auricular subclínica solo se ha evaluado en un ensayo clínico cuyos resultados han sido negativos. Por ello, a falta de más información, la decisión clínica de indicar un tratamiento con anticoagulantes orales para pacientes con fibrilación auricular subclínica es compleja y hasta la fecha no se apoya en evidencia firme (AU)

Atrial fibrillation is the most common arrhythmia seen in clinical practice. Its prevalence has increased substantially in developed countries because of population aging. Atrial fibrillation is the primary cause of cardioembolic stroke and oral anticoagulant therapy can considerably reduce its risk. Moreover, the number of patients with a cardiac implantable electronic device is increasing. Since these devices have the ability to detect heart rhythm alterations and to store electrograms, they are highly effective tools for detecting atrial high rate episodes, which in most patients usually correspond to episodes of atrial fibrillation or, to a lesser extent, to atrial flutter or tachycardia. Numerous studies have shown that episodes of subclinical atrial fibrillation are associated with an increased risk of thromboembolic events, although it has not been possible to demonstrate a temporal relationship between the two. To date, the efficacy of oral anticoagulants in patients with subclinical atrial fibrillation has been assessed in only one clinical trial, with negative results. Therefore, and until more information is available, the clinical decision on whether to start oral anticoagulant therapy in patients with subclinical atrial fibrillation is not straightforward and, at present, such treatment is not supported by solid clinical evidence (AU)