A deep learning LSTM-based approach for forecasting annual pollen curves: Olea and Urticaceae pollen types as a case study.

Airborne pollen can trigger allergic rhinitis and other respiratory diseases in the synthesised population, which makes it one of the most relevant biological contaminants. Therefore, implementing accurate forecast systems is a priority for public health. The current forecast models are generally useful, but they falter when long time series of data are managed. The emergence of new computational techniques such as the LSTM algorithms could constitute a significant improvement for the pollen risk assessment. In this study, several LSTM variants were applied to forecast monthly pollen integrals in Málaga (southern Spain) using meteorological variables as predictors. Olea and Urticaceae pollen types were modelled as proxies of different annual pollen curves, using data from the period 1992-2022. The aims of this study were to determine the LSTM variants with the highest accuracy when forecasting monthly pollen integrals as well as to compare their performance with the traditional pollen forecast methods. The results showed that the CNN-LSTM were the most accurate when forecasting the monthly pollen integrals for both pollen types. Moreover, the traditional forecast methods were outperformed by all the LSTM variants. These findings highlight the importance of implementing LSTM models in pollen forecasting for public health and research applications.

Aerobiological monitoring in a desert type ecosystem: Two sampling stations of two cities (2017-2020) in Qatar.

BACKGROUND: The increasing number of aerobiological stations empower comparative studies to determine the relationship between pollen concentrations in different localities and the appropriate distance, which should be established between sampling stations. In Qatar, this is basically the first aerobiological study for a continuous monitoring interval. OBJECTIVES: The study aimed to assess the abundance and seasonality of the most prevalent pollen types, plus identify potential differences between two sites within the country. METHODS: Airborne pollen data were collected during 2017-2020 by using Hirst-type volumetric samplers in Doha capital city and Al Khor city in Qatar, placed 50 km apart. RESULTS: Higher total pollen indexes were recorded in the Al Khor station (2931 pollen * day/m3) compared to the Doha station (1618 pollen * day/m3). Comparing the pollen spectrum between the sampling stations revealed that ten pollen types were found in common. Amaranthaceae and Poaceae airborne pollen constituted 73.5% and 70.9% of the total amount of pollen detected at the samplers of Al Khor station and Doha station. In both sampling sites, a very pronounced seasonality was shown; August-October appeared as the period with the most intense incidence of atmospheric herbaceous pollen, with 71% and 51% of the annual total counts in Al Khor and Doha stations, respectively. August (Al Khor, 21%; Doha, 9%), September (Al Khor, 33%; Doha, 26%), October (Al Khor, 17%; Doha, 16%) were the months in which the herbs pollen concentrations were highest. Significant statistical differences between the two stations were observed in specific pollen types with local distribution in each trap's vicinity. CONCLUSIONS: Comparison of data obtained by the two samplers running at a distance of 50 Km indicated that potential inter-site differences could be attributed to the vegetation surrounding the city having a decisive influence on data collected.

The correlation between middle schoolchildren allergic symptoms and airborne particle season: A cross-sectional study.

ABSTRACT: Limited studies correlate allergic symptoms and associated outdoor biological particle exposure among schoolchildren globally.This study aimed to investigate the relationship between the seasonality of symptoms of allergic diseases among middle schoolchildren and the annual variation of airborne pollen and fungal spore in a hot and humid geographical region (Qatar).During November 2017 to January 2018, a self-reported study of middle schoolchildren living in the Doha capital city of Qatar was conducted, and data gathered were evaluated in relation to the collected monthly pollen and fungal spores. Participants' data were collected by conducting a survey based on a modified questionnaire adopted from the International Study of Asthma and Allergy in Childhood (ISAAC). The airborne pollen and fungal spore in Doha's atmosphere were extracted from the Doha aerobiology project (2017-2020).Among the 1000 distributed questionnaires, 100 were excluded due to significant missing data and 644 middle schoolchildren living in Doha city responded and were included in the final analysis. The symptoms of allergic rhinitis (AR) pattern among the responders with positive symptoms were strongly linked with the higher airborne fungal spore incidence during the month of November. Out of 331 students with positive symptoms, the prevalence of AR, lifetime wheeze, and eczema was 62.8%, 28.1%, and 26.6%, respectively. Asthma was significantly higher in Qatari (39.8%) compared to non-Qatari (26.7%) middle schoolchildren (P = .02).Outdoor aeroallergen may be a contributing factor in addition to other environmental and genetic predisposing factors for childhood atopic diseases in the prevalence rate of allergic symptoms among middle schoolchildren in the peninsula of Qatar.

The association between airborne pollen monitoring and sensitization in the hot desert climate.

BACKGROUND: Pollen is a major cause of allergic respiratory diseases. In Qatar, data on the presence and prevalence of allergenic airborne types of pollen is quite limited. METHODS: The study aimed to determine and correlate the most frequently implicated airborne pollen detected by aerobiological monitoring samplers in respiratory allergy symptoms. An aerobiological survey was started on May 8, 2017. Airborne pollen was collected using two Hirst type seven-day recorder volumetric traps. Skin prick test in patients attending allergy clinics in Doha using commercial extracts was conducted. RESULTS: Twenty-five pollen types representing the native, as well as the introduced plants, with a relatively low daily mean concentration were observed from May 2017 to May 2019. The highest pollen concentrations were reached by Amaranthaceae (58.9%), followed by Poaceae (21.7%). SPT revealed a comparatively higher degree of sensitization to pollen. Among 940 patients, 204 were sensitized to pollen (54% female) with 135 (66.2%) and 114 (55.8%) to Amaranthaceae and Poaceae, respectively. Some patients had polysensitization. There was a statistically significant association between Amaranthaceae, and asthma (r = 0.169, P = 0.016) and allergic rhinitis (r = 0.177, P = 0.012). CONCLUSIONS: This is the first study to monitor airborne pollen in the state of Qatar. The main pollen detected were Amaranthaceae and Poaceae. Pollen may represent a possible exacerbating factor in adult patients with allergic diseases such as asthma and allergic rhinitis.

Medium- and long-range transport events of Alnus pollen in western Mediterranean.

Alnus pollen has been frequently detected in the atmosphere of different airborne sampling sites of Southern Spain. However, Alnus sp. populations are very scarce and fragmented in the area, being restricted to a few river valleys in the southwest, and other further away regions of the Iberian Peninsula. This leads to think that the airborne pollen detected could be mainly the result of a medium- or long-distant transport. So, the aim of this study was to characterize the annual patterns of airborne Alnus pollen detected at three different locations of Malaga province, as well as to determine its possible origin, the pollen dispersion potential of these Alnus isolated populations, and their possible reproductive connectivity. Pollen sampling was conducted by means of three Hirst-type volumetric pollen traps. Samples were mounted and counted following the recommendations of the Spanish Aerobiology Network and the European Aeroallergen Society. The possible pollen sources were detected by means of a combination of meteorological information and backward air trajectories analysis. A high inter-annual variability in the annual pollen integrals was found in all the stations, favouring certain meteorological conditions a long-range transport and, therefore, causing the high concentrations detected in some specific days. Alnus pollen seems to have a heterogeneous origin with prevalence of the long-distant transport, which would suggest a possible reproductive connection among distant populations.

Potential role of lava lizards as pollinators across the Galápagos Islands.

Lizards have been reported as important pollinators on several oceanic islands. Here we evaluate the potential role of Galápagos lava lizards (Microlophus spp.) as pollinators across their radiation. Over 3 years, we sampled pollen transport by 9 lava lizard species on the 10 islands where they are present, including 7 single-island endemics. Overall, only 25 of 296 individuals sampled (8.4%) transported pollen of 10 plant species, the most common being Prosopis juliflora, Exodeconus miersii, Sesuvium sp. and Cordia leucophlyctis. At least 8 of these plant species were native, and none were confirmed as introduced to the archipelago. Despite the low overall proportion of individuals carrying pollen, this was observed in 7 of the nine lizard species, and on 8 of the ten main islands (Española, Fernandina, Floreana, Isabela, Marchena, Pinta, Santa Cruz and Santiago), suggesting that this is a widespread interaction. The results reported here support the potential role of lava lizards as pollinators across their radiation, although they may represent a relatively modest contribution when compared with birds and insects. However, we cannot discard that lizards may be ecologically significant for particular plant species and ecosystems given the specific climatic condition and functional diversity of each island.

Lesión culpable bifurcada en infarto agudo de miocardio con elevación del segmento ST: éxito del procedimiento y pronóstico a 5 años comparado con lesión no bifurcada / Bifurcation culprit lesions in ST-segment elevation myocardial infarction: procedural success and 5-year outcome compared with nonbifurcation lesions

Introducción y objetivos: En el infarto agudo de miocardio con elevación del segmento ST, se compararon los resultados a corto y largo plazo de la angioplastia primaria de lesiones culpables bifurcadas (LCB) y no bifurcadas (LCNB). Métodos: Estudio observacional con grupo de control emparejado (1:1) por puntuación de propensión. En un total de 2.746 infartos agudos de miocardio con elevación del segmento ST consecutivos, se encontraron 274 casos de LCB (10%). El resultado principal es un combinado de muerte por cualquier causa, infarto, cirugía de revascularización coronaria o revascularización de vaso diana a 30 días y a 5 años. Resultados: No había diferencias clínicas entre los grupos emparejados (1:1). En el grupo de LCB, el tratamiento predominante fue un stent en la rama principal (84%). Respecto al grupo de LCNB, los procedimientos fueron más complejos en cuanto a dilatación con balón (el 71% de las LCB frente al 59% de las LCNB; p = 0,003), duración del procedimiento (70 ± 29 frente a 62,8 ± 28,9 min; p = 0,004) y consumo de contraste (256,2 ± 87,9 frente a 221,1 ± 82,3 ml; p < 0,001). El éxito angiográfico en la rama principal fue similar (el 93,4 frente al 93,8%; p = 0,86). La mortalidad a 30 días fue similar (el 4,7 frente al 5,1%; p = 0,84). A los 5 años de seguimiento, no había diferencias en mortalidad (el 12 frente al 13%; p = 0,95) ni en el objetivo combinado (el 22 frente al 21%; p = 0,43). Conclusiones: La angioplastia primaria de las LCB fue técnicamente más compleja, pero el éxito en la rama principal fue similar y no se hallaron diferencias en el pronóstico a largo plazo respecto a las LCNB

Introducción y objetivos: En el infarto agudo de miocardio con elevación del segmento ST, se compararon los resultados a corto y largo plazo de la angioplastia primaria de lesiones culpables bifurcadas (LCB) y no bifurcadas (LCNB). Métodos: Estudio observacional con grupo de control emparejado (1:1) por puntuación de propensión. En un total de 2.746 infartos agudos de miocardio con elevación del segmento ST consecutivos, se encontraron 274 casos de LCB (10%). El resultado principal es un combinado de muerte por cualquier causa, infarto, cirugía de revascularización coronaria o revascularización de vaso diana a 30 días y a 5 años. Resultados: No había diferencias clínicas entre los grupos emparejados (1:1). En el grupo de LCB, el tratamiento predominante fue un stent en la rama principal (84%). Respecto al grupo de LCNB, los procedimientos fueron más complejos en cuanto a dilatación con balón (el 71% de las LCB frente al 59% de las LCNB; p = 0,003), duración del procedimiento (70 ± 29 frente a 62,8 ± 28,9 min; p = 0,004) y consumo de contraste (256,2 ± 87,9 frente a 221,1 ± 82,3 ml; p < 0,001). El éxito angiográfico en la rama principal fue similar (el 93,4 frente al 93,8%; p = 0,86). La mortalidad a 30 días fue similar (el 4,7 frente al 5,1%; p = 0,84). A los 5 años de seguimiento, no había diferencias en mortalidad (el 12 frente al 13%; p = 0,95) ni en el objetivo combinado (el 22 frente al 21%; p = 0,43). Conclusiones: La angioplastia primaria de las LCB fue técnicamente más compleja, pero el éxito en la rama principal fue similar y no se hallaron diferencias en el pronóstico a largo plazo respecto a las LCNB

Comparación de la hemodinámica valvular de la prótesis transcatéter con balón expandible SAPIEN 3 frente a la autoexpandible Evolut R: estudio de casos emparejados / Comparison of the hemodynamic performance of the balloon-expandable SAPIEN 3 versus self-expandable evolut R transcatheter valve: a case-matched study

Introducción y objetivos: Las válvulas SAPIEN 3 (S3) y Medtronic Evolut R (EVR) son prótesis transcatéter de segunda generación, diseñadas para reducir el grado de insuficiencia aórtica (IAo) paravalvular. El objetivo es comparar la hemodinámica valvular en un estudio de casos emparejados con análisis ecocardiográfico independiente. Métodos: De una población de 201 pacientes tratados con implante percutáneo de válvula aórtica, se emparejó a un total de 144 (S3, n = 80; EVR, n = 64) en función del diámetro del anillo y de la puntuación de calcio aórtico medidos por tomografía computarizada. Los ecocardiogramas de seguimiento basal, al mes y a los 6 meses se analizaron de manera independiente y centralizada. Resultados: No se observaron diferencias respecto a las características basales clínicas y ecocardiográficas. La prótesis EVR mostró un mejor perfil hemodinámico evaluado mediante gradiente aórtico máximo (EVR frente a S3, 13 ± 7 frente a 20 ± 10; p < 0,001), gradiente aórtico medio (7 ± 3 frente a 11 ± 6; p < 0,001) e índice de velocidad Doppler (0,65 ± 0,15 frente a 0,51 ± 0,16; p < 0,001). Por otro lado, la tasa de IAo paravalvular moderada-grave o de cualquier grado de IAo paravalvular (≥ leve) fue mayor en el grupo de EVR (el 11 y el 50%) que en el de S3 (el 2,5 y el 21%; p < 0,05), con mayor número de chorros regurgitantes (p < 0,001). Conclusiones: En una cohorte de casos emparejados tratados con implante percutáneo de válvula aórtica de segunda generación, la S3 se asoció con una menor tasa de IAo paravalvular y mayor gradiente transprotésico residual que con la EVR

Introduction and objectives: The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis. Methods: Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed. Results: The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10 mmHg; P < .001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6 mmHg; P < .001), and Doppler velocity index (EVR 0.65 ± 0.15 vs S3 0.51 ± 0.16; P < .001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P < .05, respectively), with a larger number of paravalvular jets (P < .001). Conclusions: In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system

Valor de la puntuación SYNTAX II para la predicción de eventos clínicos en pacientes sometidos a implante percutáneo de válvula aórtica / The value of the SYNTAX Score II in predicting clinical outcomes in patients undergoing transcatheter aortic valve implantation

Introducción y objetivos: La puntuación SYNTAX (PS) tiene muy escaso valor predictivo de eventos clínicos tras el implante percutáneo de válvula aórtica (TAVI), pero que podría mejorar con la combinación de variables clínicas y anatómicas, la nueva PS-II. Nuestro objetivo es evaluar el valor de la PS-II en la predicción de eventos en pacientes sometidos a TAVI. Métodos: Se incluyó en total a 402 pacientes con estenosis aórtica grave sometidos a TAVI. Se revisó la angiografía coronaria antes del procedimiento y se calcularon la PS-I y la PS-II según los algoritmos de la PS. Se estratificó a los pacientes en 3 grupos en función de los terciles de la PS-II. Los objetivos primarios fueron muerte por cualquier causa y los eventos adversos cardiovascular mayores (MACE), un compuesto de muerte, evento cerebrovascular o infarto de miocardio al año de seguimiento. Resultados Una PS-II aumentada se asoció con más mortalidad (p = 0,036) y hemorragias mayores (p = 0,015) a los 30 días. Los riesgos de muerte (HR = 2,60; p = 0,002) y MACE (HR = 2,66; p < 0,001) al año de seguimiento fueron mayores en el tercer tercil de la PS-II y similares en el segundo tercil (muerte, HR = 1,27; p = 0,507; MACE, HR = 1,05; p = 0,895) comparados con los pacientes del primer tercil. Pertenecer al tercer tercil de la PS-II fue un predictor independiente de mortalidad (p = 0,046) y MACE (p = 0,001) a largo plazo. Conclusiones: La PS-II parece más adecuada que la PS-I para predecir eventos clínicos en pacientes sometidos a TAVI. Una mayor PS-II se asoció a más eventos clínicos al año y a los 4 años de la TAVI, independientemente de la presencia de enfermedad coronaria

Introduction and objectives: The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI. Methods: A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year. Results: Increased SS-II was associated with higher 30-day mortality (P = .036) and major bleeding (P = .015). The 1-year risk of death and MACE was higher among patients in the 3rd SS-II tertile (HR, 2.60; P = .002 and HR, 2.66; P < .001) and was similar among patients in the 2nd tertile (HR, 1.27; P = .507 and HR, 1.05; P = .895) compared with patients in the 1st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P = .046) and MACE (P = .001). Conclusions: The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease

La insuficiencia tricúspide, y no la insuficiencia mitral, determina la mortalidad en pacientes que presentan insuficiencia mitral no grave previa a TAVI / Tricuspid but not mitral regurgitation determines mortality after TAVI in patients with nonsevere mitral regurgitation

Introducción y objetivos: Muchos pacientes sometidos a implante percutáneo de válvula aórtica (TAVI) presentan insuficiencia mitral (IM) de grado moderado o menor. El impacto de la insuficiencia tricuspídea (IT) sigue sin resolverse. Se analiza el impacto de la IM moderada frente a leve-ausente y su evolución, y de la IT concomitante y su interacción con la IM. Métodos: Estudio retrospectivo multicéntrico de 813 pacientes tratados con TAVI entre 2007 y 2015 con IM ≤ 2 y abordaje transfemoral. Resultados: La edad media fue 81 ± 7 años y el Society of Thoracic Surgeons-score fue de 6,9 ± 5,1%. El 37,3% presentó IM moderada, con resultados comparables intrahospitalarios y de mortalidad a 6 meses frente a IM < 2 (11,9 frente a 9,4%; p = 0,257). Sin embargo, experimentaron más rehospitalizaciones y peor clase de la New York Heart Association (p = 0,008 y 0,001, respectivamente). Solo un 3,8% demostró un aumento en el grado de IM > 2 tras el TAVI. La presencia de IT moderada/grave se asoció con una mortalidad intrahospitalaria y de seguimiento del 13 y el 34,1%, independientemente del grado de IM. La IT moderada-grave fue predictor independiente de mortalidad (HR = 18,4; IC95%, 10,2-33,3; p < 0,001). Conclusiones: La presencia de IM moderada no supuso mayor mortalidad a corto-medio plazo tras el TAVI, pero asoció más rehospitalizaciones. La presencia de IT moderada/grave implicó mayor mortalidad. Esto sugiere que una evaluación minuciosa de los mecanismos subyacentes entre ambas insuficiencias valvulares debe realizarse para determinar la mejor estrategia para evitar la futilidad relacionada con TAVI

Introduction and objectives: Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI, as well as the impact of concomitant TR and its interaction with MR. Methods: Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015. Results: The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR < 2 (11.9% vs 9.4%; P = .257). However, they experienced more rehospitalizations and worse New York Heart Association class (P = .008 and .001, respectively). Few patients (3.8%) showed an increase in the MR grade to > 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P < .001). Conclusions: The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility

Cronología y evolución de los trastornos de conducción asociados con el implante percutáneo de válvula aórtica: impacto de la valvuloplastia aórtica con balón / Timing of onset and outcome of new conduction abnormalities following transcatheter aortic valve implantation: role of balloon aortic valvuloplasty

Introducción y objetivos: La cronología y la evolución de los trastornos de conducción (TdC) asociados con el implante percutáneo de válvula aórtica (TAVI) expandible con balón son poco conocidas. Este estudio examina la cronología de los TdC y el impacto de la valvuloplastia aórtica con balón (VAB) en su persistencia. Métodos: Se incluyó a 347 pacientes, y a 75 de ellos se les realizó una monitorización continua durante la TAVI y un electrocardiograma de 6 derivaciones en cada paso del procedimiento. Resultados: En los pacientes monitorizados, se registraron 48 (64%) bloqueos de rama izquierda (BRI) y 16 (21,3%) bloqueos auriculoventriculares completos, de los que el 51,5% apareció antes de implantar la válvula. Los BRI que aparecieron antes del implante valvular persistieron con mayor frecuencia al alta (el 53,8 frente al 22,7%; p = 0,028) y en el seguimiento a 30 días (el 38,5 frente al 13,6%; p = 0,054). Se realizó una VAB en 264 de los 347 pacientes (76,1%). En total, 78 pacientes (22,5%) presentaron un BRI o bloqueo auriculoventricular completo que requirió marcapasos permanente. Un BRI persistente o el bloqueo auriculoventricular no resuelto se observó más frecuentemente entre los pacientes con VAB (el 76,1 frente al 47,6%; p = 0,021), y la VAB se asoció con la persistencia del TdC (OR = 3,5; IC95%, 1,17-10,43; p = 0,021). Conclusiones: Más de la mitad de los TdC observados después de una TAVI ocurren antes del implante de la válvula. La aparición precoz de los TdC se asocia con una mayor persistencia del mismo a los 30 días. El uso de VAB se asocia con un aumento del riesgo de persistencia de los TdC (AU)

Introduction and objectives: Little is known about the timing of onset and outcome of conduction abnormalities (CA) following balloon-expandable transcatheter aortic valve implantation. The aim of this study was to examine the timing of CA and determine the impact of balloon aortic valvuloplasty (BAV) on the persistence of these abnormalities. Methods: A total of 347 patients were included. Of these, 75 had a continuous electrocardiogram recording and a 6-lead electrocardiogram at each step of the procedure. Results: In the transcatheter aortic valve implantation population undergoing continuous electrocardiogram monitoring, new-onset left bundle branch block (LBBB) or third-degree atrioventricular block occurred in 48 (64%) and 16 (21.3%) patients, with 51.5% of CA occurring before valve implantation. Left bundle branch block persisted more frequently at hospital discharge (53.8 vs 22.7%; P = .028) and at 1-month follow-up (38.5 vs 13.6%; P = .054) when occurring before valve implantation. Balloon aortic valvuloplasty prior to valve implantation was used in 264 (76.1%) patients, and 78 (22.5%) had persistent LBBB or complete atrioventricular block requiring pacemaker implantation. Persistent LBBB or unresolved atrioventricular block at 1 month occurred more frequently in the BAV group (76.1 vs 47.6%; P = .021), and the use of BAV was associated with a lack of CA resolution (OR, 3.5; 95%CI, 1.17-10.43; P = .021). Conclusions: In patients undergoing a balloon-expandable transcatheter aortic valve implantation, more than half of CA occurred before valve implantation. Early occurrence of CA was associated with a higher rate of persistence at 1-month follow-up. The use of BAV was associated with an increased risk of CA persistence (AU)

Selección de lo mejor del año 2017 en cardiología intervencionista: revolución en el estudio de la fisiología coronaria y nuevos parámetros / Selection of the best of 2017 in interventional cardiology: revolution in the study of coronary physiology and new parameters

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Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results.

Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.

Válvulas Portico y SAPIEN XT en el tratamiento de pacientes con anillo aórtico pequeño: comparación de resultados hemodinámicos / Self-expanding Portico valve versus balloon-expandable SAPIEN XT valve in patients with small aortic annuli: comparison of hemodynamic performance

Introducción y objetivos: La válvula autoexpandible Portico es una nueva válvula de implante transcatéter que ha mostrado resultados prometedores en estudios preliminares; sin embargo, no existen estudios que comparen este dispositivo con sistemas previos de válvula aórtica transcatéter. El objetivo de este estudio es comparar los resultados hemodinámicos de la válvula autoexpandible Portico con los de la válvula expandible mediante balón SAPIEN XT en un estudio de casos apareados con análisis en un laboratorio central de ecocardiografía Métodos: Se emparejó a 22 pacientes tratados mediante implante transcatéter de la válvula Portico de 23 mm con 40 pacientes tratados con la válvula SAPIEN XT de 23 mm, según los siguientes parámetros: área y diámetro medio del anillo aórtico por tomografía computarizada multidetector, fracción de eyección del ventrículo izquierdo, área de superficie corporal e índice de masa corporal. El diámetro medio del anillo aórtico fue de 19,6 ± 1,3 mm por ecocardiografía transtorácica y de 21,4 ± 1,2 mm por tomografía computarizada, sin diferencias significativas entre los grupos. Se obtuvieron imágenes de ecocardiografía Doppler antes de la intervención y en el seguimiento realizado al cabo de 1 mes y se analizaron en un laboratorio central de ecocardiografía. Resultados: No se objetivaron diferencias significativas entre los grupos en el gradiente transaórtico medio residual (SAPIEN XT, 10,4 ± 3,7 mmHg; Portico, 9,8 ± 1,1 mmHg; p = 0,49) ni en el área efectiva del orificio valvular (SAPIEN XT, 1,36 ± 0,27 cm2; Portico, 1,37 ± 0,29 cm2; p = 0,54). La incidencia del desajuste protésico (área efectiva del orificio valvular < 0,65 cm2/m2) fue similar en ambos grupos (el 13,5 frente al 10,0%; p = 0,56). No se observaron diferencias entre los grupos en cuanto a la incidencia de fugas paravalvulares moderadas o graves (el 5,0 frente al 4,8%; p = 0,90). Conclusiones: El implante transcatéter de la válvula autoexpandible Portico produjo resultados hemodinámicos a corto plazo similares a los de la válvula expandible por balón SAPIEN XT en el tratamiento de pacientes con estenosis aórtica grave y anillo aórtico pequeño. Son necesarios estudios prospectivos con seguimiento a más largo plazo y en pacientes con anillo aórtico mayor (AU)

Introduction and objectives: The self-expanding Portico valve is a new transcatheter aortic valve system yielding promising preliminary results, yet there are no comparative data against earlier generation transcatheter aortic valve systems. The aim of this study was to compare the hemodynamic performance of the Portico and balloon-expandable SAPIEN XT valves in a case-matched study with echocardiographic core laboratory analysis. Methods: Twenty-two patients underwent transcatheter aortic valve implantation with the Portico 23-mm valve and were matched for aortic annulus area and mean diameter measured by multidetector computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 40 patients treated with the 23-mm SAPIEN XT. Mean aortic annulus diameters were 19.6 ± 1.3 mm by transthoracic echocardiography and 21.4 ± 1.2 mm by computed tomography, with no significant between-group differences. Doppler echocardiographic images were collected at baseline and at 1-month of follow-up and were analyzed in a central echocardiography core laboratory. Results: There were no significant between-group differences in residual mean transaortic gradients (SAPIEN XT: 10.4 ± 3.7 mmHg; Portico: 9.8 ± 1.1 mmHg; P = .49) and effective orifice areas (SAPIEN XT: 1.36 ± 0.27 cm2; Portico, 1.37 ± .29 cm2; P = .54). Rates of severe prosthesis-patient mismatch (effective orifice area < 0.65 cm2/m2) were similar (SAPIEN XT: 13.5%; Portico: 10.0%; P = .56). No between-group differences were found in the occurrence of moderate-severe paravalvular leaks (5.0% vs 4.8% of SAPIEN XT and Portico respectively;P = .90). Conclusions: Transcatheter aortic valve implantation with the self-expanding Portico system yielded similar short-term hemodynamic performance compared with the balloon-expandable SAPIEN XT system for treating patients with severe aortic stenosis and small annuli. Further prospective studies with longer-term follow-up and in patients with larger aortic annuli are required (AU)

Revisión sistemática de la trombosis protésica tras implante percutáneo de válvula aórtica / Valve thrombosis following transcatheter aortic valve implantation: a systematic review

Introducción y objetivos A pesar de la rápida extensión del implante transcatéter de válvulas aórticas, la trombosis protésica tras la intervención es una complicación grave que no se ha evaluado sistemáticamente. El objetivo de este estudio es determinar las características clínicas, los criterios diagnósticos y el manejo de la trombosis protésica tras implante percutáneo de válvula aórtica mediante revisión sistemática de los datos publicados hasta la fecha. Métodos Se identificaron, mediante búsqueda electrónica sistemática, todos los artículos publicados en 2002-2012 relacionados con trombosis protésica como complicación tras implante percutáneo de válvula aórtica. Resultados Se identificaron 11 publicaciones que describían a un total de 16 pacientes (media de edad, 80 ± 5 años; el 65% varones) con trombosis protésica subaguda. En todos los casos excepto 1 (94%), se utilizaron prótesis de tipo balón expandible. Todos los pacientes recibieron doble antiagregación inmediatamente después del procedimiento y continuaban recibiendo al menos un antiagregante en el momento del diagnóstico, que se realizó una mediana de 6 meses tras el implante. La disnea progresiva fue el síntoma más común de presentación. El principal hallazgo ecocardiográfico fue un incremento en los gradientes transvalvulares (media de 10 ± 4 mmHg tras el implante a 40 ± 12 mmHg al diagnóstico), junto con el engrosamiento en las valvas. No se visualizaron directamente trombos mediante la ecocardiografía. En 3 casos la prótesis se sustituyó quirúrgicamente, mientras que el resto recibió warfarina, que consiguió un descenso efectivo de los gradientes en una mediana de 2 meses. No se produjeron embolias como consecuencia de la trombosis protésica tras implantación percutánea de la válvula. Conclusiones Aunque infrecuente y probablemente infracomunicada, ante la aparición de disnea progresiva junto con aumento de gradientes en los meses siguientes al implante transcatéter de válvula aórtica, se debe pensar en trombosis protésica. Aunque la visualización directa del trombo resulta difícil, la instauración precoz de anticoagulación oral puede restaurar de manera efectiva la función protésica (AU)

Introduction and objectives Despite the rapid global uptake of transcatheter aortic valve implantation, valve trombosis has yet to be systematically evaluated in this field. The aim of this study was to determine the clinical characteristics, diagnostic criteria, and treatment outcomes of patients diagnosed with valve thrombosis following transcatheter aortic valve implantation through a systematic review of published data. Methods Literature published between 2002 and 2012 on valve thrombosis as a complication of transcatheter aortic valve implantation was identified through a systematic electronic search. Results A total of 11 publications were identified, describing 16 patients (mean age, 80 [5] years, 65% men). All but 1 patient (94%) received a balloon-expandable valve. All patients received dual antiplatelet therapy immediately following the procedure and continued to take either mono- or dual antiplatelet therapy at the time of valve thrombosis diagnosis. Valve thrombosis was diagnosed at a median of 6 months post-procedure, with progressive dyspnea being the most common symptom. A significant increase in transvalvular gradient (from 10 [4] to 40 [12] mmHg) was the most common echocardiographic feature, in addition to leaflet thickening. Thrombus was not directly visualized with echocardiography. Three patients underwent valve explantation, and the remaining received warfarin, which effectively restored the mean transvalvular gradient to baseline within 2 months. Systemic embolism was not a feature of valve thrombosis post-transcatheter aortic valve implantation. Conclusions Although a rare, yet likely under-reported complication of post-transcatheter aortic valve implantation, progressive dyspnea coupled with an increasing transvalvular gradient on echocardiography within the months following the intervention likely signifies valve thrombosis. While direct thrombus visualization appears difficult, prompt initiation of oral anticoagulation therapy effectively restores baseline valve function (AU)

Analysis of the predicting variables for daily and weekly fluctuations of two airborne fungal spores: Alternaria and Cladosporium.

Alternaria and Cladosporium are two fungal taxa whose spores (conidia) are included frequently in aerobiological studies of outdoor environments. Both spore types are present in the atmosphere of Malaga (Spain) throughout almost the entire year, although they reach their highest concentrations during spring and autumn. To establish predicting variables for daily and weekly fluctuations, Spearman's correlations and stepwise multiple regressions between spore concentrations (measured using a volumetric 7-day recorder) and meteorological variables were made with results obtained for both spore types in 1996 and 1997. Correlations and regressions were also made between the different taxa and their concentrations in different years. Significant and positive correlation coefficients were always obtained between spore concentrations of both taxa, followed by temperature, their concentrations in different years, sunshine hours and relative humidity (this last in a negative sense). For the two spore types we obtained higher correlation and regression coefficients using weekly data. We showed different regression models using weekly values. From the results and a practical point of view, it was concluded that weekly values of the atmospheric concentration of Alternaria spores can be predicted from the maximum temperature expected and its concentrations in the years sampled. As regards the atmospheric concentration of Cladoposrium spores, the weekly values can be predicted based on the concentration of Alternaria spores, thus saving the time and effort that would otherwise be employed in counting them by optical microscopy.

Platanus pollen season in Andalusia (southern Spain): trends and modeling.

Platanus is a major cause of pollen allergy in many Spanish cities. The present paper reports an analysis of Platanus pollen season throughout the Andalusia region (southern Spain), which has among the highest pollen counts and the highest incidence of Platanus-related allergies in Europe. The main aim was to analyze pollen season trends from 1992 to 2010 in Andalusia; models were also constructed to forecast the start of the season. Daily pollen counts were recorded using Hirst-type volumetric spore-traps. Pollen season start-dates were very similar at all sites, usually occurring in March. The pollen season was delayed over the study period. The Pollen-season duration and Pollen index generally increased throughout the study period. The starting date for temperature accumulation was around the 10th February, although the threshold temperatures varied by site. The regional model for Andalusia failed to provide sufficiently accurate results compared with sub-regional or local models. For modeling purposes, three sub-regions are recommended: Inland, East Coast and West Coast.