Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long-term follow-up.

INTRODUCTION AND OBJECTIVES: Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD. METHODS: Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022. RESULTS: Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012). CONCLUSIONS: LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.

Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial.

Aims: We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results: The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P < 0.001]. The Kaplan-Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0-4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. Conclusion: Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided. The trial is registered with ClinicalTrials.gov, number NCT00862043.

Expression of epicardial adipose tissue thermogenic genes in patients with reduced and preserved ejection fraction heart failure.

Epicardial adipose tissue has been proposed to participate in the pathogenesis of heart failure. The aim of our study was to assess the expression of thermogenic genes (Uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), and PR-domain-missing 16 (PRDM16) in epicardial adipose tissue in patients with heart failure, stablishing the difference according to left ventricular ejection fraction (reduced or preserved). Among the 75 patients in our study, 42.7% (n=32) had reduced left ventricular ejection fraction. UCP1, PGC1α and PRDM16 mRNA in EAT were significantly lower in patients with reduced left ventricular ejection fraction. Multiple regression analysis showed that age, male gender, body max index, presence of obesity, type-2-diabetes mellitus, hypertension and coronary artery disease and left ventricular ejection fraction were associated with the expression levels of UCP1, PGC1α and PRDM16 mRNA. Thermogenic genes expressions in epicardial adipose tissue (UCP1: OR 0.617, 95%CI 0.103-0.989, p=0.042; PGC1α: OR 0.416, 95%CI 0.171-0.912, p=0.031; PRDM16: OR 0.643, 95%CI 0.116-0.997, p=0.044) were showed as protective factors against the presence of heart failure with reduced left ventricular ejection fraction, and age (OR 1.643, 95%CI 1.001-3.143, p=0.026), presence of coronary artery disease (OR 6.743, 95%CI 1.932-15.301, p<0.001) and type-2-diabetes mellitus (OR 4.031, 95%CI 1.099-7.231, p<0.001) were associated as risk factors. The adequate expression of thermogenic genes has been shown as possible protective factors against heart failure with reduced ejection fraction, suggesting that a loss of functional epicardial adipose tissue brown-like features would participate in a deleterious manner on heart metabolism. Thermogenic genes could represent a future novel therapeutic target in heart failure.

Type 2 diabetes is associated with decreased PGC1α expression in epicardial adipose tissue of patients with coronary artery disease.

BACKGROUND: Although recent studies indicate that epicardial adipose tissue expresses brown fat-like genes, such as PGC1α, UCP1 and PRDM16, the association of these genes with type 2 diabetes mellitus (DM2) in coronary artery disease (CAD) remains unknown. METHODS: PGC1α, UCP1, and PRDM16 mRNAs expression levels were measured by real-time PCR in epicardial and thoracic subcutaneous adipose tissue from 44 CAD patients (22 with DM2 [CAD-DM2] and 22 without DM2 [CAD-NDM2]) and 23 non-CAD patients (NCAD). RESULTS: The CAD-DM2 patients had significantly lower PGC1α and UCP1 expression in epicardial adipose tissue than the CAD-NDM2 and NCAD patients. However, PGC1α and UCP1 mRNA trended upward in subcutaneous adipose tissue from CAD-DM2 patients. At multiple regression analysis, age, body mass index, left ventricular ejection fraction, UCP1 expression of epicardial adipose tissue and diabetes came out to be independent predictors of PGC1α levels. Epicardial adipose tissue PGC1α expression was dependent on the number of injured coronary arteries and logistic regression analysis showed that PGC1α expression in epicardial adipose tissue could exert a protective effect against coronary lesions. CONCLUSIONS: DM2 is associated with decreased expression of PGC1α and UCP1 mRNA in epicardial adipose tissue of patients with CAD, likely reflecting a loss of brown-like fat features. Decreased expression of PGC1α in human epicardial adipose tissue is associated with higher prevalence of coronary lesions.

Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion.

BACKGROUND: Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. AIM: The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. METHODS: We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. RESULTS: The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). CONCLUSIONS: A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.

Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience.

BACKGROUND: Paravalvular leak occurs in 5-17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. METHODS: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. RESULTS: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. CONCLUSIONS: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.

Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival.

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.

[Cycles of improvement of the hypertensive patient's care: risk-cycle study]. / Los ciclos de mejora de calidad en la atención al paciente hipertenso: Ciclo-Risk Study.

BACKGROUND: Frequently we found deficiencies in the management of cardiovascular risk factors on hypertensive patients in primary care. OBJECTIVE: This study was to evaluate the effect of a quality improvement intervention in the care of cardiovascular risk factors in hypertensive patients. METHODS: Quality assurance study. Two health centres with fourteen family doctors. One centre (seven doctors) was assigned to receive a quality improvement intervention while the other centre was assigned the control group. 482 hypertensive patients were in the study group (64% females, mean age 61,4 years (SD 6,8)), and 360 were in the control group (63% females, mean age 60,7 (SD 7,4)). Quality improvement circles consisting of audit, feedback, training sessions, and guidelines discussion. Process criteria of hypertension control, blood pressure, weight, lipids, smoking, cardiovascular risk and antihypertensive drugs used were measurement before intervention and again one year later. RESULTS: The mean improvement in process criteria after the intervention was 5,3 percent points (CI95%:3,7-6,9). Systolic blood pressure was decreased by 3,5 mmHg(IC95%:1,6-5,3) and Diastolic blood pressure by 2,5 mmHg(IC95%:1,3-3,8). Adequate BP control was significantly increased in the intervention group (29,1% to 40,9%;p<0,01), while no effect was achieved in the control group. Absolute cardiovascular risk decreased (15,86 to14,34%, p<0.01) in the study group, with no changes in the control group. Absolute risk decreases 2,07(IC95%:1,21-2,93) and relative risk 0,25 (IC95%:0,14-0,35) percent points. CONCLUSION: The quality intervention was effective in improving the quality care process and decreased blood pressure and absolute and relative cardiovascular risk.

Association between different risk factors and vascular accelerated ageing (EVA study): study protocol for a cross-sectional, descriptive observational study.

INTRODUCTION: The process of population ageing that is occurring in developed societies represents a major challenge for the health system. The aim of this study is to analyse factors that have an influence on early vascular ageing (EVA), estimated by carotid-femoral pulse wave velocity (cf-PWV) and Cardio Ankle Vascular Index (CAVI), and to determine differences by gender in a Spanish population. METHODS AND ANALYSIS: An observational, descriptive, cross-sectional study. STUDY POPULATION: From the population assigned to the participating healthcare centres, a cluster random sampling stratified by age and gender will be performed to obtain 500 participants aged between 35 and 75. Those who meet the inclusion criteria and give written informed consent will be included in the study. MEASUREMENTS: Main dependent variables: cf-PWV determined using the SphygmoCor System and CAVI estimated using VASERA. Secondary dependent variables: telomere length, carotid intima-media thickness, central and peripheral augmentation index, ankle-brachial pulse wave velocity, ankle-brachial index, retinal arteriovenous index, and renal and cardiac organ damage. INDEPENDENT VARIABLES: lifestyles (physical activity, adherence to the Mediterranean diet, alcohol and tobacco consumption); psychological factors (depression, anxiety and chronic stress); inflammatory factors and oxidative stress. ETHICS AND DISSEMINATION: The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent form agreeing to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow the understanding of the relationship of the different influencing factors and their relative weight in the development of EVA. At least 5 publications in first-quartile scientific journals are planned. TRIAL REGISTRATION NUMBER: NCT02623894; Pre-results.

[Role of serum leptin in the severity of coronary artery disease in patients with stable angina]. / Papel de la leptina sérica en la gravedad de la enfermedad coronaria en pacientes con angina estable.

BACKGROUND AND OBJECTIVES: Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease. PATIENTS AND METHODS: 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay. RESULTS: Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03-1.27; p=0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01-1.25; p=0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765-0.7657). CONCLUSIONS: Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target.

[Effectiveness of a quality improvement intervention in reducing cardiovascular risk in hypertensive patients]. / Efectividad de una intervención de mejora de calidad en la reducción del riesgo cardiovascular en pacientes hipertensos.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of a quality improvement intervention on the reduction of cardiovascular risk in patients with hypertension. PATIENTS AND METHOD: Quasi-experimental study involving two primary care centres. One centre was assigned to implement a quality improvement intervention (n = 482 patients), while at the other center "usual care" procedures were followed (control group, n = 360 patients). The quality improvement intervention consisted of a combined program designed for the medical staff and comprising audit, feedback, training sessions and implementation of clinical practice guidelines during 6 months. The main outcome measures were blood pressure, lipid levels, diabetes, smoking and cardiovascular risk. These values were compared before the intervention and after one year. RESULTS: The baseline characteristics of the patients were similar in both groups. Absolute cardiovascular risk decreased from 15.85% to 14.36% (P< .05) in the intervention group, and no significant change was observed in the control group (15.17% to 15.76%). The intervention led to a 2.07% decrease in cardiovascular risk (95%CI, 1.21-2.93; P< .05). The percentage of patients with high cardiovascular risk (> 20% at 10 years) decreased in the intervention group from 30% to 25%, and increased in the control group from 28% to 30%. Relative cardiovascular risk decreased from 2.03 to 1.75 (P< .05) in the intervention group, and from 1.98 to 1.92 (P> .05) in the control group. The intervention thus led to a 0.25 decrease in relative risk (95%CI: 0.14-0.35). CONCLUSIONS: Absolute and relative cardiovascular risk in patients with hypertension was reduced by a quality improvement intervention. The percentage of patients with high cardiovascular risk was also reduced.

Imagen de fusión TCMC-fluoroscopia en el reemplazo percutáneo de la válvula aórtica por acceso transcava / MSCT-fluoroscopy fusion imaging for transcaval access guidance in transcatheter aortic valve replacement

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Papel de la leptina sérica en la gravedad de la enfermedad coronaria en pacientes con angina estable / Role of serum leptin in the severity of coronary artery disease in patients with stable angina

Fundamentos y objetivo: La leptina es una hormona plasmática que ha sido relacionada con la homeostasis cardiovascular y la aterosclerosis, pero no existen datos concluyentes sobre su asociación con la patogénesis de la enfermedad coronaria. El objetivo de este estudio fue evaluar el valor de la leptina sérica en pacientes con angina estable y su relación con la gravedad de la enfermedad coronaria. Pacientes y método: Se incluyeron 204 pacientes, 152 con angina estable (grupo con enfermedad coronaria) y 52 sin enfermedad coronaria, excluida por tomografía computarizada cardíaca (grupo control). El grupo con enfermedad coronaria fue dividido en 2 subgrupos atendiendo a la gravedad de la afectación (enfermedad monovaso o multivaso, 46 y 106 pacientes respectivamente). Los niveles de leptina sérica fueron determinados mediante Enzyme-Linked Inmunosorbent Assay. Resultados: Los niveles de leptina fueron significativamente superiores en los pacientes con enfermedad multivaso y se asociaron de forma independiente con una mayor gravedad de la enfermedad coronaria en comparación con los controles (OR 1,14; IC95% 1,03-1,27; p = 0,014) y con pacientes con enfermedad monovaso (OR 1,12; IC95% 1,01-1,25; p = 0,036). Se testó el valor diagnóstico de la leptina sérica para el diagnóstico enfermedad multivaso, obteniendo un área bajo la curva en la curva Receiver Operating Characteristic de 0,6764 (IC95% 0,5765-0,7657). Conclusiones: La leptina sérica se asoció en pacientes con angina estable con la mayor gravedad de la enfermedad coronaria, mostrando su implicación en el desarrollo de la enfermedad coronaria y como futuro objetivo terapéutico (AU)

Background and objectives: Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease. Patients and methods: 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay. Results: Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03-1.27; p = 0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01-1.25; p = 0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765-0.7657). Conclusions: Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target (AU)

Los ciclos de mejora de calidad en la atención al paciente hipertenso. (Ciclo-Risk study) / quality circles improve on hypertensive patients care (Ciclo-risk study)

Fundamentos: Con frecuencia encontramos deficiencias en el manejo de los factores de riesgo en las personas hipertensas. El objetivo del estudio fue evaluar el efecto de una intervención de mejora de calidad en la atención a los factores de riesgo cardiovascular en personas hipertensas. Métodos: Estudio de mejora de calidad. Dos centros de salud y catorce médicos de familia. Un centro (siete médicos) se seleccionó para recibir una intervención de mejora de calidad y otro como grupo control. Se incluyó a 482 personas hipertensas en el grupo de estudio [64% mujeres, edad media 61,4 años (DS:6.8)] y 360 en el grupo control (63% mujeres, edad media 60,7 (DS:7.4)). La intervención consistió en una auditoria de historias clínicas con feedback, sesiones de entrenamiento y discusión de guías clínicas. Previamente a la intervención y un año después de la misma se evaluaron criterios de proceso de atención a personas hipertensas, presión arterial, peso, lípidos, tabaco, riesgo cardiovascular y fármacos antihipertensivos. Resultados: La mejora media en el proceso después de la intervención fue de 5,3 puntos porcentuales (CI95%:3,7-6,9). La presión arterial sistólica descendió 3,5 mmHg (IC95%:1,6-5,3) y la presión arterial diastólica 2,5 mmHg (IC95%:1,3-3,8). El control adecuado de la presión arterial se incrementó en el grupo de intervención (29,1% a 40,9%; p<0.01) y no hubo cambios en el grupo control. El riesgo cardiovascular descendió en el grupo de intervención (15,86 a 14,34%, P<0.01) y en el grupo control no varió. El riesgo absoluto descendió 2,07(IC95%:1,21-2,93) y el relativo 0,25 puntos porcentuales (IC95%:0,14-0,35). Conclusiones: La intervención fue efectiva en la mejora de calidad de atención al proceso asistencial al haber descendido la presión arterial y el riesgo cardiovascular, tanto absoluto como relativo (AU)

Background: Frequently we found deficiencies in the management of cardiovascular risk factors on hypertensive patients in primary care. Objective this study was to evaluate the effect of a quality improvement intervention in the care of cardiovascular risk factors in hypertensive patients. Methods: Quality assurance study. Two health centres with fourteen family doctors. One centre (seven doctors) was assigned to receive a quality improvement intervention while the other centre was assigned the control group. 482 hypertensive patients were in the study group (64% females, mean age 61,4 years (SD 6,8)), and 360 were in the control group (63% females, mean age 60,7 (SD 7,4)).Quality improvement circles consisting of audit, feedback, training sessions, and guidelines discussion. Process criteria of hypertension control, blood pressure, weight, lipids, smoking, cardiovascular risk and antihypertensive drugs used were measurement before intervention and again one year later. Results: The mean improvement in process criteria after the intervention was 5,3 percent points (CI95%:3,7-6,9). Systolic blood pressure was decreased by 3,5 mmHg(IC95%:1,6-5,3) and Diastolic blood pressure by 2,5 mmHg(IC95%:1,3-3,8). Adequate BP control was significantly increased in the intervention group (29,1% to 40,9%;p<0,01), while no effect was achieved in the control group. Absolute cardiovascular risk decreased (15,86 to14,34%, p<0.01) in the study group, with no changes in the control group. Absolute risk decreases 2,07(IC95%:1,21-2,93) and relative risk 0,25 (IC95%:0,14-0,35) percent points. Conclusion: The quality intervention was effective in improving the quality care process and decreased blood pressure and absolute and relative cardiovascular risk (AU)

Resultados clínicos de las técnicas regenerativas en medicina cardiovascular / Clinical trials in cardiovascular regenerative medicine

Los primeros ensayos clínicos han demostrado que la terapia celular puede mejorar el proceso de recuperación cardiaca tras la fase aguda del infarto de miocardio y la función cardiaca en la cardiopatía isquémica crónica. Sin embargo, algunos estudios han mostrado resultados contradictorios y aún existen dudas acerca de los mecanismos de acción y sobre la estrategia de tratamiento ideal para conseguir una mayor reparación cardiaca. En este capítulo se revisa la evidencia disponible actualmente, se analizan los ensayos clínicos de fases I y II y sus limitaciones, se discuten los puntos clave para el diseño de futuros estudios y se anticipa el futuro de los nuevos campos de investigación en este fascinante campo de la investigación cardiovascular traslacional (AU)

Previous clinical trials of stem cell therapy have demonstrated that the technique can promote the recovery of heart muscle after the acute phase of myocardial infarction and can improve cardiac function in chronic ischemic heart disease. However, some studies have produced conflicting results, and there are still questions about underlying mechanisms of action and about the best treatment strategy for optimizing cardiac repair. This article contains a review of recent findings in translational cardiovascular research and of the results and limitations of phase-I and -II clinical trials, discusses key issues in the design of future trials, and summarizes new areas for investigation in this fascinating field (AU)

Efectividad de una intervención de mejora de calidad en la reducción del riesgo cardiovascular en pacientes hipertensos / Effectiveness of a quality improvement intervention in reducing cardiovascular risk in hypertensive Patients

Introducción y objetivos. Evaluar el efecto de una intervención de mejora de calidad en la reducción del riesgo cardiovascular de los pacientes hipertensos. Pacientes y método. Estudio cuasiexperimental que incluye 2 centros de atención primaria. Un centro fue asignado para recibir una intervención de mejora de calidad (n = 482 pacientes hipertensos) y otro, la atención habitual (n = 360 pacientes hipertensos). La intervención de mejora de calidad consistió en un programa combinado para el personal sanitario que incluyó: audit, feedback, sesiones de formación e implementación de guías clínicas. Las mediciones principales fueron: presión arterial, lípidos, diabetes, tabaquismo y riesgo cardiovascular al inicio del seguimiento, previo a la intervención y 1 año después. Resultados. Las características basales de los grupos fueron similares. El riesgo cardiovascular absoluto decreció del 15,85 al 14,36 por ciento (p 20 por ciento en 10 años) disminuyó en el grupo de intervención del 30 al 25 por ciento (p 0,05). El efecto de la intervención fue, por tanto, un descenso del riesgo relativo de 0,25 (IC del 95 por ciento, 0,14-0,35). Conclusiones. El riesgo cardiovascular absoluto y relativo en pacientes hipertensos disminuyó por la intervención de mejora de calidad. Además, se consiguió una reducción del porcentaje de pacientes con riesgo cardiovascular alto (AU)