The strengths and frailties of women with cardiovascular disease

Shakespeare and popular belief have tended to reinforce the view that females are weak. Scientific methodology applied to the field of cardiovascular disease suggests, to the contrary, that women are strong and enduring. Compared to males, females live at least 4 years longer, develop ischemic heart disease about 10 years later, require more risk factors before manifesting heart disease5, are less subject to sudden cardiac death6, and appear to have a more favorable outcome after the onset of heart failure

Pregnancy-Associated Plasma Protein A as Predictor of Outcome in Patients With Suspected Acute Coronary Syndromes

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Increased Platelet Reactivity Due to Platelet Receptor Polymporphisms? Not in the Real World

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clinical conundrums in antithrombotic therapy management a delphi consensus panel

Abstract Background Anticoagulants are recommended for the prevention of stroke/systemic embolism for most patients with atrial fibrillation (AF) and for the treatment of patients with venous thromboembolism (VTE). Regulatory-driven randomized trials, however, typically exclude extreme patient scenarios involving, for instance, severe bleeding, ischaemic risk, frailty or renal impairment, despite their common occurrence in clinical practice. Uncertainty in the management of such cases leads to a high degree of variability in therapeutic approaches. Consensus conferences or panels may provide insights and help bridge the gaps that separate clinical guidelines from real-world practice. In the present study, a description of challenging AF and VTE patients was submitted to a large panel of experts to investigate areas of common or divergent management. Method A modified-Delphi method was used to obtain consensus among 178 Italian AF and VTE specialists. A questionnaire was sent on the appropriateness of anticoagulant therapy in AF and VTE cases, including CHA 2 DS 2 -VASc=1, comorbid coronary artery disease, frailty, advanced age, risk of falling, prior haemorrhagic stroke, and low- or intermediate-risk pulmonary embolism. Strategies to improve guideline adherence were also investigated. Results All participants completed the questionnaire. Consensus was reached on many, but not all cases, leaving uncertainty on some debated topics (conundrums) where decisions are unsupported by clinical studies or driven by controversial results. Conclusions The indications emerging from this large panel of experts may help guide the management of challenging AF or VTE cases. Studies are needed addressing treatment options in those cases for whom no consensus was reached

When a meta-analysis equals a single large-scale trial with meaningful follow-up

© 2021 The Author(s). Published on behalf of the European Society of Cardiology. All rights reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1093/eurheartj/ehab460This commentary refers to ‘Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis’, by E.P. Navarese et al. doi:10.1093/ eurheartj/ehab246 and the discussion piece ‘In the pool: dilution or drowning?’, by V. Dayan et al. doi:10.1093/ eurheartj/ehab443Peer reviewe

Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis

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1119-99 Immunoglobulin A anticardiolipin antibodies are markers of the extent of daily life ischemia in patients with stable angina

Rising population numbers place ever increasing demands on energy resources. A large percentage of the worldwide energy production is reserved for the generation of electricity and a significant portion of the electrical energy generation is used for illumination purposes. At the same time, people demand brighter light sources that provide better light quality. The luminaire of today is not just a simple lamp, but a complex, intelligent piece of technology designed for a specific purpose. This doctoral dissertation aims to provide a link between the theoretical universe surrounding the physics of electromagnetic radiation and the practical illumination world. A theoretical framework presents the physical properties of light and connects, through the human visual system, to a number of perceptual models. Based on these perceptual models, the colourimetric qualities of an illumination spectrum are analysed and a theoretical framework that aims to optimise the balance between colour fidelity and energy efficiency is proposed. The result of this optimisation is a spectrum that needs to be implemented into a light source. Recent advancements in semiconductor technology led to the development of highly efficient light emitting diodes. The monochromatic nature of these light sources offers the possibility of creating a spectrally tuneable luminaire that is able to reproduce these optimised illumination spectra. A fully integrated spectrally tuneable light engine combines knowledge on characterising and driving LEDs, optical design and thermal management. Each group of monochromatic LEDs needs a variable current source that ensures predictable behaviour regardless of their dimming level or temperature. An advanced optical solution enables efficient light extraction from the LEDs, provides excellent luminance and chroma homogenisation and, finally, delivers a suitable beam pattern for the intended illumination application. Proper thermal management establishes sufficient heat extraction to guarantee low semiconductor temperatures. Finally, the LED light engines created during this doctoral research are incorporated into three spectrally tuneable illumination devices, each designed for a specific purpose. A set of spectrally tuneable downlights installed in the laboratories of the lighting group of the Catalonia Institute for Energy Research (IREC) in Barcelona, Spain and the department of neuroscience of the University of Newcastle in the United Kingdom serves as a valuable tool for experiments that evaluate both physical and psychovisual properties of selected illumination spectra. A compact spotlight, used during the "Making Colour" exhibition of the National Gallery in London, is optimised to provide a set of specific illumination spectra to illuminate art reproductions. Lastly, a high power luminaire was designed to generate specialised spectra to irradiate greenhouse plants, steering their morphology and the production of plant-specific compounds.El incremento de población mundial en los últimos años implica necesariamente un incremento en la demanda energética global. Un alto porcentaje de la energía producida globalmente es utilizada para iluminar los diferentes espacios. Al mismo tiempo, los usuarios reclaman cada vez fuentes de luz más potentes y entornos más iluminados y con mayor calidad de luz. Las luminarias actuales no son simplemente lámparas, sino sistemas complejos e inteligentes diseñados con propósitos específicos. Esta tesis doctoral pretende unir dos espacios que normalmente son abordados de manera separada: por un lado, el entorno teórico de la radiación visible y sus propiedades colorimétricas, y por otro lado la luminotecnia aplicada. En el ámbito teórico, se han tratado con las propiedades físicas de la luz, estableciendo un puente a través de la visión humana con diferentes modelos de percepción visual. En base a estos modelos, se han analizado las propiedades colorimétricas de los espectros de iluminación estudiados y se propone un marco teórico de optimización entre fidelidad de color y eficiencia energética. Los resultados de esta optimización se han implementado también en una fuente de luz de espectro modulable real. Recientemente, el mercado LED está alcanzando valores altísimos en cuanto a eficacias lumínicas. Sin embargo, el crecimiento del mercado pasa por mejorar otros aspectos que garanticen el progreso de la tecnología. La naturaleza esencialmente monocromática de los LEDs de estado sólido ofrece la posibilidad de crear fuentes de luz de espectro sintonizable mediante la composición espectral o adición cromática de varios tipos diferentes de LED. Para el diseño de una de estas fuentes de luz se requieren conocimientos en cuanto a la caracterización y energizado de los LEDs, diseño óptico y diseño térmico. Cada clúster de LEDs de características espectrales similares necesita una fuente de corriente variable que garantice unos valores estables y que no dependan de otros parámetros como la potencia de entrada o la temperatura. Se necesitan también soluciones ópticas avanzadas para conseguir no solo una alta eficiencia de extracción de la radiación sino también una mezcla homogénea de los colores a la salida así como una distribución angular específicamente diseñada para cada aplicación. Por otro lado, se precisa de un manejo térmico óptimo que permita la extracción de calor hacia elementos activos o pasivos para que así la temperatura de la unión de los LEDs sea óptima. Finalmente, los módulos LED creados durante esta tesis doctoral se han incorporado en tres luminarias distintas representativas de tres campos de aplicación independientes. La primera aplicación implicó el diseño y la incorporación de los módulos LED a un grupo de downlights que se instalaron en una habitación del Instituto de Investigación en Energía de Cataluña y en el Instituto de Neurociencia de la Universidad de Newcastle (UK), constituyendo dos instalaciones únicas para la investigación de los aspectos físicos y físico-visuales de diferentes espectros de iluminación. Para la segunda aplicación, se diseñaron un conjunto de luminarias tipo spotlight que fueron instaladas y demostradas en la exhibición "Making Colour" que tuvo lugar en la National Gallery (Londres). En la misma, se mostraron las propiedades de distintos espectros de iluminación. Finalmente, se ha realizado también una luminaria de alta potencia optimizada para la generación de espectros de interés en horticultura, habiéndose demostrado que es posible cambiar la morfología de los cultivos estudiados e incentivar la producción de ciertas vitaminas y compuesto

Relation Between Platelet Response to Exercise and Coronary Angiographic Findings in Patients With Effort Angina

Background— Platelet reactivity is increased by exercise in patients with obstructive coronary artery disease (CAD) but not in patients with syndrome X. In this study, we prospectively investigated whether the platelet response to exercise might help distinguish, among patients with angina, those with obstructive CAD from those with normal coronary arteries (NCAs). Methods and Results— Venous blood samples were collected before and 5 minutes after exercise from 194 consecutive patients with stable angina. Platelet reactivity was measured by the platelet function analyzer (PFA)-100 system as the time for flowing whole blood to occlude a collagen-adenosine diphosphate ring (closure time). Coronary angiography showed CAD in 163 patients (84%) and NCA in 31 patients (16%). Baseline closure time was shorter in NCA patients (78.0±16 versus 95.5±23 seconds, P <0.0001). With exercise, closure time decreased in CAD patients (−15.5 seconds; 95% confidence limits [CL], −13.0 to −18.0 seconds; P <0.0001), but increased in NCA patients (12.5 seconds; 95% CL, 7.4 to 17.7 seconds; P =0.0004). An increase in closure time with exercise ≥10 seconds had 100% specificity and positive predictive value for NCAs. Similarly, a decrease ≥10 seconds had 100% specificity and positive predictive value for CAD. A closure time change (increase or decrease) ≥10 seconds allowed a correct classification of 55% of all patients. Conclusions— Among patients with stable angina, the response of platelet reactivity to exercise was predictive of normal or stenosed coronary arteries at angiography. Specifically, an increase in closure time with exercise ≥10 seconds was invariably associated with the presence of NCA

aspirin therapy in primary cardiovascular disease prevention a position paper of the european society of cardiology working group on thrombosis

Although the use of oral anticoagulants (vitamin K antagonists) has been abandoned in primary cardiovascular prevention due to lack of a favorable benefit-to-risk ratio, the indications for aspirin use in this setting continue to be a source of major debate, with major international guidelines providing conflicting recommendations. Here, we review the evidence in favor and against aspirin therapy in primary prevention based on the evidence accumulated so far, including recent data linking aspirin with cancer protection. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to using low-dose aspirin in primary cardiovascular prevention and suggest its use in patients at high cardiovascular risk, defined as $2 major cardiovascular events (death, myocardial infarction, or stroke) projected per 100 person-years, who are not at increased risk of bleeding. (J Am Coll Cardiol 2014;64:319–27) © 2014 by the American College of Cardiology Foundation