Estudio del sistema de marcapasos auriculares en el corazón del perro

Inclou referències bibliogràfique

Myocardial function in long distance runners: Assessment by echocardiography, tissue Doppler and speckle tracking

Introducción y objetivos: El ejercicio físico provoca respuestas adaptativas y cambios morfológico-funcionales en el corazón del atleta. El objetivo del presente estudio es caracterizar dichos cambios mediante ecocardiografía convencional y las nuevas técnicas de deformación miocárdica mediante speckle tracking. Material y métodos: Se estudiaron prospectivamente a 68 varones, 38 corredores de fondo (42±8 años), y 30 controles (40±7 años). Se les realizó estudio ecocardiográfico convencional modo M, 2D y doppler así como parámetros de deformación miocárdica mediante speckle tracking a nivel de eje corto basal (B), medio (M), apical (Ap) y planos apicales 4 y 2 cámaras de ventrículo izquierdo (VI) y ventrículo derecho (VD). Se midió strain (S) y strain rate (SR) longitudinal, radial y circunferencial así como la rotación (Rot) y el untwisting (UT) a nivel basal y apical. Resultados: Todos los sujetos presentaron función cardíaca dentro de la normalidad. Se observaron mayor fracción de eyección (FE) así como mayores volúmenes ventriculares en el grupo de atletas. No se hallaron diferencias en los parámetros del anillo Mitral. Los niveles de S longitudinal y circunferencial así como la torsión (Tor) de VI fue mayor en el grupo de los deportistas (p=0.02, p=0.005 y p=0.03 respectivamente). Se observó menor S radial en el grupo de atletas. El tamaño, el TAPSE y la deformación longitudinal del VD presentaron diferencias estadísticamente significativas (p=0.01, 0.002 y 0.006 respectivamente). Conclusiones: Los niveles de deformación miocárdica valorados mediante strain longitudinal y circunferencial son mayores en los atletas así como la torsión ventricular. El mayor grado de deformación longitudinal, circunferencial y la mayor torsión puede representar una respuesta adaptativa al ejercicio.Background: Regular intense physical exercise causes cardiovascular adaptations as well as functional and morphological changes in the athlete’s heart. The aim of the present study is to characterize those changes using conventional echocardiography and new speckle tracking techniques to study myocardial deformation. Methods: 68 men were studied. 38 long distance runners (42±8 years), and 30 sedentary controls (40±7 years). Standard transthoracic echocardiography was performed: M mode, 2D, tissue and colour Doppler. Deformation parameters were studied by speckle tracking at short axis view basal (B), medium (M) and apical (Ap) levels and apical 4 and 2 chamber view of the left ventricle (LV) and right ventricle (RV). Longitudinal, radial and circumferential strain (S) and strain rate (SR) were measured as well as rotation (Rot) and untwisting (UT) at basal and apical levels. Results: Left ventricular ejection fraction and volumes were significantly higher in the athlete group. There were no differences in conventional diastolic parameters. Longitudinal and circumferential left ventricular strain and torsion were higher in the athlete group (p=0.02, p=0.005 and p=0.03 respectively). In addition, radial strain was lower in the athlete group. Right ventricular diameters, tricuspid annular plane systolic excursion (TAPSE) and longitudinal deformation were significantly higher in the athlete group (p=0.01, 0.002 y 0.006 respectively). Conclusion: Myocardial deformation parameters, studied by longitudinal and circumferential strain, as well as ventricular torsion are greater in athletes as compared to sedentary individuals. This increased myocardial longitudinal and circumferential deformation and ventricular torsion might represent an adaptive response to regular intense physical exercise

A randomized comparison ofrepeat stenting with balloon angioplasty in patients with in-stent restenosis

AbstractObjectivesThis randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-stent restenosis (ISR).BackgroundStent restenosis constitutes a therapeutic challenge. Repeat coronary interventions are currently used in this setting, but the recurrence risk remains high.MethodsWe randomly assigned 450 patients with ISR to elective stent implantation (224 patients) or conventional BA (226 patients). Primary end point was recurrent restenosis rate at six months. Secondary end points included minimal lumen diameter (MLD), prespecified subgroup analyses, and a composite of major adverse events.ResultsProcedural success was similar in both groups, but in-hospital complications were more frequent in the balloon group. After the procedure MLD was larger in the stent group (2.77 ± 0.4 vs. 2.25 ± 0.5 mm, p < 0.001). At follow-up, MLD was larger after stenting when the in-lesion site was considered (1.69 ± 0.8 vs. 1.54 ± 0.7 mm, p = 0.046). However, the binary restenosis rate (38% stent group, 39% balloon group) was similar with the two strategies. One-year event-free survival (follow-up 100%) was also similar in both groups (77% stent vs. 71% balloon, p = 0.19). Nevertheless, in the prespecified subgroup of patients with large vessels (≥3 mm) the restenosis rate (27% vs. 49%, p = 0.007) and the event-free survival (84% vs. 62%, p = 0.002) were better after repeat stenting.ConclusionsIn patients with ISR, repeat coronary stenting provided better initial angiographic results but failed to improve restenosis rate and clinical outcome when compared with BA. However, in patients with large vessels coronary stenting improved the long-term clinical and angiographic outcome

El labrador: Año I Número 3 - (14/03/22)

BACKGROUND: Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective. METHODS: Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. RESULTS: The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was €430 more costly than BMS (€8,305 vs. €7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of €3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of €25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. CONCLUSIONS: Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values

Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial.

BACKGROUND: Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective. METHODS: Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. RESULTS: The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was ¿430 more costly than BMS (¿8,305 vs. ¿7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of ¿3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of ¿25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. CONCLUSIONS: Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values

A Randomized Comparison of Drug-Eluting Balloon Versus Everolimus-Eluting Stent in Patients With Bare-Metal Stent–In-Stent Restenosis The RIBS V Clinical Trial (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent)

ObjectivesThis study sought to compare the efficacy of drug-eluting balloons (DEB) with that of everolimus-eluting stents (EES) in patients with bare-metal stents (BMS) in-stent restenosis (ISR).BackgroundTreatment of patients with ISR remains a challenge.MethodsThis was a prospective, multicenter, randomized trial comparing DEB with EES in patients with bare-metal stents (BMS) in-stent restenosis (ISR). The primary endpoint was the minimal lumen diameter at 9 months' follow-up.ResultsA total of 189 patients with BMS-ISR from 25 Spanish sites were included (95 were allocated to DEB and 94 to EES). Procedural success was achieved in all patients. At late angiography (median 249 days; 92% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.36 ± 0.6 mm vs. 2.01 ± 0.6 mm, p < 0.001; absolute mean difference: 0.35 mm; 95% confidence interval [CI]: 0.16 to 0.53) and a lower percent of diameter stenosis (13 ± 17% vs. 25 ± 20%, p < 0.001). However, late loss (0.04 ± 0.5 mm vs. 0.14 ± 0.5 mm, p = 0.14) and binary restenosis rate (4.7% vs. 9.5%, p = 0.22) were very low and similar in both groups. Clinical follow-up (median 365 days) was obtained in all (100%) patients. Occurrences of the combined clinical outcome measure (cardiac death, myocardial infarction, and target vessel revascularization; 6% vs. 8%; hazard ratio [HR]: 0.76; 95% CI: 0.26 to 2.18, p = 0.6) and the need for target vessel revascularization (2% vs. 6%; HR: 0.32: 95% CI: 0.07 to 1.59, p = 0.17) were similar in the 2 groups.ConclusionsIn patients with BMS-ISR, both DEB and EES provided excellent clinical results with a very low rate of clinical and angiographic recurrences. However, compared with DEB, EES provide superior late angiographic findings. (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent [RIBS V]; NCT01239953

Diferencias en el tratamiento y la evolución clínica de los pacientes con síndrome coronario agudo sin elevación del segmento ST en función del servicio clínico de ingreso

Síndrome coronario agudo. Infarto de miocardio. Angina inestable. Pronóstico

Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction : An analysis from the EXAMINATION randomized controlled trial

Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective. Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was €430 more costly than BMS (€8,305 vs. €7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of €3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of €25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values