Alteraciones en la función sistólica global y regional del ventrículo derecho en pacientes con síndrome de Brugada: Estudio con speckle tracking y Doppler tisular

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 07-09-2017Esta tesis tiene embargado el acceso al texto completo hasta el 07-03-201

Síndrome de Tako-Tsubo asintomático en varón recién diagnosticado de cáncer de pulmón

We present the clinical case of a man recently diagnosed with lung cancer who suffered an asymptomatic form of Tako-Tsubo syndrome. Initial echocardiographic alterations passed unnoticed as they were attributed to previous diagnosis of cardiac ischemic disease treated in another hospital. Cancer patients are prone to develop such complications because of the great number of interventions with consequent emotional stress that they are subjected to. It is necessary to maintain a low threshold of suspicion and use cardiovascular testing before aggressive interventionsSe trata de un caso de síndrome de Takotsubo asintomático en un paciente diagnosticado recientemente de cáncer de pulmón. Las alteraciones ecocardiográficas pasaron desapercibidas en el momento inicial al considerar que se debían a un diagnóstico previo de cardiopatía isquémica en otro centro sanitario. Los pacientes oncológicos están predispuestos a sufrir este tipo de complicaciones desencadenadas por el gran número de intervenciones aplicadas y el estrés emocional que todo ello supone. Es necesario mantener un bajo umbral de sospecha y emplear pruebas cardiológicas con síntomas nuevos o ante intervenciones agresivas

Stress-induced traps in multilayered structures

The trap parameters of defects in Si/CaF2 multilayered structures were determined from the analysis of optical charging spectroscopy measurements. Two kinds of maxima were observed. Some of them were rather broad, corresponding to "normal" traps, while the others, very sharp, were attributed to stress-induced traps. A procedure of optimal linear smoothing the noisy experimental data has been developed and applied. This procedure is based on finding the minimal value of the relative error with respect to the value of the smoothing window. In order to obtain a better accuracy for the description of the trapping-detrapping process, a Gaussian temperature dependence of the capture crosssections characterizing the stress-induced traps was introduced. Both the normal and the stress-induced traps have been characterized, including some previously considered as only noise features.Comment: 37 pages, 9 figure

Effectiveness of sacubitril–valsartan in cancer patients with heart failure

Aims Current guidelines recommend sacubitril/valsartan for patients with heart failure and reduced left ventricular ejection fraction (LVEF), but there is lack of evidence of its efficacy and safety in cancer therapy-related cardiac dysfunction (CTRCD). Our aim was to analyse the potential benefit of sacubitril/valsartan in patients with CTRCD. Methods and results We performed a retrospective multicentre registry (HF-COH) in six Spanish hospitals with cardiooncology clinics including all patients treated with sacubitril/valsartan. Demographic and clinical characteristics and laboratory and echocardiographic data were collected. Median follow-up was 4.6 [1; 11] months. Sixty-seven patients were included (median age was 63 ± 14 years; 64% were female, 87% had at least one cardiovascular risk factor). Median time from anti-cancer therapy to CTRD was 41 [10; 141] months. Breast cancer (45%) and lymphoma (39%) were the most frequent neoplasm, 31% had metastatic disease, and all patients were treated with combination antitumor therapy (70% with anthracyclines). Thirtynine per cent of patients had received thoracic radiotherapy. Baseline median LVEF was 33 [27; 37], and 21% had atrial fibrillation. Eighty-five per cent were on beta-blocker therapy and 76% on mineralocorticoid receptor antagonists; 90% of the patients were symptomatic NYHA functional class ≥II. Maximal sacubitril/valsartan titration dose was achieved in 8% of patients (50 mg b.i.d.: 60%; 100 mg b.i.d.: 32%). Sacubitril/valsartan was discontinued in four patients (6%). Baseline Nterminal pro-B-type natriuretic peptide levels (1552 pg/mL [692; 3624] vs. 776 [339; 1458]), functional class (2.2 ± 0.6 vs. 1.6 ± 0.6), and LVEF (33% [27; 37] vs. 42 [35; 50]) improved at the end of follow-up (all P values ≤0.01). No significant statistical differences were found in creatinine (0.9 mg/dL [0.7; 1.1] vs. 0.9 [0.7; 1.1]; P = 0.055) or potassium serum levels (4.5 mg/dL [4.1; 4.8] vs. 4.5 [4.2; 4.8]; P = 0.5). Clinical, echocardiographic, and biochemical improvements were found regardless of the achieved sacubitril–valsartan dose (low or medium/high doses). Conclusions Our experience suggests that sacubitril/valsartan is well tolerated and improves echocardiographic functional and structural parameters, N-terminal pro-B-type natriuretic peptide levels, and symptomatic status in patients with CTRCD.This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades, Spain, and the EU—European Regional Development Fund, by means of a competitive call for excellence in research projects (PIE14/00066) as well as by the Spanish Cardiovascular Network (CIBERCV)

Prognosis of Paradoxical Low-Flow Low-Gradient Aortic Stenosis: A Severe, Non-critical Form, With Surgical Treatment Benefits

Aortic stenosis; Echocardiography; Heart valve diseaseEstenosis aórtica; Ecocardiografía; Enfermedad de las válvulas del corazónEstenosi aòrtica; Ecocardiografia; Malaltia de les vàlvules cardíaquesObjectives: To determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS). Methods: A longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] 35 ml/m2) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m2). Results: Of 1,391 patients, 147 (10.5%) had LFLG, 752 (54.1%) HG, and 492 (35.4%) NFLG. Echocardiographic parameters of the LFLG group showed similar AVA to the HG group but with less severity in the dimensionless index, calcification, and hypertrophy. The HG group required AVR earlier than NFLG (p < 0.001) and LFLG (p < 0.001), with no differences between LFLG and NFLG groups (p = 0.358). Overall mortality was 27.7% (CI 95% 25.3–30.1) with no differences among groups (p = 0.319). The impact of AVR in terms of overall mortality reduction was observed the most in patients with HG (hazard ratio [HR]: 0.17; 95% CI: 0.12–0.23; p < 0.001), followed by patients with LFLG (HR: 0.25; 95% CI: 0.13–0.49; p < 0.001), and finally patients with NFLG (HR: 0.29; 95% CI: 0.20–0.44; p < 0.001), with a risk reduction of 84, 75, and 71%, respectively. Conclusions: Paradoxical LFLG AS affects 10.5% of severe AS, and has a lower need for AVR than the HG group and similar to the NFLG group, with no differences in mortality. AVR had a lower impact on LFLG AS compared with HG AS. Therefore, the findings of the present study showed LFLG AS to have an intermediate clinical risk profile between the HG and NFHG groups.AGu has received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018- 037349-I)

Atopic Dermatitis with Multiple Comorbidities Treated with Dupilumab. A Case Report and Review of the Literature Regarding the Safety of Dupilumab

Dupilumab is the only available biological treatment for moderate-to-severe atopic dermatitis (AD). Even so, limited clinical data regarding its safety profile are available. Interactions with other drugs and the adverse effects of Dupilumab on patients with multiple comorbidities, such as chronic heart disease, diabetes, chronic kidney disease, etc., are not known yet. Moreover, there have been described cases of cutaneous lymphomas induced by Dupilumab. Therefore, the clinician that wants to start treatment for moderate-to-severe atopic dermatitis, which does not respond to conventional drugs, might be reluctant to choose biologic agents such as Dupilumab. In this paper, we reported a case of severe atopic dermatitis with multiple comorbidities in which the patient was successfully treated with Dupilumab despite numerous underlying conditions. We also conducted a review of the current literature on the safety profile of Dupilumab in special categories of patients with comorbidities, such as heart, kidney, and liver disease, oncologic conditions, and during pregnancy

Pollutants resulting from intensive poultry farming activities and their impact on the environment

Poultry farming activities can have a negative impact on the environment, namely: acidification (with NH3 mainly, H2S, NOx etc.); pollution of surface water and groundwater (with NO3- and NH4+); eutrophication (N, P); air pollution with NH3, N2O, NO, dust (PM10 and PM2.5), bioaerosols; increasing the greenhouse effect (CO2, CH4, N2O etc); drying (use of groundwater); smells, noise; pollution with heavy metals, pesticides and toxic substances; the spread of pathogens that are resistant to antibiotics; pollution of waters with residues of pharmaceutical products. As a result, in order to prevent or reduce the negative impact on the environment, in the production process it is necessary to use BREF/BAT techniques (Best Available Techniques). The activity of poultry farming must be done according to the best available techniques: the farming system, production halls and related facilities are designed and built according to the latest standards in the field; implicitly the consumption of raw materials, waste emissions, wastewater, air pollutants values being according to the legislation [1]

Current status of cardio-oncology in Spain: A national multidisciplinary survey

Carta científica. Comisión de Trabajo Nacional de Cardio-Oncología.Peer reviewe