21 research outputs found
Dynamic Edematous Response of the Human Heart to Myocardial Infarction Implications for Assessing Myocardial Area at Risk and Salvage
BACKGROUND: Clinical protocols aimed to characterize the post-myocardial
infarction (MI) heart by cardiac magnetic resonance (CMR) need to be
standardized to take account of dynamic biological phenomena evolving
early after the index ischemic event. Here, we evaluated the time course
of edema reaction in patients with ST-segment-elevation MI by CMR and
assessed its implications for myocardium-at-risk (MaR) quantification
both in patients and in a large-animal model.
METHODS: A total of 16 patients with anterior ST-segment-elevation MI
successfully treated by primary angioplasty and 16 matched controls were
prospectively recruited. In total, 94 clinical CMR examinations were
performed: patients with ST-segment-elevation MI were serially scanned
(within the first 3 hours after reperfusion and at 1, 4, 7, and 40
days), and controls were scanned only once. T2 relaxation time in the
myocardium (T2 mapping) and the extent of edema on T2-weighted short-tau
triple inversion-recovery (ie, CMR-MaR) were evaluated at all time
points. In the experimental study, 20 pigs underwent 40-minute
ischemia/reperfusion followed by serial CMR examinations at 120 minutes
and 1, 4, and 7 days after reperfusion. Reference MaR was assessed by
contrast-multidetector computed tomography during the index coronary
occlusion. Generalized linear mixed models were used to take account of
repeated measurements.
RESULTS: In humans, T2 relaxation time in the ischemic myocardium
declines significantly from early after reperfusion to 24 hours, and
then increases up to day 4, reaching a plateau from which it decreases
from day 7. Consequently, edema extent measured by T2-weighted short-tau
triple inversion-recovery (CMR-MaR) varied with the timing of the CMR
examination. These findings were confirmed in the experimental model by
showing that only CMR-MaR values for day 4 and day 7 postreperfusion,
coinciding with the deferred edema wave, were similar to values measured
by reference contrast-multidetector computed tomography.
CONCLUSIONS: Post-MI edema in patients follows a bimodal pattern that
affects CMR estimates of MaR. Dynamic changes in
post-ST-segment-elevation MI edema highlight the need for
standardization of CMR timing to retrospectively delineate MaR and
quantify myocardial salvage. According to the present clinical and
experimental data, a time window between days 4 and 7 post-MI seems a
good compromise solution for standardization. Further studies are needed
to study the effect of other factors on these variables.This study was partially supported by a competitive grant from the
Spanish Society of Cardiology (Proyectos de Investigacion Traslacional
en Cardiologia de la Sociedad Espanola de Cardiologia 2015, for the
project Caracterizacion tiSUlar miocaRdica con resonancia magnetica en
pacientes tras inFarto agudo de mioCardio con elevacioN de ST sometidos
a angloplastia Coronaria primaria. Estudio SURF-CNIC), by a competitive
grant from the Carlos III Institute of Health-Fondo de Investigacion
Sanitaria- and the European Regional Development Fund (ERDF/FEDER)
(PI10/02268 and PI13/01979), the Spanish Ministry of economy, industry,
and competitiveness (MEIC) and ERDF/FEDER SAF2013-49663-EXP. Dr
Fernandez-Jimenez holds a FICNIC fellowship from the Fundacio Jesus
Serra, the Fundacion Interhospitalaria de Investigacion Cardiovascular,
and the Centro Nacional de Investigaciones Cardiovasculares Carlos III
(CNIC), and Dr Aguero is a FP7-PEOPLE-2013-ITN-Cardionext fellow. This
study forms part of a Master Research Agreement between the CNIC and
Philips Healthcare, and is part of a bilateral research program between
Hospital de Salamanca Cardiology Department and the CNIC. This research
program is part of an institutional agreement between FIIS-Fundacion
Jimenez Diaz and CNIC. The CNIC is supported by the MEIC and the Pro
CNIC Foundation, and is a Severo Ochoa Center of Excellence (MEIC award
SEV-2015-0505).S
SALMANTICOR study. Rationale and design of a population-based study to identify structural heart disease abnormalities: a spatial and machine learning analysis
[EN]Introduction: This study aims to obtain data on the prevalence and incidence of structural heart disease in a population setting and, to analyse and present those data on the application of spatial and machine learning methods that, although known to geography and statistics, need to become used for healthcare research and for political commitment to obtain resources and support effective public health programme implementation.
Methods and analysis: We will perform a cross-sectional survey of randomly selected residents of Salamanca (Spain). 2400 individuals stratified by age and sex and by place of residence (rural and urban) will be studied. The variables to analyse will be obtained from the clinical history, different surveys including social status, Mediterranean diet, functional capacity, ECG, echocardiogram, VASERA and biochemical as well as genetic analysis.
Ethics and dissemination: The study has been approved by the ethical committee of the healthcare community. All study participants will sign an informed consent for participation in the study. The results of this study will allow the understanding of the relationship between the different influencing factors and their relative importance weights in the development of structural heart disease
AfecciĂłn pericĂĄrdica y miocĂĄrdica tras infecciĂłn por SARS-CoV-2: estudio descriptivo transversal en trabajadores sanitarios
[EN] Introduction and objectives
The cardiac sequelae of SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in healthcare workers to report evidence of pericardial and myocardial involvement after SARS-CoV-2 infection.
Methods
We studied 139 healthcare workers with confirmed past SARS-CoV-2 infection. Participants underwent clinical assessment, electrocardiography, and laboratory tests, including immune cell profiling and cardiac magnetic resonance (CMR). Clinically suspected pericarditis was diagnosed when classic criteria were present and clinically suspected myocarditis was based on the combination of at least 2 CMR criteria.
Results
Median age was 52 (41-57) years, 71.9% were women, and 16.5% were previously hospitalized for COVID-19 pneumonia. On examination (10.4 [9.3-11.0] weeks after infection-like symptoms), participants showed hemodynamic stability. Chest pain, dyspnea or palpitations were present in 41.7% participants, electrocardiographic abnormalities in 49.6%, NT-proBNP elevation in 7.9%, troponin in 0.7%, and CMR abnormalities in 60.4%. A total of 30.9% participants met criteria for either pericarditis and/or myocarditis: isolated pericarditis was diagnosed in 5.8%, myopericarditis in 7.9%, and isolated myocarditis in 17.3%. Most participants (73.2%) showed altered immune cell counts in blood, particularly decreased eosinophil (27.3%; P < .001) and increased cytotoxic T cell numbers (17.3%; P < .001). Clinically suspected pericarditis was associated (P < .005) with particularly elevated cytotoxic T cells and decreased eosinophil counts, while participants diagnosed with clinically suspected myopericarditis or myocarditis had lower (P < .05) neutrophil counts, natural killer-cells, and plasma cells.
Conclusions
Pericardial and myocardial involvement with clinical stability are frequent after SARS-CoV-2 infection and are associated with specific immune cell profiles.[ES] IntroducciĂłn y objetivos
Las secuelas cardiacas tras la infecciĂłn por SARS-CoV-2 todavĂa estĂĄn poco documentadas. Se realizĂł un estudio transversal en trabajadores sanitarios para estudiar la prevalencia de afecciĂłn pericĂĄrdica y miocĂĄrdica tras la infecciĂłn por SARS-CoV-2.
MĂ©todos
Se estudiĂł a 139 trabajadores sanitarios con infecciĂłn previa confirmada por SARS-CoV-2. Los participantes se sometieron a evaluaciĂłn clĂnica, electrocardiograma, laboratorio, incluido el perfil de cĂ©lulas inmunitarias, y resonancia magnĂ©tica cardiaca (RMC). El diagnĂłstico clĂnico de pericarditis se realizĂł ante la presencia de los criterios clĂĄsicos y el diagnĂłstico clĂnico de miocarditis ante la presencia de al menos 2 criterios de RMC.
Resultados
La mediana de edad fue de 52 (41â57) años, el 71,9% eran mujeres, y el 16.5% habĂa sido hospitalizado previamente por neumonĂa por COVID-19. En la evaluaciĂłn (10,4 [9,3â11,0] semanas despuĂ©s de los sĂntomas de infecciĂłn), todos los participantes presentaban estabilidad hemodinĂĄmica. El 41,7% presentaba dolor torĂĄcico, disnea o palpitaciones; el 49,6%, alteraciones electrocardiogrĂĄficas; el 7,9%, elevaciĂłn de NT-proBNP; el 0,7%, elevaciĂłn de troponina; y el 60,4%, alteraciones en la RMC. Un total de 30,9% de participantes cumplieron los criterios clĂnicos establecidos de pericarditis o miocarditis: pericarditis aislada en el 5,8%, miopericarditis en el 7,9% y miocarditis aislada en el 17,3%. La mayorĂa de los participantes (73,2%) mostraron recuentos de cĂ©lulas inmunitarias alterados en sangre; en particular diminuciĂłn de eosinĂłfilos (27,3%; p < 0,001) y aumento del nĂșmero de cĂ©lulas T citotĂłxicas (17,3%; p < 0,001). La sospecha clĂnica de pericarditis se asociĂł (p < 0,005) particularmente con un elevado nĂșmero de cĂ©lulas T citotĂłxicas y recuento de eosinĂłfilos disminuidos; mientras que los participantes con sospecha clĂnica de miopericarditis o miocarditis tenĂan recuentos de neutrĂłfilos, cĂ©lulas natural killer y cĂ©lulas plasmĂĄticas mĂĄs bajos (p < 0,05).
Conclusiones
La afecciĂłn pericĂĄrdica y miocĂĄrdica con estabilidad hemodinĂĄmica es frecuente despuĂ©s de la infecciĂłn por SARS-CoV-2 y se asocia con perfiles de cĂ©lulas inmunitarias especĂficas.This study was supported by CIBERCV (CB16/11/00374), CIBERONC (CB16/12/00400) and the COV20/00386 grant from the Instituto de Salud Carlos III and FEDER, Ministerio de Ciencia e InnovaciĂłn, Madrid, Spain, and by GRS COVID 26/A/20 from the Gerencia Regional de Salud, Junta de Castilla y LeĂłn, Spain.Peer reviewe
Pericardial and myocardial involvement after SARS-CoV-2 infection: a cross-sectional descriptive study in healthcare workers
[ES] IntroducciĂłn y objetivos
Las secuelas cardiacas tras la infecciĂłn por SARS-CoV-2 todavĂa estĂĄn poco documentadas. Se realizĂł un estudio transversal en trabajadores sanitarios para estudiar la prevalencia de afecciĂłn pericĂĄrdica y miocĂĄrdica tras la infecciĂłn por SARS-CoV-2.
MĂ©todos
Se estudiĂł a 139 trabajadores sanitarios con infecciĂłn previa confirmada por SARS-CoV-2. Los participantes se sometieron a evaluaciĂłn clĂnica, electrocardiograma, laboratorio, incluido el perfil de cĂ©lulas inmunitarias, y resonancia magnĂ©tica cardiaca (RMC). El diagnĂłstico clĂnico de pericarditis se realizĂł ante la presencia de los criterios clĂĄsicos y el diagnĂłstico clĂnico de miocarditis ante la presencia de al menos 2 criterios de RMC.
Resultados
La mediana de edad fue de 52 (41â57) años, el 71,9% eran mujeres, y el 16,5% habĂa sido hospitalizado previamente por neumonĂa por COVID-19. En la evaluaciĂłn (10,4 [9,3â11,0] semanas despuĂ©s de los sĂntomas de infecciĂłn), todos los participantes presentaban estabilidad hemodinĂĄmica. El 41,7% presentaba dolor torĂĄcico, disnea o palpitaciones; el 49,6%, alteraciones electrocardiogrĂĄficas; el 7,9%, elevaciĂłn de NT-proBNP; el 0,7%, elevaciĂłn de troponina; y el 60,4%, alteraciones en la RMC. Un total de 30,9% de participantes cumplieron los criterios clĂnicos establecidos de pericarditis o miocarditis: pericarditis aislada en el 5,8%, miopericarditis en el 7,9% y miocarditis aislada en el 17,3%. La mayorĂa de los participantes (73,2%) mostraron recuentos de cĂ©lulas inmunitarias alterados en sangre; en particular diminuciĂłn de eosinĂłfilos (27,3%; p < 0,001) y aumento del nĂșmero de cĂ©lulas T citotĂłxicas (17,3%; p < 0,001). La sospecha clĂnica de pericarditis se asociĂł (p < 0,005) particularmente con un elevado nĂșmero de cĂ©lulas T citotĂłxicas y recuento de eosinĂłfilos disminuidos; mientras que los participantes con sospecha clĂnica de miopericarditis o miocarditis tenĂan recuentos de neutrĂłfilos, cĂ©lulas natural killer y cĂ©lulas plasmĂĄticas mĂĄs bajos (p < 0,05).
Conclusiones
La afecciĂłn pericĂĄrdica y miocĂĄrdica con estabilidad hemodinĂĄmica es frecuente despuĂ©s de la infecciĂłn por SARS-CoV-2 y se asocia con perfiles de cĂ©lulas inmunitarias especĂficas.[EN] Introduction and objectives
The cardiac sequelae of SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in healthcare workers to report evidence of pericardial and myocardial involvement after SARS-CoV-2 infection.
Methods
We studied 139 healthcare workers with confirmed past SARS-CoV-2 infection. Participants underwent clinical assessment, electrocardiography, and laboratory tests, including immune cell profiling and cardiac magnetic resonance (CMR). Clinically suspected pericarditis was diagnosed when classic criteria were present and clinically suspected myocarditis was based on the combination of at least 2 CMR criteria.
Results
Median age was 52 (41-57) years, 71.9% were women, and 16.5% were previously hospitalized for COVID-19 pneumonia. On examination (10.4 [9.3-11.0] weeks after infection-like symptoms), participants showed hemodynamic stability. Chest pain, dyspnea or palpitations were present in 41.7% participants, electrocardiographic abnormalities in 49.6%, NT-proBNP elevation in 7.9%, troponin in 0.7%, and CMR abnormalities in 60.4%. A total of 30.9% participants met criteria for either pericarditis and/or myocarditis: isolated pericarditis was diagnosed in 5.8%, myopericarditis in 7.9%, and isolated myocarditis in 17.3%. Most participants (73.2%) showed altered immune cell counts in blood, particularly decreased eosinophil (27.3%; P < .001) and increased cytotoxic T cell numbers (17.3%; P < .001). Clinically suspected pericarditis was associated (P < .005) with particularly elevated cytotoxic T cells and decreased eosinophil counts, while participants diagnosed with clinically suspected myopericarditis or myocarditis had lower (P < .05) neutrophil counts, natural killer-cells, and plasma cells.
Conclusions
Pericardial and myocardial involvement with clinical stability are frequent after SARS-CoV-2 infection and are associated with specific immune cell profiles.Este estudio contó con el apoyo de CIBERCV (CB16/11/00374) y CIBERONC (CB16/12/00400) y la subvención COV20/00386 del Instituto de Salud Carlos III y FEDER, Ministerio de Ciencia e Innovación, Madrid, España, y por GRS COVID 26/A/20 de la Gerencia Regional de Salud, Junta de Castilla y León, España.Peer reviewe
Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study
PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19âfree surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19âfree surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19âfree surgical pathways. Patients who underwent surgery within COVID-19âfree surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19âfree surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity scoreâmatched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19âfree surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19âfree surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks
Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.
PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââ„âII, EF â€35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
âIron Heartâ: Reversible Cause of Dilated Cardiomyopathy Secondary to Cardiac Toxicity in Elderly Patient with Myelodysplastic Syndrome
Triptorelin as the luteinizing hormone releasing hormone (LHRH) analogue has its own place among other available forms of androgen-depravation therapy (ADT) of locally advanced and metastatic prostate cancer (PCa). Nowadays, in times of development of new therapies in castration-resistant PCa, ADT remains the back bone therapy, which may be supplemented with one of novel drugs. The results of basic research indicate, that apart from the main mechanism of action based on lowering a testosterone concentration to the castration level, triptorelin may have a direct inhibitory effect on tumor cells. Formulations of tryptorelin are available to administer as 1-month, 3-months and 6-months sustained-release forms that may be given intramuscularly or subcutaneously. Constant concentration of triptoreline is maintained by using special microspheres in drug production. Pharmacokinetic and pharmacodynamic properties of particular forms were extensively tested, which allows for safe usage and retain of predictable and high efficacy. Indicators of effective ADT are fast reduction and maintenance of the state of castration. This phenomenon translates into a decrease of the prostate-specific antigen and longer survival. Triptorelin successfully meets these objectives based on a number of phase IâIII studies. There is a noticeable lack of comparative studies on effectiveness of particular ADT forms. This may stem from an assumption, that all LHRH analogues demonstrate similar effectiveness because of the class effect. However, some evidence highlight significant differences in efficacy among these drugs. Triptorelin compares especially favourably, particularly as a drug reducing the testosterone level to the lower recommended values (< 20 ng/dl). Side effect profile during the therapy with triptorelin is largely the result of inhibition of the hypothalamic- pituitary-testicular axis. Hormonal disturbances linked to hipoandrogenism cause changes in lipid metabolism and glucose tolerance, which may influence the cardiovascular risk. This article is a review of key reports regarding triptorelin and a summary of the role that triptorelin plays in contemporary ADT in advanced PCa
Predictors of cardiovascular events and all-cause of death in patients with transfusion-dependent myelodysplastic syndrome
Cardiovascular disease (CVD) involves the second cause of death in low-risk myelodysplastic syndrome (MDS) population. Prospective study to characterise the CVD and to identify predictors for the combined event (CE) cardiovascular event and/or all-cause mortality in transfusion dependent low-risk MDS patients. Thirty-one patients underwent a cardiac assessment including biomarkers and cardiac magnetic resonance (cMR) with parametric sequences (T1, T2 and T2* mapping) and myocardial deformation by feature tracking (FT) and were analysed for clonal hematopoiesis of indeterminate potential mutations. Cardiac assessment revealed high prevalence of unknown structural heart disease (51% cMR pathological findings). After 2·2 [0·44] years follow-up, 35·5% of patients suffered the CE: 16% death, 29% cardiovascular event. At multivariate analysis elevated NT-proBNP â„ 486pg/ml (HR 96·7; 95%-CI 1·135â8243; P = 0·044), reduced native T1 time < 983ms (HR 44·8; 95%-CI 1·235â1623; P = 0·038) and higher left ventricular global longitudinal strain (LV-GLS) (HR 0·4; 95%-CI 0·196â0·973; P = 0·043) showed an independent prognostic value. These variables, together with the myocardial T2* time < 20ms, showed an additive prognostic value (Log Rank: 12·4; P = 0·001). In conclusion, low-risk MDS patients frequently suffer CVD. NT-proBNP value, native T1 relaxation time and longitudinal strain by FT are independent predictors of poor cardiovascular prognosis, thus, their determination would identify high-risk patients who could benefit from a cardiac treatment and follow-up.This work was funded by aGerencia Regional de Salud de Castilla y LeĂłn grant(GRS1203/A/15) and a Rıo Hortega contract (CM19/00055),supported by the Instituto de Salud Carlos III in Spain (co-funded by the European Social Fund âInvesting in yourfutureâ)