Percutaneous mitral repair: current and future devices

Mitral regurgitation (MR) is the second most common valvular heart disease and its prevalence is increasing with population ageing. In the recent years we have witnessed the development of several transcatheter devices to correct MR in patients at high-risk for surgery. The majority of evidence regarding safety and efficacy of this new therapy comes from MitraClip studies. However, new alternatives on the field of valve repair have emerged with promising results. The aim of this review is to portrait the landscape of transcatheter mitral repair alternatives, from currently used devices to those that will have a role in the near future

Percutaneous treatment with Mitraclip for functional mitral regurgitation: medium-term follow up according to left ventricular function

Background: Functional mitral regurgitation (FMR) is a bad prognosis condition despite optimal medical treatment. Nowadays there is an open debate about the surgical versus percutaneous treatment. The main objective of this study is to evaluate the mid-term follow up clinical outcomes of patients with FMR treated with MitraClip((R)) system, according to their left ventricular ejection fraction (LVEF). Methods: Data was obtained from two experienced centers in transcatheter mitral valve repair (TMVR). All consecutive cases of severe FMR undergoing TMVR in both centers with the same inclusion criteria were included prospectively in this study and followed-up. Periodical follow-ups with clinical and echocardiographic evaluation were scheduled from the baseline procedure, at 3 months and then yearly. Results: From October 2015 to October 2019, a total of 119 patients with FMR at 2 centers in Spain underwent TMVR with the MitraClip((R)) procedure and were included in this study. The mean age was 73.8+/-8.9 years old and 32 patients (26.9%) were female. A 39.5% of cases [47] had a LVEF 30% (group 2). There was a similar distribution in cardiovascular risk factors, age and other diseases. All MitraClip((R)) implantations were elective and procedural success was achieved in 110 patients (92.4%) with a similar distribution between the groups. There were no differences in procedural time and the number of implanted clips. The median follow-up was 22.6 months (IQR, 11.43-34.98 months). The primary combined endpoint occurred in the 41.6% of the global cohort, 57.5% in group 1 and 30.99% in group 2 (P=0.036). LVEF was associated to the main event in the multivariate analysis (HR 2.09, 95% CI: 1.12-3.89; P=0.02). Conclusions: The MitraClip edge-to-edge technique is a safe and effective procedure for the treatment of FMR. In this study, patients with LVEF >30% treated with Mitraclip presented better clinical cardiovascular outcomes than those with a LVEF </=30%. Regardless clinical outcomes, at the end of the follow-up, there was a sustained reduction in MR grades and an important improvement in NYHA functional class

Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25?kg/m2, 72.1% in those with body mass index ?25?kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6?years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification

Risk factors for non-diabetic renal disease in diabetic patients

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and 10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95% CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine (P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis

Resistance to sulfur and oxygenated compounds of supported Pd, Pt, Rh, Ru catalysts

The poisoning resistance to sulfided and oxygenated compounds of some VIII Group PYGAS selective hydrogenation catalysts based on metals was assessed. Low content alumina supported Rh, Pd, Ru and Pt catalysts (0.35 wt%) were prepared from chlorided precursors. In the case of the palladium catalysts a nitrogenated precursor was also used. The catalysts were mainly assessed in the catalytic test of selective styrene hydrogenation in the presence or absence of known poisons. Model feedstocks spiked with thiophene, thiophane and tetrahydrofuran were used. The catalysts were further characterized by means of chemical analysis, XPS, TPR and chemisorption. The results indicate that chlorided precursors yield more sulfur resistant catalysts. The effect was attributed in part to the formation of oxychlorinated species, refractory to reduction, that leave the metal in an electron deficient state, thus inhibiting the formation of strong poison-metal bonds, the chloride species could also be a steric factor that can contribute to the sulfur resistance of the catalyst. Pd based catalyts had the highest activity and resistance to poisons of all the metals tested. This superior performance was attributed in part to the total occupancy of the 4d electronic levels of the Pd metal that was supposed to promote the rupture of the H2 bond during the hydrogenation reaction.Fil: Badano, Juan Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera". Universidad Nacional del Litoral. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera"; ArgentinaFil: Quiroga, Monica Esther. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera". Universidad Nacional del Litoral. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera"; ArgentinaFil: Betti, Carolina Paola. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera". Universidad Nacional del Litoral. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera"; ArgentinaFil: Vera, Carlos Roman. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera". Universidad Nacional del Litoral. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera"; ArgentinaFil: Canavese, Sergio Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera". Universidad Nacional del Litoral. Instituto de Investigaciones en Catálisis y Petroquímica "Ing. José Miguel Parera"; ArgentinaFil: Coloma Pascual, F.. Universidad de Alicante; Españ

Perfil químico y biológico de aceites esenciales de plantas aromáticas de interés agro-industrial en Castilla-La Mancha (España)

The chemical composition and biological activities of essential oils of &lt;i&gt;Salvia officinalis&lt;/i&gt; L., &lt;i&gt;Salvia lavandulifolia&lt;/i&gt; Vahl., &lt;i&gt;Lavandula x intermedia&lt;/i&gt; Emeric ex Loisel., &lt;i&gt;Lavandula latifolia&lt;/i&gt; Medik., &lt;i&gt;Lavandula angustifolia&lt;/i&gt; Mill. and &lt;i&gt;Thymus vulgaris&lt;/i&gt; L. are presented. The essential oils have been analysed by Gas Chromatography Mass Spectrometry and 61 compounds were identified, 23 of which represented more than 1% of the essential oil. The 1,8 cineole (16-23%) appeared as the main compound of &lt;i&gt;Salvia&lt;/i&gt; sp. essential oils. The high content of α-thujone was characteristic in &lt;i&gt;S. officinalis&lt;/i&gt; oil. Remarkable concentrations of linalool (30-33%), camphor (5-17%) and linalyl acetate (9-28%) were detected in &lt;i&gt;Lavandula&lt;/i&gt; sp. oils while carvacrol (21.6%) and p-cimene (23.7%) were the most abundant compounds in &lt;i&gt;T. vulgaris&lt;/i&gt; oil. Biological characterization was based on their bioplaguicide activity. The essential oils studied had strong antifeedant effects against &lt;i&gt;Leptinotarsa decemlineata&lt;/i&gt; Say, &lt;i&gt;Spodoptera littoralis&lt;/i&gt; Boisd., &lt;i&gt;Myzus persicae&lt;/i&gt; Sulzer and &lt;i&gt;Rhopalosiphum padi&lt;/i&gt; L., phytotoxic activity against &lt;i&gt;Lactuca sativa&lt;/i&gt; L. and &lt;i&gt;Lolium perenne&lt;/i&gt; L. and also exhibited high antifungal activity against &lt;i&gt;Fusarium&lt;/i&gt; sp. Oils from &lt;i&gt;T. vulgaris&lt;/i&gt; and &lt;i&gt;L. latifolia&lt;/i&gt; showed the highest levels of bioactivity against all target species. These results provide an added-value to the essential oils of aromatic plants of agro-industrial interest for its potential use in the development of natural agrochemicals.&lt;br&gt;&lt;br&gt;En este trabajo se presenta el estudio químico y biológico de los aceites esenciales de &lt;i&gt;Salvia officinalis&lt;/i&gt; L., &lt;i&gt;Salvia lavandulifolia&lt;/i&gt; Vahl., &lt;i&gt;Lavandula&lt;/i&gt; x intermedia Emeric ex Loisel., &lt;i&gt;Lavandula latifolia&lt;/i&gt; Medik., &lt;i&gt;Lavandula angustifolia&lt;/i&gt; Mill. y &lt;i&gt;Thymus vulgaris&lt;/i&gt; L. El estudio químico por cromatografía de gases acoplada a espectrometría de masas de los aceites esenciales permitió la identificación de 61 compuestos, de los cuales 23 presentaron un porcentaje mayor o igual al 1 %. Los aceites esenciales de &lt;i&gt;Salvia&lt;/i&gt; sp. se caracterizaron por presentar un alto contenido de 1,8 cineol (16-23%) y, en el caso específico de &lt;i&gt;S. officinalis&lt;/i&gt;, una elevada proporción de α-tuyona (15.7%). En &lt;i&gt;Lavandula&lt;/i&gt; sp., los compuestos mayoritarios del aceite fueron linalol (30-33%), alcanfor (5-17%) y acetato de linalilo (9-28%); mientras que en &lt;i&gt;T. vulgaris&lt;/i&gt; lo fueron carvacrol (21.6%) y p-cimeno (23.7%). La caracterización biológica, desde el punto de vista de la actividad bioplaguicida, mostró que los aceites ensayados disminuyeron significativamente la alimentación de &lt;i&gt;Leptinotarsa decemlineata&lt;/i&gt; Say, &lt;i&gt;Spodoptera littoralis&lt;/i&gt; Boisd., &lt;i&gt;Myzus persicae&lt;/i&gt; Sulzer y &lt;i&gt;Rhopalosiphum padi&lt;/i&gt; L., mostraron actividad fitotóxica frente a &lt;i&gt;Lactuca sativa&lt;/i&gt; L. y &lt;i&gt;Lolium perenne&lt;/i&gt; L. y disminuyeron el crecimiento del micelio del hongo de Fusarium sp. Los aceites de &lt;i&gt;T. vulgaris&lt;/i&gt; y &lt;i&gt;L. latifolia&lt;/i&gt; fueron los más activos frente a todas las especies empleadas como dianas biológicas. Los resultados obtenidos potencian el valor añadido de los aceites de plantas aromáticas de interés agro-industrial en Castilla- La Mancha como una alternativa interesante en programas de desarrollo de agroquímicos naturales