Predictors of optimal pharmacological treatment in patients with heart failure and depressed ejection fraction. Results of the VIDA-IC study

Abstrac

The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial

Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in patients with this type of lesions. Methods. Randomized, multicenter, controlled, and open-label trial to compare S-iFR versus angiography-guided PCI in patients with sequential or diffuse angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). The primary endpoint was the implanted stent length. The main secondary endpoint was targeting vessel failure (TVF) at one year. Results. A total of 100 patients underwent randomization, with 49 patients assigned to the S-iFR group and 51 to the angiography-guided PCI group. There were no differences between groups regarding clinical and anatomical characteristics. The baseline iFR was 0.71 } 0.16 vs. 0.67 } 0.19 (p = 0.279) in the S-iFR and angiography group, respectively. The mean lesion length was 42.3 } 12 mm and 39.8 } 12 (p = 0.297). The implanted stent length was 32.7 } 17.2 mm in the S-iFR group and 43.1 } 14.9 mm in the angiography group (mean difference, −10.4 mm; 95% confidence interval [CI], −16.9 to −4.0; p = 0.002). At one year, target vessel failure (TVF) occurred in four patients: three (6.1%) in the S-iFR group vs. one (1.9%) in the angiography group (p = 0.319). Conclusions. Among patients with sequential or long diffuse coronary lesions, a S-iFR-guided PCI strategy resulted in a reduction of the total stent length compared to an angiography-guided PCI strategy. A nonsignificant increase in TVF was observed in the S-iFR group

Use of a multimedia classroom with connection to Hemodynamic Laboratories for the comprehensive practical training of the medical student in the area of Cardiology

La aplicabilidad práctica de los conocimientos teóricos adquiridos durante las clases magistrales constituye una parte esencial en la formación del futuro médico. Sin embargo, las prácticas en quirófanos y en Laboratorios de Cardiología Intervencionista son deficientes. El aforo es limitado por motivos de seguridad. Además, la visibilidad es reducida y la comunicación entre el operador y el alumno puede ser difícil por la presencia del enfermo. Desarrollar un nuevo modelo de prácticas clínicas complementarias a las convencionales ayudaría a que los alumnos adquieran la capacitación básica requerida. El objetivo principal de este proyecto es conseguir que los alumnos obtengan una visión práctica e integral del paciente cardiológico, proporcionando las herramientas necesarias a través de un Aula Multimedia con conexión directa a los Laboratorios de Hemodinámica y a las bases de datos clínicos de la UGC de Cardiología del Hospital Universitario Reina Sofía. Esta acción de Innovación Docente pretende mejorar los procesos de enseñanza-aprendizaje de la Cardiología y realizar una simulación clínica del proceso de diagnóstico, tratamiento y alta hospitalaria de un paciente cardiológico. Adicionalmente, este sistema podría proporcionar al docente una herramienta objetiva para la evaluación de las prácticas clínicas de estudiantes del área de Ciencias de la Salud.The practical applicability of the theoretical knowledge acquired during the lectures constitutes an essential part of the training of the future doctor. However, the practices in operating rooms and Interventional Cardiology Laboratories are deficient. Capacity is limited for security reasons. In addition, visibility is reduced, and communication between the operator and the student can be difficult due to the patient's presence. Developing a new model of clinical practices complementary to conventional ones would help students acquire the basic training required. The main objective of this project is to ensure that students obtain a realistic and comprehensive view of the cardiology patient, providing the necessary tools through a Multimedia Classroom with a direct connection to the Hemodynamic Laboratories and the clinical databases of the UGC of Cardiology of the Reina Sofía University Hospital. This Teaching Innovation action aims to improve the teaching-learning processes of Cardiology and carry out a clinical simulation of the process of diagnosis, treatment, and hospital discharge of a cardiac patient. Additionally, this system could provide the teacher with an objective tool for evaluating the clinical practices of students in the area of Health Sciences

Utilidad de la valoración fisiológica coronaria con iFR en la práctica diaria y en todo tipo de pacientes:: resultados inmediatos y en el seguimiento

Introduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.Introducción y objetivos: El propósito del estudio fue describir nuestra experiencia con el uso del índice diastólico instantáneo sin ondas (iFR) para la evaluación fisiológica coronaria o el uso del software Syncvision/iFR (Syncvision versión 4.1.0.5, Philips Volcano, Bélgica) en todo tipo de pacientes. Métodos: Se incluyeron todos los pacientes consecutivos a quienes, entre enero de 2017 y diciembre de 2019, se realizó en nuestro centro una evaluación fisiológica coronaria con iFR o con Syncvision/iFR. El valor de corte establecido para el iFR fue 0,89. El objetivo primario fue un compuesto de muerte cardiaca, infarto de miocardio, trombosis de stent probable o definitiva y nueva revascularización de la lesión evaluada. Resultados: Se incluyeron 277 pacientes con 433 lesiones evaluadas. La edad media fue de 65 ± 10 años y el 74% eran varones. El 41% tenía antecedente de diabetes mellitus. La presentación clínica fue angina estable en 160 pacientes (58%) y síndrome coronario agudo en 117 pacientes (42%). Se obtuvo un iFR > 0,89 en 266 lesiones (61,4%), en las cuales la intervención coronaria percutánea fue diferida. Las lesiones restantes se revascularizaron. El software Syncvision/iFR se usó en 155 lesiones (36%) para guiar la toma de decisiones, principalmente lesiones largas, difusas o secuenciales (91 lesiones, 58,7%) y lesiones intermedias (52 lesiones, 33,5%). Tras un periodo de seguimiento de 18 meses, el objetivo primario se observó en 17 pacientes (6,1%), sin diferencias en función del iFR basal (≤ 0,89 o > 0,89) (4,2 frente a 3,8%; p = 0,9) ni de la presentación clínica (angina estable o síndrome coronario agudo) (4,4 frente a 8,5%; p = 0,1). Conclusiones: La evaluación fisiológica coronaria con iFR y el software Syncvision/iFR en la práctica diaria y en todo tipo de pacientes parece ser segura, con un bajo porcentaje de eventos cardiacos adversos mayores a medio plazo

Randomised, double-blind, placebo-controlled clinical trial for evaluating the efficacy of intracoronary injection of autologous bone marrow mononuclear cells in the improvement of the ventricular function in patients with idiopathic dilated myocardiopathy: a study protocol

Background Cellular therapies have been increasingly applied to diverse human diseases. Intracoronary infusion of bone marrow-derived mononuclear cells (BMMNC) has demonstrated to improve ventricular function after acute myocardial infarction. However, less information is available about the role of BMMNC therapy for the treatment of dilated myocardiopathies (DCs) of non-ischemic origin. This article presents the methodological description of a study aimed at investigating the efficacy of intracoronary injection of autologous BMMNCs in the improvement of the ventricular function of patients with DC. Methods This randomised, placebo-controlled, double-blinded phase IIb clinical trial compares the improvement on ventricular function (measured by the changes on the ejection fraction) of patients receiving the conventional treatment for DC in combination with a single dose of an intracoronary infusion of BMMNCs, with the functional recovery of patients receiving placebo plus conventional treatment. Patients assigned to both treatment groups are monitored for 24 months. This clinical trial is powered enough to detect a change in Left Ventricular Ejection Fraction (LVEF) equal to or greater than 9%, although an interim analysis is planned to re-calculate sample size. Discussion The study protocol was approved by the Andalusian Coordinating Ethics Committee for Biomedical Research (Comité Coordinador de Ética en Investigación Biomédica de Andalucia), the Spanish Medicines and Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), and is registered at the EU Clinical Trials Register (EudraCT: 2013–002015-98). The publication of the trial results in scientific journals will be performed in accordance with the applicable regulations and guidelines to clinical trials. Trial registration ClinicalTrials.gov Identifier NCT02033278 (First Posted January 10, 2014): https://clinicaltrials.gov/ct2/show/NCT02033278; EudraCT number: 2013–002015-98, EU CT Register: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-002015-98. Trial results will also be published according to the CONSORT statement at conferences and reported peer-reviewed journals.This paper presents an investigator-driven Clinical trial partially funded by research grant provided by the Regional Ministry of Health of Andalusia (Grant Reference Number salud-201600073587-tra).Ye

Seminario de Investigación Aplicada 2017 – I

Este trabajo tiene como objetivo mostrar la internacionalización y la importancia de cada uno de los temas a tratar en este libro que se llevó a cabo en el seminario de investigación aplicada que tomo por nombre de gestión financiera y contable bajo estándares internacionales. Colombia al ser uno de los últimos países de américa latina en implementar las normas de información financiera – NIIF busca la necesidad de llevar a cabo esta nueva normatividad logrando aplicar el decreto 1314 del 2009, por ende los estudiantes de último semestre del programa de contaduría pública de la Universidad Piloto de Colombia Seccional Alto Magdalena quienes tomaron por opción de grado el seminario de investigación aplicada, buscan consolidar por medio de varias problemáticas que se presentan actualmente en la mayoría de empresas tanto de personas naturales como jurídicas, obteniendo de esta manera aclarar dudas e inquietudes que se generan por medio de un trabajo realizado como una monografía de grado