Aplicaciones clínicas del strain de la aurícula izquierda

Atrial strain is a novel echocardiographic technique for assessing atrial function, which is composed of 3 phases: reservoir, conduit and pump. Advances in analysis software and the standardisation of its measurement have allowed its use to increase exponentially in recent years. This technique has been evaluated in multiple scenarios, and has been shown to provide diagnostic and prognostic value in various cardiovascular pathologies. In this review we present how atrial strain is obtained, as well as the prognostic role of this technique in different clinical settingsEl strain auricular es una técnica ecocardiográfica novedosa que permite evaluar la función auricular, que se compone de 3 fases: reservorio, conducto y bomba. Los avances en los softwares de análisis y la estandarización de su medición han permitido que su uso haya aumentado de forma exponencial en los últimos años. Esta técnica se ha evaluado en múltiples escenarios, y se ha demostrado que aporta valor diagnóstico y pronóstico en diversas patologías cardiovasculares. En esta revisión presentamos la forma de obtener el strain auricular, así como el papel pronóstico de esta técnica en distintos contextos clínicos

The concept of waste within the framework of sustainable development through the analysis of the secondary education curriculum

El propósito general era analizar la referencia al concepto de desechos (estrechamente relacionado con el desarrollo sostenible en el marco de la educación ambiental) en el reglamento que normaliza la Enseñanza Secundaria Obligatoria. Se realizó un diseño de investigación cualitativa basado en un análisis estadístico descriptivo. Se ha establecido un sistema de categorías. Se analizaron las diferentes materias en las que se enseña el concepto de residuo, los contenidos propuestos y el enfoque que se da al concepto. El concepto de residuo apareció en diferentes expresiones, que fueron los indicadores de este estudio. Los resultados revelan que la legislación vigente, tanto nacional como regional, da muy poca relevancia a este concepto. Aunque la normativa ofrece oportunidades en la educación para estudiar este concepto, es insuficiente e incompleta en este sentido. Estos resultados nos permiten afirmar que no se fomenta el estudio del concepto de desecho en la etapa escolar.The overall purpose was to analyze the reference to the concept of waste (closely related to sustainable development within the framework of environmental education) in the regulation that standardizes Compulsory Secondary Education. A qualitative research design was carried out based on a descriptive statistical analysis. A system of categories has been established. The different subjects in which the concept of waste is taught, the contents proposed and the approach that is given to the concept were analyzed. The concept of waste appeared in different expressions, which were the indicators of this study. The results reveal that the current legislation, both national and regional, gives very little relevance to this concept. Although the regulations offer opportunities in education to study this concept, it is insufficient and incomplete in this regard. These results allow us to affirm that the study of the concept of waste in the school stage is not encouraged.• Junta de Extremadura. Proyecto IB16068 y Subvención GR15009 • Agencia Estatal de Investigación. Proyecto EDU2016-77007-R • Parcialmente financiado por el Fondo Europeo de Desarrollo RegionalpeerReviewe

Diagnóstico de las emociones asociadas al proceso de enseñanza de la tecnología en docentes en formación

La formación del profesorado de ciencias ha de constituir uno de los pilares fundamentales para el desarrollo de la sociedad actual. Una de las líneas de investigación que está tomando auge en los últimos tiempos relaciona la influencia existente entre el dominio afectivo y el cognitivo en el proceso de aprender a enseñar contenidos científicos. Concretamente, un creciente número de investigaciones resaltan la importancia de las emociones y su relación bidireccional con las creencias de autoeficacia de las diferentes materias científicas. En esta línea, el objetivo de este trabajo ha sido diagnosticar y analizar las emociones que experimenta el futuro profesor de educación secundaria ante la enseñanza de la materia de tecnología. La muestra ha estado constituida por 46 alumnos del Máster de Formación del Profesorado en Educación Secundaria en la especialidad de tecnología. La metodología utilizada para la recogida de datos ha sido de tipo descriptiva por encuesta basada en estudios previos de nuestro grupo de investigación. El análisis de los datos obtenidos revela la existencia de una relación entre el recuerdo de las emociones experimentadas en la etapa escolar con la emociones que experimentan como docentes. Así mismo, se han detectado diferencias estadísticamente significativas en las diferentes variables referidas a emociones, capacidad y creencias de autoeficacia en función del curso y del contenido de tecnología a impartir

Deformación miocárdica en el diagnóstico precoz de enfermedad subclínica en familiares de pacientes con miocardiopatía genéticas.

Familial screening for genetic cardiomyopathies in asymptomatic relatives of index cases, as well as early detection of disease expression in asymptomatic relatives carrying the mutation, can be a clinical challenge. In this scenario, myocardial deformation analysis by speckle tracking may reveal early signs of underlying subclinical disease in relatives of patients with dilated, arrhythmogenic or hypertrophic cardiomyopathy. We present the clinical case of an asymptomatic young woman, referred for family screening for heart disease, with normal ECG and conventional echocardiogram, where the study of myocardial deformation allowed an early diagnosis of the underlying heart disease.El cribado familiar de cardiomiopatías genéticas en familiares asintomáticos de casos índices, así como a detección temprana de expresión de enfermedad en familiares asintomáticos portadores de la mutación, puede ser un desafío clínico. En este escenario, el analisis de deformación miocárdica mediante speckle tracking puede revelar signos precoces de enfermedad subclínica subyacente en familiares de pacientes con miocardiopatía dilatada, arritmogénica o hipertrófica. Presentamos el caso clínico de una mujer joven asintomática, remitida por cribado familiar de cardiopatía, con ECG y ecocardiograma convencional normal, donde el estudio de la deformación miocárdica permitió llegar al diagnóstico temprano de una cardiopatía subyacente

Prediction of atrial fibrillation from sinus-rhythm electrocardiograms based on deep neural networks: Analysis of time intervals and longitudinal study

Objective: Artificial Intelligence (AI) in electrocardiogram (ECG) analysis helps to identify persons at risk of developing atrial fibrillation (AF) and reduces the risk for severe complications. Our aim is to investigate the performance of AI-based methods predicting future AF from sinus rhythm (SR) ECGs, according to different characteristics of patients, time intervals for prediction, and longitudinal measures. Methods: We designed a retrospective, prognostic study to predict AF occurrence in patients from 12-lead SR ECGs. We classified patients in two groups, according to their ECGs: 3,761 developed AF and 22,896 presented only SR ECGs. We assessed the impact of age on the overall performance of deep neural network (DNN)-based systems, which consist in a variation of Residual Networks for time series. Then, we analysed how much in advance our system can predict AF from SR ECGs and the performance for different categories of patients with AUC and other metrics. Results: After balancing the age distribution between the two groups of patients, our model achieves AUC of 0.79 (0.72-0.86) without additional constraints, 0.83 (0.76-0.89) for ECGs recorded in the last six months before AF, and 0.87 (0.81-0.93) for patients with stable AF risk measures over time, with sensitivity of 90.62% (80.70-96.48) and diagnostic odd ratio of 20.49 (8.56-49.09). Conclusion: This study shows the ability of DNNs to predict new onsets of AF from SR ECGs, with the best performance achieved for patients with stable AF risk score over time. The introduction of this time-based score opens new possibilities for AF prediction, thanks to the analysis of long-span time intervals and score stabilityEuropean Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No860813 – TReSPAsS-ETNTRESPASS-ET

Del realce tardío al T1 mapping. ¿Qué queda para nuestra clínica?

Myocardial fibrosis is a pathological process common to most of heart diseases. However, the type of myocardial involvement can differ significantly depending on its etiology. Tissue characterization of myocardial fibrosis patterns can be explored in a complementary way by the sequences of late gadolinium enhancement and T1 mapping. In this review, we will discuss current evidence for the use of these imaging techniques and describe their most prominent clinical applications.La fibrosis miocárdica es un proceso patológico común a la mayoría de enfermedades cardiacas. Sin embargo, la afectación miocárdica resultante puede presentarse bajo formas muy distintas dependiendo de su etiología. La caracterización tisular de la fibrosis miocárdica y sus padrones de distribución pueden ser explorados de forma complementaria mediante las secuencias de realce tardío de gadolinio y de T1 mapping. En esta revisión, describiremos la evidencia actual del estado de estas técnicas de imagen y describiremos sus aplicaciones clínicas más destacadas

Ecocardiografía en la valoración de un fibroelastoma papilar múltiple

Fibroelastoma is the second most common primary benign cardiac tumor. It can be multiple; the aortic valve is the most frequently affected location and the most important complication is systemic embolism. We present the case of a 67-year-old woman who attended the emergency room due to heart failure. In the study, the echocardiogram showed a nodular small mass in the left coronary leaflet of the aortic valve suggestive of fibroelastoma. The transesophageal echocardiogram confirmed the finding and found a second mass in the non-coronary leaflet, for which to the final diagnosis of multiple papillary fibroelastoma.El fibroelastoma es el segundo tumor benigno cardiaco primario más frecuente. Puede ser múltiple, la válvula aórtica es la localización más frecuentemente más afectada y la complicación más importante es el embolismo sistémico. Presentamos el caso de una mujer de 67 años que acudió a Urgencias por insuficiencia cardiaca. En el estudio se realizó un ecocardiograma en el que se apreció una imagen nodular en el velo coronariano izquierdo de la válvula aórtica sugestiva de fibroelastoma, El ecocardiograma transesofágico confirmó el hallazgo y encontró una segunda masa en el velo no coronariano, por lo que se llegó al diagnóstico final de fibroelastoma papilar múltiple

Cardiomyocyte calcineurin is required for the onset and progression of cardiac hypertrophy and fibrosis in adult mice

Previous studies have demonstrated that activation of calcineurin induces pathological cardiac hypertrophy. In these studies, loss-of-function was mostly achieved by systemic administration of the calcineurin inhibitor cyclosporin A. The lack of conditional knockout models for calcineurin function has impeded progress toward defining the role of this protein during the onset and the development of cardiac hypertrophy in adults. Here, we exploited a mouse model of cardiac hypertrophy based on the infusion of a hypertensive dose of angiotensin II (AngII) to model the role of calcineurin in cardiac hypertrophy in adulthood. AngII-induced cardiac hypertrophy in adult mice was reduced by treatment with cyclosporin A, without affecting the associated increase in blood pressure, and also by induction of calcineurin deletion in adult mouse cardiomyocytes, indicating that cardiomyocyte calcineurin is required for AngII-induced cardiac hypertrophy. Surprisingly, cardiac-specific delection of calcineurin, but not treatment of mice with cyclosporin A, significantly reduced AngII-induced cardiac fibrosis and apoptosis. Analysis of pro-fibrotic genes revealed that AngII-induced expression of Tgfβ-family members and Lox was not inhibited by cyclosporin A but was markedly reduced by cardiac-specific calcineurin deletion. These results show that AngII induces a direct, calcineurin-dependent pro-hypertrophic effect in cardiomyocytes, as well as a systemic hypertensive effect that is independent of calcineurin activity

Aragon workers’ health study – design and cohort description

BACKGROUND: Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers’ Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS. METHODS/DESIGN: Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain). Study participants were recruited during a standardized clinical exam in 2009–2010 (participation rate 95.6%). Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index). Participants will be followed-up for 10 years. RESULTS: The average (SD) age, body mass index, and waist circumference were 49.3 (8.7) years, 27.7 (3.6) kg/m(2) and 97.2 (9.9) cm, respectively, among males (N = 5,048), and 40.8 (11.6) years, 24.4 (3.8) kg/m(2), and 81.9 (9.9) cm, among females (N = 351). The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male), the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least one plaque in the carotid or femoral arteries. DISCUSSION: Baseline data from the AWHS show a high prevalence of cardiovascular risk factors and of sublinical atherosclerosis. Follow-up of this cohort will allow the assessment of subclinical atherosclerosis progression and the link of disease progression to traditional and emergent risk factors