Improvement in quality of life with sacubitril/ /valsartan in cardiac resynchronization non-responders: The RESINA (RESynchronization plus an Inhibitor of Neprilysin/Angiotensin) registry

Background: Clinical management of cardiac resynchronization therapy (CRT) non-responders is difficult, and their prognosis is poor. The aim of the present study was to evaluate whether treatment with sacubitril/valsartan can improve quality of life (QoL) parameters in these patients. Methods: Thirty five non-responders to CRT were included (75 ± 7 years, 28% females, mean left ventricular ejection fraction 28 ± 8%, 54% non-ischemic cardiomyopathy) with maximally optimized drug therapy and New York Heart Association class II–III. They were all on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and were switched to sacubitril/valsartan. One week before and 6 months after initiation of the therapy they completed both the Minnesota Living with Heart Failure (MLWHF) and the 12-item Kansas City Cardiomyopathy Questionnaires (KCCQ-12). The primary outcome was the effect of sacubitril/valsartan on the physical, clinical, social and emotional QoL parameters and number of hospitalizations. Results: The mean total scores of both questionnaires improved from baseline to the follow-up visit at 6-months (KCCQ-12 40 ± 10 to 47 ± 10; p < 0.001; MLWHF 40 ± 15 to 29 ± 15; p < 0.001). The best results were seen in the KCCQ-12 total symptom domains (77% improvement), the MLWHF physical domain (81% improvement), and the MLWHF emotional domain (71% improvement). Two patients died during follow-up. The mean number of hospitalizations reduced significantly (1 ± 0.6 vs. 0.5 ± 0.8; p = 0.003) Conclusions: In CRT non-responders, sacubitril/valsartan significantly improved overall QoL, physical limitations and emotional domains and reduced the number of hospitalizations

Cambios electrocardiográficos a largo plazo en la displasia arritmogénica ventricular derecha

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 21 de Septiembre de 200

Factores de riesgo cardiovascular en la población china residente en la Comunidad de Madrid y su relación con el origen geográfico

Resumen: Antecedentes y objetivos: La población china nativa de la Comunidad de Madrid es muy numerosa. El objetivo del estudio fue analizar su prevalencia de factores de riesgo cardiovascular (FRCV). Materiales y métodos: Hemos hecho un muestreo de conveniencia con: edad, género, presión arterial, peso, altura, índice de masa corporal, glucemia, colesterol total, triglicéridos, tabaquismo, hipertensión arterial (HTA) y diabetes mellitus (DM). Se analizó la prevalencia de HTA, DM, tabaquismo, sobrepeso (índice de masa corporal ≥ 24 kg/m2) y dislipidemia (colesterol total ≥ 200 mg/dl o triglicéridos ≥ 150 mg/dl) y según 5 zonas geográficas chinas (nordeste, sureste, centro, oeste y norte). Resultados: De octubre de 2016 a enero de 2020 incluimos 642 sujetos (43 ± 15 años, 49% mujeres) de un total de 706 (el 9% rehusó participar). La prevalencia de FRCV fue: tabaquismo 36%, HTA 19%, DM 17%, dislipidemia 18% y sobrepeso 49%. Todos fueron significativamente más prevalentes en varones que en mujeres, excepto la DM, así como la media de FRCV (2 ± 1,2 vs. 1 ± 1,2; p > 0,001). El 16% de mujeres y el 35% de varones tenían al menos 3 FRCV. Un tiempo de residencia en España ≥ 15 años (OR: 3,63; IC 95% [2,61-5,05]) o ser del Sudeste de China (OR 3,13; IC 95% [2,08-4,69]) se asociaron de manera significativa a tener al menos 3 FRCV. Conclusiones: La población china nativa residente en Madrid muestra una alta prevalencia de FRCV, especialmente tabaquismo e HTA. El ser del sureste de China y un tiempo de residencia en España ≥ 15 años se asocian significativamente a una mayor prevalencia de FRCV. Abstract: Background and objectives: There is a large native Chinese population living in Madrid. The main objective of our work was to know the prevalence of the main cardiovascular risk factors (CVRF). Materials and methods: A convenience sampling was made with age, gender, blood pressure, weight, height, body mass index (BMI), glucose, total cholesterol (TC), triglycerides (TG), smoking, and previous diagnosis of hypertension or diabetes mellitus (DM). We analyzed the prevalence of five CVRF: hypertension, DM, smoking, overweight (BMI ≥ 24 kg/m2) and dyslipidemia (TC ≥ 200 mg/dl or TG ≥ 150 mg/dl) and five geographical Chinese zones: (northeast, north, southeast, center, and west). Results: From October 2016 to January 2020 we included 642 subjects (43 ± 15 years, 49% women) from a total of 706 (9% refused to participate). The prevalence of CVRF was: hypertension 19%, DM 17%, dyslipidemia 18%, overweight 49%, and smoking 36%. All of them were significantly more prevalent in males than in females except DM, and the mean CVRF (2 ± 1.2 vs. 1 ± 1.2; P > .001). At least three CVRF were present in 16% of women and 35% of males. Time of residence in Spain ≥15 years (OR 3.63; 95% CI [2.61–5.05]) or coming from the southeast of China (OR 3.13; 95% CI [2.08–4.69]) were significantly associated with having at least 3 CVRF. Conclusions: Native Chinese population living in Madrid has a high prevalence of CVRF, especially smoking and hypertension. Coming from the southeast of China and the time of residence in Spain ≥15 years were significantly associated with a high prevalence of CVRF

Diagnostic protocol for supraventricular tachycardias

Las taquicardias supraventriculares engloban a aquellas que se originan en estructuras situadas por encima de la bifurcación del haz de His. Pueden ser en general auriculares, de la unión AV o mediadas por una vía accesoria. La mayor parte de ellas se deben a mecanismos de reentrada, desde focal, a local o a macroreentradas auriculares. Para su correcto diagnóstico es fundamental primero un buen registro gráfico mediante ECG de 12 derivaciones, aunque a veces una tira de ritmo o un Holter pueden proporcionar el diagnóstico correcto. Una vez obtenido, en segundo lugar, se debe analizar siguiendo una serie de pasos que incluyan el comprobar cómo es y qué frecuencia tiene la actividad auricular, así como la relación que hay entre las aurículas y los ventrículos (P/QRS). La infusión de adenosina o las maniobras vagales pueden ayudar a establecer el diagnóstico final.Supraventricular tachycardias encompass tachycardias that originate in structures located above the bundle of His bifurcation. In general, supraventricular tachycardias can be atrial, of the AV node, or mediated by an accessory pathway. Most of them are due to reentry mechanisms, from focal to local to macro atrial reentries. For their proper diagnosis, first, a good graphical recording using a 12-lead ECG is fundamental, although sometimes a rhythm strip or a Holter can lead to a correct diagnosis. Second, once the recording has been obtained, it should be analyzed following a series of steps that includes verifying what it is like and the rate of the atrial activity as well as the relationship between the atria and the ventricles (P/QRS). An adenosine infusion or vagal maneuvers can help establish the final diagnosis.Sin financiaciónNo data JCR 20210.107 Q4 SJR 2021No data IDR 2021UE

A 34-year-old female patient who consulted for palpitations of years of evolution

Sin financiaciónNo data SJR 20210.107 SJR (2021) Q4, 2382/2489 Medicine (Miscellaneous)No data IDR 2021UE

Variable Arrangement of the Atrioventricular Conduction Axis Within the Triangle of Koch: Implications for Permanent His Bundle Pacing

Objectives: This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. Background: The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. Methods: A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. Results: Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. Conclusions: Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.Sin financiación6.375 JCR (2020) Q1, 26/142 Cardiac & Cardiovascular Systems2.279 SJR (2020) Q1, 33/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Atrial flutter

El término «flutter auricular» se describió por primera vez en 1886 en animales como una actividad eléctrica auricular rápida y regular, y en 1911 se describieron sus características electrocardiográficas con una actividad en forma de «dientes de sierra», distinguiéndose de la fibrilación auricular (FA). Actualmente se reconoce como una arritmia auricular diferenciada de la FA, pero con características etiopatogénicas y fisiopatológicas similares a esta.The term «atrial flutter» was described for the first time in animals in 1886 as rapid, regular atrial electrical activity. In 1911, its electrocardiographic characteristics were described as activity in a «rotating toothed disc» shape, distinguishing it from atrial fibrillation (AF). Currently, it is recognized as an atrial arrhythmia that is different from AF, but with similar etiopathogenic and physiopathological characteristics.Sin financiaciónNo data JCR 20210.107 SJR (2021) Q4, 2423/2489 Medicine (miscellaneous)No data IDR 2020UE

Supraventricular tachycardias

Las arritmias supraventriculares son un conjunto de taquicardias o arritmias rápidas, en las que alguna de las estructuras localizadas por encima del haz de His es esencial para su inicio y mantenimiento. Por definición, son ritmos rápidos, con una frecuencia cardíaca por encima de 100 lpm. Tienen buen pronóstico, aunque en ocasiones pueden tener un carácter incesante y favorecer el desarrollo de taquicardiomiopatía. El término taquicardia supraventricular (TSV) hace referencia a un grupo de arritmias supraventriculares del que se excluye la fibrilación auricular, por ser una entidad totalmente diferente.Supraventricular arrhythmias are a set of tachycardias or rapid arrhythmias in which any of the structures located above the bundle of His is essential for its onset and maintenance. By definition, they are rapid rhythms, with a heart rate above 100 bpm. They have a good prognosis, although on occasion they can have an incessant nature and favor the development of tachycardiomyopathy. The term supraventricular tachycardia (SVT) refers to a group of supraventricular arrhythmias which excludes atrial fibrillation, as it is an entirely different entity.Sin financiaciónNo data JCR 20210.107 Q4 SJR 2021No data IDR 2021UE

Diagnostic and treatment protocol for sinus tachycardia

La taquicardia sinusal es un tipo de arritmia auricular que se caracteriza por tener su origen dentro del propio nodo sinusal o en las proximidades de este. Sus frecuencias oscilan entre los 120 y los 240 lpm. Existen distintas familias, algunas consideradas fisiológicas o reactivas y otras patológicas.Sinus tachycardia is a type of atrial arrhythmia characterized by its origin within the sinus node itself or the surrounding area. Its rate ranges from 120 to 240 bpm. This entity is classified into different families; some are considered physiological or reactive and others pathological.Sin financiaciónNo data JCR 20210.107 Q4 SJR 2021No data IDR 2021UE

Atrial fibrillation

La fibrilación auricular y el flutter o aleteo auricular son dos tipos de arritmias muy frecuentes en la población general, tanto en pacientes con cardiopatía estructural como en pacientes sin ella. Aunque desde el punto de vista fisiopatológico son entidades diferentes, comparten muchas características entre sí (factores predisponentes, riesgo cardioembólico, tratamiento) y, en muchas ocasiones, ambas arritmias pueden coexistir en un mismo paciente.Atrial fibrillation and atrial flutter are two types of arrhythmias that are very common in the general population, both in patients with structural cardiopathy and patients without it. Although they are different entities from a physiopathological point of view, they have many characteristics in common (predisposing factors, cardioembolic risk, treatment) and, on many occasions, both arrhythmias may coexist in the same patient.Sin financiaciónNo data JCR 20210.107 SJR (2021) Q4, 2423/2489 Medicine (miscellaneous)No data IDR 2020UE