Usefulness of carotid ultrasonography in the diagnosis of coronary artery disease in patients undergoing exercise echocardiography

[Abstract] Background. Relationship between carotid and coronary artery disease (CAD) in patients undergoing invasive and non-invasive test is unclear. The aim of the study is to evaluate whether carotid disease is associated with CAD in patients submitted to exercise echocardiography (EE) and if it improves the EE ability to predict CAD. Methods. We retrospectively studied 156 subjects without previous vascular disease who underwent EE, carotid ultrasonography and coronary angiography between 2002 and 2013. Positive EE was defined as exercise induced wall motion abnormalities, carotid disease according to Manheim and American Society of Echocardiography Consensus and significant CAD as stenosis ≥50%. Results. Eighty-nine (57.1%) subjects had significant CAD. Factors associated with CAD in multivariate analysis were fasting plasma glucose (odds ratio [OR] 1.02, p = 0.031), pre-test probability of CAD > 65% (OR 3.71, p < 0.001), positive EE (OR 10.51, p < 0.001) and carotid plaque (CP) presence (OR 2.95, p = 0.013). There was neither statistical significant difference in area under the curve after addition of CP to EE results (0.77 versus 0.81, p = 0.525) nor sensitivity, specificity, predictive values or efficiency. CP presence reclassified as very high-risk according to Systematic COronary Risk Evaluation 13 patients (34.2%) with negative EE and 22 (33.3%) without CAD. Conclusion. CP is associated with CAD in patients undergoing EE, however its addition to EE does not improve CAD prediction, probably due to insufficient statistical power. CP reclassified one third of patients to very high-risk category despite negative EE or CAD absence, these subjects benefit from aggressive primary prevention interventions.Fundación Ramón Domínguez para la Investigación, el Desarrollo y la Innovación biosanitaria; ECOE

Estimating the Prevalence of Cardiac Amyloidosis in Old Patients with Heart Failure—Barriers and Opportunities for Improvement: The PREVAMIC Study

Background: Cardiac amyloidosis (CA) could be a common cause of heart failure (HF). The objective of the study was to estimate the prevalence of CA in patients with HF. Methods: Observational, prospective, and multicenter study involving 30 Spanish hospitals. A total of 453 patients >= 65 years with HF and an interventricular septum or posterior wall thickness > 12 mm were included. All patients underwent a Tc-99m-DPD/PYP/HMDP scintigraphy and monoclonal bands were studied, following the current criteria for non-invasive diagnosis. In inconclusive cases, biopsies were performed. Results: The vast majority of CA were diagnosed non-invasively. The prevalence was 20.1%. Most of the CA were transthyretin (ATTR-CM, 84.6%), with a minority of cardiac light-chain amyloidosis (AL-CM, 2.2%). The remaining (13.2%) was untyped. The prevalence was significantly higher in men (60.1% vs 39.9%, p = 0.019). Of the patients with CA, 26.5% had a left ventricular ejection fraction less than 50%. Conclusions: CA was the cause of HF in one out of five patients and should be screened in the elderly with HF and myocardial thickening, regardless of sex and LVEF. Few transthyretin-gene-sequencing studies were performed in older patients. In many patients, it was not possible to determine the amyloid subtype

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively, P<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio [ORadj]: 1.27, P=0.0001; ORadj: 1.48, P=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6, P=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7, P=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6, P=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization

Un caso raro de lesiones faciales: granulomatosis orofacial

Mujer de 61 a?os con granulomatosis orocial, diagnosticada 40 a?os despu?s de su debut

Los principios bioéticos en el preludio de la COVID 19: ¿respetados o marginados?

RESUMEN Introducción: La pandemia por COVID 19 ha generado una atmósfera de interrogantes sobre el proceder más adecuado del reparto de bienes escasos, invitándonos a reflexionar sobre cómo los principios bioéticos y la calidad asistencial en el campo de los cuidados paliativos se han visto amenazados en aras proteger la salud pública. Métodos: Revisión de la literatura desde el 1 de marzo 2020 hasta el 11 de noviembre del 2021 con los descriptores “ bioethics”, “ end of life” , “ palliative care” , “SARS CoV2” y “quality of life ” en bases de datos biomédicas (PUBMED, MEDLINE, WOS, PLOs) y en Google Académico; documentación de asociaciones destacadas en materia de bioética y legislación española relacionada con la autonomía del paciente, seguridad y salud laboral publicada en el Boletín Oficial del Estado. Resultados y discusión: El sistema sanitario se ha visto obligado a modificar los cuidados de fin de vida con el objetivo común de disminuir la expansión del virus, la incidencia de la enfermedad y la tasa de letalidad del virus. La sanidad reinventa la asistencia médica para poder mantener una adecuada calidad asistencial sin menoscabar los principios éticos básicos. Conclusiones y perspectivas: Existe una escasa protocolización sobre la atención de los pacientes al final de vida en la era post-COVID. La implementación de nuevas guías y protocolos de aislamiento, asistencia domiciliaria,pases de visita médica telemáticos, entre otros, podrían ayudar a respetar en mayor medida los criterios bioéticos básicos y mejorar la calidad asistencial en este subgrupo de pacientes. ABSTRACT Introduction: The COVID 19 pandemic has generated an atmosphere of questioning about the most appropriate course of action in the sharing of scarce goods, inviting us to reflect on how bioethical principles and quality of care in the field of palliative care have been threatened in the interest of protecting public health. Methods: Literature review from March 1, 2020 through November 11, 2021 with the descriptors " bioethics", " end of life" , "palliative care", " SARS CoV2" and "quality of life " in biomedical databases (PUBMED, MEDLINE, WOS, PLOs) and in Google Scholar; documentation of leading associations in bioethics and Spanish legislation related to patient autonomy, occupational safety and health published in the Official State Gazette. Results and discussion: The healthcare system has been forced to modify end-of-life care with the common goal of decreasing the spread of the virus, the incidence of the disease and the case fatality rate of the virus. The health system is reinventing medical care in order to maintain an adequate quality of care without undermining basic ethical principles. Conclusions and perspectives: There is little protocolization of end-of-life care in the post-COVID era. The implementation of new guidelines and protocols for isolation, home care, telematic medical visit passes, among others, could help to respect basic bioethical criteria to a greater extent and improve the quality of care in this subgroup of patients

COVID-19 and Thrombosis: Pathophysiological Mechanisms and Therapeutic Update

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pro-inflammatory and prothrombogenic virus with a high mutagenic profile, which produces active infection of variable duration in various organs and systems, and it has been observed that patients who have already suffered from the disease, especially in its more severe forms such as bilateral pneumonia or respiratory distress, present symptoms and signs of chronic multi-organ involvement. However, little is known about the molecular mechanisms that generate endothelial damage (chronic reactive endotheliitis) and subsequent thrombosis in SARS-CoV-2 infection are still not sufficiently elucidated, and in this chapter, we explore these mechanisms and therapeutic options to reduce prothrombosis and multiple vascular involvement that cause morbidity and mortality in this disease. In particular, we will evaluate heparin doses according to the stage of infection and its correlation with improved survival