Pulmonary Vascular Remodeling and Prognosis in Patients Evaluated for Heart Transplantation: Insights from the OCTOPUS-CHF Study

Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 +/- 0.5 mm vs. 0.2 +/- 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients

Pulmonary vascular remodeling and prognosis in patients evaluated for heart transplantation: insights from the OCTOPUS-CHF study

[Abstract] Objective: In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. Methods: This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. Results: A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 ± 0.5 mm vs. 0.2 ± 0.6 mm and p = 0.87). Conclusion: Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients.Instituto de Salud Carlos III; PI18/00254European Regional Development Fund; CB16/11/0050

Insulin Resistance in Chileans of European and Indigenous Descent: Evidence for an Ethnicity x Environment Interaction

<p><b>Background:</b> Effects of urbanisation on diabetes risk appear to be greater in indigenous populations worldwide than in populations of European origin, but the reasons are unclear. This cross-sectional study aimed to determine whether the effects of environment (Rural vs. Urban), adiposity, fitness and lifestyle variables on insulin resistance differed between individuals of indigenous Mapuche origin compared to those of European origin in Chile.</p> <p><b>Methodology/Principal Findings:</b> 123 Rural Mapuche, 124 Urban Mapuche, 91 Rural European and 134 Urban European Chilean adults had blood taken for determination of HOMA-estimated insulin resistance (HOMA(IR)) and underwent assessment of physical activity/sedentary behaviour (using accelerometry), cardiorespiratory fitness, dietary intake and body composition. General linear models were used to determine interactions with ethnicity for key variables. There was a significant "ethnicity x environment" interaction for HOMA(IR) (Mean +/- SD; Rural Mapuche: 1.65 +/- 2.03, Urban Mapuche: 4.90 +/- 3.05, Rural European: 0.82 +/- 0.61, Urban European: 1.55 +/- 1.34, p((interaction)) = 0.0003), such that the effect of urbanisation on HOMA(IR) was greater in Mapuches than Europeans. In addition, there were significant interactions (all p<0.004) with ethnicity for effects of adiposity, sedentary time and physical activity on HOMA(IR), with greater effects seen in Mapuches compared to Europeans, an observation that persisted after adjustment for potential confounders.</p> <p><b>Conclusions/Significance:</b> Urbanisation, adiposity, physical activity and sedentary behaviour influence insulin resistance to a greater extent in Chilean Mapuches than Chileans of European descent. These findings have implications for the design and implementation of lifestyle strategies to reduce metabolic risk in different ethnic groups, and for understanding of the mechanisms underpinning human insulin resistance.</p&gt

Matemáticas de primero de Bachillerato con DERIVE : memoria final

Ayudas a la Innovación Educativa, 1997-98. Anexo Memoria en C-Innov. 80Proyecto realizado por tres profesores del Instituto de Enseñanza Secundaria Vega del Prado de Valladolid, aplicado a alumnos de Matemáticas y Matemáticas aplicadas a las Ciencias Sociales, de primer curso de Bachillerato. Tiene un carácter transversal al tratar de fomentar desde las matemáticas, el conocimiento y valoración de las nuevas tecnología y aplicar estas últimas al aprendizaje de las matemáticas. Se utiliza el programa DERIVE para las prácticas con las matemáticas . Los objetivos del proyectos son : emplear el uso del ordenador para la enseñanza de las matemáticas, permitir a los alumnos emplear menos tiempo en los cálculos ; ofrecer unas matemáticas mas cercanas a los problemas reales ; valorar las posibilidades de las nuevas tecnologías ; potenciar la reflexión y el analisis ; favorecer a los alumnos con dificultades en el aprendizaje de las matemáticas ; favorecer una forma de trabajar más autónoma de los estudiantes al tiempo que fomentar el trabajo en equipo ; potenciar el gusto por la asignatura a través de su experimentación con el programa DERIVE. Los tres profesores han diseñado y redactado las siete prácticas matemáticas con DERIVE, cada práctica consta de un guión en el que se recuerdan los conceptos matemáticos que se utilizan y se emplean los comandos DERIVE necesarios, y una hoja de respuestas. Los contenidos de estas prácticas que realizan los alumnos son : aritmética y álgebra básicas, resolución gráfica de ecuaciones, geometría analítica, funciones, trigonometría , números complejos, estadística y probabilidad.CIDEMinisterio Educación CIDEBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; Fax +34917748026; [email protected]

Rationale and design of the optical coherence tomography observation of pulmonary ultra-structural changes in heart failure (OCTOPUS-CHF) study

Background The assessment of vascular remodeling using optical coherence tomography (OCT) has been previously described in some types of pulmonary hypertension. However, evidence about its feasibility and clinical utility for evaluation of pulmonary arterial vasculopathy in advanced heart failure (HF) is scarce. Optical Coherence Tomography Observation of Pulmonary Ultra-Structural Changes in Heart Failure (OCTOPUS-CHF) study is designed to study the correlation between OCT-morphometric parameters and hemodynamic data measured or derived from right heart catheterization (RHC). Methods OCTOPUS-CHF is an observational, prospective, multicentre study aiming to recruit 100 patients with advanced HF referred for heart transplantation (HTx) evaluation. As part of such evaluation, all patients will undergo RHC in order to rule out severe pulmonary hypertension. After RHC, a Dragonfly™ OPTIS™ imaging catheter will be used to perform OCT evaluation of a right-lower-lobe pulmonary artery with a luminal diameter ≤ 5 mm. The primary objective is to study the correlation of OCT parameters with hemodynamic RHC data. The secondary objective is to determine if OCT parameters improve prognostic stratification. Conclusions The OCTOPUS-CHF study will investigate the feasibility and clinical utility of pulmonary arterial vasculopathy evaluation with OCT in advanced HF patients and its correlation with hemodynamic RHC data. The ability of OCT-morphometric parameters to improve prognostic stratification will also be tested.Sin financiación4.164 JCR (2020) Q2, 56/142 Cardiac & Cardiovascular Systems1.406 SJR (2020) Q1, 62/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients: A Multicenter Analysis.

The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV. The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was  TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances

Biopsia endomiocárdica por vía venosa braquial.: Descripción de la técnica y experiencia en 12 años de 2 centros

ABSTRACT Introduction and objectives: Recipients of a heart transplant need to receive serial endomyocardial biopsies (EMB) to discard rejection, a procedure that is usually performed through the femoral or jugular vein. Over the last few years, we have developed a technique to perform EMBs using the brachial venous access that we have implemented as the preferential access route. In this article, we describe the technique and the initial clinical experience of 2 different centers. Methods: Between 2004 and 2016, we developed and implemented a brachial venous access technique. We registered the main clinical and procedural variables of all the brachial biopsies performed in both centers and compared them with a retrospective series of femoral and jugular procedures. Results: Brachial EMBs were successfully performed 544 of the time with no major complications. The number of brachial procedures per patient rose from 1 to 14. Over the same period of time 1054 femoral and 686 jugular procedures were performed. The total procedural time was similar with different access routes (mean for brachial/femoral/jugular access: 28/26/29 min., P = .31) while fluoroscopy time was shorter in jugular procedures (mean 5/5/3 min. respectively; P < .001). The brachial procedure was recalled as the least painful procedure of all compared to the jugular or femoral ones (2/8/9 score on a scale from 1 to 10; P = .001) with an overall patient preference towards the brachial access. Conclusions: The venous brachial access route is a good alternative to the central venous one to perform EMBs and is the route of choice in our centers. Also, it has high feasibility and safety and brings additional comfort to patients.Introducción y objetivos: Los pacientes receptores de un trasplante cardiaco necesitan someterse a biopsias endomiocárdicas (BEM) para descartar el rechazo, procedimiento que habitualmente se realiza por acceso venoso yugular o femoral. En los últimos años hemos desarrollado una técnica de biopsia por vía braquial, que hemos implementado como acceso preferente. En este artículo describimos la técnica y la experiencia clínica inicial de 2 centros empleando el acceso braquial. Métodos: Entre 2004 y 2016 desarrollamos e implementamos la técnica de biopsia por vía venosa braquial. Se registraron las principales variables clínicas y del procedimiento de todas las BEM realizadas por vía braquial en ambos centros, y se compararon las características con los procedimientos realizados por vía femoral y yugular. Resultados: Se realizó la BEM por vía braquial en 544 casos, sin complicaciones mayores. El número de procedimientos braquiales por paciente varió entre 1 y 14. En el mismo periodo se realizaron 1.054 BEM femorales y 686 yugulares. La duración total del procedimiento fue similar por los distintos accesos (mediana braquial/femoral/yugular: 28/26/29 min; p = 0,31), con un menor tiempo de escopia por vía yugular (mediana 5/5/3 min, respectivamente; p < 0,001). Los procedimientos realizados por vía braquial se valoraron como menos dolorosos que los realizados por vía yugular o femoral (2/8/9 en la escala de dolor EVA de 1-10, respectivamente; p = 0,001), y fue la vía de elección por parte de los pacientes. Conclusiones: La BEM por vía venosa braquial es una buena alternativa a la punción venosa central y la vía de elección en nuestros centros, con altas factibilidad y seguridad, y mayor comodidad para el paciente