Definición de patrones electrocardiográficos para su reconocimiento en una aplicación informática

Aprendizaje de la electrocardiografía para los alumnos de 3º y 4º de Medicina a partir de una biblioteca de electrocardiografía tutelada, creada en un proyecto de innovación y mejora de la calidad docente de 2013. Se trata de detallar los patrones electrocardiográficos reales de todas las alteraciones electrocardiográficas descritas para que puedan ser llevados a una aplicación gráfica de identificación para dispositivos móviles que diagnostique los electrocardiogramas mediante su escaneo

Addressing long-term challenges in energy for sustainable futures by applying Moonshot Thinking

The rapid and exponential changes in our world require the education of engineers who can develop solutions to future and long-term challenges such as climate change. Exploration and innovation methodologies such as Futures Thinking and Moonshot Thinking have the potential to equip engineering students with useful tools and skills to build sustainable futures. To this end, the InnoEnergy MSc Energy for Smart Cities programme at BarcelonaTech (UPC) has developed a challenge-based learning (CBL) course that applies moonshot thinking to tackle major energy problems. This paper presents the methodology refined over three years of implementing the CBL course with second-year Masters's students in Energy Engineering. The course begins by constructing a narrative working future using exploratory tools from the Futures Thinking methodology. Breakthrough technologies are introduced, and their disruptive potential is analysed. Students then define a long-term sustainability and energy problem and use various ideation methodologies to develop a solution. Using technologies such as 3D printing, artificial intelligence and open-source electronic prototyping platforms such as Arduino, they build a minimum viable product (MVP) and develop a business model. Finally, using an agile approach, students must design future iterations and analyse the potential exploitation of their solution. This subject equips students with the necessary skills to address complex energy and sustainability challenges, and the course has proven effective in preparing students to apply their knowledge in practical, real-world settings.Objectius de Desenvolupament Sostenible::13 - Acció per al ClimaObjectius de Desenvolupament Sostenible::13 - Acció per al Clima::13.2 - Incorporar mesures relatives al canvi climàtic en les polítiques, les estratègies i els plans nacionalsObjectius de Desenvolupament Sostenible::13 - Acció per al Clima::13.3 - Millorar l’educació, la conscienciació i la capacitat humana i institucional en relació amb la mitigació del canvi climàtic, l’adaptació a aquest, la reducció dels efectes i l’alerta primerencaPostprint (published version

Distortion of the QRS in elderly patients with myocardial infarction

Background: Distortion of the terminal portion of the QRS in the initial electrocardiogram (ECG) is a strong predictor of adverse outcome in myocardial infarction. Our purpose is to assess the relationship of distortion of QRS and other ECG characteristics with older age. Methods and results: We analysed 634 consecutive patients (age 62.6 &#177; 13.7, 77% male) admitted in the first 12 hours of ST-elevation myocardial infarction. Two groups of age were defined: < 75 years-old and &#8805; 75 years-old. Additionally, we defined two ECG groups according to the presence of ST segment elevation with distortion of the terminal portion of the QRS in two or more adjacent leads (QRS+) or the absence of this pattern (QRS&#8211;). Older people had more often QRS+ (30% vs. 20%, p = 0.023). The older group with QRS+ had an in-hospital mortality of 18%, vs. 7% with QRS&#8211; (p = 0.04), and an incidence of major adverse events of 40% vs. 14% (p = 0.002). In the multivariate analysis, age &#8805; 75 years was an independent predictor of distortion of the QRS (odds ratio 2.1, 1.2&#8211;4.9, p = 0.016). Conclusions: The distortion of the terminal portion of the QRS in myocardial infarction is more frequent in elderly people, and is significantly related to adverse prognosis. This ECG finding can be helpful to promptly stratify the risk in elderly patient

Eco-fusión. Aplicación en el intervencionismo estructural cardíaco

The evolution in percutaneous structural intervention has generated a parallel development in advanced imaging techniques. Echocardiography plays a key role in structural intervention in patient selection, assessment during the fluoroscopy and immediate analysis of outcomes and early detection of complications; echo-fusion images appear as a complementary tool in which two techniques with dynamic images are complemented in a single image in order to guide, decrease intervention time and reduce complications.La evolución en el intervencionismo estructural percutáneo ha generado un desarrollo paralelo en las técnicas de imagen avanzada. La ecocardiografía en el intervencionismo estructural juega un papel básico en la selección de los pacientes, en la valoración durante el procedimiento y en el análisis inmediato de los resultados y la detección precoz de complicaciones. Las imágenes de fusión eco/fluoroscopia aparecen como una herramienta complementaria en la que dos técnicas con imágenes dinámicas se complementan en una sola imagen con el fin de orientar, disminuir el tiempo de intervención y disminuir las complicaciones

Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels

Background: In patients with refractory unstable angina, the platelet glycoprotein IIb/IIIa-receptor antibody abciximab reduces the incidence of cardiac events before and during coronary angioplasty. We investigated whether serum troponin T levels identify patients most likely to benefit from therapy with this drug. Methods: Among 1265 patients with unstable angina who were enrolled in the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) trial, serum samples drawn at the time of randomization to abciximab or placebo were available from 890 patients; we used these samples for the determination of troponin T and creatine kinase MB levels. Patients with postinfarction angina were not included. Results: Serum troponin T levels at the time of study entry were elevated (above 0.1 ng per milliliter) in 275 patients (30.9 percent). Among patients receiving placebo, the risk of death or nonfatal myocardial infarction was related to troponin T levels. The six-month cumulative event rate was 23.9 percent among patients with elevated troponin T levels, as compared with 7.5 percent among patients without elevated troponin T levels (P<0.001). Among patients treated with abciximab, the respective six-month event rates were 9.5 percent for patients with elevated troponin T levels and 9.4 percent for those without elevated levels. As compared with placebo, the relative risk of death or nonfatal myocardial infarction associated with treatment with abciximab in patients with elevated troponin T levels was 0.32 (95 percent confidence interval, 0.14 to 0.62; P=0.002). The lower event rates in patients receiving abciximab were attributable to a reduction in the rate of myocardial infarction (odds ratio, 0.23; 95 percent confidence interval, 0.12 to 0.49; P<0.001). In patients without elevated troponin T levels, there was no benefit of treatment with respect to the relative risk of death or myocardial infarction at six months (odds ratio, 1.26; 95 percent confidence interval, 0.74 to 2.31; P=0.47). Conclusions: The serum troponin T level, which is considered to be a surrogate marker for thrombus formation, identifies a high-risk subgroup of patients with refractory unstable angina suitable for coronary angioplasty who will particularly benefit from antiplatelet treatment with abciximab

Estrategia para el aprendizaje activo: Biblioteca audiovisual de casos clínicos reales de la patología cardiovascular más frecuente. Implicaciones para la preparación del examen M.I.R

Ofrecer al alumno una formación práctica y real a partir de situaciones de la práctica clínica diaria. Realizar un repositorio de vídeos y preguntas que crezca cada curso académico. Se pretende que esta colección sirva como modelo para la creación posterior de una aplicación informática que permita la interpretación de cualquier electrocardiograma tras escaneo del mismo en dispositivos tales como móviles o tabletas

Chronic Oral Anticoagulation Therapy and Prognosis of Patients Admitted to Hospital for COVID-19: Insights from the HOPE COVID-19 Registry

Background. Most evidence regarding anticoagulation and COVID-19 refers to the hospitalization setting, but the role of oral anticoagulation (OAC) before hospital admission has not been well explored. We compared clinical outcomes and short-term prognosis between patients with and without prior OAC therapy who were hospitalized for COVID-19. Methods. Analysis of the whole cohort of the HOPE COVID-19 Registry which included patients discharged (deceased or alive) after hospital admission for COVID-19 in 9 countries. All-cause mortality was the primary endpoint. Study outcomes were compared after adjusting variables using propensity score matching (PSM) analyses. Results. 7698 patients were suitable for the present analysis (675 (8.8%) on OAC at admission: 427 (5.6%) on VKAs and 248 (3.2%) on DOACs). After PSM, 1276 patients were analyzed (638 with OAC; 638 without OAC), without significant differences regarding the risk of thromboembolic events (OR 1.11, 95% CI 0.59-2.08). The risk of clinically relevant bleeding (OR 3.04, 95% CI 1.92-4.83), as well as the risk of mortality (HR 1.22, 95% CI 1.01-1.47; log-rank p value = 0.041), was significantly increased in previous OAC users. Amongst patients on prior OAC only, there were no differences in the risk of clinically relevant bleeding, thromboembolic events, or mortality when comparing previous VKA or DOAC users, after PSM. Conclusion. Hospitalized COVID-19 patients on prior OAC therapy had a higher risk of mortality and worse clinical outcomes compared to patients without prior OAC therapy, even after adjusting for comorbidities using a PSM. There were no differences in clinical outcomes in patients previously taking VKAs or DOACs. This trial is registered with NCT04334291/EUPAS34399

Usefulness of the updated logistic clinical SYNTAX score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the GLOBAL LEADERS trial

Objectives: We aimed to investigate the prognostic utility of the anatomical CABG SYNTAX and logistic clinical SYNTAX scores for mortality after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG). Background: The anatomical SYNTAX score evaluated the anatomical complexity of coronary artery disease and helped predict the prognosis of patients undergoing PCI. The anatomical CABG SYNTAX score was derived from the anatomical SYNTAX score in patients with prior CABG, whilst the logistic clinical SYNTAX score was developed by incorporating clinical factors into the anatomical SYNTAX score. Methods: We calculated the anatomical CABG SYNTAX score and logistic clinical SYNTAX score in 205 patients in the GLOBAL LEADERS trial. The predictive abilities of these scores for 2-year all-cause mortality were evaluated. Results: Using the median scores as categorical thresholds between low and high score groups, the logistic clinical SYNTAX score was able to discriminate the risk of 2-year mortality, unlike the anatomical CABG SYNTAX score. The logistic clinical SYNTAX was significantly better at predicting 2-year mortality, compared to the anatomical CABG SYNTAX score, as evidenced by AUC values in receiver-operating characteristic curve analysis (0.806 vs. 0.582, p <.001) and integrated discrimination improvement (0.121, p <.001). Conclusions: The logistic clinical SYNTAX score was superior to the anatomical CABG SYNTAX score in predicting 2-year mortality

Evolution and Scientific Impact of Research Grants From the Spanish Society of Cardiology and Spanish Heart Foundation (2000-2006)

© 2011 This document is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the submitted version of a published work that appeared in final form in Revista Española de CardiologíaMétodos Utilizando los datos de identificación de cada proyecto como términos de búsqueda, se recuperaron todos los artículos derivados de estas becas en las bases de datos del Índice Médico Español, el Índice Bibliográfico Español en Ciencias de la Salud, el Science Citation Index-Expanded y Scopus. Los artículos se sometieron a un análisis estadístico descriptivo en relación con la tipología de las becas, la evolución anual de su número y de su importe, el sexo y las instituciones de los becados. Resultados Se concedieron 207 becas con un importe total de 3.270.877 € y una dotación media anual de 467.268 €. De ellas, 123 (59,42%) aportaron publicaciones derivadas. El promedio de artículos publicados por beca concedida ha sido de 1,12, y de 1,9 si se tiene en cuenta únicamente las becas que dieron lugar a publicaciones. Conclusiones Durante el periodo 2000-2006, la Sociedad Española de Cardiología/Fundación Española del Corazón destinó casi 500.000 € anuales a financiar becas de investigación y así contribuir a luchar contra las enfermedades cardiovasculares. Casi el 60% de las becas han aportado publicaciones derivadas, 231 artículos. El 73% de los artículos se publicaron en revistas extranjeras y el 91,34%, en revistas españolas o extranjeras con factor de impacto en el Journal Citation Reports.Introduction and objectives: The Sociedad Española de Cardiología (Spanish Society of Cardiology) every year awards grants to finance research in the field of cardiovascular diseases. The aim of this study is to identify the impact of these investments during the period 2000-2006 from the subsequently published articles in scientific journals. Methods: Using the identifying data of each project as search terms, all articles that resulted from these grants were located in the Spanish Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud databases, and in Science Citation Index-Expanded and Scopus. Descriptive statistical analysis of these articles included type of grant, number and amount awarded per year, and the recipient’s sex and institutional affiliation. Results: The Sociedad Española de Cardiología awarded €3 270 877 to 207 recipients, an average annual total of €467 268. We identified 231 publications that resulted from 123 (59.42%) of these grants. The average number of articles per grant awarded was 1.12, and 1.9 when taking into account only the awards that led to publication.Conclusions: During the period 2000 to 2006, the Sociedad Española de Cardiología/ Fundación Española del Corazón (Spanish Heart Foundation) provided about €500 000 per year to fund research grants, thereby contributing to the fight against cardiovascular diseases. Almost 60% of grants have led to publications, 73% of which were published in international journals, and 91.34% in national or international journals with an impact factor in the Journal Citation Reports