31 research outputs found

    Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis

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    OBJECTIVES: This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration. BACKGROUND: Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool. METHODS: We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance. RESULTS: A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90). CONCLUSIONS: Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA

    Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

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    Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25?kg/m2, 72.1% in those with body mass index ?25?kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6?years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification

    The proportion of Myeloid-Derived Suppressor Cells in the spleen is related to the severity of the clinical course and tissue damage extent in a murine model of Multiple Sclerosis

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    Multiple Sclerosis (MS) is the second cause of paraplegia among young adults, after all types of CNS traumatic lesions. In its most frequent relapsing-remitting form, the severity of the disease course is very heterogeneous, and its reliable evaluation remains a key issue for clinicians. Myeloid-Derived sSuppressor Cells (MDSCs) are immature myeloid cells that suppress the inflammatory response, a phenomenon related to the resolution or recovery of the clinical symptoms associated with experimental autoimmune encephalomyelitis (EAE), the most common model for MS. Here, we establish the severity index as a new parameter for the clinical assessment in EAE. It is derived from the relationship between the maximal clinical score and the time elapsed since disease onset. Moreover, we relate this new index with several histopathological hallmarks in EAE and with the peripheral content of MDSCs. Based on this new parameter, we show that the splenic MDSC content is related to the evolution of the clinical course of EAE, ranging from mild to severe. Indeed, when the severity index indicates a severe disease course, EAE mice display more intense lymphocyte infiltration, demyelination and axonal damage. A direct correlation was drawn between the MDSC population in the peripheral immune system, and the preservation of myelin and axons, which was also correlated with T cell apoptosis within the CNS (being these cells the main target for MDSC suppression). The data presented clearly indicated that the severity index is a suitable tool to analyze disease severity in EAE. Moreover, our data suggest a clear relationship between circulating MDSC enrichment and disease outcome, opening new perspectives for the future targeting of this population as an indicator of MS severity

    Experimental studies for valuing bone healing on Wistar rats with Zoledronic Acid

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    Antecedentes y objetivos: El aumento del consumo de bifosfonatos en la sociedad actual, puede incrementar el riesgo de osteonecrosis mandibular. Se realizó este estudio para valorar si tras la extracción dentaria, después de la administración subcutánea de ácido zoledrónico 7,5μg/Kg o 35 μg/Kg (Zometa®) en ratas Wistar, aparecen signos clínicos, radiográficos e histopatológicos de osteonecrosis y/o inflamación. Lugar de realización: Centro Experimentación Animal del Hospital de Defensa. Material y Métodos: Estudio experimental, in vitro, randomizado, intervencionista. Se utilizaron un total de 30 ratas Wistar (adultas, sanas), repartiéndolas en tres grupos de 10 animales, según sexo, grupo y fármaco: G0: Sin tratamiento con ácido zoledrónico. G1: Con tratamiento de ácido zoledrónico 7,5μg/Kg subcutáneo una dosis en los días 1, 15 y 30. G2: Con tratamiento de ácido zoledrónico 35μg/Kg subcutáneo una dosis en los días 1, 15 y 30. En todos los grupos se realizó exodoncia del primer molar inferior derecho el día 30, sacrificando los animales a las cuatro semanas postextracción, observando clínica, histológica y radiográficamente la aparición de osteonecrosis e inflamación. Resultados: Clínicamente se observaron en un 26,6% falta de epitelización compatible con signos precoces de osteonecrosis mandibular, según criterios de la American Association of Oral Maxillofacial Súrgeons (AAOMS). Esta es dosis dependiente en 3 animales de G1 (10%) y 5 animales de G2 (16,6%). Los resultados presentaron significación estadística p<0,011. Ausencia histológica y radiológica de osteonecrosis p< 0,001 e inflamación p <0,001 en todos los grupos. Conclusiones: La administración subcutánea de 7,5μg/Kg o 35μg/Kg de ácido zoledrónico durante cuatro semanas, tras la realización de una extracción dentaria, no da lugar a signos histopatológicos de osteonecrosis e inflamación (p<0,001) pero si a alteraciones clínicas dosis dependientes (p<0,011) compatibles con estadios iniciales de osteonecrosis mandibular según criterios de la AAOMS.Records and objectives: The increase of biphosphonates consumption on current society may increase the risk of mandibular osteonecrosis. This study was developed in order to value if, after dental extraction with a subcutaneous administration of zoledronic acid 7,5 μg/Kg or 35 μg/Kg (Zometa®) on Wistar rats, any clinic, radiographic or histopathological evidence of osteonecrosis or inflammation appear. Place of execution: Animal Experimentation Centre of the Hospital of Defence. Materials and methods: Experimental study, in vitro, randomized interventionist. A total amount of 30 Wistar rats were used (adults and healthy), divided into 3 groups of 10 animals according to sex, group and medicine. G0: no Zoledronic Acid treatment. G1: Zoledronic Acid treatment 7,5 μg/Kg subcutaneous, one dose on days 1, 15 and 30. G2: Zoledronic Acid treatment 35μg/Kg subcutaneous, one dose on days 1, 15 and 30. On all the groups an extraction of the lower right first molar was done on day 30, killing the animals four weeks post-extraction, observing clinically, histologically and radiographically the appearance of osteonecrosis and inflammation. Results: Clinically, a 26,6% showed a lack of epithelization compatible with early signs of mandibular osteonecrosis, according to the American Association of Oral Maxillofacial Surgeos (AAOMS) criteria. This is a dependent dose on 3 animals from G1 (10%) and 5 animals from G2 (16,6%). These results presented statistic signification p<0,011. Histological and radiological absence of osteonecrosis p<0,001 and inflammation p<0,001 in all the groups. Conclusion: Subcutaneous administration 7,5μg/Kg or 35μg/ Kg of Zoledronic Acid during four weeks, after the dental extraction, does not lead to histopathological signs of osteonecrosis and inflammation (p<0,001) but leads to clinical alterations dose-dependent (p<0,011) compatible with early stages of mandibular osteonecrosis according to AAOMS criteria.Sin financiaciónNo data (2015)UE

    Reparación valvular en la insuficiencia mitral crónica

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    La reparación valvular es el tratamiento quirúrgico ideal de la insuficiencia mitral. En este trabajo presentamos los resultados de la reparación valvular en pacientes con insuficiencia mitral crónica operados en nuestro centro durante los últimos 8 años. Analizamos el grado de corrección de la insuficiencia, el beneficio funcional, la morbimortalidad hospitalaria, la evolución posquirúrgica de la función ventricular y la supervivencia global y libre de reoperación a medio plazo

    Direct Evidence of Photoinduced Electron Diffusion and Trapping in Single Metal Nanoparticles on TiO2 by High Resolution Surface Photovoltage Imaging

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    Trabajo presentado en la Global Conference on Nanotechnology - NanoSeries, celebrada de forma virtual, del 21 al 24 de junio de 2022We studied the effect of gold nanoparticles (Au NPs) deposited on TiO2 on charge generation and trapping during illumination with photons of energy larger than the substrate band gap. We used a novel characterization technique, photoassisted Kelvin probe force microscopy (PA-KPFM), to study the process at the single Au NP level. We found that the photoinduced electron transfer from TiO2 to the Au NP increases logarithmically with light intensity due to the combined contribution of electron¿hole pair generation in the space charge region in the TiO2¿air interface and in the metal¿semiconductor junction. Our measurements on single particles provide direct evidence for electron trapping that hinders electron¿hole recombination, a key factor in the enhancement of photo(electro)catalytic performance [1]

    Resultados a corto plazo de la reparación valvular en la insuficiencia mitral crónica

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    La reparación valvular (RV) es el tratamiento quirúrgico ideal de la insuficiencia mitral (IM). Evaluamos los resultados de la RV en pacientes con IM crónica intervenidos en nuestro centro en los últimos 8 años. Métodos: Entre enero de 1997 y mayo de 2004, 70 pacientes con IM crónica fueron sometidos a RV. El 16% tenía una fracción de eyección ventricular izquierda (FEVI) ≤ 39%. La etiología de la IM fue degenerativa en 36 casos, isquémica en 11, miocardiopatía hipertrófica en 10, miocardiopatía dilatada en cinco, endocarditis en cuatro y reumática en cuatro. Las plastias más frecuentes fueron: resección cuadrangular de velo posterior y anillo (n = 25), Alfieri (n = 18), anillo (n = 14) y plicatura del velo anterior (n = 10). Resultados: El seguimiento medio fue de 38 ± 22 meses. Los grados de IM y disnea mejoraron significativamente tras la RV. La FEVI se preservó tras la cirugía, el diámetro telediastólico del ventrículo izquierdo disminuyó y el telesistólico lo hizo sólo en el grupo con FEVI deprimida. La mortalidad hospitalaria fue del 2,8 y 9% en el grupo con disfunción ventricular. La supervivencia global y libre de reoperación fue del 95,7 ± 2,4% y 94,6 ± 3,1% a los 3 años, respectivamente. Conclusiones: La RV produce una adecuada corrección de la IM, con una morbimortalidad y una tasa de reoperación bajas, previene la disfunción sistólica posquirúrgica y revierte el remodelado ventricular. En pacientes con disfunción sistólica preoperatoria se puede realizar de forma segura y puede constituir una alternativa al trasplante en casos seleccionados
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