Implante de prótesis mitral mecánica intraauricular integrada con parche de pericardio

Systemic calcifications are often seen in patients with end-stage renal failure. Focusing in the hearth, the presence of annular calcification of the mitral valve can make anatomic implantation of a prosthesis unfeasible. The debridement of the calcified tissues may result in fatal complications. However, useful surgical techniques have been developed for these patients during the past two decades. We describe the case of a 37-year-old woman with severe mitral regurgitation due to the calcification of the mitral annulus who underwent implantation of an intra-atrial prosthesis.Las calcificaciones sistémicas son un hallazgo frecuente en pacientes con enfermedad renal avanzada. A nivel cardíaco, la presencia de calcio en el anillo valvular mitral puede hacer inviable el implante de una prótesis en la posición anatómica clásica. El desbridamiento de los tejidos calcificados puede derivar en complicaciones mortales. Sin embargo, durante las pasadas dos décadas se han desarrollado alternativas eficaces para estos pacientes. Se describe el caso de una mujer de 37 años con insuficiencia mitral severa secundaria a la calcificación del anillo mitral en la que se llevó a cabo la implantación de una prótesis mecánica intraauricular

Independent estimates of marine population connectivity are more concordant when accounting for uncertainties in larval origins

Marine larval dispersal is a complex biophysical process that depends on the effects of species biology and oceanography, leading to logistical difficulties in estimating connectivity among populations of marine animals with biphasic life cycles. To address this challenge, the application of multiple methodological approaches has been advocated, in order to increase confidence in estimates of population connectivity. However, studies seldom account for sources of uncertainty associated with each method, which undermines a direct comparative approach. In the present study we explicitly account for the statistical uncertainty in observed connectivity matrices derived from elemental chemistry of larval mussel shells, and compare these to predictions from a biophysical model of dispersal. To do this we manipulate the observed connectivity matrix by applying different confidence levels to the assignment of recruits to source populations, while concurrently modelling the intrinsic misclassification rate of larvae to known sources. We demonstrate that the correlation between the observed and modelled matrices increases as the number of observed recruits classified as unknowns approximates the observed larval misclassification rate. Using this approach, we show that unprecedented levels of concordance in connectivity estimates (r = 0.96) can be achieved, and at spatial scales (20–40 km) that are ecologically relevant.Fundação para a Ciência e Tecnologia | Ref. PTDC/BIA-BIC/120483/2010Xunta de Galicia | Ref. POS-A/2012/189Xunta de Galicia | Ref. POS-B/2016/032Fundação para a Ciência e Tecnologia | Ref. SFRH/BD/ 84263/2012CESAM | Ref. UID/AMB/50017 - POCI-01-0145-FEDER-00763

The causes, consequences, and treatment of left or right heart failure

Chronic heart failure (HF) is a cardiovascular disease of cardinal importance because of several factors: a) an increasing occurrence due to the aging of the population, primary and secondary prevention of cardiovascular events, and modern advances in therapy, b) a bad prognosis: around 65% of patients are dead within 5 years of diagnosis, c) a high economic cost: HF accounts for 1% to 2% of total health care expenditure. This review focuses on the main causes, consequences in terms of morbidity, mortality and costs and treatment of HF

Prediction of Mortality and Major Cardiac Events by Exercise Echocardiography in Patients With Normal Exercise Electrocardiographic Testing

ObjectivesWe sought to assess the value of exercise echocardiography (EE) for predicting outcome in patients with known or suspected coronary artery disease and normal exercise electrocardiogram (ECG) testing.BackgroundThe prognostic value of EE in patients with normal exercise ECG testing has not been characterized.MethodsWe studied 4,004 consecutive patients (2,358 men, mean age [± SD] 59.6 ± 12.5 years) with interpretable ECG who underwent treadmill EE and did not develop chest pain or ischemic ECG abnormalities during the tests. Wall motion score index (WMSI) was evaluated at rest and with exercise, and the difference (ΔWMSI) was calculated. Ischemia was defined as the development of new or worsening wall motion abnormalities with exercise. End points were all-cause mortality and major cardiac events (MACE).ResultsOverall, 669 patients (16.7%) developed ischemia with exercise. During a mean follow-up of 4.5 ± 3.4 years, 313 patients died, and 183 patients had a MACE before any revascularization procedure. The 5-year mortality and MACE rates were 6.4% and 4.2% in patients without ischemia versus 12.1% and 10.1% in those with ischemia, respectively (p < 0.001). In the multivariate analysis, ΔWMSI remained an independent predictor of mortality (hazard ratio [HR]: 2.73, 95% confidence interval [CI]: 1.40 to 5.32, p = 0.003) and MACE (HR: 3.59, 95% CI: 1.42 to 9.07, p = 0.007). The addition of the EE results to the clinical, resting echocardiographic and exercise hemodynamic data significantly increased the global chi-square of the models for the prediction of mortality (p = 0.005) and MACE (p = 0.009).ConclusionsThe use of EE provides significant prognostic information for predicting mortality and MACE in patients with interpretable ECG and normal exercise ECG testing

Effect of low-GDP bicarbonate–lactate-buffered peritoneal dialysis solutions on plasma levels of adipokines and gut appetite-regulatory peptides: a randomized crossover study

This is a pre-cpyedited, author-produced version of an article accepted for publication in "Nephrology Dialysis Transplantation" following peer review. The version of record is avaliable online at Oxford Academic web page.Instituto de Salud Carlos III; PI051024Instituto de Salud Carlos III; PI070413Red de Grupos RGTO; G03/028Red de Grupos RGTO; PI050983Xunta de Galicia; PS07/12Xunta de Galicia; PGIDT05PXIC91605PNXunta de Galicia; INCITE08ENA916110E

Prognostic Value of Treadmill Exercise Echocardiography

[Abstract] Introduction and objectives. Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b) whether the number and location of abnormal regions and their responses to exercise influenced risk stratification. Patients and method. The 2,436 patients referred for EE were followed up for 2.1 ±1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarction or cardiovascular death) occurred before revascularization. Results. In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormal result (7.3%) and 31 in those with a normal result (2.5%; P <.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1–2.8; P = .02), metabolic equivalents or METs (RR=0.9; 95% CI, 0.86–0.98; P=.01), peak heart rate × blood pressure (RR= 0.9; 95% CI, 0.9; P=.002), resting wall motion score index (RR=2.5; 95% CI, 1.5–4.1; P <.0001), and number of abnormal regions at peak exercise (RR=1.4; 95% CI, 1.2–1.7; P<.0001) were independently associated with the risk of a serious event (final model χ2, 170; incremental P <.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model χ2, 169; incremental P = .01). Conclusions. Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease.[Resumen] Introducción y objetivos. Aunque la ecocardiografía de ejercicio es útil para el diagnóstico de la enfermedad coronaria, hay menos datos referentes a su valor pronós-tico. El objetivo de este estudio fue esclarecer: a) si hay un valor incremental de la ecocardiografía en el pico del ejercicio respecto a las variables clínicas, la prueba de esfuerzo y la ecocardiografía en reposo, y b) si el número y la localización de los territorios afectados, así como el tipo de respuesta al ejercicio, influyen en la estratificación. Pacientes y método. En 2.436 pacientes referidos para ecocardiografía de ejercicio se realizó un seguimien-to de 2,1 ± 1,5 años. Hubo 120 eventos (infarto no fatal o muerte cardiovascular) antes de la revascularización. Resultados. La ecocardiografía fue anormal en 1.203 pacientes (49%). Hubo 89 eventos en pacientes con resul-tado anormal (7,3%) frente a 31 con resultado normal (2,5%; p < 0,001). Mediante un análisis multivariable de variables clínicas, de la prueba de esfuerzo y de la ecocardiografía en reposo y ejercicio encontramos que las variables asociadas de manera independiente con el riesgo de eventos eran: ser varón (riesgo relativo [RR] = 1,7; interva-lo de confianza [IC] del 95%, 1,1–2,8; p = 0,02), los equiva-lentes metabólicos o MET (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,01), el producto frecuencia cardíaca × presión arterial (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,02), el índice de moti-lidad segmentaria basal (RR = 2,5; IC del 95%, 1,5–4,1; p < 0,0001) y el número de territorios afectados (RR = 1,4; IC del 95%, 1,2-1,7; p < 0,0001) (χ2 final = 170, valor incremental de la ecocardiografía en el máximo esfuerzo; p < 0,0001). Las mismas variables, excepto el sexo, estaban asociadas con la muerte (χ2 final = 169, valor incremental de la ecocardiografía de ejercicio; p = 0,01). Conclusiones. La ecocardiografía en el máximo ejercicio incrementa el valor pronóstico de las variables clínicas, la prueba de esfuerzo y la ecocardiografía de reposo