On the protective effect of resilience in patients with acute coronary syndrome

Research on the contribution of positive personality traits to the progression of coronary heart disease (CHD) is notably absent. Resilience is the capacity to develop oneself successfully despite adverse circumstances. In a study of patients with acute coronary syndrome (ACS), the authors investigated the effect of resilience on indicators of CV severity and the physiological mechanisms underlying this effect. Patients (n = 134) completed a scale measuring resilience. The authors measured troponin-I and myoglobin as indicators of ACS severity, and white blood cell (WBC) count and neutrophils as inflammatory markers. Results showed that self-efficacy-a component of resilience-was negatively related to both myoglobin and troponin after the acute coronary event. The relationship between resilience and these prognostic markers was mediated by the WBC count. Importantly, this result held significant after controlling for the effect of classic CV risk factors and demographics. The authors conclude that resilience decreases the extent of the myocardial infarction by affecting the inflammatory response, showing a protective effect.En la actualidad la investigación sobre la influencia de los rasgos de personalidad positivos sobre la enfermedad coronaria (EC) es escasa. La resiliencia se define como la capacidad para autodesarrollarse con éxito a pesar de las circunstancias adversas. En un estudio, los autores han investigado el efecto de la resiliencia en varios indicadores de severidad en pacientes con síndrome coronario agudo (SCA; n=134) y los mecanismos que subyacen a este efecto. Los pacientes completaron una escala que medían sus niveles de resiliencia. Los autores midieron los niveles de troponina-I y mioglobina como indicadores de la severidad del SCA, y el número total de glóbulos blancos (NGB) y neutrófilos como marcadores de inflamación. Los resultados han puesto de manifiesto que el nivel de auto-eficacia –un componente de la resiliencia– se relaciona negativamente con los niveles de mioglobina y troponina después de un evento coronario agudo. La relación entre la resiliencia y estos marcadores está mediada por el NGB. Este resultado se mantiene tras controlar el efecto de los factores cardiovasculares clásicos y demográficos. Los autores concluyen que la resiliencia reduce la extensión del infarto de miocardio influyendo en la respuesta inflamatoria, mostrando un efecto protector.Open Access funded by Asociación Española de Psicología ConductualThis research was supported by grants PSI2011-22954, to R. García-Retamero and PSI2012-39292 to Andrés Catena

Novel SCN5A mutation associated with idiopathic ventricular fibrillation due to subclinical Brugada syndrome

Idiopathic ventricular fibrillation can be caused by subclinical channelopathies such as Brugada syndrome. Our objective is to study the clinical behaviour of a new SCN5A mutation found in a woman with idiopathic ventricular fibrillation. A 53-year-old woman presented with multiple episodes of ventricular fibrillation, a structurally normal heart and normal baseline electrocardiogram. Genetic testing included KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2 and KCNJ2 and identified a mutation in SCN5A (D1816fs/g98747-98748insT). We studied 15 immediate family members by means of electrocardiogram, echocardiogram, flecainide challenge test and genetic study. Eight subjects had the mutation. The flecainide challenge test was positive for Brugada syndrome in two subjects in the case group and none in the control group. The PR and QRS intervals on the baseline electrocardiogram were longer in the case group. The left atrial volume indexed to body surface was higher in the case group, likely due to the fact that two patients with the mutation had atrial fibrillation and none had it in the control group. The D1816fs/g98747-98748insT mutation in SCN5A may be associated with idiopathic ventricular fibrillation and Brugada syndrome with a broad phenotypic spectrum and incomplete penetrance. Genetic testing may be useful to identify the etiology of idiopathic ventricular fibrillation in patients with a negative thorough clinical evaluation

A Randomized Comparison of Drug-Eluting Balloon Versus Everolimus-Eluting Stent in Patients With Bare-Metal Stent–In-Stent Restenosis The RIBS V Clinical Trial (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent)

ObjectivesThis study sought to compare the efficacy of drug-eluting balloons (DEB) with that of everolimus-eluting stents (EES) in patients with bare-metal stents (BMS) in-stent restenosis (ISR).BackgroundTreatment of patients with ISR remains a challenge.MethodsThis was a prospective, multicenter, randomized trial comparing DEB with EES in patients with bare-metal stents (BMS) in-stent restenosis (ISR). The primary endpoint was the minimal lumen diameter at 9 months' follow-up.ResultsA total of 189 patients with BMS-ISR from 25 Spanish sites were included (95 were allocated to DEB and 94 to EES). Procedural success was achieved in all patients. At late angiography (median 249 days; 92% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.36 ± 0.6 mm vs. 2.01 ± 0.6 mm, p < 0.001; absolute mean difference: 0.35 mm; 95% confidence interval [CI]: 0.16 to 0.53) and a lower percent of diameter stenosis (13 ± 17% vs. 25 ± 20%, p < 0.001). However, late loss (0.04 ± 0.5 mm vs. 0.14 ± 0.5 mm, p = 0.14) and binary restenosis rate (4.7% vs. 9.5%, p = 0.22) were very low and similar in both groups. Clinical follow-up (median 365 days) was obtained in all (100%) patients. Occurrences of the combined clinical outcome measure (cardiac death, myocardial infarction, and target vessel revascularization; 6% vs. 8%; hazard ratio [HR]: 0.76; 95% CI: 0.26 to 2.18, p = 0.6) and the need for target vessel revascularization (2% vs. 6%; HR: 0.32: 95% CI: 0.07 to 1.59, p = 0.17) were similar in the 2 groups.ConclusionsIn patients with BMS-ISR, both DEB and EES provided excellent clinical results with a very low rate of clinical and angiographic recurrences. However, compared with DEB, EES provide superior late angiographic findings. (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent [RIBS V]; NCT01239953

Evolución de la función ventricular sistólica regional y global tras angioplastia coronaria transluminal

Reducción altaUniv. de Granada, 199

Libro número: XVIII: Libro Coral del Archivo Catedralicio de Jaén

El libro núm. XVIII, dedicado a la festividad de la Purificación de la Virgen, pertenece a la colección de libros de coro de la Catedral de Jaén. Dentro de la misma existen tres ejemplares de finales del siglo XV entre los que se encuentra éste. La miniatura se localiza en el folio 15, y el objetivo de este artículo consiste en una nueva atribución de su autor. Juana Hidalgo Ogáyar, estudiosa de estos libros, atribuyó la iluminación a un anónimo Maestro Osorio, por llevar intercalado en sus orlas el escudo de este obispo. La misma autora señalaba que guarda bastantes semejanzas con los cantorales de Juan de Carrión, en concreto los que ejecutó para las catedrales de Ávila y Toledo. Hoy se sabe que las miniaturas, del siglo XV, de la Catedral de Toledo (1483-1495) son obra del iluminador Cano de Aranda. Y partiendo de esta tesis, al comparar los corales toledanos, y otras obras de Aranda, con la miniatura de la Purificación de la Catedral de Jaén, hemos llegado a la conclusión que pertenece a su mano o a su círculo de iluminadores

Proyecciones del Grupo de Investigación en MuerteSúbita 20 añosdespués de sucreación/ Projections of the Research Group on Sudden Death 20 years after its foundation

Given the challenge posed by cardiovascular sudden death to healthcare systems worldwide, it is very important a multi- and interdisciplinary approach that integrates allmedical and non-medical aspects involved in its assistance. After analyzing the results of the epidemiological research carried out in Cuba over 20 years by the Research Group on Sudden Death, which highlight the importance of this health problem because of its high incidence and its economic, family and social impact, future projections of this working group in addressing this disease were defined. The aim of this article is to describe these projections in order to achieve a better care for these patients. Projections include: better competence and performance in their knowledge and actions, and reaching a consensus to establish a universal definition for its study, diagnosis, and recording of statistical data. The scientific exchange among the various specialties and working groups involved in its medical care is essential to face its high incidence and to generate joint strategies to lessen its impact

Síndrome coronario agudo sin elevación de ST (SCASEST) : angina inestable e infarto sin elevación de ST (AI/IAMNST) : proceso asistencial integrado

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)YesProceso de atención al paciente con dolor torácico en el que la evaluación clínica inicial sugiere la posibilidad de una angina inestable (AI) o un infarto de miocardio (IAM) y en el que el ECG descarta elevación persistente del segmento ST. Una vez confirmado el diagnóstico se procede a seleccionar el tratamiento más adecuado en el menor tiempo posible, garantizando la continuidad asistencial y buscando la máxima recuperación funcional del paciente