Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

. 29. Arqueología

En el presente número, hemos intentado reunir propuestas que reflejen una variabilidad geográfica, cronológica y de enfoques teórico-metodológicos, donde prevalezcan las tipologías y la historia regional. Nuestra intención es que las colaboraciones se vayan enriqueciendo, diversificando y que, sobre todo, se mantenga y se eleve cada vez más la calidad académica. Las dos primeras contribuciones recuperan la investigación y la discusión sobre la Prehistoria de México, que sigue viva y ofrece un estimulante campo de debate. El artículo sobre “Sonora precerámica”, nos muestra que los territorios de las sociedades prehistóricas intersectan las fronteras actuales y requieren de un conocimiento compartido para tratar de entender las evidencias mexicanas. Los datos que se proporcionan revierten las reconstrucciones anteriores, básicamente tipológicas y permiten replantear algunos procesos tempranos sociales y ambientales, referentes a cazadores-recolectores y agricultores incipientes. El segundo trabajo, “El pasado del pasado”, se inicia con el hallazgo de un bifacial de tipología temprana ofrendado en una tumba de El Opeño, en Michoacán, hace una recopilación crítica de los elementos de tipología análoga encontrados en México y reflexiona sobre su presencia eventual en contextos más tardíos, que evidencian una reinterpretación no circunstancial en el ámbito ideológico. Continuando con Michoacán, les ofrecemos la aportación de una cantidad considerable de información obtenida en un “Salvamento arqueológico de dos carreteras”, en las zonas de Maravatío-Zapotlanejo y Morelia-Lázaro Cárdenas. Los datos, de por sí novedosos, en lo inmediato contienen información básica para una propuesta de secuencia cultural y abren la posibilidad de plantear investigaciones a largo plazo. El análisis tipológico tradicional es el tema del trabajo sobre “Comercio durante el Posclásico de la cerámica decorada”. A partir de la distribución espacial en grandes áreas, sobre todo del altiplano, de ciertos estilos cerámicos del Posclásico, el autor reinterpreta su génesis y significado cultural. Además plantea mecanismos de circulación y consumo, en una recopilación bibliográfica acuciosa. Para continuar con el altiplano en el Posclásico, el artículo sobre el “Cerro de los Magueyes: un centro funerario”, además de enriquecer nuestro conocimiento sobre tratamientos funerarios y características poblacionales de matlatzincas y nahuas, nos permite reconocer la importancia que tuvieron las unidades multiétnicas y sus complejos sistemas de interacción. Quedando en el tema de los contextos funerarios, muy socorrido en este número, les presentamos un hallazgo mortuorio en “Balcón de Montezuma”, sitio aún poco conocido, a pesar de ser uno de los más interesantes del estado de Tamaulipas y fronterizo entre los territorios de grupos agricultores y cazadores- recolectores. Para seguir con la “esfera” huasteca en esta misma porción del noreste de México, el trabajo sobre la “Cerámica Huasteca Negro sobre Blanco”, arrancando de consideraciones iconográficas en tres regiones clave, Pánuco, Oxitipa y Tuxpan, realiza correlaciones con estilos escultóricos y soluciones arquitectónicas y propone que esta cerámica es una manifestación tardía y de influencia foránea. El último artículo es una síntesis geográfico-histórica y arqueológica sobre la región de “Los Reyes Metzontla en el sureste de Puebla”. Por medio de la revisión documental y arqueológica, se discuten algunos rasgos de los señoríos del Posclásico y de sus transformaciones durante la colonia temprana. El número contiene las acostumbradas noticias y reseñas. Además, en reconocimiento a la labor de colegas y colaboradores, se incluye la sección de Archivo Técnico en donde se recuperan dos informes emblemáticos de la poco conocida labor del arqueólogo Héctor Gálvez, resultados de sus investigaciones en Chimalhuacán, Estado de México y en Culiacán, Sinaloa. Por último, insistiendo en nuestro propósito de impulsar la discusión académica, los invitamos a apoyar el mejoramiento de la revista a través de contribuciones originales, comentarios y críticas fundamentadas de los artículos.</p

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted