Left ventricular hypertrophy (LVH) portends a worse outcome after non–ST-elevation acute myocardial infarction (NSTEMI). However, its definition has varied and the incremental prognostic information ...provided by echocardiography has been unclear. Different electrocardiographic and echocardiographic criteria for LVH were compared for their ability to predict in-hospital complications in 451 consecutive patients with a first NSTEMI, 337 of whom had a reliable echocardiogram. Five to 8% had LVH using Sokolow-Lyon or Cornell (voltage or product) criteria on admission; 15%, using either electrocardiographic criteria; and 24%, using echocardiography. LVH predicted the occurrence of adverse events (death, reinfarction, or severe angina or heart failure), with the strongest association found for the Cornell product (50.0% vs 24.9% of patients meeting or not meeting this criterion had complications, respectively; p = 0.002). This association persisted after adjusting for baseline clinical predictors (odds ratio 2.52, 95% confidence interval 1.19 to 5.35), and considering echocardiographic LVH did not improve the prediction. LVH was more closely related to heart failure occurrence than to recurrent ischemic events. A progressive increase in the rate of complications was observed across quartiles of the components of all LVH criteria (17.1%, 23.7%, 31.7%, and 36.2% for Cornell product, respectively; p <0.001). In conclusion, LVH, especially an abnormal Cornell product, increased the risk of heart failure, but was weakly related to recurrent ischemia in patients with NSTEMI. Echocardiographic LVH did not appear to add prognostic information to the electrocardiogram. However, considering LVH criteria in a more quantitative manner may augment their ability to predict adverse events in this population.
The diagnostic yield of 24-hour ECG Holter monitoring (24H) is currently overcome by alternative ECG monitoring techniquesand it needs to be optimized. The recognition of inter-atrial block (IAB) has ...emerged as a reliable indicator of patients at risk of atrial fibrillation relapses, and its role enhancing the yield of 24H is yet to be determined. We hypothesized that a presumably low yield of 24H may be ameliorated by means of incorporating the assessment for IAB.
We retrospectively analyzed 1017 consecutive 24H registers performed in a Multidisciplinary Integrated Health Care Institution, in which a restrictive definition of diagnostic 24H findings was used. A univariate and multivariate regression analysis served to determine the variables associated with a higher 24H's yield, including the requesting medical specialty, type of indication and a number of clinical, echocardiographic and ECG variables, including IAB.
The mean age of our population was 62 ± 17 years (55% males). The majority of 24H were indicated from the Cardiology department (48%). The overall yield was 12.8%, higher for the assessment of the integrity of the electrical conduction system (26.1%) and poorer for the assessment of syncope (3.2%) and cryptogenic stroke (4.6%). The variables associated with higher diagnostic performance were indication from Cardiology (p < 0.001), IAB (p = 0.004), structural heart disease (p = 0.008) and chronic renal failure (p = 0.009). Patients ≤ 50 years old only retrieved a 7% yield. In the multivariate analysis, indication from Cardiology and IAB remained significant predictors of higher 24H's yield. In a secondary analysis including echocardiographic data, only identification of IAB remained statistically significant.
The recognition of IAB and the type of indication are major determinants of a higher 24H's diagnostic yield and may help to optimize the selection of candidates.
The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter ...registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement AVR and transcatheter aortic valve implantation TAVI). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.
Se describen los resultados del Registro Nacional de Ablación con Catéter correspondientes al año 2018.
La recogida de datos se ha realizado de manera retrospectiva con la cumplimentación de un ...formulario de recogida de datos por cada uno de los centros participantes.
Se han analizado los datos enviados por 100 centros, con un número total de procedimientos de ablación de 16.566, el más alto comunicado históricamente en este registro (con una media de 165,5±127,9 y una mediana de 119 procedimientos por centro). Se consolida la ablación de fibrilación auricular como el sustrato abordado con más frecuencia (n=4.234; 25,6%), seguida de la taquicardia por reentrada nodular (n=3.525; 21,3%) y el istmo cavotricuspídeo (n=3.425; 20,7%). Se observa un nuevo pico en el número de procedimientos de ablación de fibrilación auricular y aumenta la distancia respecto a los demás sustratos. La tasa total de éxito fue del 91%; la de complicaciones mayores, del 2,2% y la mortalidad, del 0,04%. El 2,1% de las ablaciones se realizaron en pacientes pediátricos.
El Registro Nacional de Ablación con Catéter con Catéter recoge sistemática e ininterrumpidamente los procedimientos de ablación realizados en España, lo que permite observar a lo largo de los años un aumento progresivo del número de ablaciones manteniendo una tasa de éxito elevada y unos porcentajes de complicaciones bajos.
This report presents the findings of the 2018 Spanish Catheter Ablation Registry.
Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers.
Data sent by 100 centers were analyzed, with a total number of 16,566 ablation procedures performed (the highest historically reported in this registry) for a mean of 165.5±127.9 and a median of 119 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n=4234; 25.6%), atrioventricular nodal re-entrant tachycardia (n=3525; 21.3%) and cavotricuspid isthmus (n=3425; 20.7%). A new peak was observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was 91%. The rate of major complications was 2.2%, and the mortality rate was 0.04%. A total of 2.1% of the ablations were performed in pediatric patients.
The Spanish Catheter Ablation Registry systematically and continuously enrolls the ablation procedures performed in Spain, showing a progressive increase in the number of ablations over the years, with a high success rate and low percentage of complications.
This report presents the findings of the 2018 Spanish Catheter Ablation Registry.
Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers.
...Data sent by 100 centers were analyzed, with a total number of 16566 ablation procedures performed (the highest historically reported in this registry) for a mean of 165.5±127.9 and a median of 119 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n=4234; 25.6%), atrioventricular nodal re-entrant tachycardia (n=3525; 21.3%) and cavotricuspid isthmus (n=3425; 20.7%). A new peak was observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was 91%. The rate of major complications was 2.2%, and the mortality rate was 0.04%. A total of 2.1% of the ablations were performed in pediatric patients.
The Spanish Catheter Ablation Registry enrolls systematically and continuously enrolls the ablation procedures performed in Spain, showing a progressive increasing in the number of ablations over the years, with a high success rate and low percentage of complications.
Se describen los resultados del Registro Nacional de Ablación con Catéter correspondientes al año 2018.
La recogida de datos se ha realizado de manera retrospectiva con la cumplimentación de un formulario de recogida de datos por cada uno de los centros participantes.
Se han analizado los datos enviados por 100 centros, con un número total de procedimientos de ablación de 16.566, el más alto comunicado históricamente en este registro (con una media de 165,5±127,9 y una mediana de 119 procedimientos por centro). Se consolida la ablación de fibrilación auricular como el sustrato abordado con más frecuencia (n=4.234; 25,6%), seguida de la taquicardia por reentrada nodular (n=3.525; 21,3%) y el istmo cavotricuspídeo (n=3.425; 20,7%). Se observa un nuevo pico en el número de procedimientos de ablación de fibrilación auricular y aumenta la distancia respecto a los demás sustratos. La tasa total de éxito fue del 91%; la de complicaciones mayores, del 2,2% y la mortalidad, del 0,04%. El 2,1% de las ablaciones se realizaron en pacientes pediátricos.
El Registro Nacional de Ablación con Catéter con Catéter recoge sistemática e ininterrumpidamente los procedimientos de ablación realizados en España, lo que permite observar a lo largo de los años un aumento progresivo del número de ablaciones manteniendo una tasa de éxito elevada y unos porcentajes de complicaciones bajos.
Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular ...tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.
Replication of a damaged DNA template can threaten the integrity of the genome, requiring the use of various mechanisms to tolerate DNA lesions. The Smc5/6 complex, together with the Nse2/Mms21 SUMO ...ligase, plays essential roles in genome stability through undefined tasks at damaged replication forks. Various subunits within the Smc5/6 complex are substrates of Nse2, but we currently do not know the role of these modifications. Here we show that sumoylation of Smc5 is targeted to its coiled-coil domain, is upregulated by replication fork damage, and participates in bypass of DNA lesions. smc5-KR mutant cells display defects in formation of sister chromatid junctions and higher translesion synthesis. Also, we provide evidence indicating that Smc5 sumoylation modulates Mph1-dependent fork regression, acting synergistically with other pathways to promote chromosome disjunction. We propose that sumoylation of Smc5 enhances physical remodeling of damaged forks, avoiding the use of a more mutagenic tolerance pathway.
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•Smc5-SUMO is a specific read-out for damaged replication forks•SUMO preferentially targets lysines in the coiled-coil domain of Smc5•smc5-KR is epistatic to MPH1, upregulating TLS and reducing strand exchange•Defects in Smc5 sumoylation are normally backed up by the Mms4-Mus81 nuclease
Zapatka et al. show that sumoylation of Smc5 helps cells tolerate DNA lesions at damaged replication forks in an error-free mode. Using unsumoylatable smc5-KR mutants, they show that this modification operates through Mph1 in fork regression, working in parallel with several nucleases and helicases to promote chromosome segregation.
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