Background
During COVID‐19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming.
Objective
The objective of this study was to evaluate the ...consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID‐19 outbreak in Spain.
Methods
The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID‐19 pandemic. These patients were followed‐up until April 31th.
Results
Out of the 2,158 patients, 36 (1.7%) died. Mortality was significantly higher in patients pending on structural procedures (4.5% vs. 0.8%, respectively; p < .001), in those >80 year‐old (5.1% vs. 0.7%, p < .001), and in presence of diabetes (2.7% vs. 0.9%, p = .001), hypertension (2.0% vs. 0.6%, p = .014), hypercholesterolemia (2.0% vs. 0.9%, p = .026) Correction added on December 23, 2020, after first online publication: as per Dr. Moreno's request changes in p‐values were made after original publication in ., chronic renal failure (6.0% vs. 1.2%, p < .001), NYHA > II (3.8% vs. 1.2%, p = .001), and CCS > II (4.2% vs. 1.4%, p = .013), whereas was it was significantly lower in smokers (0.5% vs. 1.9%, p = .013). Multivariable analysis identified age > 80, diabetes, renal failure and CCS > II as independent predictors for mortality.
Conclusion
Mortality at 45 days during COVID‐19 outbreak in patients with chronic cardiovascular diseases included in a waiting list due to cancellation of invasive elective procedures was 1.7%. Some clinical characteristics may be of help in patient selection for being promptly treated when similar situations happen in the future.
Introduction
Left bundle branch pacing (LBBP) has emerged in recent years as a new pacing modality, providing patients with a narrower paced QRS than conventional pacing and stable pacing parameters. ...At the same time, there is a growing concern about the use of fluoroscopy in pacemaker implantations, given its harmful effects on both patients and operators. However, there are no prior experiences of zero‐fluoroscopy in LBBP procedure.
Methods
We conducted an observational prospective study recruiting consecutive patients that underwent zero‐fluoroscopy LBBP pacemaker implantation. A 6‐month follow‐up visit was programmed for every patient. The main goal of our study was to assess the efficacy, feasibility, and safety of the procedure.
Results
From January 2021 to February 2022, we included 10 patients, 8 males. The average age was 63 ± 4 years. The procedure was successful in all patients. We observed a significant reduction in paced QRS width compared with basal QRS width (149 ± 31.9 vs. 116 ± 15.6 ms, p = .02). All device parameters remained stable at 6‐month follow‐up: no significant differences in mean impedance (700.5 ± 136.4 vs. 494 ± 72.7 Ohm, p = .09), capture threshold (0.67 ± 0.2 vs. 0.83 ± 0.2 V @ 0.4 ms, p = .27) or endocardial V‐wave amplitude (10.6 ± 5.2 vs. 13.9 ± 6.3 mV, p = .19). No complications were reported in any case.
Conclusion
Zero‐fluoroscopy LBBP is feasible and safe, and it may be considered in cases where radiation exposure is contraindicated or especially undesirable. Future randomized clinical trials are needed for the widespread use of this new technique.
A, D: Right anterior oblique views of the anatomical map of the right atrium and right ventricle from patients 1 and 2. B,E: Left anterior oblique views. C: paced QRS with the mapping catheter from left bundle area with “W” morphology, marked with green tags in the map. F: paced QRS from the final position of the electrode. His bundle are marked with yellow tags in the map. SVC: superior vena cava. RA: right atrium. RV: right ventricle. CS: coronary sinus. RAA: right atrial appendage
During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes.
The objective was to ...identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.
We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared.
Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% p < 0.001 and cardiovascular mortality 4.9% vs 0.9% p = 0.002 in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables.
Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Bioethanol has been identified as a renewable product with high potential for application as biofuel. On the other hand, high volumes of agri‐food residues are generated daily. Such residues have ...potential as raw materials for industrial bioethanol production. There is a significant advance in the synthesis of biofuels from fruit and vegetable residues; however, most of the studies are focused on the conversion of a single type of raw material, limiting the application of the synthesis routes. This work presents a conversion methodology to produce bioethanol from carrot and broccoli residues and from their mixture; the samples of vegetable wastes has been collected in the municipality of Guanajuato, Mexico. Using the 1H NMR technique, the characteristic signals of bioethanol are identified. On the other hand, using the UV–VIS spectrophotometry technique, a maximum of 25.63 mg of total sugar content has been determined for the mixture. Likewise, a maximum bioethanol concentration of 60.6 g/L is obtained. From a refractometry and HPLC study, a conversion to bioethanol of 34.8% is determined for the mixture of residues. This work analyses the potential of broccoli and carrot residues for bioethanol production, either as isolated or as mixed wastes.
This work presents a conversion methodology to produce bioethanol from carrot and broccoli residues and from the mixture of both residues. The vegetable waste has been collected in the municipality of Guanajuato, Mexico. Conversions to ethanol of 21.10%, 26.72%, and 34.82% were obtained for carrot and broccoli residues, and their mixture, respectively.
Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease.
To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and ...clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis.
Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed.
1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034).
The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.
•In a non-controlled, real-life setting, the pressure wire is safe, with an extremely low complications rate.•Following pressure wire use, we have demonstrated a very significant change in assessment of the extent of coronary disease.•Following pressure wire use, we have evidenced a very significant change not only in treatment modality (medical, PCI or CABG) but also in management strategy.•We have shown that the change in treatment modality and/or strategy has prognostic implications, particularly in those patients in which the initial intention was to perform PCI.•These results are different from those observed in previous studies conducted in populations with very limited representation of patients with ACS and in reimbursement-based healthcare systems.
ABSTRACT Introduction and objectives: Drug-eluting balloon (DEB) angioplasty is an effective technique to treat in-stent restenosis (ISR). Neointimal modification with cutting balloon (CB) or scoring ...balloon (SB) enhances the angiographic results of DEB, but with no benefits have been reported in the clinical endpoints at the mid-term. There is lack of information on the clinical long-term results of this strategy. We aim to compare very long-term results of CB before DEB vs standard DEB to treat real-world patients with ISR. Methods: Retrospective cohort registry of DEB PCIs to treat ISR defined by the use of CB. The primary endpoint was clinically driven target lesion revascularization (TLR) at 5 years. The secondary endpoints were based on the ARC-2 criteria. Results: From January 2010 to December 2015, 107 ISRs were treated with DEB in 91 patients. CBs were used in 51 lesions (46 patients). Both cohorts were well balanced regarding clinical, lesion, and procedural characteristics. Compared to standard DEBs, CBs showed lower, although statistically non-significant rates, of TLR at 5 years (9.8% vs 23.6%, OR, 0.36; 95% confidence interval 0.19 to 1.09 P = .05). The Kaplan-Meier cumulative incidence of time until TLR showed similar results (log-rank test P value = .05) with similar rates of TLR at 1 year (3.9% vs 7.1%, P = .68) as curve separation in the long-term. There were no differences in the secondary endpoints. No stent thrombosis was reported. Conclusions: In a real-world setting, neointimal modification with CB before DEB vs standard DEB to treat ISR shows lower, although statistically non-significant rates of TLR at 5 years. This benefit has been confirmed in the long-term and is consistent with bare-metal and drug-eluting stents.
A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under ...fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation.
We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences.
A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω),
= 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%,
= 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω,
< 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω,
= 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g,
= 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up.
LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.
Atrioventricular block in patients with a prosthetic tricuspid valve and a pacemaker with a dysfunctional epicardial lead is not uncommon. In such instances, coronary sinus lead placement is the ...preferred option, but it has a failure rate of 10%-15%. An atrial transseptal left ventricular lead placement has been proposed as an alternative, but this approach is not feasible in patients with a prosthetic mitral valve. This analysis represents the first reported case of His-bundle pacing from the atria in a patient with prosthetic tricuspid and mitral valves, with no suitable coronary veins for lead placement.
Le bloc auriculo-ventriculaire n'est pas rare chez les patients ayant reçu une valve tricuspide prothétique et porteurs d'un stimulateur cardiaque dont la sonde épicardique est dysfonctionnelle. Dans de tels cas, le positionnement de la sonde sur le sinus coronaire est l'option à privilégier, mais son taux d’échec varie entre 10 et 15 %. L'implantation de la sonde sur le ventricule gauche par la voie transsetale a été proposée à titre de solution de rechange, mais cette approche n'est pas envisageable chez les patients ayant reçu une valve mitrale prothétique. La présente analyse constitue le premier cas de stimulation du faisceau de His à partir des oreillettes chez un patient ayant reçu des valves tricuspides et mitrales prothétiques, en l'absence de veines coronaires se prêtant à l'implantation de la sonde.
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