Background
Current guidelines do not recommend routine assessment of right atrial volume due to the lack of standardized data. Three‐dimensional wall‐motion tracking (3D‐WMT) is a new technology that ...allows us to calculate volumes without any geometric assumptions. The aim of this study was to define the indexed reference values for two‐dimensional echocardiography (2D‐echo) and 3D‐WMT in adult healthy population and to assess the intermethod, intra‐ and interobserver agreement.
Methods
Prospective study. Nonselected healthy subjects were enrolled. Every patient underwent a 2D‐echo and a 3D‐WMT examination. 2D‐echo right atrial volume was obtained by using the area‐length method (A‐L) from four‐ and two‐chamber view. 3D‐echo volumes were assessed by 3D‐WMT. Values were indexed by the patient's body surface area.
Results
Sixty consecutive healthy subjects were enrolled. Mean age was 57 ± 12‐years old and 27 patients (45%) were male. Average indexed right atrial volume obtained by 2D‐echo and 3D‐echo was 16.76 ± 8.15 mL/m2 and 19.05 ± 6.87 mL/m2, respectively. Univariate linear regression analysis between 2D‐echo and 3D‐echo right atrial volumes shows a weak correlation between right atrial volume obtained with 2D‐echo compared with 3D‐WMT (r = 0.29, CI 95% 0.029–0.66, P = 0.033). The agreement analysis shows a similar result (intraclass correlation coefficient ICC = 0.28). The intra‐ and interobserver agreement analysis showed a better agreement when using 3D‐WMT.
Conclusions
This is the first study that reports the reference indexed right atrial volume values by means of 2D‐echo and 3D‐echo in healthy population. 3D‐WMT is a feasible and reproducible method to determine right atrial volume.
Most care for people with chronic or disabling conditions living in the community is provided in the family context, and this care is traditionally provided by women. Providing informal care has a ...negative impact on caregivers' quality of life, which adds to existing health inequalities associated with gender. The aim of this study was to analyze factors associated with the health-related quality of life of caregivers and to determine their differences in a gender-differentiated analysis.
An observational, cross-sectional, multicenter study was conducted in primary healthcare. A total of 218 caregivers aged 65 years or older were included, all of whom assumed the primary responsibility for caring for people with disabling conditions for at least 6 months per year and agreed to participate in the CuidaCare study. The dependent variable was health-related quality of life, assessed with the EQ-5D. The explanatory variables tested were grouped into sociodemographic variables, subjective burden, caregiving role, social support and variables related to the dependent person. The associations between these variables and health-related quality of life were estimated by fitting robust linear regression models. Separate analyses were conducted for women and men.
A total of 72.8% of the sample were women, and 27.2% were men. The mean score on the EQ-5D for female caregivers was 0.64 (0.31); for male caregivers, it was 0.79 (0.23). There were differences by gender in the frequency of reported problems in the dimensions of pain/comfort and anxiety/depression. The variables that were associated with quality of life also differed. Having a positive depression screening was negatively associated with quality of life for both genders: -0.31 points (95% CI: -0.47; -0.15) for female caregivers and -0.48 points (95% CI: -0.92; -0.03) for male caregivers. Perceived burden was associated with quality of life in the adjusted model for women (-0.12 points; 95% CI: -0.19; -0.06), and domestic help was associated in the adjusted model for male caregivers (-0.12 points; 95% CI: -0.19; -0.05).
Gender differences are present in informal caregiving. The impact of providing informal care is different for male and female caregivers, and so are the factors that affect their perceived quality of life. It could be useful it incorporates a gender perspective in the design of nursing support interventions for caregivers to individualize care and improve the quality of life of caregivers.
NCT01478295 https://ClinicalTrials.gov . 23/11/2011.
First experience of percutaneous Bi-Pella in Spain Puerto, Elena; Martín-Asenjo, Roberto; Maruri, Ramón ...
Revista española de cardiología (English ed.),
August 2021, 2021-08-00, Letnik:
74, Številka:
8
Journal Article
In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous ...biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted.
We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device.
The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88).
Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach.
En los últimos años se ha asistido a un gran aumento en el número de implantes de dispositivos cardiacos con terapia de resincronización cardiaca. Los beneficios obtenidos con dicha terapia están directamente relacionados con el mantenimiento de la estimulación biventricular continua. Este trabajo analiza la incidencia de pérdida de estimulación biventricular, sus causas, la actitud adoptada y los resultados.
Se analizaron los datos clínicos y de seguimiento de una serie de pacientes consecutivos de un centro a los que se implantó un dispositivo con terapia de resincronización cardiaca.
Se estudió a un total de 136 pacientes. Durante un seguimiento medio de 33,4 meses, 45 pacientes (33%) sufrieron pérdida de estimulación biventricular continua. Las causas más frecuentes fueron las taquiarritmias auriculares (21,3%), seguidas de la dislocación de cables (18%) y el fallo de captura del cable de ventrículo izquierdo (13,1%). La pérdida de estimulación biventricular continua fue transitoria y corregible en la mayoría (88,5%) de los casos y ocurrió más precozmente en los casos de dislocación de cables, sobresensado y estimulación extracardiaca. No hubo diferencias significativas de mortalidad entre los grupos de pacientes con y sin pérdida de estimulación biventricular continua (p = 0,88).
Pese a los avances técnicos en la terapia de resincronización cardiaca, la pérdida de la estimulación biventricular continua es una situación clínica frecuente pero corregible en la mayoría de los casos. Un seguimiento estrecho de los pacientes y una actitud proactiva garantizan lograr la estimulación biventricular continua en la mayoría de los pacientes.
Sprint Fidelis defibrillation leads are prone to early failure. Most of the reported series come from a single institution. This paper describes the clinical experience in nine Spanish hospitals.
...Clinical, implant, and follow-up data of all patients with a Sprint Fidelis lead were analyzed. All cases of lead failure were identified, medium-term lead survival was calculated, and possible predictors for lead failure were determined.
In total, 378 leads in 376 patients were studied. The mean age (male 85.7%) was 64.9
±
13.6
years. The majority of patients (59.8%) had ischemic heart disease. Mean left ventricular ejection fraction was 33.4%
±
14.5%. Left subclavian vein puncture was used in 74.8%. During a mean follow-up of 30.9
±
14 months, 16 lead failures have occurred, with a lead survival of 96.1% at 36 months after implantation. Eleven of 16 lead failures were caused by failure of pace/sense conductors, 3 by defects in the high-voltage conductor, and 2 by defects in both types of conductors. A less depressed left ventricular ejection fraction was associated with an increased probability of lead failure (42.4%
±
16% vs. 33%
±
14.3%;
P
=
.011). Three hospitals presented a rate of lead failure higher than 10%; the rate was less than 5% in the remaining 6 hospitals.
In this multicenter series of 378 leads, the 3-year estimated survival was higher than that reported in prior series. Clinical presentation of lead failures was similar to that reported previously. Left ventricular ejection fraction and hospital of implantation were variables associated to lead failure.
Los electrodos de desfibrilación Sprint Fidelis presentan riesgo de disfunción precoz. La mayor parte de las series en la literatura provienen de un solo centro. Describimos la experiencia clínica en nueve centros españoles.
Se analizaron los datos clínicos, del implante y el seguimiento de todos los pacientes con un electrodo Sprint Fidelis, describiendo los casos problema, calculando la supervivencia del electrodo a medio plazo e identificando posibles predictores de disfunción.
Se incluyó un total de 378 electrodos en 376 pacientes (el 85,7% varones), con una media de edad de 64,9
±
13,6 años. El 59,8% se implantó en pacientes con cardiopatía isquémica. La fracción de eyección ventricular izquierda era 33,4%
±
14,5%. En el 74,8% de los casos se implantó por punción subclavia izquierda. Tras un seguimiento medio de 30,9
±
14 meses, 16 pacientes presentaron disfunción del electrodo; la supervivencia a 36 meses fue del 96,1%. En 11 electrodos ocurrió una disfunción aislada del sistema de sensado/estimulación; en 3, del sistema de alta energía, y en 2, de ambos. Una mejor función ventricular se asoció con una mayor probabilidad de fractura del electrodo (el 42,4%
±
16% frente al 33%
±
14,3%; p
=
0,011); tres centros presentaron una tasa de fracturas superior al 10% y los seis restantes, inferior al 5%.
En esta serie multicéntrica de 378 electrodos, la supervivencia estimada a 3 años resultó mayor que en series previas, con un perfil de presentación clínica similar de las disfunciones. La fracción de eyección ventricular izquierda y el centro implantador fueron variables asociadas a la presencia de disfunción.
Fatal Presentation of a Cardiac Myxoma Domínguez-Pérez, Laura; Fernández-Elías, Elisa; Arias, Miguel A. ...
Revista española de cardiología (English ed.),
June 2012, 2012-Jun, 2012-6-00, Letnik:
65, Številka:
6
Journal Article
The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no ...differences in the number of days alive and out of the hospital at 1 year.
To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up.
The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle.
Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible n = 84) or a conservative (medical treatment with coronary angiography only if recurrent ischemia n = 83) strategy.
The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions.
Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 95% CI, -188 to 230 days). Patients under invasive treatment tended to have shorter survival in the first year (-28 95% CI, -63 to 7 days), which improved after the first year (192 95% CI, 90-230 days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 95% CI, 0.33-0.99; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points.
In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior.
ClinicalTrials.gov Identifier: NCT03208153.
An understudied variant of Alzheimer's disease (AD), the behavioral/dysexecutive variant of AD (bvAD), is associated with progressive personality, behavior, and/or executive dysfunction and frontal ...atrophy.
This study characterizes the neuropsychological and neuroanatomical features associated with bvAD by comparing it to behavioral variant frontotemporal dementia (bvFTD), amnestic AD (aAD), and subjects with normal cognition.
Subjects included 16 bvAD, 67 bvFTD, 18 aAD patients, and 26 healthy controls. Neuropsychological assessment and MRI data were compared between these groups.
Compared to bvFTD, bvAD showed more significant visuospatial impairments (Rey Figure copy and recall), more irritability (Neuropsychological Inventory), and equivalent verbal memory (Philadelphia Verbal Learning Test). Compared to aAD, bvAD indicated more executive dysfunction (F-letter fluency) and better visuospatial performance. Neuroimaging analysis found that bvAD showed cortical thinning relative to bvFTD posteriorly in left temporal-occipital regions; bvFTD had cortical thinning relative to bvAD in left inferior frontal cortex. bvAD had cortical thinning relative to aAD in prefrontal and anterior temporal regions. All patient groups had lower volumes than controls in both anterior and posterior hippocampus. However, bvAD patients had higher average volume than aAD patients in posterior hippocampus and higher volume than bvFTD patients in anterior hippocampus after adjustment for age and intracranial volume.
Findings demonstrated that underlying pathology mediates disease presentation in bvAD and bvFTD.
The aim of this study was to identify the prevalence of genes encoding resistance to three groups of antimicrobial agents in root canal samples from primary infection or post-treatment disease in ...Mexico.
A total of 64 subjects requiring root canal treatment because of primary infection or post-treatment disease were enrolled in this cross-sectional analytical study. Root canal samples were obtained and DNA was isolated. Specific primers for six antimicrobial resistance genes (ARGs) and seven bacterial taxa (five genera and two species) were used. Student's t-test, χ
test and Fisher's exact test were applied where appropriate to detect statistical differences.
The bla
, ermC and tetM genes were found more frequently in the post-treatment disease group compared with the primary infection group. The occurrence of assessed bacteria was similar in both groups, except for Enterococcus spp. and Porphyromonas endodontalis, which were found at a significantly higher frequency in the post-treatment disease group. It was observed that the post-treatment disease group harboured more ARGs. The most frequent ARG was tetW, whereas tetQ and cfxA were not detected in any case. With respect to bacterial taxa, Fusobacterium spp. was present in 100% of samples, whereas Porphyromonas gingivalis was not observed in any of the samples.
At least one ARG was detected in all cases; moreover, 32.8% of samples were positive for four ARGs, 54.7% for three ARGs, 9.4% for two ARGs and only 3.1% for one ARG. This indicates a high prevalence and diversity of ARGs in these root canal samples.
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