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Introduction: Green tea is associated with a series of health benefits, as is physical training. However, in combination they present little known chronotropic and autonomic cardiac effects. Objective: To evaluate the effect of the association of chronic administration of green tea and physical training on basal heart rate (HR) and heart rate variability (HRV) in Wistar rats. Methods: Forty-three Wistar rats (Rattus norvegicus, var. albinus), paired by weight and age, were distributed among four experimental groups, titled sedentary control (CONsed, n = 10), trained control (CONtre, n = 08), sedentary tea (CHÁsed, n = 16) and trained tea (CHÁtre, n = 09). Ingestion of the tea was ad libitum. The physical training protocol lasted for eight weeks and consisted of sessions of swimming with incremental loads. At the end of the training, basal heart rate and heart rate variability (HRV) in both time and frequency domains were determined. The level of significance adopted was 5% (p < 0.05). Results: Both physical training and consumption of green tea caused higher resting bradycardia than that of the CONsed group animals. Regarding HRV, the CONtre, CHÁsed, and CHÁtre groups presented significantly higher values than the CONsed group. Supplementation with green tea caused an increase in the variance, high frequency (HF) component, and sympathovagal balance as compared to the CONsed group. Physical training (PT) did not enhance any of the parameters evaluated. Conclusions: There was no significant optimization of the hemodynamic or autonomic cardiovascular parameters resulting from the association between the administration of green tea and physical training in Wistar rats. Level of Evidence IV; Case Series. RESUMEN Introducción: El té verde está asociado a una serie de beneficios para la salud, así como el entrenamiento físico. Sin embargo, la asociación de ambos presenta efectos cronotrópicos y autonómicos cardíacos poco conocidos. Objetivo: Evaluar el efecto de la asociación de la administración crónica de té verde y el entrenamiento físico sobre la frecuencia cardíaca (FC) basal y la variabilidad de la frecuencia cardíaca (VFC) en ratas Wistar. Métodos: Cuarenta y tres ratas Wistar (Rattus norvegicus, var. albinus), clasificadas por peso y edad, fueron distribuidas en cuatro grupos experimentales denominados control sedentario (CONsed, n = 10), control entrenado (CONtre, n = 08), té sedentario (CHÁsed, n = 16) y té entrenado (CHÁtre, n = 09). La ingesta de té fue “ad libitum”. El protocolo de entrenamiento físico duró ocho semanas y se realizó mediante sesiones de natación con incrementos de carga. Al final, se determinó la frecuencia cardíaca basal y la variabilidad de la frecuencia cardíaca (VFC) en los dominios del tiempo y la frecuencia. El nivel de significancia adoptado fue del 5% (p < 0,05). Resultados: Tanto el entrenamiento físico como el consumo de té verde promovieron una mayor bradicardia en reposo en comparación con los animales del grupo CONsed. En cuanto a la VFC, los grupos CONtre, CHÁsed y CHÁtre presentaron valores significativamente más altos que el grupo CONsed. La suplementación con té verde provocó un aumento de la varianza, del componente de alta frecuencia (HF) y del balance simpático-vagal en relación con el grupo CONsed. El entrenamiento físico (TF) no potenció ninguno de los parámetros evaluados. Conclusiones: No hubo una optimización significativa de los parámetros hemodinámicos y autonómicos cardiovasculares derivada de la asociación entre la administración de té verde y el entrenamiento de ejercicio en ratas Wistar. Nivel de Evidencia IV; Serie de casos. RESUMO Introdução: O chá verde está associado a uma série de benefícios à saúde, assim como o treinamento físico. Porém, a associação de ambos apresenta efeitos cronotrópicos e autonômicos cardíacos pouco conhecidos. Objetivo: Avaliar o efeito da associação da administração crônica de chá verde e do treinamento físico sobre a frequência cardíaca (FC) basal e a variabilidade da frequência cardíaca (VFC) em ratos Wistar. Métodos: Quarenta e três ratos Wistar (Rattus norvegicus, var. albinus), pareados pelo peso e por idade, foram distribuídos em quatro grupos experimentais, intitulados de controle sedentário (CONsed, n = 10), controle treinado (CONtre, n = 08), chá sedentário (CHÁsed, n = 16) e chá treinado (CHÁtre, n = 09). A ingestão de chá foi "ad libitum". O protocolo de treinamento físico teve duração de oito semanas e foi realizado através de sessões de natação com incrementos de carga. Ao final, foram determinadas a frequência cardíaca basal e a variabilidade da frequência cardíaca (VFC) nos domínios do tempo e da frequência. O nível de significância adotado foi de 5% (p < 0,05). Resultados: Tanto o treinamento físico quanto o consumo de chá verde promoveram bradicardia de repouso maior, quando comparados com os animais do grupo CONsed. Com relação à VFC, os grupos CONtre, CHÁsed e CHÁtre apresentaram valores significativamente maiores que o grupo CONsed. A suplementação do chá verde ocasionou aumento da variância, do componente de alta frequência (HF) e do balanço simpato-vagal com relação ao grupo CONsed. O treinamento físico (TF) não potencializou nenhum dos parâmetros avaliados. Conclusões: Não houve otimização significativa nos parâmetros hemodinâmicos e autonômicos cardiovasculares em decorrência da associação entre administração de chá verde e treinamento físico em ratos Wistar. Nível de Evidência IV; Série de casos.

Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1539/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Objetivo: identificar e analisar, a partir da literatura, quais as alterações cardiovasculares em pacientes pós-infecção de Covid-19. Materiais e método: Trata-se de uma revisão integrativa de literatura conduzida por dois revisores independentes, nas bases de dados LILACS, EMBASE, Web of Science, CINAHL e Pubmed. As buscas abrangeram o período de 2019 à 2022 e os idiomas português, inglês e espanhol. A estratégia de busca comtemplou várias palavras-chaves, utilizando-se a abordagem PICo. Resultados: As principais complicações cardíacas resultaram em arritmias com taquicardia/fibrilação ventricular, choque, lesão miocárdica aguda, dor torácica e infradesnivelamento do segmento ST no eletrocardiograma. Conclusões: O conhecimento sobre as complicações cardíacas geradas em pacientes pós infecção de covid-19 tornou-se emergente, visto que isso pode contribuir na colaboração para adoção de protocolos mais eficientes a fim de evitar de alguma forma essas complicações.

Introduction and objectives: There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes. Methods: Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34mL/m2. We analyzed its relationship with atrial electrocardiography parameters. Results: We included 356 participants, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8±8.6 vs 25.6±8.0mL/m2, P=.006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P

Introducción y objetivos La hipotensión arterial es el efecto secundario más frecuente del sacubitrilo/valsartán (SV), lo que puede dificultar su uso en la práctica clínica. Nuestro objetivo fue analizar el impacto de la presión arterial sistólica (PAS) en el tratamiento y pronóstico de los pacientes con insuficiencia cardiaca. Métodos Registro prospectivo y multicéntrico de pacientes ambulatorios que iniciaron tratamiento con SV. Se agrupó a los pacientes en función de la PAS basal y se analizaron las características iniciales, las dosis de SV y los eventos durante el seguimiento. Resultados Se incluyó a 427 pacientes, 129 (30,2%) con una PAS < 110 mmHg, 174 (40,7%) entre 110 y 130 mmHg y 124 (29%) ≥ 130 mmHg. Se realizó un seguimiento de 7 ± 1 meses, donde la hipotensión arterial fue el efecto adverso más frecuente (26,2%, 20,2% y 22,4% respectivamente; p = 0,562), independientemente de la PAS basal. Los pacientes con PAS inicial más baja alcanzaron dosis más bajas de SV al final del seguimiento (dosis máxima: 12,1%, 27,6% y 25,8%; p = 0,05), sin diferencias en la suspensión de tratamiento (15,5%, 8,1% y 11,3%; p = 0,09) ni en la aparición de eventos clínicos adversos (28,9%, 23,6% y 27,1%; p = 0,482). La PAS inicial no se asoció de forma independiente con la mortalidad (HR = 0,77; IC95%, 0,33-1,80). Conclusiones La hipotensión arterial es el efecto adverso más frecuente en pacientes con insuficiencia cardiaca tratados con SV en vida real. La PAS inicial se asocia a la dosis alcanzada pero no a la tasa de retirada de SV ni al pronóstico. Introduction and objectives Arterial hypotension is the most common side effect of sacubitril/valsartan (SV), making it difficult to manage in clinical practice. Our objective was to analyze the impact of systolic blood pressure (SBP) on heart failure patients’ management and prognosis. Methods A prospective registry of outpatients who began treatment with SV was performed. Patients were classified according to baseline SBP. Baseline characteristics, SV doses, and clinical events were analyzed during follow-up. Results A total of 427 patients were included, 129 (30.2%) with a SBP < 110 mmHg, 174 (40.7%) between 110 and 130 mmHg, and 124 (29%) ≥ 130 mmHg. A follow-up of 7 ± 1 months was performed. Arterial hypotension was the most frequent adverse effect (26.2%, 20.2%, and 22.4% respectively; P = .562), regardless of baseline SBP. Patients with a lower baseline SBP achieved lower doses of SV at the end of follow-up (maximum dose: 12.1%, 27.6%, and 25.8%, P = .05). No differences were observed in the withadrawal of treatment (15.5%, 8.1% and 11.3%, P = .09) or in the appearance of adverse clinical events (28.9%, 23.6%, and 27.1%; P = .482) based on the initial SBP. Baseline SBP was not independently associated with mortality (HR, 0.77; 95%CI, 0.33-1.80). Conclusions Arterial hypotension is the most frequent adverse effect in patients with heart failure treated with SV in real life. The initial SBP is associated with the dose achieved but not with the rate of SV withdrawal or prognosis. Sin financiación No data JCR (2021) 0.130 SJR (2021) Q4, 317/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a neuroinflammatory, multifaceted chronic disorder of unknown cause. Accumulating data indicate a link between a redox imbalance, mitochondrial dys-function, and inflammation status in ME/CFS. Coenzyme Q10 (CoQ10) and selenium as effective antioxi-dant and anti-inflammatory agents have shown potential clinical implications in chronic diseases; however, their therapeutic benefits in ME/CFS remain elusive. This open-label exploratory study aimed to evaluate the effec- tiveness of combined CoQ10 plus selenium supplementation on clinical features and circulating biomarkers in ME/CFS. Twenty-seven ME/CFS patients received an oral combination of 400 mg of CoQ10 and 200 lg of selenium daily for 8 weeks. The primary endpoint was patient-reported changes in outcome measures from baseline to 8 weeks' postintervention. Secondary endpoint included changes in circulating biomarkers from base-line to each participant. After an 8-week intervention, a significant improvement was found for overall fatigue severity ( p = 0.021) and global quality of life ( p = 0.002), while there was no significant effect on the sleep dis-turbances ( p = 0.480) among participants. After 8 week's intervention, there was significantly increased total antioxidant capacity, and there were reduced lipoperoxide levels from the participants ( p < 0.0001 for both). Circulating cytokine levels decreased significantly ( p < 0.01 for all), but with no significant changes in the C-reactive protein, FGF21, and NT-proBNP biomarkers after supplementation. Based on these findings, we hypo-thesized that long-term supplementation of combined CoQ10 and selenium may indicate a potentially beneficial synergistic effect in ME/CFS. Antioxid. Redox Signal. 36, 729-739.

Introduction and objectives Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. Methods We retrospectively studied patients aged ≥ 18 years, with a first heart transplant performed between 2000 and 2014 and surviving ≥ 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. Results The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation > 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P = .056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P = .065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P = .011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. Conclusions IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients. Introducción y objetivos El objetivo es estudiar el impacto clínico de la variabilidad intrapaciente (VIP) de la concentración sanguínea de los anticalcineurínicos en el trasplante cardiaco, pues la información actual es escasa. Métodos Se analizó retrospectivamente a pacientes de edad ≥ 18 años con un trasplante cardiaco realizado entre 2000 y 2014 y con supervivencia ≥ 1 año. La VIP se valoró mediante el coeficiente de variación de concentraciones entre los meses 4 a 12 postrasplante. El compuesto de rechazo, mortalidad o pérdida del injerto y la mortalidad o pérdida del injerto 1-5 años tras el trasplante se analizaron mediante regresión de Cox. Resultados Se estudió a 1.581 receptores (edad, 56 años; mujeres, 21%), tratados con ciclosporina (790 pacientes) o tacrolimus (791 pacientes). En el análisis multivariable, un coeficiente de variación > 27,8% tendió a asociarse con el compuesto de rechazo/mortalidad (HR = 1,298; IC95%, 0,993-1,695; p = 0,056) y con la mortalidad (HR = 1,387; IC95%, 0,979-1,963; p = 0,065) a los 5 años. La asociación con el rechazo fue significativa al analizar a la población sin rechazos durante el primer año del trasplante (HR = 1,609; IC95%, 1,129-2,295; p = 0,011). El tacrolimus tuvo menos VIP que la ciclosporina, junto con unos mejores resultados por la menor influencia de la VIP. Conclusiones La VIP de los anticalcineurínicos, especialmente con la inmunosupresión basada en el tacrolimus, se asocia solo marginalmente con los resultados a medio plazo del trasplante cardiaco, aunque puede tener influencia en los pacientes más estables durante el primer año tras el trasplante. Astellas Pharma (Spain) Heart Failure Association of the Spanish Society of Cardiology No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Resumen Introduccion y objetivos El retrasplante cardiaco (ReTC) representa un tema controvertido actualmente. Nuestro objetivo es describir y analizar los resultados del ReTC en Espana. Metodos Analisis retrospectivo del Registro Espanol de Trasplante Cardiaco de 1984 a 2018. Se recogieron datos sobre donante, receptor, cirugia, inmunosupresion y supervivencia. La mortalidad por todas las causas o la necesidad de ReTC postrasplante fueron el objetivo principal. Se estudiaron diferencias en supervivencia segun indicacion, tiempo entre trasplantes y epoca del ReTC. Resultados Se estudiaron en total 7.592 trasplantes cardiacos (TxC) y 173 (2,3%) ReTC (mediana de edad, 52,0 y 55,0 anos respectivamente). La enfermedad vascular del injerto fue la indicacion de ReTC mas frecuente (42,2%) y 59 pacientes (80,8%) recibieron el ReTC mas de 5 anos despues del trasplante inicial. El rechazo agudo y el fallo primario del injerto disminuyeron como indicaciones durante el periodo estudiado. La insuficiencia renal, la hipertension, la necesidad de ventilacion mecanica o balon intraaortico y la mayor duracion de la isquemia fria fueron mas frecuentes en el ReTC. La mediana de seguimiento del ReTC fue 5,8 anos. El ReTC tuvo peor supervivencia que el TxC (HR ponderado = 1,43; IC95%, 1,17-1,44; p Conclusiones El ReTC se asocio con mayor mortalidad que el TxC, especialmente por rechazo agudo. El pronostico del ReTC realizado mas de 5 anos despues es similar al del TxC primario.

Introducción y objetivos Los datos respecto a la utilización del oxigenador extracorpóreo de membrana venoarterial (ECMO-VA) en adultos con shock cardiogénico (SC) son escasos. El objetivo del presente estudio fue describir los datos de un registro multicéntrico español, y analizar qué factores tuvieron un impacto en la mortalidad intrahospitalaria. Métodos Registro retrospectivo multicéntrico español de pacientes en situación de SC profundo que recibieron soporte circulatorio con ECMO-VA. Resultados Desde enero de 2012 hasta octubre de 2018, se asistieron 233 pacientes con ECMO-VA. La edad media fue 56,3 ± 12,18 años y 50 eran mujeres (21,5%). Recibieron el alta hospitalaria 109 pacientes (46,8%). Las complicaciones más frecuentes observadas fueron: insuficiencia renal aguda en 131 (59,0%), hemorragia en 70 (31,7%), hipoxemia en 86 (36,9%) e infección en 99 (43,4%). Los predictores independientes de mortalidad intrahospitalaria fueron lactato al implante (OR = 1,05; IC95%, 1,05-1,19), edad (OR = 2,19; IC95%, 1,05-4,58) y canulación intraparada cardiaca (OR = 1,04; IC95%, 1,01-1,06). Un total de 45 pacientes tenían edad > 60 años y lactato al implante > 8 mmol/l, su mortalidad intrahospitalaria fue de 77,8% y llegó al 91,7% en 12 de ellos en los que la canulación fue intraparada cardiaca. Conclusiones La terapia con ECMO-VA es factible en pacientes con SC profundo. La selección adecuada parece fundamental para evitar la futilidad del implante en pacientes con escasas posibilidades de éxito. Introduction and objectives The data regarding the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults in with cardiogenic shock (CS) are scarce. The aim of this study was to describe the data of a Spanish multicenter registry, and to analyze which factors had an impact on in-hospital mortality. Methods Retrospective Spanish multicenter registry of patients with deep CS treated with VA-ECMO circulatory support. Results From January 2012 to October 2018, 233 patients were treated with VA-ECMO. Mean age was 56.3 ± 12.18 years and 50 were female (21.5%). A total of 109 patients were successfully discharged (46.8%). The most frequent complications were acute kidney injury in 131 (59.0%), hypoxemia in 86 (36.9%) major bleeding in 70 (31.7%), and infection in 99 (43.4%). The independent in-hospital mortality risk factors were lactate before implant (OR, 1.05; 95%CI, 1.05-1.19), age (OR, 2.19; 95%CI, 1.05-4.58), and cannulation during cardiac arrest (OR, 1.04; 95%CI, 1.01-1.06). A total of 45 patients > 60 years with lactate before implant > 8 mmol/l had an in-hospital mortality rate of 77.8%, in-hospital mortality and reached 91.7% in 12 of them with cannulation during cardiac arrest. Conclusions VA-ECMO therapy for patients with deep cardiogenic shock is feasibly. Appropriate selection seems critical in order to avoid the futility of using ECMO in those patients with low survival chances. Sin financiación No data JCR (2021) 0.130 SJR (2021) Q4, 317/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Thermography proves to be a new concept in measuring the thermogenesis of biological systems, a valuable method for confirming clinical diagnosis discarding subjective analysis and personal criteria. The result of the thermographic evaluation is the subject of qualitative and quantitative analyses. This study aimed to identify the thermal profile of the lower extremities of individuals diagnosed with cardiovascular and endocrine and metabolic diseases in the treatment of ulcerative wounds. A thermographic evaluation was performed from 19 dorsal, plantar, lateral, and medial extremities. In the qualitative analysis, images with and without a wound were divided according to diagnosis. After the division, a checklist was elaborated for the qualitative evaluation of the images. A total of 100 individuals (49 women and 51 men) participated, 65 with cardiovascular disease and 35 with endocrine and metabolic disease. There was a difference in the thermal pattern between the extremities in both diagnoses. The groups presented similar thermographic characteristics with signs of more radiation in the wounds, predominantly with red and white stains. More regions of interest with lesions on the medial foot, lateral, and medial ankle border were observed in individuals with chronic cardiovascular disease. Those with endocrine and metabolic disease presented more regions with lesions in the plantar (forefoot), dorsal, and medial ankle regions. The profile showed a discrepancy in the thermal pattern in the regions of interest of wounded and without wound extremities according to the diagnoses. Signs of wounds emitting high levels of radiation were similar in both groups, but the physiology of the disease and treatment differed. RESUMEN La termografía es un nuevo procedimiento para la medición de la termogénesis de los sistemas biológicos y un método valioso para confirmar el diagnóstico clínico que no requiere análisis subjetivos y criterios personales. El resultado de la evaluación termográfica está sujeto a dos análisis: cualitativo y cuantitativo. El objetivo de este estudio fue identificar el perfil térmico de los miembros inferiores en individuos con diagnóstico de enfermedades endocrinometabólicas y circulatorias en tratamiento por lesiones ulcerativas. Para ello, se realizó una evaluación termográfica de 19 regiones, distribuidas en las regiones dorsal, plantar, lateral y medial de los miembros. En el análisis cualitativo, las imágenes con y sin lesiones se dividieron por diagnóstico. Después de la división, se elaboró una lista de verificación para la evaluación cualitativa de las imágenes. Participaron 100 individuos (49 mujeres y 51 hombres), de los cuales 65 tenían enfermedad circulatoria y 35 enfermedad endocrinometabólica. Hubo una diferencia en el estándar de color entre los miembros en ambos diagnósticos. Los grupos mostraron características termográficas similares, con signos de hiperradiación en las lesiones, predominantemente de colores rojo y blanco. Se observó un mayor número de lesiones en el borde medial del pie y en el lateral y medial del tobillo en individuos con enfermedad circulatoria. Aquellos con enfermedad endocrinometabólica presentaron mayor número de lesiones en la región plantar (antepié), dorsal y medial del tobillo. El perfil reveló discrepancia en el color en las regiones de interés de los miembros con y sin lesiones según los diagnósticos. Aunque los signos de hiperradiación de las lesiones fueron similares en ambos grupos, la fisiología de las enfermedades y los tratamientos difirieron. RESUMO A termografia revela-se como um novo conceito na mensuração da termogênese de sistemas biológicos e um método valioso para confirmação de diagnóstico clínico que dispensa análises subjetivas e critérios pessoais. O resultado da avaliação termográfica é alvo de duas análises: qualitativa e quantitativa. O objetivo deste estudo foi identificar o perfil térmico das extremidades inferiores de indivíduos diagnosticados com doenças de base endocrinometabólica e circulatória em tratamento de feridas ulcerativas. Para tanto, foi realizada avaliação termográfica de 19 regiões, distribuídas nas áreas dorsal, plantar, lateral e medial das extremidades. Na análise qualitativa, as imagens com e sem ferida foram divididas de acordo com o diagnóstico. Após a divisão, elaborou-se um checklist para a avaliação qualitativa das imagens. Participaram 100 indivíduos (49 mulheres e 51 homens), sendo 65 com doença circulatória e 35 com doença endocrinometabólica. Houve diferença no padrão de coloração entre as extremidades em ambos os diagnósticos. Os grupos apresentaram características termográficas semelhantes, com sinais de hiperradiação nas feridas, predominantemente de colorações vermelho e branco. Foi observado maior número de lesões na borda medial de pé e na lateral e medial de tornozelo nos indivíduos com doença de base circulatória. Já aqueles com doença de base endocrinometabólica apresentaram maior número de lesões nas regiões plantar (antepé), dorsal e medial de tornozelo. O perfil revelou discrepância na coloração das regiões de interesse da extremidade com e sem ferida, de acordo com os diagnósticos. Os sinais de hiperradiação das feridas foram semelhantes nos dois grupos, porém a fisiologia das doenças e os tratamentos diferiram.

La arquitectura muscular del miocardio del corazón está constituida fundamentalmente por células musculares de trabajo o cardiomiocitos responsables de la contracción miocárdica, y un espacio intersticial con un componente de células productoras de colágeno o fibroblastos, rodeados de una matriz extracelular de tejido conectivo. Pequeños grupos celulares de localización predominante en las aurículas contienen características neuroendocrinas. Para que se produzca la activación del miocardio de trabajo estriado y el acoplamiento excitación-contracción a través del potencial de acción transmembrana, es necesaria la presencia de las células especializadas del sistema específico de conducción. El proceso y la secuencia de activación de las cámaras cardíacas se realiza a través del sistema específico de conducción, modulado por las fibras simpáticas y parasimpáticas del sistema neurovegetativo, que ejercen un control autónomo del mismo. El sistema de conducción auriculoventricular está compuesto por miocitos especializados y consta de un componente auricular: el nodo sinoauricular y el nodo auriculoventricular, que están en contacto con el miocardio auricular. A continuación, el haz de His atraviesa el cuerpo fibroso central y termina dividiéndose en dos haces o ramas, una izquierda y otra derecha, las cuales se ramifican en los ventrículos formando las denominadas fibras de Purkinje. El haz de His y sus ramas se encuentran rodeados de una capa de tejido conectivo, la cual se pierde en las fibras de Purkinje, lo que permite a estas establecer contacto directo con el miocardio de trabajo ventricular. Es necesario el conocimiento detallado del tejido específico de conducción para entender el ritmo normal del corazón y los sustratos anatómicos y eléctricos que constituyen las arritmias cardíacas. The specialized electrical conduction system of the heart. The heart nodes and the His-Purkinje system. Anatomical underpinnings of the accessory pathways The muscular architecture of the heart myocardium is mainly composed of muscle cells, or cardiomyocytes, that are responsible for myocardial contraction as well as an interstitial space with a component of collagen-producing cells, or fibroblasts, surrounded by an extracellular matrix of connective tissue. Small cell groups predominantly located in the atria have neuroendocrine characteristics. In order to activate of the striated myocardium and excitation-contraction coupling through transmembrane action potential, the presence of specialized cells of the specific conduction system is necessary. The process and sequence of activation of the heart chambers occurs through the specific conduction system and is modulated by sympathetic and parasympathetic fibers of the neurovegetative system, which exercise autonomous control of it. The atrioventricular conduction system is composed of specialized myocytes and has an atrial component: the sinoatrial node and atrioventricular node, which are in contact with the atrial myocardium. Next, the bundle of His crosses the central fibrous body and divides into two bundles or branches—the left and the right—which branch into the ventricles, forming what is known as Purkinje fibers. The bundle of His and its branches are surrounded by a layer of connective tissue that is lost in the Purkinje fibers, allowing them to establish direct contact with the ventricular myocardium. Detailed knowledge of the specific conduction tissue is necessary to understand normal heart rhythm and the anatomical and electrical underpinnings that constitute heart arrhythmias. Sin financiación No data JCR 2021 0.107 SJR (2021) Q4, 2423/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Background: The cuneiform nucleus is located in the center of the circuit that mediates autonomic responses to stress. Hemorrhagic hypotension leads to chemoreceptor anoxia, which consequently results in the reduction of baroreceptor discharge and stimulation of the chemoreceptor. Objective: Using the single-unit recording technique, the neuronal activities of the cuneiform nucleus were investigated in hypotensive states induced by hemorrhage and administration of an anti-hypertensive drug (hydralazine). Methods: Thirty male rats were divided into the control, hemorrhage, and hydralazine groups. The femoral artery was cannulated for the recording of cardiovascular responses, including systolic blood pressure, mean arterial pressure, and heart rate. Hydralazine was administered via tail vein. The single-unit recording was performed from the cuneiform nucleus. Results: The maximal systolic blood pressure and the mean arterial pressure significantly decreased and heart rate significantly increased after the application of hydralazine as well as the following hemorrhage compared to the control group. Hypotension significantly increased the firing rate of the cuneiform nucleus in both the hemorrhage and hydralazine groups compared to the control group. Conclusions: The present data indicate that the cuneiform nucleus activities following hypotension may play a crucial role in blood vessels and vasomotor tone. RESUMO Antecedentes: O núcleo cuneiforme está localizado no centro do circuito que media as respostas autonômicas ao estresse. A hipotensão hemorrágica leva à anóxia dos quimiorreceptores, que, consequentemente, resulta na redução da descarga dos barorreceptores e estimulação do quimiorreceptor. Objetivo: Utilizando a técnica de registro em unidade única, as atividades neuronais do núcleo cuneiforme foram investigadas em estados de hipotensão induzida por hemorragia e administração de um anti-hipertensivo (hidralazina). Métodos: Trinta ratos machos foram divididos nos grupos controle, hemorragia e hidralazina. A artéria femoral foi canulada, para o registro de respostas cardiovasculares, incluindo pressão arterial sistólica, pressão arterial média e frequência cardíaca. A hidralazina foi administrada na veia da cauda. O registro de unidade única foi realizado a partir do núcleo cuneiforme. Resultados: A pressão arterial sistólica máxima e a pressão arterial média diminuíram significativamente, e a frequência cardíaca aumentou significativamente após a aplicação de hidralazina, bem como a hemorragia seguinte, em comparação com o grupo controle. A hipotensão aumentou significativamente a taxa de disparo da população do núcleo cuneiforme em ambos os grupos de hemorragia e hidralazina, em comparação com o grupo de controle. Conclusões: Os presentes dados indicam que as atividades do núcleo cuneiforme após hipotensão podem desempenhar um papel crucial nos vasos sanguíneos e no tônus vasomotor.

Background and aims Underlying mechanisms associated with vascular dysfunction in metabolic syndrome (MetS) remain unclear and can even vary from one vascular bed to another. Methods In this study, MetS was induced by a high-fat, high-sucrose diet, and after 28 weeks, aorta and renal arteries were removed and used for isometric recording of tension in organ baths, protein expression by Western blot, and histological analysis to assess the presence of atherosclerosis. Results MetS induced a mild hypertension, pre-diabetes, central obesity and dyslipidaemia. Our results indicated that MetS did not change the contractile response in either the aorta or renal artery. Conversely, vasodilation was affected in both arteries in a different way. The aorta from MetS showed vascular dysfunction, including lower response to acetylcholine and sodium nitroprusside, while the renal artery from MetS presented a preserved relaxation to acetylcholine and an increased sensitivity to sodium nitroprusside. We did not find vascular oxidative stress in the aorta from MetS, but we found a significant decrease in PPARγ, phospho-Akt (p-Akt) and phospho-eNOS (p-eNOS) protein expression. On the other hand, we found oxidative stress in the renal artery from MetS, and PPARγ, Akt and p-Akt were overexpressed. No evidence of atherosclerosis was found in arteries from MetS. Conclusions MetS affects vascular function differently depending on the vessel. In the aorta, it decreases both the vasodilation and the expression of the PPARγ/Akt/eNOS pathway, while in the renal artery, it increases the expression of PPARγ/Akt signalling pathway without decreasing the vasodilation.

A growing number of artificial intelligence (AI)-based systems are being proposed and developed in cardiology, driven by the increasing need to deal with the vast amount of clinical and imaging data with the ultimate aim of advancing patient care, diagnosis and prognostication. However, there is a critical gap between the development and clinical deployment of AI tools. A key consideration for implementing AI tools into real-life clinical practice is their “trustworthiness” by end-users. Namely, we must ensure that AI systems can be trusted and adopted by all parties involved, including clinicians and patients. Here we provide a summary of the concepts involved in developing a “trustworthy AI system.” We describe the main risks of AI applications and potential mitigation techniques for the wider application of these promising techniques in the context of cardiovascular imaging. Finally, we show why trustworthy AI concepts are important governing forces of AI development.

Antecedentes: La enfermedad del COVID-19 causado por el virus, SARS-CoV-2, comenzó en la región de Wuhan de la República Popular de China, a finales del 2019, generando complicaciones y mortalidad en pacientes hospitalizados. Objetivo: Revisar la literatura de manera sistemática sobre las complicaciones cardiovasculares de la COVID-19 en pacientes hospitalizados. Métodos: Se incluyeron estudios observacionales, estudios sobre complicaciones cardiovasculares en pacientes hospitalizados por COVID-19, estudios con textos disponibles y estudios en idioma inglés y español. Se realizó una síntesis narrativa de los datos recopilados, sin un análisis formal estadístico. Además, de análisis cualitativo de las principales patologías y manifestaciones clínicas notificadas. Se empleo la herramienta de la calidad del estudio de los Institutos Nacionales de Salud de los Estados Unidos. Resultados: En esta revisión se observó que el 50.6 % de los pacientes infectados por el SARS-CoV-2, padecieron alguna comorbilidad cardiovascular (43.5 % hipertensión arterial (HTA) y 19.8 % diabetes mellitus). Las complicaciones del COVID-19 en pacientes infectados fueron: (44.1 %) tromboembolismo venoso, (32 %) infarto agudo de miocardio (IMA), (19.2 %) miocarditis, (16.3 %) arritmia y (11.2 %) enfermedad cerebrovascular. Conclusión: Los principales efectos cardiovasculares en pacientes infectados por el SARS-COV-2 fueron miocarditis, infarto agudo de miocardio (IAM), tromboembolismo venoso, enfermedad cerebro vascular (ECV).

Objetivou-se mensurar variáveis antropofisiológicas em portadora de FOP, comparando-as aos padrões. Para tal, realizaram-se ECG/ECC, tomografia, funções pulmonares, manovacuometria, bioimpedância, análise sanguínea e goniometria. Os resultados apontaram AA = 27 mm; AE = 26 mm; VE = 41 mm; VD = 30 mm; DSF-VE = 20 mm; septo = 5 mm; VE-PPVE = 5 mm; AE/AA = 0,96, FE = 83%; septo/PPVE = 1.00, VDF = 74 ml; VS = 61 ml; volume/massa = 1.03 ml/g; FSG-VE normalizada; sob broncodilatador, FVC, FEV1 e PEF = 54%, 64% e 81% dos preditores; FEV1% e 2575 = 118% e 116% dos preditores; Pemáx = 65 mmH (?42,7%) e Pimáx = 55 mmHg (?63,2%); MC = 39.0 kg; h = 1.57 m; IMC = 15.8 kg/m2; CA = 64 cm; %MG = 26%; MM = 27.39 kg; CMO = 1.53 kg; MLG = 28.92 kg; IRMM = 4.5 kg/m2; IO = 63,50%; glicemia, triglicerídeos e PCR normais; OD, OE, PE, TD e TE = 0º, JE = 25º, JD = 40º, CE = 55º, PD = 110º, CD = 150º. As diferenças cardiovasculares não ocasionaram disfunções. FOP causou distúrbio respiratório restritivo moderado, Pimáx/Pemáx inferiores aos preditores, MC, h, IMC, CA, conteúdo mineral ósseo, MLG e IO baixos, imobilidade em 05 articulações e comprometimento em 03, com 02 preservadas. Concluiu-se que FOP está comprometendo significativamente sistema respiratório, com distúrbio respiratório restritivo moderado ocasionado pela acentuada escoliose torácica de convexidade direcionada à esquerda, face ao comprometimento da posição de bipedestação devido às novas calcificações, além de comprometimentos de movimentação e deambulação.

Assuming that physical activity practice in Physical Education (PE) classes unrelated to the learning of theoretical concepts and referential is not enough to prepare students to make responsible decisions about issues related to corporal practices, we assumed as necessary the production of knowledge about how to teach concepts in the subject classes. Among the concepts whose learning we consider essential we highlight those referring to the exercise physiology. Considering that the object of study in PE integrates conceptual, attitudinal and procedural dimensions and the integration of thought, feeling and action to foster meaningful learning, the purpose of this study was to understand the meaningful learning process of the acute and chronic responses from the cardiovascular system to physical exercise in high school PE classes. The pedagogical intervention research with a qualitative approach was developed in a center of technological and professionalizing Education, in Rio de Janeiro city. We assumed the Human Constructivism as epistemological framework and Meaningful Learning Theory as the main theoretical framework. A teaching plan whose central theme was the responses of the cardiovascular system to physical exercise, considering its relationship with Health and Physical Fitness, was developed in regular classes of the academic years of 2016 and 2017. Varied records were obtained through audio recordings of classes, field notes, and written activities of the students. The data were analyzed and discussed considering the student, content, teacher, context, and evaluation. In both interventions, it was possible to identify evolution in students' knowledge in some of the concepts taught, although below the desired. We believe that student learning, especially in its progressive nature, has been negatively influenced by the school organizational context that was characterized by strikes, a small number of classes, a decrease in the school year, and an inadequate composition of classes. On the other hand, the teacher who was committed to foster meaningful learning seems to have positively influenced the learning process. The students demonstrated motivation to conceptual learning, but still valued much the practical content of classes. Part of them presented resistance and strangeness to do theoretical tasks and written evaluation.

Introduction and objectives: Studies assessing the effects of caffeine (CAF) on the cardiovascular system have demonstrated that CAF can delay cardiac recovery following exercise. This study intended to assess the impact of CAF intake before physical exercise on heart rate variability (HRV) and cardiovascular parameters. Methods: This is a prospective, crossover, controlled clinical trial conducted at the University of Pernambuco, Petrolina, PE, Brazil. The experimental protocol was split into three stages with a minimum of 48 hours between them. Exercises intensity was standardized based on the one repetition maximum test (1RM), obtaining the load of each volunteer for the intensity of 75% of 1RM. In the second and third phases, the control protocols were applied and 300 mg caffeine was given 45 minutes before training. HRV indices were determined at the subsequent times: 0 to 5 minutes of rest (before) and during 30 minutes of recovery (Rec) (after exercise), divided into six intervals, each of 5 minutes. Results: The final sample involved 30 volunteers. CAF delayed HRV recovery after resistance exercise. In general, CAF impaired recovery of HRV after resistance exercise. Significant changes were observed in the RMSSD, SDNN, TINN, SD1, low frequency and high frequency indices between the control and CAF group. Conclusion: CAF protocol delayed parasympathetic regulation of heart rhythm following exercise, slowing recovery of HR, blood pressure and HRV indices after exercise. Resumo: Introdução e objetivos: Estudos avaliando os efeitos da cafeína (CAF) sobre o sistema cardiovascular mostraram que a CAF pode retardar a recuperação dos batimentos cardíacos ao estado de repouso após o exercício. Este estudo teve como objetivo avaliar o impacto da ingestão de cafeína (CAF) antes do exercício físico de força sobre variabilidade da frequência cardíaca (VFC) na recuperação. Metodologia: Trata-se de um ensaio clínico prospetivo, controlado por cruzamento, realizado na Universidade de Pernambuco, em Petrolina, PE. Está registrado no ClinicalTrials.gov (Number NCT03899675). O procedimento experimental foi dividido em três etapas com um mínimo de 48 horas entre elas. A intensidade do exercício foi padronizada com base no teste de 1 repetição máxima (1RM), obtendo-se a carga de cada voluntário para a intensidade de 75% de 1RM. Na segunda e terceira fase da pesquisa, os protocolos de controle e cafeína (300 mg) foram aplicados. A ingestão de cafeína aconteceu 45 minutos antes do treinamento. Os índices de VFC foram determinados nos seguintes tempos: 0 a 5 minutos de repouso (antes) e durante 30 minutos de recuperação (Rec) (após o exercício), divididos em seis intervalos de 5 minutos cada. Resultados: A amostra final foi composta por 30 voluntários. No geral, a cafeína prejudicou a recuperação da VFC no período de recuperação após o exercício resistido. Diferenças significativas foram observadas nos índices RMSSD, SDNN, TINN, SD1, LF e HF entre o grupo controle e o grupo CAF. Conclusão: O protocolo CAF foi capaz de intensificar reduções na atividade parassimpática após o exercício, causando atraso na recuperação da FC, pressão arterial e índices de VFC após o exercício.

Introduction: The indiscriminate use of androgenic steroids may have deleterious effects on human tissue. Objectives: Evaluate the effects of chronic administration of the steroid nandrolone decanoate (DECA) on autonomic cardiovascular modulation, kidney morphometry and the association between these variables in Wistar rats subjected to physical training with swimming. Methods: Thirty-two male Wistar rats aged 20 weeks were distributed among four experimental groups according to the training received: sedentary control (SC), sedentary treated with DECA (SD), trained control (TC) and trained treated with DECA (TD). The hemodynamic parameters, including blood pressure and variations in systolic blood pressure (SBPV) and diastolic blood pressure (DBPV), and kidney morphometry were evaluated. The level of significance adopted was 5%. Results: The SD group had higher baseline SBP and DBP values when compared to the SC, TC and TD groups, which were similar to each other. The rats in the SD group had higher systolic blood pressure (SBPV) and diastolic blood pressure (DBPV) variation values and higher absolute and normalized values in the LF band of the DBPV when compared to the animals in the SC, TC and TD groups. The animals in the SD group had a significantly higher rate of kidney fibrosis compared to the SC, TC and TD groups. There were no significant differences between the sympathetic modulation of SBPV through the LF component and kidney fibrosis. Conclusions: Physical training with swimming was effective in preventing the increase in blood pressure levels and lowering the occurrence of kidney fibrosis in animals treated with anabolic steroids. Level of Evidence IV; Series of cases . RESUMEN Introducción: El uso indiscriminado de esteroides androgénicos puede tener consecuencias nocivas para el organismo. Objetivo: Evaluar los efectos de la administración crónica del esteroide decanoato de nandrolona (DECA) en ratones Wistar sometidos a entrenamiento físico con natación, sobre la modulación autonómica cardiovascular, morfometría renal y asociación entre esas variables. Métodos: Fueron utilizados 32 ratones Wistar machos con edad de 20 semanas, distribuidos en 4 grupos experimentales de acuerdo con el tratamiento recibido: sedentarios controles (SC), sedentarios que recibieron el DECA (SD), entrenados controles (EC) y entrenados que recibieron el DECA (ED). Se evaluaron parámetros hemodinámicos, como presión arterial y variación de la presión arterial sistólica (VPAS) y diastólica (VPAD) y morfometría renal. El nivel de significancia adoptado fue de 5%. Resultados: El grupo SD presentó valores basales mayores de PAS y PAD cuando comparados a los grupos SC, EC y ED, los cuales fueron semejantes entre sí. Los animales del grupo SD tuvieron valores mayores de la variancia de VPAS y VPAD y valores absolutos mayores y normalizados de la banda LF de la VPAD, en comparación con los animales de los grupos SC, EC y ED. El grupo SD tuvo tasa significativamente mayor de fibrosis renal en comparación con los animales de los grupos SC, EC y ED. No se evidenciaron diferencias considerables entre la modulación simpática de la VPAS a través del componente LF y fibrosis renal. Conclusiones: El entrenamiento físico con natación fue efectivo en prevenir el aumento de niveles presóricos y disminuir la ocurrencia de fibrosis renal en animales tratados con esteroide anabolizante. Nivel de Evidencia IV; Serie de casos . RESUMO Introdução: O uso indiscriminado de esteroides androgênicos pode ter consequências deletérias no organismo. Objetivo: Avaliar os efeitos da administração crônica do esteroide decanoato de nandrolona (DECA) em ratos Wistar submetidos a treinamento físico com natação sobre a modulação autônoma cardiovascular, morfometria renal e associação entre essas variáveis. Métodos: Foram utilizados 32 ratos Wistar machos com idade de 20 semanas, distribuídos em 4 grupos experimentais de acordo com o tratamento recebido: sedentários controles (SC), sedentários que receberam o DECA (SD), treinados controles (TC) e treinados que receberam o DECA (TD). Avaliaram-se parâmetros hemodinâmicos, como pressão arterial e variação da pressão arterial sistólica (VPAS) e diastólica (VPAD) e morfometria renal. O nível de significância adotado foi de 5%. Resultados: O grupo SD apresentou valores basais maiores de PAS e PAD quando comparado aos grupos SC, TC e TD, os quais foram semelhantes entre si. Os animais do grupo SD tiveram valores maiores da variância da VPAS e VPAD e valores absolutos maiores e normalizados da banda LF da VPAD, em comparação com os animais dos grupos SC, TC e TD. O grupo SD teve taxa significativamente maior de fibrose renal em comparação com os animais dos grupos SC, TC e TD. Não se evidenciaram diferenças consideráveis entre a modulação simpática da VPAS através do componente LF e fibrose renal. Conclusões: O treinamento físico com natação foi efetivo em prevenir o aumento de níveis pressóricos e diminuir a ocorrência de fibrose renal em animais tratados com esteroide anabolizante. Nível de Evidência IV; Série de casos .

Introdução: As doenças e agravos não transmissíveis (DANT), que inclui as doenças do aparelho circulatório, entre outras (doenças cardiovasculares, cerebrovasculares, isquêmicas, as neoplasias, as doenças respiratórias crônicas e o diabetes mellitus), são atualmente consideradas como epidemia, constituindo um grave impasse de saúde pública, em países ricos ou de média e baixa renda. Objetivo: Foi identificar o número de óbitos por principais doenças do aparelho circulatório por unidade de pessoa no ano de 2015 no estado do Pará. Metodologia: Estudo observacional, do tipo ecológico, a partir de dados secundários do Departamento de Informática do Sistema Único de Saúde (DATASUS). O estudo apresenta como população alvo os indivíduos com doenças do aparelho circulatório residentes no estado do Pará no momento do óbito, no ano de 2015. Resultados: No ano de 2015, o DATASUS registrou 8.714 números de óbitos por doenças do aparelho circulatório no estado do Pará, enquanto que no Brasil o total foi de 349.642, no mesmo período. As que possuíram maior número de óbito nesse período. Tendo como as principais: infarto agudo do miocárdio (26,92%); acidente vascular cerebral não especifico se hemorrágico ou isquêmico (23,98%); insuficiência cardíaca (8,14%). Conclusão: Foi possível identificar as doenças do aparelho circulatório que mais causaram óbito no ano de 2015, no estado do Pará, que foram em ordem decrescente: infarto agudo do miocárdio, acidente vascular encefálico não especificado em hemorrágico ou isquêmica, insuficiência cardíaca.

Introduction Beta-blockers are recommended after ST-elevation myocardial infarction (STEMI), but their benefit in patients with preserved left ventricular ejection fraction (LVEF) is unclear. Methods Consecutive patients discharged in sinus rhythm after STEMI between January 2010 and April 2015 were followed until December 2017. Percutaneous coronary intervention (PCI) was performed in 969 (99.7%, including 112 with rescue PCI) and three (0.3%) received only thrombolytic therapy without rescue PCI. Results Of these 972 patients, mean age 62.6±13.5 years, 212 (21.8%) were women and 835 (85.9%) were prescribed beta-blockers at discharge. Patients who did not receive beta-blockers had more comorbidities than those who did, including chronic obstructive pulmonary disease (14.6% vs. 4.2%), anemia (8.0% vs. 3.7%), and cancer (7.3% vs. 2.8%), and more frequently had inferior STEMI (75.9% vs. 56.0%) and high-grade atrioventricular block (13.1% vs. 5.3%) (all p40% (HR 0.67, 95% 95% CI 0.25-1.76, p=0.42). Conclusion In the LVEF >40% group, the results raise reasonable doubts about the real benefit of systematic use of beta-blockers as treatment for these patients. These findings reinforce the need for large randomized clinical trials within this group of patients. Resumo Objetivo Os betabloqueantes são recomendados após enfarte agudo do miocárdio com elevação do segment ST (STEMI). No entanto, é pouco claro o seu benefício em doentes com fração de ejeção ventricular esquerda (FEVE) preservada. Métodos Doentes consecutivos com alta hospitalar em ritmo sinusal após STEMI entre janeiro de 2010 e abril de 2015 foram seguidos até dezembro de 2017. A intervenção coronária percutânea (ICP) foi feita em 969 doentes (99,7%, inclusive 112 com ICP de recurso), os restantes 3 (0,3%) receberam apenas terapêutica trombolítica sem ICP de recurso. Resultados Dos 972 doentes, idade média 62,6 ± 13,5 anos, 212 (21,8%) eram mulheres e 835 (85,9%) estavam a medicados com betabloqueantes no momento da alta hospitalar. Os doentes não medicados com betabloqueantes apresentaram mais comorbilidades do que os tratados com esses fármacos, inclusive doença pulmonar obstrutiva crónica (14,6% versus 4,2%), anemia (8,0% versus 3,7%) e neoplasia (7,3% versus 2,8%) e tiveram mais frequentemente STEMI inferior (75,9% versus 56,0%), bloqueio auriculoventricular de alto grau (13,1% versus 5,3%). Todos os valores corresponderam a p < 0,01. Após um seguimento médio de 49,6 ± 24,9 meses, a terapêutica com betabloqueantes no momento da alta hospitalar associou-se independentemente à mortalidade inferior (hazard ratio [HR] 0,61, intervalo de confiança [IC] 0,38-0,96, p = 0,03). Esse efeito verificou-se em 192 doentes com FEVE ≤ 40% (HR 0,57, IC 0,34-0,97, p = 0,04).No entanto, não foi clara essa vantagem em 643 doentes com FEVE > 40% (HR 0,67, IC 0,25-1,76, p = 0,42). Conclusão No grupo com FEVE > 40%, os resultados levantam dúvidas sobre o benefício real da administração sistemática de betabloqueantes como forma de tratamento para esses doentes. Esses achados reforçam a necessidade de grandes ensaios clínicos aleatorizados sobre esse grupo de doentes. Sin financiación 1.374 JCR (2020) Q4, 136/142 Cardiac & Cardiovascular Systems 0.266 SJR (2020) Q3, 241/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

Resumo O raciocínio clínico nasceu 2500 anos atrás com Hipócrates, tendo evoluído ao longo dos séculos, e se tornado uma mistura de arte e ciência. Várias personalidades ao longo da história contribuíram para melhorar a acurácia diagnóstica. Contudo, o erro diagnóstico é ainda comum e causa um grande impacto nos sistemas de saúde. Para lidar com esse desafio, vários modelos de raciocínio clínico surgiram para sistematizar o processo de pensamento clínico. Este artigo descreve a história do raciocínio clínico e os métodos atuais de raciocínio diagnóstico, propõe um novo modelo de raciocínio clínico chamado Raciocínio Integrativo, e traz perspectivas sobre o futuro do raciocínio clínico. Abstract Clinical reasoning was born 2,500 years ago with Hippocrates, having evolved over the centuries, becoming a mixture of art and science. Several personalities throughout history have contributed to improving diagnostic accuracy. Nonetheless, diagnostic error is still common and causes a severe impact on healthcare systems. To face this challenge, several clinical reasoning models have emerged to systematize the clinical thinking process. This paper describes the history of clinical reasoning and current diagnostic reasoning methods, proposes a new clinical reasoning model, called Integrative Reasoning, and brings perspectives about the future of clinical reasoning.

Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Background: Anemia is common in patients with acute myocardial infarction (AMI), and is an independent predictor of mortality. The optimal transfusion strategy in these patients is unclear. Hypothesis: We hypothesized that a "restrictive" transfusion strategy (triggered by hemoglobin ≤8 g/dL) is clinically noninferior to a "liberal" transfusion strategy (triggered by hemoglobin ≤10 g/dL), but is less costly. Methods: REALITY is an international, randomized, multicenter, open-label trial comparing a restrictive vs a liberal transfusion strategy in patients with AMI and anemia. The primary outcome is the incremental cost-effectiveness ratio (ICER) at 30 days, using the primary composite clinical outcome of major adverse cardiovascular events (MACE; comprising all-cause death, nonfatal stroke, nonfatal recurrent myocardial infarction, or emergency revascularization prompted by ischemia) as the effectiveness criterion. Secondary outcomes include the ICER at 1 year, and MACE (and its components) at 30 days and at 1 year. Results: The trial aimed to enroll 630 patients. Based on estimated event rates of 11% in the restrictive group and 15% in the liberal group, this number will provide 80% power to demonstrate clinical noninferiority of the restrictive group, with a noninferiority margin corresponding to a relative risk equal to 1.25. The sample size will also provide 80% power to show the cost-effectiveness of the restrictive strategy at a threshold of €50 000 per quality-adjusted life year. Conclusions: REALITY will provide important guidance on the management of patients with AMI and anemia. Sin financiación 3.287 JCR (2021) Q3, 74/143 Cardiac & Cardiovascular Systems 0.983 SJR (2021) Q1, 82/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Background and Purpose Klotho is a membrane‐bound or soluble protein, originally identified as an age‐suppressing factor and regulator of mineral metabolism. Klotho deficiency is associated with the development of renal disease, but its role in cardiac function in the context of uraemic cardiomyopathy is unknown. Experimental Approach We explored the effects of Klotho on cardiac Ca2+ cycling. We analysed Ca2+ handling in adult cardiomyocytes from Klotho‐deficient (kl/kl) mice and from a murine model of 5/6 nephrectomy (Nfx). We also studied the effect of exogenous Klotho supplementation, by chronic recombinant Klotho treatment, or endogenous Klotho overexpression, using transgenic mice overexpressing Klotho (Tg‐Kl), on uraemic cardiomyopathy. Hearts from Nfx mice were used to study Ca2+ sensitivity of ryanodine receptors and their phosphorylation state. Key Results Cardiomyocytes from kl/kl mice showed decreased amplitude of intracellular Ca2+ transients and cellular shortening together with an increase in pro‐arrhythmic Ca2+ events compared with cells from wild‐type mice. Cardiomyocytes from Nfx mice exhibited the same impairment in Ca2+ cycling as kl/kl mice. Changes in Nfx cardiomyocytes were explained by higher sensitivity of ryanodine receptors to Ca2+ and their increased phosphorylation at the calmodulin kinase type II and protein kinase A sites. Ca2+ mishandling in Nfx‐treated mice was fully prevented by chronic recombinant Klotho administration or transgenic Klotho overexpression. Conclusions and Implications Klotho emerges as an attractive therapeutic tool to improve cardiac Ca2+ mishandling observed in uraemic cardiomyopathy. Strategies that improve Klotho availability are good candidates to protect the heart from functional cardiac alterations in renal disease. Sin financiación 8.740 JCR (2020) Q1, 12/276 Pharmacology & Pharmacy 2.432 SJR (2020) Q1, 16/314 Pharmacology No data IDR 2020 UEM

El síndrome de Bayés es una nueva entidad clínica, caracterizada por la combinación de bloqueo interauricular (BIA) avanzado en el electrocardiograma de superficie con fibrilación auricular (FA) y otras arritmias auriculares. Este síndrome se asocia con un riesgo incrementado de ictus, demencia y mortalidad. El BIA avanzado se diagnostica con la presencia de una onda P ≥ 120 ms de morfología bifásica (±) en derivaciones de cara inferior. Se produce por un bloqueo completo del haz de Bachmann que causa una despolarización retrógrada de la aurícula izquierda desde zonas cercanas a la unión auriculoventricular. La miocardiopatía auricular fibrótica es el sustrato anatómico del BIA avanzado. La disincronía inducida por el BIA avanzado funciona como desencadenante y mecanismo de mantenimiento de la FA. Esta alteración de la arquitectura auricular produce remodelado auricular, estasis sanguínea e hipercoagulabilidad, lo cual desencadena la cascada trombogénica. El BIA avanzado, incluso sin arritmias auriculares documentadas, también se ha relacionado con FA, ictus, demencia y mortalidad. Sin embargo, todavía no se ha demostrado el beneficio de la anticoagulación para los pacientes sin FA documentada. Por lo tanto, es recomendable una búsqueda proactiva de FA en los pacientes con BIA avanzado. Bayés syndrome is a new clinical entity, characterized by the association of advanced interatrial block (IAB) on surface electrocardiogram with atrial fibrillation (AF) and other atrial arrhythmias. This syndrome is associated with an increased risk of stroke, dementia, and mortality. Advanced IAB is diagnosed by the presence of a P-wave ≥ 120 ms with biphasic morphology (±) in inferior leads. The cause of IAB is complete Bachmann bundle blockade, leading to retrograde depolarization of the left atrium from areas near the atrioventricular junction. The anatomic substrate of advanced IAB is fibrotic atrial cardiomyopathy. Dyssynchrony induced by advanced IAB is a trigger and maintenance mechanism of AF. This alteration of the atrial architecture produces atrial remodeling, blood stasis and hypercoagulability, triggering the thrombogenic cascade. The presence of advanced IAB, even in patients without documented atrial arrhythmias, has also been associated with AF, stroke, dementia, and mortality. However, in these patients, there is no evidence to support the use of anticoagulation. Therefore, in patients with advanced IAB, a proactive search for AF is recommended. Sin financiación 4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems 0.455 SJR (2020) Q3, 202/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

SUMMARY OBJECTIVE To identify the use of Potentially Inappropriate Medications with imminent risk of Cardiovascular and Cerebrovascular Adverse Events (PIM-CCVAE), in addition to the factors associated with a group of elderly individuals undergoing therapeutic care in a Brazilian public service. METHODS A cross-sectional retrospective study conducted at a secondary level service located in Carapicuíba, SP, Brasil. Only elderly individuals (≥60 years) who were treated in one of the outpatient departments were included. The use of PIM-CCVAE was defined based on the PIM-CCVAEs list. In this research, we used descriptive statistics and logistic regression to identify and track possible predictors of MPI use. All statistical analyses were performed using Stata software version 15.1 (Stata Corporation). RESULTS The sample included 233 elderly individuals, with a mean age of 74.9 (± 9.4) years. Of these, 74.2% used at least one PIM-CCVAE, with an average daily intake of 1.3 (± 1) PIM/elderly. The presence of comorbidities, diseases of the circulatory system, polypharmacy, and low to moderate scores in morbidity and mortality were important factors associated with an increased odds ratio for the consumption of PIM-CCVAE. It is also emphasized that the presence of neurological symptoms proved to be a protective factor for this outcome. CONCLUSION Given the clinical severity and imminent risk of CCVAE in the researched group, preventive measures should be instituted to minimize health problems related to medication in the public network. RESUMO OBJETIVO Identificar o uso de Medicamentos Potencialmente Inapropriados (MPI) com risco iminente de EAM cardiovascular e cerebrovascular (EAM-CC), além dos fatores associados a um grupo de idosos em vigência terapêutica de um serviço público brasileiro. MÉTODOS Estudo seccional e retrospectivo realizado em um serviço de nível secundário localizado em Carapicuíba, SP, Brasil. Incluíram-se, apenas, idosos (idade ≥60 anos) que foram tratados em um departamento de atendimento ambulatorial. O uso de MPI com risco iminente de EAM-CC foi definido empregando a lista PIM-CCVAEs. Nesta pesquisa, apropriou-se da estatística descritiva e de regressão logística para identificação e rastreio de possíveis preditores de uso de MPI. Todas as análises estatísticas foram realizadas usando o software Stata version 15.1 (Stata Corporation). RESULTADOS Incluíram-se, na casuística, 233 idosos, com média de idade igual a 74,9 (±9,4) anos. Destes, 74,2% faziam uso de pelo menos um MPI com risco de EAM-CC, atingindo uma média de consumo diário igual a 1,3 (± 1) MPI/idoso. Verificou-se que a presença de comorbidades, doenças do aparelho circulatório, polifarmácia e score baixo a moderado em índices de morbimortalidade foram importantes fatores associados ao aumento da razão de chances para o consumo de MPI com risco de EAM-CC. Ressalta-se ainda que a presença de sintomas neurológicos mostrou-se como fator protetor para este desfecho. CONCLUSÃO Dada a gravidade clínica e o risco iminente de EAM-CC do grupo pesquisado, medidas de prevenção devem ser instituídas com o intuito de minimizar os problemas de saúde relacionados à medicação na rede pública.

La infección por SARS-CoV-2, denominada COVID-19 (Coronavirus Infectious Disease-19), es una enfermedad desconocida hasta diciembre de 2019 a la que nos enfrentamos en España desde el 31 de enero de 2020 —fecha del primer caso diagnosticado en nuestro país— y que ya ha causado la muerte de 7.340 personas (a 30 de marzo de 2020), sobre todo mayores. Es importante tener en cuenta que, dado que la información evoluciona con extremada rapidez en este campo, lo expuesto en el presente documento puede estar sujeto a modificaciones. La población de mayor edad es especialmente susceptible a la infección por COVID-19, así como a desarrollar criterios de gravedad. Este aumento de morbimortalidad en el paciente mayor se ha asociado tanto con las comorbilidades, especialmente la enfermedad cardiovascular, como con la situación de fragilidad, que conlleva una respuesta inmunológica más pobre. La situación actual, tanto por los países afectados como por el número de casos, constituye una pandemia y supone una emergencia sanitaria de primer nivel. Como España es uno de los países más envejecidos del mundo, la COVID-19 se ha convertido en una emergencia geriátrica. El presente documento se ha elaborado conjuntamente entre la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología y la Sociedad Española de Geriatría y Gerontología. Sin financiación 4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems 0.455 SJR (2020) Q3, 202/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

Patients with coronary heart disease (CHD) can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. This study estimated the prevalence of hypotension among CHD-treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM) in routine clinical practice. We performed a cross-sectional study with 2892 CHD-treated hypertensive patients from the Spanish ABPM Registry. Based on previous studies, hypotension was defined as systolic/diastolic BP

Aims The anatomic substrates for atrioventricular nodal re-entry remain enigmatic, but require knowledge of the normal arrangement of the inputs and exist from the atrioventricular node. This knowledge is crucial to understand the phenomenon of atrioventricular nodal re-entry. Methods and results We studied 20 human hearts with serial sections covering the entirety of the triangle of Koch and the cavotricuspid isthmus. We determined the location of the atrioventricular conduction axis and the connections between the specialized cardiomyocytes of the conduction axis and the adjacent working atrial myocardium. The atrioventricular node was found at the apex of the triangle of Koch, with entry of the conduction axis to the central fibrous body providing the criterion for distinction of the bundle of His. We found marked variation in the inferior extensions of the node, the shape of the node, the presence or absence of a connecting bridge within the myocardium of the cavotricuspid isthmus, the connections between the compact node and the myocardium of the atrial septum, the presence of transitional cardiomyocytes, and the ‘last’ connection between the working atrial myocardium and the conduction axis before it became the bundle of His. Conclusion The observed variations of the inferior extensions, combined with the arrangement of the ‘last’ connections between the atrial myocardium and the conduction axis prior to its insulation as the bundle of His, provide compelling evidence to support the concept for atrioventricular nodal re-entry as advanced by Katritsis and Becker.

PURPOSE The beneficial effects of exercise training on the cardiovascular system are well known. Because our knowledge of exercise-induced vascular function is still limited, we aimed to uncover the molecular mechanisms conditioning the improved vascular relaxation in muscular arteries. METHODS Male Wistar-Kyoto rats with the same ability to run on a treadmill after maximal exercise tests were allocated to the following two groups: trained (Tr) (treadmill, 50%-60% of maximal capacity, 5 d·wk) and untrained (UnTr). After 13 wk, the femoral arteries were harvested and used for functional, structural, and molecular analyses. RESULTS Acetylcholine (ACh)-induced relaxation and nitric oxide (NO) production were enhanced in arteries from Tr rats compared with UnTr rats. Tr arteries exhibited reduced microRNA (miRNA)-124a expression (whose target is caveolin-1), increased the density of caveolae aligned along the sarcolemma and reduced ACh-induced relaxation in the presence of methyl-β-cyclodextrin, which disrupts caveolae. Higher endothelial NO synthase (eNOS) expression with lower miRNA-155 expression and the posttranslational modification of eNOS (phosphorylation of stimulatory Ser1177 and dephosphorylation of inhibitory Thr495) by the PI3-kinase/Akt1/2/3 pathway also contributed to the higher NO production induced by exercise training. Furthermore, increased Cu/Zn- and extracellular-superoxide dismutase expression and enhanced effects of their pharmacological scavenger activity on the ACh-induced response were observed in Tr arteries. CONCLUSIONS The results of the present study provide a molecular basis for exercise-induced NO bioavailability in healthy femoral arteries. Increased caveolae domain and eNOS expression/activity in Tr arteries are associated with downregulation of miRNA-124a and -155, as well as are involved with higher antioxidant defense, subsequently inducing a favorable endothelium-dependent milieu in Tr arteries.

La concentración sérica de fósforo oscila entre 2,5 y 4,5mg/dl (0,81-1,45mmol/l) en adultos, con niveles más altos en la infancia, la adolescencia y durante la gestación. El fosfato intracelular está implicado en el metabolismo intermediario y otras funciones celulares esenciales, mientras que el extracelular es fundamental para la mineralización de la matriz ósea. La fosforemia se mantiene en un estrecho rango mediante la regulación de la absorción intestinal, la redistribución y la reabsorción tubular renal de fósforo. La hipofosfatemia y la hiperfosfatemia son situaciones clínicas frecuentes, aunque, en la mayoría de las ocasiones, se trata de alteraciones leves y poco sintomáticas. Sin embargo, pueden presentarse cuadros agudos y severos que requieren tratamiento específico. En este documento elaborado por miembros del Grupo de Trabajo de Metabolismo Mineral y Óseo de la Sociedad Española de Endocrinología y Nutrición se revisan los trastornos del fosfato y se proporcionan algoritmos de manejo clínico de la hipofosfatemia y la hiperfosfatemia. Sin financiación No data JCR 2020 0.325 SJR (2020) Q3, 166/232 Endocrinology, Diabetes and Metabolism No data IDR 2020 UEM

Background: Helping consumers to improve the nutritional quality of their diet is a key public health action to prevent cardiovascular diseases (CVDs). The modified version of the Food Standard Agency Nutrient Profiling System Dietary Index (FSAm- NPS DI) underpinning the Nutri-Score front-of-pack label has been used in public health strategies to address the deleterious consequences of poor diets. This study aimed to assess the association between the FSAm-NPS DI and some CVD risk factors including body mass index (BMI), waist circumference, plasma glucose levels, triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and diastolic and systolic blood pressure. Materials and Methods: Dietary intake was assessed at baseline and after 1 year of follow-up using a 143-item validated semi-quantitative food-frequency questionnaire. Dietary indices based on FSAm-NPS applied at an individual level were computed to characterize the diet quality of 5,921 participants aged 55–75 years with overweight/obesity and metabolic syndrome from the PREDIMED-plus cohort. Associations between the FSAm-NPS DI and CVD risk factors were assessed using linear regression models. Results: Compared to participants with a higher nutritional quality of diet (measured by a lower FSAm-NPS DI at baseline or a decrease in FSAm-NPS DI after 1 year), those participants with a lower nutritional quality of diet (higher FSAm-NPS DI or an increase in score) showed a significant increase in the levels of plasma glucose, triglycerides, diastolic blood pressure, BMI, and waist circumference (b coefficient [95% confidence interval]; P for trend) (1.67 [0.43, 2.90], official Spanish Institutions, European Commission PI13/00673 PI13/00492 PI13/00272 PI13/01123 PI13/00462 PI13/00233 PI13/02184 PI13/00728 PI13/01090 PI13/01056 PI14/01722 PI14/00636 PI14/00618, The European Regional Development Fund PI16/01120 PI17/00764 PI17/01183 PI17/00855 PI17/01347 PI17/00525 PI17/01827 PI17/00532 PI17/00215 PI17/01441 PI17/00508, Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus, European Research Council (ERC) European Commission 340918, La Caixa Foundation 2013ACUP00194, Junta de Andalucia PI0458/2013 PS0358/2016 PI0137/2018, Center for Forestry Research & Experimentation (CIEF), European Commission, SEMERGEN grant, ICREA under the ICREA Academia program, Agencia de Gestio d'Ajuts Universitaris de Recerca (AGAUR FI) 2021FI_B 00145, Sara Borrell CD21/00045 PI20/00138 PI20/01532 PI20/00456 PI20/00339 PI20/00557 PI20/00886 PI20/01158 PI17/01732 PI17/00926 PI19/00957 PI19/00386 PI19/00309 PI19/01032 PI19/00576 PI19/00017 PI19/01226 PI19/00781 PI19/01560 PI19/01332 PI20/01802 PI14/00696 PI14/01206 PI14/01919 PI14/00853 PI14/01374 PI14/00972 PI14/00728 PI14/01471 PI16/00473 PI16/00662 PI16/01873 PI16/01094 PI16/00501 PI16/00533 PI16/00381 PI16/00366 PI16/01522

Background: The evaluation of performance in endurance athletes and the subsequent individualisation of training is based on the determination of individual physiological thresholds during incremental tests. Gas exchange or blood lactate analysis are usually implemented for this purpose, but these methodologies are expensive and invasive. The short-term scaling exponent alpha 1 of detrended Fluctuation Analysis (DFA-α1) of the Heart Rate Variability (HRV) has been proposed as a non-invasive methodology to detect intensity thresholds. Purpose: The aim of this study is to analyse the validity of DFA-α1 HRV analysis to determine the individual training thresholds in elite cyclists and to compare them against the lactate thresholds. Methodology: 38 male elite cyclists performed a graded exercise test to determine their individual thresholds. HRV and blood lactate were monitored during the test. The first (LT1 and DFA-α1-0.75, for lactate and HRV, respectively) and second (LT2 and DFA-α1-0.5, for lactate and HRV, respectively) training intensity thresholds were calculated. Then, these points were matched to their respective power output (PO) and heart rate (HR). Results: There were no significant differences (p > 0.05) between the DFA-α1-0.75 and LT1 with significant positive correlations in PO (r = 0.85) and HR (r = 0.66). The DFA-α1-0.5 was different against LT2 in PO (p = 0.04) and HR (p = 0.02), but it showed significant positive correlation in PO (r = 0.93) and HR (r = 0.71). Conclusions: The DFA1-a-0.75 can be used to estimate LT1 non-invasively in elite cyclists. Further research should explore the validity of DFA-α1-0.5. Sin financiación 3.980 JCR (2021) Q2, 24/88 Sport Sciences 1.182 SJR (2021) Q1, 21/225 Physical Therapy, Sports No data IDR 2021 UEM

La terapia con restricción del flujo sanguíneo (BFR) es una técnica de intervención que limita parcialmente el flujo arterial mientras que restringe por completo el flujo venoso en la musculatura de trabajo durante el ejercicio, mediante el uso de un manguito neumatico colocado alrededor de la extremidad a nivel proximal. Este tipo de herramienta se conoce comúnmente como “entrenamiento BFR” (Blood flow restriction). Esta técnica se remonta al Dr. Yoshiaki Sato en Japón el cual empezó a experimentarlo de forma casual en si mismo a finales de la década de los 60 y fue en 1973 cuando comenzó a desarrollar protocolos de trabajo, conocido como "entrenamiento kaatsu", que significa "entrenamiento con presión adicional”. El trabajo de baja carga con BFR puede ser una herramienta alternativa al entrenamiento de fuerza con altas cargas durante el periodo de rehabilitación neuromusculoesquelética, ya que se ha comprobado en estudios recientes que se obtienen beneficios similares usando menor carga, generando menor estrés mecánico y produciendo una reducción del dolor en las primeras fases de la recuperación. Objetivos: Analizar protocolos de intervención, dispositivos disponibles y efectos de la aplicación de BFR en población clínica según la evidencia científica actual. Material y métodos: Se trata de una revisión sistemática de carácter cuantitativo. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, SCOPUS y Web of science (WOS) y se procedió al análisis de cada uno de los artículos. Resultados: Se seleccionaron un total de 16 artículos entre los 114 artículos escogidos tras la realización de la búsqueda en diferentes bases de datos siguiendo unos criterios de inclusión y exclusión, y evaluados mediante la escala de OXFORD según el nivel de evidencia y grado de recomendación. Se ha observado en la mayoría de estudios analizados que la aplicación de BFR entre el 60% y 80% de la oclusión arterial produce efectos beneficiosos sobre el dolor, en la ganancia de fuerza, masa muscular y funcionalidad, así como efectos hemodinámicos favorables. Conclusiones: Existe evidencia donde se demuestra que la aplicación de BFR en población clínica puede reducir el dolor musculoesquelético así como ayudar a mejorar la fuerza, la función y beneficios hemodinámicos, siendo una herramienta de utilidad en programas de rehabilitación.

Advanced glycation end products (AGEs) are independently related to cardiovascular disease (CVD) and favor cholesterol and oxysterol accumulation in macrophage foam cells. Soluble RAGE (sRAGE) impairs cellular AGE signaling alleviating the deleterious effects of AGE in atherogenesis. The association between plasma AGEs and sRAGE with the content of cholesterol, markers of cholesterol synthesis and absorption, and oxysterols in atherosclerotic plaques was evaluated in subjects undergoing carotid endarterectomy. Plasma and carotid plaques were obtained from symptomatic ( n = 23) and asymptomatic subjects ( n = 40). Lipids from plaques were extracted and sterols (oxysterols, cholesterol, desmosterol, lathosterol, sitosterol, and campesterol) were determined by using gas chromatography/mass spectrometry. Plasma total AGEs and pentosidine were measured by using fluorimetry and sRAGE by using ELISA. In symptomatic subjects´ atherosclerotic plaques, an increased amount of cholesterol (3x) and oxysterols [7 α-hydroxycholesterol (1.4x); 7 β−hydroxycholesterol (1.2x); 25-hydroxycholesterol (1.3x); 24-hydroxycholesterol (2.7x), and 27-hydroxycholesterol, (1.15x)], with exception to 7 ketocholesterol, were found in comparison to asymptomatic individuals. Plasma total AGEs and pentosidine significantly and positively correlated to sterols accumulated in the atherosclerotic lesion, including cholesterol, desmosterol, campesterol, sitosterol, and oxysterols. On the other hand, sRAGE inversely correlated to total AGEs and pentosidine in plasma, and with major species of oxysterols, cholesterol, and markers of cholesterol synthesis and absorption in the atherosclerotic lesion. In multiple regression analyses, it was observed a significant inverse correlation between sRAGE and 24-hydroxycholesterol and desmosterol, and a positive significant correlation between pentosidine and 24-hydroxycholesterol, 27-hydroxycholesterol, and campesterol. In conclusion, the plasma concentration of AGEs and sRAGE is a tool to predict the accumulation of sterols in atherosclerotic lesions in symptomatic and asymptomatic individuals, helping to prevent and improve the management of acute cardiovascular complications.

Este Proyecto Fin de Grado pretende implementar el sistema cardiorrespiratorio a través de la Programación Orientada a Objetos y utilizar una doble analogía eléctrica para facilitar su implementación e interpretación. En primer lugar, se realiza un estudio introductorio de la fisiología y anatomía del sistema cardiorrespiratorio, tanto de la parte respiratoria como de la cardíaca, así como de la relación entre ambos sistemas. Posteriormente, se presenta un modelo matemático basado en ecuaciones diferenciales que representan las partes cardiovascular y respiratoria por separado, lo que permite una posterior interconexión entre ambos modelos. A su vez, el sistema cardiopulmonar, que ya estará formado por la conexión entre los dos sistemas, será sometido a pruebas funcionales en condiciones normales durante el reposo y el ejercicio, y en condiciones patológicas como la obstrucción pulmonar y la regurgitación aórtica. La principal ventaja de someter a los sistemas pulmonar y cardiovascular a una patología es mostrar cómo estos sistemas se afectan mutuamente y sus consecuencias. Por último, el modelo puede ser utilizado en la investigación y por los especialistas para comprender la función cardiorrespiratoria y su estrecha relación.

12 p.-2 fig.-1 tab., Rare Diseases (RD) are defined by their prevalence in less than 5 in 10,000 of the general population. Considered individually, each RD may seem insignificant, but together they add up to more than 7000 different diseases. Research in RD is not attractive for pharmaceutical companies since it is unlikely to recover development costs for medicines aimed to small numbers of patients. Since most of these diseases are life threatening, this fact underscores the urgent need for treatments. Drug repurposing consists of identifying new uses for approved drugs outside the scope of the original medical indication. It is an alternative option in drug development and represents a viable and risk-managed strategy to develop for RDs. In 2008, the “off label” therapeutic benefits of propranolol were described in the benign tumor Infantile Hemangioma. Propranolol, initially prescribed for high blood pressure, irregular heart rate, essential tremor, and anxiety, has, in the last decade, shown increasing evidence of its antiangiogenic, pro-apoptotic, vasoconstrictor and anti-inflammatory properties in different RDs, including vascular or oncological pathologies. This review highlights the finished and ongoing trials in which propranolol has arisen as a good repurposing drug for improving the health condition in RDs., This research was funded by the Ministry of Economy and Competitivity MINECO, grant number SAF2017-83351R, and by a special internal project of CSIC (National Research Council of Spain) grant number PIE 201820E073.

The information on heart transplantation (HT) in patients with Friedreich's Ataxia (FA) is scarce, and the few published case reports are limited to young patients with mild neurological manifestations. We present the case of a 58-year-old patient with advanced FA (Scale for the Assessment and Rating of Ataxia [SARA] score 30/40), wheelchair-bound for the last 16 years and had urinary incontinence, dysarthria, and neurosensorial deafness. The patient was admitted for a refractory arrhythmic storm and had previous hypertrophic cardiomyopathy that evolved to dilated cardiomyopathy with severely reduced left ventricular ejection fraction and recurrent ventricular arrhythmias. A multidisciplinary team discussed the HT option. The patient was aware of the risks and benefits and considered worthy of the intervention, so he was listed for HT. After a successful surgical intervention, the patient had a long postoperative stay in ICU. He required a high dose of vasopressors, underwent hemofiltration for one month, suffered critical illness myopathy, had several respiratory infections and delayed tracheal extubation. Two and a half months after HT and almost five months at the hospital, the patient was successfully discharged. FA patients with severe heart conditions should be carefully evaluated by a multidisciplinary team to decide the candidacy for HT. Sin financiación 4.415 JCR (2021) Q2, 58/143 Cardiac & Cardiovascular Systems 0.897 SJR (2021) Q1, 62/265 Pharmacology (medical) No data IDR 2021 UEM

[spa] Introducción. Los catéteres venosos periféricos son el dispositivo invasivo más utilizado en la atención hospitalaria, contando por millones los catéteres colocados cada año en nuestro país. En ocasiones, la técnica de canalización puede resultar compleja, derivando en múltiples punciones que generan dolor, degradación del árbol vascular y otros efectos indeseados que pueden tener un alto impacto en la atención sanitaria. Identificar los factores de riesgo de dificultad en la canalización resultará útil para predecir y evitar estos efectos y sus consecuencias en la salud del paciente. Objetivos. La presente tesis tiene como objetivo principal identificar, analizar y modelizar los factores de riesgo que se asocian a la aparición de dificultad en la canalización venosa periférica en adultos en atención hospitalaria. Método. Se diseñó un proyecto con 2 fases: (1) una revisión sistemática de la literatura científica para identificar y analizar los factores de riesgo propuestos por estudios anteriores y (2) un estudio observacional analítico de casos y controles multicéntrico, en el que se estudiaron diferentes factores de riesgo de forma conjunta en una población de personas atendidas en hospitales. Resultados. En la revisión sistemática se seleccionaron 7 estudios de ámbito internacional, mediante los que se identificaron más de 50 factores de riesgo potenciales. Este análisis se utilizó para establecer una definición del problema de estudio, definir las variables que fueron hipotetizadas como factores de riesgo en el estudio primario e identificar otros elementos con posible influencia como el contexto de atención y las variables del profesional. En el estudio caso-control se obtuvo una muestra de 2.662 pacientes de los cuales 221 (8,3%) presentaron dificultad en la canalización. Una historia previa de dificultad en la canalización, la presencia de venas no palpables, las alteraciones agudas en las extremidades superiores y la selección de la fosa antecubital como lugar de punción resultaron factores de riesgo independientes de dificultad en la canalización venosa periférica. Los pacientes con dificultad RESUMEN Factores de riesgo de dificultad en la canalización venosa periférica en atención hospitalaria 16 requirieron mayor número de punciones (3,3 ± 1,1 vs 1,1 ± 0,3) y presentaron más dolor asociado a la técnica (3,0 vs 1,8 en la escala visual). Conclusiones. En este trabajo se identificaron 4 factores de riesgo independientes de padecer dificultad en la canalización venosa periférica, siendo la historia previa de dificultad el factor de mayor peso. Además, se concretaron variables medibles y reproducibles que pueden ser contrastadas en estudios futuros, y se propuso una definición operativa del concepto de dificultad en la canalización venosa periférica. Se encontró influencia del contexto en que se produce la atención sanitaria, pero no así de las variables relacionadas con el profesional que realiza la técnica. [cat] Introducció. Els catèters venosos perifèrics són el dispositiu invasiu més utilitzat en l'atenció hospitalària, comptant per milions els catèters col·locats cada any al nostre país. A vegades, la tècnica de canalització pot resultar complexa, derivant en múltiples puncions que generen dolor, degradació de l'arbre vascular i altres efectes no desitjats, que poden tenir un alt impacte en l'atenció sanitària. Identificar els factors de risc que dificulten la canalització, resultarà útil per a predir i evitar aquests efectes i les seves conseqüències en la salut dels pacients. Objectius. La present tesi té com a objectiu principal identificar, analitzar i modelitzar els factors de risc que s'associen a l'aparició en la dificultat de la canalització venosa perifèrica en adults, dins l’àmbit de l'atenció hospitalària. Mètode. Es va dissenyar un projecte amb 2 fases: (1) una revisió sistemàtica de la literatura científica per a identificar i analitzar els factors de risc proposats en estudis anteriors i (2) un estudi observacional analític de casos i controls multicèntric, en el qual es van estudiar diferents factors de risc de manera conjunta en una població de persones ateses a hospitals. Resultats. En la revisió sistemàtica es van seleccionar 7 estudis d'àmbit internacional, mitjançant els quals es van identificar més de 50 factors de risc potencials. Aquesta anàlisi es va utilitzar per a establir una definició del problema d'estudi, definir les variables que van ser hipotetitzadas com a factors de risc en l'estudi primari i identificar altres elements amb possible influència com el context d'atenció i les variables del professional. En l'estudi cas-control es va obtenir una mostra de 2.662 pacients, els quals 221 (8,3%) van presentar dificultat en la canalització. Una història prèvia de dificultat en la canalització, la presència de venes no palpables, les alteracions agudes en les extremitats superiors i la selecció de la fossa antecubital com a lloc de punció, van resultar factors de risc independents de dificultat en la canalització venosa perifèrica. Els pacients amb dificultat van requerir major nombre de puncions (3,3 ± 1,1 vs 1,1 ± 0,3) i van presentar més dolor associat a la tècnica (3,0 vs 1,8 en l'escala visual). RESUM Factores de riesgo de dificultad en la canalización venosa periférica en atención hospitalaria 18 Conclusions. En aquest treball es van identificar 4 factors de risc independents, de patir dificultat en la canalització venosa perifèrica, sent la història prèvia de dificultat el factor de més pes. A més a més, es varen concretar variables mesurables i reproduïbles que poden ser contrastades en estudis futurs, i es va proposar una definició operativa del concepte de dificultat en la canalització venosa perifèrica. Es va trobar influència del context en què es produeix l'atenció sanitària, però no així de les variables relacionades amb el professional que realitza tècnica. [eng] Introduction. Peripheral venous catheters are the most widely used invasive devices in hospital care, with millions of catheters placed every year in our country. In some situations, the cannulation technique can be complex, resulting in multiple punctures that generate pain, degradation of the vascular tree, and other undesired effects that may imply a high impact on health care. Identifying the risk factors for difficult cannulation will be useful in predicting and avoiding these effects and their consequences on patient health. Objective. The main objective of this thesis is to identify, analyze and model the risk factors associated with the occurrence of peripheral venous cannulation difficulty in adults in hospital care. Methods. A project was designed with 2 phases: (1) a systematic review of the scientific literature to identify and analyze the risk factors proposed by previous studies and (2) an analytical observational multicenter case-control study, in which different risk factors were studied together in a population of adult inpatients. Results. In the systematic review, 7 international studies were selected, through which more than 50 potential risk factors were identified. This analysis was used to establish a definition of the study problem, define the variables that were hypothesized as risk factors in the primary study, and identify other elements with possible influence, such as the context of care and the variables of the professional. In the case-control study, a sample of 2,662 patients was obtained, of whom 221 (8.3%) presented difficulty in canalization. A previous history of difficult cannulation, the presence of non-palpable veins, acute alterations in the upper limbs, and the selection of the antecubital fossa as the puncture site were independent risk factors for difficulty in peripheral venous cannulation. Patients with difficulty required a greater number of punctures (3.3 ± 1.1 vs. 1.1 ± 0.3) and presented higher pain levels associated with the technique (3.0 vs. 1.8 on the visual scale). ABSTRACT Factores de riesgo de dificultad en la canalización venosa periférica en atención hospitalaria 20 Conclusions. In this study, we identified 4 independent risk factors for suffering difficulty in peripheral venous cannulation, with the previous history of difficulty being the most important factor. In addition, measurable and reproducible variables were identified that can be contrasted in future studies, and an operational definition of the concept of difficulty in peripheral venous cannulation was proposed. We found that the context in which health care occurs influences difficult peripheral venous cannulation, but we found no association with the variables related to the professional performing the technique.

[eng] The pleiotropic WT1 transcription factor (WT1) was first discovered in renal tumours. It contains four zinc-finger motifs at the C-terminus which are important for DNA binding to activate gene expression and is also involved in post-transcriptional processes. The expression of WT1 is essential during development of multiple organs, among them the cardiovascular structures. In the developing heart, WT1 is strongly expressed in the epicardium, and in cardiac endothelial cells. After cardiac injury, WT1 is temporally upregulated in both lineages in the infarcted area and border zone, which points to a potential role for WT1 in cardiac repair and regeneration. In this thesis, we focused on the role of Wt1 in endothelial cells, particularly in cardiac endothelial cells during coronary vessel formation, and in the adult heart after myocardial infarction. To support some of these findings, the mouse retinal vasculature was used as a model for two-dimensional angiogenic studies. We have demonstrated that Wt1 is present in CECs during coronary development, and that Wt1 deletion abrogates for endothelial proliferation, migration, and maturation during both retinal and coronary vasculature formation in vivo. Also, RNAseq analysis of embryonic Wt1-KOΔEC CECs suggests that Wt1 controls several downstream pathways. However, the importance of Wt1 functions in neovascularization in the adult heart after injury, specifically after 14 days of MI, has proven to be limited. The so-called recapitulation of embryonic programs in the neovascularization processes arising after injury was not sufficient for Wt1 to exert a differential effect on the adult heart after myocardial infarction. We observed no significant functional changes in cardiac output, assessed by ECG imaging, nor in tissue remodelling, visualized by analysis of the fibrotic scar in the infarcted region. However, we did observe changes in Wt1-KOΔEC CECs at the molecular and transcriptomic level, suggesting that WT1 may activate some genetic programmes in these cells, even if its effects are not able to alter evident cardiac functions.

We recently developed an R-based software that could model closedloop cardiovascular interactions. In this study, we applied this tool on the EUROBAVAR data set to further test its applicability. The aim of this work is to test the effectiveness of our software to identify cardiovascular regulatory mechanisms and baroreflex impairment from these data. We first uploaded each recording into our software to model the interactions present between systolic blood pressure (SBP) and IBI by employing a wavelet detrending and multivariate autoregressive modeling algorithm. Then, our software estimated causal coherence and Gaussian-weighted baroreflex sensitivity (BRS) indexes from each model at the low frequency (LF, 0.04-0.15 Hz, sympathetic) and high frequency (HF, 0.15-0.4 Hz, parasympathetic) bands. Immediate variability transfer from SBP to IBI was also computed for each subject. Our results showed that, when standing, the estimates of only two subjects, B005 and B010, were below percentile P10 of the BRS distribution (0.719 ms/mmHg at HF, 1.678 ms/mmHg at LF) at both bands. A literature review indicated that these two subjects had a baroreflex impairment. In non-baroreflex-impaired subjects, causal coherence from IBI to SBP at LF was significantly predominant at rest when compared with the coupling from SBP to IBI (p < 0.001). This predominance disappeared during standing due to changes in the couplings, suggesting a baroreflex interaction. Closed-loop BRS supineto- standing ratios in these subjects were 1.69 ± 0.93 (LF band) and 3.1 ± 1.32 (HF band), showing a significantly decreased BRS during standing position (p < 0.01, LF; p < 0.001, HF). Immediate transfer also decreased during standing (p < 0.001). In conclusion, our software managed to evaluate causal closed-loop interactions between cardiovascular variables from the data set, evidencing a baroreflex coupling, Thus, this allows it to be a useful tool for baroreceptor evaluations. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

The incidence of thrombosis in COVID-19 patients is exceptionally high among intensive care unit (ICU)-admitted individuals. We aimed to develop a clinical prediction rule for thrombosis in hospitalized COVID-19 patients. Data were taken from the Thromcco study (TS) database, which contains information on consecutive adults (aged ≥ 18) admitted to eight Spanish ICUs between March 2020 and October 2021. Diverse logistic regression model analysis, including demographic data, pre-existing conditions, and blood tests collected during the first 24 h of hospitalization, was performed to build a model that predicted thrombosis. Once obtained, the numeric and categorical variables considered were converted to factor variables giving them a score. Out of 2055 patients included in the TS database, 299 subjects with a median age of 62.4 years (IQR 51.5–70) (79% men) were considered in the final model (SE = 83%, SP = 62%, accuracy = 77%). Seven variables with assigned scores were delineated as age 25–40 and ≥70 = 12, age 41–70 = 13, male = 1, D-dimer ≥ 500 ng/mL = 13, leukocytes ≥ 10 × 103/µL = 1, interleukin-6 ≥ 10 pg/mL = 1, and C-reactive protein (CRP) ≥ 50 mg/L = 1. Score values ≥28 had a sensitivity of 88% and specificity of 29% for thrombosis. This score could be helpful in recognizing patients at higher risk for thrombosis, but further research is needed.

Introduction: Human adaptation to high altitude is due to characteristic adjustments at every physiological level. Differences in lipid profile and cardiovascular risk factors in altitude dwellers have been previously explored. Nevertheless, there are no reports available on genotype-controlled matches among different altitude-adapted indigenous populations.Objective: To explore the possible differences in plasma lipid profile and cardiovascular risk among autochthonous Kiwcha people inhabitants of low and high-altitude locations.Methodology: A cross-sectional analysis of plasmatic lipid profiles and cardiovascular risk factors in lowland Kiwchas from Limoncocha (230 m) and high-altitude Kiwchas from Oyacachi (3,800 m).Results: In the low altitude group, 66% were women (n = 78) and 34% (n = 40) were men, whereas in the high altitude group, 59% (n = 56) were women and 41% (n = 41%) were men. We found the proportion of overweight and obese individuals to be higher among low altitude dwellers (p < 0.05). Red blood cells (RBCs), hemoglobin concentration, and SpO2% were higher among high altitude dwellers and the erythrocyte size was found to be smaller at high altitude. The group located at low altitude also showed lower levels of plasma cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), but most of these differences are not influenced by gender or elevation.Conclusions: Living at an altitude elicits well-known adaptive physiological changes such as erythrocyte count, hemoglobin concentration, hematocrit level, and serum glucose level. We also report clinical differences in the plasma lipid profile, with higher levels of cholesterol, HDL, and LDL in inhabitants of the Andes Mountain vs. their Amazonian basin peers. Despite this, we did not find significant differences in cardiovascular risk.

Varón de 57 años con antecedente de infarto de miocardio anterior. En una tomografía axial computarizada (TAC) cardíaca realizada 3 años más tarde, se objetiva una imagen hipodensa en el ápex del ventrículo izquierdo. Ante la sospecha de trombo, se completa el estudio mediante resonancia magnética cardíaca (RMC) con gadolinio, ecocardiografía transtorácica (ETT) 2D con ecopotenciador y ETT tridimensional. A través de la imagen multimodalidad se comprueba la ausencia de trombo. Cardiac computed tomography showed a hypodense area in the apex of the left ventricle in a 57-year-old man with a history of anterior myocardial infarction three years earlier. To confirm or rule out a suspected thrombus, he underwent gadolinium-enhanced cardiac magnetic resonance imaging, contrast-enhanced two-dimensional transthoracic echocardiography, and three-dimensional transthoracic echocardiography. Multimodality imaging ruled out the presence of a thrombus. Sin financiación No data JCR 2020 0.220 SJR (2020) Q4, 141/338 Radiology, Nuclear Medicine and Imaging No data IDR 2020 UEM

Objective Previous studies showed the benefit of canonical transient receptor potential 6 (TRPC6) channel deficiency in promoting endothelial healing of arterial injuries in hypercholesterolemic animals. Long-term studies utilizing a carotid wire-injury model were undertaken in wild-type (WT) and TRPC6-/- mice to determine the effects of TRPC6 on phenotypic modulation of vascular smooth muscle cells (SMC) and neointimal hyperplasia. We hypothesized that TRPC6 was essential in the maintenance or reexpression of a differentiated SMC phenotype and minimized luminal stenosis following arterial injury. Methods The common carotid arteries (CCA) of WT and TRPC6-/- mice were evaluated at baseline and 4 weeks after wire injury. At baseline, CCA of TRPC6-/- mice had reduced staining of MYH11 and SM22, fewer elastin lamina, luminal dilation, and wall thinning. After carotid wire injury, TRPC6-/- mice developed significantly more pronounced luminal stenosis compared with WT mice. Injured TRPC6-/- CCA demonstrated increased medial/intimal cell number and active cell proliferation when compared with WT CCA. Immunohistochemistry suggested that expression of contractile biomarkers in medial SMC were essentially at baseline levels in WT CCA at 28 days after wire injury. By contrast, at 28 days after injury medial SMC from TRPC6-/- CCA showed a significant decrease in the expression of contractile biomarkers relative to baseline levels. To assess the role of TRPC6 in systemic arterial SMC phenotype modulation, SMC were harvested from thoracic aortae of WT and TRPC6-/- mice and were characterized. TRPC6-/- SMC showed enhanced proliferation and migration in response to serum stimulation. Expression of contractile phenotype biomarkers, MYH11 and SM22, was attenuated in TRPC6-/- SMC. siRNA-mediated TRPC6 deficiency inhibited contractile biomarker expression in a mouse SMC line. Conclusions These results suggest that TRPC6 contributes to the restoration or maintenance of arterial SMC contractile phenotype following injury. Understanding the role of TRPC6 in phenotypic modulation may lead to mechanism-based therapies for attenuation of IH. Clinical Relevance After endovascular intervention and open vascular surgery, vascular smooth muscle cells (VSMC) undergo a coordinated reprogramming of gene expression to facilitate arterial healing. Down regulation of VSMC-specific contractile biomarkers (eg, SM22 and MYH11) and induction of pathways that promote cell proliferation, migration, and matrix synthesis are hallmarks of this phenotypic switch. Dysregulated phenotypic switching leads to the development of neointimal hyperplasia and vascular restenosis. Identifying pathways that regulate or constrain VSMC phenotypic modulation, therefore, has the potential to decrease neointimal hyperplasia and improve outcomes after vascular intervention. In this study, we demonstrate that depletion of the non-voltage-gated cation channel TRPC6 promotes phenotypic switching and loss of contractile biomarkers in systemic arterial VSMC. TRPC6-/- mice developed significantly more pronounced luminal stenosis compared with wild-type mice after carotid wire injury. These results suggest that TRPC6 contributes to the restoration or maintenance of contractile phenotype in VSMC after injury. Understanding the role of TRPC6 in phenotypic switching may lead to mechanism-based therapies to mitigate restenosis. Fil: Smith, Andrew H.. National Institute Of Environmental Health Sciences; Estados Unidos Fil: Priya, Bhanu Priya. National Institute Of Environmental Health Sciences; Estados Unidos Fil: Driscoll, Erin C.. National Institute Of Environmental Health Sciences; Estados Unidos Fil: Chaudhuri, Pinaki. National Institute Of Environmental Health Sciences; Estados Unidos Fil: Birnbaumer, Lutz. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentina Fil: Rosenbaum, Michael A.. National Institute Of Environmental Health Sciences; Estados Unidos Fil: Graham, Linda M.. National Institute Of Environmental Health Sciences; Estados Unidos

Background: Reductions in albuminuria of more than 30% are considered a strong marker of delay of chronic kidney disease (CKD) progression. Single renin–angiotensin system (RAS) blockade represents the cornerstone of CKD treatment. However, as CKD progression still occurs, other nephroprotective options were explored; mineralocorticoid receptor antagonists (MRA) were tested with generally positive results. Methods: We conducted a systematic review and meta-analysis on the effects of MRAs on albuminuria/proteinuria, and adverse events, such as change in renal function and hyperkalemia incidence. A detailed search in electronic databases, clinical trial registries and grey literature was performed to retrieve randomized controlled trials (RCTs) in which administration of an MRA alone or on-top of ACEi/ARB was compared with placebo or active treatment. Results: Of the 45 initially identified reports, 31, with 2767 participants, were included in analysis of the primary outcome. The use of MRAs (alone or on top of RAS blockade) compared with placebo decreased urine albumin-to-creatinine ratio (UACR) by −24.55% (95% CI −29.57 to −19.53%), urine protein-to-creatinine ratio (UPCR) by −53.93% (95% CI −79% to −28.86%) and 24 h albumin excretion by −32.47% (95% CI −41.1 to −23.85%). MRAs also reduced UACR by −22.48% (95% CI −24.51 to −20.44%) compared with calcium-channel-blockers (CCBs), whereas no differences were found compared with a second ACEi/ARB or nonpotassium-sparing diuretics. Addition of an MRA was associated with change in estimated glomerular filtration rate (eGFR) of −2.38 ml/min per 1.73 m2 (95% CI −3.51 to −1.25), rise in potassium by 0.22 mEq/l (95% CI 0.16–0.28 mEq/l) and a 2.6-fold increase in hyperkalemia risk (RR 2.63, 95% CI 1.69–4.08) compared with placebo/active control. Conclusion: Use of MRAs alone or on top of RAS blockade confers important antiproteinuric effects in patients with CKD, with a slight increase in mean potassium levels. Sin financiación 4.171 JCR (2019) Q1, 13/65 Peripheral Vascular Disease 1.365 SJR (2019) Q1, 42/186 Physiology, 65/362 Cardiology and Cardiovascular Medicine, 21/139 Internal Medicine No data IDR 2019 UEM

La medida de presión arterial (PA) en la clínica es el procedimiento más utilizado para el diagnóstico y tratamiento de la hipertensión arterial (HTA), pero presenta una considerable inexactitud debida, por un lado, a la propia variabilidad intrínseca de la PA y, por otro, a sesgos derivados de la técnica y condiciones de medida. Varios estudios han demostrado la superioridad pronóstica de la monitorización ambulatoria de la PA (MAPA), que además detecta la HTA de bata blanca, evitando sobrediagnósticos y sobretratamientos en numerosos casos, y la HTA enmascarada que, al contrario, tiene riesgo de infradetección e infratratamiento. La MAPA está reconocida como la técnica más apropiada para el diagnóstico y seguimiento de la HTA en la mayoría de las guías internacionales. El presente documento, tomando como referencia las recomendaciones de la Sociedad Europea de Hipertensión, tiene como objetivo revisar las evidencias sobre la MAPA, servir de guía a los profesionales sanitarios y fomentar la utilización de esta técnica en el diagnóstico y el seguimiento del paciente hipertenso. Se abordan el procedimiento, los requisitos necesarios para realizar una MAPA y sus indicaciones clínicas. También se analizan las principales aportaciones de la MAPA en el diagnóstico de los fenotipos de HTA de bata blanca y HTA enmascarada, los patrones de variabilidad a corto plazo de la PA, su utilidad en la HTA resistente y de alto riesgo, así como su papel en grupos especiales de población como ancianos, niños y embarazadas. Finalmente, se tratan aspectos sobre la situación actual del Registro español de MAPA y las perspectivas futuras en cuanto a investigación y generalización de la MAPA en la práctica clínica. Conventional blood pressure (BP) measurement in clinical practice is the most used procedure for the diagnosis and treatment of hypertension (HT), but is subject to considerable inaccuracies due to, on the one hand, the inherent variability of the BP itself and, on the other hand biases arising from the measurement technique and conditions, Some studies have demonstrated the prognosis superiority in the development of cardiovascular disease using ambulatory blood pressure monitoring (ABPM). It can also detect “white coat” hypertension, avoiding over-diagnosis and over-treatment in many cases, as well detecting of masked hypertension, avoiding under-detection and under-treatment. ABPM is recognised in the diagnosis and management of HT in most of international guidelines on hypertension. The present document, taking the recommendations of the European Society of Hypertension as a reference, aims to review the more recent evidence on ABPM, and to serve as guidelines for health professionals in their clinical practice and to encourage ABPM use in the diagnosis and follow-up of hypertensive subjects. Requirements, procedure, and clinical indications for using ABPM are provided. An analysis is also made of the main contributions of ABPM in the diagnosis of “white coat” and masked HT phenotypes, short term BP variability patterns, its use in high risk and resistant hypertension, as well as its the role in special population groups like children, pregnancy and elderly. Finally, some aspects about the current situation of the Spanish ABPM Registry and future perspectives in research and potential ABPM generalisation in clinical practice are also discussed. Sin financiación No data JCR 2019 0.130 SJR (2019) Q4, 314/362 Cardiology and Cardiovascular Medicine, 109/139 Internal Medicine No data IDR 2019 UEM

As Doenças Cardiovasculares (DCV), atualmente, causam mais de 300.000 mortes por ano no Brasil, segundo dados da Sociedade Brasileira de Cardiologia (SBC), emitido por meio do Cardiômetro, indicador do número de mortes por DCV no país. O resveratrol tem capacidade de beneficiar a função endotelial, dessa forma, prevenir aterosclerose. Diante do exposto, o objetivo deste trabalho foi realizar uma revisão da literatura sobre os benefícios do resveratrol na promoção da saúde cardiovascular e no tratamento de DCV. Trata-se de um estudo de revisão da literatura científica de artigos originais e revisão dos últimos 18 anos, sobre as vantagens do uso de resveratrol na prevenção e tratamento das DCV. O trans-3,5,4’-trihydroxystilbene, conhecido como resveratrol, é um composto fenólico, do tipo estilbenos, da classe dos polifenóis não-flavonoides encontrados em maior frequência Vitis vinífera (uvas). Foi demonstrado que a substância possui propriedades de promoção da saúde e características antioxidantes, anti-inflamatórias, cardioprotetoras, antidiabéticas, anticâncer, quimiopreventivas e neuroprotetoras. A introdução de resveratrol na dieta pode ser feita por meio de suplementação (cápsulas ou tabletes) e pelo consumo diário de alimentos fonte do composto. A formulação fitoterápica mais utilizada em estudos foi cápsulas de extrato seco de Vitis vinífera, com doses variáveis entre 2 a 25 mg/kg/dia. Todavia, os estudos realizados com alimentos fonte de resveratrol, como o suco de uva integral e vinho tinto, resultaram em maiores respostas benéficas ao organismo. Em vista disso, o consumo de alimentos naturalmente fontes de antioxidantes, aliados à dietas equilibradas e saudáveis, desempenham diversas funções benéficas.