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Sin financiación No data JCR (2021) 0.130 SJR (2021) Q4, 317/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Resumen Introduccion y objetivos Se presentan las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en Espana con la actualizacion correspondiente a 2019. Metodos Se describen las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en 2019, asi como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a anos previos, los cambios mas llamativos son el descenso hasta el 38% de los trasplantes realizados en codigo urgente, y la consolidacion en el cambio de asistencia circulatoria pretrasplante, con la practica desaparicion del balon de contrapulsacion (0,7%), la estabilizacion del uso del oxigenador extracorporeo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0,34), y ambas mejores que la del trienio 2010-2012 (p = 0,002 y p = 0,01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en Espana como los resultados en supervivencia en los ultimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoria con dispositivos de asistencia ventricular.

Introduction and objectives Degenerative aortic stenosis (DAS) is the most frequent valvular heart disease. It remains unclear how to identify asymptomatic DAS patients with normal left ventricular ejection fraction who have a high probability of event occurrence and would thus benefit from early intervention. Here, we describe a protocol for exercise hemodynamics in true asymptomatic patients with moderate or severe DAS and assess the prognostic value of the data obtained in this population. Methods This study involved a prospective single-centre registry of consecutive asymptomatic patients with moderate or severe DAS. Patients underwent cardiopulmonary exercise testing to confirm symptom absence during exercise and then right heart catheterization (RHC) at rest and during exercise. Events were defined as death, surgical aortic valve replacement, or transcatheter aortic valve implantation according to clinical guidelines. Results Thirty-three patients underwent baseline and exercise RHC. The mean aortic valve area was 1.08 cm2 and the aortic gradient was 39 mmHg. The mean pulmonary artery pressure was 21 mmHg with a pulmonary artery occlusion pressure of 14 mmHg and cardiac output of 5.6 L/min. The mean pulmonary artery pressure at peak exercise was 34 mmHg. After a mean follow-up of 27 months, 8 patients experienced an event (24%). There were no differences in baseline variables, aortic valve area, or cardiopulmonary exercise testing parameters between the event and event-free groups. Patients with an event did not have higher pulmonary or filling pressures after peak exercise but had lower pulmonary artery oxygen saturation on effort (median, 48% vs 57%, P = .03). Conclusions Exercise RHC is feasible and safe in this population. Peak pulmonary artery oxygen saturation might identify patients with increased risk of serious adverse events.

Resumen Introduccion y objetivos La estenosis aortica degenerativa es la valvulopatia mas frecuente. Aun no esta claro como identificar a los pacientes asintomaticos con fraccion de eyeccion del ventriculo izquierdo normal y alta probabilidad de eventos que por ello pudieran beneficiarse de una intervencion valvular precoz. En este estudio se describe un protocolo de hemodinamica de esfuerzo para los pacientes asintomaticos con estenosis aortica moderada o grave para evaluar su valor pronostico para esta poblacion. Metodos Estudio prospectivo unicentrico de una poblacion de pacientes con estenosis aortica moderada o grave asintomaticos. Los pacientes realizaron una ergoespirometria para confirmar la ausencia de sintomas en esfuerzo. Despues los pacientes se sometieron a un cateterismo cardiaco derecho basal y de esfuerzo. Se definio evento como muerte o necesidad de reemplazo de valvula aortica quirurgico o percutaneo basado en las guias clinicas. Resultados Se sometio a 33 pacientes a cateterismo cardiaco derecho basal y de esfuerzo. El area valvular aortica media fue de 1,08 cm2 y el gradiente aortico medio, 39 mmHg. La presion arterial pulmonar media fue de 21 mmHg, con una presion de oclusion en la arteria pulmonar de 14 mmHg y un gasto cardiaco de 5,6 l/min. La presion pulmonar media en ejercicio maximo fue de 34 mmHg. Tras un seguimiento medio de 27 meses, 8 pacientes sufrieron un evento (24%). No hubo diferencias en las variables basales, el area valvular aortica o los parametros de ergoespirometria. Los pacientes con evento no tuvieron mayores presiones pulmonares o presiones de llenado en ejercicio maximo, pero el grupo con eventos mostro menor saturacion de oxigeno en la arteria pulmonar en esfuerzo (mediana, el 48 frente al 57%; p = 0,03). Conclusiones El cateterismo cardiaco de esfuerzo es seguro y factible en esta poblacion. La saturacion de oxigeno en la arteria pulmonar en esfuerzo podria identificar a un grupo de pacientes con un aumento del riesgo de eventos adversos graves.

This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.

BackgroundSex differences in immune responses are well known. However, the humoral response in males and females in the case of influenza vaccination is yet to be characterized since studies have shown uneven results.MethodsA retrospective study was conducted in 2,243 individuals (46.9% males) divided by age (15–64 and ≥65 years old). A serological analysis was performed by hemagglutination inhibition assay (HI) just before and 28 days after annual vaccination against seasonal influenza viruses in people vaccinated during the 2006–2018 seasons. A comparison of the humoral responses against influenza A and B viruses contained in the vaccine, between male and female individuals in young adults and elderly was conducted.ResultsSignificative higher humoral response against classical influenza A (H1N1), A(H1N1)pdm09 subtype and B/Victoria lineage in terms of seroconversion rate were found in elderly women. No significant differences were found in the case of A(H3N2) subtype.ConclusionsElderly women seem to display a greater humoral response against classical A(H1N1), pandemic A(H1N1)pmd09 and B/Victoria lineage than elderly men. Sex dimorphism does not affect young adults.

The use of non-pharmaceutical interventions (NPIs), such as social distancing, lockdowns and the massive use of masks, have not only largely prevented the spread of SARS-CoV-2, but also of other respiratory viruses such as influenza or respiratory syncytial virus (RSV). This decrease has been so high that, in most countries, the influenza and RSV epidemic has not occurred. Far from being a beneficial fact, this can be problematic, since the absence of circulation of certain pathogens can lead to a decrease in herd immunity against them. This can promote the rise of more serious, longer-lasting epidemics that start sooner. To alleviate the collateral effects that may occur due to the decrease in circulation of viruses such as influenza, it is necessary to increase the production of influenza vaccines, carry out mass vaccination campaigns and focus on vaccinating the main drivers of this virus, children.

BACKGROUND The arrhythmic burden after discharge in patients with new-onset left bundle branch block (LBBB) undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 (S3) valve remains largely unknown. OBJECTIVE The purpose of this study was to determine the incidence of late arrhythmias in patients with new-onset LBBB undergoing TAVR with the balloon-expandable S3 valve. METHODS This was a multicenter, prospective study that included 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. An implantable cardiac monitor (Reveal XT, Reveal LINQ) was implanted before discharge. The primary endpoint was the incidence of high-degree atrioventricular block or complete heart block (HAVB/CHB). RESULTS A total of 40 patients (38.5%) had at least 1 significant arrhythmic event, leading to a treatment change in 17 (42.5%). Significant bradyarrhythmias occurred in 20 of 104 patients (19.2%) (34 HAVB/CHB episodes, 252 severe bradycardia episodes), with 10 of 20 patients (50%) exhibiting at least 1 episode of HAVB/ CHB. Most HAVB/CHB episodes ( 60%) occurred within 4 weeks after discharge. Nine patients ( 8.7%) underwent permanent pacemaker implantation at 12 months based on the Reveal findings (6 HAVB/CHB, 3 severe bradycardia). CONCLUSION S3 valve recipients with new-onset LBBB have a high arrhythmic burden, with more than one-third of patients exhibiting at least 1 significant arrhythmic episode within 12 months (HAVB/ CHB in 10% of patients). About one-half of bradyarrhythmic events occurred within 4 weeks after discharge. These results should inform future strategies on the use of continuous electrocardiographic monitoring in TAVR S3 patients with new conduction disturbances following the procedure.

© 2020 The Author(s)., [Objectives]: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters., [Methods]: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs)., [Results]: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22–0.47; p < 0.001) for tocilizumab, 0.82 (0.71–1.30; p 0.82) for IHDC, 0.61 (0.43–0.86; p 0.006) for PDC, and 1.17 (0.86–1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02–0.17; p < 0.001)., [Conclusions]: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation., IJ has received honoraria for participating in an advisory board from Gilead Sciences, and for educational activities from ViiV. JB has received research grants from AbbVie, Gilead Sciences, Merck, and ViiV, and honoraria for being a speaker or advisory board participation from AbbVie, Gilead Sciences, Janssen, Merck, and ViiV. JRA received fees for participating in an advisory board, being a speaker, and research grant support from Viiv, Janssen, Gilead, MSD, Teva, Alexa and Serono. PR is involved as speaker or advisory board participant for Gilead Sciences, AbbVie and ViiV. JR-B, JP, JC and MY have no conflicts of interest to declare. SAM-COVID was funded by Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (COV20/01031) co-funded by European Union (ERDF/ESF, “Investing in your future”) and Fundación SEIMC/GeSIDA. In addition, Juan Berenguer, Jesús Rodríguez-Baño, Inmaculada Jarrín, Jordi Carratalá, Jerónimo Pachón, and José R Arribas received funding for research from Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades – co- financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020 through the networks: Spanish AIDS Research Network (RIS) [RD16/0025/0017 (JB), RD16/0025/0018 (JRA), RD16/0025/00XX (IJ)] and Spanish Network for Research in Infectious Diseases (REIPI)[RD16/0016/0001 (JRB), RD16/0016/0005 (JC), and RD16/0016/0009 (JP).

Aims We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Methods and results Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year. Conclusion Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307)

REIPI-SEIMC COVID-19 group and COVID@HULP group., [Background] The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality., [Methods] In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model., [Findings] Three distinct phenotypes were derived in the derivation cohort (n=2667)—phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])—and reproduced in the internal validation cohort (n=1368)—phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4–4·3) for patients with phenotype A, 30·5% (28·5–32·6) for patients with phenotype B, and 60·7% (53·7–67·2) for patients with phenotype C (log-rank test p, [Interpretation] Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated., [Funding] Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA., Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.

Objectives The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Background Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR. Methods This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treatment change, and the incidence of HAVB at 12-month follow-up. Results A total of 1,553 new arrhythmic events were detected in 44 patients (1,443 episodes of tachyarrhythmia in 26 patients [atrial fibrillation/flutter/atrial tachycardia: 1,427, ventricular tachycardia 16]; 110 episodes of bradyarrhythmia in 21 patients [HAVB 54, severe bradycardia 56]). All arrhythmic events were silent in 34 patients (77%), the arrhythmic event led to a treatment change in 19 patients (18%), and 11 patients (11%) required pacemaker or implantable cardioverter-defibrillator implantation (due to HAVB, severe bradycardia, or ventricular tachycardia episodes in 9, 1, and 1 patient, respectively). A total of 12 patients died at 1-year follow-up, 1 from sudden death. Conclusions A high incidence of arrhythmic events was observed at 1-year follow-up in close to one-half of the patients with LBBB post-TAVR. Significant bradyarrhythmias occurred in one-fifth of the patients, and PPM was required in nearly one-half of them. These data support the use of a cardiac monitoring device for close follow-up and expediting the initiation of treatment in this challenging group of patients. (Ambulatory Electrocardiographic Monitoring for the Detection of High-Degree Atrio-Ventricular Block in Patients With New-onset PeRsistent LEft Bundle Branch Block After Transcatheter Aortic Valve Implantation [MARE study]: NCT02153307)

Objectives To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake. Methods A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population. Results Protein consumption in the age 1–3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4–8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy. Conclusions The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children. Electronic supplementary material The online version of this article (10.1007/s00394-018-1676-3) contains supplementary material, which is available to authorized users.

Resumen Introduccion y objetivos Muchos pacientes sometidos a implante percutaneo de valvula aortica (TAVI) presentan insuficiencia mitral (IM) de grado moderado o menor. El impacto de la insuficiencia tricuspidea (IT) sigue sin resolverse. Se analiza el impacto de la IM moderada frente a leve-ausente y su evolucion, y de la IT concomitante y su interaccion con la IM. Metodos Estudio retrospectivo multicentrico de 813 pacientes tratados con TAVI entre 2007 y 2015 con IM ≤ 2 y abordaje transfemoral. Resultados La edad media fue 81 ± 7 anos y el Society of Thoracic Surgeons-score fue de 6,9 ± 5,1%. El 37,3% presento IM moderada, con resultados comparables intrahospitalarios y de mortalidad a 6 meses frente a IM 2 tras el TAVI. La presencia de IT moderada/grave se asocio con una mortalidad intrahospitalaria y de seguimiento del 13 y el 34,1%, independientemente del grado de IM. La IT moderada-grave fue predictor independiente de mortalidad (HR = 18,4; IC95%, 10,2-33,3; p Conclusiones La presencia de IM moderada no supuso mayor mortalidad a corto-medio plazo tras el TAVI, pero asocio mas rehospitalizaciones. La presencia de IT moderada/grave implico mayor mortalidad. Esto sugiere que una evaluacion minuciosa de los mecanismos subyacentes entre ambas insuficiencias valvulares debe realizarse para determinar la mejor estrategia para evitar la futilidad relacionada con TAVI.

Introduction and objectives Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI , as well as the impact of concomitant TR and its interaction with MR. Methods Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015. Results The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR P = .257). However, they experienced more rehospitalizations and worse New York Heart Association class ( P = .008 and .001, respectively). Few patients (3.8%) showed an increase in the MR grade to > 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P Conclusions The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.

AIMS Empirically, transfemoral (TF) approach is the first choice for transcatheter aortic valve implantation (TAVI). We aimed to investigate whether transubclavian (TSc) and TF approaches present comparable major outcomes according to current evidence. METHODS We systematically searched PubMed, EMBASE, and Cochrane database for studies with symptomatic aortic stenosis patients who underwent TAVI through TF or TSc/axillary access from January/2006 to January/2017. Searched terms were: ("aortic stenosis" OR "transcatheter aortic" OR "TAVI" OR "TAVR") and ("transfemoral" OR "transaxillary" OR "transubclavian"). Major outcomes according to Valve Academic Research Consortium-2 criteria were gathered. The odds ratio (OR) was used as a summary statistic. A random-effects model was used. A fully percutaneous TSc TAVI case from our institution illustrates minimalist approach. RESULTS Final analysis was made with six studies including 4,504 patients (3,886 TF and 618 TSc). Baseline characteristics of compared groups in individual studies were similar, with the exception of a higher logistic EuroSCORE in the TSc group (23.7 ± 1.92 vs. 21.17 ± 3.51, P = 0.04) and higher prevalence of coronary and peripheral artery disease with OR = 0.67 [95% CI: 0.54-0.83] (P = 0.0003) and OR = 0.08 [95% CI: 0.05-0.12] (P

AIM: The inflammatory bowel disease is a highly prevalent disorder in Spain. Incident cases have been increasing during the last decades. In this study we sought to determine rates and temporal patterns of hospitalizations related both to ulcerative colitis and Crohn’s disease in a 16-year period in Spain and to characterize temporal patterns in surgical utilization, length of stay, and economic burden of IBD for the same time period. METHODS: A retrospective study using the national information system for hospital data was performed. All hospital discharges related to ulcerative colitis and Crohn's disease among general population reported during a 16-year period (January 1, 1997 through December 31, 2012) were obtained. Most frequent comorbidities, diagnostic procedures and surgeries were also reported. RESULTS: A total of 26,948 hospital discharges due to ulcerative colitis and 87,752 due to Crohn´s disease were reported in the 16 years study period in Spain. Mean age was 45.3 (SD = 20.5) and 38.0 (SD = 17.3) years, respectively and 55% and 50% were female, respectively. There were a total of 392 deaths among ulcerative colitis hospitalized patients and 565 among Crohn´s disease patients. The annual hospitalization rate was 3.94 (CI 95% 3.90-3.99) per 100,000 population for ulcerative colitis and 12.84 (CI 95%:12.76-12.93) per 100,000 population for Crohn’s disease. The hospitalization rate significantly increased during the study period in the Crohn’s disease group, but remained constant in the ulcerative colitis group. While hospitalization rate in ulcerative colitis constantly increased with age, it peaked for Crohn´s disease in young adults. Case-fatality rate was higher among ulcerative colitis patients. Hospitalization costs were higher for Crohn´s disease related hospitalizations (€4442; SD=€3708) than for ulcerative colitis (€3930; SD = €3054). CONCLUSION: The hospitalization rate for Crohn’s disease has significantly increased within a 16-year period in Spain, remaining the hospitalization rate stable for ulcerative colitis. The reported trends in hospitalizations for Crohn´s disease describe an important burden on health and economic cost to the Spanish health system.

Sin financiación 7.598 JCR (2020) Q1, 6/36 Critical Care Medicine 3.002 SJR (2020) Q1, 3/88 Critical Care and Intensive Care Medicine No data IDR 2020 UEM

Left ventricular assist devices (LVADs) have become an established treatment for advanced heart failure, although with long-term support these patients are potentially exposed to serious complications. Our purpose was to assess the role of the neutrophil to lymphocyte ratio (NLR) in LVAD complications and to evaluate if higher values of NLR after 4-6 months on LVAD support (NLR 4_6m) are associated with worse prognosis. All consecutive patients who received a HeartWare LVAD (N = 188, age 50 ± 13 years), as bridge to transplant from December 2009 to January 2018 were included. Neutrophil to lymphocyte ratio was recorded pre-LVAD, post-LVAD, after 4-6 months on support and in case of a first adverse event to occur after the 4-6 months NLR was recorded. Median NLR values were pre-LVAD 4.26 (interquartile range [IQR], 3.1-6.9), at 1 day postoperative 11.6 (IQR, 8.3-16.6), and NLR 4_6m 4.4 (IQR, 3.0-6.4) (p < 0.001). Neutrophil to lymphocyte ratio increased significantly when patients had an infection, stroke, or pump thrombosis, as compared with the NLR 4_6m (all p < 0.05). Patients with NLR 4_6m ≥ median had higher rates of stroke and mortality. Survival time was shorter among patients with NLR 4_6m ≥ 4.4 (log-rank test p = 0.006). Neutrophil to lymphocyte ratio 4_6m was found to be predictive of increased mortality (area under the curve of 0.62, p = 0.007). After multivariate analysis, NLR 4_6m remained independently associated with increased mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.03-2.7; p = 0.037). Neutrophil to lymphocyte ratio 4_6m values significantly increase in association with adverse events on LVAD support and are independently associated with mortality. This association suggests presence of inflammation adversely affects LVAD outcomes.

Objectives The aim of this study was to describe the incidence, mechanisms, features, and management of aseptic intracardiac shunts (AICS). Background AICS following transcatheter aortic valve replacement (TAVR) are an uncommon and barely described complication. Methods A systematic review was performed of all published cases of AICS following TAVR, and the incidence, predictors, main features, management, and related outcomes were analyzed. Results A total of 31 post-TAVR AICS were gathered. After excluding transapical fistulas, the 28 remaining cases corresponded with an incidence of about 0.5%. Mean age and mean logistic European System for Cardiac Operative Risk Evaluation score were 80 ± 11 years and 19.2 ± 8.3%, respectively. Prior radiation therapy for cancer was present in 14.3%, and 42.8% had severe calcification of the aortic valve. TAVR was undertaken using balloon-expandable prostheses in the majority of cases (85.7%), via the transapical approach in one-third. Median time from TAVR to diagnosis was 21 days (interquartile range: 7 to 30 days), with intraprocedural suspicion in 12 cases (42.9%) and a mean Qp/Qs ratio of 1.8 ± 0.6. The most common location for AICS was the interventricular septum (60.7%). Heart failure was frequent (46.4%), but 14 patients (50%) remained asymptomatic. Medical treatment (71.4%) was associated with poor outcomes (30-day mortality rate 25%), especially in symptomatic patients (35% vs. 0%; p = 0.020) and in those with higher Qp/Qs ratios (1.9 ± 0.6 vs. 1.4 ± 0.1), while cardiac surgery (3.6%), and percutaneous closure (25%) led to good outcomes after a median follow-up period of 3 months (interquartile range: 1 to 9 months). Conclusions Post-TAVR AICS are uncommon but have high 30-day mortality if left untreated, especially in symptomatic patients. Percutaneous closure was feasible and safe in symptomatic patients but remains controversial in asymptomatic subjects.

Background We aimed to analyze causes, management, and outcomes of the unexpected need to abort sternotomy in aortic stenosis (AS) patients accepted for surgical aortic valve replacement (SAVR) in the transcatheter aortic valve implantation (TAVI) era. Methods Cases of aborted sternotomy (AbS) were gathered from 5 centers between 2009 and 2014. A systematic review of all published cases in the same period was performed. Results A total of 31 patients (71% males, 74±8years, LogEuroSCORE 11.9±7.4%) suffered an AbS (0.19% of all sternotomies). Main reasons for Abs included previously unknown porcelain aorta (PAo) in 83.9%, mediastinal fibrosis due to radiotherapy in 12.9%, and chronic mediastinitis in 3.2%. Median time between AbS and next intervention was 2.3months (IQR: 0.7–5.8) with no mortality within this period. Only a case was managed with open surgery. In 30 patients (96.8%) TAVI was performed with a rate of success of 86.7%. Three patients (9.7%) presented in-hospital death and 17 (54.8%) had in-hospital complications including heart failure (9.6%), major bleeding (6.9%), and acute kidney injury (9.6%). Older patients (76±8 vs. 70±8years, p=0.045), previous cardiac surgery (60% vs. 15.4%, p=0.029), and shorter time from AbS to next intervention (5.1±5 vs. 1±0.7months, p=0.001) were related to higher six-month mortality (22.6%). Conclusions The main reason for AbS was PAo. This entity was associated to a higher rate of complications and mortality, especially in older patients and with prior cardiac surgery. A preventive strategy in these subgroups might be based on imaging evaluation. TAVI was the most extended therapy.

Objectives This study sought to analyze the clinical impact of the degree and improvement of mitral regurgitation in TAVR recipients, validate the main imaging determinants of this improvement, and assess the potential candidates for double valve repair with percutaneous techniques. Background Many patients with severe aortic stenosis present with concomitant mitral regurgitation (MR). Cardiac imaging plays a key role in identifying prognostic factors of MR persistence after transcatheter aortic valve replacement (TAVR) and for planning its treatment. Methods A total of 1,110 patients with severe aortic stenosis from 6 centers who underwent TAVR were included. In-hospital to 6-month follow-up clinical outcomes according to the degree of baseline MR were evaluated. Off-line analysis of echocardiographic and multidetector computed tomography images was performed to determine predictors of improvement, clinical outcomes, and potential percutaneous alternatives to treat persistent MR. Results Compared with patients without significant pre-TAVR MR, 177 patients (16%) presented with significant pre-TAVR MR, experiencing a 3-fold increase in 6-month mortality (35.0% vs. 10.2%; p 35.5 mm (odds ratio: 9.0; 95% confidence interval: 3.2 to 25.3; p Conclusions Significant MR is not uncommon in TAVR recipients and associates with greater mortality. In more than one-half of patients, the degree of MR improves after TAVR, which can be predicted by characterizing the mitral apparatus with multidetector computed tomography. According to standardized imaging criteria, at least 1 in 10 patients whose MR persists after TAVR could benefit from percutaneous mitral procedures, and even more could be treated with MitraClip after dedicated pre-imaging evaluation.

Producción Científica, Introduction: There is uncertainty about the magnitude of infectious endocarditis (IE), with a wide range in reported incidence (3.5 to 10 cases per 100,000 persons-year), and mortality (29 to 40%).1,2,3,4,5 Discrepancies may be due to clinical and methodological differences between studies. The aging of the population, more aggressive interventions, and the increase of poverty are potentials and are possible epidemiological factors affecting IE over the last decades, particularly in Europe. The Spanish public health system is free and covers nearly all population (46.5 million inhabitants in 2017). Our aim was to assess evolution of incidence, mortality, length of hospital stay, and costs related to IE between 1997 and 2014. Methods: We used the Basic Minimum Data Set (BMDS) of the National Surveillance System for Hospital Data in Spain (Spanish Ministry of Health) to obtain retrospective data in all admissions for IE with hospital discharge from January 1, 1997 to December 31, 2014. Diagnoses and comorbidities were available in ICD-9 CM codes. IE was considered (421, acute and subacute endocarditis) regardless of whether it was a primary or secondary diagnosis. An anonymized dataset with demographic data (sex, age), comorbidities, associated organ dysfunction(s), Charlson’s index, and mortality information was generated. Results: Overall, 34,399 patients were diagnosed with IE. The adjusted IE incidence (events per 100,000 persons) was 4.3%, ranging from 3.2% in 1997 to 5.6% in 2014. Age-adjusted incidence was higher in the 75–79 age group. Higher rates were observed in males than in females (67 v. 33%)., Instituto de Salud Carlos III (grant PI15/01451), Junta de Castilla y León (grants GRS1270/A/16 and GRS1255/A/16)

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p

Producción Científica, Objectives: Infective endocarditis (IE) is a serious and eventually lethal disease with rising incidence in the past couple of decades. The aim of this study was to evaluate the contemporary epidemiological trends of surgical endocarditis patients, to analyse the clinical outcomes and to study their profile, associated prognostic factors and costs. Methods: This is a retrospective study of all patients admitted for IE in Spanish hospitals and discharged between 1 January 1997 and 31 December 2014. Data were extracted from the minimum basic data set of the National Surveillance System for Hospital Data in Spain provided by the Spanish Ministry of Health. Hospitalizations, comorbidities, outcomes and costs were analysed. Results: In total, 34 399 patients with IE were included; 15.7% of patients received surgical treatment and 84.3% received medical treatment only. Surgical patients were mostly men (71.9%) and had a lower mean age (59.2 ± 16.08 years) than the medical treatment group (P < 0.0001). Mortality among surgical patients showed a decreasing trend between 1997 (32.0%) and 2014 (22.7%) and increased with age (47.6% in >_85 years of age). Length of hospital stay and the percentage of patients with organ dysfunction were also higher in this group. The cost of the surgical treatment group was higher and increased since 1997 (15 259.22 euros), remaining stable from 2010 (40 700 euros) (P < 0.0001). Conclusions: Surgical treatment in IE has trended upwards in Spain during the last 2 decades. Patients are getting older and more frequently experience organ dysfunction. Mortality ratio steadily declined without changes in the length of hospital stay., Instituto de Salud Carlos III (grant PI15/ 01451), Junta de Castilla y Leon (grants 1270/A/16 and 1255/A/16)

BACKGROUND: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. METHODS: Cross-sectional survey (November 2012–July 2014) of a representative sample of Spanish children and adolescents (six months–17 years) (n = 1862). Dietary information was collected using two non-consecutive one-day food diaries (six months–10 years old) or two 24 h dietary recalls (11 years and older) separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA) to account for within- and between-person variation. RESULTS: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. CONCLUSION: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

Background The frequency of intake of food and beverages depends on a number of ill-defined behaviour patterns. The objectives of this study were to evaluate the effects of screen time and sleep duration on food consumption frequency, and to describe frequencies and types of food consumption according to BMI category and parents’ level of education. Methods We studied 6287 and 2806 children drawn from the 2011 and 2013 cross-sectional ALADINO studies respectively. Data were collected on number of hours of sleep, screen time, and weekly frequency of consumption of 17 food groups. Weight status was measured, and information was also collected on parents’ educational level. Average food consumption frequencies were calculated by reference to hours of sleep and hours of screen time, and were defined as ≥4 times or

We read with great interest the article from Biviano et al.1 We think that their findings are of utmost importance for the prognostic assessment of patients following transcatheter aortic valve replacement. In this study, the rate of new-onset atrial fibrillation (AF) as reported in the ECG performed at discharge was 6%. This rate is low in comparison with previously reported research,2,3 especially if we consider the high rate of …

Background This study examined whether aortic valve opening (AVO) and other echocardiographic parameters influence outcomes in patients on left ventricular (LV) assist device (LVAD) support. Pump thrombosis (PT) and ischemic stroke (IS) are known complications of LVAD, but mechanisms that could influence them are not completely understood. Methods This was a retrospective analysis of 147 patients who received a HeartWare Ventricular Assist Device ( HeartWare International) as a bridge to transplant or to candidacy between July 2009 and August 2015, of whom 126 had at least 30 days of follow-up before the first event (30-days-out cohort). Outcomes included survival, PT, IS, and PT+IS (combined thrombotic event; CTE). Results Median time on support was 518 days. Of the 30-days-out cohort, 29% had a first PT and 19% a first IS. AVO was associated with longer survival on device (1,081 vs 723 days; p = 0.01) in the entire cohort. In the 30-days-out cohort, the aortic valve was more frequently closed in patients with lower ejection fractions on support (14% ± 6% vs 18% ± 9%; p = 0.009), more dilated pre-event echocardiogram (LV end-diastolic diameter, 66 ± 12 mm vs 62 ± 10 mm; p = 0.04), and pre-implant LV end-diastolic diameter (70 ± 10 mm vs 66 ± 9 mm; p = 0.06). CTE-free survival on the device was lower with a closed aortic valve (897 vs 1,314 days; p = 0.003) as was PT-free survival on the device (1,070 vs 1,457 days; p = 0.02). Cox regression analysis showed that AVO was an independent predictor of CTE ( p = 0.03) Conclusions Thrombotic events are relatively frequent in patients on long-term LVAD support. A closed aortic valve was associated with decreased overall survival, thrombosis-free survival, and poorer LV function on support. These are high-risk patients, so whether they require more intense anti-coagulation or prioritizing for transplantation requires further research.

Background: Recently, the use of transcatheter aortic valve implantation (TAVI) in inter­mediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR). Methods: We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014. Patients were matched according to age, gender, logEuroSCORE, and use of bioprosthesis. Results: Mean age of the patients was 73 ± 10.4 years, and 40.3% were women. LogEuroSCORE and Society Thoracic Surgeons score were 7.0 ± 4.4% and 4.2 ± 2.5%, respectively, with mean left ventricular ejection fraction of 52 ± 9%. There were no differences regarding other comorbidities. The length-of-hospitalization was 11 ± 5 days after TAVI vs. 17 ± 9 days after SAVR (p = 0.003). After matched comparison, no differences in terms of in-hospital mortality (5.7% after TAVI vs. 2.9% after SAVR, p = 0.687) and 1-year mortality (11.4% vs. 7.1%, p = 0.381) were found. The combined endpoint of stroke and mortality at 1-year was also similar between both groups (15.7% in TAVI patients vs. 14.4% after SAVR, p = 0.136). Multivariate analysis determined that aortic regurgitation (AR) was an independent predictor of mortality (OR = 3.623, 95% CI: 1.267–10.358, p = 0.016). Although the rate of AR was higher after TAVI, none of the patients treated with the newest generation devices (10.7%) presented more than a mild degree of AR. Conclusions: TAVI is feasible and shows comparable results to surgery in terms of early, 1-year mortality, as well as cerebrovascular events in patients with severe aortic stenosis and intermediate-low operative risk. Better transvalvular gradients, yet higher rates of AR were found, however, newer devices presented comparable rate of AR.

Background: Vascular injury (VI) remains frequent after trans catheter aortic valve implantation (TAVI). We aimed to assess the incidence, predictive factors, and the impact of early VI after fully-percutaneous (FP) TAVI. Method: We included a total of 139 consecutive patients who underwent FP transfemoral TAVI in our institution with 14 to 18Fr sheath systems, through right (119, 85.6%) or left (20, 14.4%) femoral arteries. VI was classified as mayor or minor according to VARC-2 definitions. In hospital data were prospectively collected. Follow-up was available for all patients. Reassessment of femoral artery anatomy as determined by computed tomography was performed including lumen diameters, calcification, tortuosity, height of femoral bifurcation and marked collateral circulation around common femoral artery. Results: Mean age was 81 ± 6.5, 54% were men, logEuroSCORE were 13.9 ± 7.9 and STS-score was 6.3 ± 4.9. Balloon-expandable and self-expandable devices were used in 14 (10.1%) and 125 patients (89.9%), respectively. Mayor and minor VI were observed in 25 (18%) and in 20 patients (14.3%) respectively, 20 of them due to suboptimal femoral closure (80% of major VI occurring in the first half of the learning curve). Lower platelet count (p=0.043), higher calcification of aortic valve (p=0.049), presence of femoral collaterals (OR=4.5, [95% CI: 1.6-12.9], p=0.005), height of femoral bifurcation (OR=14.5, [95% CI: 5.0-42.1], p

Aims: We aimed to develop a new simple angiographic score that would predict short- and mid-term patency problems of coronary artery bypass grafts (CABG). Methods: We enrolled 249 patients who underwent CABG. The Distal Vessel Quality (DVQ) score was calculated according to 1/visibility, 2/diameter, and 3/size of the distal vessel as angiographically evaluated at baseline. Each variable was quantified from 0 (worst) to 3 (best) and the DVQ score resulted from the addition of these values. Results: At 5-year of follow-up 16% of the patients had been admitted due to a coronary event and, after angiography, occlusion of 67 grafts (9.2%) was demonstrated (median time from surgery: 1.4 [IQR: 0.5-1.7] years). In 67% of the cases, a diseased graft was the responsible for the event. Venous grafts were 2.5 times more frequently occluded than arterial grafts (p=0.098). Indeed, the use of arterial grafts (OR=0.217, 95% CI [0.064-0.737], p=0.014) and higher values of DVQ score (OR=0.555, 95% CI [0.370-0.832], p=0.004) were independent predictors of bypass graft patency at 5-year follow-up. To remark, bad correlation of DVQ and syntax scores was found (R=0.228) and the last failed to predict the risk of early graft malfunction. Conclusions: The DVQ score is a new simple tool that may help to predict outcomes of coronary bypass grafts. Lower values of this score suggest limited benefit of bypass grafting. Therefore, the DVQ score could help to improve outcomes of cardiac surgery by improving the selection of patients. External validation of these results is warranted.

Fundamento: En abril del ano 2009 la Organizacion Mundial de la Salud declaro una Emergencia de Salud Publica de Importancia Internacional por la aparicion de casos en humanos por un nuevo virus de la gripe A H1N1. El objetivo de este trabajo es analizar las caracteristicas de los casos investigados y valorar la conformidad de los sujetos estudiados con las indicaciones y recomendaciones de la Consejeria de Sanidad de Castilla y Leon. Metodos: Estudio epidemiologico descriptivo del total de las peticiones de laboratorio solicitadas en Castilla y Leon, entre las semanas epidemiologicas 44 y 50, ambas inclusive y de los casos que resultaron positivos. Resultados: Se solicitaron 588 peticiones analiticas para gripe A H1N1 (58% hombres). La edad media fue de 34,8 anos (27,1% entre 15 y 44 anos) y la enfermedad respiratoria cronica el factor de riesgo mas frecuente (18,9%). En el 19,1% se instauro tratamiento antiviral (54,5% en las primeras 48 horas). El 42% de las peticiones cumplian criterios de gravedad y el 27,4% de las peticiones fueron positivas (53,4% varones). La edad media en las peticiones positivas fue 34,52 anos (33,1% entre 15 y 44 anos). En el 26,7% el factor de riesgo mas frecuente fue la enfermedad respiratoria cronica, el 6,8% tenia obesidad morbida. El 28,9% de los sujetos que dieron positivo recibio tratamiento antiviral (61,4% en las primeras 48 horas) y el 47,8% cumplian criterios de gravedad. Conclusion: La mayoria de los casos estudiados no cumplian criterios de gravedad, lo que pone de manifiesto el bajo cumplimiento de los protocolos de vigilancia en el ambito asistencial.

Una medida esencial en la busqueda de la eficiencia hospitalaria es evitar estancias inadecuadas. No se ha publicado ningun estudio en este sentido realizado en un servicio de cardiologia de nuestro pais. Para conocer la tasa de inadecuacion de estancias hospitalarias, hemos realizado un estudio observacional analitico retrospectivo. La recogida de datos se realizo conforme al Appropriateness Evaluation Protocol (AEP). La tasa de inadecuacion fue de 27 estancias cada 100 pacientes-dia. En el analisis multivariable, los factores relacionados con estancias inadecuadas fueron los grupos de mayor edad, las estancias mayores de 7 dias y los dias correspondientes a los ultimos tercios de estancia. Las causas mas frecuentes de estancias inadecuadas estuvieron relacionadas con el retraso en procedimientos diagnosticos o terapeuticos y con que estos procedimientos podrian haberse hecho sin ingreso.

Background: Systemic inflammatory response frequently occurs after coronary artery bypass surgery and is strongly correlated with the risk of postoperative morbidity and mortality. This study tests the hypothesis that the priming of the extracorporeal circuit with colloid solutions results in less inflammation in patients undergoing cardiac surgery than priming with crystalloid solutions. Methods: A prospective, randomized study was designed. Forty-four patients undergoing elective coronary artery bypass grafting were randomly allocated to one of two groups: 22 patients primed with Ringer's lactate (RL) solution and 22 patients primed with gelatin-containing solution during the surgery. Plasma levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, C-reactive protein (CRP) and, complement 4 were measured during the surgical intervention and over the following 48 postoperative hours. Cytokine levels were measured by enzyme-linked assays from plasma samples obtained at specific time points pre- and post-operatively. Results: In both groups the serum levels of the pro-inflammatory cytokines (IL-6, IL-8, TNF-α), CRP, complement 4, and leukocytes increased significantly over the baseline, although no significant differences were observed between the two groups. The operation time, blood loss, need for inotropic support, extubation time, and length of intensive care unit stay did not differ significantly between the two groups. Conclusion: Priming with gelatin vs. RL produces no significant differences in the inflammatory response in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Resumen Objetivos Analizar la influencia de factores del postoperatorio inmediato (primer dia), como posibles marcadores de la evolucion postoperatoria en los enfermos operados de cirugia cardiaca. Pacientes y metodos Se diseno un estudio transversal en el que se incluyeron consecutivamente pacientes intervenidos de cirugia cardiaca. Se analizo el efecto de la presion venosa central, el tiempo de recalentamiento hasta alcanzar los 35,5°C de temperatura central y los liquidos totales administrados en 24 horas, sobre la mortalidad y las complicaciones cardiacas, pulmonares y renales. Resultados Se incluyeron 236 pacientes. Se observo que la presion venosa central mayor de 18 mmHg, el tiempo de recalentamiento mayor de 6 horas y la administracion de liquidos mayores a 5 litros durante las primeras 24 horas, se asocio a un incremento de la mortalidad y a la aparicion de complicaciones cardiovasculares, pulmonares y renales. Conclusiones La presion venosa central, el tiempo de recalentamiento y los liquidos administrados durante el primer dia son determinantes de la evolucion postoperatoria.

Rotavirus is one of the most common causes of gastroenteritis worldwide. With the commercialisation of effective rotavirus vaccines in Europe in sight, it is necessary to provide studies which evaluate the disease burden. The aim of this study is two-fold, on one hand, to determine the burden of the rotavirus disease in Spanish children under the age of five, and on the other, to estimate the economic cost of these hospitalizations. The study was undertaken during a 5 year period (2000-2004). The rotavirus hospitalization rate was determined using the Minimum Basic Data Set of the national hospital discharge register. The observed data were compared with those expected by applying a model developed by the Centers for Disease Control and Prevention (CDC) adapted for European Countries. The financial expense of these hospitalizations was estimated. Of all admissions coded as gastroenteritis, 31.6% were due to rotavirus. The hospitalization rate by rotavirus was 480 cases per 100,000 children under five. These data are within the confidence range proposed by the adapted CDC model. The financial expense due to hospitalizations reaches 123,262 euros yearly in a Spanish University Hospital. In conclusion, rotavirus contributes significantly to the hospitalization of acute gastroenteritis. The rate of hospitalization by rotavirus is higher compared to other studies carried out in Spain. In view of future commercialisation of rotavirus vaccines, more in-depth analysis considering direct and indirect costs are necessary.

Fundamento y objetivo El diagnostico de gastroenteritis viricas es un importante capitulo en la virologia clinica que esta fundamentalmente condicionado por la disponibilidad de reactivos en los laboratorios, como en el caso del astrovirus. El objetivo de este estudio es estimar el incremento del rendimiento diagnostico alcanzado tras la incorporacion de la busqueda de astrovirus en el protocolo de gastroenteritis viricas agudas y analizar la tendencia de la infeccion por otros virus de busqueda mas general, como son rotavirus y adenovirus entericos. Material y metodo Se trata de un estudio retrospectivo de 20 anos en el que se procesaron 12.980 muestras de heces para diagnostico de virus de gastroenteritis. Desde 1997 se ha aplicado a las muestras negativas para rotavirus y adenovirus un enzimoinmunoanalisis para astrovirus. Se ha dividido el tiempo de estudio en 2 periodos (1986-1996 y 1997-2005, sin y con diagnostico de astrovirus, respectivamente) y se ha comparado el porcentaje de pacientes en los que se obtiene un diagnostico etiologico de virus de gastroenteritis. Se han modelizado el componente de tendencia de la serie de resultados positivos y el porcentaje que suponen del total de pacientes estudiados mediante minimos cuadrados. Resultados El porcentaje de pacientes positivos para rotavirus, adenovirus y astrovirus fue del 10,3, el 2,3 y el 6,0%, respectivamente, y fue infrecuente la aparicion de coinfecciones entre rotavirus y adenovirus (0,2%). El protocolo aplicado para el diagnostico de astrovirus permite aumentar el rendimiento diagnostico hasta un 16,8% de los casos estudiados, existiendo diferencias estadisticamente significativas entre los 2 periodos. Se ha observado un crecimiento cuadratico en el diagnostico de gastroenteritis viricas durante el periodo de estudio. Conclusiones La busqueda de astrovirus en casos de gastroenteritis mediante un protocolo selectivo ha demostrado aumentar la rentabilidad diagnostica de los virus enteropatogenos en un 6%. A la vista de los resultados, seria de utilidad ampliar la busqueda de astrovirus en pacientes con heces de consistencia liquida o semiliquida cuando la deteccion de rotavirus y adenovirus sea negativa.