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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

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

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.

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).

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 .

The anomalous origin of the pulmonary trunk in the ascending aorta, defined as arterious hemitruncus, is a rare congenital malformation in dogs, caused by a defect in the spiral septum. Thus, given the unusual occurrence in the canine species, the systemic severity and the high lethality, the aim of this study was to describe this heart disease in a three-month-old male German Spitz puppy, emphasizing clinical changes of the necropsy and microscopics. The animal had cyanosis, dyspnea and weakness and was forwarded for necropsy after sudden death. Numerous changes were detected in the post-mortem examination, including in the heart, as cardiomegaly and absence of the arterial ligament, which was replaced by the complete fusion between the ascending aorta and the pulmonary trunk, after leaving both the left and right ventricles, respectively and, among the microscopic findings, cardiomyocyte hypertrophy stood out. The association of these findings with the history indicated the diagnosis of arterious hemitruncus followed by cardiorespiratory failure, emphasizing the importance of out complementary cardiological exams in young symptomatic patients for the survival of those affected. Arterious hemitruncus, although rare, must be added in the differential diagnosis of other heart diseases that cause similar clinical signs. RESUMO A origem anômala do tronco pulmonar em aorta ascendente, definida como hemitruncus arterioso, é uma malformação congênita rara em cães, causada por defeito no septo espiral. Assim, diante da ocorrência incomum na espécie canina, da gravidade sistêmica e da alta letalidade, o objetivo deste trabalho foi descrever essa doença cardíaca em um filhote de três meses de idade, macho, Spitz Alemão, enfatizando as alterações clínicas, de necropsia e microscópicas. O animal apresentava cianose, dispneia e fraqueza e foi encaminhado para necropsia após morte súbita. Inúmeras alterações foram detectadas no exame post-mortem, inclusive no coração, como cardiomegalia e ausência do ligamento arterioso, o qual foi substituído pela fusão completa entre aorta ascendente e tronco pulmonar, após a saída de ambas dos ventrículos esquerdo e direito, respectivamente, e, dentre os achados microscópicos, destacou-se a hipertrofia de cardiomiócitos. A associação desses achados com o histórico indicou o diagnóstico de hemitruncus arterioso seguido de insuficiência cardiorrespiratória, ressaltando-se a importância de exames complementares cardiológicos em pacientes jovens sintomáticos na sobrevida dos acometidos. O hemitruncus arterioso, apesar de raro, deve ser acrescido no diagnóstico diferencial de outras cardiopatias que causam sinais clínicos similares.

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

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 2020 0.196 SJR (2021) Q4, 272/356 Cardiology and Cardiovascular Medicine No data IDR 2020 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

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

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.

Despite the standard of care, patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) progress to dialysis, are hospitalized for heart failure and die prematurely. Overactivation of the mineralocorticoid receptor (MR) causes inflammation and fibrosis that damages the kidney and heart. Finerenone, a nonsteroidal, selective MR antagonist, confers kidney and heart protection in both animal models and Phase II clinical studies; the effects on serum potassium and kidney function are minimal. Comprising the largest CKD outcomes program to date, FIDELIO-DKD (FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease) and FIGARO-DKD (FInerenone in reducinG cArdiovascular moRtality and mOrbidity in Diabetic Kidney Disease) are Phase III trials investigating the efficacy and safety of finerenone on kidney failure and cardiovascular outcomes from early to advanced CKD in T2D. By including echocardiograms and biomarkers, they extend our understanding of pathophysiology; by including quality of life measurements, they provide patient-centered outcomes; and by including understudied yet high-risk cardiorenal subpopulations, they have the potential to widen the scope of therapy in T2D with CKD. Trial registration number: FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049). Sin financiación 4.531 JCR (2019) Q1, 6/24 Transplantation 1.857 SJR (2019) Q1, 170/2754 Medicine (miscellaneous) No data IDR 2019 UEM

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.

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

Resistant hypertension prevalence is progressively increasing, and prolonged exposure to suboptimal blood pressure control results in higher cardiovascular risk and end-organ damage. Among various antihypertensive agents, spironolactone seems the most effective choice to treat resistant hypertension once triple therapy including a diuretic fails. However success in blood pressure control is not guaranteed, adverse effects are not negligible, and no clinical tools are available to predict patient's response. Complementary to our previous study of resistant hypertension metabolism, here we investigated urinary proteome changes with potential capacity to predict response to spironolactone. Twenty-nine resistant hypertensives were included. A prospective study was conducted and basal urine was collected before spironolactone administration. Patients were classified in responders or nonresponders in terms of blood pressure control. Protein quantitation was performed by liquid chromatography-mass spectrometry; ELISA and target mass spectrometry analysis were performed for confirmation. Among 3310 identified proteins, HP (haptoglobin) and HPR (haptoglobin-related protein) showed the most significant variations, with increased levels in nonresponders compared with responders before drug administration (variation rate, 5.98 and 7.83, respectively). Protein-coordinated responses were also evaluated by functional enrichment analysis, finding oxidative stress, chronic inflammatory response, blood coagulation, complement activation, and regulation of focal adhesions as physiopathological mechanisms in resistant hypertension. In conclusion, protein changes able to predict patients' response to spironolactone in basal urine were here identified for the first time. These data, once further confirmed, will support clinical decisions on patients' management while contributing to optimize the rate of control of resistant hypertensives with spironolactone. This work was supported by grants from the Instituto de Salud Carlos III co-supported by FEDER grants (PI14/01650, PI14/01917, PI14/01841, PI16/01334, IF08/3667-1, FI12/00126, CPII15/00027, CP15/00129, CP16/00116, PT13/0001/0013, PRB3 (IPT17/0019 ISCIIIS-GEFI/ERDF), REDinREN (RD12/0021/0001 and RD16/0009)) Fundación SENEFRO and Fundación Conchita Rábago de Jiménez Díaz. These results are lined up with the Spanish initiative on the Human Proteome Project. Sí

Our aim was to investigate the effects of 12 weeks of CT (ie, high‐intensity interval and resistance training) in Mapuche adults from Chile and in their peers of European descent. In total, 96 hyperglycemic adult women (mean age 46 years [95% confidence interval; 38, 53]) were divided in four groups: Mapuche CT (Map‐CT, n = 14) or control group (Map‐CG, n = 44), and European CT (Eur‐CT, n = 14) or control group (Eur‐CG, n = 23). The following endpoints were analyzed at baseline and after 12 weeks: anthropometric (body mass, body mass index, waist circumference), body composition (fat mass, muscle mass, lean mass), cardiovascular (systolic [SBP]/diastolic [DBP] blood pressure), metabolic (blood fasting glucose and total cholesterol), and muscle strength (handgrip of dominant/non‐dominant arm). There were significant positive changes in body mass, body fat, and muscle mass (P < 0.0001) in both Map‐CT and Eur‐CT groups, whereas waist circumference was decreased significantly only in the Eur‐CT group (P < 0.0001). Both Map‐CT and Eur‐CT groups showed decreased levels of fasting glucose (P < 0.05) and total cholesterol after the intervention (P < 0.0001). Also, both Map‐CT (P < 0.05) and Eur‐CT (P = 0.01) groups showed a lowered SBP. Finally, significant increases were observed after training in handgrip strength (dominant arm) in Map‐CT and Eur‐CT groups (both P < 0.0001). CT led to similar improvements in cardiometabolic risk factors for metabolic syndrome development in Mapuche and European participants, with additional improvements in other anthropometric, body composition, cardiovascular, metabolic, and muscle strength parameters related to the prevention of metabolic syndrome. These results suggest future more complex studies. Concurso Buenas Practicas en Promoción de La Salud, Región de Los Ríos ISCIII and Fondos FEDER (PI17/01814 and PI15/00558) Comite de Becas de internacionalización de la Universidad del Rosario (Contract No 10004611 de 2017) 3.255 JCR (2019) Q1, 14/85 Sport Sciences 1.373 SJR (2019) Q1, 28/284 Orthopedics and Sports Medicine, 10/207 Physical Therapy, Sports Therapy and Rehabilitation, 19/125 Sports Science No data IDR 2019 UEM

Background: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favorable effects on cardiorenal outcomes in patients with predominantly stage 3 or 4 chronic kidney disease (CKD) with severely elevated albuminuria and type 2 diabetes. The use of finerenone in patients with type 2 diabetes and a wider range of CKD is unclear. Methods: In this double-blind trial, we randomly assigned patients with CKD and type 2 diabetes to receive finerenone or placebo. Eligible patients had a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 30 to less than 300 and an estimated glomerular filtration rate (eGFR) of 25 to 90 ml per minute per 1.73 m2 of body-surface area (stage 2 to 4 CKD) or a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of at least 60 ml per minute per 1.73 m2 (stage 1 or 2 CKD). Patients were treated with renin-angiotensin system blockade that had been adjusted before randomization to the maximum dose on the manufacturer's label that did not cause unacceptable side effects. The primary outcome, assessed in a time-to-event analysis, was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. The first secondary outcome was a composite of kidney failure, a sustained decrease from baseline of at least 40% in the eGFR, or death from renal causes. Safety was assessed as investigator-reported adverse events. Results: A total of 7437 patients underwent randomization. Among the patients included in the analysis, during a median follow-up of 3.4 years, a primary outcome event occurred in 458 of 3686 patients (12.4%) in the finerenone group and in 519 of 3666 (14.2%) in the placebo group (hazard ratio, 0.87; 95% confidence interval [CI], 0.76 to 0.98; P = 0.03), with the benefit driven primarily by a lower incidence of hospitalization for heart failure (hazard ratio, 0.71; 95% CI, 0.56 to 0.90). The secondary composite outcome occurred in 350 patients (9.5%) in the finerenone group and in 395 (10.8%) in the placebo group (hazard ratio, 0.87; 95% CI, 0.76 to 1.01). The overall frequency of adverse events did not differ substantially between groups. The incidence of hyperkalemia-related discontinuation of the trial regimen was higher with finerenone (1.2%) than with placebo (0.4%). Conclusions: Among patients with type 2 diabetes and stage 2 to 4 CKD with moderately elevated albuminuria or stage 1 or 2 CKD with severely elevated albuminuria, finerenone therapy improved cardiovascular outcomes as compared with placebo. Bayer; FIGARO-DKD ClinicalTrials.gov (NCT02545049) 176.082 JCR (2021) Q1, 2/172 Medicine, General & Internal 24.907 SJR (2021) Q1, 2/2489 Medicine (miscellaneous) No data IDR 2021 UEM

El nódulo calcificado se ha establecido como el último sustrato subyacente en el síndrome coronario agudo; no obstante, el calcio está presente frecuentemente en otros escenarios agudos. La tomografía de coherencia óptica (OCT) ha logrado identificar en este sentido 3 patrones distintos de calcificación atendiendo a su a morfología. Estudios previos han documentado nódulos calcificados en pacientes con enfermedad arterial periférica; sin embargo, la presencia de distintos patrones morfológicos de calcificación sigue siendo desconocida. Paciente de 80 años derivado para angiografía coronaria por presentar disfunción sistólica. La coronariografía realizada mediante abordaje radial reveló la presencia de enfermedad calcificada grave de un vaso (porción media de la descendente anterior izquierda) así como calcificación mitral y aórtica. Los pullbacks de OCT realizados desde la arteria radial (6 ml de contraste a 3 mm por segundo, retirando 4 cm la vaina radial) revelaron la presencia de varias placas calcificadas (porción media de la arteria) definidas por la presencia de regiones heterogéneas, superficiales, bien definidas y con baja retrodispersión (vídeo 1 del material adicional). El corregistro angiografíco confirmó la presencia de una oclusión en la arteria ulnar.

Patients with venous thromboembolism (VTE) require immediate treatment with anticoagulants such as acenocoumarol. This multicentre randomised clinical trial evaluated the effectiveness of a dosing pharmacogenetic algorithm versus a standard-of-care dose adjustment at the beginning of acenocoumarol treatment. We included 144 patients with VTE. On the day of recruitment, a blood sample was obtained for genotyping (CYP2C9*2, CYP2C9*3, VKORC1, CYP4F2, APOE). Dose adjustment was performed on day 3 or 4 after the start of treatment according to the assigned group and the follow-up was at 12 weeks. The principal variable was the percentage of patients with an international normalised ratio (INR) within the therapeutic range on day 7. Thirty-four (47.2%) patients had an INR within the therapeutic range at day 7 after the start of treatment in the genotype-guided group compared with 14 (21.9%) in the control group (p = 0.0023). There were no significant differences in the time to achieve a stable INR, the number of INRs within the range in the first 6 weeks and at the end of study. Our results suggest the use of a pharmacogenetic algorithm for patients with VTE could be useful in achieving target INR control in the first days of treatment.

Sin financiación 5.848 JCR (2021) Q2, 43/143 Cardiac & Cardiovascular Systems 1.443 SJR (2021) Q1, 54/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

There are recent data suggesting an association between the R577X polymorphism (rs1815739) in the gene encoding α-actinin-3 (ACTN3) and the risk of musculoskeletal injuries. The purpose of this study was to analyze the association of rs1815739 with risk of, and recovery time from non-contact soft-tissue muscle injuries in professional soccer players. Forty-six (22 male and 24 female) players from a top-level professional soccer team were assessed during five consecutive seasons: the genotype distribution was: RR, 41.3%; RX, 47.8%; and XX, 10.9%. There was a trend towards a higher risk of muscle injury associated with the XX genotype (p = 0.092, with no injury-free XX player during the 5-year study period) and a significant genotype effect for the time needed to return to play (p = 0.044, with the highest value shown for the XX genotype, i.e., 36 ± 26 days, vs. 20 ± 10 and 17 ± 12 days for RR and RX, respectively). In conclusion, the XX genotype might be associated not only with a higher risk of non-contact muscle injuries, but also of recovery time from these conditions. However, more research in larger cohorts is needed to confirm this preliminary hypothesis. Sin financiación 4.141 JCR (2021) Q2, 72/175 Genetics & Heredity 1.032 SJR (2021) Q2, 110/347 Genetics No data IDR 2021 UEM

[EN] Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance., JS was supported by Grants #2020/12841-3, #2020/13017-2, and #2018/25606-2, Sao Paulo Research Foundation (FAPESP). FS was supported by research grants from the Medical Research Council UK (MR/S037306/1), and from the British Heart Foundation (BHF Project Grant No. PG/18/33/33780). JR-A was supported by the projects (PID2019-106623RBC41) and meHeart (PID2019-104356RB-C42 and PID2019104356RB-C43) from the Spanish Government. JP was funded by Program of Alliances for Education and Training (Scholarship Brazil-PAEC OEA-GCUB-2017). RM, AC, and MG were supported by the Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovacion y Universidades (supported by the FEDER Fondo Europeo de Desarrollo Regional PI17/01106 and RYC2018-024346B-750), EIT Health (Activity code 19600, EIT Health was supported by the EIT, a body of the European Union), received funding from the European Union's Horizon research and Innovation programme under the Marie Sklodowska-Curie grant agreement no. 860974 and the Generalitat Valenciana Grants (ACIF/2020/265). BZ and RM were supported by the NIH NHLBI Grant No. 1F30HL149327; NIH NIGMS Center for Integrative Biomedical Computing (www.sci.utah.edu/cibc), NIH NIGMS Grants P41GM103545 and R24 GM136986; and the Nora Eccles Treadwell Foundation for Cardiovascular Research. OB was supported in part by research grants from the National Institutes of Health (R01-HL118304 and R21-HL153694), Abbott, Medtronic, and CoreMap. MC was supported by a Veni Grant from the Netherlands Organization for Scientific Research (TTW 16772). FA was supported by the Instituto de Salud Carlos III (PI17/010559 and PI20/01618) and the Consorcio de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), the Ministerio de Ciencia e Innovacion (cofound by FEDER: Fondo Europeo de Desarrollo Regional), EIT Health (AFFINE 19600, EIT Health was supported by EIT, a body of the European Union).

Vasovagal reactions may occur occasionally during electrical stimulation using interferential current (IFC). The purpose of this study was to examine variations in autonomic activity during the application of IFC in asymptomatic participants by analysis of their heart rate variability (HRV). Seventy-three male volunteers were randomly assigned to a placebo group (n = 36, HRV was documented for 10 min, both at rest and during a placebo intervention) and an intervention group (n = 37, HRV was documented for 10 min in two conditions labelled as (1) rest and (2) application of IFC technique on the lumbar segment). The diameters of the Poincaré plot (SD1, SD2), stress score (SS), and the ratio between sympathetic and parasympathetic activity (S/PS) were measured. After interventions, differences amongst the placebo group and the IFC group were found in SD2 (p &lt, 0.001), SS (p = 0.01) and S/PS ratio (p = 0.003). The IFC technique was associated with increased parasympathetic modulation, which could induce a vasovagal reaction. Monitorization of adverse reactions should be implemented during the application of IFC technique. HRV indicators might have a part in prevention of vasovagal reactions. Further studies in patients with lumbar pain are needed to explore possible differences in HRV responses due to the presence of chronic pain.

Sin financiación 1.651 JCR (2021) Q4, 128/143 Cardiac & Cardiovascular Systems 0.239 SJR (2021) Q3, 260/356 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

Introducción y objetivos: La comorbilidad en ancianos con síndrome coronario agudo sin elevación del segmento ST empeora el pronóstico. El objetivo fue analizar la influencia de la carga de comorbilidad en la decisión del tratamiento invasivo en ancianos con SCASEST. Métodos: Se incluyeron 7.211 pacientes mayores de 70 años procedentes de 11 registros españoles. Los datos se analizaron en una base de datos conjunta. Se evaluó la presencia de 6 enfermedades simultáneas y su asociación con la realización de coronariografía durante el ingreso. Resultados: La edad media fue de 79 ± 6 años y la puntuación GRACE media fue de 150 ± 21 puntos. Fueron tratados de manera conservadora 1.179 pacientes (16%). La presencia de cada enfermedad se asoció con un menor abordaje invasivo (ajustado por variables clínicas predictivas): enfermedad cerebrovascular (odds ratio [OR] = 0,78; intervalo de confianza del 95% [IC95%], 0,64-0,95; p = 0,01), anemia (OR = 0,64; IC95%, 0,54-0,76; p < 0,0001), insuficiencia renal (OR = 0,65; IC95%, 0,56-0,75; p < 0,0001), arteriopatía periférica (OR = 0,79; IC95%, 0,65-0,96; p = 0,02), enfermedad pulmonar crónica (OR = 0,85; IC95%, 0,71-0,99; p = 0,05) y diabetes mellitus (OR = 0,85; IC95%, 0,74-0,98; p = 0,03). Asimismo, el aumento del número de enfermedades (carga de comorbilidad) se asoció con menor realización de coronariografías, ajustado por la escala GRACE: 1 enfermedad (OR = 0,66; IC95%, 0,54-0,81); 2 (OR = 0,55; IC95%, 0,45-0,69); 3 (OR = 0,37; IC95%, 0,29-0,47); 4 (OR = 0,33; IC95%, 0,24-0,45); ≥ 5 (OR = 0,21; IC95%, 0,12-0,36); todos p < 0,0001, en comparación con ninguna enfermedad. Conclusiones: Conforme aumenta la comorbilidad disminuye la realización de coronariografías en ancianos con síndrome coronario agudo sin elevación del segmento ST. Se necesitan estudios que investiguen la mejor estrategia diagnóstico-terapéutica en estos pacientes. Introduction and objectives: The presence of comorbidities in elderly patients with non-ST-segment elevation acute coronary syndrome worsens its prognosis. The objective of the study was to analyze the impact of the burden of comorbidities in the decision of using invasive management in these patients. Methods: A total of 7211 patients > 70 years old from 11 Spanish registries were included. Individual data were analyzed in a common database. We assessed the presence of 6 comorbidities and their association with coronary angiography during admission. Results: The mean age was 79 ± 6 years and the mean CRACE score was 150 ± 21 points. A total of 1179 patients (16%) were treated conservatively. The presence of each comorbidity was associated with less invasive management (adjusted for predictive clinical variables): cerebrovascular disease (OR, 0.78; 95%CI, 0.64-0.95; P = .01), anemia (OR, 0.64; 95%CI, 0.54-0.76; P < .0001), chronic kidney disease (OR, 0.65; 95%CI, 0.56-0.75; P < .0001), peripheral arterial disease (OR, 0.79; 95%CI, 0.65-0.96; P = .02), chronic lung disease (OR, 0.85; IC95%, 0.71-0.99; P = .05), and diabetes mellitus (OR, 0.85; 95%CI, 0.74-0.98; P < .03). The increase in the number of comorbidities (comorbidity burden) was associated with a reduction in coronary angiographies GRACE score: 1 comorbidity (OR, 0.66; 95%CI, 0.54-0.81), 2 comorbidities (OR, 0.55; 95%CI, 0.45-0.69), 3 comorbidities (OR, 0.37; 95%CI, 0.29-0.47), 4 comorbidities (OR, 0.33; 95%CI, 0.24-0.45), ≥ 5 comorbidities (OR, 0.21; 95%CI, 0.12-0.36); all P values < .0001 compared to 0. Conclusions: The number of coronary angiographies performed drops as the number of comorbidities increases in elderly patients with non-ST-segment elevation acute coronary syndrome. More studies are still needed to know what the best management of these patients should be. Instituto de Salud Carlos III (CIBERCV 16/11/00420) No data 2020 UEM

Background: Reduced glutathione (GSH) is one of the main thiols involved in antioxidant defense. Changes in circulatory levels of GSH during exercise are associated with hyperthermia and dehydration. The mechanisms by which these alterations occur are not entirely known. We hypothesize that erythrocytes could be an important source of circulatory GSH during heat stress conditions. We performed two separate experiments to address this hypothesis. Methods: In the first experiment, we sought to investigate the impact of exercise in the heat and dehydration on erythrocyte levels of GSH. A total of 10 men performed 60 min of cycling at 60% VO2peak in the heat (38.0 ± 0.9 °C) or in a control temperate environment (23.0 ± 1.0 °C), both with and without dehydration. Relative humidity ranged from 50 to 70%. Blood samples were taken before and after exercise to measure GSH and oxidized (GSSG) glutathione. In the second experiment, erythrocytes were isolated from blood samples taken at rest and heated in vitro to determine the impact of heat on erythrocyte glutathione content. Tubes with erythrocytes were exposed to water baths at different temperatures, one tube was exposed to a water bath at 35 °C and the other tube to a water bath at 41 °C for a period of 30 min. After exposure to heat, plasma and erythrocytes were extracted for GSH and GSSG analyses. Results: Dehydration decreased circulatory GSH, regardless of ambient temperature (temperate and heat decreased 15.35% and 30.31%, respectively), resulting in an altered redox balance. Heat increased GSH levels in vitro. Conclusion: Our data suggest that dehydration decreases circulatory GSH levels regardless of environmental temperature. In addition, in vitro data suggests that erythrocytes may contribute to the release of GSH during exposure to heat stress.

Objective: To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension. Methods: A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67±10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed. Results: Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (ß=2.59±0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure ≥120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of ≤119mmHg (normotensive: 7.6±2.4m/s=≤119mmHg: 8.1±2.2m/s 120-129mmHg:9.8±2.6m/s=≥130mmHg: 9.9±2.9m/s, p0.05). Conclusion: Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure. RESUMO Objetivo: Analisar a influência da hipertensão na saúde cardiovascular em pacientes com doença arterial periférica sintomática, e identificar fatores associados à hipertensão arterial não controlada. Métodos: Neste estudo transversal foram incluídos 251 pacientes com doença arterial periférica (63,9% homens e média de idade 67±10 anos). Hipertensão foi diagnosticada e pressão arterial foi avaliada para determinar o controle da hipertensão. Foram avaliadas rigidez arterial (velocidade da onda de pulso carótida-femoral) e modulação autonômica cardíaca (balanço simpatovagal). Resultados: Hipertensão foi associada com maior velocidade da onda de pulso carótida-femoral, independentemente do sexo, idade, índice tornozelo-braço, índice de massa corpórea, capacidade de deambulação, frequência cardíaca, ou comorbidades (ß=2,59±0,76m/s, b=0,318, p=0,003). Pacientes com pressão arterial sistólica ≥120mmHg tiveram maior velocidadeda onda de pulso carótida-femoral do que normotensos, e pacientes hipertensos com pressão arterial sistólica ≤119mmHg (normotensos: 7,6±2,4m/s=≤119mmHg: 8,1±2,2m/s 120-129mmHg: 9,8±2,6m/s=≥130mmHg: 9,9±2,9m/s, p

Este artículo se encuentra disponible en la siguiente URL: https://academic.oup.com/eurheartjsupp/article/23/Supplement_B/B138/6279165 En este artículo también participan: Inés Mera-Gallego, Salvador Tous, Nicanor F. de Andrés, Teresa Gijón, David Pérez-Manchon, Neil R. Poulter, Gema Ruiz-Hurtado y Luis Miguel Ruilope. The aim of the May Measurement Month (MMM) is devoted to better understanding the awareness, treatment, and control rates of hypertension in Spain. Presented here are the data corresponding to 2019 campaign. In 2019, a total of 4433 patients (61.5% males) with a mean age of 54.8 years were included. Of all, 96.0% were Caucasian, and 3294 were recruited in pharmacies. The mean values of systolic blood pressure (BP) were 125.6 and of diastolic 76.7mmHg in the whole population. The most recent previous BP measurement took place more than 1 year before in 27.6% of participants. A total of 1883 were hypertensive (systolic BP 140 mmHg or diastolic BP 90mmHg or taking antihypertensive medication), of whom 77.2%/were aware and 71.1% were onmedication. Of all, 64.9% of those on medication and 46.1% of all hypertensive participants had a BP controlled to

Supplemental Digital Content is available in the text., Background: The FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes with optimized renin–angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and cardiovascular outcomes. We report the effect of finerenone on individual cardiovascular outcomes and in patients with and without history of atherosclerotic cardiovascular disease (CVD). Methods: This randomized, double-blind, placebo-controlled trial included patients with type 2 diabetes and urine albumin-to-creatinine ratio 30 to 5000 mg/g and an estimated glomerular filtration rate ≥25 to

Objective: Cholesterol efflux capacity (CEC) is the ability of high-density lipoprotein (HDL) cholesterol to accept cholesterol from macrophages. Lipid profiles and CEC appear to be altered in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) due to disease activity and inflammation. CEC has been linked to cardiovascular events in the general population and to subclinical atherosclerosis in SLE and RA patients. The aim of this study was to establish whether CEC varies between patients with SLE and those with RA. Methods: The study encompassed 460 individuals (195 SLE patients and 265 patients with RA). CEC (using an in vitro assay) and concentrations of lipoprotein serum were assessed in both populations. A multivariable regression analysis was performed to study whether CEC differs between SLE patients and RA patients. Results: Comparison of lipid patterns revealed that patients with RA have lower HDL cholesterol and higher apolipoprotein B serum levels than SLE patients. CEC was downregulated in SLE patients compared to patients with RA (β -12 [95% confidence interval -13, -10], P < 0.001). It occurred independently of traditional cardiovascular risk factors, statin use, disease-related data, and other variations in the lipid profile related to the diseases. Conclusion: Patients with RA have a more proatherogenic lipid pattern compared to those with SLE. However, CEC seems to be more damaged in SLE patients than in RA patients. Sin financiación 5.178 JCR (2021) Q2, 12/34 Rheumatology 1.566 SJR (2021) Q1, 7/61 Rheumatology No data IDR 2021 UEC

A systematic review and meta-analysis were performed to determine if heart rate variability-guided training (HRV-g), compared to predefined training (PT), maximizes the further improvement of endurance physiological and performance markers in healthy individuals. This analysis included randomized controlled trials assessing the effects of HRV-g vs. PT on endurance physiological and performance markers in untrained, physically active, and well-trained subjects. Eight articles qualified for inclusion. HRV-g training significantly improved maximum oxygen uptake (VO2max) (MD = 2.84, CI: 1.41, 4.27; p < 0.0001), maximum aerobic power or speed (WMax) (SMD = 0.66, 95% CI 0.33, 0.98; p < 0.0001), aerobic performance (SMD = 0.71, CI 0.16, 1.25; p = 0.01) and power or speed at ventilatory thresholds (VT) VT1 (SMD = 0.62, CI 0.04, 1.20; p = 0.04) and VT2 (SMD = 0.81, CI 0.41, 1.22; p < 0.0001). However, HRV-g did not show significant differences in VO2max (MD = 0.96, CI −1.11, 3.03; p = 0.36), WMax (SMD = 0.06, CI −0.26, 0.38; p = 0.72), or aerobic performance (SMD = 0.14, CI −0.22, 0.51; p = 0.45) in power or speed at VT1 (SMD = 0.27, 95% CI −0.16, 0.70; p = 0.22) or VT2 (SMD = 0.18, 95% CI −0.20, 0.57; p = 0.35), when compared to PT. Although HRV-based training periodization improved both physiological variables and aerobic performance, this method did not provide significant benefit over PT. Sin financiación 2.679 JCR (2020) Q2, 73/160 Physics, Applied 0.435 SJR (2020) Q2, 366/2196 Computer Science Applications No data IDR 2020 UEM

Background Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare the characteristics of patients with infective endocarditis (IE) and SOT against those without SOT. Methods We used data from the Spanish Collaboration on Endocarditis during the period 2008-2018. Results We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients with other transplantation types (bone marrow, hematopoietic precursors, and cornea) were excluded from the analysis. Compared with patients without SOT, patients with SOT had lower median age (61 vs. 69 years, p

The three more important sequalae of sustained hypertension in the heart, include heart failure (HF), conduction to arrhythmia particularly atrial fibrillation (AF) and coronary artery disease (CAD). In this issue of the journal Sava et al. [1] describe analyzing the data from the INternational VErapamil SR-Trandolapril (INVEST) study [2] the optimal systolic blood pressure (BP) to reduce mortality in women with previous coronary events. In a very recent review by Mehilli and Presbitero [3] the characteristics of women with CAD and acute coronary syndrome (ACS) are amply described. Women with CAD differ from men by several aspects as the clinical presentation, the accompanying comorbidities and risk factors, as well as, by the delivery of medical care. Moreover, women use to be older and present frequent and pronounced frailty. They present more frequently ACS without obstructive coronary arteries which makes it difficult the diagnosis and treatment of ACS. Importantly, in young women compared to men early death is more frequent in women, as well as, in older women during the first year after an ACS. The two main Guidelines for the management of arterial hypertension that of European Society of Cardiology (ESC)/European Society of Hypertension (ESH) [4] and that of the American College of Cardiology (ACC)/American Heart Association (AHA) [5] differ in the recommended BP goal for patients with chronic CAD depending on their age. The European Guideline defines the systolic goal BP in patients with CAD as inferior to 130/80 mmHg when the age of the patient is

Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)., [Aims] Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients., [Methods and results] Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease [176 (24.8%) vs. 545 (16.7%)], renal disease [239 (33.8%) vs. 740 (22.7%)], diabetes [248 (35.0%) vs. 867 (26.6%)], and heart failure [348 (49.2%) vs. 978 (29.9%)]}; and fewer complications {intracardiac destruction [106 (15%) vs. 1077 (33.1%)], heart failure [215 (30.3%) vs. 1340 (41.1%)], embolism [107 (15.1%) vs. 714 (21.9%)], and neurological involvement [77 (10.8%) vs. 702 (21.5%)]} (all P-values, [Conclusion] Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED.

Background Hyponatremia is common in patients with acute heart failure (HF). Our aim was to determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF), and mid‐range ejection fraction (HFmrEF). Methods Prospective multicentre consecutive registry in 20 hospitals including patients admitted due to acute HF in cardiology departments. Sodium 145 mmol/L hypernatremia, and 135–145 mmol/L normal. Results A total of 1309 patients were included. Mean age was 72.0 ± 11.9 years, 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission, and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal‐at‐admission/normal‐at‐discharge 941 (71.9%), abnormal‐at‐admission/normal‐at‐discharge 127 (9.7%), normal‐at‐admission/abnormal‐at‐discharge 155 (11.8%), and abnormal‐at‐admission/abnormal‐at‐discharge 86 (6.6%). Hyponatremia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatremia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)), and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (Hazard Ratio (HR) 1.42, 95% confidence interval (CI) 1.15–1.76, P = 0.001), and discharge (HR 1.33, 95% CI 1.08–1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. Conclusions Hyponatremia and hypernatremia at admission and discharge predict a poor outcome in patients with acute HF, regardless of LVEF. Hyponatremia at discharge is more frequent in HFrEF than in the other LVEF groups. Sin financiación 2.611 JCR (2021) Q3, 98/172 Medicine, General & Internal 0.590 SJR (2021) Q2, 65/143 Internal Medicine No data IDR 2021 UEM

Introduction Adjustable transobturator male system (ATOMS) is a surgical device developed to treat male stress urinary incontinence (SUI) after prostate surgery. The objective was to assess the effectiveness of the ATOMS device to treat male SUI as described in the literature. Methods Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English, German and Spanish, using the databases PubMed, EMBASE and Web of Science. We excluded studies on female incontinence. We employed the DerSimonian and Laird method for defining heterogeneity, calculating the grouped standard mean deviation (SMD). The primary objective of this review is the assessment of clinical efficacy based on the achievement of dryness after device adjustment, defined as use of no pad or one safety pad per day (PPD). The secondary objective was focused on analysing improvement of incontinence with the device. Magnitude of effect was calculated by analysing decrease in pad count (PPD) and/or in 24-h pad test. Number and severity of complications according to Clavien–Dindo classification were also reviewed. Results The pooled data of 1393 patients from 20 studies (13 retrospective and 7 prospective) showed that treatment with ATOMS resulted in a mean 67% dryness rate and 90% improvement after adjustment. Mean total number of system fillings per patient was 2.4. Mean pad count and 24-h pad test decrease were − 4.14 PPD and − 443 cc, respectively. There is significant heterogeneity of the sample analysed, mainly based on variable baseline severity of incontinence, proportion of patients treated with irradiation and different generation devices. Proportion of irradiated patients affected dryness rate (p = 0.0014), together with baseline severity of incontinence (p = 0.0035) and different generation device used (p

Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as “Bayes' Syndrome”, and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. Methods and results: The prospective observational “Bayes' Syndrome-HF” study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpoint. Comprehensive multivariable Cox regression analyses were performed. Among 1050 consecutive patients, 536 (51.0%) were in sinus rhythm, 464 with a measurable P wave are the focus of this study. Two-hundred and sixty patients (56.0%) had normal atrial conduction, 95 (20.5%) partial IAB, and 109 (23.5%) advanced IAB. During a mean follow-up of 4.5 ± 2.1 years, 235 patients experienced all-cause death, new-onset AF, or stroke. In multivariable comprehensive Cox regression analyses, advanced IAB was associated with new-onset AF (HR 2.71 [1.61–4.56], P

Introduction: Patients with resistant hypertension (RH) have a high risk of developing cardiovascular events; therefore, new therapeutic approaches to better control blood pressure may be useful in improving cardiovascular outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on cardiovascular outcomes has not been explored. The main objective of the SARAH study is to assess the impact of OSA and its treatment on cardiovascular outcomes (morbidity and mortality) in patients with RH. Methods: This study is a multi-center, prospective, observational cohort study. A total of 1371 patients with RH will be enrolled in the study and followed once a year for five years. At inclusion, ambulatory blood pressure monitoring (ABPM) and a sleep study will be performed in all subjects. Socio-demographic, clinical and cardiovascular variables will be collected at baseline and follow-up. Subsequently, subjects with OSA will be managed according to local standard practice. Based on the OSA diagnosis and its treatment, three cohorts of subjects with RH will be defined: non-OSA, treated OSA and non-treated OSA. Conclusions: This study will contribute to elucidating the long-term impact of OSA treatments on blood pressure control and cardiovascular outcomes in patients with RH. These results will contribute to improve the cardiovascular prognosis of patients with RH. (C) 2018 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.

Bakground and objective: To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Patients and methods: Multicentre, prospective, randomized, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140 mmHg without relevant renal disease were randomized to one of two follow-up strategies: (1) standard follow up, with a clinic BP target

Background and Objective Elevated levels of matrix metalloproteinase‐7 (MMP7) have been observed in serum samples of subjects with type 2 diabetes mellitus (T2DM) and in gingival tissues of subjects with periodontitis. The aim of the present study was to collect in vivo and in silico evidence on the role of MMP7 in the interplay between T2DM and generalized periodontitis (GP). Material and Methods The extent of MMP7 expression and localization were immunohistochemically analyzed in gingival tissues of patients with GP with T2DM (T2DM/GP, n = 11), systemically healthy patients with GP (n = 7), and systemically and periodontally healthy controls (n = 11). An in silico network model was built to determine the interactions between MMP7 and T2DM pathways. Regulation of neutrophil transmigration by MMP7 was analyzed in a knock‐out mice model. Results In human gingival tissues, the proportion of cells with robust MMP7 expression was elevated in patients with T2DM/GP in comparison to controls (P = .014). According to the in silico analysis, “hydroxyl radical” and “hydrogen peroxide” compounds were among the most central nodes of the network, and were within the shortest paths connecting “glucose” to “MMP7.” In MMP7 knock‐out mice, an intense accumulation of neutrophils was observed in the gingival epithelium as compared to wild‐type mice (P = .0001). Conclusion Elevated MMP7 expression in gingival tissues of patients with T2DM/GP is related to the activation of reactive oxygen species by hyperglycemia. Suppression of MMP7 expression results in impaired neutrophil transmigration in gingiva. Sin financiación 2.613 JCR (2018) Q1, 18/91 Dentistry, Oral Surgery & Medicine 1.061 SJR (2018) Q2, 4/12 Periodontics No data IDR 2018 UEM

BACKGROUND AND AIM: The prevalence and associated risks of white-coat hypertension (WCH) are still a matter of debate. We aimed to assess differences in prevalence and associated conditions of WCH defined on the basis of the normality of all daytime, night-time, and 24-h blood pressure (BP), only daytime, or only 24-h BP. METHODS: We selected 115 708 patients (45 020 untreated and 70 688 treated) from the Spanish Ambulatory BP Monitoring Registry. WCH was estimated in patients with elevated office BP (≥140 and/or 90 mmHg) by using normal daytime (

Resistant hypertension (RH) affects 9% to 12% of hypertensive adults. Prolonged exposure to suboptimal blood pressure control results in end-organ damage and cardiovascular risk. Spironolactone is the most effective drug for treatment, but not all patients respond and side effects are not negligible. Little is known on the mechanisms responsible for RH. We aimed to identify metabolic alterations in urine. In addition, a potential capacity of metabolites to predict response to spironolactone was investigated. Urine was collected from 29 patients with RH and from a group of 13 subjects with pseudo-RH. For patients, samples were collected before and after spironolactone administration and were classified in responders (n=19) and nonresponders (n=10). Nuclear magnetic resonance was applied to identify altered metabolites and pathways. Metabolites were confirmed by liquid chromatography-mass spectrometry. Citric acid cycle was the pathway most significantly altered ( P