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Resumen Introduccion y objetivos Las concentraciones de potasio (K+) extracelular son trascendentales para el funcionamiento de las celulas excitables cardiacas. Nuestro objetivo fue evaluar la prevalencia de las alteraciones graves del K+ plasmatico y determinar sus implicaciones clinicas. Metodos Estudio retrospectivo en un hospital terciario de adultos hospitalizados con dispotasemias graves (hipopotasemia: K+ ≤ 2,5 mmol/L, hiperpotasemia: ≥ 6,5 mmol/L), para su caracterizacion clinica y determinar su impacto pronostico. Resultados Durante el ano 2013 se hospitalizaron 39.501 pacientes de los que 603 presentaron dispotasemias graves (hiperpotasemia 0,6%, hipopotasemia 0,9%). Los factores asociados a hiperpotasemia fueron la disfuncion renal (72%) y uso de bloqueadores del sistema renina angiotensina aldosterona (22%); de hipopotasemia lo fueron el uso de diureticos, dieta/aporte bajo de K+ y las perdidas digestivas. Se realizo un electrocardiograma en 44% de los pacientes con hiperpotasemia y en 26% con hipopotasemia. La presentacion de arritmias graves fue mas frecuente en el grupo de hiperpotasemia (20 frente al 6%; p = 0,01). La mortalidad intrahospitalaria fue alta en ambos grupos (hiperpotasemia 26 frente a hipopotasemia 19%; p = 0,04) y a los 6 meses (hiperpotasemia 11 frente a hipopotasemia 16%; p = 0,13), asi como el indice de recurrencias graves durante el seguimiento (hiperpotasemia 28 frente a hipopotasemia 15%; p Conclusiones Las dispotasemias graves son poco frecuentes, pero se asocian a mal pronostico durante la hospitalizacion y en el seguimiento. La mortalidad aguda esta asociada en una elevada proporcion de pacientes a la comorbilidad concomitante y a la presentacion de arritmias cardiacas graves, por lo que se recomienda monitorizacion electrocardiografica intensiva.

Background: The association with a preceding stressor is a characteristic feature of takotsubo syndrome (TTS). Negative emotions before TTS are common and led to the popular term "broken heart syndrome." In contrast, pleasant triggers ("happy heart syndrome") are rare and are scarcely investigated. Objectives: The authors analyzed the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry. Methods: Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant emotional events with patients with negative emotional events. Results: Of 2,482 patients in the registry, 910 patients (36.7%) exhibited an emotional trigger consisting of 873 "broken hearts" (95.9%) and 37 "happy hearts" (4.1%). Consequently, the prevalence of pleasant emotional triggers was 1.5% of all TTS cases. Compared with patients with TTS with negative preceding events, patients with happy heart syndrome were more frequently male (18.9% vs 5.0%; P< 0.01) and had a higher prevalence of atypical ballooning patterns (27.0% vs 12.5%; P = 0.01), particularly midventricular ballooning. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke (8.1% vs 12.3%; P = 0.45), and long-term mortality rates (2.7% vs 8.8%; P = 0.20) were similar in "happy hearts" and "broken hearts." Conclusions: Happy heart syndrome is a rare type of TTS characterized by a higher prevalence of male patients andatypical, nonapical ballooning compared with patients with negative emotional stressors. Despite similar short- and long-term outcomes in our study, additional data are needed to explore whether numerically lower event rates in "happyhearts" would be statistically significant in a larger sample size. (GErman-Italian-Spanish Takotsubo Registry [GEIST Registry]; NCT04361994).

Resumen Introduccion y objetivos A pesar del uso de la hipotermia terapeutica, los pacientes recuperados tras sufrir una parada cardiaca extrahospitalaria tienen un elevado riesgo de muerte o deterioro neurologico grave. Se analizaron la utilidad de diversas variables disponibles al ingreso hospitalario para predecir su evolucion a los 6 meses. Metodos Se desarrollo un estudio multicentrico en 3 unidades de cuidados intensivos cardiacos. El analisis se realizo sobre 153 pacientes ingresados en dos centros tras sufrir una parada cardiaca extrahospitalaria recuperada y que se trataron con control de temperatura, entre enero de 2007 y julio de 2015. Se consideraron secuelas neurologicas significativas si la Cerebral Performance Categories Scale > 2 a los 6 meses. Los resultados se validaron externamente con los datos procedentes de otros 91 pacientes ingresados en un tercer hospital, durante el mismo periodo de tiempo. Resultados Del total de 244 pacientes (mediana de edad, 60 anos; 77,1% varones; 50,0% en el contexto de isquemia miocardica aguda), 107 (43,8%) sobrevivieron a los 6 meses con una evolucion neurologica favorable. Se calculo un modelo predictivo que incluyo 5 variables (primer ritmo, edad, lactato al ingreso, tiempo hasta recuperacion de circulacion espontanea y diabetes), con un area bajo la curva de 0,90 (IC95%, 0,85-0,95). Cuando se realizo la validacion externa del modelo, la sensibilidad fue de 73,5%, con una especificidad de 78,6% y un area bajo la curva de 0,82 (IC95%, 0,73-0,91). Conclusiones Un modelo predictivo que incluye cinco variables disponibles en el momento de ingreso de pacientes recuperados tras sufrir una parada cardiaca extrahospitalaria puede ayudar a predecir la probabilidad de supervivencia libre de secuelas neurologicas graves en el seguimiento.

Objectives: This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS).Background: TTS can be associated with sev...

Resumen Introduccion y objetivos El sindrome de tako-tsubo es un proceso patologico potencialmente grave durante la fase aguda. Simula un infarto de miocardio, sin que haya lesiones coronarias potencialmente responsables. El objetivo de este trabajo es analizar la evolucion y el pronostico de los pacientes con sindrome de tako-tsubo en funcion del sexo. Metodos Se analizaron las caracteristicas de los pacientes incluidos en el registro RETAKO durante los anos 2003 a 2015, un registro multicentrico en el que participaron 32 hospitales espanoles. Resultados De los 562 pacientes incluidos, 493 (87,7%) eran mujeres. El dolor toracico fue menos frecuente como sintoma inicial en los varones que en las mujeres (43 [66,2%] frente a 390 [82,8%]; p Conclusiones El sindrome de tako-tsubo es una enfermedad que muestra grandes diferencias en funcion del sexo en cuanto a su incidencia, presentacion y evolucion, con un peor pronostico en los varones.

Background Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS). Methods Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included. Results 246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p Conclusion Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS. Typical ECG at admission and after 48h. Funding Acknowledgement Type of funding source: None

To compact the extracellular sides of myelin, an important transition must take place: from membrane sliding, while building the wraps, to membrane adhesion and water exclusion. Removal of the negatively charged glycocalyx becomes the limiting factor in such transition. What is required to initiate this membrane‐zipping process? Knocking‐out the Lipocalin Apolipoprotein D (ApoD), essential for lysosomal functional integrity in glial cells, results in a specific defect in myelin extracellular leaflet compaction in peripheral and central nervous system, which results in reduced conduction velocity and suboptimal behavioral outputs: motor learning is compromised. Myelination initiation, growth, intracellular leaflet compaction, myelin thickness or internodal length remain unaltered. Lack of ApoD specifically modifies Plp and P0 protein expression, but not Mbp or Mag. Late in myelin maturation period, ApoD affects lipogenic and growth‐related, but not stress‐responsive, signaling pathways. Without ApoD, the sialylated glycocalyx is maintained and ganglioside content remains high. In peripheral nervous system, Neu3 membrane sialidase and lysosomal Neu1 are coordinately expressed with ApoD in subsets of Schwann cells. ApoD‐KO myelin becomes depleted of Neu3 and enriched in Fyn, a kinase with pivotal roles in transducing axon‐derived signals into myelin properties. In the absence of ApoD, partial permeabilization of lysosomes alters Neu1 location as well. Exogenous ApoD rescues ApoD‐KO hypersialylated glycocalyx in astrocytes, demonstrating that ApoD is necessary and sufficient to control glycocalyx composition in glial cells. By ensuring lysosomal functional integrity and adequate subcellular location of effector and regulatory proteins, ApoD guarantees the glycolipid recycling and glycocalyx removal required to complete myelin compaction., Junta de Castilla y León (JCyL), Grant Number: VA180A11‐2, MICINN‐MINECO, BFU2011‐23978, and BFU2015‐68149‐R; European Regional Development fund; JAEPre – CSIC fellowship; JCyL fellowship, Grant Number: call#EDU/1883/2013; European Social Fund; Operational Programme for Castilla y León; Consejería de Educación (JCyL).

Sin financiación No data JCR 2019 UEM 1.386 SJR (2019) Q1, 293/2805 Medicine (miscellaneous) No data IDR 2019

Interatrial block (IAB) represents a conduction delay between right and left atria and is associated with an increased risk of atrial fibrillation and stroke. IAB has not been previously assessed in patients with Takotsubo syndrome (TS). Our aim was to describe the prevalence and prognostic significance of IAB in patients with TS. Data come from the Spanish National prospective registry of patients with definitive TS diagnosis. IAB was defined as a P-wave ≥120 ms and was considered partial when the P-wave was positive in inferior leads and advanced when it was biphasic (+/−). A total of 246 patients were included, normal P-wave was found in 151 (61%), partial IAB in 58 (24%), atrial fibrillation in 18 (7%), advanced IAB in 13 (5%), and 6 (2%) were pacemaker dependent. During a mean follow up of 12 months the composite of all-cause mortality and hospital readmission was significantly higher in patients with advanced IAB (31%) or atrial fibrillation (33%) than in the rest of the cohort (pacemaker stimulation 17%, normal P-wave 13%, partial IAB 12%), p < 0.01. The data regarding P wave characteristics were an independent predictor of the composite end point all-cause death and hospital readmission. IAB has a high prevalence in patients with TS. Advanced IAB and atrial fibrillation are associated with a poor prognosis. Sin financiación 2.570 JCR (2019) Q2, 63/138 Cardiac & Cardiovascular Systems 1.479 SJR (2019) Q1, 54/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Sin financiación 4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems 0.473 SJR (2019) Q3, 196/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Introduction and objectives: Despite therapeutic hypothermia, unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Our objective was to assess the usefulness of the variables obtained in the early moments after resuscitation in the prediction of 6-month prognosis. Methods: A multicenter study was performed in 3 intensive cardiac care units. The analysis was done in 153 consecutive survivors of out-of-hospital cardiac arrest who underwent targeted temperature management between January 2007 and July 2015. Significant neurological sequelae at 6 months were considered to be present in patients with Cerebral Performance Categories Scale > 2. An external validation was performed with data from 91 patients admitted to a third hospital in the same time interval. Results: Among the 244 analyzed patients (median age, 60 years; 77.1% male; 50.0% in the context of acute myocardial ischemia), 107 patients (43.8%) survived with good neurological status at 6 months. The prediction model included 5 variables (Shockable rhythm, Age, Lactate levels, Time Elapsed to return of spontaneous circulation, and Diabetes – SALTED) and provided an area under the curve of 0.90 (95%CI, 0.85-0.95). When external validation was performed, the predictive model showed a sensitivity of 73.5%, specificity of 78.6%, and area under the curve of 0.82 (95%CI, 0.73-0.91). Conclusions: A predictive model that includes 5 clinical and easily accessible variables at admission can help to predict the probability of survival without major neurological damage following out-of-hospital cardiac arrest. Introducción y objetivos: A pesar del uso de la hipotermia terapéutica, los pacientes recuperados tras sufrir una parada cardiaca extrahospitalaria tienen un elevado riesgo de muerte o deterioro neurológico grave. Se analizaron la utilidad de diversas variables disponibles al ingreso hospitalario para predecir su evolución a los 6 meses. Métodos: Se desarrolló un estudio multicéntrico en 3 unidades de cuidados intensivos cardiacos. El análisis se realizó sobre 153 pacientes ingresados en dos centros tras sufrir una parada cardiaca extrahospitalaria recuperada y que se trataron con control de temperatura, entre enero de 2007 y julio de 2015. Se consideraron secuelas neurológicas significativas si la Cerebral Performance Categories Scale > 2 a los 6 meses. Los resultados se validaron externamente con los datos procedentes de otros 91 pacientes ingresados en un tercer hospital, durante el mismo periodo de tiempo. Resultados: Del total de 244 pacientes (mediana de edad, 60 años; 77,1% varones; 50,0% en el contexto de isquemia miocárdica aguda), 107 (43,8%) sobrevivieron a los 6 meses con una evolución neurológica favorable. Se calculó un modelo predictivo que incluyó 5 variables (primer ritmo, edad, lactato al ingreso, tiempo hasta recuperación de circulación espontánea y diabetes), con un área bajo la curva de 0,90 (IC95%, 0,85-0,95). Cuando se realizó la validación externa del modelo, la sensibilidad fue de 73,5%, con una especificidad de 78,6% y un área bajo la curva de 0,82 (IC95%, 0,73-0,91). Conclusiones: Un modelo predictivo que incluye cinco variables disponibles en el momento de ingreso de pacientes recuperados tras sufrir una parada cardiaca extrahospitalaria puede ayudar a predecir la probabilidad de supervivencia libre de secuelas neurológicas graves en el seguimiento. Sin financiación 4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems 0.473 SJR (2019) Q3, 196/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Introduction and objectives: Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. Methods: We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. Results: Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P

Little is known about the role of time to initiation of therapeutic hypothermia and time to target temperature (TTT) in the prognosis of patients resuscitated from cardiac arrest.A retrospective analysis was performed in 145 survivors of cardiac arrest who underwent therapeutic hypothermia between January 2003 and January 2013. The objective was to identify predictors of survival free from significant neurological sequelae (Cerebral Performance Categories Scale (CPC):2) six months after cardiac arrest. We evaluated the effect of faster and earlier cooling.Overall survival at six months was 42.1% (61 patients); 59 of these were considered to have a good neurological status (CPC ≤ 2), and in whom therapeutic hypothermia was initiated earlier (87 ± 17 min vs. 111 ± 14 min; p=0.042), and the target temperature was reached at an earlier time (TTT: 316 ± 30 min vs. 365 ± 27 min; p=0.017). Multivariate analysis selected longer duration of cardiac arrest (odds ratio (OR) = 1.06 per min), a non-shockable initial rhythm (OR=13.8), severe acidosis (OR=0.009 per 0.01 unit), older age (OR=1.04 per year) and longer TTT (OR=1.005 per min) as associated with poor prognosis.The most important prognostic factors for death or lack of neurological recovery in patients with cardiac arrest treated with therapeutic hypothermia are initial-rhythm, time from cardiac arrest to return of spontaneous circulation and arterial-pH at admission. Although the speed of cooling initiation and the time to reach target temperature may play a role, its influence on prognosis seems to be less important.

Tako-tsubo cardiomyopathy (TTC) is a syndrome characterized by acute transient ventricular dysfunction in the absence of obstructive coronary artery disease and is predominantly associated with exposure to sudden emotional or physical stress. Patients with TTC may develop serious in-hospital complications, including ventricular arrhythmias. However, triggering of TTC after an electrical storm has not previously been described. We present two cases of TTC induced by multiple shocks in the setting of an electrical storm due to pharmacologically induced long QT syndrome.

Introduction: Myocardial fibrosis plays an important role in the pathogenesis of atrial fibrillation (AF). However, catheter ablation may eliminate AF sources but also increases fibrosis. We aimed to assess the predictive value of circulating biomarkers of collagen metabolism following AF catheter ablation. Methods: Serum levels (ELISA) of biomarkers of collagen metabolism were analyzed in patients undergoing AF ablation (62 paroxysmal, 67 persistent) at baseline and 12 months after ablation. Biomarkers levels in 20 patients in sinus rhythm were also evaluated to establish the normal values. Results: Before ablation, there was a direct linear correlation between PICP (carboxy-terminal propeptide of procollagen type I) levels and left atrial diameter for the overall sample (p=0.006). PICP levels at baseline were lower in paroxysmal AF patients with vs. without AF recurrences following ablation (68.30 ± 9.66μg/l vs 90.72 ± 3.78μg/l; p=0.017). At 12 months following ablation of paroxysmal patients, PICP levels significantly increased only in patients with AF recurrences (21.74μg/l vs -0.12 μg/l, Figure). There were no significant changes in biomarkers levels in persistent AF patients at baseline or during follow-up. Conclusions: Progressive increase of PICP levels following catheter ablation of AF is related with arrhythmia recurrence in paroxysmal AF patients. This result suggests that ablation may increase collagen turnover in non-responders paroxysmal AF patients.

Expone los cambios y reformas que ha tenido la educación, como por ejemplo los cambios de nombre de la E.G.B, el Instituto a pasar ahora a ser Educación Primaria y Secundaria, los cambios en la denominación de asignaturas, de créditos, etc. Ante ello, el autor da dos opiniones: por un lado a los políticos que busquen un buen sistema educativo lo más consensuado y bueno posible y por otro lado que las familias asuman ser las verdaderas primeras instituciones encargadas de educar a sus hijas e hijos. Castilla y León Universidad de León. Facultad de Educación. Servicio de Biblioteca; Campus de Vegazana, s. n.; 24071 León; Tel. +34987291146; Fax +34987291145; bufed@unileon.es ESP