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Optimal medical therapy decreases mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. Women have been underrepresented in clinical trials and not specifically evaluated. This study aimed to compare the safety and effectiveness of drug titration in women vs men.This post hoc gender study of the ETIFIC multicenter randomized trial included hospitalized patients with new-onset HF with reduced ejection fraction and New York Heart Association II-III and no contraindications to beta-blockers. A structured 4-month titration process was implemented in HF clinics. The primary endpoint was the mean relative dose (% of target dose) of beta-blockers achieved by women vs men. Secondary endpoints included the mean relative doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists, adverse events, and other clinical outcomes at 6 months.A total of 320 patients were included, 83 (25.93%) women and 237 (74.06%) men (76 vs 213 analyzed). The mean±standard deviation of the relative doses achieved by women vs men were as follows: beta-blockers 62.08%±30.72% vs 64.4%±32.77%, with a difference of-2.32% (95%CI,-10.58-5.94), P = .580; and mineralocorticoid receptor antagonists 79.85%±27.72% vs 67.29%±31.43%, P =.003. No other differences in drug dosage were found. Multivariate analysis showed nonsignificant differences. CV mortality was 1 (1.20%) vs 3 (1.26%), P=1, and HF hospitalizations 0 (0.00%) vs 10 (4.22%), P=.125.In a post hoc analysis from the HF-titration ETIFIC trial, we found nonsignificant gender differences in drug dosage, cardiovascular mortality, and HF hospitalizations. Trial registry number: NCT02546856.

Embargado hasta 31/01/2024 In this work, photocatalysts consisting of TiO2 supported on zeolite (USY62) were synthesized by sol-gel method and, subsequently, a noble metal (Pt, Au, or Ag) was incorporated by impregnation or photodeposition. Zeolite-TiO2 composites were characterized by SEM, TEM, XRD, N2 adsorption-desorption, Raman and UV–vis spectroscopy, and well-dispersed anatase TiO2 particles (ca. 10 nm) that exhibited a blue-shift in the UV–vis absorption due to the size quantization effect were produced. The photocatalytic activity of all zeolite-TiO2 composites was examined by the photoreforming of aqueous glycerol solution (10% w/w) under UV and solar-simulated radiation. The activity of the zeolitic photocatalysts decreased in the order Pt > Au > Ag, being catalysts prepared by photodeposition more active than those prepared by impregnation. Moreover, Zeolite-supported TiO2, led to a TiO2 with smaller deactivation in H2 production than unsupported TiO2, which can be ascribed to the small TiO2 particle size or an interaction zeolite-TiO2. All in all, a photocatalyst (USY-Ti-PPt) with TiO2 up to four times more active than unsupported TiO2 under UV radiation was prepared.

Resumen Introduccion y objetivos La insuficiencia cardiaca (IC) es un problema creciente de salud y una carga importante para la sociedad. Pese a ello, con frecuencia se minusvalora globalmente la gravedad del pronostico. Este estudio estima el pronostico al ano en pacientes con IC aguda y cronica en Espana y resto de Europa. Metodos Un total de 2.829 pacientes con IC (589 IC aguda y 2.240 IC cronica) seleccionados en 27 centros hospitalarios en Espana, atendidos por cardiologos y que participan en el registro ESC-EORP-HFA Heart Failure Long-Term, con 211 centros y 12.440 pacientes en total, se siguieron un ano para monitorizar la mortalidad y el ingreso hospitalario. Resultados La mortalidad al ano en IC aguda fue del 29,3% en Espana (IC95%, 25,6-33,2) y 27,7% en el resto de Europa (p = 0,4303). En IC cronica, las cifras correspondientes fueron 6,4% (IC95%, 5,4-7,5) y 9,5% (p Conclusiones Se confirma la gravedad de la IC, en particular cuando ya necesita ingreso, incluso en centros con buen seguimiento de guias clinicas. En pacientes ingresados por IC en Espana casi un tercio fallecera en el primer ano tras ese ingreso indice (incluyendo el 5,9% que fallece durante el mismo) y casi la mitad fallecera o necesitara reingresar por IC. La comparacion favorable con Europa en hospitalizaciones y mortalidad en IC cronica se debe interpretar con cautela por insuficiente ajuste por potenciales variables de confusion.

Resumen Introduccion y objetivos La hiperpotasemia es una preocupacion creciente en el tratamiento de los pacientes con insuficiencia cardiaca y fraccion de eyeccion reducida, pues limita el uso de farmacos eficaces. Este trabajo ofrece estimaciones de la magnitud de este problema en la practica clinica habitual en Espana, los cambios en las concentraciones de potasio en el seguimiento y los factores asociados. Metodos Pacientes con insuficiencia cardiaca aguda (n = 881) y cronica (n = 3.587) seleccionados en 28 hospitales espanoles del registro europeo de insuficiencia cardiaca de la European Society of Cardiology y seguidos 1 ano para diferentes desenlaces, incluidos cambios en las cifras de potasio y su impacto en el tratamiento. Resultados La hiperpotasemia (K+ > 5,4 mEq/l) esta presente en el 4,3% (IC95%, 3,7-5,0%) y el 8,2% (6,5-10,2%) de los pacientes con insuficiencia cardiaca cronica y aguda; causa el 28,9% de todos los casos en que se contraindica el uso de antagonistas del receptor de mineralocorticoides y el 10,8% de los que no alcanzan la dosis objetivo. Del total de 2.693 pacientes ambulatorios con fraccion de eyeccion reducida, 291 (10,8%) no tenian registrada medicion de potasio. Durante el seguimiento, 179 de 1.431 (12,5%, IC95%, 10,8-14,3%) aumentaron su concentracion de potasio, aumento relacionado directamente con la edad, la diabetes mellitus y los antecedentes de ictus e inversamente con los antecedentes de hiperpotasemia. Conclusiones Este trabajo destaca el problema de la hiperpotasemia en pacientes con insuficiencia cardiaca de la practica clinica habitual y la necesidad de continuar y mejorar la vigilancia de este factor en estos pacientes por su interferencia en el tratamiento optimo.

Altres ajuts: AstraZeneca Farmacéutica, Spain, S.A. (ESR-17-13244). Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m, and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1-5.4 mEq/L = 13.8%, 5.5-5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment.

Resumen Introduccion y objetivos Analizar el valor pronostico de la hipoxemia nocturna, evaluada mediante pulsioximetria nocturna portatil, en pacientes ingresados por insuficiencia cardiaca y su relacion con la mortalidad y el reingreso hospitalario. Metodos Incluimos a 38 pacientes ingresados de manera consecutiva en nuestra unidad con el diagnostico de insuficiencia cardiaca descompensada. La pulsioximetria se considero positiva para hipoxemia cuando se registraron mas de 10 desaturaciones a la hora durante el sueno. Se realizo seguimiento durante 30,3 (desviacion estandar [DE] 14,2) meses, el objetivo principal fue un endpoint combinado de mortalidad por cualquier causa y reingreso por insuficiencia cardiaca. Resultados La edad media fue de 70,7 (DE 10,7) anos; el 63,3% eran varones. La pulsioximetria fue considerada positiva para hipoxemia en 27 (71%) pacientes. Los pacientes con una pulsioximetria positiva presentaron con mayor frecuencia el endpoint combinado (9.1% [1] vs. 61,5% [16]; p = 0,003). Tras el analisis multivariable, la hipoxemia nocturna continuo estando relacionada con el endpoint combinado (HR = 8,37; 1,19-68,4; p = 0,03). Discusion Los pacientes ingresados por insuficiencia cardiaca e hipoxemia nocturna medida con pulsioximetro portatil presentan un riesgo aumentado de reingreso y muerte.

Aims Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a life-threatening entity with a highly heterogeneous genetic background. Cardiac magnetic resonance (CMR) imaging can identify fibrofatty scar by late gadolinium enhancement (LGE). Our aim is to investigate genotype–phenotype correlation in ARVC/D mutation carriers, focusing on CMR-LGE and myocardial fibrosis patterns. Methods and results A cohort of 44 genotyped patients, 33 with definite and 11 with borderline ARVC/D diagnosis, was characterized using CMR and divided into groups according to their genetic condition (desmosomal, non-desmosomal mutation, or negative). We collected information on cardiac volumes and function, as well as LGE pattern and extension. In addition, available ventricular myocardium samples from patients with pathogenic gene mutations were histopathologically analysed. Half of the patients were women, with a mean age of 41.6 ± 17.5 years. Next-generation sequencing identified a potential pathogenic mutation in 71.4% of the probands. The phenotype varied according to genetic status, with non-desmosomal male patients showing lower left ventricular (LV) systolic function. LV fibrosis was similar between groups, but distribution in non-desmosomal patients was frequently located at the posterolateral LV wall; a characteristic LV subepicardial circumferential LGE pattern was significantly associated with ARVC/D caused by desmin mutation. Histological analysis showed increased fibrillar connective tissue and intercellular space in all the samples. Conclusion Desmosomal and non-desmosomal mutation carriers showed different morphofunctional features but similar LV LGE presence. DES mutation carriers can be identified by a specific and extensive LV subepicardial circumferential LGE pattern. Further studies should investigate the specificity of LGE in ARVC/D.

[Abstract] Introduction and objectives: Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors. Methods: This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment. Results: Hyperkalemia (K+> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia. Conclusions: This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment. [Resumen] Introducción y objetivos. La hiperpotasemia es una preocupación creciente en el tratamiento de los pacientes con insuficiencia cardiaca y fracción de eyección reducida, pues limita el uso de fármacos eficaces. Este trabajo ofrece estimaciones de la magnitud de este problema en la práctica clínica habitual en España, los cambios en las concentraciones de potasio en el seguimiento y los factores asociados. Métodos. Pacientes con insuficiencia cardiaca aguda (n = 881) y crónica (n = 3.587) seleccionados en 28 hospitales españoles del registro europeo de insuficiencia cardiaca de la European Society of Cardiology y seguidos 1 año para diferentes desenlaces, incluidos cambios en las cifras de potasio y su impacto en el tratamiento. Resultados. La hiperpotasemia (K+ > 5,4 mEq/l) está presente en el 4,3% (IC95%, 3,7-5,0%) y el 8,2% (6,5-10,2%) de los pacientes con insuficiencia cardiaca crónica y aguda; causa el 28,9% de todos los casos en que se contraindica el uso de antagonistas del receptor de mineralocorticoides y el 10,8% de los que no alcanzan la dosis objetivo. Del total de 2.693 pacientes ambulatorios con fracción de eyección reducida, 291 (10,8%) no tenían registrada medición de potasio. Durante el seguimiento, 179 de 1.431 (12,5%, IC95%, 10,8-14,3%) aumentaron su concentración de potasio, aumento relacionado directamente con la edad, la diabetes mellitus y los antecedentes de ictus e inversamente con los antecedentes de hiperpotasemia. Conclusiones. Este trabajo destaca el problema de la hiperpotasemia en pacientes con insuficiencia cardiaca de la práctica clínica habitual y la necesidad de continuar y mejorar la vigilancia de este factor en estos pacientes por su interferencia en el tratamiento óptimo.

[Abstract] Introduction and objectives. To estimate the percentage of heart failure patients in Spain that received the European Society of Cardiology recommended treatments, and in those that did not, to determine the reasons why. Methods. The study included 2834 consecutive ambulatory patients with heart failure from 27 Spanish hospitals. We recorded general information, the treatment indicated, and the reasons why it was not prescribed in some cases. In patients who met the criteria to receive a certain drug, true undertreatment was defined as the percentage of patients who, without justification, did not receive the drug. Results. In total, 92.6% of ambulatory patients with low ejection fraction received angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 93.3% beta-blockers, and 74.5% mineralocorticoid receptor antagonists. The true undertreatment rates were 3.4%, 1.8%, and 19.0%, respectively. Target doses were reached in 16.2% of patients receiving angiotensin converting enzyme inhibitors, 23.3% of those with angiotensin receptor blockers, 13.2% of those prescribed beta-blockers, and 23.5% of those with mineralocorticoid receptor antagonists. Among patients who could benefit from ivabradine, 29.1% received this drug. In total, 36% of patients met the criteria for defibrillator implantation and 90% of them had received the device or were scheduled for implantation, whereas 19.6% fulfilled the criteria for resynchronization therapy and 88.0% already had or would soon have the device. In patients who met the criteria, but did not undergo device implantation, the reasons were not cost-related. Conclusions. When justified reasons for not administering heart failure drugs were taken into account, adherence to the guideline recommendations was excellent. Exclusive use of the percentage of treated patients is a poor indicator of the quality of healthcare in heart failure. Measures should be taken to improve the attainment of optimal dosing in each patient. [Resumen] Introducción y objetivos. Estimar la proporción de pacientes con insuficiencia cardiaca atendidos en España que reciben los tratamientos recomendados por la Sociedad Europea de Cardiología y razones de que no los reciban, en su caso. Métodos. Se incluyó a 2.834 pacientes ambulatorios consecutivos con insuficiencia cardiaca de 27 hospitales españoles. Se recogió información general, tratamiento indicado y causas de que no lo recibiera, en su caso. De los pacientes que cumplen criterios para recibir tratamiento, infratratamiento real es la proporción que, sin justificación, no lo recibe. Resultados. El 92,6% de los pacientes ambulatorios con fracción de eyección reducida recibieron inhibidores de la enzima de conversión de la angiotensina o antagonistas del receptor de la angiotensina II; el 93,3%, bloqueadores beta y el 74,5%, antagonistas del receptor mineralocorticoideo. El infratratamiento real es del 3,4, el 1,8 y el 19,0% respectivamente. Alcanzan dosis objetivo de inhibidores de la enzima de conversión de la angiotensina el 16,2% de los pacientes; de antagonistas de los receptores de la angiotensina II, el 23,3%; de bloqueadores beta, el 13,2% y de antagonistas del receptor mineralocorticoideo, el 23,5%. El 29,1% de los pacientes que podrían beneficiarse de ivabradina la reciben; el 36% cumple criterios para implantar desfibrilador; de ellos, el 90% lo tienen ya implantado o programado; las cifras correspondientes en resincronización son el 19,6 y el 88,0%; el porcentaje restante no se debe a causas económicas. Conclusiones. Considerando razones justificadas para no administrar fármacos a estos pacientes, el cumplimiento de las guías es excelente. Utilizar solo la proporción de pacientes tratados es un mal indicador de calidad de la asistencia en insuficiencia cardiaca. Es necesario introducir medidas que mejoren el logro de la dosis óptima para cada paciente.

Resumen Introduccion y objetivos Estimar la proporcion de pacientes con insuficiencia cardiaca atendidos en Espana que reciben los tratamientos recomendados por la Sociedad Europea de Cardiologia y razones de que no los reciban, en su caso. Metodos Se incluyo a 2.834 pacientes ambulatorios consecutivos con insuficiencia cardiaca de 27 hospitales espanoles. Se recogio informacion general, tratamiento indicado y causas de que no lo recibiera, en su caso. De los pacientes que cumplen criterios para recibir tratamiento, infratratamiento real es la proporcion que, sin justificacion, no lo recibe. Resultados El 92,6% de los pacientes ambulatorios con fraccion de eyeccion reducida recibieron inhibidores de la enzima de conversion de la angiotensina o antagonistas del receptor de la angiotensina II ; el 93,3%, bloqueadores beta y el 74,5%, antagonistas del receptor mineralocorticoideo. El infratratamiento real es del 3,4, el 1,8 y el 19,0% respectivamente. Alcanzan dosis objetivo de inhibidores de la enzima de conversion de la angiotensina el 16,2% de los pacientes; de antagonistas de los receptores de la angiotensina II , el 23,3%; de bloqueadores beta, el 13,2% y de antagonistas del receptor mineralocorticoideo, el 23,5%. El 29,1% de los pacientes que podrian beneficiarse de ivabradina la reciben; el 36% cumple criterios para implantar desfibrilador; de ellos, el 90% lo tienen ya implantado o programado; las cifras correspondientes en resincronizacion son el 19,6 y el 88,0%; el porcentaje restante no se debe a causas economicas. Conclusiones Considerando razones justificadas para no administrar farmacos a estos pacientes, el cumplimiento de las guias es excelente. Utilizar solo la proporcion de pacientes tratados es un mal indicador de calidad de la asistencia en insuficiencia cardiaca. Es necesario introducir medidas que mejoren el logro de la dosis optima para cada paciente.

Introduction and objectives To analyze the prognostic value of nocturnal hypoxaemia measured with portable nocturnal pulse-oximetry in patients hospitalized due to heart failure and its relation to mortality and hospital readmission. Methods We included 38 patients who were admitted consecutively to our unit with the diagnosis of decompensated heart failure. Pulse-oximetry was considered positive for hypoxaemia when more than 10 desaturations per hour were recorded during sleep. Follow-up was performed for 30.3 (standard deviation [SD] 14.2) months, the main objective being a combined endpoint of all-cause mortality and hospital readmission due to heart failure. Results The average age was 70.7 (SD 10.7) years, 63.3% were males. Pulse-oximetry was considered positive for hypoxaemia in 27 (71%) patients. Patients with positive pulse-oximetry had the most frequent endpoint (9.1% [1] vs. 61.5% [16], p = 0.003). After multivariate analysis, continuous nocturnal hypoxaemia was related to the combined endpoint (HR = 8.37, 1.19–68.4, p = 0.03). Discussion Patients hospitalized for heart failure and nocturnal hypoxaemia measured with portable pulse-oximeter have an increased risk of hospital readmission and death.

Primary malignant tumors of the heart are a rare condition. The most common type is the cardiac angiosarcoma. The symptoms of this disease are very nonspecific and can be very difficult to diagnose by conventional imaging techniques. We report the case of a male patient with cardiac angiosarcoma who also had a rare complication, this being cardiac rupture, which required the use of 18 F-FDG PET-CT to demonstrate the mass malignancy and to reach a definitive diagnosis.

Introduction. The prognosis in patients with acute coronary syndrome without persistent ST segment elevation (NSTEACS) differs depending on cardiac troponin levels. Clinical practice guidelines published by the Spanish Society of Cardiology and the ACC/AHA consider patients with NSTEACS and markedly elevated troponin levels as high risk patients. The aim of this study was to identify factors related to markedly elevated troponin I levels in NSTEACS. Patients and method. We measured troponin I levels in 219 consecutive patients with NSTEACS and normal CK-MB values, and identified 2 groups: patients with markedly elevated troponin levels (more than 10-fold the normal upper limit), and patients with normal or slightly elevated troponin levels (less than a 10-fold increase above the normal limit). We also analyzed clinical and angiographic variables. Logistic regression was used to calculate age- and sex-adjusted associations for the main variables. Results. Forty-one patients (19%) had markedly elevated troponin levels, and 178 (81%) showed normal or slightly elevated troponin I levels. Patients with markedly elevated levels had more frequently prolonged angina, class IIb angina, more severe ECG changes, a higher number of diseased vessels on coronary angiography, and greater severity of the culprit lesion. The culprit stenosis in these patients was more often characterized as ulcerated, showing visible thrombus, and excentric, bifurcated and irregular. Class IIIb angina (odds ratio [OR] = 3.1; CI 95%, 1.1-8.6), bifurcation (OR=6.04; CI 95%, 2.5-14.3), ulceration (OR=3.2; CI 95%, 1.07-9.7) and visible thrombus (OR=2.7; CI 95%, 1.1-6.3) in the culprit lesion were predictive factors associated with markedly elevated levels of troponin I independently of age or sex. Conclusions. Markedly elevated troponin I levels in patients with NSTEACS are associated with a more severe clinical presentation and increased complexity of the culprit lesion on coronary angiography.

Introduccion. Los pacientes con sindrome coronario agudo sin elevacion persistente del segmento ST (SCASEST) presentan un pronostico distinto segun los valores de troponina. Las Guias de Practica Clinica (SEC y ACC/AHA) estratifican a los pacientes con SCASEST y marcada elevacion de troponinas como pacientes de alto riesgo. El objetivo del estudio ha sido identificar los factores asociados a las elevaciones importantes de los valores de troponina en estos pacientes. Pacientes y metodo. Se ha analizado a 219 pacientes con SCASEST y valores de la isoenzima MB de la creatincinasa normales en los que se determinaron los valores de troponina I. Segun estos valores, se diferenciaron en pacientes con troponina marcadamente elevada (= 10 veces el limite superior de la normalidad) y pacientes con troponina normal o ligeramente elevada (< 10 veces el limite normal). Se analizo una serie de variables clinicas y angiograficas. Los analisis principales se realizaron mediante regresion logistica ajustando por sexo y edad. Resultados. Un total de 41 pacientes (19%) presento valores de troponina marcadamente elevados y 178 (81%) mostraron valores normales o ligeramente elevados. Los pacientes con valores marcadamente elevados presentaban con mas frecuencia angina prolongada, angina de clase IIIb, cambios electrocardiograficos mas severos, un mayor numero de vasos afectados en la coronariografia con una mayor gravedad en la lesion causal. Dichas lesiones mostraban una mayor incidencia de ulceracion, trombo visible, excentricidad, localizacion en bifurcacion e irregularidad. La presencia de angina clase IIIb (odds ratio [OR] = 3,1; intervalo de confianza [IC] del 95%, 1,1-8,6), la localizacion en bifurcacion (OR = 6,04; IC del 95%, 2,5-14,3), la presencia de ulceracion (OR = 3,2; IC del 95%, 1,07-9,7) y trombo (OR = 2,7; IC del 95%, 1,1-6,3) en las estenosis causantes fueron factores independientes de la edad y el sexo asociados a valores de troponinas marcadamente elevados. Conclusiones. Las elevaciones importantes de troponina I en pacientes con SCASEST se asocian a presentaciones clinicas mas graves y a estenosis causantes mas complejas en la coronariografia.

A 40-year-old man with previous cardiac surgery was referred to the adult congenital heart disease department at our hospital because of progressive dyspnoea during the previous 3 months. He had had successful pulmonary valvotomy when he was 9 because of a congenital pulmonary stenosis. As the initial approach in a patient with suspected heart failure (HF), a transthoracic echocardiography was performed in which a high-pressure gradient was measured by Doppler …

Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Advanced heart failure (HF) is associated with high morbidity and mortality; it represents a major burden for the health system. Episodes of acute decompensation requiring frequent and prolonged hospitalizations account for most HF-related expenditure. Inotropic drugs are frequently used during hospitalization, but rarely in out-patients. The LAICA clinical trial aims to evaluate the effectiveness and safety of monthly levosimendan infusion in patients with advanced HF to reduce the incidence of hospital admissions for acute HF decompensation. METHODS The LAICA study is a multicenter, prospective, randomized, double-blind, placebo-controlled, parallel group trial. It aims to recruit 213 out-patients, randomized to receive either a 24-h infusion of levosimendan at 0.1 μg/kg/min dose, without a loading dose, every 30 days, or placebo. RESULTS The main objective is to assess the incidence of admission for acute HF worsening during 12 months. Secondarily, the trial will assess the effect of intermittent levosimendan on other variables, including the time in days from randomization to first admission for acute HF worsening, mortality and serious adverse events. CONCLUSIONS The LAICA trial results could allow confirmation of the usefulness of intermittent levosimendan infusion in reducing the rate of hospitalization for HF worsening in advanced HF outpatients. Yes