Does Hypoxia and Stress Erythropoiesis Compromise Cardiac Function in Healthy Adults? A Randomized Trial.

OBJECTIVES: To investigate whether recombinant human erythropoietin (rHuEPO) injections during an altitude training camp impact heart function. METHODS: Thirty (12 women) moderately trained subjects stayed at 2320 m altitude for 4 weeks while training. Subjects were randomized to placebo (isotonic saline) or rHuEPO (20 IU/kg body weight) i.v. injections. Transthoracic echocardiography imaging was acquired 3 days after arrival to altitude and prior to the first placebo or rHuEPO injection as well as one day after the last rHuEPO injection three weeks later. RESULTS: rHuEPO did not alter cardiovascular morphology parameters, systolic or diastolic function. In the placebo group, altitude exposure improved left ventricle (LV) systolic function due to an increased twist angle but rHuEPO had no additional effects. Pulmonary arterial systolic pressure was unaffected in either group. Notably, rHuEPO hampered LV untwist rate without affecting LV early filling. CONCLUSION: rHuEPO provided during mild altitude exposure does not cause any major effects on heart function. The observed alteration in LV untwist induced by rHuEPO is unlikely to have a meaningful clinical effect. Trial Registration Registered on www. CLINICALTRIALS: gov (NCT04227665).

Terapia antiplaquetaria doble de 6 o de 12 meses tras implante de stents farmacoactivos de nueva generación: análisis emparejado de los registros ESTROFA-DAPT y ESTROFA-2 / Dual antiplatelet therapy for 6 months vs 12 months after new-generation drug-eluting stent implantation: matched analysis of ESTROFA-DAPT and ESTROFA-2

Introducción y objetivos: El periodo de uso recomendado del tratamiento antiagregante plaquetario combinado doble tras implante de stents farmacoactivos va de los 6 a los 12 meses o más. Ensayos recientes indican que es seguro utilizar un tratamiento antiagregante plaquetario combinado doble durante 6 meses, si bien ciertas limitaciones de estos estudios hacen que sea escasa la aplicabilidad de esta estrategia de tratamiento antiagregante plaquetario combinado doble de menor duración en la práctica clínica real. Métodos: Se puso en marcha un registro con la inscripción de pacientes consecutivos a los que se había implantado stent farmacoactivo de nueva generación seguido de una prescripción de 6 meses de tratamiento antiagregante plaquetario combinado doble. Se realizó una igualación por puntuación de propensión con una cohorte histórica de pacientes tratados con stentsfarmacoactivos de segunda generación que recibieron luego 12 meses de tratamiento antiagregante plaquetario combinado doble del registro ESTROFA-2. El tamaño muestral se calculó para el criterio de no inferioridad y el objetivo principal fue la combinación de muerte cardiaca, infarto de miocardio, revascularización o hemorragia mayor a los 12 meses. Resultados: Se incluyó en el análisis a 1.286 pacientes de cada grupo, que no presentaban diferencias significativas en sus características basales. Se produjeron episodios del objetivo principal en el 5,0 y el 6,6% de los pacientes en los grupos de 6 y de 12 meses respectivamente (p = 0,001 para no inferioridad). La incidencia de trombosis del stent definitiva o probable fue del 0,5 y el 0,7% en los grupos de tratamiento de 6 y 12 meses respectivamente (p = 0,4). Los episodios de hemorragia mayor fueron menos en el grupo de 6 meses que en el de 12 (el 0,8 y el 1,4%; p = 0,2). Conclusiones: En pacientes seleccionados de este amplio estudio multicéntrico, la seguridad y la eficacia de 6 meses de tratamiento antiagregante plaquetario combinado doble después del implante de stents farmacoactivos de nueva generación fueron no inferiores a las observadas con 12 meses de tratamiento antiagregante plaquetario combinado doble (AU)

Introduction and objectives: The recommendation for dual antiplatelet therapy following drug-eluting stent implantation ranges from 6 months to 12 months or beyond. Recent trials have suggested the safety of a 6-month dual antiplatelet therapy regimen, yet certain caveats to these studies limit the applicability of this shorter duration dual antiplatelet therapy strategy in real world settings. Methods: A registry was constructed with consecutive recruitment of patients undergoing new-generation drug-eluting stent implantation and prescribed 6 months of dual antiplatelet therapy. Propensity score matching was undertaken with a historical cohort of patients treated with second-generation drug-eluting stents who received 12 months of dual antiplatelet therapy from the ESTROFA-2 registry. The sample size was calculated using a noninferiority basis and the primary endpoint was the combination of cardiac death, myocardial infarction, revascularization, or major bleeding at 12 months. Results: The analysis included 1286 patients in each group, with no significant differences in baseline characteristics. The primary endpoint occurred in 5.0% and 6.6% in the 6-month and 12-month groups, respectively (P = .001 for noninferiority). The incidence of definite or probable stent thrombosis was 0.5% and 0.7% in the 6-month and 12-month groups, respectively (P = .4). Major bleeding events were lower in the 6-month group than in the 12-month group (0.8% vs 1.4%; P = .2) Conclusions: In selected patients in this large multicenter study, the safety and efficacy of a 6-month dual antiplatelet therapy regimen after implantation of new-generation drug-eluting stents appeared to be noninferior to those of a 12-month dual antiplatelet therapy regimen (AU)

Dual Antiplatelet Therapy for 6 Months vs 12 Months After New-generation Drug-eluting Stent Implantation: Matched Analysis of ESTROFA-DAPT and ESTROFA-2.

INTRODUCTION AND OBJECTIVES: The recommendation for dual antiplatelet therapy following drug-eluting stent implantation ranges from 6 months to 12 months or beyond. Recent trials have suggested the safety of a 6-month dual antiplatelet therapy regimen, yet certain caveats to these studies limit the applicability of this shorter duration dual antiplatelet therapy strategy in real world settings. METHODS: A registry was constructed with consecutive recruitment of patients undergoing new-generation drug-eluting stent implantation and prescribed 6 months of dual antiplatelet therapy. Propensity score matching was undertaken with a historical cohort of patients treated with second-generation drug-eluting stents who received 12 months of dual antiplatelet therapy from the ESTROFA-2 registry. The sample size was calculated using a noninferiority basis and the primary endpoint was the combination of cardiac death, myocardial infarction, revascularization, or major bleeding at 12 months. RESULTS: The analysis included 1286 patients in each group, with no significant differences in baseline characteristics. The primary endpoint occurred in 5.0% and 6.6% in the 6-month and 12-month groups, respectively (P = .001 for noninferiority). The incidence of definite or probable stent thrombosis was 0.5% and 0.7% in the 6-month and 12-month groups, respectively (P = .4). Major bleeding events were lower in the 6-month group than in the 12-month group (0.8% vs 1.4%; P = .2) CONCLUSIONS: In selected patients in this large multicenter study, the safety and efficacy of a 6-month dual antiplatelet therapy regimen after implantation of new-generation drug-eluting stents appeared to be noninferior to those of a 12-month dual antiplatelet therapy regimen.

Associations of accumulated exposure to persistent organic pollutants with serum lipids and obesity in an adult cohort from Southern Spain.

The aim of this research was to study the association of the accumulated human exposure to persistent organic pollutants with serum lipid levels and obesity, in a cohort of 298 adults. In the multivariable analyses, HCB concentrations evidenced a significant quadratic association with levels of total cholesterol, HDL, LDL, and total serum lipids. Likewise, PCBs 138 and 180 were associated with triglycerides and total serum lipids, and PCB 153 with LDL. HCB, p,p'-DDE, and ß-HCH showed quadratic associations with BMI. All quadratic models showed a positive trend at low exposure levels, while the slope decreased or even became negative at higher exposure levels. Additionally, PCB 138 was positively associated with BMI but in a linear manner. Our results suggest a potential relationship between historical POP exposure and serum lipids/obesity, which followed a non-linear pattern in most cases.

Evaluación no invasiva de la función endotelial en la práctica clínica / Noninvasive assessment of endothelial function in clinical practice

En la lucha contra las enfermedades cardiovasculares, las estrategias preventivas están pasando a ser el principal centro de interés. Una de estas estrategias propone identificar a los individuos con riesgo elevado de sufrir enfermedad cardiovascular. La disfunción endotelial podría facilitar una mejor estratificación del riesgo y la puesta en práctica de estrategias preventivas. En esta revisión nos centramos en las técnicas no invasivas que se han introducido recientemente para evaluar la función endotelial: vasodilatación mediada por flujo medida con ecografía de la arteria humeral, análisis de la onda del pulso y pletismografía digital durante la hiperemia postisquémica. Describimos los principios básicos, los principales protocolos para la aplicación de estas técnicas y su valor clínico basado en la evidencia científica existente (AU)

In the fight against cardiovascular diseases, preventive strategies are becoming the focus of attention. One of these strategies proposes to identify individuals who are at a high risk of developing cardiovascular disease. Endothelial dysfunction could improve patient risk stratification and the implementation of preventive strategies. In this review we focus on noninvasive techniques that have recently become available to assess endothelial function: flow-mediated vasodilation as measured by ultrasound of the brachial artery, pulse wave analysis, and finger plethysmography during postischemic hyperemia. We describe the basic principles, the main protocols to perform these techniques, and their clinical value based on the scientific evidence (AU)

Noninvasive assessment of endothelial function in clinical practice.

In the fight against cardiovascular diseases, preventive strategies are becoming the focus of attention. One of these strategies proposes to identify individuals who are at a high risk of developing cardiovascular disease. Endothelial dysfunction could improve patient risk stratification and the implementation of preventive strategies. In this review we focus on noninvasive techniques that have recently become available to assess endothelial function: flow-mediated vasodilation as measured by ultrasound of the brachial artery, pulse wave analysis, and finger plethysmography during postischemic hyperemia. We describe the basic principles, the main protocols to perform these techniques, and their clinical value based on the scientific evidence.

Inflamación y trombosis en la fibrilación auricular / Inflammation and thrombosis in atrial fibrillation

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Uso de antiagregantes plaquetarios durante el embarazo / Platelet antiaggregants in pregnancy

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