The Association of Desert Dust with the Risk of Acute Coronary Syndrome in Subjects of a Younger Age.

Objectives: Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age. Methods: Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 µm (PM10) on the incidence of ACS in patients under 55 years of age. Results: Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM10 concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m3) were 1.02 (95% CI 0.97-1.1; p = 0.41), 1.01 (95% CI 0.96-1.07; p = 0.66), 0.99 (95% CI 0.94-1.05; p = 0.78), 0.96 (95% CI 0.9-1.02; p = 0.18), and 0.97 (95% CI 0.91-1.04; p = 0.41). Conclusions: Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age.

Natural History of Dilated Cardiomyopathy Due to c.77T>C (p.Val26Ala) in Emerin Protein.

(1) Introduction: Dilated cardiomyopathy (DCM) mainly affects young individuals and is the main indication of heart transplantation. The variant c.77T>C (p.Val26Ala) of the gene coding for emerin (EMD) in chromosome Xq28 has been catalogued as a pathogenic variant for the development of DCM, exhibiting an X-linked inheritance pattern. (2) Methods: A retrospective study was conducted covering the period 2015-2023 in patients with DCM of genetic origin. The primary endpoint was patient age at onset of the first composite major cardiac event, in the form of a first episode of heart failure, malignant ventricular arrhythmia, or end-stage heart failure, according to the presence of truncating variant in titin gene (TTNtv) versus the p.Val26Ala mutation in the EMD protein. (3) Results: A total of 31 and 22 patients were included in the EMD group and TTNtv group, respectively. The primary endpoint was significantly higher in the EMD group, with a hazard ratio of 4.16 (95% confidence interval: 1.83-9.46; p = 0.001). At 55 years of age, all the patients in the EMD group had already presented heart failure, nine presented malignant ventricular arrhythmia (29%), and 13 required heart transplantation (42%). (4) Conclusions: DCM secondary to the c.77T>C (p.Val26Ala) mutation in the EMD gene is associated to an increased risk of major cardiac events compared to patients with DCM due to TTNtv, with a large proportion of transplanted patients in the fifth decade of life.

Urinary catheterization of patients with acute heart failure in a hospital emergency department: a factor associated with prognosis. / El sondaje vesical de los pacientes con insuficiencia cardiaca aguda en un servicio de urgencias hospitalario se asocia al pronóstico.

OBJECTIVES: To analyze whether urinary catheterization in a hospital emergency department (ED) affects short-term prognosis in patients with acute heart failure (AHF). MATERIAL AND METHODS: We prospectively recorded baseline and other clinical data in a consecutive cohort of ED patients treated for AHF. Crude and adjusted associations were calculated between catheterization and a primary composite outcome (30-day readmission for AHF and/or death) and secondary outcomes (in-hospital mortality, urinary tract infection [UTI], and duration of hospital stay.). RESULTS: Nine hundred ninety-one patients were admitted for AHF. The mean (SD) age was 66 (10.5) years; 71% were women. Catheterization was required for 29.2% in the ED. The primary composite outcome was observed in 7.7% of the patients who were not catheterized and 12.8% of the catheterized patients (P = .02). In-hospital mortality occurred in 5.9% and 9.7% of non-catheterized and catheterized patients, respectively (P = .04), and UTIs occurred in 19.1% and 26.6% (P = .01). Twelve of the non-catheterized patients (1.7%) were readmitted for AHF (vs 11 (3.8%) of the catheterized patients (P = .06), and there were no differences between the groups in hospital stay (11 vs 10.9 days, P = .78). In the adjusted analysis of associations between catheterization and the primary outcome the odds and hazard ratios (OR and HR, respectively) were OR, 1.7 (95% CI, 1.1-2.7) (P = .02) and HR, 1.6 (95% CI, 1.1-2.5) (P = .03). For secondary outcomes, significant associations emerged between catheterization and UTIs (OR, 1.8 [95% CI, 1.1-2.2]; P = .008) and readmission for AHF (OR, 2.9 [95% CI, 1.2-7.3]; P = .02). CONCLUSION: Routine insertion of a urinary catheter in patients with AHF in the ED is associated with worse 30-day clinical outcomes.

OBJETIVO: Analizar si el sondaje vesical (SV) rutinario en un servicio de urgencias hospitalario (SUH) de pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) está asociado con la evolución a corto plazo. METODO: Se recogieron prospectivamente datos basales y clínicos de una cohorte de pacientes consecutivos que ingresaron por ICA. Se analizó la asociación cruda y ajustada del SV con el evento combinado de muerte o reingreso por insuficiencia cardiaca a 30 días (objetivo primario), así como mortalidad intrahospitalaria, infección del tracto urinario (ITU) y estancia hospitalaria (objetivos secundarios). RESULTADOS: Se incluyeron 991 pacientes hospitalizados por ICA, la edad media fue de 66 años (DE 10,5) y el 71% fueron mujeres. Un 29,2% de los pacientes requirieron SV en el SUH. El evento combinado fue del 7,7% para el grupo no SV y 12,8% para grupo SV (p = 0,02); mortalidad intrahospitalaria fue del 5,9% en el grupo no SV y 9,7% en el grupo SV (p = 0,04); se diagnosticó ITU en el 19,1% de pacientes en el grupo no SV y en el 26,6% en el grupo SV (p = 0,01). A 30 días, 12 pacientes (1,7%) reingresaron por insuficiencia cardiaca en el grupo no SV versus 11 (3,8%) pacientes en el grupo SV (p = 0,06). No hubo diferencias en la estancia hospitalaria (11 versus 10,9 días); p = 0,78). En el análisis ajustado, el SV se asoció con el objetivo primario; [OR = 1,7 (IC 95%: 1,1-2,7; p = 0,02); HR = 1,6 (IC 95%: 1,1-2,5; p = 0,03)]; con la ITU (OR = 1,8; IC 95%: 1,1­2,2; p = 0,008) y con el reingreso por insuficiencia cardiaca (OR = 2,9; IC 95%: 1,2-7,3; p = 0,02). CONCLUSIONES: La inserción rutinaria del SV en el SUH en pacientes con ICA se asoció a peores resultados clínicos a los 30 días.

Rationale and Design of the Impact of Air Pollution Due to DESERT Dust in Patients with HEART Failure (DESERT HEART).

AIMS: The main objective of this study is to determine whether exposure to Saharan dust causes airway inflammation and oxidative stress in patients with stable chronic heart failure (HF) and a left ventricular ejection fraction of less than 40%. METHODS: A longitudinal study design is used, involving the inclusion of 40 patients with stable chronic HF and a left ventricular ejection fraction of less than 40%. Four sputum samplings will be taken from each patient, with one sampling taken each week over four consecutive weeks. The sputum samples will be used to analyze the degree of inflammation and oxidative stress. Air quality monitoring stations will be used to analyze the particulate matter (PM) exposure of each patient. The intrusion of desert dust will be identified using meteorological models. There will be 160 scheduled samplings in 40 patients with chronic HF. Mixed regression models will be used to assess the influence of the concentrations of PM (from the episodes of desert dust) upon the airway inflammation and oxidative stress markers. CONCLUSION: The results of this study will test the hypothesis that exposure to high concentrations of Saharan dust affects the normal function of the respiratory epithelium due to the imbalance between the production of free radicals and antioxidant enzymes, thus causing increased pulmonary inflammation and oxidative stress in patients with HF that in turn may facilitate decompensations of their background disease condition.

[Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment]. / Medio ambiente y salud cardiovascular: causas, consecuencias y oportunidades en prevención y tratamiento.

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.

Medioambiente y salud cardiovascular: causas, consecuencias y oportunidades en prevención y tratamiento / Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment

El medioambiente es un gran determinante de la salud cardiovascular. La cardiología ambiental estudia la contribución de las exposiciones ambientales con el objetivo de minimizar las influencias nocivas de la contaminación y promover la salud cardiovascular mediante estrategias preventivas o terapéuticas específicas. La presente revisión se centra en el material particulado y los metales, contaminantes con la evidencia científica más sólida, e incluye las posibles intervenciones. La legislación, la mitigación y el control de los contaminantes en el aire, el agua y los alimentos y las políticas ambientales de espacios cardiosaludables son medidas clave para la salud cardiovascular. Entre las estrategias individuales, cabe reseñar la quelación de metales divalentes como el plomo y el cadmio, que solamente pueden eliminarse del cuerpo vía quelación. El ensayo clínico TACT (NCT00044213) demostró el beneficio cardiovascular en pacientes con un infarto de miocardio previo, especialmente en los diabéticos. Actualmente, el ensayo TACT2 (NCT02733185) está reproduciendo los resultados del TACT en personas con diabetes. Datos de Estados Unidos y Argentina también han mostrado la posible utilidad de la quelación en la enfermedad arterial periférica grave. Más investigación y acción en cardiología ambiental podría contribuir sustancialmente a mejorar la prevención y el tratamiento de las enfermedades cardiovasculares.(AU)

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.(AU)

Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment.

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.

Early Treatment of Acute Myocardial Infarction with Melatonin: Effects on MMP-9 and Adverse Cardiac Events.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) is crucial in tissue remodeling after an adverse cardiac event. In experimental studies, melatonin has been found to attenuate MMP-9 activation. The present study assessed the effects of systemic melatonin administration on the prognosis of patients with acute myocardial infarction (AMI) successfully treated with primary percutaneous coronary intervention, and to examine the effects on MMP-9 levels. METHODS: We conducted a randomized controlled trial, enrolling patients who underwent primary percutaneous coronary intervention due to AMI. They were assigned to two groups for melatonin or placebo. The primary endpoint was a combined event of mortality and heart failure readmission at 2 years. The secondary endpoint was the levels of MMP-9 after the percutaneous coronary intervention. RESULTS: Ninety-four patients were enrolled, 45 in the melatonin group and 49 in the control group. At 2 years of follow-up, 13 (13.8%) patients suffered the primary endpoint (3 deaths and 10 readmissions due to heart failure), 3 patients in the melatonin group and 10 in the placebo group. The difference in the restricted mean survival time was 87.5 days (p = 0.02); HR = 0.3 (95% CI 0.08-1.08; p = 0.06); Log-rank test 0.04. After controlling for confounding variables, melatonin administration reduced MMP-9 levels to 90 ng/mL (95% CI 77.3-102.6). CONCLUSIONS: This pilot study demonstrated that compared to placebo, melatonin administration was associated with better outcomes in AMI patients undergoing primary percutaneous coronary intervention.

Melatonin and Cardioprotection in Humans: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Myocardial ischemia/reperfusion (IR) injury represents a critical problem associated with interventional approaches for coronary reperfusion. Pharmacological cardioprotective interventions are advocated to ameliorate IR injury. Melatonin is an anti-inflammatory and antioxidant agent with a wide range of therapeutic properties that may contribute to its cardioprotective effects. No systematic review or meta-analysis has compared melatonin vs. placebo as a cardioprotective agent in humans. The present study, based on a systematic review and meta-analysis, was carried out to assess melatonin's efficacy as a cardioprotective treatment. We performed a systematic review of the available literature. Randomized controlled trials (RCTs) were identified and information was extracted using predefined data extraction forms. The primary outcomes were (a) left ventricular ejection fraction (LVEF) and (b) blood troponin levels in patients who underwent myocardial revascularization and were randomized to melatonin or placebo. The inverse-variance random-effects method was used to pool the estimates. Heterogeneity and publication bias were assessed. Weighted mean differences or standardized mean differences were calculated. A total of 283 records were screened and seven RCTs met all the inclusion criteria. After the pooled analysis, the results on LVEF were consistent across all studies, and a significant heterogeneity was found in the results on troponin levels. The melatonin-treated patients had on average higher LVEF than the placebo-treated individuals with a weighted mean difference = 3.1% (95% CI 0.6-5.5, p = 0.01). Five works compared the levels of troponin after melatonin or placebo treatment. The melatonin-treated patients had lower levels of troponin with a standardized mean difference = -1.76 (95% CI -2.85 to -0.67, p = 0.002). The findings of this meta-analysis revealed that melatonin administration in humans as a cardioprotective agent attenuated heart dysfunction with a favorable effect on the LVEF.

Impacto del polvo sahariano en la incidencia de síndrome coronario agudo / Impact of Saharan dust on the incidence of acute coronary syndrome

Introducción y objetivos Recientemente, el polvo desértico se ha reconocido en Asia como desencadenante de infarto agudo de miocardio. En España, las entradas de polvo sahariano están relacionadas con empeoramientos de la calidad del aire debidos a aumentos en las concentraciones de material particulado en el aire ambiental. Nuestro objetivo es dilucidar si los eventos de polvo sahariano tienen relación con la incidencia de síndrome coronario agudo (SCA) en pacientes que habitan cerca del norte de África, la mayor fuente global de polvo desértico. Métodos Se analizan prospectivamente los datos de 2.416 pacientes consecutivos hospitalizados por SCA en un hospital terciario (Islas Canarias, España), desde diciembre de 2012 hasta diciembre de 2017. La Red Europea de Calidad del Aire midió las concentraciones de material particulado de diámetro aerodinámico <10 μm (PM10) y gases reactivos. Se aplicó un diseño mediante estratificación en el tiempo de casos cruzados, utilizando modelos de regresión condicional de Poisson, para estimar el impacto de los eventos de polvo sahariano de PM10 en la incidencia de SCA. Resultados Los eventos de polvo sahariano observados los días 0 a 5 tras el inicio del SCA no mostraron asociación significativa con la incidencia de SCA. Los cocientes de tasas de incidencia de las concentraciones de PM10 1, 2, 3, 4 y 5 días antes del inicio del SCA (para cambios de 10 μg/m3) fueron 1,27 (IC95%, 0,87-1,85), 0,92 (IC95%, 0,84-1,01), 0,74 (IC95%, 0,45-1,22), 0,98 (IC95%, 0,87-1,11) y 0,95 (IC95%, 0,84-1,06). Conclusiones Es poco probable que la exposición a polvo sahariano tenga relación con la incidencia de SCA. (AU)

Introduction and objectives Asian desert dust has recently been recognized as a trigger for acute myocardial infarction. The inflow of dust from the Sahara into Spain impairs air quality due to an increase in particulate matter concentrations in the ambient air. The aim of the present study was to elucidate whether Saharan dust events are associated with the incidence of acute coronary syndrome (ACS) in patients living near North Africa, the major global dust source. Methods We prospectively collected data on hospitalizations due to ACS in 2416 consecutive patients from a tertiary care hospital (Canary Islands, Spain) from December 2012 to December 2017. Concentrations of particulate matter with an aerodynamic diameter 10 microns or smaller (PM10) and reactive gases were measured in the European Air Quality Network implemented in the Canary Islands. We applied the time-stratified case crossover design using conditional Poisson regression models to estimate the impact of PM10 Saharan dust events on the incidence of ACS. Results The occurrence of Saharan dust events observed 0 to 5 days before the onset of ACS was not significantly associated with the incidence of ACS. Incidence rate ratios (IRR) of PM10 levels 1, 2, 3, 4 and 5 days before ACS onset (for changes in 10μg/m3) were 1.27 (95%CI, 0.87-1.85), 0.92 (95%CI, 0.84-1.01), 0.74 (95%CI, 0.45-1.22), 0.98 (95%CI, 0.87-1.11), and 0.95 (95%CI, 0.84-1.06), respectively. Conclusions Exposure to Saharan desert dust is unlikely to be associated with the incidence of ACS. (AU)