Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Registro español de marcapasos. XIX informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2021) / Spanish pacemaker registry. 19th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021)

Introducción y objetivos En el presente documento se recoge la actividad de estimulación cardiaca realizada en España en 2021: cifras de dispositivos, factores demográficos y clínicos, características del material implantado y datos de monitorización a distancia. Métodos Los datos se obtienen a través de la Tarjeta Europea del Paciente Portador de Marcapasos, la plataforma online CardioDispositivos.es, las bases de datos propias de los centros y los datos facilitados por los fabricantes. Resultados Se registraron 17.360 procedimientos de 95 hospitales, lo que supone el 43% de la actividad realizada. Crecieron en un 40,5% los procedimientos incluidos en CardiodioDispositivos.es. La tasa de marcapasos convencionales y resincronizadores de baja energía fue de 822 y 31 unidades/millón respectivamente y se implantaron 652 marcapasos sin cables. La media de edad al implante es avanzada (78,9 años) y el bloqueo auriculoventricular, la alteración electrocardiográfica más frecuente. Predomina el modo de estimulación bicameral, aunque para el 18,5% de los pacientes en ritmo sinusal es monocameral, fundamentalmente pacientes de más edad. Se incluyeron en programa de monitorización a distancia el 28,5% de los marcapasos y el 56,2% de los resincronizadores de baja energía. Conclusiones En 2021 aumentó el número de marcapasos convencionales en un 8,3% y el de resincronizadores, un 8,9%, a pesar del descenso de la resincronización de baja energía, probablemente atribuible al desarrollo de la estimulación del sistema de conducción. Aumentaron los marcapasos sin cables en un 25%. Continúa la expansión de la monitorización a distancia como modo fundamental de seguimiento (AU)

Introduction and objectives This document includes cardiac pacing activity performed in Spain in 2021: figures for implanted devices, demographic and clinical factors, characteristics of the implanted material, and remote monitoring data. Methods The European Pacemaker Patient Card, the CardioDispositivos.es online platform, the centers’ own databases and the data provided by the supplier companies are used as sources of information. Results 17.360 procedures were registered from 95 hospitals, which represents 43% of the activity. The implantation rates of conventional and resynchronization pacemakers were 822 and 31 units per million population, respectively. 652 leadless pacemakers were implanted. The mean age of implantation is high (78.8 years), and atrioventricular block is the most frequent electrocardiographic abnormality. Dual-chamber pacing mode predominated, nonetheless single-chamber pacing was performed in 19% of patients in sinus rhythm, mainly in the elderly. 28.5% of implanted conventional pacemakers and 56,2% of low-energy resynchronization pacemakers were included in the remote monitoring program. Conclusions In 2021 the number of conventional pacemakers increased by 8.3% and resynchronizers by 18.9%, despite the decrease in low-energy resynchronization, probably attributable to the development of physiological pacing. Leadless pacemakers increased by 25%. The expansion of remote monitoring continued, consolidating as a fundamental follow-up method (AU)

Hábitos de vida y mortalidad cardiovascular de las mujeres menopáusicas: estudio de cohortes de base poblacional / Lifestyle and cardiovascular mortality in menopausal women: a population-based cohort study

Introducción y objetivos: Existen modelos de predicción de riesgo cardiovascular en población general, pero no se ha estudiado de modo específico la predicción del riesgo de las mujeres posmenopáusicas. El objetivo de este estudio es conocer los hábitos de vida y las enfermedades crónicas asociados con mayor riesgo cardiovascular en mujeres menopáusicas, así como construir una escala de riesgo. Métodos: Estudio de cohortes retrospectivo de base poblacional cuya fuente de datos es la Encuesta Nacional de Salud de España de 2011. Se incluyó a mujeres de edad ≥ 50 años. Se recogieron las características que mejor definían los hábitos de vida de las mujeres del estudio, así como su estado de salud y los antecedentes médicos declarados por ellas en el momento de la encuesta. Se realizó seguimiento de la mortalidad de las mujeres del estudio desde 2011 hasta 2017. Resultados: Se incluyó a 5.953 mujeres con una media de edad de 66,4±11,4 años. La incidencia de mortalidad cardiovascular en el periodo de seguimiento fue del 4%. Se relacionaron con la mortalidad cardiovascular el consumo de verduras menor de 1 vez/semana (HR=1,758), el tabaquismo (HR=1,816) el exceso de horas de sueño (≥ 9 h/día, HR=1,809) o tener actividad principal diaria sentada la mayor parte del tiempo (HR=2,757). El modelo predictivo presenta un estadístico C «sincero» en muestra de prueba de 0,8407 (IC95%, 0,8025-0,8789). Conclusiones: Hábitos de vida como el consumo de verduras, la actividad principal diaria, las horas de sueño o el tabaquismo son factores de riesgo de mortalidad cardiovascular de gran relevancia entre las mujeres menopáusicas. Se aporta una sencilla escala de riesgo autorreferida a 6 años con elevada capacidad predictiva (AU)

Introduction and objectives: There are models for cardiovascular risk prediction in the general population, but the prediction of risk in postmenopausal women has not been specifically studied. This study aimed to determine the association of lifestyle habits and chronic diseases with cardiovascular risk in menopausal women, as well as to build a risk scale. Methods: Retrospective population-based cohort study using data from the 2011 National Health Survey of Spain as a data source, Women ≥ 50 years were included. The characteristics that best defined the life habits of the study women were collected, as well as their health status and self-reported medical history at the time of the survey. Follow-up data on all-cause mortality were obtained from participants from 2011 to 2017. Results: A total of 5953 women ≥ 50 years of age were included, with a mean age of 66.4 ± 11.4 years. The incidence of cardiovascular mortality in the follow-up period was 4%. Vegetable consumption less than 1 time/week (HR, 1.758), smoking (HR, 1.816) or excess hours of sleep (≥ 9h/day, HR, 1.809), or o have main daily activity sitting most of the time (HR, 2.757) were related to cardiovascular mortality. The predictive model presents an honest C-index in test sample of 0.8407 (95%CI, 0.8025-0.8789). Conclusions: Life habits such as the consumption of vegetables, daily main activity, sleeping hours or smoking are risk factors for cardiovascular mortality of great relevance among menopausal women. A simple 6-year self-reported risk scale with high predictive capacity is provided (AU)

Clustering of target organ damage increases mortality after acute coronary syndromes in patients with arterial hypertension.

The impact of target organ damage (TOD) clustering in hypertensive patients with established cardiovascular disease has not been clearly defined. Multicentre, observational and prospective study of 1054 consecutive patients with acute coronary syndromes (ACSs). The objective was describing the impact of TOD on first-year mortality. Ankle-brachial index (ABI), left ventricular hypertrophy and renal dysfunction were assessed during hospital stay. Hypertensive patients accounted for 80% of the cohort and had slightly higher mean age, higher prevalence of risk factors, previous cardiovascular disease and TOD. During follow-up, mean time 387.9 (7.2) days and median 382 (364.0-430.0) days, mortality rate tended to be higher in hypertensive patients (6.1 versus 3.5%; P=0.16). Cox regression survival analysis identified pathological ABI as the only TOD independently associated with mortality. When assessed globally, the presence of at least one TOD predicted mortality only in patients with hypertension and differences in mortality rate appeared very early in the follow-up. A linear increase in mortality rate was observed with the clustering of TOD: 2.0%, if no TOD was present, 7.6% in one TOD, 11.1% in two TODs and 20.0%, if three TODs were present. An increased risk in the combined end point of ischaemic events was observed in hypertensive patients without TOD (odds ratio (OR): 3.18; 95% confidence interval (CI): 1.31-7.70; P=0.01) and was still higher in patients with hypertension and TOD (OR: 4.61; 95% CI: 1.90-11.80; P<0.01). TOD predicts mortality and ischaemic events of hypertensive patients after ACS.

Clinical scores and patient risk stratification in non-ST elevation acute coronary syndrome.

BACKGROUND: Risk stratification of patients with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) is problematic given the heterogeneous presentation of the condition. This study was undertaken to compare, in UA/NSTEMI patients, the prognostic value of two clinical risk scores (RS) (i.e. Thrombolysis in Myocardial Infarction (TIMI) and physician's risk assessment (PRA)) and to assess whether serum biomarkers can increase the prognostic accuracy of these RS. METHODS: We prospectively assessed 610 consecutive UA/NSTEMI patients, 217 (36%) UA and 393 (64%) NSTEMI. In all patients RS, high sensitivity C-reactive protein, CD40 ligand, IL6, IL10, IL18, E-selectin, P-selectin, white blood cell count, neopterin, myeloperoxidase, fibrinogen and NT proBNP were assessed at study entry. The primary study endpoint was death and non-fatal MI at 30 and 360 days of follow-up. RESULTS: At 1 year, 54 patients (8.9%) had reached the primary study endpoint (26 suffered a cardiac death (4.3%) and 34 (5.6%) a non-fatal MI). For both RS, the study endpoint occurred more commonly in patients at a "higher risk" compared to those classified as being at a "lower risk". Moreover, TIMI and PRA RS had similar discriminatory accuracy. TIMI RS, however, was a better predictor of events than PRA at both 30- and 360-day follow-up. The inflammatory biomarkers assessed in the study did not improve significantly the predictive value of RS. CONCLUSIONS: Our study suggests both that TIMI RS is a better marker of risk than PRA RS and inflammatory biomarkers do not increase the predictive value of these clinical risk scores.

[Underestimation of renal risk in cardiology clinics. RICAR study]. / Infravaloración del riesgo renal en consultas de cardiología. Estudio RICAR.

AIMS: The aim of this study was to assess the rate of patients attended in cardiology outpatient clinics in whom microalbumine or glomerular filtration rate had been determined, at least once, in the previous 12 months. METHODS: It was an observational, transversal, multicentric study. 1224 patients were included from 124 centers in Spain. Epidemiological, anthropometric, analytic and electrocardiographic data were recruited. Glomerular filtration rate was calculated thereafter by means of the simplified equation of the MDRD. Results. Microalbumine was determined in 34% of the patients, of those 49% had positive microalbumine. Microalbumine rates were higher in patients with diabetes, heart failure, atrial fibrillation, peripheral artery disease or serum creatinine levels > 1.3 mg/dl. However, only young patients, diabetics and those with left ventricular hypertrophy had this exam performed more often. The glomerular filtration rate was determined in 11% of the patients. 30% of the population had moderate or severe renal dysfunction (filtration rate < 60 ml/min) and only 21% of the population hat normal renal function (filtration rate > 90 ml/min). Glomerular filtration rate was assessed more frequently in patients with serum creatinine > 1.3 mg/dl and those with history of heart failure. CONCLUSIONS: The prevalence of renal dysfunction in hypertensive patients attended in Cardiology clinics is high. However, the methods recommended for early detection of renal dysfunction are scarcely used by cardiologists. These figures do not improve significantly in high risk patients.

[Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?]. / Niveles de glucemia en pacientes no diabéticos. 'Es un factor pronóstico en el síndrome coronario agudo?

INTRODUCTION: The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. METHODS: We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. RESULTS: Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). CONCLUSIONS: In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers.

Niveles de glucemia en pacientes no diabéticos. ¿Es un factor pronóstico en el síndrome coronario agudo? / Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?

Introducción. No está bien definido el papel de la elevación de glucosa por encima de los valores considerados como normales en los pacientes no diabéticos con síndrome coronario agudo (SCA). El objetivo del presente estudio es analizar los efectos sobre el pronóstico a un año de los niveles de glucemia obtenidos durante el ingreso en este tipo de pacientes. Métodos. Estudiamos a 648 pacientes no diabéticos consecutivos con SCA, en los cuales se midieron los niveles de glucosa durante su estancia hospitalaria junto con los factores de riesgo clásicos, los marcadores bioquímicos e inflamatorios. El criterio de evaluación principal fue la muerte por todas las causas a un año. Resultados. Los pacientes con glucemia normal durante el ingreso presentaban un menor porcentaje de fallecimientos en el seguimiento que los que presentaban una glucosa basal alterada (14,1% frente a 5,7%), así como en rango de diabetes (24,7% frente a 5,7%). Conclusiones. Los niveles de glucosa obtenidos durante el ingreso en los pacientes no diabéticos con SCA sin elevación del ST son predictores de muerte, independientemente de factores bioquímicos, epidemiológicos clásicos e inflamatorios

Introduction. The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. Methods. We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. Results. Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). Conclusions. In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers

[Lung toxicity due to thalidomide]. / Toxicidad pulmonar por talidomida.

Although the side effects of thalidomide are well known, lung toxicity has not been reported. We describe the case of a 65-year-old man with multiple myeloma (IgG kappa) in stage IA who, on the thirty-seventh day of treatment with thalidomide, developed acute coughing, general malaise, dyspnea at rest and sudoresis. Blood pressure was 90/60 mm Hg and temperature was normal. An interstitial and alveolar pattern was visible on the right side of a chest film and arterial blood gases indicated partial respiratory insufficiency (pH 7.40, PaCO2 40 mmHg, PaO2 47 mmHg). Blood analysis showed alterations expected for multiple myeloma and microbiology was negative (sputum and blood cultures and urinary antigen detection for Streptococcus pneumoniae and Legionella pneumophila). After thalidomide was withdrawn and oxygen and intravenous corticoids were administered, outcome was good. A chest film 4 days later was normal and arterial blood gases showed that respiratory insufficiency had disappeared. We conclude that severe lung toxicity should be included among the potential adverse effects of thalidomide.

Toxicidad pulmonar por talidomida / Lung toxicity due to thalidomide

La talidomida es un fármaco bien conocido por sus efectos secundarios, aunque la toxicidad pulmonar no ha sido comunicada. Presentamos el caso de un varón de 65 años, diagnosticado de mieloma múltiple IgG kappa en estadio IA, que en el día 37 del tratamiento con talidomida presentó de forma aguda tos, malestar general, disnea de reposo y sudación. La presión arterial era 90/60 mmHg y no tenía fiebre. En la radiografía de tórax había un patrón intersticial alveolar en el hemitórax derecho, y en la gasometría arterial una insuficiencia respiratoria parcial (pH 7,40, PaCO2 40 mmHg, PaO2 47 mmHg). El análisis de sangre evidenció alteraciones propias de su mieloma múltiple y las determinaciones microbiológicas fueron negativas (esputo, hemocultivos y detección de antígenos de Streptococcus pneumoniae y Legionella pneumophila en orina). Tras la retirada del fármaco y recibir oxigenoterapia y corticoides intravenosos, el paciente evolucionó bien. Una radiografía de tórax realizada 4 días después fue normal y en la gasometría arterial desapareció la insuficiencia respiratoria.Como conclusión, cabe mencionar que la toxicidad pulmonar grave deberá ser incluida entre los efectos adversos potenciales de la talidomida (AU)