His-Bundle Pacing in a Patient With Tricuspid and Mitral Prosthetic Valves Without Suitable Coronary Veins for Lead Placement.

Atrioventricular block in patients with a prosthetic tricuspid valve and a pacemaker with a dysfunctional epicardial lead is not uncommon. In such instances, coronary sinus lead placement is the preferred option, but it has a failure rate of 10%-15%. An atrial transseptal left ventricular lead placement has been proposed as an alternative, but this approach is not feasible in patients with a prosthetic mitral valve. This analysis represents the first reported case of His-bundle pacing from the atria in a patient with prosthetic tricuspid and mitral valves, with no suitable coronary veins for lead placement.

Le bloc auriculo-ventriculaire n'est pas rare chez les patients ayant reçu une valve tricuspide prothétique et porteurs d'un stimulateur cardiaque dont la sonde épicardique est dysfonctionnelle. Dans de tels cas, le positionnement de la sonde sur le sinus coronaire est l'option à privilégier, mais son taux d'échec varie entre 10 et 15 %. L'implantation de la sonde sur le ventricule gauche par la voie transsetale a été proposée à titre de solution de rechange, mais cette approche n'est pas envisageable chez les patients ayant reçu une valve mitrale prothétique. La présente analyse constitue le premier cas de stimulation du faisceau de His à partir des oreillettes chez un patient ayant reçu des valves tricuspides et mitrales prothétiques, en l'absence de veines coronaires se prêtant à l'implantation de la sonde.

Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity.

BACKGROUND: Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH. METHODS AND RESULTS: Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7-9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up. CONCLUSION: In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.

Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation.

BACKGROUND: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

[Update on preventive cardiology and rehabilitation]. / Actualidades en cardiología preventiva y rehabilitación.

The aim of the Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology is to promote knowledge about and adoption of the lifestyle, therapy and rehabilitation program guidelines that are best able to improve cardiovascular health in the Spanish population. To achieve this aim, a number of working groups have carried out research into and provided education about the latest developments in cardiovascular prevention, and have provided information about these developments to all those affected, including physicians, healthcare workers, healthcare administrators and the general public. This year, the working group on smoking produced an key document that was presented to cardiologists in our Society; its intention was to provide a simple algorithm to help patients give up smoking that could be applied in only 3 minutes. The working group on cardiac rehabilitation gave a presentation on the true impact of rehabilitation on survival after percutaneous coronary intervention and heart failure. Also this year, the European Society of Cardiology published a major revision of guidelines on the treatment of dyslipidemia, which was welcomed by many but criticized by others. Our correspondent at the European Society reflects on the role and usefulness of these guidelines in practice.

[Erectile dysfunction as a marker of silent cardiovascular disease in type-2 diabetic patients in Spain. The DIVA (DIabetes and VAscular disease) study]. / Disfunción eréctil como marcador de vasculopatía en la diabetes mellitus tipo 2 en España. Estudio DIVA.

BACKGROUND AND OBJECTIVES: Erectile dysfunction (ED) is a sign of vascular disease in type 2 diabetic patients. The present subanalysis of the DIVA Registry, whose main objective was to estimate the prevalence of clinical vascular disorder and silent vascular disorder, as well as risk factors in type 2 diabetic patients treated in Spain, aims to analyze the relationship between those data and the prevalence of ED in these patients. PATIENTS AND METHODS: A total of 2444 type 2 diabetic patients (56% male; mean age 65.2 years) attended by 387 cardiologists and endocrinologists at ambulatory care were included. RESULTS: Coronary heart disease was present in 37% of the patients, cerebrovascular disease in 12%, and peripheral arterial disease in 13%. Forty percent of male patients had ED (according to the IIEF criteria), although in this group, as compared to those patients without ED, the prevalence of cardiovascular disease and signs of subclinical vascular disorder (microalbuminuria and abnormal ankle/brachial index (ABI)) was higher. The only independent predictor of ED was left ventricular hypertrophy (OR 5.2; 95% CI: 1.1-24.1; P=.03), with the ABI <0,9 being of borderline significance (OR 5.9; 95% CI: 0.9-39.9; P=.06). Poor glycemic and lipemic control (P<.05 in both cases) as well as cerebrovascular and peripheral arterial disease (P<.01 in both cases) and renal dysfunction (P<.001) were all more frequent among patients with severe ED. CONCLUSIONS: Forty percent of diabetic patients suffer from ED. The results of this study suggest that ED may be considered as an atherosclerosis marker and could be included in algorithms for risk stratification and subclinical vascular disorder detection.

Disfunción eréctil como marcador de vasculopatía en la diabetes mellitus tipo 2 en España. Estudio DIVA / Erectile dysfunction as a marker of silent cardiovascular disease in type-2 diabetic patients in Spain. The DIVA (Diabetes and Vascular disease) study

Fundamento y objetivo: la disfunción eréctil (DE) es un signo de enfermedad vascular en los sujetos con diabetes mellitus tipo 2 (DM2). El objetivo principal del estudio DIVA (por las letras iniciales de diabetes y vasculopatía) fue estimar la prevalencia de vasculopatía clínica y asintomática, así como la prevalencia de factores de riesgo en los sujetos diabéticos atendidos por especialistas en España; en él se analizó la relación de los datos citados con la prevalencia de DE. Pacientes y método: registro transversal compuesto por 2.444 sujetos consecutivos (56% varones con una edad media de 65,2 años) diagnosticados de DM2, atendidos en consulta por 387 cardiólogos y endocrinólogos. Resultados: el 37% de los sujetos presentaba cardiopatía isquémica, el 12% presentaba enfermedad cerebrovascular (ECRV) y el 13% presentaba arteriopatía periférica. El 40% de los varones tenía DE (según criterios del Índice internacional de la función eréctil), aunque en comparación con los grupos que no presentaban DE, en este grupo la enfermedad cardiovascular era significativamente más prevalente, así como los signos de vasculopatía subclínica (albuminuria e índice tobillo-brazo [ITB] anormal). El único factor predictor de DE independiente de otras variables de confusión fue la hipertrofia ventricular izquierda (riesgo relativo [RR] de 5,2; intervalo de confianza [IC] del 95%: 1,1¿24,1; p=0,03); el ITB fue menor que 0,9 de significación limítrofe (RR de 5,9; IC de 95%: 0,9¿39,9; p=0,06). El mal control glucémico y lipídico (p<0,05 en ambos casos) así como la presencia de ECRV, de enfermedad arterial periférica (p<0,01 en ambos casos) y de disfunción renal (p<0,001) eran más prevalentes en sujetos con DE grave. Conclusiones: el 40% de los varones diabéticos presenta DE. Los resultados de este estudio demuestran que la DE puede considerarse como marcador de aterosclerosis e incluirse en los algoritmos de estratificación de riesgo y detección de vasculopatía asintomática (AU)

Background and objectives: Erectile dysfunction(ED) is a sign of vascular disease in type 2 diabetic patients. The presents ubanalys is of the DIVA Registry, whos emain objective wast o estimate the prevalence of clinical vascular disorder and silent vascular disorder, as well as risk factors in type2diabetic patients treated in Spain, aims to analyze the relationship between those data and the prevalence of ED in these patients. Patients and Methods: A total of 2444 type 2 diabetic patients (56%male; meanage 65.2 years) attended by 387 cardiologists and endocrinologists at ambulatory care were included. Results: Coronary heart disease was present in 37%of the patients, cerebrovascular disease in12%,and peripheral arterial disease in 13%. Forty percent of male patients had ED (according to the IIEF criteria),although in this group, as compared to those patients without ED, the prevalence of cardiovascular disease and signs of subclinical vascular disorder (microalbuminuria and abnormalankle/brachialindex (ABI)) was higher. The only independent predictor of ED was left ventricular hypertrophy (OR5.2;95%CI: 1.1–24.1; P ¼ .03), with the ABI o0,9 being of border line significance (OR5.9;95%CI:0.9–39.9;P ¼ .06).Poor glycemic and lipemic control (Po.05 in both cases)as well as cerebrovascular and peripheral arterial disease (Po.01inbothcases) and renaldys function (Po.001)were all more frequent among patients with severe ED. Conclusions: Forty percent of diabetic patients suffer from ED. The results of this study suggest that EDmay be considered as an at hero sclerosis marker and could be included in algorithms for risk stratification and subclinical vascular disorder detection (AU)

Recomendaciones para el control de la colesterolemia en España / Recommendations for controlling cholesterolemia in Spain

Se presentan una serie de recomendaciones sobre detección, evaluación e intervención en prevención primaria y secundaria, abordando la hipercolesterolemia desde una perspectiva multifactorial basada en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Dentro de ellas las más importantes son la enfermedad isquémica del corazón y la enfermedad cerebrovascular. Su impacto demográfico, sanitario y social aumentará a lo largo de las próximas décadas. El control de la hipercolesterolemia, junto con la erradicación del tabaquismo y el control de la hipertensión arterial, la diabetes, la obesidad y el sedentarismo, es una de las principales estrategias para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas tomando en consideración los principales factores de riesgo cardiovascular es esencial, ya que condiciona la periodicidad del seguimiento y la modalidad e intensidad del tratamiento. Basándose en esta estratificación se han establecido las prioridades de la actuación preventiva cardiovascular. En prevención primaria, en las personas de riesgo alto (riesgo igual o superior al 20 por ciento o las que presentan dos o más factores de riesgo) el objetivo terapéutico se establece en un cLDL inferior a 130 mg/dl. En prevención secundaria el tratamiento farmacológico se instaurará con un cLDL> 130mg/dl y el objetivo terapéutico será cLDL <100mg/dl. Los pacientes con cardiopatía isquémica deben incluirse en programas de prevención secunadria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)

Control de la colesterolemia en España, 2000: un instrumento para la prevención cardiovascular / Cholesterolemia control in Spain, 2000: A tool for cardiovascular disease prevention

El documento 'Control de la Colesterolemia en España, 2000: Un instrumento para la Prevención Cardiovascular' revisa la evidencia existente en el campo de la prevención cardiovascular y los avances terapéuticos producidos en los últimos años, con el objetivo de ayudar a tomar decisiones clínicas basadas en el riesgo cardiovascular. Las enfermedades cardiovasculares son la primera causa de muerte en España. Su impacto demográfico, sanitario y social está aumentando y va a continuar haciéndolo en las próximas décadas. El adecuado tratamiento de la hipercolesterolemia y del resto de los factores de riesgo es fundamental para prevenir las enfermedades cardiovasculares. La estratificación del riesgo de las personas es esencial, por cuanto condiciona la periodicidad del seguimiento y la indicación e intensidad del tratamiento. Basándose en dicha estratificación se han establecido unas prioridades de control de la colesterolemia y del riesgo cardiovascular derivado de la misma. En prevención primaria en los pacientes de riesgo alto, el objetivo terapéutico se establece en un cLDL inferior a 130 mg/dl. En prevención secundaria, el tratamiento farmacológico se instaurará con un cLDL 130 mg/dl y el objetivo terapéutico será cLDL < 100 mg/dl. Las estatinas son los fármacos de primera elección en el tratamiento de la hipercolesterolemia. Cuando exista hipertrigliceridemia moderada-grave y cHDL bajo se emplearán los fibratos. En el síndrome coronario agudo, el tratamiento hipolipemiante, cuando esté indicado, debe iniciarse precozmente. Los pacientes con cardiopatía isquémica se deben incluir en programas de prevención secundaria que aseguren, de forma continuada, un buen control clínico y de los factores de riesgo (AU)