Registro multicéntrico Impella CP para shock cardiogénico o angioplastía de alto riesgo protegida en Chile

Antecedentes: El Shock Cardiogénico (SC) y las Angioplastías de Alto Riesgo (AAR) están asociadas con altas tasas de mortalidad. El uso del dispositivo Impella CP podría reducir el riesgo de muerte en estos escenarios. En Chile no existen reportes evaluando el uso del dispositivo Impella CP. Objetivo: Analizar los desenlaces clínicos en pacientes que fueron sometidos al uso del dispositivo Impella CP por SC o por AAR. Métodos: Se realizó un estudio retrospectivo en 17 pacientes, los cuales representan el total de implantes realizados en el país, entre octubre 2021 y agosto 2023. Se describió las características, demográficas, procedimentales y después del implante. Se estimó la mortalidad general y se identificaron factores asociados. Resultados: La edad de los pacientes fue 69± 3,7 años y 88,2% fueron hombres. El 64,7% recibió el dispositivo por SC y 35,3% por AAR. Dentro de las comorbilidades estudiadas, la hipertensión arterial fue la más frecuente, 94,1%. Un 58,8% de los pacientes fueron revascularizados a través de la arteria radial. El 29,4% recibió el dispositivo previo a la angioplastía y 70,6% lo recibió después. El 47,1% de las angioplastías fue guiada por imágenes. En 11,8% de ellos se realizó litotricia intracoronaria y 5,9% por ablación intracoronaria. Los pacientes estuvieron 13 ±3,4 días con el soporte. La mortalidad global fue de 41,2%. Conclusiones: El uso del dispositivo Impella presentó pocas complicaciones vasculares. La mortalidad asociada con su colocación en Chile fue relativamente similar con la reportada en la literatura.

Background: Cardiogenic shock and high-risk Angioplasty are associated with a high mortality rate. Using the Impella CP device could reduce the risk of death in these scenarios. In Chile, there are no studies evaluating the use of the Impella CP device. Objective: To analyse the clinical outcomes in patients who have undergone placement of the Impella CP device for cardiogenic shock and high-risk angioplasties. Methods: A retrospective study was carried out on 17 patients, which represent the total number of implants performed in the country, between October 2021 and August 2023. The demographic, procedural and post-implant characteristics were described. Overall mortality and associated factors were identified. Results: The age was 69± 3.7 years, where 88.2% were men. 64.7% of patients received the device by SC and 35.3% by AAR. Among the comorbidities studied, arterial hypertension was the most frequent with 94.1%. 58.8% of patients were revascularized through the radial artery. 29.4% of patients received the device before angioplasty and 70.6% received it afterwards. 47.1% of angioplasties were image-guided, 11.8% had intracoronary lithotripsy, and 5.9% had intracoronary ablation. The patients spent 13 ±3.4 days with the support. Overall mortality was 41.2%. Conclusion: use of the Impella device was associated with few vascular complications. Mortality associated with use of the Impella device in Chile was similar to that previously reported in other studies.

National Health Systems and COVID-19 Death Toll Doubling Time.

Coronavirus disease 2019 (COVID-19) has placed stress on all National Health Systems (NHSs) worldwide. Recent studies on the disease have evaluated different variables, namely, quarantine models, mitigation efforts, damage to mental health, mortality of the population with chronic diseases, diagnosis, use of masks and social distancing, and mortality based on age. This study focused on the four NHSs recognized by the WHO. These systems are as follows: (1) The Beveridge model, (2) the Bismarck model, (3) the National Health Insurance (NHI) model, and (4) the "Out-of-Pocket" model. The study analyzes the response of the health systems to the pandemic by comparing the time in days required to double the number of disease-related deaths. The statistical analysis was limited to 56 countries representing 70% of the global population. Each country was grouped into the health system defined by the WHO. The study compared the median death toll DT, between health systems using Mood's median test method. The results show high variability of the temporal trends in each group; none of the health systems for the three analyzed periods maintain stable interquartile ranges (IQRs). Nevertheless, the results obtained show similar medians between the study groups. The COVID-19 pandemic saturates health systems regardless of their management structures, and the result measured with the time for doubling death rate variable is similar among the four NHSs.

Transcriptomic and Physiological Response of Durum Wheat Grain to Short-Term Heat Stress during Early Grain Filling.

In a changing climate, extreme weather events such as heatwaves will be more frequent and could affect grain weight and the quality of crops such as wheat, one of the most significant crops in terms of global food security. In this work, we characterized the response of Triticum turgidum L. spp. durum wheat to short-term heat stress (HS) treatment at transcriptomic and physiological levels during early grain filling in glasshouse experiments. We found a significant reduction in grain weight (23.9%) and grain dimensions from HS treatment. Grain quality was also affected, showing a decrease in starch content (20.8%), in addition to increments in grain protein levels (14.6%), with respect to the control condition. Moreover, RNA-seq analysis of durum wheat grains allowed us to identify 1590 differentially expressed genes related to photosynthesis, response to heat, and carbohydrate metabolic process. A gene regulatory network analysis of HS-responsive genes uncovered novel transcription factors (TFs) controlling the expression of genes involved in abiotic stress response and grain quality, such as a member of the DOF family predicted to regulate glycogen and starch biosynthetic processes in response to HS in grains. In summary, our results provide new insights into the extensive transcriptome reprogramming that occurs during short-term HS in durum wheat grains.

[Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension]. / Angioplastía con balón para el tratamiento de la hipertensión arterial pulmonar por enfermedad tromboembólica crónica. Resultados hemodinámicos y clínicos inmediatos.

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). AIM: To report the initial experience with the "refined BPA technique" with the use of intravascular images. PATIENTS AND METHODS: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. RESULTS: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm-5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). CONCLUSIONS: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.

Angioplastía con balón para el tratamiento de la hipertensión arterial pulmonar por enfermedad tromboembólica crónica. Resultados hemodinámicos y clínicos inmediatos / Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension

Background: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm−5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.

Enfermedades cardiovasculares y enfermedades inflamatorias sistémicas / Cardiovascular disease and systemic inflammatory diseases

A lo largo de más de un siglo, las investigaciones han demostrado que la arteriosclerosis más que un proceso infiltrativo o trombogénico es un proceso inflamatorio. Se ha demostrado epidemiológicamente y mediante técnicas de imagen que las enfermedades inflamatorias sistémicas (especialmente, pero no exclusivamente, la artritis reumatoide y el lupus eritematoso sistémico) aumentan el proceso arteriosclerótico, lo cual tiene base fisiopatológica demostrada. Además, los tratamientos para controlar las enfermedades inflamatorias pueden modificar el curso del proceso aterosclerótico. Aunque todavía no hay escalas específicas validadas para valoración del riesgo cardiovascular en los pacientes con estas enfermedades, su riesgo cardiovascular es elevado. Se están desarrollando varias escalas de riesgo específicas, considerando factores propios como el grado de actividad inflamatoria

More than a century of research has shown that atherosclerosis is an inflammatory process more than an infiltrative or thrombogenic process. It has been demonstrated epidemiologically and by imaging techniques, that systemic inflammatory diseases (in particular, but not exclusively, rheumatoid arthritis and systemic lupus erythematosus) increase the atherosclerotic process, and has a demonstrated pathophysiological basis. Furthermore, treatments to control inflammatory diseases can modify the course of the atherosclerotic process. Although there are no specific scales for assessing cardiovascular risk in patients with these diseases, cardiovascular risk is high. A number of specific risk scales are being developed, that take into account specific factors such as the degree of inflammatory activity

[Cardiovascular disease and systemic inflammatory diseases]. / Enfermedades cardiovasculares y enfermedades inflamatorias sistémicas.

More than a century of research has shown that atherosclerosis is an inflammatory process more than an infiltrative or thrombogenic process. It has been demonstrated epidemiologically and by imaging techniques, that systemic inflammatory diseases (in particular, but not exclusively, rheumatoid arthritis and systemic lupus erythematosus) increase the atherosclerotic process, and has a demonstrated pathophysiological basis. Furthermore, treatments to control inflammatory diseases can modify the course of the atherosclerotic process. Although there are no specific scales for assessing cardiovascular risk in patients with these diseases, cardiovascular risk is high. A number of specific risk scales are being developed, that take into account specific factors such as the degree of inflammatory activity.

[Clinical profile of patients with very high hypertriglyceridemia from the Registry of Hypertriglyceridemia of the Spanish Atherosclerosis Society]. / Perfil clínico de los pacientes con hipertrigliceridemia muy severa del Registro de Hipertrigliceridemias de la Sociedad Española de Arteriosclerosis.

BACKGROUND AND OBJECTIVE: To describe clinical and epidemiological characteristics of patients with very high hypertriglyceridemia (HTG) who were attended in lipid units of the Spanish Society of Atherosclerosis (SEA). PATIENTS AND METHOD: Patients of the HTG Registry of SEA with at least one triglyceride concentration greater than 1,000mg/dL (n=298, HTG severe group) and those whose baseline triglycerides were between 200 and 246mg/dL (HTG control group, n=272) were included. RESULTS: Patients with very high triglyceride levels were younger (46.9±11.5 years vs 52.7±13 years; p<0.0001), with a larger waist circumference (100.5±10.6cm vs 98.5±11.1cm; p=0.0426), higher alcohol intake (170.7±179.1g/wk vs 118.8±106.4g/wk; p=0,0473), active smoking status (45.6% vs 26.8%; p<0.0001) and a higher frequency of pancreatitis (10.2% vs 3%; p=0.0006) than HTG control group. There was a higher percentage of patients with atherogenic dietary pattern in severe HTG group compared with the control group (138 [46.3%] vs. 94 [34.5%]; p=0,001). The multivariate analysis showed that factors associated with a triglyceride concentration greater than 1,000mg/dl were age, male sex, weight, waist circumference, alcohol, physical inactivity in non-business hours and the presence of diabetes mellitus. CONCLUSIONS: Patients with very high HTG were usually men in the fourth decade of life, with abdominal obesity, smoking and alcohol consumption. In 60% of cases the HTG was primary, and pancreatitis the most frequently complication.

Perfil clínico de los pacientes con hipertrigliceridemia muy severa del Registro de Hipertrigliceridemias de la Sociedad Española de Arteriosclerosis / Clinical profile of patients with very high hypertriglyceridemia from the Registry of Hypertriglyceridemia of the Spanish Atherosclerosis Society

Fundamento y objetivo Describir las características clínico-epidemiológicas de los pacientes con hipertrigliceridemia (HTG) muy severa atendidos en las Unidades de Lípidos de la Sociedad Española de Arteriosclerosis (SEA).Pacientes y método Se incluyeron los pacientes del Registro de HTG de la SEA con al menos una trigliceridemia superior a 1.000mg/dl (n=298, grupo HTG muy severa) y aquellos cuya trigliceridemia basal fuese entre 200 y 246mg/dl (grupo HTG control, n=272). Resultados Los pacientes con HTG muy severa eran más jóvenes (46,9±11,5 vs 52,7±13 años; p<0,0001), con un perímetro de cintura abdominal mayor (100,5±10,6 vs 98,5±11,1cm; p=0,0426), mayor ingesta de alcohol (170,7±179,1 vs 118,8±106,4g/semana; p=0,0473), tabaquismo activo (45,6 vs 26,8%; p<0,0001) y una mayor frecuencia de pancreatitis (10,2 vs 3%; p=0,0006) que el grupo control. Hubo un mayor porcentaje de pacientes con un patrón de consumo aterógeno en el grupo de HTG muy severa comparado con el grupo control (138 [46,3%] vs. 94 [34,5%]; p=0,001). El modelo multivariante mostró que los factores asociados a alguna determinación de triglicéridos mayor de 1.000mg/dl fueron la edad, el sexo masculino, el peso, el perímetro de cintura abdominal, el alcohol, la inactividad física fuera de la jornada laboral y la presencia de diabetes mellitus. Conclusiones Los pacientes con HTG muy severa suelen ser varones en la cuarta década de la vida, con obesidad abdominal, fumadores y consumidores de alcohol. En el 60% de los casos la HTG fue primaria, y la pancreatitis fue la complicación más frecuente (AU)

Background and objective To describe clinical and epidemiological characteristics of patients with very high hypertriglyceridemia (HTG) who were attended in lipid units of the Spanish Society of Atherosclerosis (SEA).Patients and method Patients of the HTG Registry of SEA with at least one triglyceride concentration greater than 1,000mg/dL (n=298, HTG severe group) and those whose baseline triglycerides were between 200 and 246mg/dL (HTG control group, n=272) were included.ResultsPatients with very high triglyceride levels were younger (46.9±11.5 years vs 52.7±13 years; p<0.0001), with a larger waist circumference (100.5±10.6cm vs 98.5±11.1cm; p=0.0426), higher alcohol intake (170.7±179.1g/wk vs 118.8±106.4g/wk; p=0,0473), active smoking status (45.6% vs 26.8%; p<0.0001) and a higher frequency of pancreatitis (10.2% vs 3%; p=0.0006) than HTG control group. There was a higher percentage of patients with atherogenic dietary pattern in severe HTG group compared with the control group (138 [46.3%] vs. 94 [34.5%]; p=0,001). The multivariate analysis showed that factors associated with a triglyceride concentration greater than 1,000mg/dl were age, male sex, weight, waist circumference, alcohol, physical inactivity in non-business hours and the presence of diabetes mellitus. Conclusions Patients with very high HTG were usually men in the fourth decade of life, with abdominal obesity, smoking and alcohol consumption. In 60% of cases the HTG was primary, and pancreatitis the most frequently complication (AU)

Valvuloplastía mitral percutánea: experiencia del Hospital San Juan de Dios / Percutaneous mitral valvuloplasty: the San Juan de Dios Hospital experience

Objetivo: Evaluar los resultados alejados de la valvuloplastía mitral percutánea (VMP), y analizar los factores asociados con eventos y reestenosis tardía. Métodos y resultados: De 252 VPM realizadas entre diciembre de 1987 y diciembre de 2006, 245 pacientes tuvieron un mínimo de 6 meses de seguimiento y evaluación ecocardiográfica antes y después del procedimiento (97 por ciento). La edad media fue de 46,3 +/- 11,37 años, las mujeres fueron 83,6 por ciento. La media de seguimiento fue de 35,25 +/- 28,84 meses, rango 6-132. La muerte cardiovascular, y el reemplazo de la válvula mitral o una segunda VMP fueron considerados como marcadores de peor resultado. El área de la válvula mitral aumentó de 1,0 +/- 0,17 cm2 a 1,71 +/- 0,31 cm2 (p <0,0001) después del procedimiento. Durante el seguimiento, 53 pacientes (21,6 por ciento) presentaron reestenosis, que fue predicha por un Score de Wilkins > 8 (p = 0,03). Cinco pacientes fallecieron (2,04 por ciento), 22 (8,9 por ciento) requirieron reemplazo de la válvula mitral y 11 (4,5 por ciento) una segunda VMP. No encontramos variables clínicas o ecocardiográficas capaces de predecir estos eventos. Conclusiones La VMP tuvo una tasa aceptable de complicaciones atribuibles al procedimiento. Las características ecocardiográficas de la válvula mitral se correlacionaron con la reestenosis. La incidencia de eventos tardíos es baja.

Objective: To evalúate the long-term results of percutaneous mitral valvuloplasty (PMV), and analyze the factors associated with restenosis and late events. Methods and results: Of 252 PMV performed between December 1987 and December 2006, 245 patients with a minimum of 6 months follow-up and echocardiographic evaluation before and after the procedure, were selected for long-term follow-up (97 percent). The mean age was 46.3 +/- 11.37 years old, 83.6 percent women. The mean follow-up was 35.25 +/- 28.84 months, range 6-132. Cardiovascular death, and mitral valve replacement or second PMV, were considered as markers of worst outcome. The mitral valve area increased from 1.0+/-0.17cm2 to 1.71 +/- 0.31 cm2 (p <0.0001) after the first procedure. During follow up, 53 patients (21.6 percent) developed restenosis, which was predicted by a Wilkins score > 8 (p = 0.03). Five (2.04 percent) patients died. Twenty-two (8.9 percent) required mitral valve replacement and 11(4.5 percent) a second PMV. We found that no clinical or echocardiographic variables were able to predict these events. Conclusions: PMV had an acceptable rate of complications attributable to the procedure. The echocardiographic characteristics of the mitral valve correlated with restenosis. The incidence of late events is low.

Relationship between ankle-brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease.

Both decreased GFR and albuminuria are associated with an elevated prevalence of peripheral artery disease. However, the combined effects of these alterations previously were not evaluated. Patients with hypertension and with no known vascular disease (n = 955; mean age 66 yr; 56% male) were selected from internal medicine outpatient clinics throughout Spain. Cardiovascular risk factors, urinary albumin excretion, and the ankle-brachial index (ABI) were assessed in all participants. GFR was estimated according to the Cockroft-Gault equation. Of the study population, 62% had diabetes, 23.8% had a GFR <60 ml/min per 1.73 m2, and 43.8% had albuminuria. The prevalence of ABI <0.9 was greater in patients with a GFR <60 ml/min per 1.73 m2 (37.4 versus 24.3%; P < 0.0001) and in those who had albuminuria (32.2 versus 23.3%; P = 0.001). In patients with both alterations, the prevalence of ABI <0.9 was 45.7%. Multivariate analysis indicated that the factors that were associated independently with low ABI were age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03 to 1.08; P < 0.0001), triglyceride concentration (OR 1.003; 95% CI 1.001 to 1.005; P = 0.001), presence of albuminuria (OR 1.61; 95% CI 1.18 to 2.20; P = 0.003), smoking habit (OR 1.72; 95% CI 1.13 to 2.63; P = 0.012), and a GFR <60 ml/min per 1.73 m2 (OR 1.47; 95% CI 1.01 to 2.17; P = 0.049). In patients with hypertension and without known vascular disease, reduced GFR and albuminuria are associated independently with an ABI <0.9. Their combined presence characterizes a subgroup of the population who have an elevated prevalence of peripheral artery disease and could benefit from early diagnosis and treatment.

Obese subjects carrying the 11482G>A polymorphism at the perilipin locus are resistant to weight loss after dietary energy restriction.

CONTEXT: Dietary treatment of obesity could be improved if predictive information about the individual's genetic response to diet was available. Adipose tissue has been the focus of efforts to identify candidate genes. Perilipin is a major protein found in adipocytes, and perilipin knockout mice are lean and resistant to diet-induced obesity. OBJECTIVE: The objective of the study was to examine the association of several polymorphisms at the perilipin (PLIN) locus with obesity and weight reduction in response to a low-energy diet in obese patients. DESIGN: This study was a 1-yr randomized (depending on the PLIN genotype) trial with three follow-up evaluations. SETTING: The study was conducted at a university research center. SUBJECTS: One hundred fifty obese patients (body mass index, 42 +/- 8 kg/m2) at baseline and 48 patients who completed the dietary follow-up treatment for weight loss participated in the study. INTERVENTIONS: Subjects completed a 1-yr low-energy diet. MAIN OUTCOMES MEASUREMENTS: Body weight (BW) at baseline and 3, 6, and 12 months was measured. RESULTS: The minor A-allele at the PLIN 11482G>A polymorphism was associated with lower baseline BW. Moreover, we found a gene-diet interaction (P = 0.015) between this polymorphism and weight loss in patients that completed the 1-yr dietary treatment. Diet resulted in significant decreases in BW (from 114.3 +/- 3.9 kg at baseline to 105.5 +/- 3.5 kg at 1 yr; P lineal trend, 0.020) in GG patients (n = 33). Conversely, carriers of the minor A allele (n = 15) did not show significant changes in BW (from 105.0 +/- 4.6 kg at baseline to 104.3 +/- 4.4 kg at 1 yr; P lineal trend, 0.985). This gene-diet interaction remained statistically significant, even after adjustment for differences in BW at baseline and for other potential confounders. CONCLUSIONS: PLIN11482A carriers were resistant to weight loss, suggesting that this polymorphism may predict outcome of BW reduction strategies based on low-energy diets.