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1.
Europace ; 23(10): 1559-1567, 2021 10 09.
Article in English | MEDLINE | ID: mdl-33975341

ABSTRACT

AIMS: Left atrial (LA) fibrosis is present in patients with atrial fibrillation (AF) and can be visualized by magnetic resonance imaging with late gadolinium enhancement (LGE-MRI). Previous studies have shown that LA fibrosis is not randomly distributed, being more frequent in the area adjacent to the descending aorta (DAo). The objective of this study is to analyse the relationship between fibrosis in the atrial area adjacent to the DAo and the distance to it, as well as the prognostic implications of this fibrosis. METHODS AND RESULTS: Magnetic resonance imaging with late gadolinium enhancement was obtained in 108 patients before AF ablation to analyse the extent of LA fibrosis and the distance DAo-to-LA. A high-density electroanatomic map was performed in a subgroup of 16 patients to exclude the possibility of an MRI artifact. Recurrences after ablation were analysed at 1 year of follow-up. The extent of atrial fibrosis in the area adjacent to the DAo was inversely correlated with the distance DAo-to-LA (r = -0.34, P < 0.001). This area had the greatest intensity of LGE [image intensity ratio (IIR) 1.14 ± 0.15 vs. 0.99 ± 0.16; P < 0.001] and also the lowest voltage (1.07 ± 0.86 vs. 1.54 ± 1.07 mV; P < 0.001) and conduction velocity (0.65 ± 0.06 vs. 0.96 ± 0.57 mm/ms; P < 0.001). The extent of this regional fibrosis predicted recurrence after AF ablation [hazard ratio (HR) 1.02, 95% CI 1.01-1.03; P = 0.01], however total fibrosis did not (HR = 1.01, 95% CI 0.97-1.06, P = 0.54). CONCLUSIONS: Atrial fibrosis was predominantly located in the area adjacent to the DAo, and increased with the proximity between the two structures. Furthermore, this regional fibrosis better predicted recurrence after AF ablation than total atrial fibrosis.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/pathology , Contrast Media , Fibrosis , Gadolinium , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Atria/surgery , Humans , Magnetic Resonance Imaging , Prognosis
2.
Rev. esp. cardiol. (Ed. impr.) ; 69(8): 754-759, ago. 2016. graf, tab
Article in Spanish | IBECS | ID: ibc-155117

ABSTRACT

Introducción y objetivos: Los sistemas de atención urgente del infarto se han creado para mejorar su tratamiento y la revascularización, pero pueden mejorar el manejo de todos los pacientes con síndrome coronario agudo. Métodos: Estudio comparativo de todos los pacientes ingresados por síndrome coronario agudo antes y tras la implantación de un código infarto. Resultados: Se incluyó a 1.210 pacientes, y aunque la media de edad fue igual en ambos periodos, los pacientes ingresados tras la implantación del código infarto presentaron menor prevalencia de diabetes mellitus e hipertensión pero más tabaquismo activo y mayor GRACE. Se observó un incremento significativo en el porcentaje de pacientes ingresados por síndrome coronario agudo con elevación del segmento ST (29,8-39,5%) y de revascularizaciones coronarias (82,1-90,1%), así como la generalización de la angioplastia primaria (51,9-94,9%), además de una reducción en el tiempo hasta el cateterismo e incremento de la revascularización precoz. La estancia hospitalaria media fue significativamente más corta tras la implantación del código infarto. No se observaron diferencias en la mortalidad hospitalaria, salvo entre los pacientes de alto riesgo (38,8-22,4%). Tras el alta no se observan diferencias entre ambos periodos en mortalidad cardiovascular, mortalidad por cualquier causa, reinfarto o complicaciones cardiovasculares mayores. Conclusiones: La implantación del código infarto conllevó un incremento de pacientes ingresados por síndrome coronario agudo con elevación del segmento ST y mayor GRACE. Se redujo la estancia hospitalaria, se generalizó la angioplastia primaria y se redujo la mortalidad hospitalaria de los pacientes de alto riesgo. El pronóstico tras el alta fue igual en ambos periodos (AU)


Introduction and objectives: Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. Methods: A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. Results: The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. Conclusions: After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods (AU)


Subject(s)
Humans , Acute Coronary Syndrome/therapy , Myocardial Infarction/therapy , Myocardial Revascularization/methods , Hemodynamics/physiology , Hospital Units/organization & administration , Civil Codes , Quality of Health Care/organization & administration
3.
Rev Esp Cardiol (Engl Ed) ; 69(8): 754-9, 2016 Aug.
Article in English, Spanish | MEDLINE | ID: mdl-26979766

ABSTRACT

INTRODUCTION AND OBJECTIVES: Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. METHODS: A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. RESULTS: The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. CONCLUSIONS: After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.


Subject(s)
Acute Coronary Syndrome/surgery , Cardiac Catheterization/methods , Coronary Care Units , Myocardial Infarction/diagnosis , Myocardial Revascularization/methods , Risk Assessment , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Aged , Coronary Angiography , Diagnosis, Differential , Electrocardiography , Female , Hospital Mortality , Humans , Male , Prognosis , Spain/epidemiology , Treatment Outcome
4.
Am J Cardiol ; 117(7): 1088-94, 2016 Apr 01.
Article in English | MEDLINE | ID: mdl-26851962

ABSTRACT

Diabetes mellitus confers the highest mortality risk in primary and secondary cardiovascular prevention, but long-term prognosis differences between different forms of cardiovascular disease have not been assessed. We hypothesized that acute heart failure (HF) could have poorer outcomes than acute coronary heart disease (CHD) in patients with diabetes. We performed a prospective study of all consecutive patients admitted in a single year. Patients were categorized according to main cardiologic diagnosis: acute HF, acute CHD, rhythm disorders, or noncardiac disease. A total of 1,293 patients were included, 31.8% had diabetes and had higher mean age, more risk factors, previous cardiovascular disease, and co-morbidities. Hospital mortality (5.6% vs 1.7%; p <0.01) was higher in patients with diabetes. During follow-up (median 58.0 months; interquartile range 31.0 to 60.0), diabetic patients had higher cardiovascular mortality (27.2% vs 9.6%; p <0.01) and all-cause mortality (35.8% vs 14.5%; p <0.01); cardiovascular disease accounted for 75% of deaths. According to discharge diagnosis, patients with diabetes only had higher mortality rates in the subgroup of acute CHD. Acute HF was the diagnosis with higher cardiovascular (36.9%) and all-cause mortality (44.1%), followed by acute CHD (16.8% and 24.4%) and rhythm disorders (5.8% and 8.8%). Multivariate analysis identified an independent association with higher long-term mortality of acute HF and acute CHD in patients with and without diabetes. In conclusion, 1/3 of cardiology-admitted patients have diabetes and have poorer long-term prognosis, especially when discharged with the diagnosis of acute HF or acute CHD.


Subject(s)
Acute Coronary Syndrome/mortality , Arrhythmias, Cardiac/mortality , Diabetes Complications/epidemiology , Heart Failure/mortality , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Acute Disease , Aged , Aged, 80 and over , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Diabetes Complications/diagnosis , Female , Heart Failure/complications , Heart Failure/diagnosis , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Prospective Studies
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