Un análisis general de la prolisil-oxidasa circulante en pacientes no isquémicos con una insuficiencia cardiaca común con fracción de eyección conservada / A global assessment of circulating prolysyl oxidase in nonischemic patients with garden-variety heart failure with preserved ejection fraction

Introducción y objetivos: La enzima lisil-oxidasa se expresa al alza en el miocardio de pacientes con cardiopatía hipertensiva. Se propone investigar si los pacientes con insuficiencia cardiaca y fracción de eyección conservada de origen hipertensivo-metabólico (ICFEc-HM) presentaban también concentraciones elevadas de prolisil-oxidasa circulante (pLOXc) y las posibles consecuencias de ello. Métodos: Se cuantifican las concentraciones de pLOXc de 85 pacientes no isquémicos con ICFEp-HM en estadio C y se comparan con las de 51 controles sanos. Se evaluaron además las correlaciones entre las concentraciones de pLOXc y ciertos parámetros de rigidez miocárdica, productos del ciclo del colágeno y citocinas fibrogénicas, así como el valor predictivo de la concentración plasmática de la proenzima a 1 año de seguimiento. Resultados: Se detectaron valores aumentados de pLOXc y se encontró que se correlacionaban con los cocientes E/E' y las constantes de rigidez que se calcularon. El subgrupo de pacientes con disfunción diastólica de tipo 1 mostró una correlación negativa solo entre la pLOXc y el péptido natriurético cerebral, mientras que en los pacientes con un patrón diastólico restrictivo se demostró una fuerte correlación entre la pLOXc y la galectina-3. El análisis de Kaplan-Meier reveló que las concentraciones de pLOXc > 52,20 ng/ml incrementaron ligeramente el riesgo de desenlace fatal (test de log rank= 4,45; p = 0,034). Al aplicar la regresión de COX, se obtuvo que la pLOXc es un significativo predictor independiente de muerte u hospitalización por descompensación de la ICFEp-HM (HR = 1,360; IC95%, 1,126-1,638; p = 0,046). Conclusiones: Los pacientes con ICFEp-HM sintomática tienen altas concentraciones séricas de pLOXc, lo cual se asocia con índices de llenado diastólico restrictivo. Tales concentraciones representan un factor de riesgo moderado de mal pronóstico. A lo largo de la historia natural de la ICFEp-HM, se ha constatado que las concentraciones de pLOXc al principio se correlacionan negativamente con las de péptido natriurético cerebral, y después tienen correlación positiva con las de galectina-3, a medida que se desarrolla una disfunción diastólica avanzada

Introduction and objectives: Lysyl oxidase is overexpressed in the myocardium of patients with hypertensive cardiomyopathy. We aimed to explore whether patients with hypertensive-metabolic heart failure with preserved ejection fraction (HM-HFpEF) also have increased concentrations of circulating prolysyl oxidase (cpLOX) and its possible consequences. Methods: We quantified cpLOX concentrations in 85 nonischemic patients with stage C, HM-HFpEF, and compared them with those of 51 healthy controls. We also assessed the correlations of cpLOX with myocardial stiffness parameters, collagen turnover products and fibrogenic cytokines, as well as the predictive value of plasma proenzyme levels at 1-year of follow-up. Results: We detected raised cpLOX values and found that they correlated with calculated E/E' ratios and stiffness constants. The subgroup of patients with type I diastolic dysfunction showed a single negative correlation between cpLOX and B-type natriuretic peptide whereas patients with a restrictive diastolic pattern showed a strong correlation between cpLOX and galectin-3. Kaplan-Meier analysis revealed that cpLOX > 52.20 ng/mL slightly increased the risk of a fatal outcome (log-rank = 4.45; P = .034). When Cox regression was used, cpLOX was found to be a significant independent predictor of cardiovascular death or hospitalization due to the decompensation of HM-HFpEF (HR, 1.360; 95%CI, 1.126-1.638; P = .046). Conclusions: Patients with symptomatic HM-HFpEF show high cpLOX serum levels associated with restrictive diastolic filling indices. These levels represent a moderate risk factor for poor clinical outcome. Throughout the natural history of HM-HFpEF, we observed that cpLOX concentrations were initially negatively correlated with B-type natriuretic peptide but positively correlated with galectin-3 as advanced diastolic dysfunction developed

A Global Assessment of Circulating Prolysyl Oxidase in Nonischemic Patients With Garden-variety Heart Failure With Preserved Ejection Fraction.

INTRODUCTION AND OBJECTIVES: Lysyl oxidase is overexpressed in the myocardium of patients with hypertensive cardiomyopathy. We aimed to explore whether patients with hypertensive-metabolic heart failure with preserved ejection fraction (HM-HFpEF) also have increased concentrations of circulating prolysyl oxidase (cpLOX) and its possible consequences. METHODS: We quantified cpLOX concentrations in 85 nonischemic patients with stage C, HM-HFpEF, and compared them with those of 51 healthy controls. We also assessed the correlations of cpLOX with myocardial stiffness parameters, collagen turnover products and fibrogenic cytokines, as well as the predictive value of plasma proenzyme levels at 1-year of follow-up. RESULTS: We detected raised cpLOX values and found that they correlated with calculated E/E' ratios and stiffness constants. The subgroup of patients with type I diastolic dysfunction showed a single negative correlation between cpLOX and B-type natriuretic peptide whereas patients with a restrictive diastolic pattern showed a strong correlation between cpLOX and galectin-3. Kaplan-Meier analysis revealed that cpLOX > 52.20 ng/mL slightly increased the risk of a fatal outcome (log-rank = 4.45; P = .034). When Cox regression was used, cpLOX was found to be a significant independent predictor of cardiovascular death or hospitalization due to the decompensation of HM-HFpEF (HR, 1.360; 95%CI, 1.126-1.638; P = .046). CONCLUSIONS: Patients with symptomatic HM-HFpEF show high cpLOX serum levels associated with restrictive diastolic filling indices. These levels represent a moderate risk factor for poor clinical outcome. Throughout the natural history of HM-HFpEF, we observed that cpLOX concentrations were initially negatively correlated with B-type natriuretic peptide but positively correlated with galectin-3 as advanced diastolic dysfunction developed.

[Controversy over one use only medical devices]. / Controversias sobre los dispositivos médicos de un sólo uso.

At the present time, concern has arisen as to whether or not medical devices designed for one use only should be reutilized after the appearances of outbreaks of Hepatitis C infections in Spain as well as in other countries. 80% of Spanish hospitals, both public and private, reprocess these one use only devices; there is no regulation at this time which guarantees this practice. The increase in endoscopic surgeries has led to an increase in health care costs, plus an increase in the residues which derive from their use. This fact has caused the reutilization of one use only devices in order to balance costs. According to a study in the United States, the price of a reprocessed one use only device is approximately half the price of a new one, and at times, the cost of these reprocessed devices is less than 10% that of a new one. In our country, a precise classification regarding which materials may or may not be reused does not exist, nor do protocols for sterilization and reprocessing and reuse of one use only devices. An agreement should be made by the parties involved; the administration, sanitary professionals, manufacturers of medical devices and the users which guarantees a balance between the important increase in health care costs due to throwing away these products and the insecurity which their use without a ratified guarantee means.

Controversias sobre los dispositivos médicos de un sólo uso / Controversy over one use only medical devices

Actualmente ha surgido la preocupación de si deben o no reutilizarse los dispositivos médicos de un solo uso (DMSU), tras la aparición de brotes de infección por virus de la Hepatitis C tanto en España como en otros países. El 80% de los hospitales españoles, tanto del ámbito público como del privado, reprocesa los DMSU, no existiendo en este momento una normativa que avale dicha práctica. El auge de las cirugías endoscópicas ha supuesto un aumento de los costes sanitarios, así como un incremento de los residuos que se derivan de su utilización. Este hecho ha llevado a la reutilización de los DMSU para intentar equilibrar gastos. Según un estudio realizado en EEUU el precio de un DMSU reprocesado es aproximadamente la mitad que el de un artículo nuevo, e incluso en ocasiones el coste de éstos resulta inferior al 10%. En nuestro país, no se cuenta con una clasificación precisa sobre los materiales que pueden ser o no reutilizables, ni con protocolos de esterilización y reprocesado que respondan de su inocuidad. Por ello se precisa una normativa que sistematice las técnicas de esterilización y reutilización de los DMSU. Se debería llegar a un acuerdo entre los implicados: Administración, profesionales sanitarios, fabricantes de dichos productos y usuarios, que avale un equilibrio entre el importante incremento en el gasto sanitario por desechar todos estos productos, y la inseguridad que supone su uso sin unas garantías ratificadas

At the present time, concern has arisen as to whether or not medical devices designed for one use only should be reutilized after the appearances of outbreaks of Hepatitis C infections in Spain as well as in other countries. 80% of Spanish hospitals, both public and private, reprocess these one use only devices; there is no regulation at this time which guarantees this practice. The increase in endoscopic surgeries has led to an increase in health care costs, plus an increase in the residues which derive from their use. This fact has caused the reutilization of one use only devices in order to balance costs. According to a study in the United States, the price of a reprocessed one use only device is approximately half the price of a new one, and at times, the cost of these reprocessed devices is less than 10% that of a new one. In our country, a precise classification regarding which materials may or may not be reused does not exist, nor do protocols for sterilization and reprocessing and reuse of one use only devices. An agreement should be made by the parties involved; the administration, sanitary professionals, manufacturers of medical devices and the users which guarantees a balance between the important increase in health care costs due to throwing away these products and the insecurity which their use without a ratified guarantee means