Anticoagulation and Antiplatelet Regimen in Cardiac Transplant. Clinical Characteristics, Outcomes, and Blood Product Transfusion.

BACKGROUND: We aimed to evaluate the characteristics, clinical outcomes, and blood product transfusion (BPT) rates of patients undergoing cardiac transplant (CT) while receiving uninterrupted anticoagulation and antiplatelet therapy. METHODS: A retrospective, single-center, and observational study of adult patients who underwent CT was performed. Patients were classified into four groups: (1) patients without anticoagulation or antiplatelet therapy (control), (2) patients on antiplatelet therapy (AP), (3) patients on vitamin K antagonists (AVKs), and (4) patients on dabigatran (dabigatran). The primary endpoints were reoperation due to bleeding and perioperative BPT rates (packed red blood cells (PRBC), fresh frozen plasma, platelets). Secondary outcomes assessed included morbidity and mortality-related events. RESULTS: Of the 55 patients included, 6 (11%) received no therapy (control), 8 (15%) received antiplatelet therapy, 15 (27%) were on AVKs, and 26 (47%) were on dabigatran. There were no significant differences in the need for reoperation or other secondary morbidity-associated events. During surgery patients on dabigatran showed lower transfusion rates of PRBC (control 100%, AP 100%, AVKs 73%, dabigatran 50%, p = 0.011) and platelets (control 100%, AP 100%, AVKs 100%, dabigatran 69%, p = 0.019). The total intraoperative number of BPT was also the lowest in the dabigatran group (control 5.5 units, AP 5 units, AVKs 6 units, dabigatran 3 units; p = 0.038); receiving significantly less PRBC (control 2.5 units, AP 3 units, AVKs 2 units, dabigatran 0.5 units; p = 0.011). A Poisson multivariate analysis showed that only treatment on dabigatran reduces PRBC requirements during surgery, with an expected reduction of 64.5% (95% CI: 32.4%-81.4%). CONCLUSIONS: In patients listed for CT requiring anticoagulation due to nonvalvular atrial fibrillation, the use of dabigatran and its reversal with idarucizumab significantly reduces intraoperative BPT demand.

Silent challenge: Early kidney transplant failure and cardiomyopathy.

Differentiation of hypertrophic cardiomyopathy phenotypes is challenging but crucial for appropriate management. We report a case of myocardial oxalate deposition as an infrequent cause of infiltrative cardiomyopathy.

Tratamiento de la insuficiencia cardiaca: la cuenta atrás empieza en el momento del diagnóstico / Heart failure treatment: the countdown begins at diagnosis

Sacubitrilo-valsartán tiene demostrada eficacia en disminuir las hospitalizaciones y las muertes por insuficiencia cardiaca en los ensayos clínicos, y los datos de práctica clínica real corroboran su efectividad y su seguridad. Asimismo su uso temprano durante la hospitalización, incluso en pacientes con insuficiencia cardiaca de inicio y/o sin tratamiento previo, también parece ser seguro y recomendable para simplificar el tratamiento del paciente y facilitar la transición de cuidados. También tiene un efecto favorable sobre el remodelado cardiaco, como demuestran los resultados del estudio PROVE-HF, que es mayor con un inicio temprano y a dosis más altas en estudios observacionales. Información sobre el suplemento: este artículo forma parte del suplemento titulado «Controversias para una nueva era en el tratamiento de la insuficiencia cardiaca», que ha sido patrocinado por Novartis

Clinical trials have found that sacubitril-valsartan is effective in reducing the risk of hospitalization and death from heart failure and real-life data have confirmed the drug combination's effectiveness and safety. Moreover, early use during hospitalization, in both patients with de novo heart failure and previously untreated patients, also appears to be safe and is recommended for simplifying patient management and easing transitional care. In addition, sacubitril-valsartan has a beneficial effect on cardiac remodeling, as demonstrated by the results of the PROVE-HF study, which is greater with an early onset and at higher doses in observational studies. Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis

Tratamiento de la hipercolesterolemia con inhibidores de la PCSK9 en receptores de trasplante cardiaco. Primera experiencia en España / Treatment of hypercholesterolemia with PCSK9 inhibitors in heart transplant recipients. First experience in Spain

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Flecainide Reduces Ventricular Arrhythmias in Patients With Genotype RyR2-positive Catecholaminergic Polymorphic Ventricular Tachycardia.

INTRODUCTION AND OBJECTIVES: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease characterized by polymorphic or bidirectional ventricular arrhythmias (VA) triggered by physical or emotional stress in young people with a structurally normal heart. Beta-blockers are the cornerstone of treatment, while flecainide has recently been incorporated into the therapeutic arsenal. The aim of this study was to report our experience with this drug. METHODS: The cohort included 174 genotype-positive CPVT-patients from 7 families. We collected data from patients who were receiving flecainide and analyzed the indications, adverse effects and dosage, clinical events, VA and arrhythmic window during exercise testing, and implantable cardioverter-defibrillator (ICD) shocks during follow-up. RESULTS: Eighteen patients (10.4%) received flecainide; 17 patients in combination with beta-blockers, and 1 patient as monotherapy due to beta-blocker intolerance. None of the patients presented side effects. In 13 patients (72.2%) the indication was the persistence of exercise-induced VA and in 5 patients (27.7%) persistent ICD-shocks, despite on beta-blockers. After flecainide initiation, the exercise-induced VA quantitative score was reduced by more than 50% in 66.7% of the members of family 1 (32.76 ± 84.06 vs 74.38 ± 153.86; P = .018). The arrhythmic window was reduced (5.8 ± 11.9 bpm vs 19.69 ± 21.27 bpm; P = .007), and 4 of 5 patients with appropriate ICD shocks experienced no further shocks in the follow-up. CONCLUSIONS: In CPVT-patients flecainide reduces clinical events, exercise-induced VA, the arrhythmic window, and ICD shocks, with good tolerance.

Elevada prevalencia de hipovitaminosis D en los estudiantes de medicina de Gran Canaria, Islas Canarias (España) / High prevalence of hypovitaminosis D in medical students in Gran Canaria, Canary Islands (Spain)

Fundamento: Se ha descrito la existencia de deficiencia de vitamina D tanto en la población general como en un gran número de enfermedades. Sin embargo, se han publicado pocos estudios realizados en población joven y sana en España. Teóricamente no debería encontrarse deficiencia de vitamina D entre los estudiantes de Medicina de la Universidad de Las Palmas de Gran Canaria, porque disponen de todos los medios para evitarla. Objetivo: Estimar la prevalencia de deficiencia de vitamina D en una población de estudiantes de Medicina de ambos sexos de la Universidad de Las Palmas de Gran Canaria. Método: Se estudiaron 103 alumnos de Medicina de ambos sexos de la Universidad de Las Palmas de Gran Canaria. A todos se les realizó un cuestionario y una exploración física. Se determinó la vitamina D 25-hidroxicolecalciferol (25-HCC), la hormona paratiroidea, varios marcadores bioquímicos de remodelado óseo y un estudio bioquímico general. Se estimó la densidad mineralósea por absorciometría radiológica dual en la columna lumbar y en la extremidad proximal del fémur. Asimismo, se midieron los parámetros ultrasonográficos en el calcáneo. Resultados: Sólo el 38,8% de los estudiantes de Medicina (el 42,1% de los varones y el 44,9%de las mujeres) presentaron niveles de 25-HCC superiores a 30 ng/dl tal y como se recomienda (..) (AU)

Background: Vitamin D deficiency has been described in many diseases and indeed in the general population. However fewer reports have been published in young and healthy people. Vitamin D deficiency should not be found in medical students of the Canary Islands, because they have all the resources to avoid it. Objective: To estimate the prevalence of vitamin D deficiency in a population of medical students of both gender from the University of Las Palmas de Gran Canaria. Methods: 103 medical students of both genders from the University of Las Palmas de Gran Canaria. They completed a questionnaire and a physical examination. Vitamin D (25- hydroxycholecalciferol [25-HCC]), parathyroid hormone, biochemical markers of bone remodeling and ag eneral biochemical study were performed. Bone mineral density was assessed by dual energyX-ray absorptiometry at the lumbar spine and the proximal femur. Quantitative ultrasounds parameters were measured at the calcaneus. Results: Only 38.8% of the students of Medicine (42.1% of males and 44.9% of females) have25-HCC values higher than 30 ng/dl as widely recommended nowadays. Vitamin D deficiency(< 20 ng/ml) is observed in 32.6% and vitamin D insufficiency (< 30 ng/ml) in 28.6% of the students of Medicine in Las Palmas de Gran Canaria. Conclusion: Although they have optimal conditions for having good levels of vitamin D, near two thirds of the medical students in the Canaries have low values of vitamin D (AU)

[High prevalence of hypovitaminosis D in medical students in Gran Canaria, Canary Islands (Spain)]. / Elevada prevalencia de hipovitaminosis D en los estudiantes de medicina de Gran Canaria, Islas Canarias (España).

BACKGROUND: Vitamin D deficiency has been described in many diseases and indeed in the general population. However fewer reports have been published in young and healthy people. Vitamin D deficiency should not be found in medical students of the Canary Islands, because they have all the resources to avoid it. OBJECTIVE: To estimate the prevalence of vitamin D deficiency in a population of medical students of both gender from the University of Las Palmas de Gran Canaria. METHODS: 103 medical students of both genders from the University of Las Palmas de Gran Canaria. They completed a questionnaire and a physical examination. Vitamin D (25- hydroxycholecalciferol [25-HCC]), parathyroid hormone, biochemical markers of bone remodeling and a general biochemical study were performed. Bone mineral density was assessed by dual energy X-ray absorptiometry at the lumbar spine and the proximal femur. Quantitative ultrasounds parameters were measured at the calcaneus. RESULTS: Only 38.8% of the students of Medicine (42.1% of males and 44.9% of females) have 25-HCC values higher than 30 ng/dl as widely recommended nowadays. Vitamin D deficiency (< 20 ng/ml) is observed in 32.6% and vitamin D insufficiency (< 30 ng/ml) in 28.6% of the students of Medicine in Las Palmas de Gran Canaria. CONCLUSION: Although they have optimal conditions for having good levels of vitamin D, near two thirds of the medical students in the Canaries have low values of vitamin D.