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The importance of Cascaded H-Bridge (CHB) converters in several applications has led to the introduction of advanced control strategies like Model Predictive Control (MPC). This paper proposes a new adaption of the Optimal Switching Sequence MPC (OSS-MPC) for application in a Single-Phase CHB. The control region of CHB converters is studied in order to apply this new strategy with the objective of tracking grid current and balancing the capacitor voltages of the modules. Another important contribution is the fixed switching period, which is an improvement over other MPC techniques. Starting from the control region, switching sequences are designed considering both switching states and time duration of each state. The method is tested through simulations.

The Modular Multilevel Converter is used for a variety of applications including HVDC transport, photovoltaic generation and electric system storage among others. Its characteristic circulating currents can be employed for energy balance but they increase the losses of the converter. This paper focuses on obtaining the minimum currents that can still be used for this purpose. The optimization is made analytically, so that the numerical methods from previous publications are no longer needed. The method is tested through simulations.

A doubly three-phase fed synchronous reluctance machine (SynRM) is designed for electrical vehicle powertrain application. SynRM aims to deliver instant power and high power density, high torque at low speeds and high power at high speeds, wide speed range, high efficiency throughout its range of operation, ruggedness, high safety at a reasonable cost. Under these requirements, a 60 kW, 9000 rpm and 400 Nm SynRM has been designed. The main objective is to demonstrate the SynRM powertrain operation behaviour and determinate the operation points electrically and thermally. To reach the proposed SynRM goal, a new direct torque control algorithm based on output regulation subspace theory control is presented. The winding motor topology is galvanic isolated, so it is possible to operate with the six phases directly to the load and because of that, the combination with a back-to-back (B2B) converter becomes so profitable. To validate the system, two B2B full-converters and two motors (SynRM and induction machine) were used in a real test bench. Finally, a simulated and real efficiency map is obtained covering different drive cycles range. Some remarks about normal and failure mode of operation are presented.

Resumen Introduccion y objetivos Los requisitos existentes en el informe de posicionamiento terapeutico y la necesidad de visado dificultan el uso de anticoagulantes orales de accion directa (ACOD) en Espana. El mal control de la anticoagulacion con antagonistas de la vitamina K es un criterio aceptado para su prescripcion. Nuestro objetivo es analizar el acceso al tiempo en rango terapeutico (TRT) por parte del cardiologo durante la consulta, y el tiempo empleado para realizar dichos tramites. Metodos Participaron 171 servicios de cardiologia de Espana. Los cardiologos propuestos por sus jefes de servicio fueron entrevistados por una empresa externa durante su consulta, solicitandoles que accedieran a la historia clinica de un paciente con fibrilacion auricular no valvular anticoagulado con antagonistas de la vitamina K y se cronometraron los tiempos requeridos. Resultados Se entrevistaron a 588 cardiologos (49% Conclusiones Un tercio de los cardiologos en nuestro pais no tiene acceso directo al INR y TRT durante la consulta. El porcentaje de pacientes mal controlado es muy elevado. Los tiempos necesarios para el proceso de prescripcion de ACOD son relevantes. Estos datos pueden ayudar a mejorar el uso de ACOD en una indicacion admitida por la administracion.

A six-phase synchronous reluctance machine (SynRM) is designed for electrical vehicle (EV) powertrain applications. The SynRM in the charger mode is able to provide instantaneous power and high power density, high efficiency with two modes of charge, robust reliability, high safety and fault tolerance. The properties of the SynRM are 60 kW, 9000 rpm and 400 N m. The main objective of the SynRM powertrain used as a charger is proved electrically, thermically and to be fault tolerant using a specific test bench. The winding motor topology is galvanic isolated, making it possible to load directly from the single-phase and three-phase grid, enabling two ways of charging, which increases the reliability. For this reason, the back-to-back full-converter and the SynRM as a charger are used. The main goal is to prove the utility as a charger and the great efficiency derived from the SynRM plus inverter topology for electric cars. This SynRM + inverter topology offers redundancy for all load modes.

Resumen Introduccion y objetivos Comparar la estrategia de revascularizacion percutanea de lesiones graves en ramas coronarias secundarias (RS) (diametro ≥ 2 mm) de arterias epicardicas mayores frente al tratamiento conservador. Metodos Estudio de cohortes retrospectivo en el que se compara a pacientes con lesiones graves en RS de arterias epicardicas principales tratados con revascularizacion percutanea o con un tratamiento farmacologico a criterio del operador. Se analizo el porcentaje de eventos relacionados con la rama (muerte cardiovascular, infarto de miocardio atribuible a RS o necesidad de revascularizacion de la RS). Resultados Se analizaron 679 lesiones en RS (662 pacientes). Tras un seguimiento medio de 22,2 ± 10,5 meses, no hubo diferencias significativas entre ambos grupos de tratamiento en mortalidad de causa cardiovascular (el 1,7 frente al 0,4%; p = 0,14), infarto agudo de miocardio (IAM) no fatal (el 1,7 frente al 1,7%; p = 0,96) o necesidad de revascularizacion de la RS (el 4,1 frente al 5,4%; p = 0,45) ni en el porcentaje total de eventos (el 5,1 frente al 6,3%; p = 0,54). Las variables que mostraron asociacion con la ocurrencia de eventos en el analisis multivariable fueron la diabetes (sHR = 2,87; IC95%, 1,37-5,47; p = 0,004), IAM previo (sHR = 3,54; IC95%, 1,77-7,30; p Conclusiones En el seguimiento, el porcentaje de eventos relacionados con la RS fue bajo respecto al total de pacientes, sin diferencias significativas entre una y otra estrategia de tratamiento. Las variables que se asociaron con la ocurrencia de eventos en el analisis multivariable fueron la diabetes mellitus, el antecedente de IAM y la mayor longitud de la lesion.

INTRODUCTION AND OBJECTIVES To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P

Introduction and objectives Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive fibrofatty replacement of predominantly right ventricular myocardium . This cardiomyopathy is a frequent cause of sudden cardiac death in young people and athletes. The aim of our study was to determine the incidence of pathological or likely pathological desmosomal mutations in patients with high-risk definite ARVC. Methods This was an observational, retrospective cohort study , which included 36 patients diagnosed with high-risk ARVC in our hospital between January 1998 and January 2015. Genetic analysis was performed using next-generation sequencing . Results Most patients were male (28 patients, 78%) with a mean age at diagnosis of 45 ± 18 years. A pathogenic or probably pathogenic desmosomal mutation was detected in 26 of the 35 index cases (74%): 5 nonsense, 14 frameshift, 1 splice, and 6 missense. Novel mutations were found in 15 patients (71%). The presence or absence of desmosomal mutations causing the disease and the type of mutation were not associated with specific electrocardiographic, clinical, arrhythmic, anatomic, or prognostic characteristics. Conclusions The incidence of pathological or likely pathological desmosomal mutations in ARVC is very high, with most mutations causing truncation. The presence of desmosomal mutations was not associated with prognosis.

Resumen Introduccion y objetivos La miocardiopatia arritmogenica del ventriculo derecho (MCAVD) es una cardiopatia hereditaria definida por la sustitucion progresiva de miocardio ventricular derecho por tejido fibroadiposo. Es causa frecuente de la muerte subita de jovenes atletas. El objetivo del presente estudio es conocer la incidencia de variantes desmosomicas patogenicas o probablemente patogenicas en pacientes con MCAVD definitiva de alto riesgo. Metodos El estudio de cohortes retrospectivo observacional incluyo a 36 pacientes diagnosticados de MCAVD definitiva de alto riesgo en nuestro hospital entre enero de 1998 y enero de 2015. El analisis genetico se realizo con next-generation sequencing. Resultados La mayoria eran varones (28 pacientes, 78%) con una media de edad al diagnostico de 45 ± 18 anos. Se detecto al menos 1 variante desmosomica patogenica o probablemente patogenica en 26 de los 35 casos indice (74%): 5 nonsense, 14 frameshift, 1 splice y 6 missense. En 15 pacientes (71%) se encontraron mutaciones nuevas. La presencia o la ausencia de mutaciones desmosomicas o la naturaleza de estas no se asociaron con caracteristicas electrocardiograficas, clinicas, arritmicas, anatomicas o pronosticas especificas. Conclusiones La incidencia de variantes desmosomicas patogenicas o probablemente patogenicas en MCAVD definitiva de alto riesgo fue muy alta, con mayoria de mutaciones que causan truncamiento. La presencia de mutaciones desmosomicas no se asocio con el pronostico.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

This paper focusses on a hybrid topology for a CHB, where some or the modules are equipped with energy storage systems. In addition to the well-known capabilities of the CHB as a STATCOM, the hybrid topology has new advantages as a grid stabilizer. However, the current ripple on the energy storage systems has negative effects which tends to result in expensive solutions. To overcome this inconvenient, a previously known balance strategy is modified to prevent the ripple without compromising the DC-Link balance. This new control method is demonstrated through simulations.

Resumen Antecedentes y objetivos La cardiopatia isquemica es la principal causa de mortalidad en el anciano. Los sindromes geriatricos se han relacionado con un aumento de comorbilidad y mortalidad en este grupo etario. El objetivo del estudio es evaluar la influencia de los sindromes geriatricos en los pacientes de edad avanzada que reciben revascularizacion coronaria percutanea. Metodos Se incluyeron de forma prospectiva 220 pacientes diagnosticados de enfermedad coronaria multivaso. Los sindromes geriatricos estudiados fueron: fragilidad por cuestionario de Fried, comorbilidad por indice de Charlson y dependencia por escala de Barthel. Resultados En el 42,1% de los pacientes existia algun grado de fragilidad (indice de Fried ≥ 1), se observo algun grado de dependencia funcional (Barthel Conclusiones En nuestra poblacion los sindromes geriatricos estudiados son mas frecuentes en los pacientes que presentan algun MACE. Observamos una tendencia a sufrir menos MACE si la revascularizacion percutanea realizada es completa.

INTRODUCTION Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy characterized by ventricular arrhythmias and heart failure. The variable phenotype suggesting that determined environmental factors may have an influence. The aim of our study was to discover the impact of the dynamic physical activity on patients with high-risk definite ARVC/D. METHODS AND RESULTS Collection of data on physical activity at the time of diagnosis was conducted at an in-person clinical interview. The intensity of the activity was classified in accordance with the mean frequency of weekly physical exercise sessions in the 10 years before diagnosis and into the following three groups of dynamic activity: high/competitive (>3 h/wk), moderate (1 to 3 h) and minimal/inactive (

Resumen Introduccion La regurgitacion mitral es la segunda valvulopatia en frecuencia, y pese a su mal pronostico casi la mitad de los pacientes no son considerados candidatos a cirugia. Para este perfil de pacientes se ha empleado MitraClip® con resultados prometedores en regurgitacion mitral funcional y degenerativa. Material y metodos Analisis retrospectivo de las caracteristicas y resultados de 72 pacientes tratados con MitraClip® entre noviembre de 2011 y octubre de 2016. Resultados La etiologia de la regurgitacion fue funcional en el 61,1%, degenerativa o mixta en el 38,9%. La etiologia funcional se asocio a menor edad (67,9 ± 8,74 vs 74,6 ± 13,06 anos, p = 0,21) y fraccion de eyeccion (34 ± 8,5% vs 57 ± 15%; p Conclusion El tratamiento con MitraClip® es seguro y efectivo en etiologia funcional y degenerativa, aunque esta ultima podria asociarse a menor mortalidad tardia.

Resumen Introduccion La prevalencia del sindrome coronario agudo en la poblacion joven se estima en torno al 6-10%. Estudios previos han mostrado diferencias clinicas y evolutivas entre hombres y mujeres jovenes que sufren un evento de este tipo. Metodos Estudio retrospectivo que incluyo a todos los pacientes hombres menores de 45 anos y mujeres menores de 55 anos, ingresados por sindrome coronario agudo en nuestro centro entre 2006 y 2014. Se estudiaron los factores de riesgo cardiovascular, tipo de enfermedad coronaria y estrategia de tratamiento, asi como la mortalidad y los eventos en el seguimiento. Resultados Se incluyeron 471 pacientes, siendo 283 hombres y 188 mujeres. La hipertension arterial y la diabetes mellitus fueron mas frecuentes entre las mujeres (30 vs. 46,8% y 9,5 vs. 30,9% respectivamente, ambos p Conclusiones Existieron diferencias significativas entre sexos en cuanto a la distribucion de los factores de riesgo cardiovascular, el tipo de enfermedad coronaria y el tratamiento. La mortalidad a largo plazo fue mayor entre las mujeres.

Resumen Introduccion La valvula aortica bicuspide (VAB) es la malformacion cardiaca congenita mas frecuente. Se asocia a un mayor riesgo de complicaciones cardiovasculares, entre las que se incluye la endocarditis infecciosa (EI). Metodos Estudio observacional, unicentrico de cohorte, que incluye de forma prospectiva a todos los pacientes ingresados por EI entre 1996 y 2014. Se analizan datos epidemiologicos, clinicos, microbiologicos, ecocardiograficos, complicaciones durante la hospitalizacion, necesidad quirurgica, mortalidad intrahospitalaria y seguimiento a un ano. Se excluyen los casos con endocarditis sobre valvulas protesicas o en otras localizaciones, y aquellos de cuya valvula aortica no se tienen datos certeros acerca de su morfologia. Se ha realizado un analisis estadistico comparativo entre VAB y tricuspide (VAT). Resultados De un total de 328 casos con EI, 118 (35,67%) fueron sobre valvula aortica. Tenian VAB 18 (16,22%). Los casos con VAB eran mas jovenes que los portadores de VAT (51 ± 19,06 vs. 60,83 ± 15,73 anos, p = 0,021) y tenian menos comorbilidad (indice de Charlson 0,67 ± 0,77 vs. 1,44 ± 1,64, p = 0,03). En el grupo con VAB observamos tendencia a EI causada por Staphylococcus spp. (38,9 vs. 21,5%, p = 0,137). Con diferencia estadistica, hubo mas complicaciones perivalvulares entre los casos con VAB (55,6% vs. 16,1%, p = 0,001) predominando los abscesos (38,9 vs. 16,1%, p = 0,047). Ser portador de VAB fue el unico factor predictor de las mismas (OR 7,87, IC del 95%, 2,38-26,64, p = 0,001). Los pacientes con VAB se operaron mas (83,3 vs. 44,1%, p = 0,004) y la mortalidad durante el ingreso hospitalario fue menor, aunque no alcanzo significacion estadistica (5,6 vs. 25,8%, p = 0,069). La supervivencia a un ano fue significativamente superior en el grupo de VAB (93,8 vs 69,3%, p = 0,048). Conclusiones Los pacientes con EI sobre VAB son jovenes, con poca comorbilidad asociada. Tienen frecuentemente complicaciones perivalvulares por lo que requieren cirugia precoz. La mortalidad intrahospitalaria comparada con EI sobre VAT es menor y la supervivencia a un ano es significativamente mayor.

Resumen Las nuevas tecnicas desarrolladas para el analisis genetico nos aportan informacion sobre las bases geneticas de las distintas miocardiopatias, entre ellas, de la miocardiopatia dilatada familiar. Realizamos esta revision con el fin de aportar informacion sobre la utilidad clinica del estudio genetico en el manejo de estos pacientes.

Aim: To evaluate the possible relationship between high levels of CA-125 and long-term prognosis in chronic heart failure patients after they undergo a cardiac transplantation (CT). Materials & methods: We retrospectively studied all patients who underwent a CT and had a previous determination of CA-125. Congestive patients and those whose survival was 35 U/ml). After CT, survival was significantly inferior in this group (96.3 vs 81%, 84.9 vs 64%, 70.7 vs 32.9% at 2, 5 and 8 years, p = 0.014). CA-125 >35 U/ml was the only factor independently associated to long-term mortality (OR: 3.94; 95% CI: 1.2–12.82; p = 0.023). Conclusion: Noncongestive patients with high levels of CA-125 had inferior long-term survival after CT.

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

This paper presents a new DC-Link voltage control method for Y-connected Cascaded H-Bridge Converters. Such converters have several redundancies which the presented method exploits to independently control the DC-Link voltages without affecting the output currents. This is achieved by solving an equivalent linear optimization problem subject to constraints. Simulation results are shown to verify that the method keeps DC-Links controlled even when power sources operate under different conditions.

Objectives Bicuspid aortic valve (BAV) is the most prevalent congenital cardiac malformation, frequently associated with aortic dilatation (AD). The molecular mechanisms involved in AD and its aetiological link with BAV formation are poorly understood. Altered fibrillin-1 (FBN1) and metalloprotease-2, -9 (MMP2,9) protein activities have been suggested to be involved in BAV aortopathy. In addition, FBN2 participates in embryonic valve formation, but its possible involvement in BAV-associated AD has never been explored. In this report, we evaluate the expression levels of MMP2,9 and FBN1,2 in the ascending aorta of patients with normal or dilated aortas and with tricuspid aortic valve (TAV) or BAV, using appropriate tissue-specific reference genes. Methods Gene expression was quantified by real-time quantitative polymerase chain reaction in 52 patients, using one or three reference genes previously validated in the same patient population. Results FBN2 expression was significantly increased in the aortas of patients with BAV compared with individuals with TAV (0.178 ± 0.042 vs 0.096 ± 0.021, P = 0.015), whereas differences in FBN1 did not reach statistical significance (1.946 ± 0.228 vs 1.430 ± 0.114, P = 0.090). When four groups of samples were considered, FBN2 expression was significantly higher in patients with BAV and AD compared with patients with TAV and AD (0.164 ± 0.035 vs 0.074 ± 0.027, P = 0.040). No significant differences were found when FBN1/FBN2 ratio, and MMP2 and MMP9 expression levels were analysed. No linear relationship between aortic diameter and gene expression levels were found. Conclusions BAV patients have an increased FBN (especially FBN2) gene expression level in the ascending aorta, irrespective of dilatation, whereas MMP expression does not change significantly. These results add a new piece of information to the pathophysiology of BAV disease and point to FBN2 as a new molecular player.

Background and objectives Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease. Patients and methods 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay. Results Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03–1.27; p = 0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01–1.25; p = 0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765–0.7657). Conclusions Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target.

BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve® (Medtronic, Minneapolis, MN, USA) prosthesis.MethodsA total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure.ResultsAKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53–41.9); p

Aims Hypertrophic cardiomyopathy is one of the main causes of sudden death in young people. Recent clinical practice guidelines include a risk prediction model for sudden death (HCM Risk-SCD), which facilitates the decision of whether to implant a defibrillator. The aim of our study was to ascertain the percentage of events in our series of primary prevention implantable cardioverter-defibrillator recipients with hypertrophic cardiomyopathy and whether HCM Risk-SCD predicts the onset of arrhythmic events. Methods and results This was an observational, retrospective cohort study, which included 48 primary prevention defibrillator recipient patients with HCM. We compiled their demographic and clinical characteristics, estimated 5-year risk using HCM Risk-SCD, and collected the documentation on arrhythmias during follow-up. The majority was male (66.7%) and mean age at implantation was 44.44 ± 14.46 years. Non-sustained ventricular tachycardia was the most prevalent risk factor (66.67%), followed by a family history of sudden death (47.92%). Mean HCM Risk-SCD was 6.15 ± 5.01%. HCM Risk-SCD was the only factor independently associated with the onset of ventricular tachyarrhythmia, above any other classic risk factor or association [odds ratio = 1.46 (95% confidence interval 1.051–2.013); P = 0.02]. None of the 11 patients estimated as low risk using HCM Risk-SCD suffered any appropriate events ( P < 0.05). Conclusions During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.

Resumen Introduccion y objetivo Realizamos este estudio para conocer si la normalizacion de la funcion ventricular tras terapia de resincronizacion (TRC) es mantenida a largo plazo, y su impacto sobre terapias con desfibrilador (DAI) y mortalidad cardiovascular. Metodos En pacientes con miocardiopatia dilatada idiopatica con DAI-TRC, se analizo la fraccion de eyeccion (FE) basal y tras 6 meses del implante, definiendo un grupo (A) que normalizo la FE (≥ 55%) y un grupo (B) restante, con seguimiento a largo plazo, para conocer la evolucion de la FE en ambos grupos y su impacto clinico-arritmico. Resultados De 47 pacientes incluidos, 10 normalizaron la FE a los 6 meses. Los unicos factores predictores fueron el volumen telesistolico del ventriculo (OR: 0,94; IC 95%: 0,92-0,97) y orificio regurgitante mitral (OR: 0,89; IC 95%: 0,86-0,93). Tras seguimiento ecocardiografico medio de 46 meses los pacientes del grupo A mantuvieron la FE preservada (61 ± 6 vs. 64 ± 6%; p = 0,342), y no presentaron ningun evento arritmico. El grupo B, sin mejoria significativa de la FE, presento mas eventos arritmicos (0 vs. 29,7%; p = 0,039). Ademas, en el grupo A no se registro muerte cardiovascular, frente al grupo B con 12 (0 vs. 32,4%; p = 0,031). Conclusiones La normalizacion de la FE a corto plazo en pacientes con miocardiopatia dilatada idiopatica tras TRC se mantiene en el tiempo, e identifica a pacientes con un excelente pronostico a largo plazo.

Resumen Fundamento y objetivo La enfermedad cardiovascular es la principal causa de morbimortalidad en los paises industrializados. La cuantificacion del calcio arterial coronario (CAC) ha demostrado tener un valor pronostico independiente e incremental con respecto a los factores de riesgo tradicionales para la prediccion de mortalidad y episodios cardiovasculares. El objetivo de nuestro estudio fue determinar la posible relacion entre el CAC y la cistatina C (CTC). Pacientes y metodo Se incluyeron 104 pacientes con dolor toracico estable, libres de enfermedad cardiovascular y nefropatia, con riesgo cardiovascular intermedio, en los que se determinaron el CAC (Agatston) y CTC. Resultados La CTC se asocio de forma independiente respecto a los factores de riesgo clasicos con el nivel de CAC y con la presencia de enfermedad coronaria. Conclusiones Los valores de CTC podrian asociarse con el CAC y con el riesgo de enfermedad coronaria. Es necesaria la aparicion de nuevos estudios para conocer la importancia de estos marcadores en la practica clinica habitual.

Aims We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P

This study analyzed the potential associations of 7 myocardial fibrosis-related microRNAs with the quality of the collagen network (e.g., the degree of collagen fibril cross-linking or CCL) and the enzyme lysyl oxidase (LOX) responsible for CCL in 28 patients with severe aortic stenosis (AS) of whom 46% had a diagnosis of chronic heart failure (HF). MicroRNA expression was analyzed in myocardial and blood samples. From the studied microRNAs only miR-19b presented a direct correlation (p in vitro studies miR-19b inhibition increased (p

IntroductionCardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial.Study designThe AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days.Ethics and disseminationThe institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings.Trial registration numberClinicalTrials.gov:NCT02798276, pre-results.

Resumen Introduccion y objetivos Diversos marcadores neurohormonales (MR-proANP, MR-proADM, endotelina-1 y copeptina) se encuentran elevados en pacientes con insuficiencia cardiaca (IC), teniendo implicaciones diagnosticas y terapeuticas. Se desconoce su reproducibilidad y relacion con los estadios de la IC por disfuncion sistolica. Pacientes y metodo Este estudio pretende estimar la concentracion de estos nuevos biomarcadores en pacientes en diferentes estadios de IC por disfuncion sistolica, y su variabilidad cinetica a traves del tiempo. Se incluyeron 27 pacientes en 3 grupos: a) grupo control sin IC; b) pacientes con un diagnostico de IC estable, sin ingresos en los 3 meses previos, y c) pacientes ingresados por IC descompensada, con 48 h de estabilidad. Resultados La concentracion basal y final de MR-proANP no mostro diferencias significativas en los grupos A (p = 0,401) y B (p = 0,61), existiendo diferencias en el grupo C (p = 0,018). Se encontraron diferencias significativas en la concentracion de MR-proADM basal y final en el grupo C (p = 0,028), sin diferencias en los grupos A (p = 0,78) o B (p = 0,17). La concentracion basal y final de endotelina-1 presento diferencias significativas en el grupo C (p = 0,018), pero no en el A (p = 0,9) o el B (p = 0,7). La concentracion basal y final de copeptina no presento diferencias significativas en ninguno de los 3 grupos. Conclusiones Las concentraciones de MR-proANP, MR-proADM y endotelina-1 tienen una buena reproducibilidad en los diferentes estadios de la IC con disfuncion sistolica, no sucediendo lo mismo con las de copeptina. La variabilidad intra- e interindividual observada en estos biomarcadores fue baja en cada grupo.

Resumen La influencia del genero en el manejo y pronostico del sindrome coronario agudo sin elevacion del segmento ST (SCASEST) es un tema debatido. El objetivo del estudio fue analizar la repercusion del genero en el pronostico del SCASEST, y la influencia en los resultados de una estrategia intervencionista precoz. Para ello se realizo un analisis retrospectivo de 715 pacientes ingresados consecutivamente por SCASEST entre enero de 2004 y diciembre de 2005, con una mediana de seguimiento de 24 meses. Se estudiaron variables pronosticas, realizandose un analisis ajustado de repercusion del genero y del intervencionismo precoz (

Resumen Introduccion Un tercio de los pacientes con estenosis aortica severa sometidos a recambio valvular quirurgico asocian enfermedad coronaria, incrementandose el riesgo de la cirugia. El implante valvular aortico transcateter (TAVI) ha emergido como tratamiento alternativo para los pacientes con estenosis aortica severa y alto riesgo quirurgico. Sin embargo, se conoce poco el efecto de la enfermedad coronaria en estos pacientes. El objetivo fue conocer la prevalencia y el impacto que presenta la enfermedad coronaria en los pacientes sometidos al implante valvular percutaneo. Metodos Entre abril de 2008 y diciembre de 2011 se trataron 230 pacientes con estenosis aortica severa y sintomatica, con alto riesgo quirurgico, con la protesis aortica CoreValve. A todos los pacientes se les realizo una coronariografia previa. Resultados El 36,1% presentaron enfermedad coronaria, predominando varones (60%) y con mayor disfuncion ventricular que los pacientes sin enfermedad coronaria (24% vs. 12%, p = 0,02). No hubo diferencias en la mortalidad hospitalaria (4,1% vs. 7,2%, p = 0,303) al comparar los pacientes con y sin enfermedad coronaria. La supervivencia a los 12 y 24 meses fue ligeramente inferior en los pacientes con enfermedad coronaria (80,9% vs. 91,4% y 72,6% vs. 86,5%, p = 0,048, respectivamente). Los pacientes con enfermedad coronaria revascularizados previamente presentaron una supervivencia ligeramente superior a los pacientes no revascularizados, 82,9% vs. 78,6% a los 12 meses y del 67,2% vs. 61,15% a los 24 meses, p = 0,63. Conclusiones El tratamiento de la enfermedad coronaria en los pacientes con estenosis aortica severa previo al implante de la protesis aortica percutanea CoreValve mejora el pronostico de los mismos a corto y a medio plazo.

ResumenIntroduccion y objetivos La mortalidad por endocarditis infecciosa izquierda continua siendo muy elevada. El objetivo de este estudio es valorar el impacto en la mortalidad precoz de la endocarditis infecciosa izquierda de una estrategia de alerta multidisciplinaria (AMULTEI, basada en la alerta clinica, ecocardiografica y microbiologica) iniciada en 2008 en un centro hospitalario de tercer nivel. Metodos Estudio de cohortes que compara nuestra serie historica (1996-2007) con la serie de pacientes de 2008-2011 diagnosticada de endocarditis izquierda (AMULTEI). Resultados La cohorte AMULTEI incluye a 72 pacientes, frente a los 155 de la cohorte historica. Los pacientes AMULTEI presentaron significativamente mas edad (62,5 frente a 57,9 anos en la cohorte historica; p = 0,047) y mas comorbilidad (indice de Charlson, 3,33 frente a 2,58 en la cohorte historica; p = 0,023). Se observo una tendencia a mas etiologia enterococica (el 20,8% del grupo AMULTEI frente al 11,6% de la cohorte historica; p = 0,067). Se realizo cirugia sin demora durante el ingreso hospitalario mas frecuentemente (el 48,6 frente al 23,2%; p

Introduction and Objectives Mortality from left-sided infective endocarditis remains very high. The aim of this study was to assess the impact of a multidisciplinary alert strategy (AMULTEI), based on clinical, echocardiographic and microbiological findings, implemented in 2008 in a tertiary hospital. Methods Cohort study comparing our historical data series (1996-2007) with the number of patients diagnosed with left-sided endocarditis from 2008-2011 (AMULTEI). Results The AMULTEI cohort included 72 patients who were compared with 155 patients in the historical cohort. AMULTEI patients were significantly older (62.5 vs 57.9 years in the historical cohort; P=.047) and had higher comorbidity (Charlson index, 3.33 vs 2.58 in the historical cohort; P=.023). There was also a trend toward more enterococcal etiology in the AMULTEI group (20.8% vs 11.6% in the historical cohort; P=.067). In the AMULTEI group, early surgery was more frequently performed (48.6% vs 23.2%; P

Resumen Introduccion y objetivos En nuestro medio hay pocos datos sobre los resultados del tratamiento quirurgico de la insuficiencia tricuspidea grave. Nuestro objetivo es analizar los resultados clinicos y ecocardiograficos de nuestra poblacion con insuficiencia tricuspidea grave sometida a cirugia comparandolos segun el tipo de reparacion o de sustitucion valvular. Metodos Realizamos un estudio retrospectivo incluyendo a 119 pacientes consecutivos con insuficiencia tricuspidea grave sometidos a cirugia de dicha valvula entre abril de 1996 y febrero de 2010. Resultados Se realizaron 61 anuloplastias sin anillo y 23 con anillo, y se implantaron 11 protesis biologicas y 24 mecanicas. La mortalidad perioperatoria fue del 18,5%, y se asociaron a ella la edad y el tiempo de circulacion extracorporea. Durante el seguimiento clinico (mediana, 41 [intervalo intercuartilico, 24-89] meses), el grupo anuloplastia con anillo preciso dos reoperaciones, al igual que el grupo de protesis mecanica, en el que se diagnostico trombosis protesica a 4 pacientes. La mortalidad total tras seguimiento fue del 29,9%, y se asociaron a ella la edad > 70 anos y el tiempo de circulacion extracorporea. La aparicion de nueva insuficiencia tricuspidea grave se asocio a la edad y la anuloplastia sin anillo (p = 0,04). Conclusiones La reparacion sin anillo se asocio significativamente con recurrencia de insuficiencia tricuspidea grave. El implante de protesis mecanica se asocio a una elevada tasa de trombosis en el seguimiento. No se encontraron diferencias significativas en la mortalidad perioperatoria o total segun el tipo de reparacion o sustitucion valvular.

Objective Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI). Design Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008). Setting Tertiary hospital centre. Patients 232 patients underwent elective PCI for stable or unstable angina. Interventions Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo. Main outcome measures The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1 year of follow-up. The use of RIP in diabetic patients was specifically studied. Results The mean age was 64.6 years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478 ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907). Conclusions RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.

The NADPH oxidases are a key family of ROS (reactive oxygen species)-producing enzymes which may differentially contribute to cardiac pathophysiology. Animal studies show uncertain results regarding the regulation of cardiac Nox4 by pressure overload and no data are available on human myocardial Nox4. In the present study, we evaluated Nox4 expression and its relationship with myocardial remodelling and LV (left ventricular) function in patients with severe AS (aortic valve stenosis). Endomyocardial biopsies from 34 patients with AS were obtained during aortic valve replacement surgery. LV morphology and function were assessed by echocardiography. Myocardial samples from subjects deceased of non-CVDs (cardiovascular diseases) were analysed as controls. Nox4 localization was evaluated by immunohistochemistry and quantified by Western blot. Myocardial capillary density, fibrosis and cardiomyocyte dimensions and apoptosis were assessed histologically to evaluate myocardial remodelling. Nox4 was present in samples from all subjects and expressed in cardiomyocytes, VSMCs (vascular smooth muscle cells), endothelium and fibroblasts. Nox4 levels were reduced 5-fold in AS patients compared with controls (P

Background Although recent studies indicate that epicardial adipose tissue expresses brown fat-like genes, such as PGC1α, UCP1 and PRDM16, the association of these genes with type 2 diabetes mellitus (DM2) in coronary artery disease (CAD) remains unknown. Methods PGC1α, UCP1, and PRDM16 mRNAs expression levels were measured by real-time PCR in epicardial and thoracic subcutaneous adipose tissue from 44 CAD patients (22 with DM2 [CAD-DM2] and 22 without DM2 [CAD-NDM2]) and 23 non-CAD patients (NCAD). Results The CAD-DM2 patients had significantly lower PGC1α and UCP1 expression in epicardial adipose tissue than the CAD-NDM2 and NCAD patients. However, PGC1α and UCP1 mRNA trended upward in subcutaneous adipose tissue from CAD-DM2 patients. At multiple regression analysis, age, body mass index, left ventricular ejection fraction, UCP1 expression of epicardial adipose tissue and diabetes came out to be independent predictors of PGC1α levels. Epicardial adipose tissue PGC1α expression was dependent on the number of injured coronary arteries and logistic regression analysis showed that PGC1α expression in epicardial adipose tissue could exert a protective effect against coronary lesions. Conclusions DM2 is associated with decreased expression of PGC1α and UCP1 mRNA in epicardial adipose tissue of patients with CAD, likely reflecting a loss of brown-like fat features. Decreased expression of PGC1α in human epicardial adipose tissue is associated with higher prevalence of coronary lesions.

A good design of a photovoltaic power system is based on the use of efficient PV converters and fast and accurate maximum power point tracking (MPPT) algorithms to extract maximum energy from existing irradiance under different weather conditions. The typical configuration of a PV system for PV power plants is to use high-power central inverters (500 kilowatts each typically) and the MPPT method performance becomes critical to achieve maximum efficiency in the overall power system. In this paper, the well-known computer-science field binary search method has been adapted to be used as a MPPT controller for a high-power PV power system. It is demonstrated that the obtained performance is superior in both transient and steady-state conditions compared with the most well-known and simple MPPT techniques.

Aims Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. Methods and results Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16–74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study. All tracings were classified by the same cardiologist, according to the Minnesota Code criteria. The mean age of the sample was 40 years, and 73.4% were male. Frequencies of complete right bundle branch block, complete left bundle branch block, and left ventricular hypertrophy were 1.1, 0.2, and 3.6%, respectively. Major Q wave abnormalities were observed in 1.7% of the subjects, T wave abnormalities in 0.7%, early repolarization in 2.4%, and other ST segment abnormalities in 0.2%. Atrial fibrillation was present in 0.08% of the workers and atrial flutter in 0.02%. Frequencies of the Wolff–Parkinson–White pattern, Brugada pattern, long QT pattern, and short QT pattern were 0.2, 0.068, 0.038, and 0.015%, respectively. Conclusion This study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low.