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Limited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure.

Los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT2) han demostrado su beneficio cardiovascular y renal en pacientes con diabetes mellitus tipo 2, insuficiencia cardiaca (IC) o enfermedad renal crónica (ERC). Desde los primeros estudios, con estos fármacos se objetivó un incremento inicial de los niveles de hemoglobina/hematocrito que se atribuyó a un aumento de la hemoconcentración asociados a su efecto diurético, aunque pronto se constató que aumentaban los niveles de eritropoyetina (EPO) y eritropoyesis, mejorando el metabolismo férrico. Los estudios de mediación objetivaron que el incremento de hemoglobina se asociaba estrechamente con los beneficios cardiorrenales de estas sustancias. En la presente revisión se discuten los mecanismos de mejora de la eritropoyesis y la implicación del aumento de hemoglobina sobre el beneficio pronóstico cardiorrenal de estos medicamentos.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits in patients with type 2 diabetes mellitus, heart failure, or chronic kidney disease. Since the first studies with these drugs, an initial increase in hemoglobin/hematocrit levels was observed, which was attributed to an increase in hemoconcentration associated with its diuretic effect, although it was early appearent that these drugs increased erythropoietin levels and erythropoiesis, and improved iron metabolism. Mediation studies found that the increase in hemoglobin was strongly associated with the cardiorenal benefits of these drugs. In this review, we discuss the mechanisms for improving erythropoiesis and the implication of the increase in hemoglobin on the cardiorenal prognostic benefit of these drugs.

Beta-adrenergic receptor blockers (beta-blockers) are frequently used for patients with heart failure (HF) with preserved ejection fraction (HFpEF), although evidence-based recommendations for this indication are still lacking. Our goal was to assess which clinical factors are associated with the prescription of beta-blockers in patients discharged after an episode of HFpEF decompensation, and the clinical outcomes of these patients.

ABSTRACTIntroductionDespite the relevant advances achieved thanks to the traditional step-by-step therapeutic approach, heart failure with reduced ejection fraction (HFrEF) remains associated with considerable morbidity and mortality. The pathogenesis of HFrEF is complex, with the implication of various neurohormonal systems, including activation of deleterious pathways (i.e. renin-angiotensin-aldosterone, sympathetic, and sodium-glucose cotransporter-2 [SGLT2] systems) and the inhibition of protective pathways (i.e. natriuretic peptides and the guanylate cyclase system). Therefore, the burden of HF can only be reduced through a comprehensive approach that involves all evidence-based use of available HF drugs targeting the neurohormonal systems involved.Areas coveredWe performed a critical analysis of evidence from recent clinical trials and assessed the effects of HF therapies on hemodynamics and renal function.Expert opinionHF therapy must be adapted to the clinical profile (i.e. congestion, blood pressure, heart rate, renal function, and electrolytes). Consequently, blood pressure is reduced by beta blockers, renin-angiotensin-aldosterone system inhibitors, sacubitril/valsartan, and, minimally, by SGLT2 inhibitors and vericiguat; heart rate decreases with beta blockers and ivabradine; and renal function is impaired and potassium are levels increased with renin-angiotensin-aldosterone system inhibitors and sacubitril/valsartan. Practical recommendations on how to individualize HF therapy according to patient profile are provided.

Graphical AbstractIn the context of acute heart failure, patients with intraabdominal hypertension (>12 mmHg), showed higher levels of CA125 at admission. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP.

Lipases are ubiquitously used in chemo-enzymatic synthesis and industrial applications. Nevertheless, the modulation of the activity of lipases by organic solvents still is not fully understood at the molecular level. We systematically investigated the activity and structure of lipase A from Bacillus subtilisin binary water–organic solvent mixtures of dimethyl sulfoxide (DMSO), acetonitrile (ACN), and isopropyl alcohol (IPA) using activity assays, fluorescence spectroscopy, molecular dynamics (MD) simulations, and FRET/MD analysis. The enzymatic activity strongly depended on the type and amount of organic solvent in the reaction media. Whereas IPA and ACN reduced the activity of the enzyme, small concentrations of DMSO led to lipase activation via an uncompetitive mechanism. DMSO molecules did not directly interfere with the binding of the substrate in the active site, contrary to what is known for other solvents and enzymes. We propose that the His156-Asp133 interaction, the binding of organic molecules to the active site, and the water accessibility of the substrate are key factors modulating the catalytic activity. Furthermore, we rationalized the role of solvent descriptors on the regulation of enzymatic activity in mixtures with low concentrations of the organic molecule, with prospective implications for the optimization of biocatalytic processes via solvent tuning.

Pineapple shell, considered a waste in the juice industry, was used as a reinforcement material to produce biodegradable foam trays (FTs) based on cassava starch by a compression molding process. These foams were prepared with different starch/fiber ratios and then were characterized according to their microstructure and physical and mechanical properties. The starch/fiber ratio of 95/5 showed the lowest values of thickness and density (2.58 mm and 367 kg m−3, respectively). There was a good distribution of the pineapple shell fiber throughout the polymeric matrix. All FTs showed a semicrystalline structure and 95/5 ratio showed the highest crystallinity index (CI) value (39%). In addition, this ratio improved the tensile strength of the FTs, obtaining similar values to expanded polystyrene (EPS) samples, used as the reference material. Nevertheless, all FTs reinforced with pineapple shell fiber showed high water absorption capacity (WAC); therefore, future studies should focus on to improve the physicochemical and structural properties of the cassava starch-based foams, considering the promising potential of this novel biodegradable material for dry food packaging, such as a viable alternative to reduce the use of petroleum-based materials such as commercial EPS trays.

Para lograr el éxito del dispositivo, se recomienda cierto sobredimensionamiento de la prótesis (SP) SAPIEN 3. Sin embargo, un aumento en el SP puede incrementar las tasas de implante de marcapasos definitivo (IMD). Por lo tanto, se investiga la influencia del SP en el fallo del dispositivo y el IMD.

La disfunción renal es común en pacientes con insuficiencia cardiaca (IC) que aumenta a medida que disminuye el filtrado glomerular estimado. Además, tiene implicaciones en el pronóstico del paciente con IC. Las recomendaciones de tratamiento de pacientes con IC y enfermedad renal crónica (ERC) concomitante no difieren, en general, de las de los pacientes con función renal normal. Pero los pacientes con enfermedad renal moderada o grave han sido excluidos de la mayoría de los ensayos clínicos, y faltan evidencia y seguridad en los tratamientos que aplicar a estos pacientes. En este artículo se analizan las evidencias existentes de los diferentes tratamientos de la IC en pacientes con ERC moderada o grave, incluidas las terapias con ultrafiltración mediante diálisis peritoneal, así como complicaciones del tratamiento como la hiperpotasemia y el deterioro en la función renal.

Introdução: O benefício de uma revascularização completa (RC) em termos de redução total de eventos a longo prazo em doentes com enfarte agudo do miocárdio com elevação do segmento ST (EAMCST) e doença coronária multivaso (DCM), ainda não está claro. Avaliamos a eficácia de três estratégias diferentes de revascularização em eventos recorrentes totais a longo prazo.

La obstrucción microvascular produce efectos nocivos después del infarto de miocardio. Con objeto de esclarecer el papel de la lesión por isquemia-reperfusión en la aparición y la dinámica de la obstrucción microvascular, se llevó a cabo un estudio metodológico preliminar para definir con exactitud este proceso en un modelo in vivo.

This study sought to examine the prognostic value of the soluble form of neprilysin (sNEP) in acute heart failure (AHF) and sNEP kinetics during hospital admission.

Background: Acute glycometabolic derangement in non-diabetic patients with acute myocardial infarction (AMI) has been reported with discrepant prognostic results. The aim of the present study was to assess the prognostic impact of glycated haemoglobin (HbA1c) levels, reflecting long-term glycometabolic disturbance, in a population of patients without known diabetes mellitus.Methods: We examined 601 consecutive prospective patients diagnosed with AMI and unknown diabetes mellitus. We analysed metabolic function as a stratified variable using three groups of patients according to HbA1c: Group 1 (< 5.5%): 222 patients (37%); Group 2 (5.5 to 6.4%): 337 patients (56%); Group 3 (>6.4%): 42 patients (7%). Association between HbA1c groups and classic cardiovascular risk factor and in-hospital outcomes were assessed through univariate and multivariate analysis.Results: In-hospital mortality was 5% (32/601 patients). Higher HbA1c was associated with poor glycometabolic control, older patients, obesity, hypertension, Killip’s class>1, increased heart rate, initial bundle branch block, atrial fibrillation and higher mortality during follow-up. In a multivariate adjusted risk, in-hospital mortality was associated with age (odds ratio (OR)= 1.056; 1–1.1; p=0.006), Killip’s class>1 (OR=2.4; 1–6.1; p=0.05) and HbA1c (OR=1.5; 1.15–1.9; p=0.002). Hypertension (OR=0.39; 0.18–0.87; p=0.022) and angiotensin-converting enzyme inhibitors (OR=0.28; 0.12–0.69; p=0.005) were protective factors.Conclusions: HbA1c is an important risk marker in the absence of a history of diabetes mellitus in patients with AMI. The optimal management strategy in these patients may contribute to decreased in-hospital mortality.

No se conoce el valor pronóstico incremental que aporta la isquemia miocárdica inducible respecto a la necrosis determinada por resonancia magnética cardiaca de estrés en pacientes con función ventricular izquierda deprimida. Se determina el valor pronóstico de la necrosis y la isquemia en pacientes con función ventricular izquierda deprimida remitidos a exploración por resonancia magnética de estrés con perfusión de dipiridamol.

Infarct size (IS) determined by cardiac magnetic resonance (CMR) has proven an additional value, on top of left ventricular ejection fraction (LVEF), in prediction of adverse arrhythmic cardiac events (AACEs) in chronic ischemic heart disease. Its value soon after an acute ST-segment–elevation myocardial infarction remains unknown. Our aim was to determine whether early CMR can improve AACE risk prediction after acute ST-segment–elevation myocardial infarction.

To determine the effects of long-term nocturnal intermittent positive-pressure ventilation (NIPPV) on symptoms, pulmonary function test results, sleep, and respiratory muscle performance in patients with ventilatory insufficiency due to severe kyphoscoliosis.