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Resumen Introduccion En ultimos anos ha surgido el interes por nuevos indices para la valoracion funcional de lesiones coronarias. Nuestro objetivo ha sido analizar la utilidad y la correlacion entre la ratio presion coronaria distal y la presion aortica (Pd/Pa) obtenida tras hiperemia submaxima con contraste no ionico y la FFR con adenosina en una poblacion no seleccionada de pacientes en practica real Material y metodos Estudio multicentrico en el que se incluyo de manera prospectiva a pacientes con lesiones coronarias en los que se considero indicada su valoracion funcional mediante guia de presion midiendose: el cociente en reposo Pd/Pa, la FFR adenosina intracoronaria (IC) y la FFR con contraste (cFFR). Resultados Se incluyo a 70 pacientes (80 lesiones coronarias). Los 2 parametros estudiados mostraron buena correlacion con FFR-adenosina: Pd/Pa (r = 0,82, p 0,92 y > 0,85, mostrando ambos un valor predictivo negativo del 80%, una sensibilidad del 84% y una especificidad del 75 y el 83%, respectivamente. Conclusiones El indice cFFR demostro tener buena capacidad de discriminacion de lesiones funcionalmente significativas tomando como referencia el FFR. Este indice podria eliminar la necesidad de administrar adenosina en algunos casos, reduciendo tanto costes como tiempo de procedimiento.

Inconsistencies between gradients and aortic valve area are frequent in the echocardiographic evaluation of aortic stenosis (AS). Assessing AS severity is essential for the correct management of the disease. The aim of this study was to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), could be diagnostic parameters in patients with AS.Patients with AS (aortic peak velocity 2 m/sec) were prospectively enrolled. Quantitative echocardiographic Doppler parameters including ejection dynamics (AT, ET, and AT/ET ratio) as well as conventional and clinical parameters were analyzed. AT, ET, and AT/ET ratio were calculated in different stages of AS. A receiver operating characteristic curve was plotted to determine the best cutoff value to identify severe AS.Two hundred sixty-two patients were included (mean age, 75 ± 8 years; 54% women), of whom 109 (42%) had severe AS, 99 (38%) had moderate AS, 22 (8%) had mild AS, 24 (9%) had classical low-flow, low-gradient severe AS, and eight (3%) had paradoxical low-flow, low-gradient severe AS. AT was higher in patients with higher levels of severity of AS (65 ± 16 vs 82 ± 19 vs 109 ± 23 msec, P .001) as well as AT/ET ratios (0.22 ± 0.05 vs 0.29 ± 0.07 vs 0.37 ± 0.06, P .001). Using a cutoff of 94 msec, AT had sensitivity of 71% and specificity of 81% for severe AS; using a cutoff of 0.35, the AT/ET ratio had sensitivity of 59% and specificity of 86%. On multivariate analysis, AT was associated with effective orifice area (B = -0.64, P .001) and ET with heart rate (B = -0.62, P .001) and age (B = 0.30, P = .04).Ejection dynamics parameters, such as AT and AT/ET, can help evaluate AS severity.

Objectives and background Patients with aortic stenosis (AS) may have impaired coronary flow reserve (CFR) despite angiographically normal coronary arteries. This is the first report of invasive thermodilution-derived CFR and IMR in patients with AS and their associations with echocardiographic parameters for AS assessment. Methods Thirty-six consecutive severe AS patients and ten patients without AS underwent prospectively cardiac catheterization and coronary physiological parameters were determined in the left anterior descending (LAD). Mean transit time (Tmn), a surrogate of absolute coronary flow, was obtained from the coronary thermodilution curve. Results In AS patients we found a high LAD flow at rest (Tmn rest 0.55±0.3 vs 0.99±0.4, p=0.01) and a low flow at hyperemia (Tmn hyp 0.44±0.2 vs 27.7±0.1, p=0.02) and consequently a severe CFR impairment (1.4±0.4 vs 3.8±1.4, p In AS patients there were significant correlations between CFR and left ventricular mass index (r=−0.32; p=0.02), and the ratio of acceleration time to ejection time (AT/ET) (r=−0.4; p=0.01) a non-flow dependent echocardiographic parameter for AS assessment. Multiple linear stepwise regression analysis showed that AT/ET (β=−0.441, p=0.019) was the only independently variable associated with CFR Conclusions In severe AS, invasive CFR shows a progressive decrease with AS severity and a good correlation with echocardiographic parameters of AS, especially with flow-independent ones.

Background: In the COVID-19 pandemic, elderly people with cardiovascular risk factors and/or cardiovascular disease have been the most seriously affected We sought to evaluate the impact of the pandemic, due to both the social confinement and the infection itself, in the population of patients older than 75 years of age with previous percutaneous coronary revascularization Methods: A subgroup of patients from the SIERRA 75 registry were included in the study This is a prospective registry of patients older than 75 years undergoing percutaneous revascularization in 42 centers in Spain and Portugal The follow-up of the patients has been updated, covering the entire period of outbreak and confinement (March 14 to May 10) through direct telephone contact to carry out a specific questionnaire for patients and their relatives In addition, all electronic health records have been reviewed Results: A total of 709 patients have been included Among those, 17 had died in the 12 5 ± 3 4 months follow-up prior to the start of the outbreak-confinement period Therefore, 692 patients were followed during the study period: (mean age of 80 8 ± 4 2 years, 37% were women, 83% with hypertension, 44% with diabetes, 75% with previous STEMI/NSTEMI, 100% with previous PCI) During this period, 11 (1 6%) had confirmed COVID-19 (age 81 2 ± 5 years, 36% women) Eight were admitted to the hospital but none in the ICU Among the 11 cases, 2 (18%) died, an 80-year-old man and a 76-year-old woman, both in the hospital COVID-19 incidence was higher than in the global population in the region (1 6% vs 0 4%;p < 0 0001) During this period of confinement, 91 patients (13%) presented cardiac symptoms (21 stable angina, 82 dyspnea and 6 syncope) Medical attention was demanded by 43 (6 2%), of whom 22 were admitted to the hospital There were 4 (0 6%) cases with acute coronary syndrome and 4 (0 6%) underwent revascularization Death was reported in 7 (1%) patients (2 due to COVID-19, 4 due to cardiovascular disease, and 1 due to multiple pathologies) The monthly mortality rate in this period was 2 6 times higher than in the previous months Outpatient visits were canceled in 119 cases (17%) but 108 were contacted by phone Conclusion: In this elderly population with coronary artery disease revascularized before the pandemic, an increase in cardiovascular and general morbidity as well as in total mortality was observed during the outbreak and confinement Incidence of COVID-19 was higher than in the general population Mortality among COVID-19 patients was very high Categories Other: COVID-19

Resumen El tratamiento percutaneo de bioprotesis aorticas degeneradas se esta asentando como una opcion valida en pacientes inoperables. Sin embargo, la experiencia con homoinjertos aorticos (HIA) es aun escasa. Presentamos el caso de una paciente con un HIA disfuncionante, tratada con exito mediante la implantacion de una protesis auto-expandible CoreValve® Evolut® R.

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%–70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%–90.1%; P Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.

Patent foramen ovale (PFO) usually represents a benign incidental finding. Occasionally, a PFO can open widely, resulting in paradoxical embolism, with potentially devastating consequence. Floating intracardiac thrombi and thrombus straddling a PFO are 2 extremely rare conditions associated with a dismal prognosis and encountered almost exclusively in the setting of pulmonary embolism (PE). We report the unusual case of a 47-year-old man with an unremarkable medical history who presented with a bilateral PE and multiple paradoxical and intracardiac floating thrombi in the setting of a thrombus entrapped in a PFO.

Objectives We aim to evaluate the long-term efficacy of two different paclitaxel-coated balloons (PCBs) for the treatment of coronary in-stent restenosis (ISR). Methods Between February 2011 and February 2012, all consecutive patients with ISR lesions treated with the SeQuent® Please (B. Braun, Melsungen, Germany) PCB or with the DIOR® (Eurocor GmbH, Bonn, Germany) PCB at our institution were prospectively included and followed up for 36 months by clinical observation. The primary endpoint was the clinically driven target lesion revascularization (TLR) rate at 36 months. Results 65 patients with 74 ISR lesions were included. 43 ISR lesions were treated with the SeQuent® Please PCB and 31 with the DIOR® PCB. Baseline clinical, lesion characteristics and procedural data did not significantly differ between the groups. The TLR rate was significantly lower in patients treated with the SeQuent® Please PCB compared with the DIOR® PCB (4.7% vs. 22. 6%, p = 0.03) at 36 months. Conclusions This registry suggests that there are differences in terms of TLR between two clinically available PCBs. The SeQuent® Please PCB demonstrated lower TLR rate compared to the DIOR® PCB at 36 months follow up.

Background: In the coronavirus disease-2019 (COVID-19) pandemic, elderly people with cardiovascular risk factors and/or cardiovascular disease have been the most seriously affected We sought to evaluate the impact of the pandemic, due to both the social confinement and the infection itself, in the population of patients older than 75 years of age with previous percutaneous coronary revascularization Methods: A subgroup of patients from the SIERRA 75 registry were included in the study This is a prospective registry of patients older than 75 years undergoing percutaneous revascularization in 42 centers in Spain and Portugal The follow-up of the patients has been updated, covering the entire period of outbreak and confinement (March 14–May 10, 2020) through direct telephone contact to carry out a specific questionnaire for patients and their relatives In addition, all electronic health records have been reviewed Results: A total of 709 patients have been included, of whom 17 had died in the 12 5 ± 3 4 months follow-up before the start of the outbreak and lockdown Therefore, 692 patients were followed during the study period (mean age of 80 8 ± 4 2 years, 37% women) During this period, 11 (1 6%) had confirmed COVID-19 (age 81 2 ± 5 years, 36% women) of which 8 were admitted to the hospital but none in the intensive care unit Among the 11 cases, 2 (18%) died, an 80-year-old man and a 76-year-old woman, both in Hospital COVID-19 incidence was higher than in the global population in the region (1 6% vs 0 4%;p < 0 0001) During this period of confinement, 91 patients (13%) presented cardiac symptoms (21 stable angina, 82 dyspnea, and 6 syncope) Medical attention was demanded by 43 (6 2%), of whom 22 were admitted in hospitals There were 4 cases with acute coronary syndrome and 4 underwent revascularization Death was reported in 7 (1%) patients (2 due to COVID-19, 4 due to cardiovascular disease, and 1 due to multiple pathologies) The monthly mortality rate in this period was 2 6 times higher than in the previous months Outpatient visits were canceled in 119 cases (17%) but 108 were contacted by phone Conclusion: In this elderly population with coronary artery disease revascularized before the pandemic, an increase in cardiovascular and general morbidity as well as in total mortality was observed during the outbreak and confinement period Incidence of COVID-19 was higher than in the general population Mortality among COVID-19 patients was very high Categories: OTHER: COVID-19

Resumen Introduccion y objetivos La pericarditis es una entidad frecuente y supone el 5% de las consultas de urgencias. Entre el 15 y el 35% presentan elevacion de biomarcadores cardiacos (miopericarditis). Analizamos las caracteristicas y la evolucion de los pacientes ingresados por miopericarditis en nuestro centro. Material y metodos Se trata de un estudio retrospectivo, observacional y monocentrico en el que se incluyeron los pacientes ingresados por miopericarditis aguda de origen virico o idiopatico entre 2001 y 2011. Se registraron parametros clinicos, electrocardiograficos, ecocardiograficos y su evolucion. Resultados Se incluyeron 66 pacientes (95% varones, edad media 29,8 ± 9,7 anos). El sintoma guia fue dolor toracico en el 98% de los casos, detectandose fiebre en el 48%. Se objetivaron alteraciones electrocardiograficas en el 98%, derrame pericardico en el 14%, con un caso de derrame severo. El 92,4% de los pacientes fueron tratados con antiinflamatorios no esteroideos. Tras un seguimiento medio de 50 meses la tasa de recurrencias fue del 10,3%, sin casos de miocardiopatia dilatada o pericarditis constrictiva. Un paciente sufrio taponamiento cardiaco y solo hubo un caso de muerte cardiaca intrahospitalaria, sin otras muertes en el seguimiento. Conclusiones La miopericarditis es una entidad que afecta predominantemente a varones jovenes. Su pronostico a largo plazo es excelente, y la complicacion mas frecuente es la pericarditis recurrente.

A new collagen-based MANTA vascular closure device (VCD) was developed for closing large-bore arteriotomies after transfemoral transcatheter aortic valve replacement (TAVR). We evaluated safety and feasibility in terms of vascular complications, bleeding, and 30-day outcomes of the collagen-based

Fractional flow reserve (FFR) is the gold standard for assessing the physiological significance of coronary disease during invasive angiography. Evaluation of alternative adenosine-free indexes to elucidate ischemic predicament is ongoing. A total of 255 lesions evaluated with pressure wires in 212

We hypothesized that good coronary collateral circulation(CCC) may be related to myocardial viability and left ventricular ejection fraction (LVEF) in late presenter myocardial infarction (MI) patients (>24h). Ambispective multicenter study on 190 patients with a late presentation MI and