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Aim: To analyze the frequency and variables related to inappropriate rivaroxaban dosage in clinical practice and its impact on outcomes after 2 years. Materials & methods: Postauthorization, observational, multicenter study, in which atrial fibrillation patients, treated with rivaroxaban ≥6 months were included. Results: A total of 1421 patients (74.2 ± 9.7 years, CHA 2 DS 2 -VASc 3.5 ± 1.6) were included. Overall, 22.9% received rivaroxaban 15 mg. The proper dose of rivaroxaban was taken by 83.3% (9.7% underdosed, 7.0% overdosed). Older age and renal insufficiency were associated with inadequate rivaroxaban dosage. There was a trend toward higher all-cause mortality among underdosed patients (adjusted hazard ratio 1.39; 95% CI 0.75–2.58), and more bleedings in overdosed patients (2.29 vs 0.80 events/100 patient-years; p = 0.14). Conclusion: In clinical practice, rivaroxaban is properly dosed in most patients.

International audience; Aims: Despite the use of rotational atherectomy (RA) in interventional cardiology for over three decades, data regarding factors affecting the clinical outcomes of the RA procedure remain scarce. The aim of the present study was to describe the contemporary use and outcomes of RA in Europe.Methods and results: We conducted, for the first time, a prospective international registry in 8 European countries and 19 centres and included patients treated by percutaneous coronary intervention with RA. Between October 2016 and July 2018, 966 patients with complete data were recruited. Mean age was 74.5 years, 72.4% were male and 43.4% had diabetes. Initial presentation was an acute coronary syndrome (ACS) for 25.1% of the patients. Clinical success was observed in 91.9% of the procedures. The rate of in-hospital major adverse cardiac events (MACE) - defined as cardiovascular death, myocardial infarction, target lesion revascularisation, stroke and coronary artery bypass grafting - was 4.7%. At one year, the rate of MACE was 13.2%. Factors independently associated with the occurrence of MACE at one year were female gender, renal failure, ACS at admission, depressed left ventricular ejection fraction (LVEF) and presence of a significant left main coronary artery (LMCA) lesion.Conclusions: Despite the high level of complexity of the studied population, RA turned out to be an effective procedure with a low rate of in-hospital complications and demonstrated good immediate and midterm results.

Prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) assays have been assessed in selected populations in different studies and in registries of members of the general population with low cardiovascular risk. The aim of this study was to determine the prognostic value of hs-cTnT in an asymptomatic very-high cardiovascular risk Spanish population.From a previous prospective cohort of the TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow-up was conducted in 602 patients (93.18%). The association of high hs-cTnT (≥99th percentile value) and incidence of primary event was studied. A primary event was defined as a combined major cardiovascular event (incidence of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction, or coronary revascularization). The association between high hs-cTnT and incidence of secondary events was studied as well.In patients with high hs-cTnT, the incidence of primary event during follow-up was significantly higher (18.30% vs 3.67% P.001): heart failure (6.25% vs 0.73% P.001), cardiovascular death (7.29% vs 0.00% P.001), and death from any cause (7.81% vs 0.98% P.001).In an asymptomatic very-high cardiovascular risk Spanish population, elevated hs-cTnT was significantly associated with incident major cardiovascular combined end point and incidence of heart failure, cardiovascular death, and death from any cause.

Background Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3–12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. Methods and results The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004–2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. Conclusions Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.

High-sensitivity troponin T assays (Hs-TnT) have been carried out in selected populations in clinical trials and in registries of the general population with low cardiovascular risk (CVR). The aim of this study was to determine the proportion of individuals with detectable Hs-TnT and the proportion of individuals with elevated Hs-TnT in a Spanish population of asymptomatic individuals with very high CVR, as well as the parameters associated with Hs-TnT elevation.The study included 690 patients. Hs-TnT detection and Hs-TnT elevation (≥99th percentile value), as well the association of elevated Hs-TnT and clinical, analytical, and treatment data were analyzed.Hs-TnT was analyzed in 646 patients and was detected in 645. Elevated TnT was detected in 212 patients (32.9%). On multivariate analysis, elevated TnT was independently associated with male sex (OR, 2.81; 95%CI, 1.67-4.73; P .001), older age (OR, 1.06; 95%CI, 1.04-1.09; P .001), a higher body mass index (OR, 1.07; 95%CI, 1.02-1.12; P .002), insulin therapy (OR, 1.99; 95%CI, 1.15-3.46; P = .01), history of heart failure (OR, 3.92; 95%CI, 1.24-12.39; P = .02), and estimated glomerular filtration rate calculated by CKD-EPI (OR, 0.96; 95%CI, 0.95-0.97; P .001).In a Spanish population of asymptomatic individuals at very high CVR, Hs-TnT was associated with older age, male sex, higher body mass index, insulin therapy, history of heart failure, and lower glomerular filtration rate.

Resumen Introduccion y objetivos La troponina T ultrasensible (TnT-us) se ha cuantificado en poblaciones de ensayos clinicos y en registros poblacionales de bajo riesgo cardiovascular (RCV). El objetivo del estudio es determinar en que proporcion de la poblacion espanola asintomatica de muy alto RCV se puede cuantificar la TnT-us, que proporcion presenta TnT-us elevada y que variables se asocian con la presencia de TnT-us elevada. Metodos Se incluyo a 690 pacientes. Se analizo la deteccion de la TnT-us y de la TnT-us elevada (≥ percentil 99 de referencia) y su asociacion con las diferentes variables recogidas. Resultados Se analizo la TnT-us en 646 pacientes y se detecto en 645. Presentaron TnT-us elevada 212 pacientes (32,9%). En el analisis multivariable, la TnT-us elevada se asocio al sexo masculino (OR = 2,81; IC95%, 1,67-4,73; p Conclusiones En una poblacion espanola asintomatica de muy alto RCV, la TnT-us se detecto practicamente en todos los pacientes, y estaba elevada en un tercio de ellos. La TnT-us elevada se asocio a mayor edad, el sexo masculino, el indice de masa corporal, la insuficiencia cardiaca previa, el tratamiento con insulina y un menor filtrado glomerular.

PhDObjective: To explore the variations of brain natriuretic peptide (BNP) secretion afterleft atrial appendage occlusion. Background: Left atrial appendage occlusion hasbeen increasingly performed in the last few years, however little is known about thephysiological consequences of left atrial appendage occlusion. Left atrial appendageregulates partially intravascular volume via release of brain natriuretic peptide. Brainnatriuretic peptide levels have been related to increased risk of stroke in atrial fibrilla-tion patients. Methods: Venous blood samples were obtained in consecutive patientsundergoing left atrial appendage occlusion before, 24 hr after device implantation andat the first visit after discharge (45–60 days) for BNP measurement. Results: Left atrialappendage occlusion was performed in 34 patients with non-valvular atrial fibrillationand contraindication to long-term oral anticoagulation or at high-risk of bleeding.There were no differences in BNP levels between baseline and 24 hr after deviceimplantation. However left atrial appendage closure resulted in a significant decreasein BNP levels at the first follow-up visit (45–60 days) compared to baseline measure-ments (759.90 pg ml

To explore the variations of brain natriuretic peptide (BNP) secretion after left atrial appendage occlusion.Left atrial appendage occlusion has been increasingly performed in the last few years, however little is known about the physiological consequences of left atrial appendage occlusion. Left atrial appendage regulates partially intravascular volume via release of brain natriuretic peptide. Brain natriuretic peptide levels have been related to increased risk of stroke in atrial fibrillation patients.Venous blood samples were obtained in consecutive patients undergoing left atrial appendage occlusion before, 24 hr after device implantation and at the first visit after discharge (45-60 days) for BNP measurement.Left atrial appendage occlusion was performed in 34 patients with non-valvular atrial fibrillation and contraindication to long-term oral anticoagulation or at high-risk of bleeding. There were no differences in BNP levels between baseline and 24 hr after device implantation. However left atrial appendage closure resulted in a significant decrease in BNP levels at the first follow-up visit (45-60 days) compared to baseline measurements (759.90 pg ml(-1) vs. 636.90 pg ml(-1) , P = 0.013).Left atrial appendage occlusion modifies BNP levels. These levels decrease after left atrial appendage occlusion. The clinical consequences of these findings need to be evaluated in further studies. © 2015 Wiley Periodicals, Inc.

J Thorac Cardiovasc Surg Jesus Herreros Gonzalez Palazuelos Molinero, Jose Daniel Saenz de Buruaga, Alejandro Martin Trenor and Diego Martin Raymondi, Sergio Mejia Viana, Alejandro Berenguel Senen, Jorge anomalous coronary origin Supravalvular pulmonary stenosis as a late complication of surgery for http://jtcs.ctsnetjournals.org/cgi/content/full/123/6/1218 located on the World Wide Web at: The online version of this article, along with updated information and services, is

Clinical Summary A 116-year-old woman came to the emergency department 36 hours after a closed thoracic trauma that had occurred when she was dropped from her horse and then was trodden on by her horse. Acute dyspnea and concomitant hemoptysis were her reasons for seeking treatment. Physical examination showed a pulse of 130 beats/min and blood pressure of 95/45 mm Hg, paleness, and erosions over the skin in the image of a horseshoe. The heart had a normal S1 and S2 sounds and grade 6/6 holosystolic murmur at the left bottom sternal border irradiating to the right bottom sternal border. There was bibasal hypoventilation with a tubaric murmur on the right thorax. Electrocardiography demonstrated elevation of the ST segment in the right leads. Biochemical testing showed a hemoglobin level of 10.3 g/dL, total creatine kinase of 222 IU/L, MB isoenzyme of creatine kinase of 7.8 (index 3.5%), and cardiac troponin I level of 13.10 ng/mL. Chest radiography (Figure 1) showed a normal cardiac size, Kerley B lines, pulmonary congestion, and bilateral pleural effusion. Computed tomographic scan showed multiple rib fractures, pulmonary contusion, and pericardial effusion. These data were compatible with a ventricular septal defect. An echocardiogram was therefore performed (Figure 2). On transthoracic apical 4-chamber view, the ventricles appeared dilated and dysfunctional and demonstrated a ventricular septal