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Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted. The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01-1.06, p = 0.016). Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.

The acquisition of competencies is essential in clinically relevant areas such as cardiovascular pathology. This study aims to assess the acquisition of the main competencies regarding the cardiovascular system by medical students, as well as their self-perception, and the relation with regular lecture attendance and academic performance. In order to achieve this aim, data were remotely obtained from 142 students in the fourth, fifth and sixth year of Medicine Degree at University of Málaga using an author-made questionnaire (0-15 points) with multiple-choice questions based on clinical situations and a self-evaluation survey about competencies. Analyzing the results, the competencies that were considered as acquired by the largest and the lowest number of students were, respectively, the handling of cardiovascular risk factors (100%) and cardiopulmonary auscultation (38.3%), respectively. Better results were obtained by students who regularly attended lectures (11.28±1.84 vs 9.54±2.45; p La adquisición de competencias resulta fundamental en ámbitos tan relevantes clínicamente como la patología cardiovascular. Este estudio pretende valorar la adquisición por parte de estudiantes de Medicina de las principales competencias respecto al sistema cardiovascular, así como su autopercepción y la relación con la asistencia presencial y el rendimiento académico. Para lograr este objetivo, se analizaron los datos obtenidos mediante la cumplimentación telemática por parte de 142 estudiantes de cuarto, quinto y sexto curso del Grado en Medicina de la Universidad de Málaga de un cuestionario de elaboración propia (0-15 puntos) con preguntas de elección múltiple basadas en situaciones clínicas y una autoevaluación sobre competencias. Analizando los resultados, las competencias consideradas como adquiridas por un mayor y menor número de estudiantes fueron, respectivamente, el manejo de los factores de riesgo cardiovascular (100%) y la auscultación cardiopulmonar (38,3%). Se obtuvieron mejores resultados en estudiantes que asistieron a clase (11,28±1,84 vs 9,54±2,45; p

Pulmonary vein (PV) isolation is a well-established rhythm control therapy in atrial fibrillation (AF). Currently, there is no consensus on which ablation technique to use for the first procedure, cryoballoon (CB) or radiofrequency (RF). A retrospective cohort study was conducted on 1055 patients who underwent a first ablation, to assess both techniques based on the need for reablation. Patients with CB (n = 557) and RF (n = 498) ablations were clinically characterized and the need for reablation during a 30-month follow-up was used as the primary endpoint. Independent variables were analyzed to identify potential predictors. The need for reablation was significantly lower in the CB group than in the RF group (hazard ratio = 0.45 and 95% confident interval = 0.32–0.61; p < 0.001); in both paroxysmal and persistent AF, using a full-adjusted regression Cox model by age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, severe obstructive sleep apnea, dilated left atrium, persistent AF and early recurrence. RF ablation, dilated left atrium, persistent AF and early recurrence were identified as independent predictors of reablation. In addition, the CB-redo subgroup had a lower PV reconnection than the RF-redo subgroup. In conclusion, CB ablation suggests a reduction in the need for reablation and lower PV reconnection during the follow-up than RF ablation.

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

Background: Currently, studies are underway to determine whether coronary stent implantation with percutaneous transluminal coronary angioplasty before a coronary artery bypass graft (CABG) influences the prognosis of surgery. This study aimed to assess the need for future revascularisation or all-cause mortality as a composite endpoint after CABG surgery among patients with previous stent implantation. Methods: A retrospective, non-randomised study was performed on 721 patients who underwent CABGin our centre between 2012 and 2017. This single-centre study compared two groups: 1) the previous stent group, patients with previous stent implantation (n=144), and 2) the non-previous stent group, patients without previous stent implantation (n=577). Results: After a median follow-up of 36 months, the previous stent group presented a decreased combined event-free survival at 1, 3 and 5 years compared with the non-previous stent group (67.4, 43.5 and 23.0% vs. 91.0, 80.3 and 63.0%, respectively; p Conclusions: Patients with percutaneous coronary intervention before CABG present higher comorbidities and clinical events during follow-up than those who do not undergo stenting.

IntroductionThe incidence of acute coronary syndrome is rising in step with the growth of life expectancy. An increase in the age of patients with coronary artery disease has been related to in-hospital mortality, which has seen an upsurge over a short period of time. However, there is no consensus about the percutaneous coronary angioplasty strategy to follow for older patients with multivessel coronary artery disease (MVCAD). Complete revascularisation (CR) or incomplete revascularisation (ICR) strategy depends on prognosis but this has not yet been accurately described because of geriatric conditions and comorbidities. The aim of this study is to evaluate changes of clinical and biochemical parameters in older patients with MVCAD undergoing revascularisation and to establish a prognostic stratification model for CR and ICR.Methods and analysisThis observational, longitudinal, prospective study will include 150 patients with MVCAD and subsequent revascularisation who attend the Hospital Universitario Virgen de la Victoria (Málaga, Spain). Because of the dropout rates, 180 patients will be recruited at the beginning. Sociodemographic characteristics, clinical and angiographic parameters, and biochemical variables, such as cardiovascular, metabolic, inflammatory, stress oxidative biomarkers, will be collected in the admission for coronary revascularisation and three follow-ups at 6, 12 and 18 months. Statistical analyses will be conducted with these data using CR and ICR as the primary exposure variable. Relevant explanatory variables will be selected from a predictive model for their inclusion in a prognostic stratification model. The primary outcome measures will be major adverse cardiovascular events.Ethics and disseminationProtocols and patient information have been approved by the regional research ethics committee (CEIm Provincial de Málaga-PEIBA (PI0131/2020). The results will be disseminated in international peer-reviewed journals, presented at conferences in Cardiology and Gerontology, and sent to participants, medical and health service managers, clinicians and other researchers.

The coronavirus disease of 2019 (COVID-19) has been a cause of significant morbidity and mortality worldwide. Among the short- and long-term consequences of COVID-19, myocarditis is a disease to be taken into consideration. Myocarditis, in general, is related to a poor prognosis. However, the epidemiology and prognosis of myocarditis related to COVID-19 are currently unknown. While vaccination against COVID-19 is of great benefit at a public health level, the risk of myocarditis should be considered in the context of the global benefits of vaccination. In this narrative review, we will summarize the etiopathogenic bases, the epidemiology, the clinical manifestations, the course, diagnosis, prognosis, and the treatment of myocarditis related to SARS-CoV-2, as well as myocarditis secondary to mRNA vaccines.

[Abstract] Ischemic heart disease (IHD) and type-2 diabetes mellitus (T2DM) remain major health problems worldwide and commonly coexist in individuals. Gut microbial metabolites, such as trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), have been linked to cardiovascular and metabolic diseases. Previous studies have reported dysbiosis in the gut microbiota of these patients and the prebiotic effects of some components of the Mediterranean diet. Essential oil emulsions of savory (Satureja hortensis), parsley (Petroselinum crispum) and rosemary (Rosmarinus officinalis) were assessed as nutraceuticals and prebiotics in IHD and T2DM. Humanized mice harboring gut microbiota derived from that of patients with IHD and T2DM were supplemented with L-carnitine and orally treated with essential oil emulsions for 40 days. We assessed the effects on gut microbiota composition and abundance, microbial metabolites and plasma markers of cardiovascular disease, inflammation and oxidative stress. Our results showed that essential oil emulsions in mice supplemented with L-carnitine have prebiotic effects on beneficial commensal bacteria, mainly Lactobacillus genus. There was a decrease in plasma TMAO and an increase in fecal SCFAs levels in mice treated with parsley and rosemary essential oils. Thrombomodulin levels were increased in mice treated with savory and parsley essential oils. While mice treated with parsley and rosemary essential oils showed a decrease in plasma cytokines (INFɣ, TNFα, IL-12p70 and IL-22); savory essential oil was associated with increased levels of chemokines (CXCL1, CCL2 and CCL11). Finally, there was a decrease in protein carbonyls and pentosidine according to the essential oil emulsion. These results suggest that changes in the gut microbiota induced by essential oils of parsley, savory and rosemary as prebiotics could differentially regulate cardiovascular and metabolic factors, which highlights the potential of these nutraceuticals for reducing IHD risk in patients affected by T2DM. Junta de Andalucía; PI-0170-2018 Instituto de Salud Carlos III; PT20/00101 Junta de Andalucía; RH-0078-2021 Instituto de Salud Carlos III; CPII19/00022 Instituto de Salud Carlos III; FI20/00227

The aim of our study was to assess the outcomes of surgical treatment for severe tricuspid regurgitation according to whether cardiac surgery had been performed before the tricuspid valve intervention. Between 1996 and 2013, 201 consecutive patients with severe tricuspid regurgitation underwent tricuspid surgery at our center. Patients were classified according to whether or not they had undergone previous cardiac surgery, which 33% of the sample had. Perioperative as well as long-term morbidity and mortality were analyzed. Mean patient age was 62.3 years. 32.8% underwent suture annuloplasty, 41.3% underwent ring annuloplasty, 15.4% received a bioprosthesis, and 10.4% received a mechanical prosthesis. There were no significant differences in perioperative mortality between the group that had not undergone previous cardiac surgery and the group that had (12.7% vs. 17.9%, respectively; p = 0.32). The long-term mortality rate (median follow-up time: 53 months) was 43.3%. Long-term survival curves showed no significant differences between the two groups (p = 0.884), and previous cardiac surgery was not a predictive factor for long-term mortality (hazard ratio = 1.211; p = 0.521). In a series of patients who underwent tricuspid valve surgery, no significant differences were observed in perioperative mortality or in long-term survival according to whether or not subjects had undergone previous cardiac surgery.

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.

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.

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p

Resumen Introduccion Las descompensaciones en la insuficiencia cardiaca (IC) se asocian a retencion hidrica. La impedanciometria cuantifica el liquido de un organismo midiendo la amortiguacion de una corriente electrica al pasar a traves del mismo. El objetivo de nuestro estudio es determinar cambios en la impedancia periferica en pacientes ingresados por IC y relacionarlos con parametros bioquimicos y clinicos. Metodos y pacientes Estudio observacional prospectivo con 46 pacientes ingresados por IC descompensada. Se recogieron caracteristicas basales, parametros clinicos y bioquimicos habituales y mediciones de impedancia periferica diarias con el impedanciometro Bioscan. Resultados Veintisiete de los 46 pacientes eran mujeres. La edad fue de 68,2 ± 11,7 anos. La etiologia mas frecuente fue isquemica (37%). El 54% presentaba funcion sistolica conservada y el 26% severamente deprimida. Iniciar tratamiento depletivo intravenoso en lugar de oral se correlaciono con menores valores de impedancia (821 vs 156; p Conclusiones La impedancia periferica podria ser una herramienta valida para titular el tratamiento diuretico en pacientes ingresados por IC.

Thepresenceoflategadoliniumenhancement(LGE)incardiacmag-netic resonance (CMR), that enables quantification of myocardialfibro-sis[1],iscommoninpatientswithnonischemicdilatedcardiomyopathy(NIDC). LGE has been related to adverse clinical outcomes in patientswith NIDC, mainly in those with idiopathic dilated cardiomyopathy[1,2]. This study pretends to assess the long-term prognostic signifi-cance of LGE in an unselected population of patients with NIDC. Everyunderlying possible cause was included.Weperformed aretrospective cohortstudyinwhich64consecutiveoutpatients with heart failure secondary to NIDC were included. Allunderwent a CMR between August 2005 and November 2011. Thepresence and location of LGE were evaluated.Diagnosis was established according to the World HealthOrganization/International Society and Federation of Cardiology'sdefinition [3]. None of the patients presented previous history ofsignificant valvular disease, hypertrophic cardiomyopathy, restrictivecardiomyopathy, congenital heart disease, or coronary artery disease.PatientsunderwentCMRjustafterthediagnosisofNIDCtocompletethe diagnostic evaluation. Exclusion criteria were: cardiac pacemaker/implantable cardioverter defibrillator (ICD)/cardiac resynchronizationtherapy, renal insufficiency and severe obesity or claustrophobia.Patientswerefollowedviaclinicalvisits.Theprimaryoutcomewasacomposite endpoint of three events: cardiac death, hospitalization forheart failure and appropriate ICD firing. ICD devices were implanted insome patients after they underwent CMR.CMRimagingwasperformedona1.5Teslascanner(PhilipsMRSys-tem Achieva Release 2.6.3.7). Delayed contrast-enhanced images wereacquired 10 min after intravenous administration of 0.2 mmol/kg ofgadolinium-diethylenetriaminepentaacetate, using inversion-recoveryfast gradient-echo pulse sequences in sequential short- and long-axisslices of the left ventricle.Allstudies were analyzedby aradiologistand acardiologist usinga workstation (Extended MR Work Space 2.6.2.4.). The presence andlocation of LGE were visually assessed.Qualitativevariableswereexpressedaspercentagesandquantitativeasmean±SD.Qualitativevariableswerecomparedwiththeχ

Left ventricular reverse remodeling (LVRR) in dilated cardiomyopathy is poorly known within the context of current therapeutic approach. Our goal is to describe the present incidence of LVRR, the factors able to predict it and the long term prognosis of these patients.We performed a retrospective analysis of a cohort or 387 consecutive outpatients. Mean follow-up was 50.4 ± 28.4 months. Sustained LVRR occurred in 57.6% of patients. The number of coronary arteries with severe stenosis (HR 0.69, 95% CI 0.55-0.86; p=0.001), New York Heart Association Functional Class (NYHA FC) (HR 0.39, 95% CI 0.27-0.54; p0.001) as well as the severity of mitral regurgitation (MR) at the end of follow-up (HR 0.42, 95% CI 0.30-0.58; p0.001) and the time until first event (HR 1.02, 95% CI 1.01-1.03; p0.001) were independent predictors of left ventricular ejection fraction improvement. LVRR was tightly related to prognosis due to the fact that both improvement in cardiac function achieving normal or slightly impaired LVEF (HR 0.31, 95% CI 0.17-0.56; p0.001) and shorter time to achieve LVRR (HR 0.99, 95% CI 0.98-0.99; p=0.017) formed part of the best model for predicting events in DCM.More than half of the patients showed sustained LVRR associated with a significantly better prognosis. Fewer numbers of coronary arteries with severe stenosis, milder NYHA FC and the absence of significant MR at the end of follow-up as well as longer event free period formed a simple model to prognosticate LVRR. LVRR and the time to achieve it were strongly related to long term prognosis in patients with DCM.

BACKGROUND AND OBJECTIVE An ideal strategy of percutaneous coronary revascularization in patients with renal insufficiency has not been established yet. Our aim was to compare in this group the clinical results of bare metal stents and drug-eluting stents, and identify predictors. PATIENTS AND METHOD In a group of 200 patients with renal disease, 93 received bare metal stents and 107 drug-eluting stents; for over 2 years we studied rates of a combined event: death, non fatal myocardial infarction, or target lesion revascularization. RESULTS We did not identify differences in the combined event. With multivariate analysis, peripheral arterial disease, left ventricular ejection fraction

a Seccion de Cardiologia, Unidad de Medicina Interna, Hospital de Poniente, Carretera de Almerimar s/n, 04700 El Ejido, Almeria, Spain b Area del Corazon, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Malaga, Spain c Seccion de Cardiologia, Unidad de Medicina Interna, Fundacion Hospital Calahorra, Carretera de Logrono s/n, 26500 Calahorra, La Rioja, Spain d Unidad de Cardiologia, Hospital Parque San Antonio, Avenida Pintor Joaquin Sorolla n°2, 29016, Malaga, Spain

Introduction and objectives There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation . The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Methods Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. Results A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty ( P=.04). Conclusions Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

An ideal strategy of percutaneous coronary revascularization in patients with renal insufficiency has not been established yet. Our aim was to compare in this group the clinical results of bare metal stents and drug-eluting stents, and identify predictors.In a group of 200 patients with renal disease, 93 received bare metal stents and 107 drug-eluting stents; for over 2 years we studied rates of a combined event: death, non fatal myocardial infarction, or target lesion revascularization.We did not identify differences in the combined event. With multivariate analysis, peripheral arterial disease, left ventricular ejection fraction45% and treatment with statins were predictor factors.We had no evidence of the superiority of any type of stent in the revascularization in patients with chronic renal insufficiency.