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The optimal duration of anticoagulation in patients with left-ventricular thrombus (LVT) is unclear. In the present study, we aimed to analyze the effect of treatment duration (≤12 months [short-term anticoagulation, (STA)] versus12 months [long-term anticoagulation, (LTA)]) in the incidence of stroke and other secondary outcomes (acute myocardial infarction, bleeding, and mortality). Multivariate Cox regression was used to determine the association between treatment duration and stroke, adjusted for baseline embolic risk. A total of 98 cases of LVT (age 64.3 ± 12.8 years, female 18 [18%]) were identified. Sixty-one patients (62%) received LTA. Patients receiving LTA were older than those receiving STA (66.5 ± 11.6 vs 60.7 ± 13.9 years, p = 0.029), more often had atrial fibrillation (31% vs 0%, p0.001), and had a higher CHA

Severe acute respiratory syndrome coronavirus 2 infections are associated with greater risk of both arterial and venous thromboembolic events. This has been attributed to a florid pro-inflammatory state resulting in microvascular dysfunction, activation of platelets and procoagulant systems as well as possible direct endothelial injury. The associated morbidity and mortality of these events has prompted much speculation and varied anticoagulation and fibrinolytic strategies based on multiple criteria including disease severity and biomarkers. No clear definitive benefit has been established with these approaches, which have frequently led to greater bleeding complications without significant mortality benefit. In this review, we outline the burden of these thromboembolic events in coronavirus disease-2019 (COVID-19) as well as the hypothesized contributory biological mechanisms. Finally, we provide a brief overview of the major clinical studies on the topic, and end with a summary of major societal guideline recommendations on anticoagulation in COVID-19.

Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in patients with heart failure. These benefits of MRAs vary in different heart failure populations based on left ventricular ejection fraction and associated comorbidities.We define the pharmacologic properties of MRAs and the pathophysiological rationale for their utility in heart failure. We outline the current literature on the use of MRAs in different heart failure populations, including reduced and preserved ejection fraction (HFrEF/HFpEF) and acute heart failure decompensation. Finally, we describe the limitations of currently available data and propose future directions of study.While there is strong evidence supporting the use of MRAs in HFrEF, evidence in patients with HFpEF or acute heart failure is less definitive. Comorbidities such as obesity or atrial fibrillation could be clinical modifiers of the response to MRAs and potentially alter the risk/benefit ratio in these subpopulations. Emerging evidence for new non-steroidal MRAs reveal promising preliminary results that, if confirmed in large randomized clinical trials, could favor a change in clinical practice.

Introduction It has been recently postulated that cardiac resynchronization therapy (CRT) might have a higher efficacy in women, with a greater reverse cardiac remodeling in this population. The reasons for these differences are not yet completely understood. We aimed to detect sex differences in the degree of ventricular asynchrony (VA) and mitral regurgitation (MR) in patients undergoing CRT implantation. Methods We analyzed baseline characteristics of a prospective international clinical trial that compared CRT response rate in a HF population with a comparable distribution of men and women (BIOWOMEN). A total of 408 patients were analyzed. The degree of mitral regurgitation and intra and inter-ventricular asynchrony was assessed by independent echocardiographers in a core lab. Inter-ventricular asynchrony was defined as an interventricular mechanical delay greater than 40ms and intra-ventricular asynchrony as differences greater than 50ms among regional pre-ejection periods. Multivariable logistic regression was performed using commercial data analysis software. Results As expected, ventricular asynchrony was dependent on QRS duration and the presence of LBBB (p Conclusions In our analysis, for a given QRS duration there was not a higher degree of asynchrony in women with HF. However, female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration irrespective of baseline HF etiology. Further investigations are needed to establish a possible link between these findings and better CRT outcomes in women. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG

espanolLa enfermedad cardiovascular es una de las causas principales de morbimortalidad en todo el mundo. Clasicamente se han descrito una serie de factores de riesgo que participan de forma causal en el desarrollo de la ateroesclerosis. Sin embargo, recientemente se han descrito nuevos factores que podrian ser de utilidad en la estratificacion de riesgo, entre los que se encuentran nuevos biomarcadores, alteraciones geneticas o determinados indicadores de enfermedad subclinica establecida. La importancia radica en que las intervenciones de prevencion, tanto a nivel poblacional como individual, han demostrado ser de utilidad de forma consistente, logrando disminuir de forma efectiva la morbimortalidad asociada a la enfermedad cardiovascular. Por ello, es de vital importancia la estratificacion individual del riesgo cardiovascular, segun el cual se determinaran los candidatos que mas se beneficiaran de un determinado tratamiento y en base a lo cual se realizaran las recomendaciones terapeuticas. EnglishCardiovascular disease is one of the leading causes of morbidity and mortality worldwide. Several risk factors have been traditionally described as causally involved in the development of atherosclerosis. Recently, however, new factors have been described that could be useful in risk stratification, including new biomarkers, genetic disturbances, or certain indicators of established subclinical disease. It is relevant that prevention interventions, both at the population and individual level, have consistently been shown to be useful, effectively reducing the morbidity and mortality associated with cardiovascular disease. Therefore, individual cardiovascular risk stratification is vitally important, which will establish the candidates who will benefit most from a given treatment and provide the basis for therapeutic recommendations.

espanolLa identificacion de los diferentes factores de riesgo cardiovascular y su tratamiento es la mejor estrategia para prevenir la morbimortalidad de la enfermedad cardiovascular (ECV). Las principales sociedades cientificas recomiendan la evaluacion del riesgo cardiovascular total del paciente, mas alla de la evaluacion dicotomica sobre la presencia o ausencia de determinados factores de riesgo. De esta forma, se presenta el riesgo del individuo de una forma continua, facilmente interpretable y transmisible al sujeto. El metodo recomendado para la valoracion del riesgo en nuestro medio es el sistema SCORE, propuesto por la Sociedad Europea de Cardiologia y en el que evalua el riesgo cardiovascular en base a los datos prospectivos de 12 estudios europeos con mas de 200000 pacientes. En base a este riesgo calculado de forma individual, se podra planificar el grado de intensidad y la necesidad de intervencion farmacologica en cada individuo. En este protocolo, se expondran las caracteristicas y peculiaridades del sistema SCORE, asi como su forma de uso. EnglishIdentifying the different cardiovascular risk factors and their treatment is the best strategy to prevent cardiovascular disease (CVD) morbidity and mortality. The main scientific societies recommend assessing the patient's total cardiovascular risk, beyond the dichotomous assessment of the presence or absence of certain risk factors. Thus, the individual's risk is presented in a continuous form, easily interpretable and conveyable to the subject. The SCORE system is the recommended method for risk assessment in our setting, proposed by the European Society of Cardiology, which evaluates cardiovascular risk based on prospective data from 12 European studies with more than 200,000 patients. Based on this individually calculated risk, the degree of intensity and the need for pharmacological intervention can be planned for each individual. We shall outline in this protocol the characteristics and peculiarities of the SCORE system, and how it is used.

espanolEl control de los factores de riesgo cardiovascular es clave en la prevencion de la morbimortalidad asociada a la enfermedad cardiovascular: es la estrategia mas eficaz a nivel poblacional, y ha demostrado ser coste-efectiva en una gran variedad de escenarios. Segun las guias actuales, los objetivos terapeuticos recomendados para cada individuo dependen de la evaluacion de su riesgo cardiovascular total y del tipo de prevencion. En vista de la evidencia acumulada en los ultimos anos, se han adoptado objetivos mas estrictos en el control de los factores de riesgo cardiovascular, especialmente en sujetos de alto riesgo y en prevencion secundaria. En este protocolo revisaremos los principales objetivos terapeuticos de los pacientes con diabetes y dislipemia en funcion de su riesgo cardiovascular. EnglishControl of cardiovascular risk factors is crucial in the prevention of morbidity and mortality associated with cardiovascular disease. It is the most effective strategy at the population level, and has been shown to be cost-effective in a wide variety of settings. According to current guidelines, the recommended therapeutic targets for each individual depend on the assessment of their total cardiovascular risk and type of prevention. From the evidence accumulated in recent years, stricter targets for cardiovascular risk factor control have been adopted, especially in high-risk subjects and in secondary prevention. In this protocol we shall review the main therapeutic targets for patients with diabetes and dyslipidaemia according to their cardiovascular risk.

espanolLa hipertension es un factor de riesgo cardiovascular clasico con efectos directos sobre el corazon y los grandes vasos. No solo predispone al desarrollo de insuficiencia cardiaca, fibrilacion auricular, cardiopatia isquemica y valvulopatia aortica, sino que un mal control de la presion arterial depara un mal pronostico para el paciente cardiopata. Se pretende revisar aspectos fundamentales de la hipertension arterial y su impacto sobre el corazon, abordando su fisiopatologia, historia natural y manifestaciones clinicas. Asimismo, se recogen generalidades de grupos especiales (embarazadas y personas mayores) y se revisan las principales caracteristicas de la hipertension del paciente de raza negra. Por ultimo, se describen comorbilidades frecuentes y las peculiaridades de la asociacion de la hipertension con cada una de ellas. EnglishHypertension is a classic cardiovascular risk factor with direct effects on the heart and large vessels. Not only does it predispose to the development of heart failure, atrial fibrillation, ischaemic heart disease and aortic valve disease, but poor blood pressure control also carries a poor prognosis for patients with heart disease. The aim is to review fundamental aspects of arterial hypertension and its impact on the heart, addressing its pathophysiology, natural history, and clinical manifestations. It also provides general information on special groups (pregnant women and older adults) and reviews the main characteristics of hypertension in black patients. Finally, we describe frequent comorbidities and the peculiarities of the association of hypertension with each.

espanolLas enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en los paises desarrollados. Se considera que la prevencion de las ECV se basa en el conjunto de acciones coordinadas dirigidas a la poblacion, o a una persona de forma individual, con el fin de eliminar o minimizar el impacto de las ECV y las discapacidades asociadas a estas. A pesar de los avances diagnosticos y en las diferentes terapias intervencionistas, las ECV siguen siendo un problema de primer nivel desde el punto de vista de la salud publica, asi como una importante carga a nivel sociosanitario y economico. Los principales factores de riesgo cardiovascular (FRCV) son la edad, la hipertension arterial, la hipercolesterolemia, la obesidad, el tabaquismo y la diabetes mellitus. Los cambios en el estilo de vida, asi como el tratamiento farmacologico disminuyen los eventos cardiovasculares y alargan la esperanza de vida de los pacientes. EnglishCardiovascular disease (CVD) remains the leading cause of death in developed countries. CVD prevention is considered a set of coordinated actions aimed at the population, or at an individual person, to eliminate or minimise the impact of CVD and the disabilities associated with it. Despite advances in diagnosis and interventional therapies, CVD remains a major public health problem, and a major health and economic burden. The main cardiovascular risk factors (CVRFs) are age, high blood pressure, high cholesterol, obesity, smoking and diabetes mellitus. Lifestyle changes and pharmacological treatment reduce cardiovascular events and extend life expectancy.

espanolSe presenta una guia terapeutica del paciente con hipertension arterial y alto riesgo cardiovascular. Se establecen las cifras de presion arterial a partir de las cuales se recomienda el inicio de tratamiento farmacologico y los objetivos que se persiguen en distintas poblaciones. Se resumen las indicaciones de los distintos farmacos disponibles y se propone un algoritmo para su eleccion en funcion de las comorbilidades del paciente. EnglishWe present therapeutic guidelines for patients with hypertension and high cardiovascular risk. The blood pressure readings are set out from which we recommend pharmacological treatment should be started and the objectives pursued in different populations. We summarise the indications for the different available drugs and propose an algorithm for their selection according to the patients’ comorbidities.