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Introduction Stroke survivors usually experience long-lasting functional, emotional and social consequences that might contribute to sedentary behaviour and participation restrictions, which are important targets to address during rehabilitation. However, the trajectory and inter-relationship between these factors are unknown.Methods and analysis Part&Sed is a research project based on an observational study design with 6 and 12 months of follow-ups in stroke survivors. In addition, a qualitative analysis of the impact of the stroke on the stroke survivor, validation of the Satisfaction with Daily Occupation-Occupational Balance assessment tool and analysis of the reliability of the Fitbit Inspire 2 activity tracker wristband will be carried out. Participants will be chronic stroke survivors with independent walking capacity. Sociodemographic and clinical data, physical activity, ambulation, sleep, quality of life, anxiety and depression, community participation, and occupational satisfaction and balance, as well as data provided by the activity tracker wristband, will be collected. In addition, if the participant has a primary caregiver, the caregiver will also be monitored. A minimum of 130 participants will be recruited to conduct a random-effects multiple regression model. Mixed models for repeated measures will assess the variation over time of the different variables associated with participation and sedentary behaviour. Psychometric properties (eg, internal consistency, construct validity, test–retest reliability) of the Satisfaction with Daily Occupation-Occupational Balance will be determined. Additionally, intraclass correlation coefficients and minimum detectable change will be calculated to assess intrasubject reliability of physical activity and sleep parameters recorded by the Fitbit Inspire 2. The qualitative analysis process will be carried out using the analysis proposed by Giorgi.Ethics and dissemination The study received ethical approval from the Spanish Regional Ethics Committee ‘Comité de Ética de la Investigación de la Comunidad de Aragón’ (PI21/333). The results will be made available via peer-reviewed publications, international conferences and official channels.

Abstract We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti‐cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways. We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti‐cancer therapies. The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients. We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio‐oncology.

Objectives: Mitral regurgitation (MR) is the second most common valve disease in Europe, and differences between men and women have been described in relation to aetiology or management, which might impact the decision for intervention and patients' clinical and economic outcomes. Thus, the objective was to analyse the burden of MR in Spain by aetiology and sex, and the management of all patients suffering from MR being admitted to hospital between 2016–2021. Methods: An analysis was carried out with the Ministry of Health's database, including all patients in public and subsidised hospitals and defining two groups, general MR and those patients undergoing Transcatheter Edge-to-Edge repair (TEER), using a descriptive analysis of patients' characteristics, use of resources, and outcomes; standardised rates were calculated and observed outcomes were described. Results: Hospital admissions increased from 2016 (n = 32,806) to 2021 (total n = 61,036). In general, the women were older and presented more complications. The majority of patients suffered from degenerative MR (DMR) (n = 183,005, 59.55%), and 61.56% were women, contrary to functional MR (FMR) (n = 124,278), which consisted of 62.15% males. In total, 1,689 TEERs were performed, 23.33% of them in urgent admissions, and mostly in men (65.66%). All groups showed higher rates of intervention for males. Regarding costs, women presented lower mean costs in the general MR groups but those undergoing TEER presented, in all cases, costs higher than men. Conclusions: MR entails a significant burden for patients and the Spanish healthcare system, increasing over the period of study. Differences in aetiologies by sex have been found in patients' characteristics as well as outcomes. Further studies are needed to optimise patients' management and their outcomes in relation to sex and aetiology. [ABSTRACT FROM AUTHOR]

Carlos Ferrera,1 Isidre Vilacosta,1 Beatriz Cabeza,2 Javier Cobiella,3 Isaac Martínez,4 Melchor Saiz-Pardo Sanz,5 Ana Bustos,2 Francisco Javier Serrano,4 Luis Maroto3 1Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain; 2Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain; 3Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain; 4Department of Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain; 5Pathology Department, Hospital Clínico San Carlos, Madrid, SpainCorrespondence: Carlos FerreraDepartment of Cardiology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos S/N, Madrid 28040, SpainTel +34 91 330 3149Fax +34 91 330 3142Email carlosferreraduran@gmail.comAbstract: Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.Keywords: aortic intramural hematoma, acute aortic syndrome, diagnosis

En la primavera de 1969 se produjo la dramática salida de la población española del recién nacido Estado de Guinea Ecuatorial. El proyecto neocolonial trazado desde Madrid para mantener la influencia política y económica sobre la antigua colonia fracasó a pocos meses de la independencia. Este artículo intenta explicar en qué consistía dicho plan, cómo fue el proceso y qué factores determinaron su negativo desenlace, a partir de múltiples fuentes documentales y orales, intentando salvar las lagunas y las imprecisiones de buena parte de la historiografía publicada, muy condicionada por la dificultad de acceso a archivos fundamentales por la ley española de secretos oficiales y por la situación política del país africano

Se presenta el caso de un varón de 72 años con válvulas protésicas mecánicas mitral y aórtica, insuficiencia renal crónica e hipertensión pulmonar grave. En 2019, se procedió al cierre percutáneo de una fuga periprotésica (FPP) anterolateral mitral con implante de 2 dispositivos (el AVP III 10 x 5 mm y el AVP III 8 x 4 mm, St Jude Medical, Estados Unidos) ante la presencia de insuficiencia cardiaca. La evolución clínica del paciente fue favorable con insuficiencia mitral moderada. Un año después, los síntomas empeoraron y un ecocardiograma transesofágico reveló la presencia de insuficiencia mitral grave por FPP recurrente alrededor de los dispositivos (figura 1A). Se programó un segundo intento de cierre percutáneo de la FPP. La intervención inicial consistió en implantar otro dispositivo al lado de los ya implantados, pero embolizaron dentro del ventrículo izquierdo con la manipulación del catéter guía orientable (figura 1B). Fueron capturados empleando un lazo a través de la FFP y recuperados usando 2 vainas en la aurícula izquierda (figura 1C). Dos horas después, el paciente desarrolló inestabilidad hemodinámica y elevación del segmento ST. Una angiografía coronaria de urgencia confirmó la presencia de estenosis grave en el tronco común izquierdo (TC) que no se...

This is the case of a 72-year-old man with mitral and aortic mechanical prosthetic valves, chronic kidney disease, and severe pulmonary hypertension. In 2019, a mitral anterolateral paravalvular leak (PVL) was percutaneously closed with implantation of 2 devices (the AVP III 10 mm x 5 mm, and the AVP III 8 mm x 4 mm, St Jude Medical, United States) due to heart failure. The patient’s clinical progression was favorable with moderate mitral regurgitation. One year later, the patient’s symptoms worsened, and the transesophageal echocardiogram performed revealed severe mitral regurgitation due to recurrent PVL around the devices (figure 1A). A second percutaneous closure attempt was scheduled to close the PVL. The initial procedure was to implant another device next to the other devices, but they embolized into the left ventricle when the deflectable catheter touched them (figure 1B). They were captured using a gooseneck loop snare through the PVL and then retrieved using 2 sheaths in the left atrium (figure 1C). Two hours later, the patient developed hemodynamic instability, and ST-segment elevation. An emergency coronary angiogram revealed the presence of severe stenosis in the left main coronary artery (LMCA) that was not present in the previous angiogram (figure 1D). The...

We present the case of a 91-year-old man with a past medical history of moderate-to-severe aortic stenosis referred due to breathlessness. The routine invasive coronary angiography performed before transcatheter aortic valve replacement confirmed the presence of a severely calcified left anterior descending coronary artery proximal segment (figure 1A; video 1 of the supplementary data). The functional assessment performed showed a fractional flow reserve of 0.79. The optical coherence tomography (OCT) interrogation revealed an arc of calcium > 180°, thickness of 0.6 mm, and length > 5 mm with a calcified nodule with a minimum lumen area of 3.49 mm2 (figure 1C; video 2 of the supplementary data). Orbital atherectomy with the Diamondback 360 Coronary OAS (Cardiovascular Systems, Inc., United States) was selected to prepare the lesion. After 5 runs at low speed (80 000 rpm), a new OCT was performed that confirmed the fracture of the calcified nodule achieving a minimum lumen area of 7.5 mm2 (figure 1D; video 3 of the supplementary data). Consecutively, a 2.5 mm x 15 mm SC balloon (OrbusNeich, China) plus a 3.0 mm x 10 mm NC balloon (Medtronic, United States) were advanced through the lesion and inflated twice. Finally, a Megatron 3.5 mm...

Presentamos el caso de un varón de 91 años con una historia clínica de estenosis aórtica entre moderada y grave derivado con un cuadro de disnea. La coronariografía invasiva rutinaria previa al implante percutáneo de prótesis valvular aórtica confirmó la presencia de un segmento proximal gravemente calcificado en la descendente anterior (figura 1A; vídeo 1 del material adicional). Según la valoración funcional, los valores de la reserva fraccional de flujo fueron 0,79. La interrogación con tomografía de coherencia óptica (OCT) reveló la presencia de un arco de calcio > 180°, un grosor de 0,6 mm y una longitud > 5 mm acompañado de un nódulo calcificado y una área luminal mínima de 3,49 mm2 (figura 1C; vídeo 2 del material adicional). Se optó por una aterectomía orbital con el dispositivo estándar de AO coronaria Diamondback 360 (Cardiovascular Systems, Inc., Estados Unidos) para preparar la lesión. Tras 5 pasadas a baja velocidad (80.000 rpm), se hizo una nueva OCT que confirmó la fractura del nódulo calcificado, alcanzando un área luminal mínima de 7,5 mm2 (figura 1D; vídeo 3 del material adicional). Consecutivamente, se avanzaron 2 balones, uno semidistensible de 2,5 × 15 mm (OrbusNeich, China) y otro no distensible de 3,0...

Cancer and cancer therapies might be a risk factor for developing Atrial Fibrillation (AF). It remains unclear if one is the cause or consequence of the other, or if they simply coexist. An unpredictable response to anticoagulation can be expected, as a result of the lack of information in oncology patients. The balance between thromboembolic and bleeding risks of AF in these patients is particularly challenging. Little is known about whether embolic and bleeding risk scores used for the general population can be applied in oncologic patients. Cardiology involvement in the management of these patients seems to be associated with favourable AF-related outcomes.