Ana Martín

Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis.

Background: Takotsubo syndrome (TKS) usually mimics an acute coronary syndrome. However, several clinical forms have been reported. Our aim was to assess if different stressful triggers had prognostic influence on TKS, and to establish a working classification. Methods: We performed an analysis including patients with TKS between 2003–2013 from our prospective local database and the RETAKO National Registry, fulfilling Mayo criteria. Patients were divided in two groups regarding their potential triggers: (a) none/psychic stress as ‘primary forms’ and (b) physical factors (asthma, surgery, trauma, etc.) as ‘secondary forms’. Results: Finally, 328 patients were included, 90.2% women, with a mean age of 69.7 years. Patients were divided into primary TKS (n=265) and 63 secondary TKS groups. Age, gender, previous functional class and cardiovascular risk profile displayed no differences between groups before admission. However, primary-TKS patients suffered a main complaint of chest pain (89.4% vs 50.7%, p<0.0001) with frequent vegetative symptoms. Regarding treatment before admission, there were no differences either. During admission, differences were related to more intensive antithrombotic and anxiolytic drug use in the primary TKS group. Inotropic and mechanical ventilation use was higher in the secondary cohort. After discharge, a more frequent prescription of beta-blockers and statins in primary-TKS patients was seen. Secondary forms displayed more in-hospital stay and evolutive complications: death (hazard ratio (HR): 3.41; 95% confidence interval (CI): 1.14–10.16, p=0.02), combined event variable (MACE) (HR: 1.61; 95% CI: 1.01–2.6, p=0.04) and recurrences (HR: 1.85; 95% CI: 1.06–3.22, p=0.02). Conclusion: Secondary TKS could present or mark worse short and long-term prognoses in terms of mortality, recurrences and readmissions. We propose a simple working nomenclature for TKS.

Moduli Spaces of Semistable Sheaves on Singular Genus 1 Curves

We find some equivalences of the derived category of coherent sheaves on a Gorenstein genus one curve that preserve the (semi)-stability of pure-dimensional sheaves. Using them we establish new identifications between certain Simpson moduli spaces of semistable sheaves on the curve. For rank zero, the moduli spaces are symmetric powers of the curve whilst for a fixed positive rank there are only a finite number of nonisomorphic spaces. We prove similar results for the relative semistable moduli spaces on an arbitrary genus one fibration with no conditions either on the base or on the total space. For a cycle E N of projective lines, we show that the unique degree 0 stable sheaves are the line bundles having degree 0 on every irreducible component and the sheaves supported on one irreducible component. We also prove that the connected component of the moduli space that contains vector bundles of rank r is isomorphic to the rth symmetric product of the rational curve with one node.

Influence of beta-blocker therapy on antitachycardia pacing effectiveness for monomorphic ventricular tachycardias occurring in implantable cardioverter-defibrillator patients: a dose-dependent effect

AIMS To determine, in a non-selected population of 282 implantable cardioverter-defibrillator (ICD) patients with left ventricular dysfunction, the influence of the dose of beta-blockers on antitachycardia pacing (ATP) effectiveness and on the incidence of shock due to monomorphic ventricular tachycardias (VT). METHODS AND RESULTS We followed 282 ICD patients along 26 +/- 19 months. Antitachycardia pacing and shock programming were standardized. We determined the indexed dose equivalent of beta-blockers (IDE-BB), using metoprolol as a reference, at each VT presentation. The median of IDE-BB was 55 mg/m(2)/day. We analysed 846 VT occurred in 100 patients. The ATP success rate was 84%. Upon classification of the events into three groups (IDE-BB = 0, IDE-BB < 55, and IDE-BB > or = 55), the frequency of effective ATP increased with the IDE-BB: 75 vs. 83 vs. 92% (P < 0.001). According to logistic regression, IDE-BB remained as an independent predictor of effective ATP (P < 0.001) and VT-related shock (P = 0.001). Both the mean ATP effectiveness per patient (67 vs. 80 vs. 91%, P = 0.007) and the mean survival time free of VT-related shock (583 vs. 847 vs. 1158 days, P = 0.019, log-rank test) increased linearly with the dose of beta-blockers. CONCLUSION Beta-blockers increase the effectiveness of ATP through a dose-dependent effect. As a result, they reduce the incidence of shocks due to VT.

Pronóstico hospitalario del síndrome coronario agudo sin elevación del segmento ST determinado por una nueva escala de riesgo integrada por variables electrocardiográficas obtenidas al ingreso

Diferentes variables electrocardiograficas tienen capacidad predictiva en el sindrome coronario agudo sin elevacion del ST (SCASEST). Tras analizar a 427 pacientes, construimos una escala de riesgo (ER) basada en el ECG al ingreso (ER-ECG) para definir la probabilidad de muerte o isquemia recurrente (M-IsqR) durante la hospitalizacion, que fue del 36%. En un analisis de regresion logistica que incluyo siete variables electrocardiograficas y las de la ER TIMI, alcanzaron la significacion estadistica: QTc ≥ 450 ms (odds ratio [OR] = 4,2; p 0,5 (OR = 2,7; p 0,5 mm y 1 a crecimiento auricular izquierdo. Agrupando a los pacientes segun la ER-ECG en: ≤ 1, 2-3, ≤ 4, esta discrimino adecuadamente la probabilidad de M-IsqR: el 11 frente al 27 frente al 58% (p

Relative integral functors for singular fibrations and singular partners

We study relative integral functors for singular schemes and characterise those which preserve boundedness and those which have integral right adjoints. We prove that a relative integral functor is an equivalence if and only if its restriction to every fibre is an equivalence. This allows us to construct a non-trivial auto-equivalence of the derived category of an arbitrary genus one fibration with no conditions on either the base or the total space and getting rid of the usual assumption of irreducibility of the fibres. We also extend to Cohen�Macaulay schemes the criterion of Bondal and Orlov for an integral functor to be fully faithful in characteristic zero and give a different criterion which is valid in arbitrary characteristic. Finally, we prove that for projective schemes both the Cohen�Macaulay and the Gorenstein conditions are invariant under Fourier�Mukai functors.

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Objectives: To determine, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI), the mechanisms and clinical implications of the acute changes in QT dispersion (QTd). Methods: In this prospective study we included 216 patients admitted with a STEMI of <12 h of evolution. All were treated with PPCI. QTd was measured prior to PPCI and within 1 h after. Results: The ratio of QTd reduction after PPCI (QTd-R) – defined as [(QTd before PPCI – QTd after PPCI)/QTd before PPCI] ×100 – was significantly correlated with the percentage of ST-segment elevation resolution (ST-R; p < 0.001). To determine the significance of the different values of QTd-R, we further subdivided our population into 3 groups according to the tertiles of QTd-R (<10, 11–49, ≥50%). Patients with longer QTd-R had higher percentages of ST-R: 32 ± 43 for QTd-R <10% vs. 60 ± 21 for 11–49% vs. 71 ± 12 for ≥50% (p < 0.05). By logistic regression, patients with QTd-R ≥50% had a reduction of 75% in the adjusted frequency of death or severe heart failure during hospitalization (95% CI 13–73%, p = 0.03). Conclusion: QTd-R after PPCI occurs early, is closely related to the restoration of reperfusion at the microvascular level and provides additional prognostic information.

Influence of cycle length variations on antitachycardia pacing effectiveness among ICD patients

BACKGROUND Antitachycardia pacing (ATP) fails to terminate 5% to 25% of ventricular tachycardias (VTs) occurring in implantable cardioverter-defibrillator patients. We speculated that small fluctuations in VT cycle length (CL) may be related to the efficacy of subsequent ATP. OBJECTIVE The purpose of this study was to determine the relationship between the R-R variations of the last 12 R-R intervals before ATP and the efficacy of the first ATP attempt. METHODS We studied 551 VTs (CL 329±35 ms) occurring in 67 patients. We also analyzed the percentage of variation (P-RR), which was calculated by dividing the mean difference between each R-R interval and the next one by the CL (×100), and the acceleration index (AI), which was calculated by dividing the CL of the first 6 R-R intervals by the CL of the next 6. RESULTS The effectiveness of the first ATP therapy was 81%, being higher in VTs with AI<1 (85% vs 64%; P<.001). After classifying the events according to the tertiles of P-RR, ATP efficiency was better in higher values of P-RR (VTs with AI<1): 99% (third tertile) vs 85% (second tertile) vs 76% (first tertile), P<.001; and for VTs with AI≥1: 94% vs 68% vs 42% (P<.001). By logistic regression, P-RR (%; odds ratio 2.37; P<.001), and AI<1 (odds ratio 4.17; P<.001) were found to be independent predictors of successful first ATP attempts. CONCLUSION Small changes in CL increase the effectiveness of ATP significantly. VTs with lower degrees of R-R fluctuations, especially when the pattern is a progressive CL shortening, are infrequently terminated by ATP.

Morphology of Far-Field Electrograms and Antitachycardia Pacing Effectiveness Among Fast Ventricular Tachycardias Occurring in ICD Patients: A Multicenter Study

Fast ventricular tachycardias (FVT) are less likely to be terminated by antitachycardia pacing (ATP). No information is available regarding the ability of far‐field electrogram (Ff‐EG) morphology (Ff‐EGm) in predicting the result of the subsequent ATP. Our objective is to determine the relationship between Ff‐EGm and ATP efficacy.

In-Hospital Prognosis in Non-ST-Segment Elevation Acute Coronary Syndrome Derived Using a New Risk Score Based on Electrocardiographic Parameters Obtained at Admission

Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.2, P< .001), ST-segment depression >0.5 mm (odds ratio 2.7, P< .001), and left atrial enlargement (odds ratio 1.8, P =.005). After taking the odds ratios into consideration, we awarded 3 points for a QTc > or =450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. < or =1, 2-3 and > or =4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P< .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS.

Fourier–Mukai partners of singular genus one curves

Abstract The objective of the paper is to prove that, as it happens for smooth elliptic curves, any Fourier–Mukai partner of a projective reduced Gorenstein curve of genus one and trivial dualizing sheaf, is isomorphic to itself.