Ignacio Ferreira

Prevalence of Metabolic Syndrome in the Spanish Working Population: MESYAS Registry

INTRODUCTION AND OBJECTIVES To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.

Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability

Several indexes have been reported to improve the accuracy of exercise test electrocardiogram (ECG) analysis in the diagnosis of coronary artery disease (CAD), compared with the classical ST depression criterion. Some of them combine repolarisation measurements with heart rate (HR) information (such as the so-called ST/HR hysteresis); others are obtained from the depolarisation period (such as the Athens QRS score); finally, there are heart rate variability (HRV) indexes that account for the nervous system activity. The aim of this study was to identify the best exercise ECG indexes for CAD diagnosis. First, a method to automatically estimate repolarisation and depolarisation indexes in the presence of noise during a stress test was developed. The method is divided into three stages: first, a preprocessing step, where QRS detection, filtering and baseline beat rejection are applied to the raw ECG, prior to a weighted averaging secondly, a post-processing step in which potentially noisy averaged beats are identified and discarded based on their noise variance; finally, the measurement step, in which ECG indexes are computed from the averaged beats. Then, a multivariate discriminant analysis was applied to classify patients referred for the exercise test into two groups: ischaemic (positive coronary angiography) and low-risk (Framingham risk index<5%). HR-corrected repolarisation indexes improved the sensitivity (SE) and specificity (SP) of the classical exercise test (SE=90%, SP-79% against SE=65%, SP=66%). Depolarisation indexes also achieved an improvement over ST depression measurements (SE=78%, SP=81%). HRV indexes obtained the best classification results in our study population (SE=94%, SP=92%) by means of the very high-frequency power (VHF) (0.4–1 Hz) at stress peak.

Comentarios a la guía de práctica clínica de la ESC sobre prevención de la enfermedad cardiovascular (versión 2012). Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

As proposed by the SEC clinical practice guidelines committee, the Hypertension and Preventive Cardiology and Rehabilitation sections selected a group of CVD prevention experts to review the ESC guidelines published in 2012 and translated in REVISTA ESPAÑOLA DE CARDIOLOGÍA. Their objective was to discuss the contents and appropriacy of the guidelines, analyze the method and highlight issues considered innovative, positive or questionable, as well as any left with no comment. The guidelines were divided into 5 parts and each was independently commented on by 2 experts. Based on their opinions, a document was prepared and, in turn, reviewed and approved by a group of experts designated by the SEC sections involved. All the experts have declared their conflicts of interest, which are stated in detail at the end of this article.

Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS

Fundamento y objetivo Describir la prevalencia de la disfuncion renal subclinica, valorada mediante el filtrado glomerular (FG), e identificar a que factores de riesgo cardiovascular se asocial en una poblacion laboral activa espanola. Sujetos y metodo Se recogieron los datos de 11.582 trabajadores activos (un 78,5% varones), con una edad media (desviacion estandar) de 40,2 (10,7) anos, mediante las revisiones anuales de las mutuas laborales. La funcion renal se clasifico segun el FG, valorado mediante la formula abreviada del estudio Modification of Diet in Renal Disease (MDRD), la formula Cockroft- Gault (CG) y el cociente peso/creatinina. El diagnostico del sindrome metabolico se realizo mediante los criterios del Adult Treatment Panel III modificados. Resultados Las 3 formulas de estimacion del FG aportan valores diferentes. Los valores medios de FG fueron mayores con la formula CG (99,0 [25,0]) ml/min/1,73 m 2 , seguidos de los obtenidos por la formula MDRD (90,2 [18,5]) ml/min/1,73 m 2 y la formula peso/creatinina (81,2 [18,3]) ml/min/1,73 m 2 . La prevalencia de disfuncion renal leve (FG: 60-89 ml/min/1,73 m 2 ) vario entre el 35,7 y el 50,8% en funcion de la ecuacion empleada, y moderada-grave (FG 2 ) entre un 1,2 y un 2,6%. Todos los factores de riesgo cardiovascular fueron mas prevalentes en las categorias de mayor disfuncion renal. El analisis de regresion multivariante muestra que la hipertrigliceridemia ( odds ratio [OR] = 1,2), el sindrome metabolico (OR = 1,2), el sobrepeso OR = 1,2) y la hipercolesterolemia (OR = 1,5) se asocian independientemente a la disfuncion renal leve. La hipercolesterolemia (OR = 1,6), la hipertension (OR = 1,6), una concentracion baja de colesterol unido a lipoproteinas de alta densidad (OR = 2,4) y la diabetes mellitus (OR = 3,2) se asocian con la disfuncion renal moderada-grave. Conclusiones La disfuncion renal subclinica es muy prevalente y se asocia independientemente a los factores de riesgo cardiovascular clasicos y el sindrome metabolico.

El bloqueo de rama izquierda inducido por el ejercicio en pacientes con y sin enfermedad coronaria

Introduccion y objetivos La aparicion de un bloqueo de rama izquierda inducido por el ejercicio no siempre significa presencia de enfermedad coronaria subyacente. El motivo de este estudio fue analizar las caracteristicas clinicas y evolutivas de los pacientes con bloqueo de rama izquierda dependiente de la frecuencia. Pacientes y metodo Se revisaron 9.318 estudios ergometricos de esfuerzo practicados de forma consecutiva y se estudiaron las caracteristicas clinicas y evolutivas (seguimiento medio: 6,9 anos) de los 20 pacientes que presentaron bloqueo de rama izquierda dependiente de frecuencia y en los que se disponia de coronariografia. Resultados Un total de ocho de los 20 pacientes tenian coronarias normales (grupo A) y 12 tenian enfermedad coronaria (grupo B). El consumo maximo de O2, el consumo miocardico de O2 y la frecuencia cardiaca en el momento de aparicion del bloqueo (132 ± 20 frente a 95,4 ± 23 lat/min; p = 0,002) fueron significativamente superiores en el grupo A. Siete de los 8 pacientes del grupo A presentaron dolor precordial coincidiendo con el primer latido en que aparecio el bloqueo. No hubo ningun caso de fallecimiento en el grupo A, y en cinco de los 8 pacientes de este grupo se observo evolucion a bloqueo de rama izquierda permanente con desaparicion del dolor inducido por el esfuerzo. En el grupo B, 3 pacientes fallecieron y dos presentaron un infarto durante el seguimiento. Un paciente de cada grupo evoluciono a bloqueo auriculoventricular completo. Conclusiones A diferencia de los pacientes con bloqueo de rama izquierda dependiente de frecuencia y enfermedad coronaria, el pronostico de los pacientes con bloqueo de rama izquierda doloroso y coronarias normales es muy bueno en cuanto a mortalidad, aunque pueden evolucionar a bloqueo de rama izquierda permanente y, excepcionalmente, a bloqueo auriculoventricular.

Determinantes del éxito de la revascularización de las oclusiones coronarias crónicas: estudio mediante tomografía computarizada con multidetectores

INTRODUCTION AND OBJECTIVES Percutaneous revascularization of chronic total coronary artery occlusion is a technical challenge and has a lower success rate than other angioplasty procedures. Identification of predictors of failure could lead to better selection of patients with the greatest possibility of success. In this study, we investigate the multidetector computed tomography features associated with failure of percutaneous treatment for chronic total coronary occlusion. METHODS This is a prospective, single-center study of 69 consecutive patients with chronic total occlusion in whom multidetector computed tomography study was performed before percutaneous coronary revascularization. RESULTS Seventy-seven lesions were analyzed. The mean length of the occlusion was 19.9 (14.3) mm and the estimated duration of occlusion was 47 (62) months. The only angiographic factor independently predictive of failure was a severe curve between the plaque and the proximal patent vessel (odds ratio 3.8, 95% confidence interval, 1.2-12; P=.02). On multidetector computed tomography, the only factor predictive of failure was an arc of calcium affecting more than 50% of the vessel circumference in the proximal (P=.04) and middle (P=.03) third of the occlusion. CONCLUSIONS Multidetector computed tomography identified a variable that cannot be measured by angiography that can predict failure in percutaneous revascularization of chronic total coronary occlusions. In selected cases, this parameter could be useful for preprocedure screening.

Electrocardiographic Findings Typical of Brugada Syndrome Unmasked by Cocaine Consumption

Brugada syndrome is characterized by the presence of right bundle branch block on electrocardiography and by ST-segment elevation in the right precordial leads (V1-V3), by the absence of structural cardiac abnormalities, and by episodes of syncope or sudden death. On occasion, diagnosis is made difficult by temporary normalization of the ECG. The condition can be unmasked by potent sodium channel blockers, such as flecainide. Our patient presented with a Brugada syndrome-type ECG after intake of a large amount of cocaine.

ECG-based clinical indexes during exercise test including repolarization, depolarization and HRV

In this work, we compared ECG clinical ischemia indexes from ventricular depolarization, repolarization and heart rate variability (HRV) measurements during exercise tests. ST segment deviations, ST/heart-rate hysteresis, Q-, Rand S-wave amplitudes, QRS duration and HRV indexes were automatically measured. Coronary angiography was used as the gold standard to include patients in the ischemic group. Multivariate discriminant analysis was applied to classify the patients. Results based on classical ST indexes correctly classified 58% of patients. When depolarization, repolarization and HRV indexes were jointly considered, the exactness improved to 91% (sensitivity=94%, specificity=89%). These results are close to those obtained by exercise echocardiography or exercise nuclear imaging.

PatrÓn electrocardiogràfico de Brugada desenmascarado por consumo de cocaína

El diagnostico del sindrome de Brugada se caracteriza por la presencia en el electrocardiograma (ECG) de bloqueo de rama derecha y elevacion del segmento ST en las derivaciones precordiales derechas, ausencia de enfermedad cardiaca estructural y episodios de sincope o de muerte subita. En ocasiones, el diagnostico se encuentra dificultado por la normalizacion transitoria del ECG y puede ser desenmascarado por bloqueadores de los canales de sodio, como la flecainida. Presentamos un caso en el que no fue un farmaco, sino el consumo de cocaina, lo que puso de manifiesto un patron tipico de Brugada.

Totally biological composite aortic stentless valved conduit for aortic root replacement: 10-year experience

ObjectivesTo retrospectively analyze the clinical outcome of a totally biological composite stentless aortic valved conduit (No-React® BioConduit) implanted using the Bentall procedure over ten years in a single centre.MethodsBetween 27/10/99 and 19/01/08, the No-React® BioConduit composite graft was implanted in 67 patients. Data on these patients were collected from the in-hospital database, from patient notes and from questionnaires. A cohort of patients had 2D-echocardiogram with an average of 4.3 ± 0.45 years post-operatively to evaluate valve function, calcification, and the diameter of the conduit.ResultsImplantation in 67 patients represented a follow-up of 371.3 patient-year. Males were 60% of the operated population, with a mean age of 67.9 ± 1.3 years (range 34.1-83.8 years), 21 of them below the age of 65. After a mean follow-up of 7.1 ± 0.3 years (range of 2.2-10.5 years), more than 50% of the survivors were in NYHA I/II and more than 60% of the survivors were angina-free (CCS 0). The overall 10-year survival following replacement of the aortic valve and root was 51%. During this period, 88% of patients were free from valved-conduit related complications leading to mortality. Post-operative echocardiography studies showed no evidence of stenosis, dilatation, calcification or thrombosis. Importantly, during the 10-year follow-up period no failures of the valved conduit were reported, suggesting that the tissue of the conduit does not structurally change (histology of one explant showed normal cusp and conduit).ConclusionsThe No-React® BioConduit composite stentless aortic valved conduit provides excellent long-term clinical results for aortic root replacement with few prosthesis-related complications in the first post-operative decade.