Zona Urbana Río Tijuana, Mexico

Inhaled Versus Intravenous Milrinone for Patients Undergoing Mitral Valve Replacement Surgery

All patients underwent standard preoperative cardiac surgery assessment. Premedication included bromazepam and ranitidine, given the night before and 2 hours prior to arrival to OT. On arrival, IV access and arterial cannula were inserted under local anesthesia, along with routine monitoring electrocardiogram (ECG), pulse oximetery (SpO2), and IBP. Anesthesia was induced with midazolam, fentanyl, and cis-atracurium. After tracheal intubation, ultrasound (US) guided- central venous catheter (CVC) was inserted and TEE also applied and then anesthesia maintained with morphine, cis-atracurium infusions, and sevoflurane. Mechanical ventilation was set to maintain end-tidal carbon dioxide (etco2) in the range of 30-40 mmHg using lung protective ventilation strategies. During CPB, flow of 2.2 L.min-1.m-2, a custodiol cardioplegia was given, temperature kept at 28-32℃ and anesthesia maintained by sevoflurane- through a vaporizer mounted on CPB machine-. A senior consultant certified cardiac anesthetist conducted a baseline TEE using Philips EPIQ CVxi echocardiography machine. Baseline measures included left ventricular ejection fraction (LVEF), and RV function represented by tricuspid annulus plane systolic excursion (TAPSE), fractional area changes (FAC), and right ventricular systolic pressure (RVSP) by doppler also, PVR and systemic vascular resistance (SVR) was calculated, plus patients hemodynamics (mean arterial blood pressure (MAP), heart rate (HR)), all measures were recorded.

Prasugrel Or Ticagrelor De-escalation in NSTE-ACS

Improved Recovery by Iron Following Surgery With Blood Loss, the IRIS-trial

Study of the Safety and Efficacy of RPH-104 in Preventing Recurrences in Patients With Idiopathic Recurrent Pericarditis

This long-term open-label study is an extension of the main double-blind, randomized, placebo-controlled study, CL04018068. This study will include the following periods: - screening period - carried out on Day 0 (where Day 182, Week 26 from randomization in the main study CL04018068 will be considered as Day 0 of this study); - re-screening period - up to 28 days (for patients who have completed the CL04018077 study); - scheduled treatment period - 24-60 weeks (depends on the duration of treatment with RPH-104 during the main study CL04018068); - safety follow-up period - 168 weeks. 60-week treatment re-initiation is possible in case of a disease recurrence reported during this period (with follow-up assessments 4 and 8 weeks after the last dosing of the investigational drug and telephone visits after 20, 32, 44, 56, 68, 80, 92 and 104 weeks after the administration of the final dose of the investigational drug, respectively). It is planned that this study will include no more than 25 patients who completed the main study. During the screening period, patients will be evaluated for eligibility for inclusion/non-inclusion in this study. Patients who do not meet these criteria will not receive treatment with the study drug. Patients who meet the criteria for inclusion/non-inclusion in the study will enter the treatment period, where they will start open-label treatment with RPH-104 80 mg once every 2 weeks subcutaneously (SC). The study drug to patients will be administered by qualified medical personnel every 2 weeks when the patient visits the study site, or at the patient's home by the patient him/herself. Safety and efficacy assessments are performed at Visit 1, Visit 2 (after 2 weeks) and then every 4 weeks according to the visits schedule. After the patients receive the last dose of the study drug the treatment period will be considered completed and a 168 week period of safety follow-up will start. During this period, the patients will have to visit the study site after 4 weeks, then - after 8 weeks, and thereafter - every 12 weeks if in the Investigator's opinion it is considered safe and acceptable for a particular patient (it is possible to conduct the visits every 4 weeks until the completion of the study, if necessary in the Investigator's opinion and in agreement with Sponsor). There will also be eight telephone visits. In case of a suspected recurrence of pericarditis, the patient will need to contact the study physician and come to the study site for an unscheduled visit. Recurrence of pericarditis is defined as the presence of at least two of the following symptoms in a patient: - the chest pain intensity score according to the numeric rating scale (NRS) > 3 (in the absence of other possible reasons for the increase in the pain intensity); - C-reactive protein (CRP) level > 5 mg/L (in the absence of other possible reasons for an increase in CRP levels); - development of a new pericardial effusion or progression of the existing one in diastole according to echocardiography (EchoCG). If recurrence of the disease is confirmed during the treatment period as well as if any of the above-described signs of relapse of pericarditis and its persistence (two consecutive visits) or a tendency to increase the values of the sign (estimated at two consecutive visits) are detected, therapy with the study drug could be canceled ahead of schedule or continued at a dose of 80 mg every 2 weeks with the addition of NSAIDs and / or colchicine at the discretion of the Investigator. If the patient develops a pericarditis recurrence during the safety follow-up period, at the discretion of the investigator treatment with the study drug might be re-initiated in this patient for a duration of 60 weeks or therapy with alternative drugs of the researcher's choice might be prescribed (in this case, the patient will have to come to two follow-up visits - 4 and 8 weeks after the last dose of the study drug and perform eight telephone visits after 20, 32, 44, 56, 68, 80, 92 and 104 weeks after the administration of the last dose of the study drug. After that the patient will be considered to have completed the study). In case of study drug re-initiation, the drug will be administered according to the following regimen: a single dose of 160 mg (first injection) followed by a dose of 80 mg 7 days and 14 days after the first injection and at doses of 80 mg every two weeks thereafter (at the discretion of the investigator). At the discretion of the investigator, NSAIDs and/or colchicine might be used for the treatment of recurrences in these patients. The assessment of the patient's condition will be carried out 3 days, 7 and 14 days, as well as 12 weeks after the continuation of the study therapy with the addition of NSAIDs and / or colchicine during the therapy period or after the study drug re-initiation during the safety monitoring period. The criterion for the resolution of the relapse is the presence of all the following signs simultaneously: - the chest pain intensity score according to the numeric rating scale (NRS) ≤ 3 AND - CRP level ≤ 5 mg/L AND - absence or small (<10 mm) pericardial effusion or progression of the existing one in diastole according to echocardiography (EchoCG). If the recurrence of the disease is resolved by the week 12, the patient will continue to use RPH-104 80 mg every 2 weeks and will conduct efficacy and safety assessments every 2 weeks for 12 weeks and thereafter every 4 weeks until the end of the scheduled treatment period or re-initiated therapy, depending on the period the study when the recurrence occurred. If glucocorticoid prescription is required by week 12 to resolve a recurrence, the investigated therapy will be canceled to the patient ahead of schedule. If the patient develops a pericarditis recurrence after the study drug re-initiation (the patient already receives RPH-104 80 mg every 2 weeks during the safety monitoring period), as well as if any of the signs of a relapse of pericarditis and its persistence or a tendency to increase the values of the sign (as described above for the period of planned therapy), the use of RPH-104 might be canceled ahead of schedule or continued until the end of the period of re-initiated therapy at a dose of 80 mg every 2 weeks with the addition of NSAIDs and/or colchicine at the discretion of the investigator. After the end of the re-initiated therapy, the patient will have to come to two follow-up visits - 4 or 8 weeks after the last dose of the study drug and perform eight telephone visits after 20, 32, 44, 56, 68, 80, 92 and 104 weeks after the administration of the last dose of the study drug. No decrease or increase in the doses of the study drug (other than those described in this study) are envisaged in this study. Patients who have discontinued the open-label therapy with the study drug early for any reason, should perform two safety follow-up visits at Week 4 and Week 8 after the last dose of the study drug and perform eight telephone visits after 20, 32, 44, 56, 68, 80, 92 and 104 weeks after the administration of the last dose of the study drug. The duration of one patient participation in this open study is from 192 to 228 weeks, depends on the duration of the therapy period, which will be calculated for each patient, taking into account the duration of the RPH-104 use during the main study (CL04018068), as well as on the absence or presence of a pericarditis recurrence and the decision to resume the studied therapy in the safety follow-up period of the study.

REDEFINE 3: A Research Study to See the Effects of CagriSema in People Living With Diseases in the Heart and Blood Vessels

Effect of Dapagliflozin on Cardiac Structure, Function and Secondary Mitral Regurgitation in Patients with Left Ventricle Dysfunction

A functional mitral regurgitation (MR) occurs when the mitral valve (MV) becomes tethered due to abnormal LV remodelling in individuals with heart failure (HF) and left ventricular (LV) dilatation. The primary treatment for HF is medical, and it is based on established guidelines, as LV failure is the most common cause of secondary functional MR. Standard medical therapy for patients with functional MR, including beta blockers, ACE inhibitors, and angiotensin receptor blockers (ARB), does not reduce the morbidity or mortality associated with these conditions. Similar to the neprilysin inhibitor, which promotes sodium excretion and has vasodilatory effects via relaxing blood vessels, Dapagliflozin reduce cardiac preload and afterload by inducing natriuresis and reducing arterial stiffness. Effects on blood pressure reduction and weight loss may also positively affect left ventricular (LV) remodelling. Using echocardiography, researchers hope to test the hypothesis that dapagliflozin improves MR in patients with functional MR due to LV dysfunction. This hypothesis is based on studies showing the beneficial effects of Dapagliflozin on LV modelling.

Therapeutic Approach in Colchicine-resistant Recurrent pEricarditis in Children

Although steroids represent the second-line treatment for recurrent pericarditis (RP), to be used in case of inadequate response to NSAIDs and colchicine, their use is controversial due to their side effects. Indeed, in adult patients with RP it has been demonstrated that the use of steroids is associated with an increased risk of recurrence: in a study carried out in adult patients, 64% of patients taking high-dose steroids (> 1 mg/kg/ of prednisone or equivalent), and 32% of patients taking this low-dose drug (< 1 mg/kg/day of prednisone or equivalent) relapsed. Furthermore, the therapy is associated with serious side effects and an increased risk of hospitalization, especially in patients treated with high doses. Finally, a high percentage of RP patients (both adult and pediatric) treated with steroids tend to become steroid-dependent, experiencing a disease exacerbation during tapering of treatment or soon after its discontinuation. The side effects associated with the chronic use of steroids are well known, especially in childhood, as their use is associated not only with reduced bone density, but also with growth retardation. Therefore, their long-term use is contraindicated, especially in children. In a recent retrospective study of 58 pediatric patients with recurrent pericarditis treated with IL-1 inhibitors, a high steroid dependence rate was observed (45 of 48 treated patients). In this study, the presence of predictive factors associated with the possibility of achieving long-term remission was evaluated. Unfortunately, it could not be shown that avoiding steroid use was associated with an increased chance of withdrawing anakinra without relapse. This is likely due to the large variability of the cohort included in the retrospective study. Therapy with anakinra in recurrent pericarditis is aimed at obtaining rapid and complete control of the disease and maintaining it over time, allowing the suspension of steroid therapy and thus reducing the risk of complications, chronicity and recurrence. In the field of pediatric rheumatology, there is convincing evidence that in children with chronic arthritis a more aggressive therapy at an early stage can take advantage of the so-called "window of opportunity": according to this theory, early biological treatment can modify the pathogenetic mechanism of the disease by improving its long-term outcomes. In particular, it has been shown that anakinra therapy in children with systemic JIA can lead to rapid attainment of inactive disease and allow for early discontinuation of treatment in the absence of recurrence in the majority of patients. Among all the rheumatological pathologies of the pediatric age, systemic JIA is the one that has the greatest similarities with autoinflammatory diseases due to the presence of fever, sometimes recurrent, rash and serositis, typical characteristics of AID, especially of inflammasomopathies. Recurrent pericarditis itself has many similarities to these conditions, as demonstrated by the efficacy of interleukin-1 inhibition. In fact, both of these conditions are considered by many to be real autoinflammatory diseases, with a multifactorial etiology. It is therefore reasonable to think that the concept of the "window of opportunity" can also be translated to recurrent pericarditis: the early blockade of cytokines could in fact abrogate the pathogenetic mechanism of the disease and therefore its chronic course and/or its relapses.

The Effect of Colchicine on Inflammation in ACS Patients

This study will evaluate the effect of colchicine on inflammation, cardiac remodeling, and atherosclerotic risk in STEMI patients through the assessment of the IL-1β, sST2, and lipid profile parameters as well as to examine the drug safety and tolerability in these patients.

LEVosimendan to Improve Exercise Limitation in Patients with PH-HFpEF

This is a Phase 3, double-blind, randomized, placebo-controlled study of oral levosimendan in patients with PH-HFpEF. There will be a Screening Period of up to 30 days. Subjects will provide written informed consent prior to completing any study procedures. Upon meeting all eligibility criteria, patients will continue to the 12-week randomized, double-blind treatment phase. Approximately 230 subjects will be randomized in a 1:1 ratio to receive an oral dose of levosimendan or placebo All randomized subjects will have the option to enter the 92-week OLE following the completion of all study events at Week 12.

Dapagliflozin Effects on Coronary Calcium and Epicardial Fat Assessed by Cardiotomography

It is now well recognized that Coronary Artery Disease (CAD) is part of the spectrum of cardiovascular diseases (CVDs) that have common underlying risk factors and may manifest as myocardial infarction, stroke or death. CAD is a pathological process characterized by the accumulation of atherosclerotic plaque in the epicardial arteries, whether obstructive or non-obstructive; it can have long and stable periods, but it can also become unstable at any time. It is unknown whether the high risk provided by the presence of obstructive coronary artery atherosclerotic disease is due to stenosis per se, or due to its correlation with the total burden of atherosclerotic plaque. Studies suggest that calcified atherosclerotic burden, not stenosis, is the main predictor of future events of cardiovascular disease (myocardial infarction and cerebrovascular disease) and death in patients with coronary artery disease. Atherosclerosis imaging allows measurable assessments of disease progression and activity, revealing early signs of potential drug effects. Non-invasive methods are preferable for serial imaging in drug trials because of the potential risks associated with invasive procedures. High participant dropout rates are also observed when invasive methods are used. Therefore, coronary artery calcium scanning offers a simple, non-invasive, rapid, and reliable method to quantify coronary calcium, which is pathognomonic for established atherosclerosis. It is a powerful screening tool for asymptomatic patients at low or intermediate risk of CVD, including those with diabetes mellitus, and can potentially improve adherence to lifestyle advice and medication. Coronary artery calcium can be quantified by non-contrast-enhanced CT using the Agatston score, which is currently the most widely used method. Conceptually, the Agatston score is the sum of the scores for all calcified coronary lesions, representing both the total area and the maximum density of coronary calcification. The area of the lesion is multiplied by the density factor that is determined by pre-defined cut points. The density factor is used so that the regions with higher attenuation contribute more strongly to the final calcium score. A CT attenuation threshold of 130 Hounsfield units (HU) is used for calcium detection, and only contiguous voxels totaling an area greater than 1 mm2 are counted as "lesions" to reduce the influence of image noise. Standardized categories have been developed for the calcium score with scores of 0 indicating the absence of calcified plaque, 1 to 10 minimal plaque, 11 to 100 mild plaque, 101 to 400 moderate plaque, and > 400 severe plaque. In 2017, the Society of Cardiovascular Computed Tomography (SCCT) and the Society of Thoracic Radiology (STR) proposed the CAC-DRS as a way to standardize communication regarding CAC findings on non-contrast-enhanced CT scans. CAC-DRS categories are defined as Ax/Ny, where A represents the Agatston score group (where A0, A1, A2, and A3 represent CAC of 0, CAC of 1-99, CAC of 100-299, and CAC ≥ 300, respectively), and N represents the number of vessels affected by CAC, ranging from 0 to 4 for the major epicardial coronary arteries., respectively), and N represents the number of vessels affected by CAC, which varies from 0 to 4 for the main epicardial coronary arteries.