Quintanilla J.G.,Institute Investigacion Sanitaria del Hospital Clinico San Carlos IdISSC |
Moreno J.,Institute Investigacion Sanitaria del Hospital Clinico San Carlos IdISSC |
Moreno J.,Hospital Ramon y CajalMadrid |
Archondo T.,Institute Investigacion Sanitaria del Hospital Clinico San Carlos IdISSC |
And 9 more authors.
Heart Rhythm | Year: 2015
Background Heart failure (HF) electrophysiological remodeling (HF-ER) often includes the effect of chronically increased intraventricular pressures (IVPs) and promotes ventricular tachycardia/ventricular fibrillation (VT/VF). In addition, acutely increased IVPs have been associated with a higher rate of VT/VF episodes in chronic HF. Objective We hypothesized that increased IVPs and/or an ionic-imbalanced (acidified), catecholamine-rich (adrenergic) milieu (AA milieu) may contribute as much as HF-ER to the substrate for reentry in HF. We used a porcine model of tachycardiomyopathy and evaluated the individual/combined contributions of (1) increased IVPs, (2) HF-ER, and (3) an AA milieu. Methods HF-ER was induced in 7 pigs by rapid pacing. Seven pigs were used as controls. Hearts were isolated and Langendorff perfused. Programmed ventricular stimulation was conducted under low or increased IVP and normal/AA milieu (4 combinations). Epicardial optical mapping was used to quantify conduction velocity (CV), action potential duration (APD), and dispersion of repolarization (DoR). Results HF-ER decreased CV (-34%; P =.002) and increased APD (11%; P =.024) and DoR (21%; P =.007). Increased IVP amplified DoR (36%; P <.001) and decreased CV (-17%; P =.001) and APD (-8%; P <.001). The AA milieu consistently modified only APD (-9%; P <.001) and led to amplified inter-/intra-subject heterogeneity. Increased IVP similarly raised the odds of inducing sustained VT/VF as the presence of HF-ER (>6-fold). Conclusion By magnifying DoR, decreasing CV, and shortening APD, increased IVP was as harmful as HF-ER in favoring the substrate for sustained reentry in this model. The AA milieu contributed to a much lesser extent. Thus, a stricter control of IVP might be postulated as a useful add-on antiarrhythmic strategy in HF. © 2015 Heart Rhythm Society.
PubMed | Institute Investigacion Sanitaria Del Hospital Clinico San Carlos Idissc Madrid, Complutense University of Madrid and Mount Sinai School of Medicine
Type: Journal Article | Journal: Actas espanolas de psiquiatria | Year: 2016
Current literature suggests that personality disorder comorbidity negatively contributes to both the severity and prognosis of other disorders; however, little literature has been devoted to its influence on borderline personality disorder (BPD). The objective of the present work is to study comorbidity with other personality disorders in a severe clinical sample of patients with BPD, and its relationship with global functionality.A sample of 65 patients with severe borderline personality disorder was included in the study. Clinical and functionality measures were applied in order to study comorbidity of BPD with other disorders and its relationship with functionality. Associations with other comorbid PDs were analyzed with t-tests and linear correlations.Most patients (87%) presented comorbidity with other PDs. Almost half of the sample (42%) presented more than two PDs, and cluster A (paranoid) and C (obsessive and avoidant) PD were more frequent than cluster B (histrionic and antisocial). Only the presence of avoidant PD predicted a worse functional outcome in the long term (U Mann Withney p<0.01).Severely impaired BPD patients present greater comorbidity with cluster A and C PDs. Comorbid avoidant personality disorder might negatively predict for prognosis.