Background Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. Methods Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the “data warehouse of the Galician Healthcare Service” using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. Results A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA 2 DS 2 -VASc (4.21 vs 3.46; P =0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P <0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P =0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P =0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality. Conclusion AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.

Background and objectives: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. Methods: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine–Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. Results: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine–Gray models show that the ‘PG-HACKER’ risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. Conclusion: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes.

Cardiac resynchronization therapy represents a therapeutic option for heart failure drug-refractory patients. However, due to the lack of success in 30% of the cases, there is a demand for an in-depth analysis of individual heterogeneity. In this study, we aimed to evaluate the prognostic value of circulating miRNA differences. Responder patients were defined by a composite endpoint of the presence of left ventricular reverse remodelling (a reduction ≥15% in telesystolic volume and an increment ≥10% in left ventricular ejection fraction). Circulating miRNAs signature was analysed at the time of the procedure and at a 6-month follow-up. An expression analysis showed, both at baseline and at follow-up, differences between responders and non-responders. Responders presented lower baseline expressions of miR-499, and at follow-up, downregulation of miR-125b-5p, both associated with a significant improvement in left ventricular ejection fraction. The miRNA profile differences showed a marked sensitivity to distinguish between responders and non-responders. Our data suggest that miRNA differences might contribute to prognostic stratification of patients undergoing cardiac resynchronization therapy and suggest that preimplant cardiac context as well as remodelling response are key to therapeutic success.

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El presente trabajo, realiza una breve introducción a las medidas QND (Quantum nondemolition measurement) y sus características.  Además, se describe teóricamente un qubit acoplado a un oscilador armónico cuántico forzado como ejemplo de una medición QND en un qubit. El formalismo desarrollado para este tipo de sistemas cuánticos acoplados se desenvuelve dentro de la teoría cuántica de la computación. Como parte del estudio de las mediciones QND, se introducen los qubits de flujo que hacen uso de los interferómetros superconductores cuánticos (SQUIDs). El análisis de este esquema informático intenta introducir al lector en los conceptos de computación cuántica como el quibit que es el componente base que permite procesar información de forma cuántica.  El  objetivo de este trabajo es caracterizar si las medidas elaboradas sobre el qubit acoplado son o no QND.  En este sentido, la aplicación del formalismo expuesto permitirá vislumbrar los alcances y limitaciones de los qubits acoplados en el desarrollo y aplicación de los sistemas cuánticos de la computación hasta el día de hoy. Adicionalmente, la aplicación de esta teoría se puede emplear a mediciones QND sobre qubits superconductores articulados a un oscilador armónico cuántico. Todo este proceso es sujeto al análisis y metodología que nos proporciona la historia de la ciencia y la tecnología. AbstractThe present work makes a brief introduction to QND (Quantum non demolition measurement) measurements and its characteristics. In addition, a qubit coupled to a forced quantum harmonic oscillator which is described theoretically as an example of a QND measurement in a qubit. The formalism developed for this type of coupled quantum systems is developed within the quantum theory of computation. As part of the study of QND measurements, the flow qubits making use of quantum superconducting interferometers (SQUIDs) are introduced. The analysis of this computer schema attempts to introduce the reader to the concepts of quantum computing such as qubit, which is the basic component that allows information to be processed quantumly. The objective of this work is to characterize whether the elaborated measures on the coupled qubit are QND or not. In this sense, the application of the exposed formalism will allow us to glimpse the scope and limitations of coupled qubits in the development and application of quantum computing systems to this day. Additionally, the application of this theory can be applied to QND measurements on superconducting qubits coupled to a quantum harmonic oscillator. All this process is subject to the analysis and methodology provided by the history of science and technology.