Jorge Solis

To compare the risk of cardiovascular disease and the occurrence of cardiovascular events in the mid-long term after delivery, between women with and without a history of early-onset preeclampsia. A prospective case-control study has been conducted in Hospital Universitario 12 de Octubre, Madrid. 50 women with early-onset preeclampsia (diagnosed < 34 + 0 weeks) who delivered between 2008 and 2017 and a matched group (by age, parity, pregestational body mass index and date of delivery) of 50 women with uncomplicated pregnancies were recruited. In them, a 1-day visit for cardiovascular assessment was performed 3-12 years after delivery, consisting of the completion of blood and urine tests including oxidative stress analysis, vascular ultrasound to assess subclinical atherosclerosis and 24-hour blood pressure monitoring. Furthermore, Framingham10 and Framingham30 scales of cardiovascular disease risk were applied. Univariate analysis was used for comparisons, and the Kaplan-Meier method was performed to estimate their survival time until the development of a cardiovascular disease event (chronic hypertension, renal disease, myocardial infarction, thromboembolism and cerebrovascular disease). Patients were evaluated at a median of 7.5 years (interquartile range, 6.5-9) after delivery. Women with a history of early-onset preeclampsia vs controls showed significantly lower levels of hemoglobin (12.9 vs 13.7 g/dL), hematocrit (38.9 vs 40.8%), prothrombin activity (93.1 vs 99.8%), IgA (223.5 vs 279.9 mg/dL) and C3 factor (101.0 vs 110.5 mg/dL) and prolongated prothrombin time (12.4 vs 11.6 s). Early-onset preeclampsia cases showed worse blood pressure control, with higher percentages of over-limit systolic blood pressure (17.9 vs. 11.2%, p < 0.01) and diastolic blood pressure (28.1 vs. 18.7%, p < 0.01) readings in 24 h. There were no significant differences in the vascular ultrasound studies as well as in the estimated cardiovascular risk obtained with the Framingham scales. At the visit time, a cardiovascular event was present in 44% women with history of early-onset preeclampsia vs 10% in the control group (p < 0.01). The most common event was chronic hypertension, with a relative risk of 4.7 (95% confidence interval 1.7-13.0) for the early-onset preeclampsia group. Women with a history of early-onset preeclampsia, compared to their matched controls, showed a greater risk of cardiovascular disease mainly at the expense of a 4.7-fold risk of developing chronic hypertension, with a median follow-up of 7.5 years after delivery.

Identifying the subgroup of patients with mitral valve prolapse (MVP) and high incidence of ventricular arrhythmias (VA) represents a challenge. The arrhythmic MVP (AMVP) has been defined as the presence of MVP, combined with frequent and/or complex VA in the absence of any other arrhythmic substrate, regardless of the presence of mitral regurgitation (MR).^1–4 There have been efforts to identify echocardiographic characteristics of AMVP, being bileaflet prolapse and mitral annular disjunction (MAD) the most studied ones.^5,6 It has been previously postulated that leaflet displacement exerts increased tension on papillary muscles (PMs) causing excessive traction,⁷ which may be linked to the reduced regional strain and myocardial fibrosis at the PMs and basal inferior-lateral left ventricular (LV) wall, that is seen in this population.^8–10

Degenerative aortic stenosis is the most common valve disease in the elderly and is usually confirmed at an advanced stage when the only treatment is surgery. This work is focused on the study of previously defined biomarkers through systems biology and artificial neuronal networks to understand their potential role within aortic stenosis. The goal was generating a molecular panel of biomarkers to ensure an accurate diagnosis, risk stratification, and follow-up of aortic stenosis patients. We used in silico studies to combine and re-analyze the results of our previous studies and, with information from multiple databases, established a mathematical model. After this, we prioritized two proteins related to endoplasmic reticulum stress, thrombospondin-1 and endoplasmin, which have not been previously validated as markers for aortic stenosis, and analyzed them in a cell model and in plasma from human subjects. Large-scale bioinformatics tools allow us to extract the most significant results after using high throughput analytical techniques. Our results could help to prevent the development of aortic stenosis and open the possibility of a future strategy based on more specific therapies.

Aortic stenosis (AS) and diabetes mellitus (DM) are both progressive diseases that if left untreated, result in significant morbidity and mortality. Several studies revealed that the prevalence of DM is substantially higher in patients with AS and, thus, the progression from mild to severe AS is greater in those patients with DM. DM and common comorbidities associated with both diseases, DM and AS, increase patient management complexity and make aortic valve replacement the only effective treatment. For that reason, a better understanding of the pathogenesis underlying both these diseases and the relationships between them is necessary to design more appropriate preventive and therapeutic approaches. In this review, we provided an overview of the main aspects of the relationship between AS and DM, including common comorbidities and risk factors. We also discuss the established treatments/therapies in patients with AS and DM.