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SYNERGY-Everolimus-Eluting Stent With a Bioabsorbable Polymer in ST-Elevation Myocardial Infarction: CLEAR SYNERGY OASIS-9 Registry
(Elsevier, 2024-06-01) Jolly, Sanjit S; Lee, Shun Fu; Mian, Rajibul; Kedev, Sasko; Lavi, Shahar; Moreno, Raul; Montalescot, Gilles; Hillani, Ali; Henry, Timothy D; Asani, Valon; Storey, Robert F; Silvain, Johanne; Spratt, James C S; d'Entremont, Marc-André; Stankovic, Goran; Zafirovska, Biljana; Natarajan, Madhu K; Sabate Tenas, Manuel; Shreenivas, Satya; Pinilla-Echeverri, Natalia; Sheth, Tej; Altisent, Omar Abdul-Jawad; Ribas, Núria; Skuriat, Elizabeth; Tyrwhitt, Jessica; Mehta, Shamir R
Our objective was to evaluate the clinical effectiveness of the SYNERGY stent (Boston Scientific Corporation, Marlborough, Massachusetts) in patients with ST-elevation myocardial infarction (STEMI). The only drug-eluting stent approved for treatment of STEMI by the Food and Drug Administration is the Taxus stent (Boston Scientific) which is no longer commercially available, so further data are needed. The CLEAR (Colchicine and spironolactone in patients with myocardial infarction) SYNERGY stent registry was embedded into a larger randomized trial of patients with STEMI (n = 7,000), comparing colchicine versus placebo and spironolactone versus placebo. The primary outcome for the SYNERGY stent registry is major adverse cardiac events (MACE) as defined by cardiovascular death, recurrent MI, or unplanned ischemia-driven target vessel revascularization within 12 months. We estimated a MACE rate of 6.3% at 12 months after primary percutaneous coronary intervention for STEMI based on the Thrombectomy vs percutaneous coronary intervention alone in STEMI (TOTAL) trial. Success was defined as upper bound of confidence interval (CI) to be less than the performance goal of 9.45%. Overall, 733 patients were enrolled from 8 countries with a mean age 60 years, 19.4% diabetes mellitus, 41.3% anterior MI, and median door-to-balloon time of 72 minutes. The MACE rate was 4.8% (95% CI 3.2 to 6.3%) at 12 months which met the success criteria against performance goal of 9.45%. The rates of cardiovascular death, recurrent MI, or target vessel revascularization were 2.7%, 1.9%, 1.0%, respectively. The rates of acute definite stent thrombosis were 0.3%, subacute 0.4%, late 0.4%, and cumulative stent thrombosis of 1.1% at 12 months. In conclusion, the SYNERGY stent in STEMI performed well and was successful compared with the performance goal based on previous trials.
Does cognitive impairment in bipolar disorder impact on a SIMPLe app use?
(Elsevier B.V., 2021-03-01) Bonnín Roig, Caterina del Mar; Solé Cabezuelo, Brisa; Reinares, María; García Estela, Aitana; Samalin, Ludovic; Martínez-Arán, Anabel, 1971-; Sánchez-Moreno, José; Colom, Francesc, 1971-; Vieta i Pascual, Eduard, 1963-; Hidalgo Mazzei, Diego
Background. Smartphone apps are becoming increasingly used by service users in mental health care and research for diverse aims. However, it is well-known the high prevalence of cognitive impairment in some people suffering from severe mental illnesses such as bipolar disorder (BD), which impacts on their psychosocial functioning and quality of life. In this context, the main aim of this paper is to investigate through exploratory analyses the role of specific cognitive deficits in the retention, engagement, and usability of a psychoeducational smartphone app in a group of patients with BD. Methods. 51 remitted BD patients were asked to use the app for 3 months. Baseline and 3-months follow-up clinical and usability assessments were conducted. Twenty-seven independent results from a comprehensive neurocognitive test of the same participants were retrieved separately of the 2 years before or after the use of the app. Post-hoc exploratory analyses were carried out using Spearman correlations to identify significant cognitive deficits domains influencing the usability and retention with the app. Results. There were no statistically significant cognitive variables associated with the use, reported usability or retention with the app. Some variables associated with executive functions, verbal and visual memory correlated significantly with previous use of smartphones. Limitations. Post-hoc analysis with a limited sample size. Conclusion. These preliminary results suggests that patients with BD and mild cognitive deficits do not present any limitation in using mental health apps. In our case, the adoption of a user-centred design in the development process of the app could have mitigated the participants' difficulties when using the app.
Neurofilament light levels predict clinical progression and death in multiple system atrophy.
(Oxford University Press, 2022-07-29) Chelban, Viorica; Nikram, Elham; Pérez-Soriano, Alexandra; Wilke, Carlo; Foubert-Samier, Alexandra; Vijiaratnam, Nirosen; Guo, Tong; Jabbari, Edwin; Olufodun, Simisola; González, Mariel; Senkevich, Konstantin; Laurens, Brice; Péran, Patrice; Rascol, Olivier; Le Traon, Anne Pavy; Todd, Emily G; Costantini, Alyssa A; Alikhwan, Sondos; Tariq, Ambreen; Lin Ng, Bai; Muñoz, Esteban; Painous, Cèlia; Compta, Yaroslau; Junqué i Plaja, Carme, 1955-; Segura i Fàbregas, Bàrbara; Zhelcheska, Kristina; Wellington, Henny; Schöls, Ludge; Jaunmuktane, Zane; Kobylecki, Christopher; Church, Alistair; Hu, Michele T M; Rowe, James B.; Leigh, P Nigel; Massey, Luke; Burn, David J; Pavese, Nicola; Foltynie, Tom; Pchelina, Sofya; Wood, Nicholas; Heslegrave, Amanda J; Zetterberg, Henrik; Bocchetta, Martina; Rohrer, Jonathan D.; Martí, M.J; Synofzik, Matthis; Morris, Huw R; Meissner, Wassilios G; Houlden, Henry
Disease-modifying treatments are currently being trialled in multiple system atrophy. Approaches based solely on clinical measures are challenged by heterogeneity of phenotype and pathogenic complexity. Neurofilament light chain protein has been explored as a reliable biomarker in several neurodegenerative disorders but data on multiple system atrophy have been limited. Therefore, neurofilament light chain is not yet routinely used as an outcome measure in multiple system atrophy. We aimed to comprehensively investigate the role and dynamics of neurofilament light chain in multiple system atrophy combined with cross-sectional and longitudinal clinical and imaging scales and for subject trial selection. In this cohort study, we recruited cross-sectional and longitudinal cases in a multicentre European set-up. Plasma and CSF neurofilament light chain concentrations were measured at baseline from 212 multiple system atrophy cases, annually for a mean period of 2 years in 44 multiple system atrophy patients in conjunction with clinical, neuropsychological and MRI brain assessments. Baseline neurofilament light chain characteristics were compared between groups. Cox regression was used to assess survival; receiver operating characteristic analysis to assess the ability of neurofilament light chain to distinguish between multiple system atrophy patients and healthy controls. Multivariate linear mixed-effects models were used to analyse longitudinal neurofilament light chain changes and correlated with clinical and imaging parameters. Polynomial models were used to determine the differential trajectories of neurofilament light chain in multiple system atrophy. We estimated sample sizes for trials aiming to decrease neurofilament light chain levels. We show that in multiple system atrophy, baseline plasma neurofilament light chain levels were better predictors of clinical progression, survival and degree of brain atrophy than the neurofilament light chain rate of change. Comparative analysis of multiple system atrophy progression over the course of disease, using plasma neurofilament light chain and clinical rating scales, indicated that neurofilament light chain levels rise as the motor symptoms progress, followed by deceleration in advanced stages. Sample size prediction suggested that significantly lower trial participant numbers would be needed to demonstrate treatment effects when incorporating plasma neurofilament light chain values into multiple system atrophy clinical trials in comparison to clinical measures alone. In conclusion, neurofilament light chain correlates with clinical disease severity, progression and prognosis in multiple system atrophy. Combined with clinical and imaging analysis, neurofilament light chain can inform patient stratification and serve as a reliable biomarker of treatment response in future multiple system atrophy trials of putative disease-modifying agents.
Determinants of early antibody responses to COVID-19 mRNA vaccines in a cohort of exposed and naïve healthcare workers
(Elsevier, 2022-01-11) Moncunill, Gemma; Aguilar, Ruth; Ribes, Marta; Ortega, Natalia; Rubio, Rocío; Salmerón, Gemma; Molina, María José; Vidal, Marta; Barrios, Diana; Mitchell, Robert A.; Jiménez, Alfons; Castellana, Cristina; Hernández-Luis, Pablo; Rodó, Pau; Méndez, Susana; Llupià García, Anna; Puyol, Laura; Rodrigo Melero, Natalia; Carolis, Carlo; Mayor Aparicio, Alfredo Gabriel; Izquierdo, Luis; Varela, Pilar; Trilla Garcia, Antonio De Padua; Vilella, Anna; Barroso, Sonia; Angulo Aguado, Ana; Engel Rocamora, Pablo; Tortajada, Marta; Garcia-Basteiro, Alberto L.; Dobaño, Carlota
Background: Two doses of mRNA vaccination have shown >94% efficacy at preventing COVID-19 mostly in naïve adults, but it is not clear if the second dose is needed to maximize effectiveness in those previously exposed to SARS-CoV-2 and what other factors affect responsiveness. Methods: We measured IgA, IgG and IgM levels against SARS-CoV-2 spike (S) and nucleocapsid (N) antigens from the wild-type and S from the Alpha, Beta and Gamma variants of concern, after BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccination in a cohort of health care workers (N=578). Neutralizing capacity and antibody avidity were evaluated. Data were analyzed in relation to COVID-19 history, comorbidities, vaccine doses, brand and adverse events. Findings: Vaccination induced robust IgA and IgG levels against all S antigens. Neutralization capacity and S IgA and IgG levels were higher in mRNA-1273 vaccinees, previously SARS-CoV-2 exposed, particularly if symptomatic, and in those experiencing systemic adverse effects (p<0·05). A second dose in pre-exposed did not increase antibody levels. Smoking and comorbidities were associated with 43% (95% CI, 19-59) and 45% (95% CI, 63-18) lower neutralization, respectively, and 35% (95% CI, 3-57%) and 55% (95% CI, 33-70%) lower antibody levels, respectively. Among fully vaccinated, 6·3% breakthroughs were detected up to 189 days post-vaccination. Among pre-exposed non-vaccinated, 90% were IgG seropositive more than 300 days post-infection. Interpretation: Our data support administering a single-dose in pre-exposed healthy individuals as primary vaccination. However, heterogeneity of responses suggests that personalized recommendations may be necessary depending on COVID-19 history and life-style. Higher mRNA-1273 immunogenicity would be beneficial for those expected to respond worse to vaccination and in face of variants that escape immunity such as Omicron. Persistence of antibody levels in pre-exposed unvaccinated indicates maintenance of immunity up to one year. Funding: This work was supported by Institut de Salut Global de Barcelona (ISGlobal) internal funds, in-kind contributions from Hospital Clínic de Barcelona, the Fundació Privada Daniel Bravo Andreu, and European Institute of Innovation and Technology (EIT) Health (grant number 20877), supported by the European Institute of Innovation and Technology, a body of the European Union receiving support from the H2020 Research and Innovation Programme. We acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. L. I. work was supported by PID2019-110810RB-I00 grant from the Spanish Ministry of Science & Innovation. Development of SARS-CoV-2 reagents was partially supported by the National Institute of Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Surveillance (contract number HHSN272201400008C). The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.
Effects of the COVID 19 pandemic and lockdown in Spain: comparison between community controls and patients with a psychiatric disorder. Preliminary results from the BRIS-MHC STUDY
(Elsevier B.V., 2021-02-15) Vieta i Pascual, Eduard, 1963-; Torrent Font, Carla; Solé Cabezuelo, Brisa; Verdolini, Norma; Amoretti Guadall, Silvia; Montejo, L .; Rosa, Adriane Ribeiro; Hogg, Bridget; Garcia, C.; Mezquida Mateos, Gisela; Bernardo Arroyo, Miquel; Martínez, Amalia
Background: The aim of this study was to evaluate potential differences about the effects of the COVID-19 pandemic and lockdown between community controls (CC) and patients with a mental illness (MI) in a Spanish population during the state of emergency. Methods: Individuals with a psychiatric condition and the general population were invited to complete an anonymous online survey. Bivariate analyses were used to compare them in a broad range of measures: sociodemographic, clinical variables, behavioral changes related to the lockdown and coping strategies to face it. Two groups of different psychiatric disorders were compared: depression or anxiety disorders (D+A) versus bipolar disorder and schizophrenia related disorders (BD+SCZ). Results: 413 CC and 206 MI were included in the study. CC reported to use more adaptive coping strategies as following a routine, talking to friends/relatives, practicing physical exercise and maintaining a balanced diet. MI reported significantly more anxiety and depression symptoms during the lockdown when compared to CC. Gaining weight, sleep changes, and tobacco consumption were more prevalent in the MI group. The D+A group showed significantly more psychological distress and negative expectations about the future, suffered more sleep disturbances when compared to BD+SCZ, whilst reported to practice more exercise. Limitations: psychiatric disorders were self-reported. Conclusions: Imposed restrictions and uncertainty during confinement had a higher psychological impact in individuals with a psychiatric illness, with less healthy behavior strategies to face the situation. Developing interventions to mitigate negative mental health outcomes among this vulnerable population will be essential in the coming months.
Electrodermal activity in bipolar disorder: Differences between mood episodes and clinical remission using a wearable device in a real-world clinical setting
(Elsevier B.V., 2023-10-21) Anmella, Gerard; Mas, Ariadna; Sanabra González, Miriam; Valenzuela-Pascual, Clàudia; Valentí Ribas, Marc; Pacchiarotti, Isabella; Benabarre, Antonio; Grande i Fullana, Iria; De Prisco, Michele; Oliva, Vincenzo; Fico, Giovanna; Giménez Palomo, Anna; Bastidas, Anna; Agasi, Isabel; Young, Allan H.; Garriga, Marina; Corponi, Filippo; Li, Bryan M.; De Looff, Peter; Vieta i Pascual, Eduard, 1963-; Hidalgo Mazzei, Diego
Background: Bipolar disorder (BD) lacks objective measures for illness activity and treatment response. Electrodermal activity (EDA) is a quantitative measure of autonomic function, which is altered in manic and depressive episodes. We aimed to explore differences in EDA (1) inter-individually: between patients with BD on acute mood episodes, euthymic states and healthy controls (HC), and (2) intra-individually: longitudinally within patients during acute mood episodes of BD and after clinical remission. Methods: A longitudinal observational study. EDA was recorded using a research-grade wearable in patients with BD during acute manic and depressive episodes and at clinical remission. Euthymic BD patients and HC were recorded during a single session. We compared EDA parameters derived from the tonic (mean EDA, mEDA) and phasic components (EDA peaks per minute, pmEDA, and EDA peaks mean amplitude, pmaEDA). Inter- and intra-individual comparisons were computed respectively with ANOVA and paired t-tests. Results: 49 patients with BD (15 manic, 9 depressed, and 25 euthymic), and 19 HC were included. Patients with bipolar depression showed significantly reduced mEDA (p = 0.003) and pmEDA (p = 0.001), which increased to levels similar to euthymia or HC after clinical remission (mEDA, p = 0.011; pmEDA, p < 0.001; pmaEDA, p < 0.001). Manic patients showed no differences compared to euthymic patients and HCs, but a significant reduction of tonic and phasic EDA parameters after clinical remission (mEDA, p = 0.035; pmEDA, p = 0.004). Limitations: Limited sample size, high inter-individual variability of EDA parameters, limited comparability to previous studies and non-adjustment for medication. Conclusion: EDA ecological monitoring might provide several opportunities for early detection of depressive symptoms, and might aid at assessing early response to treatments in mania and bipolar depression.
Prognostic relevance of Exercise Pulmonary Hypertension: Results of the multi-center PEX-NET Clinical Research Collaboration
(European Respiratory Society, 2024-08-26) Kovacs, Gabor; Humbert, Marc; Avian, Alexander; Lewis, Gregory D; Ulrich, Silvia; Vonk Noordegraaf, Anton; Souza, Rogerio; Galiè, Nazzareno; Malhotra, Rajeev; Saxer, Stephanie; Grünig, Ekkehard; Egenlauf, Benjamin; Ewert, Ralf; Heine, Alexander; Tedford, Ryan J; Houston, Brian A; Kasperowicz, Krzysztof; Kurzyna, Marcin; Rosenkranz, Stephan; Herkenrath, Simon; Barbera Mir, Joan Albert; Blanco Vich, Isabel; Oliveira, Rudolf K F; Andersen, Mads; Savale, Laurent; Systrom, David; Maron, Bradley A; Tello, Khodr; Condliffe, Robin; Mak, Susanna; Baratto, Claudia; Hsu, Steven; D'Alto, Michele; McCabe, Colm; Herve, Philippe; Olschewski, Horst; PEX-NET (Pulmonary Hemodynamics during Exercise Network) ERS-Clinical Research Collaboration.
Background: Exercise pulmonary hypertension (PH) was defined by a mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope >3 mmHg·min·L-1 between rest and exercise in the 2022 European Society of Cardiology/European Respiratory Society PH guidelines. However, large, multicentre studies on the prognostic relevance of exercise haemodynamics and its added value to resting haemodynamics are missing. Patients and methods: The PEX-NET (Pulmonary Haemodynamics during Exercise Network) registry enrolled patients who underwent clinically indicated right heart catheterisations both at rest and ergometer exercise from 23 PH centres worldwide. In this retrospective analysis we included subjects with resting mPAP <25 mmHg and complete haemodynamic data at rest and exercise in the same body position. Mixed effects Cox proportional hazard models with random effect centre were applied to identify independent markers of prognosis among the haemodynamic parameters. Results: We included 764 patients (64% females; median (interquartile range) age 59 (46-69) years and mPAP 17 (14-20) mmHg). Median (range) observation time was 6.8 (0.1-15.9) years and 87 patients (11%) died during follow-up. After adjustment for age, sex, haemoglobin level and resting haemodynamics, CO (hazard ratio (HR) 0.85, 95% CI 0.77-0.93; p=0.001) and transpulmonary gradient (HR 1.04, 95% CI 1.00-1.08; p=0.044) at peak exercise and the mPAP/CO slope (HR 1.12, 95% CI 1.06-1.18; p<0.001) were the only independent predictors of prognosis. Patients with a mPAP/CO slope >3 mmHg·min·L-1 had significantly worse survival compared to those with a mPAP/CO slope ≤3 mmHg·min·L-1 (HR 2.04, 95% CI 1.16-3.58; p=0.013). Conclusion: The mPAP/CO slope is a robust and independent predictor of prognosis in patients with normal or mildly elevated resting PAP that provides prognostic information beyond resting haemodynamics and appears suitable to define exercise PH.
Contribuciones de la Comisión Nacional para el Uso Forense del ADN desde una perspectiva bioética
(Universidad de Deusto, 2014-12-31) Lecuona Ramírez, Itziar
Desde una visión práctica de la bioética a través de los comités de ética, el objetivo es constatar la utilidad de dichas instancias para la reflexión y el tratamiento de cuestiones que afectan a la sociedad en su conjunto, en términos de seguridad, y de forma individual, a la protección de los derechos de las personas implicadas. Tomando como punto de partida que los comités de ética, en distintos ámbitos y con distinta intensidad, son mecanismos de protección de las personas y absolutamente necesarios para el tratamiento de los retos que el progreso científico y tecnológico plantea, se analizan las contribuciones de la Comisión Nacional para el Uso Forense del ADN (CNUFADN), en una materia típicamente bioética como es la del genoma humano, a través de los usos del ADN en el ámbito forense. Se trata de dar cuenta de una forma de hacer bioética útil, que requiere un trabajo interdisciplinar, revisable y basado en la evidencia científica, y que no puede obviar que la protección de los derechos de la persona, su bienestar y seguridad y el interés de la sociedad prima sobre los intereses de la ciencia. Pocas veces se analizan normativas y decisiones desde la aportación que realizan dichas estancias, y escasa es su caracterización y el estudio de sus funciones y procedimientos. El análisis de la CNUFADN permite concluir que los comités de ética se han convertido en piezas sustanciales para el poder político-legislativo, aportando una visión crítica que se refiere al desarrollo de procedimientos de trabajo, a la transparencia, y a la verdadera independencia e interdisciplinariedad, para revertir resultados útiles que generen credibilidad y confianza en los ciudadanos -a quienes pertenece el ADN-.
Evaluating maintenance electroconvulsive therapy in Bipolar Disorders: 3-year mirror-image study
(Elsevier B.V., 2022-02-01) Madero Gómez, Santiago; Anmella, Gerard; Sagué Vilavella, Maria; Pons-Cabrera, Maria Teresa; Giménez Palomo, Anna; Murru, Andrea; Gómez-Ramiro, Marta; Gil Badenes, Joaquín; Ríos, José; Bioque Alcázar, Miquel; Vieta i Pascual, Eduard, 1963-; Benabarre, Antonio
Backgorund: Maintenance electroconvulsive therapy (mECT) is underused in the treatment of bipolar disorder (BD). We aimed to study the real-life effectiveness of mECT in BD. Methods: Naturalistic 3-year mirror-image study in individuals diagnosed with BD who underwent mECT at a tertiary hospital. Intra-subject comparisons of psychiatric hospitalization were performed using McNemar test. Days and number of psychiatric hospitalizations before and during mECT were compared through wilcoxon signed-rank test. Mean annual days and mean annual number of psychiatric hospitalizations per patient were compared by means of the rate ratio (RR) estimation through a generalized estimating equation (GEE) model. Results: A total of 43 patients were included and 37 required psychiatric hospitalization during the study. The use of mECT showed an effectiveness of 62.2% for preventing psychiatric hospitalizations (p<0.01). We found significant reduction in days and number of psychiatric hospitalizations during mECT compared to before mECT (p<0.01). Comparison of the 3-year period before/during mECT showed a reduction in mean annual days (RR=0.14; 95%CI: 0.07-0.29) and mean annual number (RR=0.24; 95%CI: 0.13-0.43) of psychiatric hospitalizations, without substantial changes for adjusted models for gender and age of onset of the illness. Limitations: The main limitations of this study consisted of the mirror-image retrospective naturalistic study design, the relatively small sample size, and possibly patient selection bias. Conclusions: mECT reduced the number of psychiatric hospitalizations and hospitalization days in BD. The use of mECT outlines a mood stabilizing effect in BD. This naturalistic study supports the effectiveness of mECT in BD across several mood states.
Evaluación de los aspectos metodológicos, éticos, legales y sociales de proyectos de investigación en salud con datos masivos (Big Data)
(Elsevier, 2018-05-31) Lecuona Ramírez, Itziar de
El actual modelo evaluador de la investigación con seres humanos depende básicamente de los procesos de toma de decisiones de los comités de ética de la investigación. Resulta prioritario que estos comités tomen conciencia de la relevancia del nuevo paradigma digital asentado en la explotación a gran escala de datos personales, incluidos los de salud. El artículo ofrece pautas para una adecuada evaluación de los proyectos que apliquen analítica de datos masivos en salud ante los cambios introducidos por el Reglamento General de Protección de Datos. Los procesos de recolección y explotación de datos constituyen el nicho donde desarrollar la investigación. En este contexto, los protocolos de obtención del consentimiento de los participantes han quedado claramente desfasados debido a que se presuponía no solo que los datos eran anónimos, sino que siempre lo seguirían siendo en el futuro. Por ese motivo, resulta imprescindible que los citados comités asimilen nuevas capacidades y procedan a una relectura de valores como la intimidad y la libertad, actualizando para ello protocolos, metodologías y procedimientos de trabajo. Este cambio de cultura de trabajo dotará de seguridad jurídica al personal implicado en las investigaciones, posibilitará que se garantice la protección de la intimidad de los titulares de los datos, y permitirá orientar la explotación de estos de tal forma que se evite la comercialización de conjuntos de datos personales en la era de la reidentificación, para que la investigación responda a las necesidades sociales y no a intereses espurios u oportunistas disfrazados de investigación.
Suicidal ideation with and without intention to act: A transdiagnostic network analysis on the interplay between psychopathology, impulsivity, and childhood maltreatment.
(Cambridge University Press (CUP), 2025-10-15) De Prisco, Michele; Roberto, Natalia; Andreo-Jover, Jorge ; Ayad Ahmed, Wala ; Bobes Bascarán, M. Teresa; Canal Rivero, Manuel; Canosa García, Irene; Cebrià Meca, Ana Isabel; Crespo Facorro, Benedicto; Curto Ramos, Javier; Diaz Marsa, Marina; De la Torre Luque, Alejandro; Elices, Matilde; Jiménez Treviño, Luis; Palao Tarrero, Angela; Palao Vidal, Diego J.; Pemau, Andrés; Lopez Pena, Maria Purificación; Ruiz Veguilla, Miguel; Sáiz, Pilar Alejandra; Suárez-Soto, Elizabeth; Courtet, Philippe; Vieta i Pascual, Eduard, 1963- ; Grande i Fullana, Iria; Pérez, Víctor; SURVIVE Group
Background: Suicide represents a significant public health concern. Suicide prevention strategies are shifting toward transdiagnostic perspectives examining interrelated risk factors, but their interrelationships remain unclear. This study investigated relationships between psychopathological dimensions, impulsivity, and childhood maltreatment in individuals with suicidal ideation (SI), comparing those with versus without intention to act using network analysis. Methods: Data were obtained from the Suicide Prevention and Intervention Study project. Participants were categorized into two groups based on their intention to act according to the Columbia Suicide Severity Rating Scale. Psychological symptoms, impulsivity traits, and childhood maltreatment were assessed. Network analysis was performed, and centrality measures were computed. Results: A total of 1,265 individuals were categorized into the SI without intention to act (n = 345) and SI with intention to act (n = 920) groups. The former showed lower depression and hostility scores, and lower prevalence of major depressive and anxiety disorders. Network analyses revealed that in the SI without intention to act group, obsessive-compulsive symptoms were central, connecting to depression and anxiety, while negatively correlating with non-planning impulsivity. In contrast, the SI with intention to act group showed a more densely interconnected network where emotional abuse served as a bridge between childhood maltreatment and other psychopathological dimensions. Conclusions: This study identifies symptom interaction patterns between individuals with SI without and with intention to act. Understanding these relationships may improve suicide risk assessment and inform personalized interventions, potentially reducing the transition from ideation to action. Trauma-focused approaches addressing emotional abuse may be especially relevant for individuals at high risk.
Seven-month kinetics of SARS-CoV-2 antibodies and protective role of pre-existing antibodies to seasonal human coronaviruses on COVID-19
(Nature Publishing Group, 2021-08-06) Ortega, Natalia; Ribes, Marta; Vidal, Marta; Rubio, Rocío; Aguilar, Ruth; Williams, Sarah; Barrios, Diana; Alonso, Selena; Hernández-Luis, Pablo; Mitchell, Robert A.; Jairoce, Chenjerai; Cruz, Angeline; Jiménez, Alfons; Santano, Rebeca; Méndez, Susana; Lamoglia Puig, Montserrat; Rosell, Neus; Llupià García, Anna; Puyol, Laura; Chi, Jordi; Rodrigo-Melero, Natalia; Parras, Daniel; Serra, Pau; Pradenas Saavedra, Edwards; Trinité, Benjamin; Blanco, Julià; Mayor Aparicio, Alfredo Gabriel; Barroso, Sonia; Varela, Pilar; Vilella, Anna; Trilla Garcia, Antonio De Padua; Santamaria, Pere; Carolis, Carlo; Tortajada, Marta; Izquierdo Lázaro, Luis; Angulo Aguado, Ana; Engel, Pablo; Garcia-Basteiro, Alberto L; Moncunill Piñas, Gemma; Dobaño, Carlota
Unraveling the long-term kinetics of antibodies to SARS-CoV-2 and the individual characteristics influencing it, including the impact of pre-existing antibodies to human coronaviruses causing common cold (HCoVs), is essential to understand protective immunity to COVID-19 and devise effective surveillance strategies. IgM, IgA and IgG levels against six SARS-CoV-2 antigens and the nucleocapsid antigen of the four HCoV (229E, NL63, OC43 and HKU1) were quantified by Luminex, and antibody neutralization capacity was assessed by flow cytometry, in a cohort of health care workers followed up to 7 months (N = 578). Seroprevalence increases over time from 13.5% (month 0) and 15.6% (month 1) to 16.4% (month 6). Levels of antibodies, including those with neutralizing capacity, are stable over time, except IgG to nucleocapsid antigen and IgM levels that wane. After the peak response, anti-spike antibody levels increase from ~150 days post-symptom onset in all individuals (73% for IgG), in the absence of any evidence of re-exposure. IgG and IgA to HCoV are significantly higher in asymptomatic than symptomatic seropositive individuals. Thus, pre-existing cross-reactive HCoVs antibodies could have a protective effect against SARS-CoV-2 infection and COVID-19 disease.
Level I PD-MCI Using Global Cognitive Tests and the Risk for Parkinson's Disease Dementia
(Wiley, 2022-04-29) Boel, Judith A; MDS Study Group Mild Cognitive Impairment in Parkinson's Disease; de Bie, Rob M A; Schmand, Ben A; Dalrymple-Alford, John C; Marras, Connie; Adler, Charles H; Goldman, Jennifer G; Tröster, Alexander I; Burn, David J; Litvan, Irene; Geurtsen, Gert J
Background: The criteria for PD-MCI allow the use of global cognitive tests. Their predictive value for conversion from PD-MCI to PDD, especially compared to comprehensive neuropsychological assessment, is unknown. Methods: The MDS PD-MCI Study Group combined four datasets containing global cognitive tests as well as a comprehensive neuropsychological assessment to define PD-MCI (n = 467). Risk for developing PDD was examined using a Cox model. Global cognitive tests were compared to neuropsychological test batteries (Level I&II) in determining risk for PDD. Results: PD-MCI based on a global cognitive test (MMSE or MoCA) increases the hazard for developing PDD (respectively HR = 2.57, P = 0.001; HR = 4.14, P = <0.001). The C-statistics for MMSE (0.72) and MoCA (0.70) were lower than those based on neuropsychological tests (Level I = 0.82; Level II = 0.81). Sensitivity, specificity and diagnostic accuracy balance was best in Level II. Conclusion: MMSE and MoCA predict conversion to PDD. However, Level II neuropsychological assessment seems the preferred assessment for PD-MCI.
Symptomatic networks in suicide attempt and reattempt: Relevance of psychiatric comorbidity
(Cambridge University Press (CUP), 2025-01-10) Pemau, Andres; Torre Luque, Alejandro de la; Marin Martin, Carolina; Díaz-Marsá, Marina; Andreo-Jover, Jorge; Ayad Ahmed, Wala; Bravo Ortiz, María Fe; Bobes-Bascarán, T.; Canal Rivero, Manuel; Canosa García, Irene; Cebriá, Anabel; Crespo Facorro, Benedicto; Botí, María Ángeles; Elices, Matilde; González-Pinto, Ana; Grande i Fullana, Iria; Jiménez Treviño, Luis; Palao Vidal, Diego J.; Palao Tarrero, Angela; Pérez Guerra, Carla; Roberto, Natalia; Ruiz Veguilla, Miguel; Sáiz Martínez, Pilar Alejandra; The SURVIVE Consortium; Pérez Solà, Victor
Background. One of the most relevant risk factors for suicide is the presence of previous attempts. The symptomatic profile of people who reattempt suicide deserves attention. Network analysis is a promising tool to study this field. Objective. To analyze the symptomatic network of patients who have attempted suicide recently and compare networks of people with several attempts and people with just one at baseline. Methods. 1043 adult participants from the Spanish cohort “SURVIVE” were part of this study. Participants were classified into two groups: single attempt group (n = 390) and reattempt group (n = 653). Different network analyses were carried out to study the relationships between suicidal ideation, behavior, psychiatric symptoms, diagnoses, childhood trauma, and impulsivity. A general network and one for each subgroup were estimated. Results. People with several suicide attempts at baseline scored significantly higher across all clinical scales. The symptomatic networks were equivalent in both groups of patients (p > .05). Although there were no overall differences between the networks, some nodes were more relevant according to group belonging. Conclusions. People with a history of previous attempts have greater psychiatric symptom severity but the relationships between risk factors show the same structure when compared with the single attempt group. All risk factors deserve attention regardless of the number of attempts, but assessments can be adjusted to better monitor the occurrence of reattempts.
Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction.
(Oxford University Press, 2021-11-29) Jáuregui Garrido, Beatriz; Soto Iglesias, David; Penela, Diego; Acosta, Juan; Fernández Armenta, Juan; Linhart, Markus; Scherer, Claudia; Ordóñez, Augusto; San Antonio, Rodolfo; Falasconi, Giulio; Terés Castillo, Cheryl; Chauca, Alfredo; Carreño, José María; Prat González, Susanna; Perea Palazón, Rosario Jesús; Mont Girbau, Lluís; Bosch Genover, Xavier; Ortiz Pérez, José Tomás; Berruezo Sánchez, Antonio
Aims To non-invasively characterize, by means of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), scar differences, and potential variables associated with ventricular tachycardia (VT) occurrence in chronic post-myocardial infarction (MI) patients. Methods and results A case–control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients (i) consecutively referred for VT substrate ablation after a first VT episode (n = 66) and (ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ), and BZ channels (BZCs) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. One hundred and fifty post-MI patients were included. Four multivariable Cox proportional hazards regression models were created for total scar mass, BZ mass, core mass, and BZC mass, adjusting them by age, sex, and left ventricular ejection fraction (LVEF). A cut-off of 5.15 g of BZC mass identified the cases with 92.4% sensitivity and 86.9% specificity [area under the ROC curve (AUC) 0.93 (0.89–0.97); P < 0.001], with a significant increase in the AUC compared to other scar parameters (P < 0.001 for all pairwise comparisons). Adding BZC mass to LVEF allowed to reclassify 33.3% of the cases and 39.3% of the controls [net reclassification improvement = 0.73 (0.71–0.74)]. Conclusions The mass of BZC is the strongest independent variable associated with the occurrence of sustained monomorphic ventricular tachycardia in post-MI patients after adjustment for age, sex, and LVEF. Border zone channel mass measurement could permit a more accurate VT risk stratification than LVEF in chronic post-MI patients.
Longer illness duration is associated with greater individual variability in functional brain activity in Schizophrenia, but not bipolar disorder
(Elsevier, 2022-01-01) Gallucci, Julia; Pomarol-Clotet, Edith; Voineskos, Aristotle N; Guerrero Pedraza, Amalia; Alonso-Lana, Silvia; Vieta i Pascual, Eduard, 1963-; Salvador, Raymond; Hawco, Colin
Background: Individuals with schizophrenia exhibit greater inter-patient variability in functional brain activity during neurocognitive task performance. Some studies have shown associations of age and illness duration with brain function; however, the association of these variables with variability in brain function activity is not known. In order to better understand the progressive effects of age and illness duration across disorders, we examined the relationship with individual variability in brain activity. Methods: Neuroimaging and behavioural data were extracted from harmonized datasets collectively including 212 control participants, 107 individuals with bipolar disorder, and 232 individuals with schizophrenia (total n = 551). Functional activity in response to an N-back working memory task (2-back vs 1-back) was examined. Individual variability was quantified via the correlational distance of fMRI activity between participants; mean correlational distance of one participant in relation to all others was defined as a 'variability score'. Results: Greater individual variability was found in the schizophrenia group compared to the bipolar disorder and control groups (p = 1.52e-09). Individual variability was significantly associated with aging (p = 0.027), however, this relationship was not different across diagnostic groups. In contrast, in the schizophrenia sample only, a longer illness duration was associated with increased variability (p = 0.027). Conclusion: An increase in variability was observed in the schizophrenia group related to illness duration, beyond the effects of normal aging, implying illness-related deterioration of cognitive networks. This has clinical implications for considering long-term trajectories in schizophrenia and progressive neural and cognitive decline which may be amiable to novel treatments.
Predicted plasma proteomics from genetic scores and treatment outcomes in major depression: a meta-analysis
(Elsevier B.V., 2025-07-01) Oliva, Vincenzo; Possidente, Chiara; Fanelli, Giuseppe; Domschke, Katharina; Minelli, Alessandra; Gennarelli, Massimo; Martini, Paolo; Bortolomasi, Marco; Squassina, Alessio; Pisanu, Claudia; Kasper, Siegfried; Zohar, Joseph; Souery, Daniel; Montgomery, Stuart; Albani, Diego; Forloni, Gianluigi; Ferentinos, Panagiotis; Rujescu, Dan; Mendlewicz, Julien; Baune, Bernhard T.; Vieta i Pascual, Eduard, 1963-; Serretti, Alessandro; Fabbri, Chiara
Proteomics has been scarcely explored for predicting treatment outcomes in major depressive disorder (MDD), due to methodological challenges and costs. Predicting protein levels from genetic scores provides opportunities for exploratory studies and the selection of targeted panels. In this study, we examined the association between genetically predicted plasma proteins and treatment outcomes - including non-response, non-remission, and treatment-resistant depression (TRD) - in 3559 patients with MDD from four clinical samples. Protein levels were predicted from individual-level genotypes using genetic scores from the publicly available OmicsPred database, which estimated genetic scores based on genome-wide genotypes and proteomic measurements from the Olink and SomaScan platforms. Associations between predicted protein levels and treatment outcomes were assessed using logistic regression models, adjusted for potential confounders including population stratification. Results were meta-analysed using a random-effects model. The Bonferroni correction was applied. We analysed 257 proteins for Olink and 1502 for SomaScan; 111 proteins overlapped between the two platforms. Despite no association was significant after multiple-testing correction, many top results were consistent across phenotypes, in particular seven proteins were nominally associated with all the analysed outcomes (CHL1, DUSP13, EVA1C, FCRL2, KITLG, SMAP1, and TIM3/HAVCR2). Additionally, three proteins (CXCL6, IL5RA, and RARRES2) showed consistent nominal associations across both the Olink and SomaScan platforms. The convergence of results across phenotypes is in line with the hypothesis of the involvement of immune-inflammatory mechanisms and neuroplasticity in treatment response. These results can provide hints for guiding the selection of protein panels in future proteomic studies.
Prediction of premature ventricular complex origin in left vs. right ventricular outflow tract: a novel anatomical imaging approach
(Oxford University Press, 2019-01) Korshunov, Viatcheslav; Penela, Diego; Linhart, Markus; Acosta, Juan; Martinez, Mikel; Soto Iglesias, David; Fernández Armenta, Juan; Vassanelli, Francesca; Cabrera, Mario; Borràs, Roger; Jáuregui Garrido, Beatriz; Ortiz Pérez, José Tomás; Perea Palazón, Rosario Jesús; Bosch Genover, Xavier; Sánchez Quintana, Damian; Mont Girbau, Lluís; Berruezo Sánchez, Antonio
Aims Left ventricular (LV) outflow tract ventricular arrhythmias (OTVA) are associated with hypertension (HT), older age, and LV dysfunction, suggesting that LV overload plays a role in the aetiopathogenesis. We hypothesized that anatomical modifications of the LV outflow tract (LVOT) could predict left vs. right OTVA site of origin (SOO). Methods and results Fifty-six (32 men, 53 ± 18 years old) consecutive patients referred for OTVA ablation were included. Cardiac multidetector computed tomography was performed before ablation and then imported to the CARTO system to aid the mapping and ablation procedure. Anatomical characteristics of the aortic root as well as aortopulmonary valvular planar angulation (APVPA) were analysed. The LV was the OTVA SOO (LVOT-VA) in 32 (57%) patients. These patients were more frequently male (78% vs. 22%, P = 0.001), older (57 ± 18 vs. 47 ± 18 years, P = 0.055), and more likely to have HT (59% vs. 21%, P = 0.004), compared to right OTVA patients. Aortopulmonary valvular planar angulation was higher in LVOT-VA patients (68 ± 5° vs. 55 ± 6°, respectively; P < 0.001). Absolute size of all aortic root diameters was associated with LVOT origin. However, after indexing by body surface area, only sinotubular junction diameter maintained a significant association (P = 0.049). Multivariable analysis showed that APVPA was an independent predictor of LVOT origin. Aortopulmonary valvular planar angulation ≥62° reached 94% sensitivity and 83% specificity (area under the curve 0.95) for predicting LVOT origin. Conclusions The measurement of APVPA as a marker of chronic LV overload is useful for the prediction of left vs. right ventricular OTVA origin.
Influence of myocardial scar on the response to frequent premature ventricular complex ablation
(BMJ Publishing Group & British Cardiovascular Society, 2019-03) Penela, Diego; Martinez, Mikel; Fernández Armenta, Juan; Aguinaga, Luis; Tercedor, Luis; Ordóñez, Augusto; Acosta, Juan; Martí Almor, Julio; Bisbal, Felipe; Rossi, Luca; Borràs, Roger; Linhart, Markus; Soto Iglesias, David; Jáuregui Garrido, Beatriz; Ortiz Pérez, José Tomás; Perea Palazón, Rosario Jesús; Bosch Genover, Xavier; Mont Girbau, Lluís; Berruezo Sánchez, Antonio
Objective This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction. Methods 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18–32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done. Results Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60–284) to 46 (23–81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5–20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0–4.7) g vs 2 (0–14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01–1.16), p=0.02) and scar mass (OR 0.9 (0.81–0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy. Conclusions Presence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.
A QRS axis-based algorithm to identify the origin of scar-related ventricular tachycardia in the 17-segment American Heart Association model
(Elsevier, 2018-10-01) Andreu, David; Fernández Armenta, Juan; Acosta, Juan; Penela, Diego; Jáuregui Garrido, Beatriz; Soto Iglesias, David; Syrovnev, Vladimir; Arbelo, Elena; Tolosana, José M. (José María); Berruezo Sánchez, Antonio
Background Previously proposed algorithms to predict the ventricular tachycardia (VT) exit site have been based on diverse left ventricular models, but none of them identify the precise region of origin in the electroanatomic map. Moreover, no electrocardiographic (ECG) algorithm has been tested to predict the region of origin of scar-related VTs in patients with nonischemic cardiomyopathy. Objective The purpose of this study was to validate a simple ECG algorithm to identify the segment of origin (SgO) of VT relative to the 17-segment American Heart Association model in patients with structural heart disease (SHD). Methods The study included 108 consecutive patients with documented VT and SHD [77 (71%) with coronary artery disease]. A novel frontal plane axis-based ECG algorithm (highest positive or negative QRS voltage) together with the polarity in leads V3 and V4 was used to predict the SgO of VT. The actual SgO of VT was obtained from the analysis of the electroanatomic map during the procedure. Conventional VT mapping techniques were used to identify the VT exit. Results In total, 149 12-lead ECGs of successfully ablated VT were analyzed. The ECG-suggested SgO matched with the actual SgO in 122 of the 149 VTs (82%). In 21 of the 27 mismatched ECG-suggested SgOs (77.8%), the actual SgO was adjacent to the segment suggested by the ECG. There were no differences in the accuracy of the algorithm based on the SgO or the type of SHD. Conclusion This novel QRS axis-based algorithm accurately identifies the SgO of VT in the 17-segment American Heart Association model in patients with SHD.

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