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Publication

Distinct response patterns of endothelial markers to the BNT162b2 mRNA COVID-19 booster vaccine are associated with the spike-specific IgG antibody production

(Frontiers, 2025) Castro Robles, Beatriz; Cimas Felipe, Francisco José; Arias Salazar, Lourdes; Ontañón, Jesús; Lozano, Julia; López Lopez, Susana; Andrés Pretel, Fernando; Requena Calleja, María Ángeles; Mas López, Antonio; Serrano Heras, Gemma; Segura Martín, Tomás; Solera Santos, José Javier

Introduction: Despite the efficacy and safety of SARS-CoV-2 vaccines, inflammatory and/or thrombotic episodes have been reported. Since the impact of COVID-19 vaccines on the endothelium remains uncertain, our objective was to assess endothelial activation status before and 90 days after the third dose of the BNT162b2 mRNA COVID-19 vaccine.Methods: A prospective longitudinal study was conducted at University General Hospital of Albacete, involving 38 healthy health-care workers. Serum levels of endothelial markers (endocan and sVCAM-1) and spike S1-specific IgG antibodies were determined before and at 7, 15, 24 and 90days following vaccination. To analyze each participant´s individual response, we calculated relative increases/decreases (delta values) in endothelial markers and antibodies concentrations compared to their pre-vaccination levels.Results: We identified two significantly distinct profiles of endothelial markers response, characterized by either increased or decreased serum levels of endocan and sVCAM. Incremental and decremental response groups did not differ in terms of age, sex, cardiovascular risk factors, previous SARS-CoV-2 infection and influenza vaccine co-administration. However, these responses were significantly associated with the relative spike-specific antibody production. Specifically, the greatest relative increase in antibodies was found in the decremental responders. Additionally, the higher delta antibody production was observed in non-previously infected individualsConclusion: Administration of the BNT162b2 booster vaccine triggered a non-homogenous response of endothelial function markers among the study participants. Our findings improve the understanding of individual responses to the mRNA COVID-19 booster vaccine, which could be useful in assessing the need for booster doses, particularly in population at risk of vascular complications.

Publication

An Efficient Hybrid Methodology for Local Activation Waves Detection under Complex Fractionated Atrial Electrograms of Atrial Fibrillation

(MDPI, 2022) Osorio, Diego; Vraka, Aikaterini; Quesada, Aurelio; Hornero, Fernando; Alcaraz Martínez, Raúl; Rieta, José J

Local activation waves (LAWs) detection in complex fractionated atrial electrograms (CFAEs) during catheter ablation (CA) of atrial fibrillation (AF), the commonest cardiac arrhythmia, is a complicated task due to their extreme variability and heterogeneity in amplitude and morphology. There are few published works on reliable LAWs detectors, which are efficient for regular or low fractionated bipolar electrograms (EGMs) but lack satisfactory results when CFAEs are analyzed. The aim of the present work is the development of a novel optimized method for LAWs detection in CFAEs in order to assist cardiac mapping and catheter ablation (CA) guidance. The database consists of 119 bipolar EGMs classified by AF types according to Wells’ classification. The proposed method introduces an alternative Botteron’s preprocessing technique targeting the slow and small-ampitude activations. The lower band-pass filter cut-off frequency is modified to 20 Hz, and a hyperbolic tangent function is applied over CFAEs. Detection is firstly performed through an amplitude-based threshold and an escalating cycle-length (CL) analysis. Activation time is calculated at each LAW’s barycenter. Analysis is applied in five-second overlapping segments. LAWs were manually annotated by two experts and compared with algorithm-annotated LAWs. AF types I and II showed 100% accuracy and sensitivity. AF type III showed 92.77% accuracy and 95.30% sensitivity. The results of this study highlight the efficiency of the developed method in precisely detecting LAWs in CFAEs. Hence, it could be implemented on real-time mapping devices and used during CA, providing robust detection results regardless of the fractionation degree of the analyzed recordings.

Publication

Comparative study of methods for cycle length estimation in fractionated electrograms of atrial fibrillation

(MDPI, 2022) Osorio, Diego; Vraka, Aikaterini; Moreno Arribas, José; Bertomeu González, Vicente; Alcaraz Martínez, Raúl; Rieta, José J.

Atrial cycle length (CL) is an important feature for the analysis of electrogram (EGM) characteristics acquired during catheter ablation (CA) of atrial fibrillation (AF), the commonest cardiac arrhythmia. Nevertheless, a robust ACL estimator requires the precise detection of local activation waves (LAWs), which still remains a challenge. This work aims to compare the performance in (CL) estimation, especially under fractionated EGMs, of three different LAW detection methods relying on different operation strategies. The methods are based on the hyperbolic tangent (HT) function, an adaptive amplitude threshold (AAT) and a (CL) iteration (ACLI), respectively. For each method, LAW detection has been assessed with respect to manual annotations made by two experts and performance has been estimated by confusion matrix and mean and individual (CL) error calculation by EGM types of fractionation. The influence of EGM length on the individual (CL) error has been additionally considered. For the HT method, accuracy, sensitivity and precision were 92.77–100%, while for the AAT and ACLI methods they were 78.89–99.91% for all EGM types. The CL error on the HT method was lower than AAT and ACLI methods (up to 12 ms versus up to 20 ms), with the difference being more prominent in complex EGMs. The HT method also showed the lowest dependency on EGM length, presenting the lowest and least variable error values. Therefore, the HT method achieves higher performance in (CL) estimation in comparison with previous LAW detection techniques. The high robustness and precision demonstrated by this method suggest its implementation on CA mapping devices for a more successful location of ablation targets and improved results during CA procedures.

Publication

Estudio de los factores de riesgo de deterioro cognitivo en el medio rural: metodología y pilotaje desde la farmacia comunitaria

(Sociedad Española de Farmacia Clínica, Familiar y Comunitaria, 2023) Martínez López, Luis Antonio; García García, Cristina; Moreno Royo, Lucrecia

Introduction: Cognitive impairment is known to be mediated by a variety of risk factors, with age being the most influential of these. The worldwide phenomenon of an aging population makes decoupling old age from disease through the concept of healthy aging a matter of major interest. In Spain, rural depopulated areas, where the lack of health services is an additional concern, constitute a group of particularly aged population. Community pharmacies are widely distributed throughout the territory and are in close contact with this vulnerable population group.Methods: We designed and piloted a methodology to assess cognitive impairment and healthy aging from a holistic point of view. Our questionnaire comprises five sections: cognitive impairment, sociodemographic factors, health problems, lifestyle and psychosocial factors.Results: The estimated prevalences of cognitive impairment and healthy aging in our cohort were 28.2 % and 15.4 %, respectively. The prevalences (or the population mean values) found for well-known risk and protective factors for cognitive impairment were consistent with those described for Spanish population in the scientific literature. The results showed that our questionnaire can be an appropriate tool for collecting information in our media and suitable for researching how modifiable risk and protective factors influence cognitive status from a holistic perspective.Conclusion: The complex interrelationships between variables should be further investigated. In this respect, novel areas, such as psychosocial variables, should also be the focus of efforts to advance the cognitive impairment knowledge.

Publication

(MDPI, 2022) Vraka , Aikaterini; Bertomeu González, Vicente; Fácila , Lorenzo; Moreno Arribas, José; Alcaraz Martínez, Raúl; Rieta , José J.

Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (??=0.0014 ) and distal/mid-proximal channels (??=0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (=93%) than distal (=91%) areas. P-waves: duration was significantly shortened after LPVI (after L: ??=0.0012, -13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, ??=0.0480, R: <-33.94%, ??=0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.