https://hdl.handle.net/11000/6 2026-06-29T23:30:12Z https://hdl.handle.net/11000/40125 Título : Heart Rate Variability-Guided Training for Improving Mortality Predictors in Patients with Coronary Artery Disease. Autor : Manresa Rocamora, Agustin; Sarabia, José M.; GUILLEN, SILVIA; Pérez-Berbel, Patricio; Miralles-Vicedo, Beatriz; Roche, Enrique; Vicente-Salar, Néstor; MOYA-RAMÓN, MANUEL Resumen : The objective of this research was to investigate whether heart rate variability (HRV)-guided training improves mortality predictors to a greater extent than predefined training in coronary artery disease patients. Twenty-one patients were randomly allocated to the HRV-guided training group (HRV-G) or the predefined training group (PRED-G). They measured their HRV at home daily and trained three times a week for six weeks. Resting heart rate, isolated vagal-related HRV indices (i.e., RMSSD, HF, and SD1), weekly averaged RMSSD, heart rate recovery, and maximum oxygen uptake were assessed before and after the training period. There was a statistically significant difference (p = 0.034) in the change in weekly averaged RMSSD in favor of the HRV-G, while no differences were found in the remaining analyzed variables (p > 0.050). Regardless of the training prescription method, exercise training decreased resting heart rate (p = 0.001; 􀀀4.10 [95% CI = 􀀀6.37–􀀀1.82] beats per minute (bpm)), and increased heart rate recovery at 2 min (p = 0.010; 4.33 [95% CI = 1.15–7.52] bpm) and maximum oxygen uptake (p < 0.001; 3.04 [95% CI = 1.70–4.37] mL kg􀀀1 min􀀀1). HRV-guided training is superior to predefined training in improving vagal-related HRV when methodological factors are accounted for. 2026-06-23T11:35:49Z https://hdl.handle.net/11000/40124 Título : Análisis del perfil de no adherencia a las estatinas en pacientes en prevención secundaria cardiovascular Autor : Alcalá Belmonte, María; Quesada Rico, Jose Antonio; NOUNI GARCÍA, RAUF; Carbonell Soliva, Álvaro; Cordero Fort, Alberto; Arrarte Esteban, Vicente Ignacio; Guillén García, Silvia; González Llopis, Francisco; Pereira, Avelino; Cazorla-Morallon, Diego; Esquerdo Arroyo, Amanda; Carratalá Munuera, Concepción; Orozco-Beltrán, Domingo; López Pineda, Adriana Resumen : Introducción y objetivos: La falta de adherencia al medicamento implica mal control de la enfermedad, peor calidad de vida y posibles complicaciones y eventos. La adherencia es difícil de medir debido a su carácter multidimensional. En este estudio se midió la adherencia a las estatinas mediante un método directo y se describen los factores con mayor prevalencia entre los pacientes no adherentes. Métodos: Estudio transversal descriptivo que incluyó pacientes con cardiopatía isquémica en tratamiento con estatinas durante al menos un año. La adherencia se evaluó mediante la concentración plasmática de atorvastatina o rosuvastatina (y su metabolito en caso de atorvastatina) en sangre, definiendo la falta de adherencia como la ausencia de al menos dos dosis diarias. El punto de corte para rosuvastatina se estableció mediante curvas teóricas de farmacocinética, y el de atorvastatina a partir de valores propuestos en estudios experimentales previos. Se recogieron variables sociodemográficas, comorbilidades y tratamientos. Resultados: Se analizaron 309 pacientes de entre 30 y 92 años (media 66 años), siendo el 32,7% mujeres. Se estima que 49 pacientes (15,9%) eran no-adherentes, siendo en mayor medida pacientes sin estudios o solo estudios primarios (22,7%), separados/as o divorciados/as (25,7%), que tenían una renta neta del hogar inferior a 800 € (20%) o no la declararon (25%), que presentaban un SCA con elevación del ST (21,6%), alguna dificultad en actividades de la vida diaria (26,8%), mala o muy mala salud autopercibida (24%), fumadores actuales (22,9%), con fibrilación auricular (20%) o insuficiencia cardiaca (21,4%). Conclusiones: La falta de adherencia a las estatinas en prevención secundaria es moderada y se asocia a un perfil con menor nivel socioeconómico, peor calidad de vida y mayor carga de comorbilidades cardiovasculares. Son necesarias intervenciones para mejorar la adherencia en estos pacientes y optimizar el control lipídico para prevenir eventos en esta población de mayor riesgo cardiovascular. 2026-06-23T11:35:11Z https://hdl.handle.net/11000/40123 Título : Validez de los cuestionarios MMAS-8 y Haynes-Sackett como métodos de detección de la baja adherencia a estatinas en prevención secundaria cardiovascular: estudio transversal Autor : Vidal Planelles, Inmaculada; NOUNI GARCÍA, RAUF; Carbonell Soliva, Álvaro; Quesada Rico, Jose A.; Esquerdo Arroyo, Amanda; Carratalá Munuera, Concepción; Orozco Beltrán, Domingo; López Pineda, Adriana; Cordero Fort, Alberto; Guillén García, Silvia; Arrarte Esteban, Vicente Ignacio; González Llopis, Francisco; Pereira, Avelino; Gil-Guillén, Vicente F Resumen : Introducción y objetivos: La falta de adherencia al tratamiento se asocia a un peor control clínico, menor calidad de vida y mayor riesgo de complicaciones y eventos cardiovasculares. Su medición resulta compleja debido a las variables latentes que la determinan. Este estudio evalúa la adherencia al tratamiento con estatinas mediante un método directo y la compara con la clasificación de los cuestionarios de adherencia MMAS-8 y Haynes-Sackett. Métodos: Estudio transversal descriptivo en pacientes en prevención secundaria con cardiopatía isquémica, en tratamiento diario con estatinas durante al menos un año. La adherencia se evaluó mediante análisis plasmático de concentración de atorvastatina y su metabolito o de rosuvastatina, definiéndose la falta de adherencia como la ausencia de al menos dos dosis según puntos de corte establecidos por curvas teóricas de farmacocinética (rosuvastatina) y estudios experimentales previos (atorvastatina). Se comparó con la clasificación de los cuestionarios mediante el cálculo de sensibilidad, especificidad y valores predictivos. Resultados: Se analizaron 309 pacientes de entre 30 y 92 años (media: 66 años), siendo el 32,7% mujeres. Se estimó que 49 pacientes (15,9%) no eran adherentes. El cuestionario MMAS-8 mostró una sensibilidad del 2% (IC95%: 0-5,9%) y especificidad del 95% (IC95%: 92,4-97,6%), con valores predictivos positivo (VPP) y negativo (VPN) de 7,1% y 83,7%, respectivamente. Estos indicadores fueron peores en mujeres. El cuestionario Haynes-Sackett presentó una sensibilidad del 18,4% (IC95%: 7,6-29,2%) y especificidad del 79,2% (IC95%: 74,3-84,1%), con VPP de 14,3% y VPN de 83,7%, sin diferencias relevantes por sexo. Conclusiones: El cuestionario MMAS-8 presenta una sensibilidad muy baja y alta especificidad, con peor rendimiento en mujeres, y no resulta válido como herramienta de cribado para detectar baja adherencia a las estatinas. Aunque el cuestionario Haynes-Sackett presenta indicadores ligeramente superiores, tampoco demuestra utilidad suficiente para identificar pacientes no adherentes al tratamiento con estatinas en prevención secundaria. 2026-06-23T11:29:41Z https://hdl.handle.net/11000/40121 Título : Sarcopenia en pacientes con insuficiencia cardíaca con fracción de eyección reducida. Prevalencia y propuesta de protocolo diagnóstico en consulta Autor : Bellot Beltrán, Ana; Guillén García, Silvia; Sánchez Aleixandre, Andrés; Niosi Mazzoni, María Laura; Berenguer Vila, Alicia; González Llopis, Francisco Ángel Resumen : Introducción: la sarcopenia es una enfermedad prevalente entre los adultos mayores, y especialmente en pacientes con insuficiencia cardíaca. Es un factor de riesgo independiente de hospitalizaciones y mortalidad. Existen diferentes herramientas de cribado, pero no existe consenso sobre cuál es más recomendada para la práctica clínica. Este estudio tiene como objetivo evaluar, en un entorno de práctica clínica, la prevalencia de la sarcopenia en pacientes con insuficiencia cardíaca con fracción de eyección reducida, mediante técnicas diagnósticas sencillas y reproducibles. Con los datos obtenidos, se pretende establecer un algoritmo diagnóstico viable en una consulta ambulatoria. Material y métodos: se realizó un estudio observacional descriptivo longitudinal en pacientes con disfunción ventricular sistólica izquierda (<40%) demostrada reciente mediante ecocardiograma o resonancia cardíaca. Se obtuvieron datos demográficos (género y edad), antropométricos (peso, talla) y por último se realizaron diversos métodos de detección de sarcopenia validados por las guías vigentes, incluyendo el cuestionario SARC-F, medición de la fuerza de agarre de la mano mediante dinamometría, test de levantarse de la silla, medición de la circunferencia del gastrocnemio y uso de bioimpedancia eléctrica para la obtención del índice de masa muscular esquelética. Resultados: se calcula una elevada prevalencia de sarcopenia en pacientes con insuficiencia cardíaca con fracción de eyección reducida (26%). Conclusiones: protocolos sencillos de cribado y alta sensibilidad deberían realizarse de forma sistemática en estos pacientes. Proponemos un nuevo algoritmo que mejora la capacidad diagnóstica de la sarcopenia en pacientes con insuficiencia cardíaca y fracción de eyección reducida.; Introduction: Sarcopenia is a prevalent condition among older adults, particularly in patients with heart failure. It is an independent risk factor for hospitalizations and mortality. Various screening tools exist, but there is no consensus on which is most recommended for clinical practice. This study aims to evaluate, in a clinical practice setting, the prevalence of sarcopenia in patients with heart failure with reduced ejection fraction, using simple and reproducible diagnostic techniques. Based on the data obtained, the goal is to establish a viable diagnostic algorithm for outpatient consultation. Material and Methods: A longitudinal descriptive observational study was conducted in patients with recently demonstrated left ventricular systolic dysfunction (< 40%) via echocardiogram or cardiac MRI. Demographic data (gender and age) and anthropometric data (weight and height) were collected. Various sarcopenia detection methods validated by current guidelines were applied, including the SARC-F questionnaire, handgrip strength measurement using dynamometry, chair stand test, calf circumference measurement, and bioelectrical impedance to obtain the skeletal muscle mass index. Results: A high prevalence of sarcopenia is estimated in patients with heart failure with reduced ejection fraction (26%). Conclusions: Simple, highly sensitive screening protocols should be systematically implemented in these patients. We propose a new algorithm that improves the diagnostic capacity. for sarcopenia in patients with heart failure and reduced ejection fraction. 2026-06-23T10:57:01Z https://hdl.handle.net/11000/40120 Título : Acute Increase in Blood αCGRP at Maximal Exercise and Its Association to Cardiorespiratory Fitness, Carbohydrate Oxidation and Work Performed: An Exploratory Study in Young Men Autor : Aracil Marco, Adolfo; Sarabia, José Manuel; Pastor, Diego; Guillén, Silvia; López-Grueso, Raúl; Gallar, Juana; Moya-Ramón, Manuel Resumen : This study aimed to explore if the acute variations in plasma concentration of α-calcitonin gene-related peptide (αCGRP) induced by a single maximal exercise bout may be associated to cardiorespiratory fitness and carbohydrate oxidation in humans. Twelve young adult Caucasian men (24.3 ± 0.9 years-old; 179.2 ± 1.9 cm of height; 23.9 ± 0.6 kg·m-2 body mass index) performed a graded exercise test. A venous catheter was placed before testing, and blood samples were taken at baseline, maximal effort and recovery. αCGRP was measured in plasma using a commercial double-sandwich enzyme-linked-immunoassay. A two-way repeated measurements ANOVA was used to compare the values obtained at baseline, maximal effort and recovery. In the whole sample, αCGRP increased at maximal effort and its concentration correlated directly, albeit non-significantly, with the muscle mass normalised VO2, VCO2, carbohydrate oxidation and relative power. Two thirds of the participants showed an increase in αCGRP concentration at maximal effort. Post hoc analysis showed that in these individuals, the muscle mass normalised VO2, VCO2, carbohydrate oxidation rate and relative power were higher than in the participants lacking this molecular response. Therefore, our data suggest that (a) a majority of young men respond to exercise with an increase in blood αCGRP concentration; and (b) individuals exhibiting this response also show a higher cardiorespiratory fitness, carbohydrate oxidation and work performed. These findings suggest that this neuropeptide could act as an exerkine with potential effects on physical performance. 2026-06-23T10:56:01Z https://hdl.handle.net/11000/40119 Título : Identifying Dimensions and Items for a Questionnaire to Assess Medication Adherence in Men and Women with Ischemic Heart Disease: Insights from the GENADHECAR Study Autor : Carbonell Soliva, Álvaro; NOUNI GARCÍA, RAUF; Quesada, Jose A.; González-Llopis, Francisco; Cordero, Alberto; Bertomeu-Gonzalez, Vicente; Orozco-Beltrán, Domingo; Verdú-Soriano, Jose; Nolasco, Andreu; Pérez-Jover, Virtudes; Mira, José Joaquín; López-Pineda, Adriana; Guillén-García, Silvia; Martínez Pérez, Pablo; Carratalá-Munuera, Concepción Resumen : Purpose: The objective of this study was to identify dimensions and items for a future questionnaire aimed at measuring medication nonadherence in people with ischemic heart disease, considering gender differences and incorporating the views of healthcare professionals, researchers, and patients. Patients and methods: We conducted a mixed-method cross-sectional study at San Juan de Alicante University Hospital and Miguel Hernández University (Spain). The methods used to identify dimensions included a consensus group of healthcare and scientific professionals, an open-response survey for community pharmacists, a closed-response patient survey, and patient focus groups. When drafting the item list, we followed international recommendations related to the number and wording of items. Our study also included a qualitative review of the item list and response scales by psychologists. Results: The resulting item list includes 41 potential items grouped into 26 dimensions and five domains: "patient", "treatment", "disease", "health professional-patient relationship" and "healthcare system". It covers aspects such as personal beliefs, mood, polypharmacy, disease symptoms, patient-healthcare professional interaction and healthcare system factors. Response options are presented on a 5-point Likert scale, including agreement-level responses and frequency-level responses. Conclusion: With the collaboration of patients, researchers, and healthcare providers, we potentially identified five domains, 26 dimensions, and 41 items with 5-point Likert scale response options. These will be considered in the subsequent development and validation of a questionnaire to measure medication adherence in patients with ischemic heart disease. 2026-06-23T10:54:02Z https://hdl.handle.net/11000/40118 Título : Impact of Exercise on Body Composition and Cardiometabolic Risk Factors in Patients Awaiting Bariatric Surgery Autor : Marc-Hernández, A; Ruiz-Tovar, J; Guillén, Silvia; Moya-Ramón, Manuel Resumen : Background: The role of exercise to achieve weight reductions in patients awaiting bariatric surgery has been little studied. The aim of this study was to describe the effects of an exercise program on body composition and cardiometabolic risk factors in patients awaiting bariatric surgery. Methods: Twenty-three patients awaiting bariatric surgery were divided into two groups: (a) an exercise group (EG, n = 12) and (b) a control group (CG, n = 11). Both groups received the usual care prior to surgery, but the EG also performed a 12-week exercise program which combined endurance and resistance training. Body composition, cardiometabolic risk factors, physical fitness, basal metabolic rate, and quality of life were assessed at baseline and at the end of the study. Results: After the exercise program, the EG achieved significant reductions in total weight (- 7.3 ± 4.1 kg, P < 0.01), fat mass (- 7.1 ± 4.7 kg, P < 0.01), and waist circumference (- 5.3 ± 2.1 cm, P < 0.01), while they maintained their fat-free mass and basal metabolic rate levels. Only the EG showed reductions in HbA1c (- 0.4 ± 0.45%, P < 0.05), systolic (- 10.5 ± 12.7 mmHg), and diastolic blood pressure (- 3.9 ± 5.2 mmHg, P < 0.05), as well as a decrease in waist-to-height ratio (- 0.032 ± 0.12, P < 0.01) and an improvement in quality of life. Conclusions: The implementation of an exercise program prior to bariatric surgery reduces fat mass and central obesity and improves cardiometabolic risk factors and quality of life, especially in the physical scales. 2026-06-23T10:51:48Z https://hdl.handle.net/11000/40110 Título : Has “respiratory coaching” before deep inspiration an impact on the incidence of transient contrast interruption during pulmonary CT angiography? Autor : Bernabé García, Juan Matías; García-Espasa, Cristina; Arenas-Jiménez, Juan; Sánchez-Payá, José; De La Hoz- Rosa, Javier; Carreres-Polo, Joan O. Resumen : Purpose To evaluate if respiratory coaching performed prior to CT pulmonary angiography (CTPA) image acquisition has an impact on the occurrence of transient interruption of contrast (TIC) phenomenon. Materials and methods Two hundred and thirty-one consecutive patients with suspected pulmonary embolism (PE) were referred for CTPA. They were randomised into two groups, with or without respiratory coaching (groups A and B, respectively). Those patients who were deemed not able to be coached were not randomised and were assigned to a third group (C). Two radiologists evaluated the degree of enhancement of the pulmonary arteries and the presence and grade of TIC. The χ2 test was used to compare differences among groups in occurrence and grade of this phenomenon. Results There were no significant differences in the presence of any grade of TIC among the three groups, with 30 positive cases (32%) in group A, 33 (35%) in group B, and 12 (27%) in group C (P00.61). When TIC was graded and divided into significant or not, the different groups also did not differ significantly. Conclusion Performing respiratory coaching before CTPA had no statistically significant effect on the incidence and severity of TIC in this prospective randomised study. Main Messages • Significant transient interruption of contrast appears in 12% of pulmonary CT angiograms. • Severe transient interruption of contrast leading to nondiagnostic tests appears in 2% of studies. • In our study respiratory coaching has no impact on the incidence of transient interruption of contrast. 2026-06-22T08:31:54Z https://hdl.handle.net/11000/40107 Título : Costes y consumos de agua y energía en comunidades de regantes: aplicación a un caso de estudio Autor : Ruiz Canales, A.; Melián Navarro, A.; Abadía Sánchez, R.; Rocamora Osorio, M.C.; Mora Gómez, M.; Puerto Molina, H.; Cámara Zapata, J.M.; Andreu Rodríguez, J. 2026-06-19T11:26:38Z https://hdl.handle.net/11000/40106 Título : Ahorro y eficiencia energética en comunidades de regantes: Auditorías energéticas Autor : Ruiz Canales, A.; Abadía Sánchez, R.; Rocamora Osorio, M.C.; Cámara Zapata, J.M.; Puerto Molina, H.; Andreu Rodríguez, J.; Vera Morales, J.; Melián Navarro, A. Resumen : Se realizó un estudio piloto de auditoría energética en la Comunidad de Regantes de Lorca (Murcia). El trabajo se desarrolló a partir de datos de las campañas de riego de 2005 y 2006. El objetivo general fue la determinación de la eficiencia energética de la comunidad de regantes, la propuesta de medidas para conseguir un ahorro energético y la valoración de las mismas. En este trabajo se describen las principales demandas energéticas del regadío en función del sistema de riego y la procedencia del agua. Posteriormente se enumeran las técnicas más frecuentes para el ahorro y la eficiencia energética del regadío. Por último se describe la experiencia piloto de auditoría energética en la Comunidad de Regantes de Lorca, centrándose en las principales medidas de ahorro y eficiencia energética propuestas. 2026-06-19T11:25:46Z