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Santoro C, Pardo A, Hinojar R, Garcia A, Salido L, Gonzalez-Gomez A, Jimenez-Nacher JJ, Marco Del Castillo A, Abellas M, Hernandez-Antolin R, Zamorano JL, Fernandez-Golfin C. 2139Left atrial dysfunction assessed by strain correlates with symptoms and severity of aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) results in high pressure afterload causing detrimental effect especially on the left chambers. Structural and functional changes of the left ventricle (LV) usually corresponds to concomitant remodelling of the left atrium (LA). However, how this pressure afterload specifically affects LA function and whether the study of LA function could help in stratifying patients with different degree of AS it is not known.
Purpose
We aim to evaluate the differences in LA and LV function according different degree of AS by standard and speckle tracking echocardiographic.
Methods
From January 2016 to May 2018 we recruited 135 patients referring to our echo-lab with diagnosis of AS (mean age 79.5±4.4; 60/55% female). We divided this population according to AS severity in patients with moderate AS, severe asymptomatic and severe symptomatic AS and matched with 35 control group with no aortic stenosis (n=45, mean age: 77.6±4.5). All patients underwent standard and 2-dimensional speckle tracking echocardiography computing global longitudinal strain (GLS) of LV and peak atrial strain of LA (PALS).
Results
In all patients PALS was a good predictor of E/e' ratio after correction for LV EF and age (p<0.001, β: −0.48). LVEF and GLS progressively decreased together with worsening of AS degree, as well as parameters of geometry and function of LA (Table1). By excluding patients with LV dysfunction the reduction gradient of parameters of LA geometry and function was still present. However, when severe symptomatic with asymptomatic severe AS are compared, no difference in E/e' ratio was found while both GLS and PALS were significantly reduced (both p<0.0001).
Variables Overall population (180) Control (45) Moderate AS (45) Severe asympt AS (45) Severe sympt. AS (45) p LVEF 65.0±11.1 67.7±5.6 69.4±8.5 66.1±10.7 59.5±13.5 0.0001 GLS −20.4±4.1 −23.1±2.4 −21.5±2.9 −21.4±3.2 −17.1±4.3 0.0001 LA vol index 41.6±21.5 28.2±10.4 40.1±19.7 39.8±16.7 52.3±24.9 0.0001 LA strain 23.6±10.9 30.8±10.3 27.8±9.2 24.4±9.7 15.2±7.1 0.0001 LA reservoir 46.4±15.9 51.9±11.5 53.0±15.0 48.3±14.1 37.2±16.1 0.0001 Ee' ratio 14.8±7.0 9.6±2.7 13.7±6.3 15.4±6.2 19.3±7.2 0.0001
Conclusions
LA function seems to progressively decrease according to the degree of AS, independently from LV function. Significant difference was found between parameters of LA remodelling and dysfunction between symptomatic and asymptomatic AS patients. The assessment of LA function by strain may help stratify the patients with AS, identifying those who need intensive medical/surgical treatment.
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Garcia Martin A, Hinojar R, Gonzalez Gomez A, Pascual Izco M, Plaza Martin M, Alonso Salinas G, Hernandez Jimenez S, Monteagudo JM, Casas Rojo E, Moya Mur JL, Jimenez Nacher JJ, Ruiz Leria S, Barrios Alonso V, Zamorano JL, Fernandez Golfin C. P5569Effective regurgitant oriffice area vs vena contracta method as predictors of outcomes in severe tricuspid regurgitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is no gold standard echocardiographic method to evaluate tricuspid regurgitation (TR) severity. ESC guidelines recommend using a combination of several methods. The purpose of this study was to compare the prognostic value of the two most commonly used methods for the evaluation of the TR: Effective regurgitant orifice area (EROA) method and biplane vena contracta (VC) method.
Methods
Consecutive asymptomatic patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015–2018 were included.
TR severity was evaluated by a combination of several methods, including EROA method and biplane VC method, using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.
Results
A total of 70 patients were included (mean age was 74±8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). During a median follow up of 18 months [IQR: 4–28], 35% of the patients reached the combined end-point (n=16 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died).
Patients with events showed a larger EROA (0.55 vs 0.40 p: 0.036) but no significance different was found in VC (8.03 vs 7.80 p: 0.27). Among both parameters, the tricuspid EROA was the only prognostic factor of the combined endpoint (EROA, HR 24.22 [1.54–380.86], p=0.023; VC, HR 1.022 [0.882–1.183]. A value of EROA of 0.42 reached the best accuracy to predicted poor outcomes (p<0.01).
Conclusion
Among the two most commonly used methods for the evaluation of the TR, EROA was the only method that obtained prognostic value during follow-up.
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Lozano-Granero C, Moreno J, Matia R, Hernandez-Madrid A, Sanchez-Perez I, Zamorano JL, Franco E. P2839The golden age of ablation: results for atypical flutter ablation in the very elderly. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks.
Purpose
To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients.
Methods
From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months.
Results
107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence.
Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference.
Survival function
Conclusion
AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.
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Stokke TM, Sarvari SI, Bjerring AW, Haugaa KH, Elahi MT, Hoedemakers SI, Rademakers F, Monaghan M, Sicari R, Engvall J, Nagel E, Zamorano JL, Ukkonen H, D'hooge J, Edvardsen T. P606High intermodality variability in ejection fraction measured by echocardiography, cardiac magnetic resonance and single photon emission computed tomography in chronic coronary artery disease patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical treatment strategies are often based on measurement of left ventricular ejection fraction (LVEF). There is limited evidence about variations in LVEF when measured by different imaging modalities.
Purpose
To investigate the intermodality variability of LVEF measured by two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), cardiac magnetic resonance (CMR), and single photon emission computed tomography (SPECT) in patients with chronic coronary artery disease (CAD).
Methods
Patients from a multicenter study (DOPPLER-CIP – Determining optimal noninvasive parameters for the prediction of left ventricular remodeling in chronic ischemic patients) with chronic CAD were included. LVEF was measured by CMR and at least one additional modality. In each modality, LVEF was measured by a core laboratory independently of the other modalities. Measurements of LVEF by CMR were compared to 2DE, 3DE and SPECT using correlation and Bland-Altman plots.
Results
A total of 343 patients were included. Mean age was 63.9±8.3 years and 253 (74%) were males. Mean LVEF by CMR was 61.8±11.6%. Correlations between CMR LVEF and other modalities were moderate for 2DE and 3DE, and good for SPECT (Figure A-C). CMR had significantly greater correlation to SPECT, compared to 2DE and 3DE. Bland-Altman plots indicated relatively wide limits of agreement between all modalities, ranging from 31% to 42% (Figure, D-F). Mean absolute difference of LVEF between CMR and other modalities were 8.5% for 2DE, 9.0% for 3DE, and 8.3% for SPECT. The percentage of measurements that fell within a range of 5% difference compared to CMR LVEF was 41% for 2DE, 34% for 3DE and 37% for SPECT (all p>0.05).
Conclusions
In a multicenter study with chronic CAD patients, LVEF assessed by CMR had better correlation to SPECT, compared to 2DE and 3DE. However, there was considerable variability among all three modalities that were compared to CMR. Awareness of these variations are important in clinical management.
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Pardo Sanz A, Rincon LM, De Lara G, Tamayo A, Belarte LC, Cruz A, Contreras H, Guedes P, Huertas S, Portero J, Martinez A, Alddin-Rajjoub E, Marco A, Monteagudo JM, Zamorano JL. P690Incidence of events between vitamin K antagonists and direct oral anticoagulants in patients with cancer. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Balance between embolic and bleeding risk is challenging in patients with cancer. There is a lack of specific recommendations for the use of antithrombotic therapy in oncologic patients with atrial fibrillation (AF).
We aimed to evaluate the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) within patients with breast cancer. We also compared the embolic and bleeding risk, the preventive management and the incidence of events between patients with and without cancer.
Methods
It is an ambispective observational multicentric study that analysed patients with non-valvular AF treated in Oncology and Cardiology Departments in Spain in the period 2011–2018. A total of 1237 female patients with AF were enrolled: 637 with breast cancer and 599 without cancer. The incidence of thromboembolic and major bleeding events according to the antithrombotic strategy with VKAs or DOACs was evaluated in the cohort of 637 patients with cancer. Analysis were conducted using SPSS software V.22.0 and R V.3.5.1, with a two-tailed significance value of 0.05.
Results
Mean follow-up was 3.1 years. Both groups were similar in age, CHA2DS2-VASc and HASB-LED scores. There was no evidence that the incidence of ischemic stroke/systemic embolism differed between patients with cancer treated with AVK and DOAC after CHA2DS2-VASc adjustment: HR 0.91 (95% CI, 0.42–1.99). In addition, no significant differences in the incidence of major bleeding events were found between DOACs and VKA after adjustment for HAS-BLED score: HR 1.53 (95% CI, 0.93–2.53) (Figure 3). Gastrointestinal bleeding was the main source of haemorrhages in both groups (45% of bleedings among patients treated with DOACs and, 37% in VKAs group). Metastatic disease or active chemotherapy were studied as potential covariates but none of them posed any relevant change in the result.
Kaplan-Meier analysis
Conclusions
Cancer patients treated with DOACs did not differ versus those treated with VKAs with regards to stroke or systemic embolism in a model adjusted for CHA2DS2-VASc. Neither significant differences were found for bleeding events in a model adjusted for baseline HASBLED.
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Pascual-Tejerina V, Sánchez-Recalde Á, Gutiérrez-Larraya F, Zamorano JL. A Novel and Simple Percutaneous Technique to Treat a Complex Pseudoaneurysm of Post-Aortic Coarctation Patch Aortoplasty. JACC Cardiovasc Interv 2019; 12:e159-e160. [PMID: 31473233 DOI: 10.1016/j.jcin.2019.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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Alonso Salinas GL, Sanmartin-Fernandez M, Pacual Izco M, Rincon LM, Marco Del Castillo A, Recio-Mayoral A, Martin-Asenjo R, Camino A, Jimenez Mena M, Zamorano JL. P6286Role of Frailty on acute coronary syndromes in the elderly. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pardo Sanz A, Santoro C, Hinojar R, Garcia A, Salido Tahoces L, Abellas M, Marco A, Gonzalez A, Jimenez Nacher JJ, Del Val D, Del Prado S, Valverde M, Hernandez-Antolin R, Zamorano JL, Fernandez-Golfin C. 4921Differences in right ventricular function in patients with severe aortic stenosis with normal flow/low flow undergoing TAVI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abellas Sequeiros M, Pardo A, Garcia A, Rincon LM, Moya Mur JL, Jimenez Nacher JJ, Rodriguez D, Franco E, Moreno J, Fernandez-Golfin C, Zamorano JL. P6465Echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillation prior to catheter ablation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fernandez-Golfin C, Hinojar-Baydes R, Esteban Peris A, Gonzalez-Gomez A, Fernandez MA, Alonso Salinas G, Monteagudo JM, Pardo A, Abellas M, Garcia-Martin A, Jimenez-Nacher JJ, Zamorano JL. P4678Cardiac magnetic resonance left ventricular myocardial mechanics in patients with significant aortic resgurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gonzalez Gomez A, Abellas M, Monteagudo Ruiz JM, Hinojar Baydes R, Garcia Martin A, Marco A, Casas Rojo E, Jimenez Nacher JJ, Moya JL, Ruiz Leria S, Barrios V, Zamorano JL, Fernandez-Golfin C. P3416Low gradient severe aortic stenosis with preserved ejection fraction: reclassification of severity by 3D transesophageal echocardiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Franco E, Rodriguez Munoz D, Lozano Granero C, Matia R, Hernandez-Madrid A, Sanchez Perez I, Zamorano JL, Moreno J. P4841To the root of the matter: better long-term success of para-Hisian atrial tachycardias ablated from the aortic root than any other origin of atrial tachycardia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sorbets E, Greenlow N, Ford I, Tendera M, Ferrari R, Tardif JC, Hu D, Danchin N, Shalnova S, Kalra P, Kaab S, Zamorano JL, Dorian P, Fox KM, Steg PG. P4591Outcomes of stable coronary artery disease worldwide. Insights from the CLARIFY registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pardo Sanz A, Abellas M, Garcia A, Rincon LM, Moya JL, Casas E, Gonzalez A, Hinojar R, Jimenez-Nacher JJ, Monteagudo JM, Rodriguez D, Franco E, Moreno J, Zamorano JL, Fernandez-Golfin C. P6468Echocardiographic predictors for early recurrence of atrial fibrillation undergoing catheter ablation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pardo Sanz A, Rincon LM, Tamayo A, De Lara G, Contreras H, Rueda A, Cruz A, Belarte L, Huertas S, Portero JJ, Martinez A, Zamorano JL. P1574Oncology patients with atrial fibrillation: same or different story? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pardo Sanz A, Rincon LM, Tamayo A, De Lara G, Contreras H, Rueda A, Cruz A, Belarte L, Portero JJ, Huertas S, Martinez A, Sanmartin M, Salido Tahoces L, Marco A, Zamorano JL. P1580Performance of atrial fibrillation ischemic and bleeding risk scores in patients with cancer. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pardo Sanz A, Rincon LM, Tamayo A, De Lara G, Rueda A, Cruz A, Belarte L, Contreras H, Martinez A, Huertas S, Portero JJ, Sanmartin M, Monteagudo JM, Del Prado S, Zamorano JL. 6138Embolic and bleeding events related with atrial fibrillation in oncologic patients. A multicenter case-control study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodriguez Munoz D, Franco E, Matia R, Hernandez-Madrid A, Sanchez Perez I, Lozano Granero C, Marco Del Castillo A, Monteagudo JM, Pardo Sanz A, Zamorano JL, Moreno J. 2120Myocarditis-associated ventricular tachycardias require epicardial access to ablate an LV basal inferolateral substrate. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abellas Sequeiros M, Del Prado S, Alonso Salinas G, Lorente A, Vieitez JM, Pardo A, Plaza M, Ramos J, Hernandez S, Gonzalez Ferrer E, Zamorano JL. P897Sacubitril/valsartan: science-fiction, or current practice? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Murray S, Carrera C, Lazure P, Vardas P, Zamorano JL, Kearney P, Goncalves L, Fox K, Vahanian A. Identifying the needs for competency-based education in Europe: a needs assessment of cardiologists across 52 countries. J Eur CME 2018; 6:1337478. [PMID: 29644134 PMCID: PMC5843045 DOI: 10.1080/21614083.2017.1337478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/16/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: This international needs assessment was mandated by the European Society of Cardiology (ESC) to obtain an in-depth understanding of the current gaps and challenges of European cardiology professionals, with the aim to provide evidence for the development of needs-driven educational and professional development activities. Methods: This ethics-approved needs assessment was conducted among cardiologists from all sub-specialties across 56 countries of Europe and the Mediterranean basin. A mixed-methods research approach was used, combining qualitative in-depth interviews and focus groups with a quantitative survey. Results: Seventy-four (74) cardiologists participated in the qualitative phase and 866 completed the survey. Respondents represented 52 of the 56 targeted countries. Three themes were identified: 1) Challenges in the clinical decision-making process, 2) Challenges in establishing the patient-physician relationship, and 3) Sub-optimal team communication and collaboration. Specific gaps and causalities related to each challenge were found. Although most of the gaps were common across countries and sub-specialties, some significant differences were noted. Conclusion: The findings of this needs assessment indicate gaps and challenges in clinical practice across countries and across sub-specialities. Taking cardiology as an example, this study identifies clear areas of focus, especially around issues of collaboration and communication, for targeted competency-based education in Europe.
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Lozano-Granero C, Moreno J, Rodriguez Munoz D, Matia R, Hernandez-Madrid A, Sanchez-Perez I, Marco Del Castillo A, Zamorano JL, Franco E. P905Anterior mitral lines for perimitral flutter ablation: are we ablating down the right path? Europace 2018. [DOI: 10.1093/europace/euy015.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Grande E, Glen H, Aller J, Argenziano G, Lamas MJ, Ruszniewski P, Zamorano JL, Edmonds K, Sarker S, Staehler M, Larkin J. Recommendations on managing lenvatinib and everolimus in patients with advanced or metastatic renal cell carcinoma. Expert Opin Drug Saf 2017; 16:1413-1426. [PMID: 28920492 DOI: 10.1080/14740338.2017.1380624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There are several second-line treatment options for patients with renal cell carcinoma after first-line failure of a tyrosine kinase inhibitor, especially with the recent approvals of cabozantinib, nivolumab, and the lenvatinib plus everolimus combination. A lack of reliable biomarkers and an overall lack of prospective head-to-head comparisons make it a challenge to choose a second-line treatment in the clinic. Areas covered: In this review/meta-opinion, we describe the safety profile of the lenvatinib plus everolimus combination in renal cell carcinoma. The combination of lenvatinib plus everolimus has achieved the highest rates of objective responses and the longest progression free and overall survival in cross-comparison trials. At the same time, the safety profile of this combination, including the rate of total and severe adverse events, the percentage of dose reductions required, and the rate of treatment discontinuation, was less favorable compared with available monotherapy options, suggesting that better management could help to maximize the activity of this combination while protecting patients from undue harm. Expert opinion: Herein, we aim to postulate multidisciplinary recommendations on the advice to offer to patients and caregivers before starting treatment and how to manage the combination from the perspective of daily clinical practice.
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Zamorano JL, Manuel Monteagudo J, Mesa D, Gonzalez-Alujas T, Sitges M, Carrasco-Chinchilla F, Li CH, Grande-Trillo A, Martinez A, Matabuena J, Alonso-Rodriguez D, Fernandez-Golfin C. Frequency, Mechanism and Severity of Mitral Regurgitation: Are There any Differences Between Primary and Secondary Mitral Regurgitation? THE JOURNAL OF HEART VALVE DISEASE 2016; 25:724-729. [PMID: 28290172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Although mitral regurgitation (MR) is a well-recognized prognosis factor, its true prevalence is probably underestimated and its etiology and mechanisms have not been sufficiently explored. The study aim was to evaluate the burden of MR, focusing attention on its frequency, severity, etiology, mechanism, and other associated conditions. METHODS Between February and June 2015, a total of 39,855 consecutive echocardiographic studies was performed at nine tertiary hospitals, and were prospectively included in the study. MR severity was graded into four groups, ranging from none or trace to severe MR, in accordance with the recommendations of the European Association of Cardiovascular Imaging. Patients with moderate to severe MR were selected for the analysis. RESULTS MR was detected in 22.6% of cases. MR severity was mild in 82.5% of patients (n = 7,376), moderate in 11.7% (n = 1,048), and severe in 5.8% (n = 521). Concomitant valvular heart disease was present in 3,544 patients (39.7%), with tricuspid regurgitation the most frequently encountered (21.6%). Among moderate and severe MR, primary MR was more frequent than secondary MR (58.8% versus 23.5%), with degenerative valve disease being the most common cause of primary MR (49.2%). A third group composed of mixed forms of MR was described in 17.8% of cases. CONCLUSIONS MR is a common finding on echocardiography, and is frequently associated with other valvular heart disease. Most MRs are of degenerative origin. The primary and secondary forms of MR differ significantly in their clinical presentation with regard to gender, age, and ventricular function. There appears to be a gap for a 'mixed' group, though further studies are needed to confirm this suggestion.
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Roolvink V, Ibáñez B, Ottervanger JP, Pizarro G, van Royen N, Mateos A, Dambrink JHE, Escalera N, Lipsic E, Albarran A, Fernández-Ortiz A, Fernández-Avilés F, Goicolea J, Botas J, Remkes W, Hernandez-Jaras V, Kedhi E, Zamorano JL, Navarro F, Alfonso F, García-Lledó A, Alonso J, van Leeuwen M, Nijveldt R, Postma S, Kolkman E, Gosselink M, de Smet B, Rasoul S, Piek JJ, Fuster V, van 't Hof AWJ. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2016; 67:2705-2715. [PMID: 27050189 DOI: 10.1016/j.jacc.2016.03.522] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. METHODS STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. RESULTS A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. CONCLUSIONS In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (Early-Beta blocker Administration before reperfusion primary PCI in patients with ST-elevation Myocardial Infarction [EARLY-BAMI]; EudraCT no: 2010-023394-19).
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