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Moreno R, Monedero MDC, Jiménez-Valero S, Calvo Orbe L, Laborde JC, López-Sendón JL. Preventing coronary occlusion with a retrievable aortic valve. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Alonso-Cánovas A, López-Sendón JL, Buisán J, deFelipe-Mimbrera A, Guillán M, García-Barragán N, Corral I, Matute-Lozano MC, Masjuan J, Martínez-Castrillo JC, Walter U. Sonography for diagnosis of Parkinson disease-from theory to practice: a study on 300 participants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2069-2074. [PMID: 25425362 DOI: 10.7863/ultra.33.12.2069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Hyperechogenicity of the substantia nigra on transcranial sonography is used for diagnosing Parkinson disease (PD). Cutoff values for the substantia nigra echogenic area, defining substantia nigra hyperechogenicity, vary among ultrasound systems from different manufacturers. In this study we wanted to determine the cutoff criterion for a Toshiba (Tokyo, Japan) system and to assess its diagnostic value. METHODS Three hundred participants (controls, n = 138; patients with PD, n = 105; and patients with essential tremor, n = 57) underwent transcranial sonography following a standardized protocol. RESULTS The substantia nigra was assessable in 92.7% of all participants. The substantia nigra echogenic area (larger of bilateral measurements) was larger in patients with PD (mean ± SD, 0.24 ± 0.05 cm(2)) than controls (0.14 ± 0.05 cm(2); P < .001) and patients with essential tremor (0.14 ± 0.04 cm(2); P < .001). Substantia nigra echogenicity was larger in male participants (0.20 ± 0.07 cm(2)) than female participants (0.15 ± 0.06 cm(2); P< .001). Age did not correlate with substantia nigra echogenicity in any group. Frontal horn width was larger and lenticular nucleus hyperechogenicity and a discontinuous raphe were more frequent in the PD group than the other groups. On multivariate analysis, only substantia nigra hyperechogenicity was associated with the diagnosis of PD. The 90th-percentile substantia nigra echogenic area in the control group, which defined marked substantia nigra hyperechogenicity, also represented the optimum cutoff value for discrimination of PD from non-PD participants on receiver operating characteristic curve analysis (area under the curve, 0.913; Youden index, 0.73). This cutoff value (≥0.21 cm(2), larger of bilateral measurements) yielded sensitivity of 83% and specificity of 90% for the diagnosis of PD. CONCLUSIONS Transcranial sonography shows good diagnostic validity for diagnosis of PD when implemented according to a strictly standardized protocol.
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Valero SJ, Lizcano G, Moreno R, López-Sendón JL. Interpretation of optical coherence tomography images. Lancet 2014; 383:1887-8. [PMID: 24881989 DOI: 10.1016/s0140-6736(14)60916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fernández-Ruiz I, Arnalich F, Cubillos-Zapata C, Hernández-Jiménez E, Moreno-González R, Toledano V, Fernández-Velasco M, Vallejo-Cremades MT, Esteban-Burgos L, de Diego RP, Llamas-Matias MA, García-Arumi E, Martí R, Boscá L, Andreu AL, López-Sendón JL, López-Collazo E. Mitochondrial DAMPs induce endotoxin tolerance in human monocytes: an observation in patients with myocardial infarction. PLoS One 2014; 9:e95073. [PMID: 24797663 PMCID: PMC4010397 DOI: 10.1371/journal.pone.0095073] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/23/2014] [Indexed: 02/07/2023] Open
Abstract
Monocyte exposure to mitochondrial Danger Associated Molecular Patterns (DAMPs), including mitochondrial DNA (mtDNA), induces a transient state in which these cells are refractory to further endotoxin stimulation. In this context, IRAK-M up-regulation and impaired p65 activity were observed. This phenomenon, termed endotoxin tolerance (ET), is characterized by decreased production of cytokines in response to the pro-inflammatory stimulus. We also show that monocytes isolated from patients with myocardial infarction (MI) exhibited high levels of circulating mtDNA, which correlated with ET status. Moreover, a significant incidence of infection was observed in those patients with a strong tolerant phenotype. The present data extend our current understanding of the implications of endotoxin tolerance. Furthermore, our data suggest that the levels of mitochondrial antigens in plasma, such as plasma mtDNA, should be useful as a marker of increased risk of susceptibility to nosocomial infections in MI and in other pathologies involving tissue damage.
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Oyanguren B, Sánchez V, González FJ, de Felipe A, Esteban L, López-Sendón JL, Garcia-Barragán N, Martínez-San Millán J, Masjuán J, Corral I. Limbic encephalitis: a clinical-radiological comparison between herpetic and autoimmune etiologies. Eur J Neurol 2013; 20:1566-70. [PMID: 23941332 DOI: 10.1111/ene.12249] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/08/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Herpetic (HE) and autoimmune (AE) encephalitis share clinical and radiological features. We compared both types of encephalitis with the aim of making a differential clinical-radiological pattern. MATERIALS AND METHODS All cases with a clinical diagnosis of encephalitis who attended our hospital between 1999 and 2012 were reviewed. We selected those cases with positive polymerase chain reaction for herpes simplex virus 1 (HSV-1) in the cerebrospinal fluid (CSF), and those with antineuronal antibodies or paraneoplastic etiology. We compared epidemiological, clinical, CSF, electroencephalographic and radiological findings. RESULTS Twelve patients with positive polymerase chain reaction for HSV-1, and 10 patients with antineuronal antibody or paraneoplastic etiology were found. The only features found exclusively in one group were the presence of psychiatric symptoms and tumors in AE. Acute onset of symptoms, fever and aphasia were more frequent in HE, which showed higher level of proteins and erythrocyte count in CSF. Neuroimaging was abnormal in all cases of HE, but only in 60% of AE. Insular and diffuse temporal lobe involvement and absence of basal ganglia involvement were more frequent in HE, and mesial temporal involvement in AE. The highest diagnostic values for differentiating HE from AE were the association of acute onset of symptoms and fever (sensitivity 0.92, specificity 1), and the absence of basal ganglia involvement (sensitivity 0.82, specificity 1). CONCLUSIONS There are few differences between HE and AE. Psychiatric symptoms and association with tumors were unique for AE. Acute onset with fever and absence of basal ganglia involvement in magnetic resonance imaging support a diagnosis of HE.
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Bettencourt C, López-Sendón JL, García-Caldentey J, Rizzu P, Bakker IMC, Shomroni O, Quintáns B, Dávila JR, Bevova MR, Sobrido MJ, Heutink P, de Yébenes JG. Exome sequencing is a useful diagnostic tool for complicated forms of hereditary spastic paraplegia. Clin Genet 2013; 85:154-8. [PMID: 23438842 DOI: 10.1111/cge.12133] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 01/02/2023]
Abstract
Hereditary spastic paraplegias constitute a heterogeneous group of neurodegenerative diseases encompassing pure and complicated forms, for which at least 52 loci and 31 causative genes have been identified. Although mutations in the SPAST gene explain approximately 40% of the pure autosomal dominant forms, molecular diagnosis can be challenging for the sporadic and recessive forms, which are often complicated and clinically overlap with a broad number of movement disorders. The validity of exome sequencing as a routine diagnostic approach in the movement disorder clinic needs to be assessed. The main goal of this study was to explore the usefulness of an exome analysis for the diagnosis of a complicated form of spastic paraplegia. Whole-exome sequencing was performed in two Spanish siblings with a neurodegenerative syndrome including upper and lower motor neuron, ocular and cerebellar signs. Exome sequencing revealed that both patients carry a novel homozygous nonsense mutation in exon 15 of the SPG11 gene (c.2678G>A; p.W893X), which was not found in 584 Spanish control chromosomes. After many years of follow-up and multiple time-consuming genetic testing, we were able to diagnose these patients by making use of whole-exome sequencing, showing that this is a cost-efficient diagnostic tool for the movement disorder specialist.
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, López-Sendón JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Bøtker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR. Documento de consenso de expertos. Tercera definición universal del infarto de miocardio. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Worner F, Cequier A, Bardají A, Bodí V, Bover R, Martínez-Sellés M, Sabaté M, Sionis A, Vázquez de Prada JA, Arós F, Arribas F, Barrabés J, Díaz de Castro O, Heras M, López Palop R, López-Sendón JL, Manito N, de Pablo MC, Ripoll T, San Román A, de la Torre JM, Fernandez-Ortiz A, Alonso Gómez ÁM, Anguita M, Cequier A, Comín J, Diaz-Buschmann I, Fernández Lozano I, Gómez de Diego JJ, Pan M, Worner F. Comments on the ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation. Rev Esp Cardiol 2012; 66:5-11. [PMID: 23485179 DOI: 10.1016/j.recesp.2012.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/30/2022]
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Ruiz-García J, Jiménez-Valero S, Moreno R, Galeote G, Sánchez-Recalde Á, Calvo L, Moreno-Yangüela M, Carrizo S, García-Blas S, López-Sendón JL. Percutaneous balloon pericardiotomy as the initial and definitive treatment for malignant pericardial effusion. ACTA ACUST UNITED AC 2012; 66:357-63. [PMID: 24775817 DOI: 10.1016/j.rec.2012.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/25/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. METHODS Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. RESULTS Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. CONCLUSIONS Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.
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Martín-Reyes R, Galeote G, Moreno R, Sánchez-Recalde A, López De Sá E, López-Sendón JL. [Percutaneous coronary intervention in HIV infected patients with human immunodeficiency virus admitted with acute coronary syndrome: case-control study]. Med Clin (Barc) 2010; 135:691-4. [PMID: 20599234 DOI: 10.1016/j.medcli.2010.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/04/2010] [Accepted: 05/06/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) has been linked in recent years with a higher rate of cardiovascular events. The aim of our study was to analyze the main risk factors associated with the onset of an acute coronary syndrome (ACS) and in-hospital prognosis in patients with HIV, undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS We studied the baseline clinical characteristics, angiographic findings, results of PCI and in-hospital outcome in 23 patients with HIV hospitalized for an ACS between September 2006 and March 2009. The results were compared with 60 HIV-negative patients admitted with an ACS. RESULTS HIV patients showed a lower average age and a higher rate of smoking. From a clinical point of view there were no statistically significant differences in clinical presentation, with a similar incidence of ACS with or without ST segment elevation ACS. HIV patients presented a non significant higher incidence of cardiogenic shock on admission (13% HIV vs 8% HIV negative, p 0,301). HIV-negative patients angiography showed the most calcified multivessel involvement with the highest number of diseased vessels (2.35 vs. 1.45, p<0.001). PCI results: HIV patients presented a lower rate of success (TIMI 3 final); 75% versus 85% in HIV-negative patients (p=0.105). There was no significant difference in hospital mortality (8.7 vs 1.7%, p=0.129). CONCLUSIONS HIV patients hospitalized for an ACS, despite being younger and presenting lower prevalence of traditional cardiovascular risk factors, did not present differences in terms of cardiovascular mortality compared with HIV negative patients.
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Dobarro D, Moreno R, Filgueiras D, Calvo L, López-Fernández T, Sánchez-Recalde A, Jiménez-Valero S, Galeote G, Gómez-Rubín MDC, Moreno-Gómez I, Mesa JM, Plaza I, López-Sendón JL. [Implantation of aortic valvular prosthesis via transfemoral catheter. Evaluation of candidates undergoing the procedure]. Med Clin (Barc) 2009; 133:414-21. [PMID: 19674759 DOI: 10.1016/j.medcli.2009.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/26/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE In recent years, techniques for implantation of aortic prosthesis via catheter have been developed as a therapeutic alternative in patients with severe aortic stenosis rejected for surgery. The correct selection of candidates is one of the more complex aspects of this treatment. We analyzed the acceptance rate in our environment for transcatheter aortic valve implantation in patients referred to our hospital for evaluation as possible candidates, describing the exclusion reasons. PATIENTS AND METHOD 30 patients with severe aortic stenosis and rejected for surgical aortic valve replacement were referred to our hospital to evaluate transcatheter aortic valve implantation. The patients first underwent clinical evaluation and were studied with echocardiography, angiography and computed tomography. RESULTS Of the 30 patients, 18 were rejected for the procedure (60%): 4 patients with non-severe aortic stenosis, 2 asymptomatic patients, 2 patients who finally underwent surgery because of a low-surgical-risk, 5 patients with contraindications for the procedure, 2 patients who finally did not want to undergo the procedure and 3 patients were further rejected because the vascular access was inappropriate. Of the remaining 12 patients initially accepted, 3 died before the procedure was performed. Finally, only 9 patients (30%) underwent transcatheter aortic valve implantation. CONCLUSIONS Of the patients referred for transcatheter aortic valve implantation, only 40% were accepted. The mortality rate during the evaluation process of this procedure is high, showing that these patients are terminally ill.
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Dobarro D, Gómez-Rubín MC, Sanchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, López de Sá E, López-Sendón JL. Current pharmacological approach to restore endothelial dysfunction. Cardiovasc Hematol Agents Med Chem 2009; 7:212-222. [PMID: 19689260 DOI: 10.2174/187152509789105480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Endothelial dysfunction is characterized by an impairment of endothelium-dependent vasodilatation. It has been linked to each of the known atherogenic risk factors, including diabetes mellitus, hypertension, dyslipidaemia, cigarette smoking, menopause, etc. A number of recent studies have shown that the severity of endothelial dysfunction correlates with the development of coronary artery disease and predicts future cardiovascular events. Therefore, these findings strengthen the hypothesis that endothelial dysfunction may be an early stage of coronary atherosclerosis. This phenomenon primarily reflects an imbalance between the vasodilating (nitric oxide) and vasoconstrictor agents (endothelin-1). Several invasive (intracoronary or intrabrachial infusions of vasoacting agents) and non-invasive techniques (assessment of flow mediated vasodilatation in the brachial artery by ultrasound) have been developed during the last few years to evaluate endothelial function in the coronary and peripheral circulation. This new methodology has allowed assessing the severity of the abnormalities in vascular function and their regression by several pharmacological and non-pharmacological interventions. It is likely that restoration of endothelial function can regress the atherosclerotic disease process and prevent future cardiovascular events. Most pharmacological interventions attempting to improve endothelial dysfunction targeted the risk factors linked to endothelial dysfunction: hypertension (ACE-inhibitors, calcium antagonists), dyslipidaemia (lipid-lowering agents) and menopause (estrogens). Nevertheless, several pharmacological agents have been suggested to achieve vascular protection through different mechanisms beyond their primary therapeutic actions: ACE-inhibitors, statins, third generation of beta-blockers (nebivolol), endothelium-derived nitric oxide synthesis (tetrahydrobiopterin, BH4) and antioxidants agents. In this review we will focus on the current pharmacological management of the endothelial dysfunction.
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Zarza B, Alonso de Leciñana M, García-Barragán N, Díaz-Sánchez M, López-Sendón JL, Cruz-Culebras A, Masjuán J. [Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke]. Neurologia 2008; 23:349-355. [PMID: 18307056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION We present the experience for thrombolytic treatment using recombinant tisular plasminogen activator (rt-PA) at a university hospital. We analyze the influence of individual and collective acquired experience and of the activation of an out-of-hospital stroke code (OSC) on the delays to onset of treatment, number of patients treated and outcome. METHOD Prospective register of patients with ischemic stroke treated with rt-PA within the period 1/2004- 12/2006. Comparison of results between patients treated during the three years of study and based on the individual experience of the neurologist who applies the treatment and on the patients treated with or without activation of OSC. RESULTS A total of 87 patients were treated (mean age: 66.6 +/- 13.7). Door-to-needle time was 79 +/- 21 min in 2004, 64 +/-22 in 2005 and 63 +/- 26 in 2006 (p=0.003). Experienced neurologists started thrombolysis sooner (door-to-needle time: 62 +/- 22 min vs 75 +/- 27, p=0.03). Activation of the ESC reduced door-to-needle time (53 +/ 17 min vs 65 +/- 21; p=0.032) and door-to-computed tomography scan time (21 +/- 10 min vs 29 +/-24; p=0.016). There were no differences in outcome in the different groups. CONCLUSIONS Individual and collective acquired experience and the activation of an OSC can lower in-hospital delays. This contributes to increasing the number of patients eligible for thrombolysis. Thrombolytic therapy is safe and effective even when it is applied by inexperienced neurologists if strict guidelines are followed.
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Pérez-David E, García-Fernández MA, Quiles J, Mahía P, López-Sendón JL, López de Sa E, Ledesma MJ, Moreno M, Desco M, García E. Usefulness of quantitative myocardial contrast echocardiography for prediction of ventricular function recovery after myocardial infarction treated with primary angioplasty. Heart 2006; 92:693-4. [PMID: 16614292 PMCID: PMC1860906 DOI: 10.1136/hrt.2005.071357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, López-Sendón JL, Nieminen MS, Piérard L, Remme WJ. Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca crónica. Versión resumida (actualización 2005). Rev Esp Cardiol 2005; 58:1062-92. [PMID: 16185619 DOI: 10.1157/13078554] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Avanzas P, Quiles J, López de Sá E, Sánchez A, Rubio R, García E, López-Sendón JL. Neutrophil count and infarct size in patients with acute myocardial infarction. Int J Cardiol 2005; 97:155-6. [PMID: 15336829 DOI: 10.1016/j.ijcard.2003.06.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2003] [Accepted: 06/14/2003] [Indexed: 12/31/2022]
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De Velasco JA, Cosín J, López-Sendón JL, De Teresa E, De Oya M, Sellers G. [New data on secondary prevention of myocardial infarction in Spain. Results of the PREVESE II study]. Rev Esp Cardiol 2002; 55:801-9. [PMID: 12199975 DOI: 10.1016/s0300-8932(02)76708-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction and objectives. The PREVESE Study reported the situation of secondary prevention after myocardial infarction in Spain. Similar surveys conducted in Europe have also shown that the implementation of secondary prevention is not adequate. The aim of this second PREVESE study was to compare the situation in Spain four years after the first study.Patients and method. We included retrospectively 2,054 patients discharged after myocardial infarction from 74 Spanish hospitals. We studied the available information recorded in medical records after discharge, the prevalence of risk factors, procedures performed, and medical treatment before admission and at discharge. We compared the data collected with those from the first PREVESE study because the data collection methodology was similar.Results. The information recorded in the hospital medical records was satisfactory in relation to the most important risk factors (hypertension 94.8%; dyslipidemia and diabetes 97.9%; and smoking 89.2%). Compared with the previous study, there was a significant decrease in the percentage of smokers (46.1 vs. 35.4%). The echocardiogram was performed more frequently (60.1 vs. 85.6%) and there were also significant differences related to drug treatment at discharge, with an important increase in the prescription of beta-blockers (33.5 vs. 45.1%), ACE inhibitors (32.5 vs. 46.4%), and lipid-lowering drugs (6.7 vs 30.5%).Conclusions. This study shows some improvement in the management of myocardial infarction patients after a four-year period, mainly due to more prescription of cardioprotective drugs at hospital discharge.
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Moreno R, Garcia E, Zamorano J, López-Sendón JL, Sánchez-Harguindey L. Acute myocardial infarction in diabetic patients. Are we actually doing bad? Eur Heart J 2001; 22:1359-61. [PMID: 11465970 DOI: 10.1053/euhj.2001.2667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Moreno R, García E, Pérez de Isla L, Acosta J, Abeytua M, Soriano J, López-Sendón JL. [In-hospital major complications associated with rotational atherectomy: experience with 800 patients at a single center]. Rev Esp Cardiol 2001; 54:460-8. [PMID: 11282051 DOI: 10.1016/s0300-8932(01)76334-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rotational atherectomy is usually performed in patients with angiographically determined high risk coronary lesions. The aim of this study was to evaluate the rate of major adverse cardiac events (death, Q-wave infarction or new revascularization) after rotational atherectomy, as well as to identify the clinical characteristics associated with this incidence. PATIENTS AND METHODS The study population included 800 patients treated with rotational atherectomy from 1993 to 1999: 512 (64%), for de novo lesions, and 288 (36%) for restenosis. Balloon dilation and coronary stenting was performed in 95% and 34% of patients, respectively. RESULTS During hospitalization, 17 patients (2.1%) died, 16 (2%) had a Q-wave infarction, 30 (3.8%) a non-Q infarction, and new revascularization was performed in 28 (3.5%). The incidence of major adverse cardiac events was 6.5% (n = 52), this incidence being higher in the presence of diabetes (8.9 vs. 4.4%; p = 0.01), unstable angina or acute/recent myocardial infarction (7.6 vs. 3.3%; p = 0.02), multivessel disease (8.6 vs. 3.3%; p < 0.01), treated vessel other than right coronary (7.0 vs. 1.7%; p = 0.01), procedure in > 1 vessel (10.7 vs. 4.7%; p < 0.01), angiographic failure (62.5 vs. 5.5%; p < 0.001), and de novo lesions (8.4 vs. 2.5%; p < 0.01), with diabetes and treatment of de novo lesions being independent predictors of major adverse cardiac events. However, age, previous infarction, and left ventricular dysfunction, were not associated with the rate of events. CONCLUSION Some simple variables are associated with a higher incidence of major adverse cardiac events after rotational atherectomy. Advanced age, previous infarction and left ventricular dysfunction, however, do not necessarily imply a poorer prognosis in these patients.
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López-Sendón JL, López de Sá E. Respuesta. Rev Esp Cardiol (Engl Ed) 2001. [DOI: 10.1016/s0300-8932(01)76510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bermejo García J, López de Sá E, López-Sendón JL, Pabón Osuna P, García-Morán E, Bethencourt A, Bosch Genover X, Roldán Rabadán I, Calviño Santos R, Valle Tudela V. [Unstable angina in the elderly: clinical, profile, management and mortality at three months. The PEPA Registry Data]. Rev Esp Cardiol 2000; 53:1564-72. [PMID: 11171478 DOI: 10.1016/s0300-8932(00)75281-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients > or = 70 years of age. PATIENTS AND METHODS A total of 1,551 patients > or = 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years. RESULTS In comparison, the elderly (76 +/- 5 years) versus the younger group (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), diabetics (30 vs 23%)and hypertensive patients (60 vs 49%) with a lower proportion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs31%) and comorbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 out of 34 vs 15%). The elderly were treated with fewer invasive procedures (25 vs 44%) or catheterization (26 vs 36%) and they were more frequently controlled with medical treatment (86 vs 83%) although with a lower use of beta blockers (45 vs 53%). The mortality at 3 months was greater in the elderly (7.4 vs 3.0%;p < 0.005) with age being an independent predictor of bad prognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis in the elderly. CONCLUSIONS A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortality is greater. Diabetes, heart failure and ST segment depression on admission are independent predictors of bad prognosis in elderly patients.
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Moreno R, García E, Soriano J, Abeytua M, Martínez-Sellés M, Acosta J, Elízaga J, Botas J, Rubio R, López de Sá E, López-Sendón JL, Delcán JL. [Coronary angioplasty in the acute myocardial infarction: in which patients is it less likely to obtain an adequate coronary reperfusion?]. Rev Esp Cardiol 2000; 53:1169-76. [PMID: 10978231 DOI: 10.1016/s0300-8932(00)75221-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In patients with acute myocardial infarction treated with primary angioplasty, the inability to achieve successful coronary reperfusion is associated with higher mortality. The objective of the study was to identify which characteristics may predict a lower angiographic success rate in patients with acute myocardial infarction treated with coronary angioplasty. PATIENTS AND METHODS The study population is constituted by the 790 patients with acute myocardial infarction that were treated with angioplasty within the 12 hours after the onset of symptoms from 1991 to 1999 at our institution. A successful angiographic result was considered in presence of a residual stenosis < 50% and a TIMI flow 2 or 3 after the procedure. RESULTS A successful angiographic result and a final TIMI 3 flow were achieved in 736 (93.2%) and 652 (82.5%) patients, respectively. In-hospital mortality was higher in patients with angiographic failure than in those with angiographic successful result (48 vs. 10%; p < 0.01). Age under 65 (91 vs. 95%; p = 0.02), non smoking (90 vs. 96%; p < 0,01), previous infarction (87 vs. 94%; p < 0.01), angioplasty after failed thrombolysis (83 vs. 94%; p = 0. 02), cardiogenic shock (80 vs. 95%; p < 0.01), undetermined location (67 vs. 93%; p < 0.01), non-inferior location (92 vs. 96%; p = 0.04), left bundle branch block (64 vs. 94%; p < 0.01), multivessel disease (91 vs. 95%; p = 0.02), left ventricular ejection fraction < 0.40 (89 vs. 97%; p < 0.01), no utilization of coronary stenting (90 vs. 96%; p < 0.01), and use of intraaortic balloon counterpulsation pump (82 vs. 95%; p < 0.01) were associated with a lower angiographic success rate. In the multivariable analysis, the following were independent predictors for angiographic failure: left bundle branch block (odds ratio [OR], 12.95; CI 95%, 3.00-53.90), cardiogenic shock (OR, 4.20; CI 95%, 1.95-8.75), no utilization of coronary stent (OR, 3.44; CI 95%, 1.71-7.37), and previous infarction (OR, 2.82; CI 95%, 1.29-5.90). CONCLUSIONS Coronary angioplasty allows a successful coronary recanalization in most patients with acute myocardial infarction. Some basic characteristics, however, may identify some subsets in which a successful angiographic result may be more difficult to obtain.
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Moreno R, García E, Cantalapiedra JL, Ortega A, López de Sá E, López-Sendón JL, Delcán JL. [Management of unstable angina: advanced age is still an independent predictive factor of more conservative management after prognostic stratification with stress test]. Rev Esp Cardiol 2000; 53:911-8. [PMID: 10944989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVE In the management of ischemic heart disease, elderly patients constitute a subgroup that, despite having a worse prognosis, are usually managed more conservatively. The objective of this study was to evaluate if, in the management of unstable angina, a more conservative attitude in elderly patients is maintained after stratification by exercise test. PATIENTS AND METHODS The study population is constitude by 859 patients admitted to hospital due to suspected unstable angina that were referred to exercise test after medical stabilization. The management (invasive versus conservative, according to submission to cardiac catheterization or not) of patients was retrospectively studied, comparing patients < or = 70 versus > 70 years-of age. RESULTS Out of the 859 patients, 156 (18%) were > 70 years old, and the exercise test was positive in 281 (33%). Cardiac catheterization was performed in 494 (57%): 62% in older and 38% in younger patients (p < 0.0001). Other characteristics associated with a more conservative management were: a negative exercise test, > 85% of the maximum heart rate, duration of exercise test more than 6 minutes, female gender, smoking and absence of episodes of rest angina. In the multivariate analysis, the statistically significant characteristics associated with an invasive management were the result of the exercise test (OR for positive result: 4.50; IC 95% = 2.73-7.63; p < 0.0001), the duration of exercise (OR for > or = 6 minutes: 0.51; IC 95% = 0.29-0.88; p = 0.0177), the percentage of the maximum heart rate (OR for > or = 85%: 0.65; IC 95% = 0.42-0.98; p = 0.0391) and age (OR for > 70 years 0.36; IC 95% = 0.20-0.62; p = 0.0004). CONCLUSIONS In the management of unstable angina, elderly patients constitute a more conservatively managed subgroup even after risk stratification with exercise test.
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Moreno R, García E, López-Sendón JL. [Prognostic stratification of unstable angina controlled with medical treatment: is the stress test sufficient?]. Rev Esp Cardiol 2000; 53:770-2. [PMID: 10944967 DOI: 10.1016/s0300-8932(00)75155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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