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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Llàcer P, Pomares A, Fort A, Ponz de Antonio I, Méndez A, Blázquez-Bermejo Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, Zegrí I, García Pinilla JM, Montero Hernández E, Castro A, Soler MJ, Górriz JL, Bascompte Claret R, Fluvià-Brugués P, Manzano L, Núñez J. Prevalence and clinical profile of kidney disease in patients with chronic heart failure. Insights from the Spanish cardiorenal registry. Rev Esp Cardiol (Engl Ed) 2024; 77:50-59. [PMID: 37217135 DOI: 10.1016/j.rec.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with combined heart failure (HF) and chronic kidney disease (CKD) have been underrepresented in clinical trials. The prevalence of CKD in these patients and their clinical profile require constant evaluation. This study aimed to analyze the prevalence of CKD, its clinical profile, and patterns of use of evidence-based medical therapies in HF across CKD stages in a contemporary cohort of ambulatory patients with HF. METHODS From October 2021 to February 2022, the CARDIOREN registry included 1107 ambulatory HF patients from 13 HF clinics in Spain. RESULTS The median age was 75 years, 63% were male, and 48% had heart failure with reduced left ventricular ejection fraction (HFrEF). A total of 654 (59.1%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and 122 (11%) patients with eGFR ≥ 60 mL/min/1.73 m2 had a urine albumin-creatinin ratio ≥ 30 mg/g. The most important variables associated with lower eGFR were age (R2=61%) and furosemide dose (R2=21%). The proportion of patients receiving an angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blockers (ARB), an angiotensin receptor-neprilysin inhibitor (ARNi), a sodium-glucose cotransporter 2 inhibitor (SGLT2i), or a mineralocorticoid receptor antagonist (MRA) progressively decreased with lower eGFR categories. Notably, 32% of the patients with HFrEF and an eGFR <30 mL/min/1.73 m2 received the combination of ACEI/ARB/ARNi+beta-blockers+MRA+SGLT2i. CONCLUSIONS In this contemporary HF registry, 70% of patients had kidney disease. Although this population is less likely to receive evidence-based therapies, structured and specialized follow-up approaches within HF clinics may facilitate the adoption of these life-saving drugs.
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Affiliation(s)
- Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Antonia Pomares
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aleix Fort
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - Ana Méndez
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Jorge Rubio Gracia
- Servicio de Medicina Interna, Hospital Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | | | - Isabel Zegrí
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esther Montero Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro (IDIPHISA), Majadahonda, Madrid, Spain
| | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - María José Soler
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Ramón Bascompte Claret
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova. Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Zegrí I, Pomares A, Llácer P, Fort A, Rodríguez Chavarri A, Méndez A, Blázquez Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, García Pinilla JM, Soler MJ, Garrido González R, Górriz JL, González Rico M, Castro A, Núñez J. Sex differences in Cardiorenal Syndrome: Insights from CARDIOREN Registry. Curr Heart Fail Rep 2023:10.1007/s11897-023-00598-x. [PMID: 37222949 DOI: 10.1007/s11897-023-00598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE OF THE WORK Although sex-specific differences in heart failure (HF) or kidney disease (KD) have been analyzed separately, the predominant cardiorenal phenotype by sex has not been described. This study aims to explore the sex-related differences in cardiorenal syndrome (CRS) in a contemporary cohort of outpatients with HF. FINDINGS An analysis of the Cardiorenal Spanish registry (CARDIOREN) was performed. CARDIOREN Registry is a prospective multicenter observational registry including 1107 chronic ambulatory HF patients (37% females) from 13 Spanish HF clinics. Estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 was present in 59.1% of the overall HF population, being this prevalence higher in the female population (63.2% vs. 56.6%, p = 0.032, median age: 81 years old, IQR:74-86). Among those with kidney dysfunction, women displayed higher odds of showing HF with preserved ejection fraction (HFpEF) (odds ratio [OR] = 4.07; confidence interval [CI] 95%: 2.65-6.25, p < 0.001), prior valvular heart disease (OR = 1.76; CI 95%:1.13-2.75, p = 0.014), anemia (OR: 2.02; CI 95%:1.30-3.14, p = 0.002), more advanced kidney disease (OR for CKD stage 3: 1.81; CI 95%:1.04-3.13, p = 0.034; OR for CKD stage 4: 2.49, CI 95%:1.31-4.70, p = 0.004) and clinical features of congestion (OR:1.51; CI 95%: 1.02-2.25, p = 0.039). On the contrary, males with cardiorenal disease showed higher odds of presenting HF with reduced ejection fraction (HFrEF) (OR:3.13; CI 95%: 1.90-5.16, p < 0.005), ischemic cardiomyopathy (OR:2.17; CI 95%: 1.31-3.61, p = 0.003), hypertension (OR = 2.11; CI 95%:1.18-3.78, p = 0.009), atrial fibrillation (OR:1.71; CI 95%: 1.06-2.75, p = 0.025), and hyperkalemia (OR:2.43, CI 95%: 1.31-4.50, p = 0.005). In this contemporary registry of chronic ambulatory HF patients, we observed sex-related differences in patients with combined heart and kidney disease. The emerging cardiorenal phenotype characterized by advanced CKD, congestion, and HFpEF was predominantly observed in women, whereas HFrEF, ischemic etiology, hypertension, hyperkalemia, and atrial fibrillation were more frequently observed in men.
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Affiliation(s)
- Marta Cobo Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Isabel Zegrí
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonia Pomares
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain. Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - Aleix Fort
- Department of Cardiology, Hospital Universitari Dr. Josep Trueta., Girona, Spain
| | | | - Ana Méndez
- Department of Cardiology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Zorba Blázquez
- Department of Cardiology, Hospital Universtiario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Rubio Gracia
- Department of Internal Medicine, Hospital Universitario Lozano Blesa, University of Zaragoza, Saragossa, Spain
| | | | | | - Maria Jose Soler
- Department of Nephrology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Ramón Garrido González
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Jose Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Miguel González Rico
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Almudena Castro
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.
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Maestro-Benedicto A, Vela P, de Frutos F, Mora N, Pomares A, Gonzalez-Vioque E, Briceño A, Cabrera E, Cobo-Marcos M, Dominguez F, Gonzalez-Lopez E, Segovia J, Lara-Pezzi E, Garcia-Pavia P. Frequency of hereditary transthyretin amyloidosis among elderly patients with transthyretin cardiomyopathy. Eur J Heart Fail 2022; 24:2367-2373. [PMID: 35999650 PMCID: PMC10087903 DOI: 10.1002/ejhf.2658] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR-CM) is increasingly recognized as a cause of heart failure in the elderly. Although wild-type transthyretin amyloidosis is the most frequent form of ATTR-CM found in the elderly, hereditary transthyretin amyloidosis (ATTRv) can also occur. We sought to determine the prevalence of ATTRv among elderly ATTR-CM patients, identify predictors of ATTRv and evaluate the clinical consequences of positive genetic testing in this population. METHODS AND RESULTS Prevalence of ATTRv in elderly ATTR-CM patients (≥70 years) was assessed in a cohort of 300 consecutive ATTR-CM patients (median age 78 years at diagnosis, 82% ≥70 years, 16% female, 99% Caucasian). ATTRv was diagnosed in 35 (12%; 95% confidence interval [CI] 3.1-8.8) and 13 (5.3%; 95% CI 5.6-26.7) patients in the overall cohort and in those ≥70 years, respectively. Prevalence of ATTRv among elderly female patients with ATTR-CM was 13% (95% CI 2.1-23.5). Univariate analysis identified female sex (odds ratio [OR] 3.66; 95% CI 1.13-11.85; p = 0.03), black ancestry (OR 46.31; 95% CI 3.52-Inf; p = 0.005), eye symptoms (OR 6.64; 95% CI 1.20-36.73; p = 0.03) and polyneuropathy (OR 10.05; 95% CI 3.09-32.64; p < 0.001) as the only factors associated with ATTRv in this population. Diagnosis of ATTRv in elderly ATTR-CM patients allowed initiation of transthyretin-specific drug treatment in 5 individuals, genetic screening in 33 relatives from 13 families, and identification of 9 ATTRv asymptomatic carriers. CONCLUSIONS Hereditary transthyretin amyloidosis is present in a substantial number of ATTR-CM patients aged ≥70 years. Identification of ATTRv in elderly patients with ATTR-CM has clinical meaningful therapeutic and diagnostic implications. These results support routine genetic testing in patients with ATTR-CM regardless of age.
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Affiliation(s)
- Alba Maestro-Benedicto
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain.,IIB Sant Pau, Barcelona, Spain.,Heart Failure and Transplant Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Vela
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Fernando de Frutos
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Nerea Mora
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Antonia Pomares
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Emiliano Gonzalez-Vioque
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Ana Briceño
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Eva Cabrera
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Marta Cobo-Marcos
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Javier Segovia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Enrique Lara-Pezzi
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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Martinez Rey-Ranal E, Cordero A, Moreno MJ, Bertomeu Gonzalez V, Moreno Arribas J, Pomares A, Torroba G, Bertomeu Martinez V. P1759Elevated NT-pro BNP predicts Heart Failure re-hospitalizations after an acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
NT pro-BNP is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF) and, also, with acute coronary syndrome (ACS). Nonetheless, there is scarce evidence on the predictive capacity of NT pro-BNP for HF re-admission after an ACS.
Objective
To test whether elevated values of NT pro-BNP can predict subsequent hospitalizations for HF in patients discharged after an ACS.
Methods
We performed a prospective study of all patients discharged after an ACS in a single center. HF re-admission was analysed by competing risk regression, taking all-cause mortality as a competing event, and results are presented as sub-Hazard Ratio (sHR); recurrent hospitalizations were tested by negative binomial regression and results are presented as incidence risk ratio (IRR).
Results
We included 1,679 patients, mean age 70.1 (29.7) year, 71.9% males, 41.4% STEMI and mean GRACE score 151.7 (44.4). Median NT pro-BNP was 948.2 pg/ml (IQ range 274.5–2923) and patients were divided in <300U (27.0%), 300–600 pg/ml (13.4%), 600–1000 pg/ml (10.8%) and >1000 pg/ml (46.7%) A total of 132 (5.9%) died within hospitalization and follow-up was available 98% of the patients, with a median follow-up of 33 months (IQ range 16–59). A total of 220 patients (13.1%) had at least one hospital re-admission of HF and 126 (7.5%) had more than one re-hospitalization for HF. Patients with NT pro-BNP had higher un-adjusted HF re-admissions (22.2% vs. 4.4%; p<0.01). Cardiovascular mortality increased significantly in each category of NT pro-BNP (3.8%; 8.0%; 7.7%; 18.5%) as well as all-cause mortality (0.1%; 12.4%; 11.6%; 25.3%), first HF readmission (2.7%; 7.1%; 5.5%; 23.5%); patients with NT pro-BNP had higher rates of recurrent HF readmissions: 11.6/1000 vs. 2.4/1000 patients/years (p<0.01). Multivariate analyses, adjusted by age, gender, GRACE score, left ventricle ejection fraction, revascularization and medical treatments at discharge, identified that NT pro-BNP >1000 pg/ml was associated to HF re-hospitalization (sHR: 2.60 95% CI 1.12–5.95) and recurrent hospitalizations (IRR: 1.10 95% CI 1.04–1.14).
Conclusions
NT pro-BNP >1000 pg/ml is an accurate risk factor for first and recurrent HF rehospitalisations after an ACS.
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Affiliation(s)
| | - A Cordero
- University Hospital of San Juan, Alicante, Spain
| | - M J Moreno
- University Hospital of San Juan, Alicante, Spain
| | | | | | - A Pomares
- University Hospital of San Juan, Alicante, Spain
| | - G Torroba
- University Hospital of San Juan, Alicante, Spain
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Cordero A, Bertomeu-González V, Moreno-Arribas J, Marco A, Sánchez A, Pomares A, Torroba G, Martínez Rey-Rañal E, Moreno MJ, Quiles J, Valero R, Bertomeu-Martínez V. Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rccl.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ribes F, Pomares A, Marco A, López-Palop R. Platypnea–orthodeoxia syndrome: a rare presentation of inferior vena cava thrombosis. Eur Heart J Case Rep 2019; 3:yty158. [PMID: 31020234 PMCID: PMC6439424 DOI: 10.1093/ehjcr/yty158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Francisco Ribes
- Department of Cardiology, Hospital Universitario San Juan, Alicante, Spain
| | - Antonia Pomares
- Department of Cardiology, Hospital Universitario San Juan, Alicante, Spain
| | - Antonio Marco
- Department of Cardiology, Hospital Universitario San Juan, Alicante, Spain
| | - Ramón López-Palop
- Department of Cardiology, Hospital Universitario San Juan, Alicante, Spain
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Viudes-de-Castro MP, Pomares A, Saenz de Juano I Ribes MD, Marco-Jiménez F, Vicente JS. Effect of luteinizing hormone on rabbit ovarian superstimulation and embryo developmental potential. Theriogenology 2015; 84:446-51. [PMID: 25930731 DOI: 10.1016/j.theriogenology.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/10/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
Assisted reproduction technologies require ovarian stimulation to increase the number of oocytes and embryos. Currently, superstimulation is achieved by gonadotropin treatment, but the embryo yield and quality are highly variable. Commonly, commercial preparations derived from pituitary and urinary origin are used to superovulate. Hence, ovarian superstimulation protocols have usually included both FSH and LH. The appearance of recombinant gonadotropins manufactured by genetic engineering techniques has ensured high quality and batch-to-batch consistency. Moreover, this enables us to assess the importance of LH in the ovarian stimulation. The main aim of this study was to evaluate the effect of recombinant human LH supplementation (10%) on embryonic development produced by rabbit does superovulated with low or high concentration (18.75 or 37.50 IU) of recombinant human FSH (rhFSH). Females treated with rhFSH increased the ovulation rate, and it was significantly higher when the high FSH dose was supplemented with LH. The superstimulation treatment used did not significantly affect in vitro development rate until the expanded blastocyst stage. The results of this study seem to suggest that, in terms of superovulatory response, when rabbit does are treated with 37.5-IU rhFSH, the use of LH supplementation allows an increase in the number of follicles recruited and the quality of embryos, in terms of ability to develop in vitro until blastocyst, and the expression profile of OCT4, NANOG, and SOX2 genes is not affected.
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Affiliation(s)
- M P Viudes-de-Castro
- Centro de Investigación y Tecnología Animal (CITA), Instituto Valenciano de Investigaciones Agrarias (IVIA), Castellón, Spain.
| | - A Pomares
- Instituto de Ciencia y Tecnología Animal, Universidad Politécnica de Valencia, Valencia, Spain
| | | | - F Marco-Jiménez
- Instituto de Ciencia y Tecnología Animal, Universidad Politécnica de Valencia, Valencia, Spain
| | - J S Vicente
- Instituto de Ciencia y Tecnología Animal, Universidad Politécnica de Valencia, Valencia, Spain
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Gil V, Pomares R, Pomares A, Alberola T, Belda J, Merino J. [Indicators of follow-up activities undertaken by an arterial hypertension unit over a 5 year period]. Aten Primaria 1993; 12:264-8. [PMID: 16977765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To assess the efficacy and effectiveness of an AHT programme by means of indicators which analyse the coverage, results and attendance. SETTING AHT unit at the Health Centre in Novelda, Alicante. DESIGN A quasi-experimental design of internal comparison with temporal series. The years analysed were 1985, '87, '88 and '90. The following were assessed: support, therapeutic compliance, risk level, weight, monitoring, visits per year, therapy, risk factors. PATIENTS A cohort of 266 hypertense patients (175 women and 91 men). MEASUREMENTS AND MAIN RESULTS The Unit significantly increased the number of patients being monitored and treated (WHO 46.7% and JNC 9.1%), but never exceeded 60%. Serious risk was eliminated and moderate risk went down (27.7%). Visits to the Centre were reduced by 2.8 per year. Of risk factors, weight did not go down, but hypercholesterolaemia diminished by 48.4%, hypertriglyceridaemia by 9.8%, hyperglycaemia by 4.4%, hyperuricaemia by 7.9% and tobacco addiction by 19.9%. CONCLUSIONS These figures contain extremely interesting information. They reveal the achievements and difficulties of clinical practice and point to practical strategies.
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Affiliation(s)
- V Gil
- Departamento de Medicina de la Universidad de Alicante, Unidad de Medicina Familiar y Comunitaria, Alicante
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