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Pérez-Belmonte LM, Gómez-Doblas JJ, Millán-Gómez M, López-Carmona MD, Guijarro-Merino R, Carrasco-Chinchilla F, de Teresa-Galván E, Jiménez-Navarro M, Bernal-López MR, Gómez-Huelgas R. Use of Linagliptin for the Management of Medicine Department Inpatients with Type 2 Diabetes in Real-World Clinical Practice (Lina-Real-World Study). J Clin Med 2018; 7:jcm7090271. [PMID: 30208631 PMCID: PMC6162816 DOI: 10.3390/jcm7090271] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 01/14/2023] Open
Abstract
The use of noninsulin antihyperglycaemic drugs in the hospital setting has not yet been fully described. This observational study compared the efficacy and safety of the standard basal-bolus insulin regimen versus a dipeptidyl peptidase-4 inhibitor (linagliptin) plus basal insulin in medicine department inpatients in real-world clinical practice. We retrospectively enrolled non-critically ill patients with type 2 diabetes with mild to moderate hyperglycaemia and no injectable treatments at home who were treated with a hospital antihyperglycaemic regimen (basal-bolus insulin, or linagliptin-basal insulin) between January 2016 and December 2017. Propensity score was used to match patients in both treatment groups and a comparative analysis was conducted to test the significance of differences between groups. After matched-pair analysis, 227 patients were included per group. No differences were shown between basal-bolus versus linagliptin-basal regimens for the mean daily blood glucose concentration after admission (standardized difference = 0.011), number of blood glucose readings between 100–140 mg/dL (standardized difference = 0.017) and >200 mg/dL (standardized difference = 0.021), or treatment failures (standardized difference = 0.011). Patients on basal-bolus insulin received higher total insulin doses and a higher daily number of injections (standardized differences = 0.298 and 0.301, respectively). Basal and supplemental rapid-acting insulin doses were similar (standardized differences = 0.003 and 0.012, respectively). There were no differences in hospital stay length (standardized difference = 0.003), hypoglycaemic events (standardized difference = 0.018), or hospital complications (standardized difference = 0.010) between groups. This study shows that in real-world clinical practice, the linagliptin-basal insulin regimen was as effective and safe as the standard basal-bolus regimen in non-critical patients with type 2 diabetes with mild to moderate hyperglycaemia treated at home without injectable therapies.
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Affiliation(s)
- Luis M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Juan J Gómez-Doblas
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Mercedes Millán-Gómez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - María D López-Carmona
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Ricardo Guijarro-Merino
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Fernando Carrasco-Chinchilla
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Eduardo de Teresa-Galván
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Manuel Jiménez-Navarro
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - M Rosa Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Cano-García M, Millán-Gómez M, Sánchez-González C, Alonso-Briales JH, Muñoz-Jiménez LD, Carrasco-Chinchilla F, Domínguez-Franco A, Muñoz-García AJ, Bullones-Ramírez JA, Álvarez-Rubiera JM, de Mora-Martín M, de Teresa-Galván E, Hernández-García JM, Urbano-Carrillo CA, Jiménez-Navarro MF. Impact of Percutaneous Coronary Revascularization of Severe Coronary Lesions on Secondary Branches. ACTA ACUST UNITED AC 2018; 72:456-465. [PMID: 29859894 DOI: 10.1016/j.rec.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/17/2017] [Accepted: 04/10/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. CONCLUSIONS The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.
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Affiliation(s)
- Macarena Cano-García
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mercedes Millán-Gómez
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Carlos Sánchez-González
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Juan H Alonso-Briales
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Luz D Muñoz-Jiménez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio Domínguez-Franco
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio J Muñoz-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Juan A Bullones-Ramírez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jesús M Álvarez-Rubiera
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel de Mora-Martín
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - José M Hernández-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Cristóbal A Urbano-Carrillo
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel F Jiménez-Navarro
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain.
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Rodríguez-Capitán J, Fernández-Meseguer A, Romero-González E, Calvo-Bonacho E, Gómez-Doblas JJ, de Teresa-Galván E. Frecuencia de fibrilación auricular en una amplia muestra de adultos jóvenes extraída de la población laboral española. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rodríguez-Capitán J, Fernández-Meseguer A, Romero-González E, Calvo-Bonacho E, Gómez-Doblas JJ, de Teresa-Galván E. Frequency of Atrial Fibrillation in a Large Sample of Young Adults Selected From the Spanish Working Population. Rev Esp Cardiol (Engl Ed) 2018; 71:498-500. [PMID: 28528888 DOI: 10.1016/j.rec.2017.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Eva Romero-González
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Eva Calvo-Bonacho
- Ibermutuamur, Mutua Colaboradora con la Seguridad Social, Madrid, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
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Becerra-Muñoz VM, Rodríguez-Capitán J, Sánchez-Espín G, Such-Martínez M, Gómez-Doblas JJ, de Teresa-Galván E. Outcomes After Surgical Treatment of Severe Tricuspid Regurgitation in a Contemporary Series. ACTA ACUST UNITED AC 2018; 72:178-180. [PMID: 29588136 DOI: 10.1016/j.rec.2017.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/19/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain.
| | - Jorge Rodríguez-Capitán
- Servicio de Medicina Interna, Hospital de Antequera, Área Sanitaria Norte de Málaga, Antequera, Málaga, Spain
| | - Gemma Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Miguel Such-Martínez
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
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Becerra-Muñoz VM, Gómez-Doblas JJ, Porras-Martín C, Such-Martínez M, Crespo-Leiro MG, Barriales-Villa R, de Teresa-Galván E, Jiménez-Navarro M, Cabrera-Bueno F. The importance of genotype-phenotype correlation in the clinical management of Marfan syndrome. Orphanet J Rare Dis 2018; 13:16. [PMID: 29357934 PMCID: PMC5778633 DOI: 10.1186/s13023-017-0754-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/29/2017] [Indexed: 01/16/2023] Open
Abstract
Background Marfan syndrome (MFS) is a disorder of autosomal dominant inheritance, in which aortic root dilation is the main cause of morbidity and mortality. Fibrillin-1 (FBN-1) gene mutations are found in more than 90% of MFS cases. The aim of our study was to summarise variants in FBN-1 and establish the genotype-phenotype correlation, with particular interest in the onset of aortic events, in a broad population of patients with an initial clinical suspicion of MFS. Material and methods This single centre prospective cohort study included all patients presenting variants in the FBN-1 gene who visited a Hereditary Aortopathy clinic between September 2010 and October 2016. Results The study included 90 patients with FBN-1 variants corresponding to 58 non-interrelated families. Of the 57 FBN-1 variants found, 25 (43.9%) had previously been described, 23 of which had been identified as associated with MFS, while the the remainder are described for the first time. For 84 patients (93.3%), it was possible to give a definite diagnosis of Marfan syndrome in accordance with Ghent criteria. 44 of them had missense mutations, 6 of whom had suffered an aortic event (with either prophylactic surgery for aneurysm or dissection), whereas 20 of the 35 patients with truncating mutations had suffered an event (13.6% vs. 57.1%, p < 0.001). These events tended to occur at earlier ages in patients with truncating compared to those with missense mutations, although not significantly (41.33 ± 3.77 vs. 37.5 ± 9.62 years, p = 0.162). Conclusions Patients with MFS and truncating variants in FBN-1 presented a higher proportion of aortic events, compared to a more benign course in patients with missense mutations. Genetic findings could, therefore, have importance not only in the diagnosis, but also in risk stratification and clinical management of patients with suspected MFS. Electronic supplementary material The online version of this article (10.1186/s13023-017-0754-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Carlos Porras-Martín
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Miguel Such-Martínez
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - María Generosa Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco. Servicio de Cardiología. CIBERCV. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS. Universidade da Coruña (UDC). As Xubias, 15006, A Coruña, Spain
| | - Roberto Barriales-Villa
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco. Servicio de Cardiología. CIBERCV. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS. Universidade da Coruña (UDC). As Xubias, 15006, A Coruña, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain.
| | - Fernando Cabrera-Bueno
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
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Jiménez-Navarro M, Pérez-Belmonte LM, Gómez-Doblas JJ, de Teresa-Galván E. Cardiovascular Disease and Gross Domestic Product in Spain: Correlation Analysis By Autonomous Community. Response to Related Letters. Rev Esp Cardiol (Engl Ed) 2017; 70:223. [PMID: 28131562 DOI: 10.1016/j.rec.2016.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Jiménez-Navarro
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, Spain.
| | - Luis M Pérez-Belmonte
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, Spain
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Becerra-Muñoz VM, Sobrino-Márquez JM, Rangel-Sousa D, Fernández-Cisnal A, Lage-Gallé E, García-Pinilla JM, Martínez-Martínez Á, de Teresa-Galván E. Long-term prognostic role of CA-125 in noncongestive patients undergoing a cardiac transplantation. Biomark Med 2017; 11:239-243. [PMID: 28156128 DOI: 10.2217/bmm-2016-0247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate the possible relationship between high levels of CA-125 and long-term prognosis in chronic heart failure patients after they undergo a cardiac transplantation (CT). MATERIALS & METHODS We retrospectively studied all patients who underwent a CT and had a previous determination of CA-125. Congestive patients and those whose survival was <1 year after CT were excluded. RESULTS Of 55 patients, 23 had elevated CA-125 levels (>35 U/ml). After CT, survival was significantly inferior in this group (96.3 vs 81%, 84.9 vs 64%, 70.7 vs 32.9% at 2, 5 and 8 years, p = 0.014). CA-125 >35 U/ml was the only factor independently associated to long-term mortality (OR: 3.94; 95% CI: 1.2-12.82; p = 0.023). CONCLUSION Noncongestive patients with high levels of CA-125 had inferior long-term survival after CT.
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Affiliation(s)
- Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - José Manuel Sobrino-Márquez
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Diego Rangel-Sousa
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ernesto Lage-Gallé
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Manuel García-Pinilla
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | | | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
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9
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Pérez-Belmonte LM, Moreno-Santos I, Gómez-Doblas JJ, García-Pinilla JM, Morcillo-Hidalgo L, Garrido-Sánchez L, Santiago-Fernández C, Crespo-Leiro MG, Carrasco-Chinchilla F, Sánchez-Fernández PL, de Teresa-Galván E, Jiménez-Navarro M. Expression of epicardial adipose tissue thermogenic genes in patients with reduced and preserved ejection fraction heart failure. Int J Med Sci 2017; 14:891-895. [PMID: 28824327 PMCID: PMC5562197 DOI: 10.7150/ijms.19854] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/25/2017] [Indexed: 12/02/2022] Open
Abstract
Epicardial adipose tissue has been proposed to participate in the pathogenesis of heart failure. The aim of our study was to assess the expression of thermogenic genes (Uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), and PR-domain-missing 16 (PRDM16) in epicardial adipose tissue in patients with heart failure, stablishing the difference according to left ventricular ejection fraction (reduced or preserved). Among the 75 patients in our study, 42.7% (n=32) had reduced left ventricular ejection fraction. UCP1, PGC1α and PRDM16 mRNA in EAT were significantly lower in patients with reduced left ventricular ejection fraction. Multiple regression analysis showed that age, male gender, body max index, presence of obesity, type-2-diabetes mellitus, hypertension and coronary artery disease and left ventricular ejection fraction were associated with the expression levels of UCP1, PGC1α and PRDM16 mRNA. Thermogenic genes expressions in epicardial adipose tissue (UCP1: OR 0.617, 95%CI 0.103-0.989, p=0.042; PGC1α: OR 0.416, 95%CI 0.171-0.912, p=0.031; PRDM16: OR 0.643, 95%CI 0.116-0.997, p=0.044) were showed as protective factors against the presence of heart failure with reduced left ventricular ejection fraction, and age (OR 1.643, 95%CI 1.001-3.143, p=0.026), presence of coronary artery disease (OR 6.743, 95%CI 1.932-15.301, p<0.001) and type-2-diabetes mellitus (OR 4.031, 95%CI 1.099-7.231, p<0.001) were associated as risk factors. The adequate expression of thermogenic genes has been shown as possible protective factors against heart failure with reduced ejection fraction, suggesting that a loss of functional epicardial adipose tissue brown-like features would participate in a deleterious manner on heart metabolism. Thermogenic genes could represent a future novel therapeutic target in heart failure.
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Affiliation(s)
- Luis M Pérez-Belmonte
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Inmaculada Moreno-Santos
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Juan J Gómez-Doblas
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - José M García-Pinilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Luis Morcillo-Hidalgo
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Lourdes Garrido-Sánchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain
| | - Concepción Santiago-Fernández
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Instituto de Investigación Biomédica A Coruña (INIBIC), Complejo Hospitalario Universitario A Coruña, CIBERCV Enfermedades Cardiovasculares, A Coruña. Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Pedro L Sánchez-Fernández
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBISAL), Hospital Universitario de Salamanca, Universidad de Salamanca (USAL), CIBERCV Enfermedades Cardiovasculares, Salamanca, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
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10
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Pérez-Belmonte LM, Moreno-Santos I, Cabrera-Bueno F, Sánchez-Espín G, Castellano D, Such M, Crespo-Leiro MG, Carrasco-Chinchilla F, Alonso-Pulpón L, López-Garrido M, Ruiz-Salas A, Becerra-Muñoz VM, Gómez-Doblas JJ, de Teresa-Galván E, Jiménez-Navarro M. Expression of Sterol Regulatory Element-Binding Proteins in epicardial adipose tissue in patients with coronary artery disease and diabetes mellitus: preliminary study. Int J Med Sci 2017; 14:268-274. [PMID: 28367087 PMCID: PMC5370289 DOI: 10.7150/ijms.17821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022] Open
Abstract
Objectives: Sterol regulatory element-binding proteins (SREBP) genes are crucial in lipid biosynthesis and cardiovascular homeostasis. Their expression in epicardial adipose tissue (EAT) and their influence in the development of coronary artery disease (CAD) and type-2 diabetes mellitus remain to be determined. The aim of our study was to evaluate the expression of SREBP genes in EAT in patients with CAD according to diabetes status and its association with clinical and biochemical data. Methods: SREBP-1 and SREBP-2 mRNA expression levels were measured in EAT from 49 patients with CAD (26 with diabetes) and 23 controls without CAD or diabetes. Results: Both SREBPs mRNA expression were significantly higher in patients with CAD and diabetes (p<0.001) and were identified as independent cardiovascular risk factor for coronary artery disease in patients with type-2 diabetes (SREBP-1: OR 1.7, 95%CI 1.1-2.5, p=0.02; SREBP-2: OR 1.6, 95%CI 1.2-3, p=0.02) and were independently associated with the presence of multivessel CAD, left main and anterior descending artery stenosis, and higher total and LDL cholesterol levels, and lower HDL cholesterol levels, in patients with CAD and diabetes. Conclusions: SREBP genes are expressed in EAT and were higher in CAD patients with diabetes than those patients without CAD or diabetes. SREBP expression was associated as cardiovascular risk factor for the severity of CAD and the poor lipid control. In this preliminary study we suggest the importance of EAT in the lipid metabolism and cardiovascular homeostasis for coronary atherosclerosis of patients with diabetes and highlight a future novel therapeutic target.
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Affiliation(s)
- Luis M Pérez-Belmonte
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Inmaculada Moreno-Santos
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Fernando Cabrera-Bueno
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Gemma Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Daniel Castellano
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Laboratorio del Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario de Málaga (Virgen de la Victoria), Málaga, Spain. CIBER Pathophysiology of obesity and nutrition, Spain
| | - Miguel Such
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña (INIBIC), CIBERCV Enfermedades Cardiovasculares, A Coruña. Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Luis Alonso-Pulpón
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, CIBERCV Enfermedades Cardiovasculares, Madrid, Spain
| | - Miguel López-Garrido
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Amalio Ruiz-Salas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Víctor M Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Juan J Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
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11
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Becerra-Muñoz VM, Ruíz-Morales J, Rodríguez-Bailón I, Sánchez-Espín G, López-Garrido MA, Robledo-Carmona J, Guijarro-Contreras A, García-López MV, Ivanova-Georgieva R, Mora-Navas L, Gómez-Doblas JJ, de Teresa-Galván E. Infective endocarditis in patients with bicuspid aortic valve: Clinical characteristics, complications, and prognosis. Enferm Infecc Microbiol Clin 2016; 35:645-650. [PMID: 27493083 DOI: 10.1016/j.eimc.2016.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE). METHODS Retrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV). RESULTS Of a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38-26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048). CONCLUSIONS Patients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher.
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Affiliation(s)
- Víctor M Becerra-Muñoz
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
| | - Josefa Ruíz-Morales
- UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Isabel Rodríguez-Bailón
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Gemma Sánchez-Espín
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Miguel A López-Garrido
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Juan Robledo-Carmona
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Ana Guijarro-Contreras
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - María Victoria García-López
- UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Rada Ivanova-Georgieva
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Laura Mora-Navas
- UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Juan José Gómez-Doblas
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Eduardo de Teresa-Galván
- UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España
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12
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Jerez-Valero M, Meliveo-García A, Jordán-Martínez L, Carrasco-Chinchilla F, Moreno-Santos I, Ordóñez A, Sánchez-Fernández PL, Vázquez R, Hernández-García JM, Gómez-Doblas JJ, Pérez-Belmonte LM, de Teresa-Galván E, Jiménez-Navarro M. [Role of serum leptin in the severity of coronary artery disease in patients with stable angina]. Med Clin (Barc) 2016; 147:7-12. [PMID: 27197882 DOI: 10.1016/j.medcli.2016.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/30/2016] [Revised: 03/18/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease. PATIENTS AND METHODS 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay. RESULTS Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03-1.27; p=0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01-1.25; p=0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765-0.7657). CONCLUSIONS Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target.
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Affiliation(s)
- Miguel Jerez-Valero
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Ana Meliveo-García
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Laura Jordán-Martínez
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Inmaculada Moreno-Santos
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Antonio Ordóñez
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla (US), Red de Investigación Cardiovascular (RIC), Sevilla, España
| | - Pedro L Sánchez-Fernández
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBISAL), Universidad de Salamanca (USAL), Red de Investigación Cardiovascular (RIC), Salamanca, España
| | - Rafael Vázquez
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Puerta del Mar, Cádiz, Universidad de Cádiz (UCA), Red de Investigación Cardiovascular (RIC), Cádiz, España
| | - José M Hernández-García
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Juan J Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Luis M Pérez-Belmonte
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España.
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
| | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Red de Investigación Cardiovascular (RIC), Málaga, España
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13
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Rodríguez-Capitán J, García-Pinilla JM, Ruiz-Zamora I, Rueda-Calle E, Morcillo-Hidalgo L, Jurado-Canca C, Robledo-Carmona J, Gómez-Doblas JJ, de Teresa-Galván E. Reply to the letter "Prognostic value of late gadolinium enhancement in cardiomyopathy: Causative risk factor or surrogate marker?". Int J Cardiol 2014; 181:102-3. [PMID: 25497528 DOI: 10.1016/j.ijcard.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Jorge Rodríguez-Capitán
- Sección de Cardiología, Unidad de Medicina Interna, Hospital de Poniente, Carretera de Almerimar s/n, 04700 El Ejido, Almería, Spain.
| | - José Manuel García-Pinilla
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Isabel Ruiz-Zamora
- Sección de Cardiología, Unidad de Medicina Interna, Fundación Hospital Calahorra, Carretera de Logroño s/n, 26500 Calahorra, La Rioja, Spain
| | - Eloy Rueda-Calle
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Morcillo-Hidalgo
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Carmen Jurado-Canca
- Unidad de Cardiología, Hospital Parque San Antonio, Avenida Pintor Joaquín Sorolla n°2, 29016, Málaga, Spain
| | - Juan Robledo-Carmona
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Juan José Gómez-Doblas
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Eduardo de Teresa-Galván
- Área del Corazón, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
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Muñoz-García AJ, Muñoz-García E, Jiménez-Navarro MF, Domínguez-Franco AJ, Alonso-Briales JH, Hernández-García JM, de Teresa-Galván E. Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis. J Cardiol 2014; 66:46-9. [PMID: 25454207 DOI: 10.1016/j.jjcc.2014.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 06/26/2014] [Revised: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after cardiac surgery is associated with increased mortality, but few data exist on the occurrence and clinical impact of AKI associated with transcatheter aortic valve implantation (TAVI). The objective of this study was to determine the incidence and prognosis of AKI after percutaneous implantation of the CoreValve(®) (Medtronic, Minneapolis, MN, USA) prosthesis. METHODS A total of 357 patients with severe aortic stenosis and 9 patients with pure native aortic regurgitation were treated with the CoreValve prosthesis. AKI was defined according to Valve Academic Research Consortium criteria as the absolute increase in serum creatinine ≥0.3mg/dl at 72h post percutaneous procedure. RESULTS AKI was identified in 58 patients (15.8%), none of whom required renal replacement therapy. In patients with AKI, the mortality at 30 days was 13.5% compared with 1.6% of patients without AKI, [odds ratio (OR)=12.2 (95% CI 3.53-41.9); p<0.001] and total mortality after a mean of 26.2±17 months was 29.3% vs. 14.9% [OR=2.36 (95% CI 1.23-4.51), p=0.008]. In the multivariate analysis, AKI was an independent predictor of cumulative total mortality [hazard ratio=2.151, (95% CI from 1.169 to 3.957), p=0.014]. CONCLUSIONS The deterioration of renal function in patients undergoing TAVI with the CoreValve prosthesis is a serious and frequent complication. The occurrence of AKI was associated with increased early mortality and was also a predictor of worse outcomes in follow-up.
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Affiliation(s)
- Antonio J Muñoz-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain.
| | - Erika Muñoz-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Manuel F Jiménez-Navarro
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Antonio J Domínguez-Franco
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Juan H Alonso-Briales
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - José M Hernández-García
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
| | - Eduardo de Teresa-Galván
- Department of Cardiology, Instituto de Biomedicina de Málaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Málaga, University of Málaga, Spain
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Rodríguez-Capitán J, García-Pinilla JM, Ruiz-Zamora I, Rueda-Calle E, Morcillo-Hidalgo L, Jurado-Canca C, Robledo-Carmona J, Gómez-Doblas JJ, de Teresa-Galván E. Long-term prognostic value of late gadolinium enhancement in a cohort of patients with nonischemic dilated cardiomyopathy. Int J Cardiol 2014; 177:17-9. [DOI: 10.1016/j.ijcard.2014.09.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
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16
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Losada-Mora P, Sánchez-Espín G, Mataró MJ, Algarra J, Jiménez-Navarro M, de Teresa-Galván E. Permeabilidad a medio-largo plazo de los injertos arteriales compuestos en cirugía cardíaca de revascularización miocárdica. Cirugía Cardiovascular 2014. [DOI: 10.1016/j.circv.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Isasti G, García-Pinilla JM, Jiménez-Navarro MF, Gómez-Doblas JJ, Cabrera-Bueno F, Rodríguez-Losada N, Robledo-Carmona J, de Teresa-Galván E. Elevation of circulating progenitor cells in patients with acute myocarditis. Int J Cardiol 2014; 172:608-9. [PMID: 24485612 DOI: 10.1016/j.ijcard.2014.01.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Guillermo Isasti
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
| | - José Manuel García-Pinilla
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
| | - Manuel F Jiménez-Navarro
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain.
| | - Juan José Gómez-Doblas
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
| | - Fernando Cabrera-Bueno
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
| | - Noela Rodríguez-Losada
- Laboratorio de Medicina Regenerativa, Instituto de Biomedicina de Málaga (IBIMA), Hospital Regional Carlos Haya, Avda. Carlos Haya s/n, Málaga, Spain
| | - Juan Robledo-Carmona
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
| | - Eduardo de Teresa-Galván
- UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga, Spain
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Jiménez-Navarro MF, Fernández-Pastor J, Garrido-Sánchez L, Molina-Mora MJ, Ortiz-García C, Alonso-Briales JH, Pérez-Cabeza A, Hernández-García JM, de Teresa-Galván E, Tinahones FJ. Newly impaired glucose metabolism and prognosis after percutaneous revascularization. Cardiol J 2014; 22:44-51. [PMID: 24671899 DOI: 10.5603/cj.a2014.0024] [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] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/24/2014] [Accepted: 02/23/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information. METHODS We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose < 7 mmol/L. RESULTS Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022). CONCLUSIONS Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.
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Affiliation(s)
- Manuel F Jiménez-Navarro
- Unidad de Gestion Clinica del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, University of Malaga, Malaga, Spain, Red de Investigación Cardiovascular (RIC); 2Medicine Department, School of Medicine, University of Malaga, Spain.
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Carrasco-Chinchilla F, Sánchez-Espín G, Ruiz-Morales J, Rodríguez-Bailón I, Melero-Tejedor JM, Ivanova-Georgieva R, García-López V, Muñoz-García A, Gómez-Doblas JJ, de Teresa-Galván E. Influence of a multidisciplinary alert strategy on mortality due to left-sided infective endocarditis. ACTA ACUST UNITED AC 2014; 67:380-6. [PMID: 24774731 DOI: 10.1016/j.rec.2013.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 07/08/2013] [Accepted: 09/16/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Mortality from left-sided infective endocarditis remains very high. The aim of this study was to assess the impact of a multidisciplinary alert strategy (AMULTEI), based on clinical, echocardiographic and microbiological findings, implemented in 2008 in a tertiary hospital. METHODS Cohort study comparing our historical data series (1996-2007) with the number of patients diagnosed with left-sided endocarditis from 2008-2011 (AMULTEI). RESULTS The AMULTEI cohort included 72 patients who were compared with 155 patients in the historical cohort. AMULTEI patients were significantly older (62.5 vs 57.9 years in the historical cohort; P=.047) and had higher comorbidity (Charlson index, 3.33 vs 2.58 in the historical cohort; P=.023). There was also a trend toward more enterococcal etiology in the AMULTEI group (20.8% vs 11.6% in the historical cohort; P=.067). In the AMULTEI group, early surgery was more frequently performed (48.6% vs 23.2%; P<.001) during hospitalization, the incidence of septic shock was significantly lower (9.7% vs 24.5%; P=.009) and there was a trend toward reductions in neurological complications (19.4% vs 29.0%; P=.25) and severe heart failure (12.5% vs 18.7%; P=.24). In-hospital mortality and mortality during the first month of follow-up were significantly lower in the AMULTEI group (16.7% vs 36.1%; P=.003). CONCLUSIONS Despite the trend toward older age and more comorbidity measured by the Charlson index, early mortality was significantly lower in patients treated with the AMULTEI strategy.
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Affiliation(s)
| | - Gemma Sánchez-Espín
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Josefa Ruiz-Morales
- Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Spain
| | | | - Jose M Melero-Tejedor
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Victoria García-López
- Unidad de Microbiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Muñoz-García
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan J Gómez-Doblas
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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20
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Carrasco-Chinchilla F, Muñoz-García AJ, Domínguez-Franco A, Millán-Vázquez G, Guerrero-Molina A, Ortiz-García C, Enguix-Armada A, Alonso-Briales JH, Hernández-García JM, de Teresa-Galván E, Jiménez-Navarro MF. Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial. Heart 2013; 99:1431-7. [PMID: 23850844 DOI: 10.1136/heartjnl-2013-304172] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 12/20/2022] Open
Abstract
OBJECTIVE Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI). DESIGN Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008). SETTING Tertiary hospital centre. PATIENTS 232 patients underwent elective PCI for stable or unstable angina. INTERVENTIONS Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo. MAIN OUTCOME MEASURES The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1 year of follow-up. The use of RIP in diabetic patients was specifically studied. RESULTS The mean age was 64.6 years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478 ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907). CONCLUSIONS RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.
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Affiliation(s)
- Fernando Carrasco-Chinchilla
- Área del Corazón del Hospital Clínico Universitario Virgen de la Victoria, Fundación IMABIS, RECAVA, Málaga, Spain
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Muñoz-García AJ, Muñoz-García M, Carrasco-Chinchilla F, Molina-Mora MJ, Rodríguez-Bailón I, Domínguez-Franco AJ, Jiménez-Navarro MF, Alonso-Briales JH, Gómez-Doblas JJ, Hernández-García JM, de Teresa-Galván E. Incidence and clinical outcome of prosthesis-patient mismatch after transcatheter aortic valve implantation with the CoreValve prosthesis. Int J Cardiol 2012; 167:1074-6. [PMID: 23164585 DOI: 10.1016/j.ijcard.2012.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/28/2012] [Indexed: 11/27/2022]
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22
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Jiménez-Navarro MF, Gómez-Doblas JJ, Hernández-García JM, de Teresa-Galván E. Health care research unit: a challenging environment for a new context? Rev Esp Cardiol 2012; 66:74. [PMID: 22989619 DOI: 10.1016/j.recesp.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/19/2022]
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Rodríguez-Bailón I, Carrasco-Chinchilla F, Ruiz-Salas A, Melero-Tejedor JM, Sánchez-Espín G, Ruiz-Morales J, de Teresa-Galván E. Right atrium vegetation in prosthetic aortic endocarditis. Int J Cardiol 2012; 156:335-6. [DOI: 10.1016/j.ijcard.2012.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/30/2012] [Accepted: 02/05/2012] [Indexed: 10/28/2022]
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Muñoz-García AJ, Hernández-García JM, Jiménez-Navarro MF, Alonso-Briales JH, Domínguez-Franco AJ, Fernández-Pastor J, Peña Hernández J, Barrera Cordero A, Alzueta Rodríguez J, de Teresa-Galván E. Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System. JACC Cardiovasc Interv 2012; 5:533-539. [DOI: 10.1016/j.jcin.2012.03.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Muñoz-García AJ, Hernández-García JM, Jiménez-Navarro MF, Alonso-Briales JH, Domínguez-Franco AJ, Rodríguez-Bailón I, Molina-Mora MJ, Hernández-Rodríguez P, Such-Martínez M, de Teresa-Galván E. Survival and predictive factors of mortality after 30 days in patients treated with percutaneous implantation of the CoreValve aortic prosthesis. Am Heart J 2012; 163:288-94. [PMID: 22305849 DOI: 10.1016/j.ahj.2011.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 11/17/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few data exist on the clinical impact of transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis and a high surgical risk. The aim of this study was to determine the survival and the factors predicting mortality after 30 days post-TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN). METHODS From April 2008 to October 2010, the CoreValve prosthesis (Medtronic) was implanted in 133 consecutive high-risk surgical patients with symptomatic severe aortic stenosis. RESULTS The mean age was 79.5 ± 6.7 years. The logistic European System for Cardiac Operative Risk Evaluation was 21.5% ± 14%. The implantation success rate was 97.7%. In-hospital mortality was 4.5%, and the combined end point of death, vascular complications, myocardial infarction, or stroke had a rate of 9%. Survival at 12 and 24 months was 84.5% and 79%, respectively, after a mean follow-up of 11.3 ± 8 months. The New York Heart Association functional class improved from 3.3 ± 0.5 to 1.18 ± 0.4 and remained stable at 1 year. A high Charlson index (hazard ratio [HR] 1.44, 95% CI 1.09-1.89, P < .01) and a worse Karnofsky score before the procedure (HR 0.95, 95% CI 0.92-0.99, P = .021) were predictors of mortality after 30 days. CONCLUSIONS Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient.
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Affiliation(s)
- Antonio J Muñoz-García
- Department of Cardiology, Virgen de la Victoria Clinical University Hospital, Málaga, Spain.
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Muñoz-García AJ, Alonso-Briales JH, Jiménez-Navarro MF, Caballero-Borrego J, Domínguez-Franco AJ, Rodríguez-Bailón I, Such-Martínez M, Hernández-García JM, de Teresa-Galván E. Mechanisms, treatment and course of paravalvular aortic regurgitation after percutaneous implantation of the CoreValve aortic prosthesis. Int J Cardiol 2011; 149:389-92. [DOI: 10.1016/j.ijcard.2011.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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Rodríguez-Bailón I, Jiménez-Navarro MF, Pérez-González R, García-Orta R, Morillo-Velarde E, de Teresa-Galván E. Left ventricular deformation and two-dimensional echocardiography: temporal and other parameter values in normal subjects. Rev Esp Cardiol 2011; 63:1195-9. [PMID: 20875360 DOI: 10.1016/s1885-5857(10)70234-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Segmental contractility can be assessed quantitatively by analyzing deformation, or strain, and the rate of deformation, or the strain rate. This type of analysis can be performed using either tissue Doppler imaging or, more recently, two-dimensional speckle-tracking echocardiography. The aim of this study was to determine typical parameter values in healthy subjects and their reproducibility. The study involved 105 healthy individuals, including 55 women (52.45%). Their mean age was 38.8 ± 9.5 years (range, 20-59 years). All underwent speckle-tracking echocardiography with velocity vector imaging. Mean values for the strain and strain rate for each segment as well as for the time-to-peak normalized by the length of the cycle (TPN) were obtained. The resulting mean values were: circumferential strain, 22.2 ± 4.81% with a TPN of 0.39 ± 0.06; longitudinal strain, 19.84 ± 4.59% with a TPN of 0.42 ± 0.06; circumferential strain rate, 1.64 ± 0.48 1/s with a TPN of 0.23 ± 0.06; and longitudinal strain rate, 1.3 ± 0.49 1/s with a TPN of 0.21 ± 0.09. Intra- and inter-observer variability were moderate in magnitude.
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Muñoz-García AJ, Rodríguez-Bailón I, Briales JHA, Navarro MJ, García JMH, de Teresa-Galván E. Aorto-right ventricular fistula after percutaneous aortic valve implantation of a CoreValve prosthesis. Tex Heart Inst J 2011; 38:728-729. [PMID: 22199450 PMCID: PMC3233346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Antonio J Muñoz-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain.
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Jiménez-Navarro MF, Muñoz-García AJ, Cabrera-Bueno F, de Teresa-Galván E. Disparity between best scientific evidence and cardiovascular events. Rev Esp Cardiol 2010; 63:1214-1216. [PMID: 20875367 DOI: 10.1016/s1885-5857(10)70241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Jiménez-Navarro MF, Muñoz-García AJ, Cabrera-Bueno F, de Teresa-Galván E. Disparidad entre la mejor evidencia científica y los eventos cardiovasculares. Rev Esp Cardiol (Engl Ed) 2010. [DOI: 10.1016/s0300-8932(10)70259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodríguez-Bailón I, Jiménez-Navarro MF, Pérez-González R, García-Orta R, Morillo-Velarde E, de Teresa-Galván E. Deformación ventricular izquierda en ecocardiografía bidimensional: valores y tiempos en sujetos normales. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70252-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Aleixandre-Benavent R, Alonso-Arroyo A, Chorro-Gascó FJ, Alfonso-Manterola F, González-Alcaide G, Salvador-Taboada MJ, Bolaños-Pizarro M, de Sá y Areses EL, Valderrama-Zurián JC, Barón-Esquivias G, Plaza-Celemín L, de Teresa-Galván E, Macaya-Miguel C, Pulpón-Rivera LA, Anguita-Sánchez M, Pérez-Villacastín J, Escosa-Royo L, Martin-Burrieza F. Cardiovascular scientific production in Spain and in the European and global context (2003-2007). Rev Esp Cardiol 2009; 62:1404-17. [PMID: 20038407 DOI: 10.1016/s1885-5857(09)73535-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES The publication of research articles has increased considerably in recent years in all biomedical fields. The present study examines the position of Spanish quality research in cardiology in the European and world context, and its evolution during the 5-year period 2003-2007. METHODS Using the Science Citation Index Expanded of Thomson Reuters as data source, we compared Spanish cardiovascular scientific production with that of the rest of countries in the European Union and of the most important countries worldwide, along with relative productivity as per number of inhabitants and Gross Domestic Product, and the number of citations in the journals of the <<Cardiac and Cardiovascular Systems>> area of the Journal Citation Reports (CCS-JCR). RESULTS Spain ranks sixth in the European Union and ninth worldwide in scientific production (tenth worldwide if only the journals of the first quartile of the CCS-JCR area are considered). As regards the number of citations received, Spain ranks seventh in the European Union and eleventh worldwide. In terms of relative productivity as per number of inhabitants and Gross Domestic Product, the Spanish ranking is less favorable (positions 15 and 18, respectively). CONCLUSIONS The ranking of Spanish cardiovascular research is similar to that of other biomedical fields, though its position is less favorable in relation to certain demographic and economical indicators. In order to maintain adequate investigational levels, it is necessary for the European governments and scientific societies to regard the promotion of high-quality cardiological research as a priority concern.
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Molina-Mora MJ, Cabrera-Bueno F, Jiménez-Navarro M, Linde-Estrella A, García-Pinilla JM, Teresa-Galván ED. [Prognostic value of B-type natriuretic peptide in unstable angina and non-ST-elevation myocardial infarction]. Med Clin (Barc) 2009; 133:569-73. [PMID: 19783260 DOI: 10.1016/j.medcli.2009.04.057] [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] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The B-type natriuretic peptide (BNP) has recently emerged as a prognostic marker in acute coronary syndromes (ACS). This role is based on results from randomized trials and other high selected population studies. The aim of this study was to determine the prognostic value of BNP in unselected patients with non-ST-elevated-ACS. PATIENTS AND METHOD BNP plasma concentrations were measured in 100 consecutive patients admitted in 2007 with non-ST-elevated-ACS, taking as cut-off value 80pg/ml (high BNP levels on 48% of patients). RESULTS After one year-of follow-up, 21 major adverse cardiovascular events occurred: 12 ACS, 7 hospitalizations for heart failure and 2 sudden cardiac deaths. No relationship was found between BNP levels and events on follow-up. BNP >80pg/ml was the only independent predictor of heart failure and death. No relationship was found between high levels of BNP and coronary events during the follow-up. CONCLUSIONS BNP was an independent predictor of heart failure and mortality in unselected patients with non-ST-elevated-ACS.
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Domínguez-Franco AJ, Jiménez-Navarro MF, Hernández-García JM, Alonso-Briales JH, Linde-Estrella AL, Pérez-González O, Leruite-Martín I, Olalla-Mercadé E, de Teresa-Galván E. Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis. Rev Esp Cardiol 2009; 62:491-500. [PMID: 19406063 DOI: 10.1016/s1885-5857(09)71831-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. METHODS This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (> or =2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years. RESULTS Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P< .01), but no more often had a depressed left ventricular ejection fraction < or =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P< .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P< .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). CONCLUSIONS In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke.
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Domínguez-Franco AJ, Jiménez-Navarro MF, Hernández-García JM, Alonso-Briales JH, Linde-Estrella AL, Pérez-González O, Leruite-Martín I, Olalla-Mercadé E, de Teresa-Galván E. Comparación de los resultados clínicos a medio plazo de los stents farmacoactivos frente a la cirugía de revascularización coronaria en una población no seleccionada de pacientes diabéticos con afección multivaso. Análisis mediante propensity score. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71029-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alonso-Briales JH, Muñoz-García AJ, Jiménez-Navarro MF, Domínguez-Franco AJ, Melero-Tejedor JM, Rodríguez-Bailón I, Hernández-García JM, de Teresa-Galván E. Closure of perivalvular leaks using an Amplatzer occluder. Rev Esp Cardiol 2009; 62:442-6. [PMID: 19401130 DOI: 10.1016/s1885-5857(09)71672-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reoperation of patients with perivalvular leaks due to heart failure or hemolysis is associated with increased morbidity and mortality. Percutaneous closure using an Amplatzer device offers a promising alternative. We describe our initial experience between 2004 and 2006, during which we used an Amplatzer device in eight patients for the percutaneous closure of perivalvular leaks (four aortic and four mitral). The patients were all symptomatic and had a high surgical risk. Device placement was successful in all patients with mitral leaks and in three with aortic leaks. There were no periprocedural complications. With four of the seven (57%) device placements, there was a significant reduction in the degree of regurgitation and, at 12-month follow-up, only these four patients showed clinical improvements. Of the other three, one required reoperation and two died of non-cardiovascular causes. Percutaneous closure of perivalvular leaks was feasible and safe and can be regarded as a treatment option in patients with a high surgical risk.
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Affiliation(s)
- Juan H Alonso-Briales
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Jiménez-Navarro MF, Cabrera-Bueno F, Muñoz-García AJ, de Teresa-Galván E. Ensayos clínicos y práctica clínica en el «mundo real». ¿Conocemos los factores de confusión entre la eficacia y la efectividad? Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)70384-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jiménez-Navarro MF, Cabrera-Bueno F, Muñoz-García AJ, de Teresa-Galván E. Clinical trials and clinical practice in the real world. Do we know why efficacy is confused with effectiveness? Rev Esp Cardiol 2009; 62:332-334. [PMID: 19268084 DOI: 10.1016/s1885-5857(09)71570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Cabrera-Bueno FJ, Gómez-Doblas JJ, Garcia-Pinilla JM, Montiel-Trujillo A, Jiménez-Navarro M, Martinez-del-Valle D, Jiménez-Hoyuela JM, de Teresa-Galván E. Dobutamine Stress Echocardiography Identifies Patients with Angina and Dynamic Left Ventricular Outflow Obstruction in Physiological Exercise. Echocardiography 2009; 26:272-80. [DOI: 10.1111/j.1540-8175.2008.00808.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Caballero-Borrego J, Gómez-Doblas JJ, Valencia-Serrano FM, Cabrera-Bueno F, Rodríguez-Bailón I, Sánchez-Espín G, Such M, Orrit J, Porras C, Melero JM, Olalla-Mercadé E, de Teresa-Galván E. [Influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis]. Rev Esp Cardiol 2009; 62:31-38. [PMID: 19150012] [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: 05/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis. METHODS This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007. RESULTS Women (44% of patients) were older than men (70.3+/-7.9 years vs. 66.8+/-9.8 years; P< .001), had a smaller body surface area (1.68+/-0.15 m(2) vs. 1.83+/-0.16 m(2); P< .001), more often had arterial hypertension (73% vs. 49%; P< .001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P< .001), and less often had coronary artery disease (19.1% vs. 31.8%; P< .001) and severe ventricular dysfunction (7.9% vs. 17.4%; P< .001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119). CONCLUSIONS Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality.
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Montiel-Trujillo A, Rodríguez-Bailón I, Alonso-Briales JH, de Teresa-Galván E. [The pressure recovery phenomenon in an interventricular septal defect with a high pressure gradient]. Rev Esp Cardiol 2008; 61:783-784. [PMID: 18590657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Montiel-Trujillo Á, Rodríguez-Bailón I, Alonso-Briales JH, de Teresa-Galván E. Comunicación interventricular con gradiente elevado y fenómeno de recuperación de presiones. Rev Esp Cardiol 2008. [DOI: 10.1157/13124005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cabrera-Bueno F, Peña-Hernández J, Fernández-Pastor J, Barrera-Cordero A, García-Pinilla JM, Gómez-Doblas JJ, Alzueta-Rodríguez J, de Teresa-Galván E. [Benefits of cardiac resynchronization therapy in patients with atrial fibrillation who have not undergone atrioventricular node ablation]. Rev Esp Cardiol 2008; 61:422-425. [PMID: 18405524] [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: 05/26/2023]
Abstract
The aim of this study was to compare the effects of cardiac resynchronization therapy on left ventricular function and reverse remodeling in patients in sinus rhythm with the effects in patients with atrial fibrillation who have not undergone atrioventricular node ablation. Echocardiographic and clinical parameters were evaluated at baseline and after 6 months of cardiac resynchronization therapy in 55 patients: 15 had atrial fibrillation and 40 were in sinus rhythm. Device programming was similar in the 2 groups, as were the reductions in QRS interval and echocardiographic measures of asynchrony observed after implantation. However, although significant improvements in end-systolic volume and ejection fraction were seen in both groups, reverse remodeling was greater in patients in sinus rhythm (reduction in end-systolic volume 30.9%+/-24.6% vs 12.5%+/-18.6%; P=.024), as was the relative increase in ejection fraction (15.4%+/-12.6% vs 5.0%+/-7.2%; P=.010). Cardiac resynchronization therapy in patients with atrial fibrillation who had not undergone atrioventricular node ablation resulted in significant improvements in ejection fraction and reverse remodeling, but these were less than those observed in patients in sinus rhythm.
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Cabrera-Bueno F, Peña-Hernández J, Fernández-Pastor J, Barrera-Cordero A, García-Pinilla JM, Gómez-Doblas JJ, Alzueta-Rodríguez J, de Teresa-Galván E. Beneficio de la terapia de resincronización cardiaca en la fibrilación auricular sin ablación del nodo. Rev Esp Cardiol 2008. [DOI: 10.1157/13117736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Caballero-Borrego J, García-Pinilla JM, Rueda-Calle E, de Teresa-Galván E. [Evidence of gadolinium late-enhancement on cardiac magnetic resonance imaging in a patient with peripartum cardiomyopathy]. Rev Esp Cardiol 2008; 61:219-220. [PMID: 18364197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Caballero-Borrego J, García-Pinilla JM, Rueda-Calle E, de Teresa-Galván E. Evidencia de realce tardío de gadolinio en la resonancia magnética de una paciente con miocardiopatía periparto. Rev Esp Cardiol 2008. [DOI: 10.1157/13116216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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García-Pinilla JM, Gálvez J, Cabrera-Bueno F, Jiménez-Navarro M, Gómez-Doblas JJ, Galisteo M, Camuesco D, de Teresa Galván C, Espinosa-Caliani S, Zarzuelo A, de Teresa-Galván E. Baseline glutathione peroxidase activity affects prognosis after acute coronary syndromes. Tex Heart Inst J 2008; 35:262-267. [PMID: 18941641 PMCID: PMC2565519] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Oxidative stress is associated with atherosclerosis and plaque lesions in experimental in vitro models. Few in vivo studies have examined the association between redox status and the prognosis of acute coronary syndromes.We undertook a prospective, observational study of 137 patients who had been admitted because of an acute coronary syndrome. We determined glutathione peroxidase activity (a marker of systemic antioxidant status) and recorded clinical and angiographic features and cardiovascular events (cardiovascular death, reinfarction, readmission with a new ischemic event, or need for coronary revascularization).The mean age of the patients (78% of whom were men) was 61.7 +/- 10.9 years; 76% were admitted with non-ST-segment-elevation acute coronary syndrome. Left ventricular ejection fraction was normal in 61%. In the 23.4% who experienced cardiovascular events, glutathione peroxidase activity was higher (mean, 2.38 vs 1.76 mU/mg of protein; P < 0.01). Two-year event-free survival was lower in patients whose glutathione peroxidase activity was higher than the 50th percentile (63% vs 82%; P = 0.01). Multivariate analysis showed a direct independent relationship between glutathione peroxidase activity and cardiovascular events (hazard ratio, 3.72; 95% confidence interval, 1.53-9.02; P < 0.01).We conclude that patients who experienced acute coronary syndromes and events during follow-up had higher plasma glutathione peroxidase activity, and that glutathione peroxidase activity was an independent predictor of events during follow-up.
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Cabrera-Bueno F, García-Pinilla JM, Peña-Hernández J, Jiménez-Navarro M, Gómez-Doblas JJ, Barrera-Cordero A, Alzueta-Rodríguez J, de Teresa-Galván E. Repercussion of functional mitral regurgitation on reverse remodelling in cardiac resynchronization therapy. Europace 2007; 9:757-61. [PMID: 17573358 DOI: 10.1093/europace/eum122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) reduces the degree of functional mitral regurgitation (FMR). However, FMR has also been associated with a lack of clinical response to CRT. We undertook this study to determine whether the presence of FMR influences the reverse remodelling induced by CRT. METHODS AND RESULTS We used Doppler echocardiography to assess 20 patients with dilated cardiomyopathy before and 6 months after undergoing CRT. We evaluated the effect of reverse remodelling (reduction > or = 10% in end-systolic volume) according to the presence or absence of important FMR, defined as a regurgitant orifice area (ROA) of > or = 0.20 cm(2). Of the 20 patients (mean age, 64.7 +/- 8.2 years, eight women), 9 had marked FMR (ROA 0.40 +/- 0.12 cm(2)), 6 mild FMR (ROA 0.15 +/- 0.02 cm(2)), and 5 had trivial or no FMR. CRT reduced the presence of mitral regurgitation by 33.3% and induced reverse remodelling in 60% of the patients. A ROA > or = 0.20 cm(2) was associated with a lack of reverse remodelling, despite presenting similar baseline characteristics and a reduction in asynchrony to the other patients. Reverse remodelling was produced in all the other patients, with a significant reduction in end-systolic volume (41.7 +/- 21%; P = 0.003), accompanied by improvement in the ejection fraction (P = 0.003) and myocardial performance index (P = 0.027). CONCLUSION CRT improved FMR, although the baseline presence of important mitral regurgitation, with a ROA > or = 0.20 cm(2), in patients undergoing CRT was associated with a lack of response in reverse remodelling.
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Affiliation(s)
- Fernando Cabrera-Bueno
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, Colonia Santa Ines, Malaga, Spain.
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García-Pinilla JM, Espinosa-Caliani S, Gómez-Doblas JJ, Jiménez-Navarro M, Gaitán MJ, Muñoz-Morán E, Cabrera-Bueno F, Hernández-García JM, Ortega-Jiménez MV, Ruiz-Galdón M, Reyes-Engel A, de Teresa-Galván E. Influence of high homocysteine and low folate plasmatic levels in medium-term prognosis after acute coronary syndromes. Int J Cardiol 2007; 118:220-6. [PMID: 17023072 DOI: 10.1016/j.ijcard.2006.06.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/05/2006] [Accepted: 06/11/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND To test prospectively whether moderate hyperhomocysteinemia and low folate levels could have an influence in the prognosis of 155 patients who presented with an acute coronary syndrome. METHODS AND RESULTS After a mean follow-up of 13.4+/-7.4 months, patients with low folate levels had higher percentages of cardiovascular death and major cardiovascular events (33% vs. 5%, p<0.001; 44% vs. 22%, p<0.05) and patients with high homocysteine levels had a higher percentage of major cardiovascular events (31% vs. 14.5%, p<0.03). Kaplan-Meier survival estimates analysis showed that patients with low folate levels had a significantly higher probability of cardiovascular death and lower free-of-events survival (log rank statistic: 21.17, p<0.001 and 6.59, p=0.01). Patients with high homocysteine levels had a lower free-of-events survival (log rank statistic: 4.95, p=0.02). Different survival multivariate analysis model showed that the presence of low folate levels was an independent predictor of cardiovascular death (hazard ratio 8.85, 95% confidence interval 2.6-29.3, p<0.000) and high homocysteine levels was identified as independent predictor of major cardiovascular events (hazard ratio 2.34, 95% confidence interval 1.07-5.12, p<0.03). CONCLUSIONS Low folate levels and moderate hyperhomocysteinemia were identified as independent predictors of cardiovascular events in the follow-up.
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Affiliation(s)
- José Manuel García-Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, School of Medicine, University of Malaga, Spain
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Cabrera-Bueno F, García-Pinilla JM, Gómez-Doblas JJ, Montiel-Trujillo A, Rodríguez-Bailón I, de Teresa-Galván E. Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise. Int J Cardiol 2007; 117:222-6. [PMID: 16844244 DOI: 10.1016/j.ijcard.2006.04.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Revised: 04/05/2006] [Accepted: 04/28/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients who present with angina, dynamic left ventricular outflow tract obstruction may be responsible of symptoms. The aim of our study was to evaluate the effect of negative inotropic therapy on ventricular physiology and symptoms of patients with dynamic left ventricular outflow tract obstruction induced by exercise in the absence of hypertrophic cardiomyopathy. METHODS Seventy eight patients with symptoms of angina, normal exercise SPECT test and normal resting left ventricular systolic function were prospectively analysed with exercise echocardiography. Fifteen of them developed high outflow tract velocities (greater than 2.57 m/s) on effort. After treatment with bisoprolol (mean dose 6.9+/-3.5 mg) in these patients, symptoms and dynamic left ventricular outflow tract obstruction during exercise were re-evaluated. RESULTS After negative inotropic therapy, there was a significant reduction of 86.6% in the development of intracavitary gradient (15 to 2 patients). In all patients the left ventricular outflow tract velocities decreased (2.91+/-0.4 m/s to 1.92+/-0.46 m/s, p=0.001). However, the oxygen consumption during exercise was higher (7.3+/-1.7 METs to 8.5+/-1.8 METs, p=0.005), and symptoms improved significantly following therapy, with a reduction in mean NYHA class from 1.9+/-0.5 to 1.0+/-0.0 (p=0.001). CONCLUSIONS Negative inotropic therapy may represent a beneficial therapeutic approach in selected patients with dynamic left ventricular outflow tract obstruction induced by exercise and identified during exercise echocardiography.
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Affiliation(s)
- Fernando Cabrera-Bueno
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Teatinos S/n, Colonia Santa Inés, 29010 Málaga, Spain.
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