1
|
López-Mínguez JR, Martín de Francisco AL, Soler MJ, Hernández F, Moreno R, Pinar E, Sampedro A, Mareque M, Oyagüez I. Cost-effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain. Catheter Cardiovasc Interv 2023. [PMID: 37300893 DOI: 10.1002/ccd.30744] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI). METHODS A Markov model was developed to estimate, over 3-month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality-adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b-4 and an average age of 72 years. The incidence of contrast-induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all-cause and state-specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes. RESULTS The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice. CONCLUSIONS The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b-4 undergoing PCI in Spain.
Collapse
Affiliation(s)
- Jose R López-Mínguez
- Sección de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Badajoz, Badajoz, España
| | | | - M J Soler
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Felipe Hernández
- Unidad de Hemodinámica y Cardiología Intervencionista, Clínica Universidad de Navarra, Madrid, España
| | - Raul Moreno
- Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Pinar
- Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| |
Collapse
|
2
|
García-Galindo A, Agujetas R, López-Mínguez JR, Ferrera C. Assessment of valve implantation in the descending aorta as an alternative for aortic regurgitation patients not treatable with conventional procedures. Biomech Model Mechanobiol 2022; 22:575-591. [PMID: 36550245 PMCID: PMC10097802 DOI: 10.1007/s10237-022-01665-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aortic Regurgitation (AR) produces the entrance of an abnormal amount of blood in the left ventricle. This disease is responsible for high morbidity and mortality worldwide and may be caused by an aortic valve dysfunction. Surgical and transcatheter aortic valve replacement (TAVR) are the current options for treating AR. They have replaced older procedures such as Hufnagel's one. However, some physicians have reconsidered this procedure as a less aggressive alternative for patients not eligible for surgical or TAVR. Although Hufnagel suggested a 75% regurgitation reduction when a valve is placed in the descending aorta, a quantification of this value has not been reported. METHODS In this paper, CFD/FSI numerical simulation is conducted on an idealized geometry. We quantify the effect of placing a bileaflet mechanical heart valve in the descending aorta on a moderate-severe AR case. A three-element Windkessel model is employed to prescribe pressure outlet boundary conditions. We calculate the resulting flow rates and pressures at the aorta and first-generation vessels. Moreover, we evaluate several indices to assess the improvement due to the valve introduction. RESULTS AND CONCLUSIONS Regurgitation fraction (RF) is reduced from 37.5% (without valve) to 18.0% (with valve) in a single cardiac cycle. This reduction clearly shows the remarkable efficacy of the rescued technique. It will further ameliorate the left ventricle function in the long-term. Moreover, the calculations show that the implantation in that location introduces fewer incompatibilities' risks than a conventional one. The proposed methodology can be extended to any particular conditions (pressure waveforms/geometry) and is designed to assess usual clinical parameters employed by physicians.
Collapse
Affiliation(s)
- A García-Galindo
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - R Agujetas
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - J R López-Mínguez
- Sección de Cardiologıa Intervencionista, Servicio de Cardiologıa, Hospital Universitario de Badajoz, Avda. de Elvas s/n, E-06006, Badajoz, Spain
| | - C Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain.
| |
Collapse
|
3
|
Pascual I, Carrasco-Chinchilla F, Benito-Gonzalez T, Li CH, Avanzas P, Nombela-Franco L, Pan M, Serrador Frutos A, Freixa X, Trillo-Nouche R, Hernández-Antolín RA, Andraka Ikazuriaga L, Cruz-Gonzalez I, López-Mínguez JR, Diez JL, Berenguer-Jofresa A, Sanchis J, Ruiz-Quevedo V, Urbano-Carrillo C, Dominguez JFO, Ortas-Nadal MR, Molina Navarro E, Carrillo X, Alonso-Briales JH, Fernández-Vázquez F, Asmarats Serra L, Hernandez-Vaquero D, Jimenez-Quevedo P, Mesa D, Rodríguez-Gabella T, Regueiro A, Martinez Monzonís A, Salido Tahoces L, Ruiz Gomez L, Trejo-Velasco B, Becerra-Muñoz VM, Garrote-Coloma C, Fernández Peregrina E, Lorca R, Agustín JAD, Romero M, Amat-Santos IJ, Sabaté M, Alvarez ABC, Hernandez-Garcia JM, Gualis J, Arzamendi D, Moris C, Tirado-Conte G, Sánchez-Recalde A, Estevez-Loureiro R. Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study. J Clin Med 2020; 9:E1792. [PMID: 32526978 PMCID: PMC7356666 DOI: 10.3390/jcm9061792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/28/2020] [Revised: 05/24/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip® between two groups according to LVEF. METHODS In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. RESULTS Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. CONCLUSION FMR patients with LVEF <30% treated with MitraClip® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.
Collapse
Affiliation(s)
- Isaac Pascual
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Fernando Carrasco-Chinchilla
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Tomas Benito-Gonzalez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Chi Hion Li
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Pablo Avanzas
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Manuel Pan
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ana Serrador Frutos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Xavier Freixa
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ramiro Trillo-Nouche
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Rosa A. Hernández-Antolín
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Leire Andraka Ikazuriaga
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Ignacio Cruz-Gonzalez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | | | - Jose L. Diez
- Cardiology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | | | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, University of Valencia, INCLIVA, CIBERCV, 46010 Valencia, Spain;
| | | | | | - Juan F. Oteo Dominguez
- Cardiology Department, University Hospital Puerta de Hierro/Majadahonda, 28222 Madrid, Spain;
| | - Maria R. Ortas-Nadal
- Cardiology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain;
| | | | - Xavier Carrillo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain;
| | - Juan H. Alonso-Briales
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Felipe Fernández-Vázquez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Luis Asmarats Serra
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Daniel Hernandez-Vaquero
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Dolores Mesa
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Tania Rodríguez-Gabella
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Amparo Martinez Monzonís
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Luisa Salido Tahoces
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Lara Ruiz Gomez
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Blanca Trejo-Velasco
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | - Victor M. Becerra-Muñoz
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Carmen Garrote-Coloma
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | | | - Rebeca Lorca
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Jose A. De Agustín
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Miguel Romero
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ignacio J. Amat-Santos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Manel Sabaté
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ana B. Cid Alvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Jose M. Hernandez-Garcia
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Javier Gualis
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Dabit Arzamendi
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Cesar Moris
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Angel Sánchez-Recalde
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | | |
Collapse
|
4
|
Ordiales JM, Vano E, Nogales JM, Ramos J, López-Mínguez JR, Martínez G, Cerrato P, Álvarez FJ. Optimisation of imaging protocols in interventional cardiology: impact on patient doses. J Radiol Prot 2017; 37:684-696. [PMID: 28677594 DOI: 10.1088/1361-6498/aa7dae] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this work is to evaluate the impact of the imaging protocol as part of the optimisation of patient doses in interventional cardiology. This paper reports the results of an initial study to refine the existing fluoroscopy and cine settings, evaluates a new imaging protocol by measuring the image quality and phantom entrance air kerma values, and tests the clinical implementation of the new protocol in terms of the reduction in patient doses and the impact on clinical images. The initial study developed a new fluoroscopy mode using 7.5 frames s-1 (instead of the previous 15 frames s-1) with a similar dose/frame and a reduction of approximately 26% in dose/frame for the existing standard cine mode. For the new imaging protocol, the reduction in entrance air kerma was characterised for water depths of 16, 20, and 24 cm and the image quality was evaluated using a Leeds test object. A reduction in dose of around 50% was observed for the low fluoroscopy mode and an 18%-38% reduction was measured for cine. The image quality was unchanged in fluoroscopy mode and did not suffer noticeable alterations in cine mode. In the clinical implementation, cardiologists evaluated the new imaging protocol in clinical practice and cooperated with medical physicists to ensure full optimisation. The image quality criteria evaluated the ability to visualise the standard coronary arteries and small vessels (<2 mm), and the proper visualisation of the heart and diaphragm. A total of 1635 interventional cardiac procedures were assessed. The median kerma-area product exhibited a reduction of 37% for CA and 43% for PTCA examinations, and the quality of the clinical images was considered sufficient for standard clinical practice.
Collapse
Affiliation(s)
- J M Ordiales
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Ordiales JM, Nogales JM, Vano E, López-Mínguez JR, Alvarez FJ, Ramos J, Martínez G, Sánchez RM. Occupational dose reduction in cardiac catheterisation laboratory: a randomised trial using a shield drape placed on the patient. Radiat Prot Dosimetry 2017; 174:255-261. [PMID: 27247448 DOI: 10.1093/rpd/ncw139] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the occupational radiation dose in interventional cardiology by using a shielding drape on the patient. A random study with and without the protective material was conducted. The following control parameters were registered: demographic data, number of stents, contrast media volume, fluoroscopy time, number of cine images, kerma-area product and cumulative air kerma. Occupational dose data were obtained by electronic active dosemeters. No statistically significant differences in the analysed control parameters were registered. The median dose value received by the interventional cardiologist was 50% lower in the group with a shielding drape with a statistically significant p-value <0.001. In addition, the median value of the maximum scatter radiation dose was 31% lower in this group with a statistically significant p-value <0.001. This study showed that a shielding drape is a useful tool for reducing the occupational radiation dose in a cardiac catheterisation laboratory.
Collapse
Affiliation(s)
- J M Ordiales
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
- Sensory Systems Research Group, University of Extremadura, Badajoz, Spain
| | - J M Nogales
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - E Vano
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - J R López-Mínguez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - F J Alvarez
- Sensory Systems Research Group, University of Extremadura, Badajoz, Spain
- Department Electrical Engineering, Electronics and Automation, University of Extremadura Badajoz, Spain
| | - J Ramos
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
| | - G Martínez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital de Mérida, Mérida, Spain
| | - R M Sánchez
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
6
|
Gemma D, Moreno Gómez R, Fernández de Bobadilla J, Galeote García G, López Fernandez T, López-Mínguez JR, López-Sendón JL. Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2016.10.008] [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: 11/26/2022] Open
|
7
|
Gemma D, Moreno Gómez R, Fernández de Bobadilla J, Galeote García G, López Fernandez T, López-Mínguez JR, López-Sendón JL. Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention. Rev Port Cardiol 2016; 35:617.e1-617.e7. [PMID: 27693110 DOI: 10.1016/j.repc.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/07/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/19/2022] Open
Abstract
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.
Collapse
|
8
|
Ordiales JM, Nogales JM, Sánchez-Casanueva R, Vano E, Fernández JM, Álvarez FJ, Ramos J, Martínez G, López-Mínguez JR. Reduction of occupational radiation dose in staff at the cardiac catheterisation laboratory by protective material placed on the patient. Radiat Prot Dosimetry 2015; 165:272-275. [PMID: 25848096 DOI: 10.1093/rpd/ncv090] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Reducing occupational radiation dose in cardiac catheterisation laboratories is one of the objectives of the radiation protection system because the procedures performed involve high levels of radiation compared with others in health care. Recommendations on protection methods used are referred to different structural types and personal protection tools. In this work, the effectiveness of a shielding drape above the patient in different geometric shapes for a standard procedure in interventional cardiology was evaluated. Values of personal dose equivalent Hp(10) obtained simultaneously with three active electronic semiconductor dosemeters located at the usual position of staff and at the C-arm have been used to show the usefulness of the shielding drape.
Collapse
Affiliation(s)
- J M Ordiales
- Medical Physics Department, Hospital de Mérida, Mérida, Spain Sensory Systems Research Group, University of Extremadura, Badajoz, Spain
| | - J M Nogales
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - R Sánchez-Casanueva
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - E Vano
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - J M Fernández
- Medical Physics Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - F J Álvarez
- Sensory Systems Research Group, University of Extremadura, Badajoz, Spain Departament of Electrical Engineering, Electronics and Automation, University of Extremadura, Badajoz, Spain
| | - J Ramos
- Medical Physics Department, Hospital de Mérida, Mérida, Spain
| | - G Martínez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - J R López-Mínguez
- Department of Cardiology, Hemodynamics and Interventionist Cardiology Section, Hospital Universitario Infanta Cristina, Badajoz, Spain
| |
Collapse
|
9
|
Alfonso F, Pérez-Vizcayno MJ, Hernandez R, Fernandez C, Escaned J, Bañuelos C, Bethencourt A, López-Mínguez JR, Angel J, Cequier A, Sabaté M, Morís C, Zueco J, Seabra-Gomes R. Sirolimus-eluting stents versus bare-metal stents in patients with in-stent restenosis: Results of a pooled analysis of two randomized studies. Catheter Cardiovasc Interv 2008; 72:459-67. [DOI: 10.1002/ccd.21694] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
10
|
Nogales-Asensio JM, López-Mínguez JR, González-Fernández R, Merchán-Herrera A, Martínez G, Doncel J, Palanco C, Morales A. Influence of diabetes on long-term survival after rapamycin and paclitaxel-eluting stent implantation in a nonselected sample. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.023] [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: 10/22/2022]
|
11
|
Nogales Asensio JM, Moreno Sánchez N, Doncel Vecino LJ, Villar Mariscal C, López-Mínguez JR, Merchán Herrera A. Torsade-de-pointes in a patient under flecainide treatment, an unusual case of proarrhythmicity. Int J Cardiol 2007; 114:E65-7. [PMID: 17056139 DOI: 10.1016/j.ijcard.2006.07.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 07/17/2006] [Indexed: 11/20/2022]
Abstract
Flecainide is an antiarrhythmic considered safe in patients who have no structural cardiopathy, and frequently used in the prevention of atrial fibrillation. However, in patients with a history of infarction and/or severe conduction disorders, its proarrhythmicity may be lethal. Torsade-de-pointes type tachycardia is not included as one of these proarrhythmic effects, since the drug's scant action on ventricular repolarization makes this adverse effect very unlikely. We present the case of a patient who, shortly after beginning treatment with flecainide, was admitted because of syncope related to bradyarrhythmias, long QT, and torsade-de-pointes. There have been very few published cases in which one finds such an association between flecainide and this infrequent arrhythmia.
Collapse
|
12
|
Alfonso F, Pérez-Vizcayno MJ, Hernandez R, Bethencourt A, Martí V, López-Mínguez JR, Angel J, Mantilla R, Morís C, Cequier A, Sabaté M, Escaned J, Moreno R, Bañuelos C, Suárez A, Macaya C. A randomized comparison of sirolimus-eluting stent with balloon angioplasty in patients with in-stent restenosis: results of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Sirolimus-Eluting Stenting (RIBS-II) trial. J Am Coll Cardiol 2006; 47:2152-60. [PMID: 16750678 DOI: 10.1016/j.jacc.2005.10.078] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [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: 08/21/2005] [Revised: 10/14/2005] [Accepted: 10/25/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to assess the effectiveness of sirolimus-eluting stents (SES) in patients with in-stent restenosis (ISR). BACKGROUND Treatment of patients with ISR remains a challenge. METHODS The Restenosis Intrastent: Balloon Angioplasty Versus Elective Sirolimus-Eluting Stenting (RIBS-II) study is a multicenter randomized trial conducted in 150 patients with ISR (76 allocated to SES and 74 to balloon angioplasty [BA]). The primary end point was recurrent restenosis rate at nine months. Secondary end points included prespecified subgroup analysis, lumen volume on intravascular ultrasound (IVUS), and a composite of major clinical events at one year. RESULTS Angiographic success was obtained in all patients. At 9-month angiographic follow-up (96% of eligible patients) minimal lumen diameter was larger (2.52 mm [interquartile range (IQR) 2.09 to 2.81] vs. 1.54 mm [IQR 0.91 to 2.05]; p < 0.001) and recurrent restenosis rate was lower (11% vs. 39%; p < 0.001) in the SES group. Prespecified subgroup analyses were consistent with the main outcome measure. Lumen volume on IVUS at 9 months was also larger (279 mm3 [IQR 227 to 300] vs. 197 mm3 [IQR 177 to 230]; p < 0.001) in the SES group. At one-year clinical follow-up (100% of patients), the event-free survival (freedom from death, myocardial infarction, and target vessel revascularization) was significantly improved in the SES group (88% vs. 69%; p < 0.004) as the result of a lower requirement for target vessel revascularization (11% vs. 30%; p < 0.003). CONCLUSIONS In patients with ISR, the use of SES provides superior long-term clinical, angiographic, and IVUS outcome than BA treatment.
Collapse
|
13
|
López-Mínguez JR, González Fernández R, Millán Núñez V, Merchán Herrera A, Altozano Gómez JC, García-Andoaín JM. [Acute myocardial infarction secondary to anaphylactic reaction following shellfish ingestion. The need for rescue coronary angioplasty]. Rev Esp Cardiol 2000; 53:1663-6. [PMID: 11171492 DOI: 10.1016/s0300-8932(00)75295-x] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During anaphylactic (or anaphylactoid) reactions severe cardiovascular events may occur, acute myocardial infarction among them. This etiology of myocardial infarction, is known, although it is infrequent and only sporadically reported in literature. A case of acute myocardial infarction secondary to anaphylactic reaction following shellfish ingestion, treated with subcutaneous epinephrine and in whom a rescue coronary angioplasty was necessary is reported. The mechanism of coronary occlusion in this kind of reaction and the possible influence on the efficacy of treatment is discussed.
Collapse
Affiliation(s)
- J R López-Mínguez
- Unidad de Hemodinámica y Cardiología Intervencionista. Hospital Universitario Infanta Cristina. Badajoz
| | | | | | | | | | | |
Collapse
|
14
|
López-Mínguez JR, Urbano Gálvez JM, González Fernández R, García-Andoain JM, Cimbora Ortega A, Millán Núñez V, Merchán Herrera A, de Argila D. [Atrial fibrillation and the Wolff-Parkinson_White syndrome in a 68-year-old patient with tuberous sclerosis]. Rev Esp Cardiol 1999; 52:207-10. [PMID: 10193177] [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: 02/11/2023]
Abstract
Tuberous sclerosis is an autosomal-dominant disease with involvement of several organs, the heart included. The cardiac anomaly most frequently found is the rhabdomyoma association. However, WPW association has also been encountered more common than usual. In the majority of the published related-series, infant or adolescent patients are described. We report the case of a 68-year-old patient with tuberous sclerosis whose first cardiac manifestation was a pre-excited atrial fibrillation. This association is reviewed and the consideration of accessory pathways is highlighted as the first mechanism to take into account when arrhythmias are present in these patients even in adult age.
Collapse
Affiliation(s)
- J R López-Mínguez
- Sección de Cardiología, Hospital Infanta Cristina de Badajoz, Universidad de Extremadura
| | | | | | | | | | | | | | | |
Collapse
|
15
|
López-Mínguez JR, Merchán Herrera A, Cimboria Ortega A, Millán Núñez V, García-Andoain JM, Alvarez Suárez-Bárcenas JM, Martínez de la Concha L, Fernández de la Concha J, Alonso Ruiz F. [Ventricular tachycardia in a patient with mid-ventricular hypertrophic myocardiopathy and apical aneurysm]. Rev Esp Cardiol 1997; 50:593-6. [PMID: 9340702] [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: 02/05/2023]
Abstract
A case is presented of a 77-year-old patient who was admitted with a pattern of sustained ventricular tachycardia and diagnosed with midventricular hypertrophic myocardiopathy with apycal aneurysm. Under treatment with amiodarone at low doses, the patient is asymptomatic with no recurrence of the arrhytmias at one year. The association of midventricular hypertrophic myocardiopathy with apycal aneurysm and of those with sustained ventricular tachycardia are reviewed in conjunction with their treatment.
Collapse
Affiliation(s)
- J R López-Mínguez
- Servicio de Cardiología, Hospital Regional Universitario Infanta Cristina, Badajoz
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
López-Mínguez JR, Merchán A, Arrobas J, Fernández G, González-Egüaras M, García-Andoaín JM, Alonso M, Gamero C, Poblador MA, Alonso F. [Aortic intramural hematoma. An atypical pattern equivalent to aortic dissection]. Rev Esp Cardiol 1995; 48:634-7. [PMID: 7569267] [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: 01/26/2023]
Abstract
A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided.
Collapse
Affiliation(s)
- J R López-Mínguez
- Servicio de Cardiología, Hospital Regional Universitario Infanta Cristina, Badajoz
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
López-Mínguez JR, Cobos Gil MA, García Andoaín JM, Merchán Herrera A, Sánchez Montero F, Alonso Ruiz F, Pérez Miranda M. [Conventional stress test in patients with dilated cardiomyopathy. Variables with prognostic value. Correlations with non-invasive and invasive tests]. Rev Esp Cardiol 1993; 46:57-68. [PMID: 8451485] [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: 01/30/2023]
Abstract
The variables of conventional stress testing were studied to determine their prognostic value and their correlations with other tests, in 34 patients with dilated cardiomyopathy divided into a first group of 20 in-patients admitted because of acute pulmonary edema (GI), and a second group of 14 stable out-patients (GII), with a mean follow-up of 3 years. The GI-patients had data of more evolved disease as reflected by a lower fractional shortening (13.5 +/- 4.6 vs 17.8 +/- 3.9%; p < 0.05). The only variables with prognostic capacity were functional aerobic incapacity (FAI), and systolic arterial pressure reached on exercise (SAPE), this being applicable only to GI-patients (FAI: 19.6 +/- 17.34 vs 46 +/- 26.4% in alive vs patients who died respectively; p < 0.05) (SAPE: 155 +/- 23.21 vs 127.14 +/- 24.9 mmHg, respectively; p < 0.05). Also a good correlation between the cardiac rate reached on exercise and the cardiothoracic index on chest X-ray was found (p = 0.0001), again, for GI-patients only. The presence of ventricular arrhythmias (VA) on stress testing had a very good correlation with a Holter VA-score (p < 0.0001), this being applicable for both GI and GII patients. The correlations with haemodynamic variables obtained by, basal or post-dobutamine infusion, right catheterism were not good by and large, except between FAI and systemic resistances. It is conclude that: 1) Conventional stress testing provides variables of prognostic value in dilated cardiomyopathy patients but only in those with more evolved disease. These variables are the FAI and the SAPE. 2) The presence of VA during exercise predicts their presence in daily life, and in this case at an earlier phase of the disease. 3) There are not good correlations between the haemodynamic and stress testing variables except in the case of systemic resistances and FAI.
Collapse
Affiliation(s)
- J R López-Mínguez
- Departamento de Medicina Interna, Hospital Infanta Cristina de Badajoz, Universidad de Extremadura
| | | | | | | | | | | | | |
Collapse
|
18
|
Farré J, Hernández R, Grande A, Ramírez M, Martí F, López-Mínguez JR, de Rábago P. [New electrocardiographic observations in the differential diagnosis of tachycardia with wide QRS complex. Role of electrophysiologic studies in the re-evaluation of the diagnostic potential of the surface ECG]. Rev Esp Cardiol 1984; 37:47-59. [PMID: 6739925] [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: 01/21/2023]
|