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Playan Escribano J, Segura De La Cal T, Dos Subira L, Lazaro Salvador M, Barbera Mir J, Garrido-Lestache E, Otero Gonzalez I, Martinez-Quintana E, Lopez Ramon M, Martinez Menaca A, Molina Ferragut L, Suberviola V, Lopez Reyes R, Barrios Garrido-Lestache E, Escribano Subias P. Pretriscuspid shunt and Eisenmenger syndrome: a deadly combination. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Pulmonary arterial hypertension (PAH) is a common comorbidity in congenital heart disease (CHD) and significantly affects prognosis. Our aim was to investigate how the location of the shunt influences the outcome of these patients.
Methods
The REHAP registry is a Spanish multicentre voluntary registry of patients over 14 years of age, which includes patients with congenital heart disease and PAH, starting in 2007. Baseline characteristics, functional class, right catheterization data, treatment and survival were compared. We performed a cox regression model for assessing the impact of the type of shunt on prognosis, after looking for confusing and effect modifying variables.
Results
664 patients were analyzed, their characteristics are detailed in the table. Mean follow up time was 10 years. We performed a survival analysis adjusted for the confounding variables: age (Hazard ratio (HR) 1.02 p<0.001), functional class (HR 2.45 p 0.001) and clinical group. The clinical group was also an effect-modifying variable, which means there is no unique effect (HR) of the type of shunt, instead it depends on the clinical group. We did a multiple regression analysis, adjusting for the confounding variables, to calculate the HR for each clinical group: in patients with Eisenmenger syndrome, the HR is 0.27 (p<0.001) for simple posttricuspid shunt and HR 0.38 (p<0.001) for complex posttricuspid shunt (reference group: pretricuspid shunt). In the others clinical groups, the type of shunt did not reach statistical significance.
Conclusion
The type of shunt significantly affects prognosis in Eisenmenger patients, with a much worse outcome for those with pretricuspid shunts. Functional class and clinical group are also closely related to outcome.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD, GSK
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Affiliation(s)
| | | | - L Dos Subira
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - E Martinez-Quintana
- University Hospital Insular of Gran Canaria, Las Palmas De Gran Canaria, Spain
| | | | | | | | - V Suberviola
- University Hospital Infanta Leonor, Madrid, Spain
| | - R Lopez Reyes
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
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Enache R, Sawada N, Molina Ferragut L, Monney P, Jobbe Duval A, Peluso D, Beladan CC, Diego Bellavia DB, Popa E, Jurcut R, Badea R, Calin A, Beladan CC, Rosca M, Platon P, Coman IM, Popescu BA, Ginghina C, Kawata T, Daimon M, Kimura K, Nakao T, Chiang S, Mahara K, Okubo T, Yatomi Y, Komuro I, Uhl D, Gomez M, Ble M, Mas-Stachurska A, Cladellas M, Enjuanes C, Moliner P, Marti J, Comin J, Ehret G, Crisinel V, Reverdin S, Conti L, Mach F, Jeanrenaud X, Bochud M, Mueller H, Thebault O, Poilane M, Piriou N, Jaafar P, Warin-Fresse K, Serfaty JM, Cueff C, Le Tourneau T, Kovacs A, Surkova E, Muraru D, Perazzolo Marra M, Iliceto S, Badano LP, Predescu L, Platon P, Mateescu AD, Enache R, Calin A, Rosca M, Egher L, Inta O, Jurcut R, Ginghina C, Popescu BA, Attilio Iacovoni AI, Sonia Dell'oglio SD, Giuseppe Romano GR, Michele Senni MS, Chiara Mina' CM, Gabriele Di Gesaro GD, Michele Pilato MP, Fletcher Miller FAM, Cesare Scardulla CS, Francesco Clemenza FC, Joseph Maalouf JM, Michael Dandel MD. Moderated Posters: Imaging of the right heart - What is new?P814Prognostic value of parameters of pulmonary artery stiffness in patients with pulmonary hypertension receiving specific vasodilator therapyP815Reconsidering of inferior vena cava parameters for estimating right atrial pressure: a comparative simultaneous ultrasound-catheterization studyP816Pulmonary hypertension is the main factor echocardiography to predicting mortality in medium and long term in a cohort of patients with heart failureP817Normal values for 3D-right atrial volumes : results from the SKIPOGH-II population studyP818Assessment of right ventricular function by free wall longitudinal strain in organic mitral regurgitationP819Importance of radial dysfunction to determine the impairment of right ventricular ejection fraction in patients with pulmonary hypertensionP820Influence of tricuspid regurgitation severity on non-invasive assessment of right heart hemodynamics: a simultaneous echocardiography-catheterization studyP821Right ventricular failure following ventricular assist device implant: systematic review and meta-analysis of clinical and echocardiographic predictors. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Esteban Torné E, Molina Ferragut L, Hernández Estaregui A, García-Algar O, Thió Lluch M, Moreno Hernando J, Mur Sierra A. [Neonatal endocarditis due to staphylococcus aureus as a complication of neonatal sepsis]. An Esp Pediatr 2002; 56:564-6. [PMID: 12042154] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We present the case of a newborn with bacterial endocarditis with mitral valve involvement as a complication of late-onset sepsis due to Staphylococcus aureus with associated pyelonephritis and meningitis. The diagnosis was confirmed by echocardiogram and blood culture with growth of S. aureus. Treatment was medical and surgical. Neonatal bacterial endocarditis is extremely difficult to diagnose. The signs and symptoms are usually nonspecific and cannot be distinguished from those of sepsis or congenital heart disease. Consequently, a high degree of suspicion is needed for the early diagnosis of this condition. Echocardiography should be performed in children who present sepsis and heart murmur and even in those with staphylococcemia (sepsis due to S. aureus) without associated heart murmur. This investigation enables an early diagnosis of endocarditis to be made and appropriate treatment to be given without having to wait for the development of signs and symptoms that frequently go undetected.
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Esteban Torné E, Molina Ferragut L, Hernández Estaregui A, García-Algar O, Thió Lluch M, Moreno Hernando J, Mur Sierra A. Endocarditis neonatal por Staphylococcus aureus como complicación de sepsis neonatal. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77865-x] [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: 11/28/2022] Open
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Pons Masanés S, Molina Ferragut L, Paniagua Clusells J, Soler Massana JM. [Effectiveness of exercise echocardiography in the diagnosis of left bundle branch block. A case report]. Rev Esp Cardiol 1998; 51:245-7. [PMID: 9577171 DOI: 10.1016/s0300-8932(98)74740-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/07/2023]
Abstract
A left bundle branch block is very often suggestive of cardiac diseases. Left bundle branch block is also present with angina in patients with normal coronary arteries. We report a case of a man with a left bundle branch block in which the most effective, rapid and economic method of diagnosis was exercise echocardiography. Different diagnostic techniques are discussed and compared.
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