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Almenar-Bonet L, Sánchez-Lázaro I, Soldevila A, López-Vilella R, Donoso Trenado V, Devesa R, Carmona P, Tormo S, Montero Hernández MJ, Hernández J, Martínez Dolz L, Sánchez-Pérez P. Practical Requirements for the Development of an Advanced Cardiorenal Unit. Cardiorenal Med 2024; 14:136-146. [PMID: 38301611 DOI: 10.1159/000536104] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/15/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Heart failure is frequently associated with kidney disease, and patients with kidney disease are at increased risk of heart failure. The co-occurrence of both entities not only significantly increases morbidity and mortality but also complicates therapy. SUMMARY Cardiorenal syndrome often requires a broad, comprehensive, and multidisciplinary approach. As a result, a need has arisen to create specialized cardiorenal units that allow for rigorous and personalized management of this condition. Moreover, in some cases, cardiorenal syndrome is more complex, owing to an acute and critical situation that requires the concept of the cardiorenal unit to be extended toward advanced diagnostic and therapeutic positions, thus confirming the need for an advanced cardiorenal unit. The creation of these units constitutes a real challenge, necessitating a specific multilevel action plan, covering governance and management, type of patient, personnel requirements, service portfolio, care process, information systems, and other resources. Specific lines of action must be proposed for each of the relevant points in order to facilitate development of these units, together with continuous evaluation of unit activity through specific indicators, and to detect areas for improvement. KEY MESSAGES This study addresses the conditions and organizational characteristics that enable the creation, development, and continuous improvement of advanced cardiorenal units.
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Affiliation(s)
- Luis Almenar-Bonet
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Amparo Soldevila
- Chronic Kidney Disease and Renal Replacement Therapy Section, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Nephrology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramón Devesa
- Chronic Kidney Disease and Renal Replacement Therapy Section, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Nephrology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Paula Carmona
- Anesthesia and Critical Care Department Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Sergi Tormo
- Intensive Care Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Julio Hernández
- Chronic Kidney Disease and Renal Replacement Therapy Section, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Nephrology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Sánchez-Pérez
- Chronic Kidney Disease and Renal Replacement Therapy Section, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Nephrology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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López-Vilella R, DonosoTrenado V, Guerrero Cervera B, Sánchez-Lázaro I, Martínez Dolz L, Almenar Bonet L. Annual evolution of the prescription of drugs with prognostic implications in acute decompensated heart failure with reduced ejection fraction. BMC Cardiovasc Disord 2024; 24:105. [PMID: 38355445 PMCID: PMC10865667 DOI: 10.1186/s12872-024-03728-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Quadruple therapy (renin angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists and sodium/glucose cotransporter type 2 inhibitors [SGLT2i]) has become the current prognostic modifying treatment for heart failure (HF) with reduced ejection fraction (HFrEF). This study aimed to analyse the prescription´s evolution of this combination therapy, the analysis of each pharmacological group and the differences according to HF subgroups. METHODS Retrospective analysis of consecutive patients admitted for cardiac decompensation. Inclusion period: from 1-1-2020 to 12-31-2022. Patients with left ventricular ejection fraction > 40% and deceased during admission were excluded. Finally, 602 patients were included. These were divided into: (a) de novo HF without previous heart disease (n:108), (b) de novo with previous heart disease (n:107), and (c) non-de novo (n:387). RESULTS Over the study time, all pharmacological groups experienced an increase in drugs prescription (p < 0.001). The group with the largest prescription rate increase was SGLT2i (2020:20%, 2021:42.9%, 2022:70.4%; mean increase 47.2%). The discharge rate prescription of quadruple therapy increased progressively (2020:7.4%, 2021:21.1%, 2022:32.5%; mean increase 21.9%). The subgroup with the highest combined prescription in 2022 was de novo with previous heart disease (43.9%). CONCLUSION The pharmacological group with the largest prescription´s rate increase was SGLT2i. The percentage of patients discharged on quadruple therapy has progressed significantly in recent years, although it remains low. The most optimised subgroup at discharge was that of de novo HF with previous heart disease.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain.
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain.
| | - Víctor DonosoTrenado
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
| | | | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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López-Vilella R, Jover Pastor P, Donoso Trenado V, Sánchez-Lázaro I, Martínez Dolz L, Almenar Bonet L. Clinical phenotypes according to diuretic combination in acute heart failure. Hellenic J Cardiol 2023; 73:1-7. [PMID: 37068639 DOI: 10.1016/j.hjc.2023.03.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments. METHODS Single-center study of 1,559 patients admitted for decompensated HF was done between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilization and discharge from the hospital: (1) Loop diuretic. (2) Loop diuretic + distal tubule (antialdosterone ± thiazides). (3) Loop diuretic + distal + proximal tubule (acetazolamide ± SGLT2 inhibitor). (4) Loop diuretic + distal tubule + collecting duct (tolvaptan). (5) Loop diuretic + distal + proximal + collecting duct. Based on these diuretic combinations, profiles with clinical, analytical, and echocardiographic differences were established. RESULTS There were more previous hospitalizations in groups 4 and 5 (p = 0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p = 0.01 and p = 0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p = 0.0001) and left ventricular (p = 0.003) function. Diuretic therapy-defined groups showed difference in clinical characteristics. CONCLUSIONS The diuretic treatment used identifies five clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - Pablo Jover Pastor
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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López-Vilella R, Guerrero Cervera B, Sánchez-Lázaro I, Donoso Trenado V, Soldevila Orient A, Devesa Such R, Martínez Dolz L, Sánchez Pérez P, Almenar Bonet L. Therapeutic approach in heart failure with poor diuretic response: peripheral ultrafiltration vs. conventional treatment. ESC Heart Fail 2023. [PMID: 37144350 PMCID: PMC10375185 DOI: 10.1002/ehf2.14386] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
AIMS Patients with heart failure (HF) admitted for decompensation often require high doses of intravenous diuretics. This study aims to analyse whether the use of peripheral ultrafiltration (UF) in patients hospitalized for acute HF with systemic-predominant congestion results in better hydric control, renal protection, and reduction of hospital stay compared with conventional treatment. METHODS AND RESULTS This study was a retrospective, comparative, single-centre study of 56 patients admitted for HF with systemic congestion with a poor diuretic response after diuretic escalation. One group underwent peripheral UF (35 patients) and others were maintained on intense diuretic treatment (control group, 21 patients). The diuretic response and days of hospital stay were compared between and within groups. The baseline characteristics of both groups were similar: males with right ventricular failure and renal dysfunction. The inter-group analysis showed that patients who received UF had better glomerular filtration rate (GFR; UF: 39.2 ± 18.2 vs. control: 28.7 ± 13.4 mL/min; P = 0.031) and higher diuresis (UF: 2184 ± 735 vs. control: 1335 ± 297 mL; P = 0.0001) at hospital discharge despite less need for diuretic drugs. Days of hospital stay were shorter in the UF group (UF: 11.7 ± 10.1 vs. control: 19.1 ± 14.4 days; P = 0.027). Intra-group analysis showed that patients receiving UF improved GFR, increased diuresis, and reduced weight at discharge (P < 0.001), whereas patients on conventional treatment only experienced improved weight but worsening renal function at discharge. CONCLUSIONS In patients with acute HF with systemic congestion and diuretic resistance, UF compared with conventional treatment produces greater decongestion and renal protection, reduces the total diuretic load, and shortens the length of hospital stay.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Soldevila Orient
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Ramón Devesa Such
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Sánchez Pérez
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Kidney and Urinary Tract Area, Chronic Kidney Disease and Renal Replacement Therapy Section, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell, 106, CP 46026, Valencia, Spain
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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López-Vilella R, Jover Pastor P, Donoso Trenado V, Sánchez-Lázaro I, Barge Caballero E, Crespo-Leiro MG, Martínez Dolz L, Almenar Bonet L. Mortality After the First Hospital Admission for Acute Heart Failure, De Novo Versus Acutely Decompensated Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 196:59-66. [PMID: 37088048 DOI: 10.1016/j.amjcard.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 10/08/2022] [Revised: 02/26/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
It is not clear to date whether a first admission in heart failure (HF) marks a worse evolution in patients not previously diagnosed with HF ("de novo HF") than those already diagnosed as outpatients ("acutely decompensated HF"). The aim of the study was to analyze whether survival in patients admitted for de novo HF differs from the survival in those admitted for a first episode of decompensation but with a previous diagnosis of HF. This study includes an analysis of 1,728 patients admitted for decompensated HF during 9 years. Readmissions and patients with left ventricular ejection fraction ≥50% were excluded (finally, 524 patients analyzed). We compared de novo HF (n = 186) in patients not diagnosed with HF, although their structural heart disease was defined, versus acutely decompensated HF (n = 338). The clinical profiles in both groups were similar. The de novo HF group more frequently presented with normal right ventricular function, with less presence of severe tricuspid regurgitation. The probability of survival was low in both groups. Thus, the median life in the de novo HF group was 2.1 years and in the acutely decompensated HF group, 3.5 years. There was a lower probability of long-term survival in the de novo HF group (p = 0.035). The variables associated with mortality were age (p <0.0001), ischemic heart disease (p <0.0001), hypertension (p = 0.009), obesity (p = 0.025), diabetes (p = 0.001), and N-terminal pro-brain natriuretic peptide at admission (p <0.0001). A higher glomerular filtration rate was associated with better survival (p = 0.033). De novo HF was associated with a higher mortality than chronic HF with acute decompensation (hazard ratio 1.53, 95% confidence interval 1.03 to 2.27, p = 0.036). In conclusion, the first admission for HF decompensation in patients with no previous diagnosis of HF identifies a subgroup of patients with higher long-term mortality.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain.
| | - Pablo Jover Pastor
- Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Barge Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain
| | - María Generosa Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain
| | - Luis Martínez Dolz
- Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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López-Vilella R, Guerrero Cervera B, Donoso Trenado V, Sánchez-Lázaro I, Martínez Dolz L, Almenar Bonet L. Is the Benefit of Treating Iron Deficiency Greater in Acute Heart Failure with Renal Dysfunction? Life (Basel) 2023; 13:915. [PMID: 37109444 PMCID: PMC10144873 DOI: 10.3390/life13040915] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND This study aims to analyse whether in acute heart failure (AHF) with iron deficiency (ID), the administration of ferric carboxymaltose (FCM) produces a greater benefit in renal dysfunction. METHODS A total of 812 consecutive patients admitted for AHF and ID were studied. Untreated (n:272) and treated (n:540) patients were compared. The six-month prevalence of a combined event (readmission for HF, all-cause death, and emergency department visit for decompensation) was analysed. Three grades of renal dysfunction (KDIGO) were compared, Group 1 (grades 1 and 2), Group 2 (grades 3a and 3b), and Group 3 (grades 4 and 5). RESULTS There were differences in sex distribution (untreated group: males 39.7% vs. treated group: males 51.9%; p < 0.001). Sex-adjusted combined event analysis showed a greater benefit in Group 1 (OR: 0.31, 95% CI:0.19-0.5; p < 0.001) and Group 2 (OR: 0.23, 95% CI:0.14-0.38; p < 0.001), but not in Group 3 (OR: 0.51, 95% CI:0.17-0.55; p: 0.237). CONCLUSIONS The administration of FCM in patients with AHF and ID reduces the combined event analysed. The benefit is greater when renal dysfunction is present, except in very advanced degrees where no significant benefit is obtained.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe,106, 46026 Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
| | - Borja Guerrero Cervera
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe,106, 46026 Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe,106, 46026 Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Martínez Dolz
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe,106, 46026 Valencia, Spain
- Cardiology Department, Hospital Universitari i Politècnic La Fe, 106, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
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López-Vilella R, Donoso Trenado V, Jover Pastor P, Sánchez-Lázaro I, Martínez Dolz L, Almenar Bonet L. Why Iron Deficiency in Acute Heart Failure Should Be Treated: A Real-World Clinical Practice Study. Life (Basel) 2022; 12:life12111828. [PMID: 36362983 PMCID: PMC9699465 DOI: 10.3390/life12111828] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background. This study aims to determine whether the administration of ferric carboxymaltose (FCM) in patients with acute heart failure (AHF) and iron deficiency (ID) improves morbidity and mortality. Methods. We studied 890 consecutive patients admitted for AHF. Patients were divided into six groups according to reduced left ventricular ejection fraction (HFrEF) or preserved (HFpEF), presence of ID, and administration of FCM. Emergency visits, re-admissions, and all-cause mortality were assessed at 6 months. Results. The overall prevalence of ID was 91.2%. In the HFrEF group, no differences were found in isolated events when patients with untreated vs. treated ID were compared, while differences were found in the combined event rate (p = 0.049). The risk calculation showed an absolute risk reduction (ARR) of 10% and relative risk reduction (RRR) of 18%. In HFpEF there was a positive trend with regard to the combined event (p = 0.107), with an ARR of 9% and an RRR of 15%. The number of patients we needed to treat to prevent a combined event was 10.5 in HFrEF and 10.8 in HFpEF. Conclusions. FCM in AHF reduced the combined event rate of emergency visits, re-admission, and all-cause death at 6 months in HF with left ventricular ejection fraction <50%, and showed a positive trend in HFpEF.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-961245851
| | - Víctor Donoso Trenado
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Pablo Jover Pastor
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Caravaca Perez P, González-Juanatey JR, Nuche J, Matute-Blanco L, Serrano I, Martínez Selles M, Vázquez García R, Martínez Dolz L, Gómez-Bueno M, Pascual Figal D, Crespo-Leiro MG, García-Osuna Á, Ordoñez-Llanos J, Cinca Cuscullola J, Guerra JM, Delgado JF. Renal Function Impact in the Prognostic Value of Galectin-3 in Acute Heart Failure. Front Cardiovasc Med 2022; 9:861651. [PMID: 35463785 PMCID: PMC9021836 DOI: 10.3389/fcvm.2022.861651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Galectin-3 (Gal-3) is an inflammatory marker associated with the development and progression of heart failure (HF). A close relationship between Gal-3 levels and renal function has been observed, but data on their interaction in patients with acute HF (AHF) are scarce. We aim to assess the prognostic relationship between renal function and Gal-3 during an AHF episode. Materials and Methods This is an observational, prospective, multicenter registry of patients hospitalized for AHF. Patients were divided into two groups according to estimated glomerular filtration rate (eGFR): preserved renal function (eGFR ≥ 60 mL/min/1.73 m2) and renal dysfunction (eGFR <60 mL/min/1.73 m2). Cox regression analysis was performed to evaluate the association between Gal-3 and 12-month mortality. Results We included 1,201 patients in whom Gal-3 values were assessed at admission. The median value of Gal-3 in our population was 23.2 ng/mL (17.3–32.1). Gal-3 showed a negative correlation with eGFR (rho = −0.51; p < 0.001). Gal-3 concentrations were associated with higher mortality risk in the multivariate analysis after adjusting for eGFR and other prognostic variables [HR = 1.010 (95%-CI: 1.001–1.018); p = 0.038]. However, the prognostic value of Gal-3 was restricted to patients with renal dysfunction [HR = 1.010 (95%-CI: 1.001–1.019), p = 0.033] with optimal cutoff point of 31.5 ng/mL, with no prognostic value in the group with preserved renal function [HR = 0.990 (95%-CI: 0.964–1.017); p = 0.472]. Conclusions Gal-3 is a marker of high mortality in patients with acute HF and renal dysfunction. Renal function influences the prognostic value of Gal-3 levels, which should be adjusted by eGFR for a correct interpretation.
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Affiliation(s)
- Pedro Caravaca Perez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (Imas12), Madrid, Spain
| | - José R. González-Juanatey
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Facultad de Medicina, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago, Santiago de Compostela, Spain
| | - Jorge Nuche
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Lucia Matute-Blanco
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IBRLLEIDA, Lleida, Spain
| | - Isabel Serrano
- Department of Cardiology, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, Tarragona, Spain
| | - Manuel Martínez Selles
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain
| | - Rafael Vázquez García
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, Spain
| | - Luis Martínez Dolz
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, IIS La Fe, Valencia, Spain
| | - Manuel Gómez-Bueno
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Domingo Pascual Figal
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - María G. Crespo-Leiro
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomedica A Coruña, Universidade da Coruña, A Coruña, Spain
| | - Álvaro García-Osuna
- Servicio de Bioquímica-IIB Sant Pau, Departamento de Bioquímica y Biología Molecular, Universitat Autónoma, Barcelona, Spain
- Fundación Para la Bioquímica y la Patología Molecular, Barcelona, Spain
| | - Jordi Ordoñez-Llanos
- Servicio de Bioquímica-IIB Sant Pau, Departamento de Bioquímica y Biología Molecular, Universitat Autónoma, Barcelona, Spain
- Fundación Para la Bioquímica y la Patología Molecular, Barcelona, Spain
| | - Juan Cinca Cuscullola
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, IIB Sant Pau Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José M. Guerra
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, IIB Sant Pau Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan F. Delgado
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (Imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Juan F. Delgado
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9
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López-Vilella R, Marqués-Sulé E, Sánchez-Lázaro I, Laymito Quispe R, Martínez Dolz L, Almenar Bonet L. Creatinine and NT-ProBNP levels could predict the length of hospital stay of patients with decompensated heart failure. Acta Cardiol 2021; 76:1100-1107. [PMID: 33480331 DOI: 10.1080/00015385.2020.1871264] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome that causes high morbidity and mortality with a high number of admissions and sometimes prolonged admissions. This study aimed at assessing whether parameters detected during the first 24 h of admission may predict a prolonged hospital stay in patients admitted to hospital for decompensated HF. METHODS From January 2016 to December 2019, 2359 admissions of decompensated HF were recorded. In-hospital transfers, de novo HF, deaths and scheduled admissions were discarded to homogenise the sample. Finally, 1196 patients were included. The sample was divided into two groups: (a) non-prolonged admission (n = 643, admission ≤7 days) or (b) prolonged admission (n = 553, admission >7 days). Clinical, analytical, electrocardiographic and echocardiographic variables obtained during the first 24 h of admission were analysed. RESULTS Univariate differences were found at admission in NT-ProBNP, creatinine, history of cardiac surgery, smoking and alcoholism, left and right ventricular ejection fraction, systolic blood pressure and heart rate. The ROC analysis showed significant areas under the curve for the NT-ProBNP (AUC: 0.63, 95% CI: 0.60-0.67; p < 0.001) and creatinine (AUC: 0.69, 95% CI: 0.66-0.72; p < 0.0001). The variables associated with prolonged hospital admission were NT-ProBNP (OR: 1, 95% CI: 1-1; p < 0.001), creatinine (OR: 2.2, 95% CI: 1.8-2.7; p < 0.0001) and previous smoking (OR: 1.5, 95% CI: 0.4-1; p < 0.02). CONCLUSIONS Variables such as creatinine and NT-ProBNP at hospital admission may define a subgroup of patients who will probably have a long hospital stay. Therefore, the planning of hospital care and transition to discharge may be enhanced.
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Affiliation(s)
- Raquel López-Vilella
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Ignacio Sánchez-Lázaro
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Rocío Laymito Quispe
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
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10
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López-Vilella R, Sánchez-Lázaro I, Trenado VD, Edo SL, Dolz LM, Bonet LA. COVID-19 and Heart Transplantation. Initial Experience in a Tertiary Hospital. Transplant Proc 2021; 53:2743-2746. [PMID: 34598811 PMCID: PMC8418905 DOI: 10.1016/j.transproceed.2021.07.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus that is affecting the entire world population. The objective of this study was to analyze the repercussion of the disease in a group of patients at risk such as heart transplant recipients. METHODS From February 2020 to February 2021, heart transplant recipients diagnosed with COVID-19 were consecutively included. The total number of transplant recipients in outpatient follow-up at that time was 381. Three levels of infection were determined: group A: asymptomatic patients or with trivial symptoms without the need for hospital admission (6 patients); group B: patients admitted to the hospital for respiratory symptoms (12 patients); and group C: patients with severe symptoms and need for admission to the critical care unit (2 patients). At each risk level, medical performance was different: group A: close control, no therapeutic modification; group B: reduction of calcineurin inhibitor and substitution of mycophenolate mofetil for everolimus; group C: reduction of calcineurin inhibitor and withdrawal of mycophenolate mofetil. RESULTS The prevalence of infection in the series was 5.2%. Most patients admitted had a pathologic chest x-ray with fever, cough, dyspnea, or vomiting. The change in immunosuppression performed in patients in group 2 was well tolerated and there was no graft rejection. Antiviral treatment was little used. However, boluses of steroids and some antibiotics were used frequently. The need for supplemental oxygen was 50% in group 2 and 100% in group 3. CONCLUSIONS A significant number of transplant recipients will be affected by COVID-19 (5.3%). Management of the infection will depend on the severity of the infection and must be based on a balance between reduction and adjustment of immunosuppression, strict control of the cardiologic situation, and treatment of the infection.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain,Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain,Address correspondence to Dr Raquel López-Vilella. Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Avenida Fernando Abril Martorell, 106, Valencia 46026, Spain. Tel: (+34) 615884883
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain,Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain,Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Silvia Lozano Edo
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain,Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain,Universidad de Valencia, Valencia, Spain
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11
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López-Vilella R, Sánchez-Lázaro I, Moncho AP, Esteban FP, Guillén MP, Jáuregui IZ, Costa RG, Dolz LM, Puerta ST, Bonet LA. Complications After Heart Transplantation According to the Type of Pretransplant Circulatory/Ventricular Support. Transplant Proc 2021; 53:2739-2742. [PMID: 34600757 DOI: 10.1016/j.transproceed.2021.08.040] [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: 05/31/2021] [Revised: 07/06/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of the study was to analyze postcardiac transplant complications in patients who received transplants with short-term mechanical ventricular assist devices and to compare complications according to the type of device. METHODS Ambispective and consecutive study of urgent heart transplants from 2015 to 2019. Pediatric transplants, retransplants, and combined transplants were excluded. A total of 45 patients were analyzed in 4 groups: (1) venoarterial extracorporeal membrane oxygenation (ECMO) implanted <10 days before heart transplant (HTx) (n = 17); (2) ECMO implanted for more than 10 days (n = 8); (3) Levitronix Centrimag implanted in INTERMACS 2 to 3 patients (n = 13); and (4) Levitronix Centrimag implanted in INTERMACS 2 patients (n = 7). ECMO assistance was in INTERMACS 2 and severe right ventricular dysfunction. Levitronix Centrimag was implanted in patients with preserved right ventricular function. RESULTS Primary graft failure associated with the need for ECMO was more frequent in patients with ECMO than with Levitronix (P < .05). When comparing the 2 groups with ECMO, an implant more than 10 days before HTx was associated, after transplant, with a longer stay in the critical care unit (P = .02), higher mortality (P = .03), and an increase in complications in general. When comparing the 2 groups with Levitronix, all the parameters studied were much better when the Levitronix was implanted in INTERMACS 2-3 (P < .05). On the other hand, all cases of deep vein thrombosis and pulmonary thromboembolism occurred in patients who were assisted with ECMO. CONCLUSIONS HTx with mechanical assist devices is associated with significant complications. ECMO produces more complications than the Levitronix Centrimag, although they are related to the days of implantation. The best group are patients implanted with a Levitronix in INTERMACS 2-3.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Azucena Pajares Moncho
- Department of Anesthesiology and Resuscitation, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Francisca Pérez Esteban
- Department of Intensive Medicine, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Manuel Pérez Guillén
- Department of Cardiovascular Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Ricardo Gimeno Costa
- Department of Intensive Medicine, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Universidad de Valencia, Valencia, Spain
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12
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López-Vilella R, Sánchez-Lázaro I, Moncho AP, Peregrina MT, Guillén MP, Jáuregui IZ, Costa RG, Trenado VD, Dolz LM, Puerta ST, Bonet LA. Analysis of the Intrahospital and Long-Term Survival of Heart Transplant Patients With a Short-Term Mechanical Assistance Device. Transplant Proc 2021; 53:2728-2730. [PMID: 34598806 DOI: 10.1016/j.transproceed.2021.06.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to compare early and late survival among patients who have undergone heart transplantation (HTx) with a short-term mechanical assist device. METHODS This was an ambispective, single-center, consecutive study of patients undergoing urgent HTx for 5 years. Pediatric transplants, retransplants, and combined transplants were excluded. Forty-five patients were included. Four groups were analyzed: those with venoarterial extracorporeal membrane oxygenation (ECMO) implanted <10 days before HTx; those with ECMO implanted for >10 days; patients classified as INTERMACS 2 to 3 with Levitronix Centrimag implanted; and those classified as INTERMACS 2 with Levitronix Centrimag implanted. Survival and the influence of orotracheal intubation (OI) at the time of transplantation were compared. RESULTS There were differences in in-hospital mortality (P = .03) and total mortality (P = .06). The groups with the highest risk for mortality were those who carried ECMO for >10 days before transplantation or those classified as INTERMACS 2 with Levitronix Centrimag implanted. In these groups, the need for posttransplant circulatory support was also greater (P = .04) as was the length of stay in critical care (P = .02). The need for OI during the days of care and until transplantation had a negative effect on survival in all groups (P < .1). CONCLUSIONS There are different risk subgroups among patients who are transplanted with a circulatory/ventricular assist device. The lowest mortality occurs when the days of ECMO implantation are <10 and when the implanted device is a Levitronix Centrimag in INTERMACS 2 to 3 profile, particularly when the patient reaches the HTx without requiring OI.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Azucena Pajares Moncho
- Department of Anesthesiology and Resuscitation, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Manuel Pérez Guillén
- Department of Cardiovascular Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Ricardo Gimeno Costa
- Department of Intensive Medicine, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; University of Valencia, Valencia, Spain
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13
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López-Vilella R, Martín PA, Trenado VD, Sánchez-Lázaro I, Ezzitouny M, Pastor PJ, Solé JM, Edo SL, Dolz LM, Bonet LA. Usefulness of Immunoglobulin A in Patients With Decompensated Heart Failure: Is It a Future Marker of Congestion? Preliminary Experience. Transplant Proc 2021; 53:2706-2709. [PMID: 34598812 DOI: 10.1016/j.transproceed.2021.07.051] [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: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to analyze whether the level of IgA is related to right ventricular function and systemic congestion in patients with decompensated heart failure (HF) and reduced ejection fraction (EF). METHODS This was a consecutive prospective and observational study of hospitalized patients diagnosed with decompensated HF with reduced EF. The recruitment period lasted 2 months. In the first 24 hours after admission, clinical assessment, general laboratory tests, determination of HF biomarkers, IgA and echocardiographic study were performed. Patients were classified into 2 groups according to whether the plasma IgA level was lower (n = 11) or higher than 300 mg/dL (n = 12). RESULTS Significant differences in IgA levels were found in the peripheral congestion variables (no congestion: 232, interquartile range [IQR], 125-310 mg/dL vs congestion: 429, IQR, 308-520 mg/dL; P = .03). There were also differences in echocardiographic parameters of right ventricular function, with a greater deterioration of right ventricular function in the group with higher IgA levels (P < .05). There was a highly significant correlation between tricuspid annulus systolic excursion values and IgA levels (P = .004). CONCLUSIONS In decompensated HF, patients with greater clinical congestion and echocardiographic parameters of right ventricular dysfunction have higher plasma IgA levels. This study is a preliminary experience that will help to establish the basis of the cardiointestinal syndrome as a clinical picture of systemic congestion in HF.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | | | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Meryem Ezzitouny
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Jover Pastor
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Julia Martínez Solé
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Silvia Lozano Edo
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; University of Valencia, Valencia, Spain
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14
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López-Vilella R, Sánchez-Lázaro I, Husillos Tamarit I, Monte Boquet E, Núñez Villota J, Donoso Trenado V, Martínez Dolz L, Almenar Bonet L. Administration of Subcutaneous Furosemide in Elastomeric Pump vs. Oral Solution for the Treatment of Diuretic Refractory Congestion. High Blood Press Cardiovasc Prev 2021; 28:589-596. [PMID: 34596886 DOI: 10.1007/s40292-021-00476-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/13/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The most common symptom in heart failure (HF) is congestion, which can be refractory to diuretic treatment. AIM To verify whether, in patients with advanced HF and diuretic resistance, subcutaneous furosemide or furosemide in an oral solution can improve the clinical-analytical status. METHODS From 2018 to 2020, 27 consecutive outpatients with diuretic resistance, not candidates for other alternatives, were recruited. Patients were treated either with subcutaneous furosemide in elastomeric pump (n: 10) or with oral solution (n: 17) for 5 days. RESULTS The functional status (NYHA) improved with subcutaneous administration (predose: 3.8 ± 0.5 vs. postdose: 3.1 ± 0.7; p: 0.02) and oral solution (predose: 3.7 ± 0.3 vs. postdose: 2.5 ± 0.7; p: 0.0001). Weight loss was greater with the oral solution (predose: 85.5 ± 19.5 vs. postdose: 81.3 ± 18.8Kg; p: 0.0001) than subcutaneous (predose: 81.6 ± 15.9 vs. postdose: 80.4 ± 15.1kg; p: 0.16). Creatinine showed a non-significant increase in both groups. The number of hospital visits showed no difference between both options. CONCLUSIONS The administration of furosemide, both subcutaneously by elastomeric pump or drinking the oral solution, is effective for the treatment of congestion in advanced HF refractory to diuretic treatment.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Number 106, Fernando Abril Martorell Av, 46026, Valencia, Spain. .,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Number 106, Fernando Abril Martorell Av, 46026, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Inmaculada Husillos Tamarit
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Number 106, Fernando Abril Martorell Av, 46026, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Emilio Monte Boquet
- Hospital Pharmacy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Julio Núñez Villota
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain.,Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Number 106, Fernando Abril Martorell Av, 46026, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Number 106, Fernando Abril Martorell Av, 46026, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
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15
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Osca Asensi J, Izquierdo de Francisco MT, Cano Pérez Ó, Sancho Tello de Carranza MJ, Alberola Rubio J, Planells Palop C, Lozano Vidal JV, Martínez Dolz L. The RITHMI study: diagnostic ability of a heart rhythm monitor for automatic detection of atrial fibrillation. Rev Esp Cardiol (Engl Ed) 2021; 74:602-607. [PMID: 32792313 DOI: 10.1016/j.rec.2020.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection. METHODS RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram. RESULTS The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98). CONCLUSIONS This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.
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Affiliation(s)
- Joaquín Osca Asensi
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | - Óscar Cano Pérez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - José Alberola Rubio
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Luis Martínez Dolz
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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16
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López-Vilella R, Marqués-Sulé E, Laymito Quispe RDP, Sánchez-Lázaro I, Donoso Trenado V, Martínez Dolz L, Almenar Bonet L. The Female Sex Confers Different Prognosis in Heart Failure: Same Mortality but More Readmissions. Front Cardiovasc Med 2021; 8:618398. [PMID: 33748194 PMCID: PMC7973030 DOI: 10.3389/fcvm.2021.618398] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/16/2020] [Accepted: 02/10/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Heart failure (HF) is a major cause of morbimortality both in men and women. Differences between sex in etiopathogenesis, response to treatment, and quality of care have been found in patients with HF. Females are usually under-represented in clinical trials and there is no solid evidence demonstrating the influence of sex in the prognostic of chronic HF. The primary objective of this study was to analyse the differences in mortality and probability of hospital readmission between males and females with HF. The secondary objective was to compare mortality and probability of hospital readmission by ejection fraction (reduced vs. preserved). Methods: Patients with decompensated HF that were consecutively admitted to a Cardiology Service of a tertiary hospital for 4 years were recruited. De novo HF, death during hospitalization, programmed admissions and those patients with moderate left ventricular ejection fraction (LVEF) (40-50%) were discarded. Finally, 1,291 patients were included. Clinical profiles, clinical history, functional status, treatment at admission, first blood analysis performed, readmissions and mortality at follow-up were analyzed and compared. All patients underwent an echocardiographic study at admission. HF with reduced ejection fraction (HFrEF) was considered when left ventricular ejection fraction (LVEF) was <40%, whilst HF with preserved ejection fraction (HFpEF) was considered when LVEF was ≥50%. Results: 716 participants were male (55%). Basal characteristics showed differences in some outcomes. No differences were found in probability of survival among patients with decompensated HF by sex and ejection fraction (p = 0.25), whereas there was a clear tend to a major survival in females with HFrEF (p < 0.1). Females presented more readmissions when compared to males, independently from the LVEF (females = 33.5% vs. males = 26.8%; p = 0.009). Adjusted multivariate analysis showed no association between sex and mortality (HR = 0.97, IC 95% = 0.73-1.30, p = 0.86), although there was association between female sex and probability of readmission (OR = 1.37, IC 95% = 1.04-1.82, p = 0.02). Conclusions: Sex does not influence mid-term mortality in patients admitted for decompensated HF. Nevertheless, probability of readmission is higher in females independently from LVEF. Thus, it should be considered whether healthcare may be different depending on sex, and a more personalized and frequent care may be recommended in females.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Rocío Del Pilar Laymito Quispe
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
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17
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Caravaca Perez P, González-Juanatey JR, Nuche J, Morán Fernández L, Lora Pablos D, Alvarez-García J, Bascompte Claret R, Martínez Selles M, Vázquez García R, Martínez Dolz L, Cobo-Marcos M, Pascual Figal D, Crespo-Leiro MG, Nuñez Villota J, Cinca Cuscullola J, Delgado JF. Serum potassium dynamics during acute heart failure hospitalization. Clin Res Cardiol 2020; 111:368-379. [DOI: 10.1007/s00392-020-01753-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
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18
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González Saldivar H, Vicent Alaminos L, Rodríguez-Pascual C, de la Morena G, Fernández-Golfín C, Amorós C, Baquero Alonso M, Martínez Dolz L, Ariza Solé A, Guzmán-Martínez G, Gómez-Doblas JJ, Arribas Jiménez A, Fuentes ME, Galian Gay L, Ruiz Ortiz M, Avanzas P, Abu-Assi E, Ripoll-Vera T, Díaz-Castro O, Pozo Osinalde E, Bernal E, Martínez-Sellés M. Evolución de los pacientes con estenosis aórtica grave tras la indicación de intervención. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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19
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González Saldivar H, Vicent Alaminos L, Rodríguez-Pascual C, de la Morena G, Fernández-Golfín C, Amorós C, Baquero Alonso M, Martínez Dolz L, Ariza Solé A, Guzmán-Martínez G, Gómez-Doblas JJ, Arribas Jiménez A, Fuentes ME, Galian Gay L, Ruiz Ortiz M, Avanzas P, Abu-Assi E, Ripoll-Vera T, Díaz-Castro O, Pozo Osinalde E, Bernal E, Martínez-Sellés M. Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention. ACTA ACUST UNITED AC 2018; 72:392-397. [PMID: 29997054 DOI: 10.1016/j.rec.2018.03.023] [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: 06/10/2017] [Accepted: 03/02/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months. METHODS Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR. RESULTS Of 726 patients with severe AS diagnosed in January 2014, the decision to perform an intervention was made in 300, who were included in the present study. The mean age was 74.0 ± 9.7 years. A total of 258 (86.0%) underwent an intervention: 59 TAVI and 199 SAVR. At the end of the year, 42 patients (14.0%) with an indication for an intervention did not receive it, either because they remained on the waiting list (34 patients) or died while waiting for the procedure (8 patients). Of the patients who died while on the waiting list, half did so in the first 100 days. The mean waiting time was 2.9 ± 1.6 for TAVI and 3.5 ± 0.2 months for SAVR (P = .03). The independent predictors of mortality were male sex (HR, 2.6; 95%CI, 1.1-6.0), moderate-severe mitral regurgitation (HR, 2.6; 95%CI, 1.5-4.5), reduced mobility (HR, 4.6; 95%CI, 1.7-12.6), and nonintervention (HR, 2.3; 95%CI, 1.02-5.03). CONCLUSIONS Patients with severe aortic stenosis awaiting therapeutic procedures have a high mortality risk. Some clinical indicators predict a worse prognosis and suggest the need for early intervention.
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Affiliation(s)
- Hugo González Saldivar
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Lourdes Vicent Alaminos
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Gonzalo de la Morena
- Unidad de Imagen, Servicio de Cardiología, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Carmen Amorós
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Luis Martínez Dolz
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Albert Ariza Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gabriela Guzmán-Martínez
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdIPaz), Madrid, Spain
| | | | | | | | - Laura Galian Gay
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Tomás Ripoll-Vera
- Servicio de Cardiología, Hospital Son Llàtzer, Instituto de Investigación Sanitaria de Palma (Idispa), Palma de Mallorca, Balearic Islands, Spain
| | - Oscar Díaz-Castro
- Servicio de Cardiología, Hospital de Pontevedra, Vigo, Pontevedra, Spain
| | | | - Eva Bernal
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain.
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20
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Osca J, Andrés A, Cano O, Alonso P, Sancho Tello MJ, Olagüe J, Martínez Dolz L, Salvador A. Aislamiento eléctrico venoso pulmonar con catéter láser en el tratamiento de la fibrilación auricular paroxística y persistente. Resultados a un año. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Osca J, Andrés A, Cano O, Alonso P, Sancho Tello MJ, Olagüe J, Martínez Dolz L, Salvador A. Electrical Isolation of Pulmonary Veins Using Laser Catheter in the Treatment of Paroxysmal and Persistent Atrial Fibrillation. One-year Results. ACTA ACUST UNITED AC 2015; 69:488-93. [PMID: 26684057 DOI: 10.1016/j.rec.2015.08.022] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/03/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES A new laser balloon that allows visualization of atrial tissue has recently been introduced for pulmonary vein electrical isolation. The aim of this study was to evaluate the mid-term safety and efficacy of this catheter in the treatment of atrial fibrillation. METHODS Laser balloon ablation was performed in 71 patients with paroxysmal (80%) or persistent (20%) atrial fibrillation. Arrhythmia recurrence was defined as any episode lasting longer than 30 seconds. During follow-up, regular visits were performed every 3 months with 24- to 48-hour Holter tests. RESULTS Isolation was possible in 275 of 278 (99%) of pulmonary veins. Mean procedure and fluoroscopy times were 154 ± 25 and 34 ± 15minutes, respectively. A total of 89% of veins were isolated during the first attempt. The most common complication was phrenic nerve paralysis (5.6%), which appeared in only the first 18 cases. A total of 59 patients received follow-up for a mean of 420 ± 193 days, with a rate of arrhythmia recurrence of 12% and 30%, respectively, in paroxysmal and persistent atrial fibrillation (P = .155). CONCLUSIONS The laser balloon is a safe and effective system for pulmonary vein electrical isolation. Its advantages include the capacity to adapt to pulmonary vein anatomy using a single catheter, the efficacy with which pulmonary vein electrical isolation is achieved, and the favorable mid-term clinical progress, even for patients with persistent atrial fibrillation.
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Affiliation(s)
- Joaquín Osca
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Ana Andrés
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Oscar Cano
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pau Alonso
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María José Sancho Tello
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Olagüe
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martínez Dolz
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Salvador
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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22
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Bonet LA, Guillén RV, Lázaro IS, de la Fuente C, Osseyran F, Dolz LM, Hernández MM, Sanz MP, Otero MR, Sanz AS. Intravenous sildenafil in right ventricular dysfunction with pulmonary hypertension following a heart transplant. Heart Int 2014; 9:22-5. [PMID: 27004093 PMCID: PMC4774940] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022] Open
Abstract
The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant (HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented. The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg. In all cases, the hemodynamic study demonstrated PH reactivity (positive vasodilator test with nitric oxide). All 5 patients developed RVD with hemodynamic instability immediately after the HT, despite the administration of nitric oxide from the time of intubation prior to the implant, optimal medical treatment in all cases, and a ventricular assist in 2 cases. In all patients, IV sildenafil was initiated at 10 mg/8 h for 48 h and was subsequently increased to 20 mg/8 h. in its oral formulation until discharge from the hospital. The change in pulmonary pressure was assessed using a Swan-Ganz catheter. Ventricular function was assessed using echocardiography. Length of stay in the Resuscitation Unit and mid-term survival were also assessed. Average time of extracorporeal circulation was 200 ± 110 min and organ ischemic time was 210 ± 95 min. All of the patients demonstrated pulmonary and systemic hemodynamic improvement, as well as recovery of right ventricular function after completing the treatment with IV sildenafil. The stay in the Resuscitation Unit lasted 3-25 days. All the patients were discharged from hospital with no mortality to date. Intravenous sildenafil improves right ventricle hemodynamics associated with pulmonary hypertension post-HT. Prophylactic prevention with this drug could be indicated for patients with reactive PH who are about to receive a transplant.
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Affiliation(s)
- Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Cardiology Department, University and Polytechnic Hospital La Fe, Valencia - Spain
| | - Rosario Vicente Guillén
- Resuscitation Unit, Anesthesiology and Resuscitation Department, University and Polytechnic Hospital La Fe, Valencia - Spain
| | - Ignacio Sánchez Lázaro
- Heart Failure and Transplantation Unit, Cardiology Department, University and Polytechnic Hospital La Fe, Valencia - Spain,Address for correspondence:
avenida Ausias March 2, esc 2, pta 15, 46111 Rocafort, Valencia, Spain
| | - Carmen de la Fuente
- Resuscitation Unit, Anesthesiology and Resuscitation Department, University and Polytechnic Hospital La Fe, Valencia - Spain
| | - Faisa Osseyran
- Resuscitation Unit, Anesthesiology and Resuscitation Department, University and Polytechnic Hospital La Fe, Valencia - Spain
| | - Luis Martínez Dolz
- Heart Failure and Transplantation Unit, Cardiology Department, University and Polytechnic Hospital La Fe, Valencia - Spain
| | | | | | - Miguel Rivera Otero
- Research Center, University and Polytechnic Hospital La Fe, Valencia - Spain
| | - Antonio Salvador Sanz
- Heart Failure and Transplantation Unit, Cardiology Department, University and Polytechnic Hospital La Fe, Valencia - Spain
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23
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Sánchez Lázaro IJ, Almenar Bonet L, Martínez Dolz L, Buendía Fuentes F, Navarro Manchón J, Agüero Ramón-Llin J, Vicente Sánchez JL, Salvador Sanz A. Repeated daclizumab administration to delay the introduction of calcineurin inhibitors in heart transplant patients with postoperative renal dysfunction. Rev Esp Cardiol 2011; 64:237-9. [PMID: 21310520 DOI: 10.1016/j.recesp.2010.05.001] [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] [Received: 02/02/2010] [Accepted: 05/01/2010] [Indexed: 11/29/2022]
Abstract
Daclizumab is an interleukin-2 receptor antagonist which is used for induction therapy in heart transplant patients. It has few side effects and is associated with a low infection rate. Postoperative renal failure after heart transplantation is common and potentially fatal. The administration of calcineurin inhibitors in the postoperative period can aggravate the situation. We report the cases of six patients who underwent heart transplantation and developed acute renal failure in the immediate postoperative period. All were administered daclizumab weekly to avoid the introduction of calcineurin inhibitors and to facilitate recovery of renal function. Calcineurin inhibitors were introduced only once renal function had improved. Renal function recovered in all cases and there was a low complication rate. The administration of repeated doses of daclizumab to patients who experience acute postoperative renal failure after heart transplantation may provide an alternative therapeutic approach that enables calcineurin inhibitors to be avoided and, consequently, renal function to recover.
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Affiliation(s)
- Ignacio J Sánchez Lázaro
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, España
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24
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Rueda Soriano J, Zorio Grima E, Arnau Vives MA, Osa Sáez A, Martínez Dolz L, Almenar Bonet L, Palencia Pérez MA, Salvador Sanz A. Reversal of protein-losing enteropathy after heart transplantation in young patients. Rev Esp Cardiol 2009; 62:937-40. [PMID: 19706251 DOI: 10.1016/s1885-5857(09)72660-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Protein-losing enteropathy is a rare but life-threatening complication that occurs in some patients who develop intestinal lymphangiectasis secondary to increased systemic venous pressure. Although different forms of treatment have been tried, with varying results, the majority were reported to be unsuccessful. The aim of this study was to demonstrate that heart transplantation may be an appropriate therapeutic option for patients who do not respond to medical treatment. At our center, we performed heart transplantations in three patients with this condition. The mean follow-up period was 11+/-2 months. No patient died and the enteropathy regressed in all three.
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25
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Abstract
Imaging techniques play a vital clinical role in patients with heart failure, not only in diagnosis, but also in determining prognosis and evaluating treatment. The more established imaging modalities of echocardiography, nuclear cardiology and computerized tomography, which have been developed in recent years, have been supplemented by nuclear magnetic resonance imaging, a technique that is being rapidly introduced and increasingly used in the field of cardiology. The wide range of imaging techniques available makes it advisable for us to improve our knowledge of their performance, benefits and drawbacks so that we can select the most appropriate techniques for studying this clinical syndrome. This article contains a review of the usefulness of and indications for the different imaging techniques used in managing patients with heart failure.
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Affiliation(s)
- Luis Martínez Dolz
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain.
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26
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Affiliation(s)
- L Almenar
- Service of Cardiology, University Hospital La Fe, Valencia, Spain
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27
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Almenar L, Osa A, Miró V, Arnau MA, Dicenta F, Dolz LM, Rueda J, Palencia M. Utility of acoustic densitometry in graft rejection diagnosis in heart transplantation. Transplant Proc 1999; 31:2544. [PMID: 10500709 DOI: 10.1016/s0041-1345(99)00492-3] [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] [Indexed: 11/23/2022]
Affiliation(s)
- L Almenar
- Service of Cardiology, University Hospital La Fe, Valencia, Spain
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28
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Arnau Vives MA, Bonet LA, Lalaguna LA, Blasco PM, Dolz LM, Sáez AO, Pérez MP. Left ventricular end-diastolic extrasystole with pseudonormalization of a left bundle branch block unmasking inferior ischemia. J Electrocardiol 1999; 32:73-6. [PMID: 10037092 DOI: 10.1016/s0022-0736(99)90024-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An electrocardiogram tracing of a patient in conducted sinus rhythm with left bundle branch block is shown, in which occasional pseudonormalization of intraventricular conduction is seen. This event is attributed to ventricular fusions with end-diastolic extrasystoles of the left His-Purkinje system distal to the block site. This type of extrasystole is discussed. In this case, normalization of ventricular activation allowed for diagnosis of inferior subepicardial ischemia.
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