1
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Pätz T, Santoro F, Cetera R, Ragnatela I, El-Battrawy I, Mezger M, Rawish E, Andrés-Villarreal M, Almendro-Delia M, Martinez-Sellés M, Uribarri A, Pérez-Castellanos A, Guerra F, Novo G, Mariano E, Musumeci MB, Arcari L, Cacciotti L, Montisci R, Akin I, Thiele H, Brunetti ND, Vedia O, Núñez-Gil IJ, Eitel I, Stiermaier T. Trigger-Associated Clinical Implications and Outcomes in Takotsubo Syndrome: Results From the Multicenter GEIST Registry. J Am Heart Assoc 2023:e028511. [PMID: 37421264 PMCID: PMC10382102 DOI: 10.1161/jaha.122.028511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/13/2023] [Indexed: 07/10/2023]
Abstract
Background Takotsubo syndrome is usually triggered by a stressful event. The type of trigger seems to influence the outcome and should therefore be considered separately. Methods and Results Patients included in the GEIST (German-Italian-Spanish Takotsubo) registry were categorized according to physical trigger (PT), emotional trigger (ET), and no trigger (NT) of Takotsubo syndrome. Clinical characteristics as well as outcome predictors were analyzed. Overall, 2482 patients were included. ET was detected in 910 patients (36.7%), PT in 885 patients (34.4%), and NT was observed in 717 patients (28.9%). Compared with patients with PT or NT, patients with ET were younger, less frequently men, and had a lower prevalence of comorbidities. Adverse in-hospital events (NT: 18.8% versus PT: 27.1% versus ET: 12.1%, P<0.001) and long-term mortality rates (NT: 14.4% versus PT: 21.6% versus ET: 8.5%, P<0.001) were significantly lower in patients with ET. Increasing age (P<0.001), male sex (P=0.007), diabetes (P<0.001), malignancy (P=0.002), and a neurological disorder (P<0.001) were associated with a higher risk of long-term mortality, while chest pain (P=0.035) and treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (P=0.027) were confirmed as independent predictors for a lower risk of long-term mortality. Conclusions Patients with ET have better clinical conditions and a lower mortality rate. Increasing age, male sex, malignancy, a neurological disorder, chest pain, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and diabetes were confirmed as predictors of long-term mortality.
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Affiliation(s)
- Toni Pätz
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
| | - Francesco Santoro
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Rosa Cetera
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology Bergmannsheil University Hospitals, Ruhr University of Bochum Bochum Germany
- University of Mannheim, DZHK Partner Site Heidelberg/Mannheim, ECAS (European Center of Angioscience) Mannheim Germany
| | - Matthias Mezger
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
| | - Elias Rawish
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
| | | | | | - Manuel Martinez-Sellés
- Cardiology Department Hospital General Universitario Gregorio Marañon, CIBERCV. Universidad Europea, Universidad Complutense Madrid Spain
| | - Aitor Uribarri
- Servicio de Cardiología Hospital Universitario Vall d'Hebron Barcelona Spain
| | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi" Ancona Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit University of Palermo, University Hospital P. Giaccone Palermo Italy
| | | | - Maria Beatrice Musumeci
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology Sapienza University of Rome Rome Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital Rome Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital Rome Italy
| | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health University of Cagliari Cagliari Italy
| | - Ibrahim Akin
- University of Mannheim, DZHK Partner Site Heidelberg/Mannheim, ECAS (European Center of Angioscience) Mannheim Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany
| | | | - Oscar Vedia
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Universidad Complutense de Madrid Madrid Spain
| | - Ivan J Núñez-Gil
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Universidad Complutense de Madrid Madrid Spain
| | - Ingo Eitel
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
| | - Thomas Stiermaier
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
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2
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Stiermaier T, Walliser A, El-Battrawy I, Pätz T, Mezger M, Rawish E, Andrés M, Almendro-Delia M, Martinez-Sellés M, Uribarri A, Pérez-Castellanos A, Guerra F, Novo G, Mariano E, Musumeci MB, Arcari L, Cacciotti L, Montisci R, Akin I, Thiele H, Brunetti ND, Núñez-Gil IJ, Santoro F, Eitel I. Happy Heart Syndrome: Frequency, Characteristics, and Outcome of Takotsubo Syndrome Triggered by Positive Life Events. JACC Heart Fail 2022; 10:459-466. [PMID: 35772855 DOI: 10.1016/j.jchf.2022.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/08/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association with a preceding stressor is a characteristic feature of takotsubo syndrome (TTS). Negative emotions before TTS are common and led to the popular term "broken heart syndrome." In contrast, pleasant triggers ("happy heart syndrome") are rare and are scarcely investigated. OBJECTIVES The authors analyzed the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry. METHODS Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant emotional events with patients with negative emotional events. RESULTS Of 2,482 patients in the registry, 910 patients (36.7%) exhibited an emotional trigger consisting of 873 "broken hearts" (95.9%) and 37 "happy hearts" (4.1%). Consequently, the prevalence of pleasant emotional triggers was 1.5% of all TTS cases. Compared with patients with TTS with negative preceding events, patients with happy heart syndrome were more frequently male (18.9% vs 5.0%; P < 0.01) and had a higher prevalence of atypical ballooning patterns (27.0% vs 12.5%; P = 0.01), particularly midventricular ballooning. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke (8.1% vs 12.3%; P = 0.45), and long-term mortality rates (2.7% vs 8.8%; P = 0.20) were similar in "happy hearts" and "broken hearts." CONCLUSIONS Happy heart syndrome is a rare type of TTS characterized by a higher prevalence of male patients and atypical, nonapical ballooning compared with patients with negative emotional stressors. Despite similar short- and long-term outcomes in our study, additional data are needed to explore whether numerically lower event rates in "happy hearts" would be statistically significant in a larger sample size. (GErman-Italian-Spanish Takotsubo Registry [GEIST Registry]; NCT04361994).
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Affiliation(s)
- Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | | | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; German Center for Cardiovascular Research, Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Toni Pätz
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Matthias Mezger
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Elias Rawish
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Mireia Andrés
- Cardiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Aitor Uribarri
- Cardiology Service, Valladolid University Hospital, Valladolid, Spain
| | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Umberto I-Lancisi-Salesi University Hospital, Ancona, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit, University of Palermo, P. Giaccone University Hospital, Palermo, Italy
| | - Enrica Mariano
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Maria Beatrice Musumeci
- Department of Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Roberta Montisci
- Division of Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; German Center for Cardiovascular Research, Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Ivan J Núñez-Gil
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
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3
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Diaz-Gonzalez L, Bruña V, Valenzuela PL, Velásquez-Rodriguez J, Boraita A, Lucia A, Martinez-Sellés M. Sinus bradycardia in paediatric athletes. Eur J Prev Cardiol 2021; 28:1142-1144. [PMID: 32517502 DOI: 10.1177/2047487320932254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Vanesa Bruña
- Cardiology Department, University General Hospital Gregorio Marañon, Spain
| | | | | | - Araceli Boraita
- Department of Cardiology, Spanish Sports Health Protection Agency, Spain
| | - Alejandro Lucia
- Universidad Europea de Madrid, Faculty of Sports Sciences, Spain
- Research Institute, Hospital 12 de Octubre (imas12), Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, University General Hospital Gregorio Marañon, Spain
- Universidad Complutense de Madrid, Spain
- Universidad Europea de Madrid, Faculty of Biomedics Sciences, Spain
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4
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Vicent L, Alvarez-Garcia J, Gonzalez-Juanatey JR, Rivera M, Segovia J, Worner F, Bover R, Pascual-Figal D, Vázquez R, Cinca J, Fernandez-Aviles F, Martinez-Sellés M. Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction. Intern Med J 2021; 51:930-938. [PMID: 32237007 DOI: 10.1111/imj.14836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/04/2019] [Revised: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyponatraemia is common in patients with acute heart failure (HF). AIMS To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). METHODS This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal. RESULTS A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. CONCLUSIONS Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Jesús Alvarez-Garcia
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - José Ramón Gonzalez-Juanatey
- Cardiology and Coronary Care Unit Department, Complexo Hospitalario Universitario de Santiago de Compostela, CIBERCV, A Coruña, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Rafael Vázquez
- Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - Francisco Fernandez-Aviles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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5
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Liblik K, Byun J, Saldarriaga C, Perez GE, Lopez-Santi R, Wyss FQ, Liprandi AS, Martinez-Sellés M, Farina JM, Mendoza I, Burgos LM, Baranchuk A. Snakebite Envenomation and Heart: Systematic Review. Curr Probl Cardiol 2021; 47:100861. [PMID: 33992425 DOI: 10.1016/j.cpcardiol.2021.100861] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022]
Abstract
Snakebite envenomation is a neglected tropical disease which can result in morbidity and mortality. Cardiac implications are poorly understood due to the low frequency of cardiotoxicity combined with a lack of robust information, as snakebites commonly occur in remote and rural areas. This review aims to assess cardiovascular implications of snakebite envenoming and proposes an algorithm for screening of cardiovascular manifestations. A systematic review was performed and 29 articles relating to cardiovascular involvement in snakebite envenomation were selected. Cardiovascular involvement seems to be rare and includes a wide spectrum of outcomes, such as myocardial infarction, ventricular dysfunction, hypotension, cardiac arrest, and myocarditis. In a significant proportion of the cases analyzed (24.39%), the cardiovascular manifestations had major consequences (cardiac arrest, myocardial infarction, malignant ventricular arrhythmias, or death). Clinical monitoring, physical examination, and early electrocardiogram should be considered as key measures to detect cardiovascular involvement in patients with evidence of systemic illness.
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Affiliation(s)
- Kiera Liblik
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Jin Byun
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia
| | - Gonzalo E Perez
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Ricardo Lopez-Santi
- Division of Cardiology, Hospital Italiano de la Plata, Buenos Aires, Argentina
| | - Fernando Q Wyss
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Alvaro S Liprandi
- Guatemala Cardiovascular Services and Technology, Cardiosolutions, Guatemala City
| | | | - Juan M Farina
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ivan Mendoza
- Tropical Cardiology, Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela
| | - Lucrecia M Burgos
- Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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6
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Diaz-Gonzalez L, Bruña V, Velásquez-Rodriguez J, Valenzuela PL, Jesús Valero-Masa M, González-Saldívar H, Martinez-Sellés M, Lucia A, Boraita A. The "V1 continuum" in the athletes' ECG. Scand J Med Sci Sports 2021; 30:2277-2278. [PMID: 33463780 DOI: 10.1111/sms.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Vanesa Bruña
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - María Jesús Valero-Masa
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Hugo González-Saldívar
- Hemodynamics Department of the National Institute of Cardiology, San Jorge Hospital, Asunción, Paraguay
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Alejandro Lucia
- European University (Faculty of Sport Sciences) and Research Institute Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
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7
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Diaz-Gonzalez L, Bruña V, Velásquez-Rodriguez J, Valenzuela PL, Valero-Masa MJ, González-Saldívar H, Martinez-Sellés M, Lucia A, Boraita A. Young athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern. Scand J Med Sci Sports 2020; 30:1992-1998. [PMID: 32640481 DOI: 10.1111/sms.13763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/08/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incomplete right bundle branch block (IRBBB) is prevalent among athletes, but its etiology remains to be clearly elucidated and the commonly advocated mechanism, an intraventricular conduction delay, does not explain all cases. In the general population, an apparently similar phenomenon but with different pathophysiology and potential consequences, "crista supraventricularis pattern" (CSP, defined as QRS ≤ 100 ms, S wave <40 ms in I or V6 together with an RSR´ pattern in lead-V1) has been described. Yet, this manifestation has not been studied in athletes. Given that IRBBB can be associated with some serious conditions (including Brugada syndrome, arrhythmogenic cardiomyopathy, or atrial septal defects) the differentiation between IRBB and CSP could enhance the accuracy of the pre-participation screening (PPS). We thus aimed to determine the prevalence of CSP in young athletes. METHODS Observational study of standard 12-lead resting ECG in a cohort of children (5-16 years) attending a PPS program (August 2018-May 2019). RESULTS 6,401 children (mean ± SD age 11.2 ± 2.9 years, 99.2% Caucasian, 93.8% male, 97.2% soccer players) were studied. We found CSP in 850 participants (prevalence = 13.3% [95% confidence interval 12.5-14.1]) whereas 553 (8.6%) had IRBBB. The proportion of athletes showing an S1S2S3 pattern was higher in those with CSP compared with the other QRS morphologies (P < .05). CONCLUSIONS CSP might have been overlooked in previous reports of sports PPS for children and misdiagnosed as IRBBB, as the proportion of the former condition was higher. Our findings might add useful information to improve the interpretation of the young athletes' ECG and thus the diagnostic value of PPS.
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Affiliation(s)
| | - Vanesa Bruña
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - María Jesús Valero-Masa
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Hugo González-Saldívar
- Hemodynamics Department of the National Institute of Cardiology, San Jorge Hospital, Asunción, Paraguay
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Alejandro Lucia
- European University (Faculty of Sport Sciences) and Research Institute Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
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8
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Martinez-Sellés M, Diaz-Gonzalez L, Lucia A. Right ventricular remodeling in athletes and crista supraventricularis pattern. Clin Cardiol 2020; 43:657. [PMID: 32445401 PMCID: PMC7368351 DOI: 10.1002/clc.23383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Manuel Martinez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea. Universidad Complutense, Madrid, Spain
| | | | - Alejandro Lucia
- Faculty of Sport Sciences, European University and Research Institute Hospital 12 de Octubre ('imas12'), Madrid, Spain
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9
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Martínez-Sellés D, Martínez-Sellés H, Martinez-Sellés M. Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion. Eur Cardiol 2020; 15:e48. [PMID: 32514316 PMCID: PMC7265102 DOI: 10.15420/ecr.2020.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is resulting in ethical decisions regarding resource allocation. Prioritisation reflects established practices that regulate the distribution of finite resources when demand exceeds supply. However, discrimination based on sex, race or age has no role in prioritisation unless clearly justified. The risk posed by COVID-19 is higher for elderly people than for younger people, so older adults should be prioritised in preventive measures. In the case of people who already have COVID-19, healthcare professionals might prioritise those most likely to survive. Making decisions based on chronological age alone is not justified; in addition to age, other aspects that determine theoretical life expectancy must be taken into account. Individualised correct prioritisation in the allocation of scarce resources is essential to good clinical practice.
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Affiliation(s)
| | | | - Manuel Martinez-Sellés
- School of Medicine, Complutense University of MadridMadrid, Spain
- Cardiology Department, Gregorio Marañón University Hospital, CIBERCV, European University of MadridMadrid, Spain
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10
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Vicent L, Bruña V, Devesa C, Sousa-Casasnovas I, Juárez M, Fernández-Avilés F, Martinez-Sellés M. Seasonality in Mortality in a Cardiology Department: A Five-Year Analysis in 500 Patients. Cardiology 2019; 142:67-72. [PMID: 30999316 DOI: 10.1159/000497815] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have indicated that cardiovascular mortality follows a seasonal trend. The aim of this work was to determine the evolution of mortality throughout the year in a cardiology department. METHODS All admissions and deaths occurring in our Cardiology Department over a 5-year period (2013-2017) were recorded retrospectively. RESULTS From a total of 17,829 hospital admissions, 500 patients died (2.8%, 0.3 patients/day). The mean age of deceased patients was 74.2 ± 13.1 years, and 186 (37.2%) were women. Mortality ranged from 0.17 deaths/day in August to 0.40 deaths/day in February (p = 0.03), and from 0.20 deaths/day in summer to 0.36 deaths/day in winter (p = 0.001). There was also a trend towards a variation in hospitalizations, with a peak in January (10.5 admissions/day) and the lowest figure in August (7.0 admissions/day), p = 0.047. We found no significant seasonal trend regarding mortality rate with respect to the number of hospital admissions (p = 0.89). The most common cause of death was refractory heart failure (267 patients [65.8%]). A noncardiac cause of death was observed in 134 patients (26.8%). CONCLUSIONS In a cardiology department, there are twice as many deaths in winter as in summer. Hospitalizations also tend to be more frequent in winter than in summer.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Vanesa Bruña
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa-Casasnovas
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martinez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain, .,Universidad Complutense de Madrid, Madrid, Spain, .,Universidad Europea de Madrid, Madrid, Spain,
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Vicent L, Juárez M, Bruña V, Devesa C, Sousa-Casasnovas I, Fernández-Avilés F, Martinez-Sellés M. Clinical Profile and Ventricular Arrhythmias after Sacubitril/Valsartan Initiation. Cardiology 2019; 142:26-27. [PMID: 30870841 DOI: 10.1159/000497190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Lourdes Vicent
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Vanesa Bruña
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa-Casasnovas
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Manuel Martinez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain, .,Universidad Complutense, Madrid, Spain, .,Universidad Europea, Madrid, Spain,
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12
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Lopez-de-Sa E, Juarez M, Armada E, Sanchez-Salado JC, Sanchez PL, Loma-Osorio P, Sionis A, Monedero MC, Martinez-Sellés M, Martín-Benitez JC, Ariza A, Uribarri A, Garcia-Acuña JM, Villa P, Perez PJ, Storm C, Dee A, Lopez-Sendon JL. A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial. Intensive Care Med 2018; 44:1807-1815. [PMID: 30343315 DOI: 10.1007/s00134-018-5256-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 03/16/2018] [Accepted: 05/30/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To obtain initial data on the effect of different levels of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA). METHODS We designed a multicentre pilot trial with 1:1:1 randomization to either 32 °C (n = 52), 33 °C (n = 49) or 34 °C (n = 49), via endovascular cooling devices during a 24-h period in comatose survivors of witnessed OHCA and initial shockable rhythm. The primary endpoint was the percentage of subjects surviving with good neurologic outcome defined by a modified Rankin Scale (mRS) score of ≤ 3, blindly assessed at 90 days. RESULTS At baseline, different proportions of patients who had received defibrillation administered by a bystander were assigned to groups of 32 °C (13.5%), 33 °C (34.7%) and 34 °C (28.6%; p = 0.03). The percentage of patients with an mRS ≤ 3 at 90 days (primary endpoint) was 65.3, 65.9 and 65.9% in patients assigned to 32, 33 and 34 °C, respectively, non-significant (NS). The multivariate Cox proportional hazards model identified two variables significantly related to the primary outcome: male gender and defibrillation by a bystander. Among the 43 patients who died before 90 days, 28 died following withdrawal of life-sustaining therapy, as follows: 7/16 (43.8%), 10/13 (76.9%) and 11/14 (78.6%) of patients assigned to 32, 33 and 34 °C, respectively (trend test p = 0.04). All levels of cooling were well tolerated. CONCLUSIONS There were no statistically significant differences in neurological outcomes among the different levels of TTM. However, future research should explore the efficacy of TTM at 32 °C. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov unique identifier: NCT02035839 ( http://clinicaltrials.gov ).
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Affiliation(s)
- Esteban Lopez-de-Sa
- Acute Cardiac Care Unit, Cardiology Department, Hospital Universitario La Paz, IdiPaz. CIBERCV, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Miriam Juarez
- Cardiology Department, Hospital Universitario Gregorio Marañón. CIBERCV, Calle Dr Esquerdo, 46, 28007, Madrid, Spain
| | - Eduardo Armada
- Acute Cardiac Care Unit, Cardiology Department, Hospital Universitario La Paz, IdiPaz. CIBERCV, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - José C Sanchez-Salado
- Cardiology Department, Hospital Universitario de Bellvitge, Carrer Prínceps d'Espanya s/n, L'Hospitalet de Llobregat, 08902, Barcelona, Spain
| | - Pedro L Sanchez
- Cardiology Department, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Pablo Loma-Osorio
- Cardiology Department, Hospital Universitario Josep Trueta, Avenida França, s/n, 17007, Girona, Spain
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau. IIB-Sant Pau. CIBERCV, Universitat Autònoma de Barcelona, Calle de San Quintín, 89, 08026, Barcelona, Spain
| | - Maria C Monedero
- Acute Cardiac Care Unit, Cardiology Department, Hospital Universitario La Paz, IdiPaz. CIBERCV, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón. CIBERCV, Calle Dr Esquerdo, 46, 28007, Madrid, Spain.,Universidad Complutense, Avenida Séneca 2, Universidad Europea, Calle Tajo s/n, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Juán C Martín-Benitez
- Intensive Care Department, Hospital Clínico San Carlos, Calle Profesor Martin Lagos, 2, 28040, Madrid, Spain
| | - Albert Ariza
- Cardiology Department, Hospital Universitario de Bellvitge, Carrer Prínceps d'Espanya s/n, L'Hospitalet de Llobregat, 08902, Barcelona, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - José M Garcia-Acuña
- Cardiology Department, Complejo Hospitalario Universitario de Santiago. CIBERCV, Travesía Da Choupana S/N, Santiago de Compostela, La Coruña, 15706, Spain
| | - Patricia Villa
- Intensive Care Department, Hospital Universitario Principe de Asturias, Carretera. Alcalá-Meco, s/n, Alcalá de Henares, 28805, Madrid, Spain
| | - Pablo J Perez
- Cardiology Department, Hospital Universitario de Canarias, Calle Ofra S/N, San Cristóbal de La Laguna, 38320, Santa Cruz de Tenerife, Spain
| | - Christian Storm
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne Dee
- Biostatistics Department, ZOLL Medical Corporation, 2000 Ringwood Ave, San Jose, CA, 95131, USA
| | - Jose L Lopez-Sendon
- Acute Cardiac Care Unit, Cardiology Department, Hospital Universitario La Paz, IdiPaz. CIBERCV, Paseo de La Castellana, 261, 28046, Madrid, Spain
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, de Benito AH, Vilardell P, Sánchez-Salado JC, Lorente V, de Luna AB, Martinez-Sellés M. Corrigendum to “Interatrial block, frailty and prognosis in elderly patients with myocardial infarction” [J Electrocardiol 51(2018) 1–7]. J Electrocardiol 2018; 51:747. [DOI: 10.1016/j.jelectrocard.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, Hernández de Benito A, Vilardell P, Sánchez-Salado JC, Lorente V, Bayés de Luna A, Martinez-Sellés M. Interatrial block, frailty and prognosis in elderly patients with myocardial infarction. J Electrocardiol 2017; 51:1-7. [PMID: 28969847 DOI: 10.1016/j.jelectrocard.2017.08.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Eva Bernal
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria T Vidán
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Aboal
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Lídia Alcoberro
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Guerrero
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Iván Ariza-Segovia
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Hernández de Benito
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pau Vilardell
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Victoria Lorente
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés de Luna
- Instituto Catalán de Ciencias Cardiovasculares, Hospital de Sant Pau, Barcelona, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
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Pérez-David E, Martinez-Sellés M, Yotti R, Bermejo J, Alegre MLS, Borreguero JJ, Olivera MJ, Loughlin G, Fernandez Avilés F. Impact of left ventricular late enhancement on pulmonary arterial hypertension in idiopathic dilated cardiomyopathy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328822 DOI: 10.1186/1532-429x-17-s1-p286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martinez-Sellés M, Bueno H, Almendral J, Diaz-Castro O. Pulmonary embolism after pacemaker implantation. Tex Heart Inst J 2001; 28:318-9. [PMID: 11777161 PMCID: PMC101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
One day after implantation of a permanent pacemaker in an 82-year-old man, transthoracic echocardiography showed a mass in the right ventricle and a small pericardial effusion. Transesophageal echocardiography revealed a mass attached to the pacemaker lead. Subcutaneous administration of enoxaparin was begun, and the patient remained free of symptoms for the duration of his hospital stay Follow-up echocardiography performed before discharge failed to show the right ventricular mass, but a lung perfusion scan revealed multiple bilateral perfusion defects consistent with pulmonary emboli. The patient was discharged on a regimen of enoxaparin for another 30 days. Two years later, he remained asymptomatic.
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Affiliation(s)
- M Martinez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Martinez-Sellés M, García-Fernandez MA, Moreno M, Bermejo J, Delcán JL. Echocardiographic features of left atrial dissection. Eur J Echocardiogr 2000; 1:147-50. [PMID: 11916586 DOI: 10.1053/euje.2000.0020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To study left atrial dissection, a rare complication of mitral valve replacement. METHODS AND RESULTS From our hospital database of 5497 transoesophageal echocardiograms, we analysed 524 echocardiograms performed on 478 patients with mitral valve prosthesis. We found four patients (0.84%) with left atrial dissection diagnosed by transoesophageal echocardiography that visualized the left atrial dissection: in three patients the diagnosis was confirmed intraoperatively. Three patients had previously had replacements of the mitral valve. Left atrial dissection was a severe complication: one patient died and the two patients successfully operated on had paraprosthetic regurgitation. CONCLUSION Transoesophageal echocardiography is the first choice for diagnosis of left atrial dissection, a rare complication of mitral valve replacement with an acute/subacute clinical course. Previous mitral valve replacement seems to be the main risk factor to develop left atrial dissection.
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