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Cruz-González I, Antúnez-Muiños P, López-Tejero S, Arnold L, Oldroyd KG. Patient-Specific Commissural Alignment With a Self-Expanding Transcatheter Heart Valve. JACC Case Rep 2024; 29:102190. [PMID: 38379652 PMCID: PMC10874896 DOI: 10.1016/j.jaccas.2023.102190] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/22/2024]
Abstract
A simple and reproducible technique to achieve commissural alignment during transcatheter aortic valve replacement with the Allegra valve is described. Slight rotation of the system before system insertion is necessary. Moreover, thanks to its permaflow system (Biosensors) and its radiopaque markings, small adjustments before valve deployment can be made to reassess correct alignment.
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Affiliation(s)
- Ignacio Cruz-González
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Pablo Antúnez-Muiños
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Sergio López-Tejero
- Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
- Centro de Investigación Biomédica En Red. Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain
| | - Lars Arnold
- Biosensors International, Singapore, Singapore
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López-Tejero S, Antúnez-Muiños P, Fraile-Gómez P, Sousa GBD, Rodríguez-Collado J, Herrero-Garibi J, Blanco-Fernández F, Diego-Nieto A, Delgado-Lapeira GC, Del Villar-Moro MCP, Martín-Moreiras J, Sánchez-Fernández PL, Cruz-González I. Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long-term follow-up. Catheter Cardiovasc Interv 2024; 103:499-510. [PMID: 38168895 DOI: 10.1002/ccd.30946] [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: 10/19/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD. METHODS Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022. RESULTS Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012). CONCLUSIONS LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.
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Affiliation(s)
- Sergio López-Tejero
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pablo Antúnez-Muiños
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pilar Fraile-Gómez
- Department of Nephrology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
| | - Gilles Barreira-de Sousa
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Javier Rodríguez-Collado
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Jesús Herrero-Garibi
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Fabián Blanco-Fernández
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Alejandro Diego-Nieto
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | | | - M Candelas Pérez Del Villar-Moro
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Javier Martín-Moreiras
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Pedro L Sánchez-Fernández
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Spain
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Flores-Umanzor E, Nogic J, Cepas-Guillén P, Hascoet S, Pysz P, Baz JA, Cruz-González I, Amat-Santos IJ, Antúnez-Muiños P, González JC, Ruíz-Quevedo V, Estévez-Loureiro R, Gerardin B, Millan X, Santaló-Corcoy M, Regueiro A, Ibrahim R, Arzamendi D, Onorato EM, Rodés-Cabau J, Horlick E, Calvert PA, Freixa X. Percutaneous paravalvular leak closure after transcatheter aortic valve implantation: the international PLUGinTAVI Registry. EUROINTERVENTION 2023:EIJ-D-22-01110. [PMID: 37128805 PMCID: PMC10397666 DOI: 10.4244/eij-d-22-01110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Data regarding the safety and long-term effectiveness of percutaneous closure of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) are scarce. AIMS This study aims to present a large multicentre international experience of percutaneous post-TAVI PVL closure. METHODS All patients who underwent percutaneous post-TAVI PVL closure in 14 hospitals across Europe and North America between January 2018 and October 2022 were included. RESULTS Overall, 45 patients (64% male) were enrolled. The median age was 80 years (75-84). Among them, 67% and 33% had self-expanding and balloon-expandable valve implantations, respectively. Baseline post-TAVI PVL was severe in 67% of cases and moderate in the rest. The time from index TAVI to PVL closure procedure was 16.1 (8.7-34.8) months. Most patients were in NYHA Class III and IV (73%) before the procedure, and 40% had referred hospitalisations for heart failure between TAVI and the PVL closure procedure. Successful PVL closure was achieved in 94%, reducing regurgitation to ≤mild in 91% and moderate in the rest. The Amplatzer Valvular Plug III was the most frequently used device (27 cases), followed by the Amplatzer Valvular Plug 4. The incidence of severe adverse events was 11%. None of the patients died during the index hospitalisation. During long-term follow-up (21.7±16.2 months), the all-cause mortality rate was 14%, and patients presented improvement in functional status and a significant reduction in the rate of hospitalisation for heart failure (from 40% to 6%). CONCLUSIONS Percutaneous PVL closure is a feasible and safe option for treating post-TAVI leaks. Successful PVL reduction to mild or less could be associated with acute and long-lasting improvements in clinical outcomes.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), Toronto, ON, Canada
| | - Jason Nogic
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Pedro Cepas-Guillén
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | - Sebastian Hascoet
- Marie Lannelongue Hospital, Department of Congenital Heart Diseases, M3C Network, INSERM UMR-S 999, Paris-Saclay University, Plessis-Robinson, Paris, France
| | - Piotr Pysz
- Medical University of Silesia, Katowice, Poland
| | - Jose Antonio Baz
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | | | - Ignacio J Amat-Santos
- Hospital Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | | | - Rodrigo Estévez-Loureiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Benoit Gerardin
- Marie Lannelongue Hospital, Department of Congenital Heart Diseases, M3C Network, INSERM UMR-S 999, Paris-Saclay University, Plessis-Robinson, Paris, France
| | | | | | - Ander Regueiro
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), Toronto, ON, Canada
| | | | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
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López-Tejero S, Antúnez-Muiños P, Cruz-González I. CAVI in CAVI to resolve prosthesis migration. Rev Esp Cardiol (Engl Ed) 2023; 76:390. [PMID: 36202318 DOI: 10.1016/j.rec.2022.09.010] [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] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/19/2022] [Indexed: 04/29/2023]
Affiliation(s)
- Sergio López-Tejero
- Sección de Hemodinámica e Intervencionismo Estructural, Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Pablo Antúnez-Muiños
- Sección de Hemodinámica e Intervencionismo Estructural, Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio Cruz-González
- Sección de Hemodinámica e Intervencionismo Estructural, Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Antúnez-Muiños P, Vicente-Palacios V, Pérez-Sánchez P, Sampedro-Gómez J, Sánchez-Puente A, Dorado-Díaz PI, Nombela-Franco L, Salinas P, Gutiérrez-García H, Amat-Santos I, Peral V, Morcuende A, Asmarats L, Freixa X, Regueiro A, Caneiro-Queija B, Estevez-Loureiro R, Rodés-Cabau J, Sánchez PL, Cruz-González I. Predictive Power for Thrombus Detection after Atrial Appendage Closure: Machine Learning vs. Classical Methods. J Pers Med 2022; 12:jpm12091413. [PMID: 36143197 PMCID: PMC9503612 DOI: 10.3390/jpm12091413] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Device-related thrombus (DRT) after left atrial appendage (LAA) closure is infrequent but correlates with an increased risk of thromboembolism. Therefore, the search for DRT predictors is a topic of interest. In the literature, multivariable methods have been used achieving non-consistent results, and to the best of our knowledge, machine learning techniques have not been used yet for thrombus detection after LAA occlusion. Our aim is to compare both methodologies with respect to predictive power and the search for predictors of DRT. To this end, a multicenter study including 1150 patients who underwent LAA closure was analyzed. Two lines of experiments were performed: with and without resampling. Multivariate and machine learning methodologies were applied to both lines. Predictive power and the extracted predictors for all experiments were gathered. ROC curves of 0.5446 and 0.7974 were obtained for multivariate analysis and machine learning without resampling, respectively. However, the resampling experiment showed no significant difference between them (0.52 vs. 0.53 ROC AUC). A difference between the predictors selected was observed, with the multivariable methodology being more stable. These results question the validity of predictors reported in previous studies and demonstrate their disparity. Furthermore, none of the techniques analyzed is superior to the other for these data.
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Affiliation(s)
- Pablo Antúnez-Muiños
- CIBERCV, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-923291100
| | | | - Pablo Pérez-Sánchez
- CIBERCV, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | | | | | - Pedro Ignacio Dorado-Díaz
- CIBERCV, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
| | - Pablo Salinas
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
| | - Hipólito Gutiérrez-García
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Ignacio Amat-Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Vicente Peral
- Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, 07120 Palma, Spain
| | - Antonio Morcuende
- Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, 07120 Palma, Spain
| | - Lluis Asmarats
- Quebec Heart and Kung Institute, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Xavier Freixa
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Kung Institute, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Pedro Luis Sánchez
- CIBERCV, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Ignacio Cruz-González
- CIBERCV, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
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Núñez García JC, Barreiro-Perez M, Martin-Moreiras J, Antúnez-Muiños P, López-Tejero S, Diego-Nieto A, Collado JR, Herrero-Gabiri J, Sanchez PL, Cruz-Gonzalez I. Transcatheter Management of Tricuspid Regurgitation: The Bailouts and the Process to Success With Multimodality Imaging. JACC Cardiovasc Interv 2022; 15:996-998. [PMID: 35430169 DOI: 10.1016/j.jcin.2022.01.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jean C Núñez García
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain.
| | - Manuel Barreiro-Perez
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain. https://twitter.com/manuelbarreirop
| | - Javier Martin-Moreiras
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain. https://twitter.com/jmmoreiras
| | - Pablo Antúnez-Muiños
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Sergio López-Tejero
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Alejandro Diego-Nieto
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain
| | - Javier Rodriguez Collado
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain
| | - Jesus Herrero-Gabiri
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain
| | - Pedro L Sanchez
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain
| | - Ignacio Cruz-Gonzalez
- Department of Cardiology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain; Network Biomedical Research Center-Cardiovascular Diseases, CIBER-CV (ISCiii), Spain; Medicine Faculty, University of Salamanca (USAL), Salamanca, Spain. https://twitter.com/icruzgonzalez
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Aparisi Á, Catalá P, Amat-Santos IJ, Marcos-Mangas M, López-Otero D, Veras C, López-Pais J, Cabezón-Villalba G, Cacho Antonio CE, Candela J, Antúnez-Muiños P, Gil JF, González Ferrero T, Rojas G, Pérez-Poza M, Uribarri A, Otero-García O, García-Granja PE, Jiménez Ramos V, Revilla A, Dueñas C, Gómez I, González-Juanatey JR, San Román JA. Chronic use of renin–angiotensin–aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis. Medicina Clínica (English Edition) 2022; 158:315-323. [PMID: 35531305 PMCID: PMC9063316 DOI: 10.1016/j.medcle.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/13/2021] [Indexed: 11/08/2022]
Abstract
Background Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. Methods We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings. Results Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (−0.151 [95% CI −0.218, −0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (−0.167 [95% CI −0.220, −0.114]) and during hospitalization (0.090 [−0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224–0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42–0.8]) among hypertensive COVID-19. Conclusion Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.
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López-Tejero S, Antúnez-Muiños P, Martín-Moreiras J, Díaz-Peláez E, Herrero-Garibi J, Diego-Nieto A, Núñez-García JC, Rodríguez-Collado J, Sánchez-Fernández PL, Cruz-González I. Mitral Valve in Valve over “invisible” prothesis with thrombus guided by CT-Fluoro fusion. Can J Cardiol 2022; 38:1323-1324. [DOI: 10.1016/j.cjca.2022.04.001] [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] [Received: 02/08/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
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López-Tejero S, Núñez-García JC, Antúnez-Muiños P, González-Calle D, Martín-Moreiras J, Diego-Nieto A, Rodríguez-Collado J, Herrero-Garibi J, Sánchez-Fernández PL, Cruz-González I. TAVR to Solve Perceval Sutureless Valve Migration. JACC Cardiovasc Interv 2022; 15:e65-e67. [PMID: 35219616 DOI: 10.1016/j.jcin.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Sergio López-Tejero
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain.
| | - Jean C Núñez-García
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain. https://twitter.com/JeanNunezG
| | - Pablo Antúnez-Muiños
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain. https://twitter.com/pjantunez
| | - David González-Calle
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain. https://twitter.com/icruzgonzalez
| | - Javier Martín-Moreiras
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain. https://twitter.com/jmmoreiras
| | - Alejandro Diego-Nieto
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain
| | - Javier Rodríguez-Collado
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain
| | - Jesús Herrero-Garibi
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain
| | | | - Ignacio Cruz-González
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBER-CV, IBSAL, Salamanca, Spain
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Aparisi Á, Catalá P, Amat-Santos IJ, Marcos-Mangas M, López-Otero D, Veras C, López-Pais J, Cabezón-Villalba G, Cacho Antonio CE, Candela J, Antúnez-Muiños P, Gil JF, González Ferrero T, Rojas G, Pérez-Poza M, Uribarri A, Otero-García O, García-Granja PE, Jiménez Ramos V, Revilla A, Dueñas C, Gómez I, González-Juanatey JR, San Román JA. Chronic use of renin-angiotensin-aldosterone inhibitors in hypertensive COVID-19 patients: Results from a Spanish registry and meta-analysis. Med Clin (Barc) 2021; 158:315-323. [PMID: 34088524 PMCID: PMC8101788 DOI: 10.1016/j.medcli.2021.04.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin-angiotensin-aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial. METHODS We have performed a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings. RESULTS Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (-0.151 [95% CI -0.218, -0.084]). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (-0.167 [95% CI -0.220, -0.114]) and during hospitalization (0.090 [-0.008,0.188]). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 [95% CI 0.224-0.881]). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 [95% CI 0.42-0.8]) among hypertensive COVID-19. CONCLUSION Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.
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Affiliation(s)
- Álvaro Aparisi
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain.
| | - Pablo Catalá
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
| | | | - Diego López-Otero
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Carlos Veras
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Javier López-Pais
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - Jordi Candela
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Pablo Antúnez-Muiños
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - José Francisco Gil
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Teba González Ferrero
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Gino Rojas
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Marta Pérez-Poza
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
| | - Oscar Otero-García
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Pablo Elpidio García-Granja
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
| | - Víctor Jiménez Ramos
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Ana Revilla
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
| | - Carlos Dueñas
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario, Valladolid, Spain
| | - Itzíar Gómez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
| | - José Ramón González-Juanatey
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red - Cardiovascular (CIBERCV), Spain
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