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Flores-Umanzor E, Keshvara R, Reza S, Asghar A, Rashidul Anwar M, Cepas-Guillen PL, Osten M, Halankar J, Abrahamyan L, Horlick E. A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes. J Cardiovasc Comput Tomogr 2023; 17:373-383. [PMID: 37635033 DOI: 10.1016/j.jcct.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/25/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300-850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Seleman Reza
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Mohammed Rashidul Anwar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Freixa X, Tolosana JM, Cepas-Guillen PL, Hernández-Enríquez M, Sanchis L, Flores-Umanzor E, Farrero M, Andrea R, Roqué M, Carretero MJ, Regueiro A, Brugaletta S, Rodés-Cabau J, Mont L, Sitges M, Sabaté M, Castel MÁ. Edge-to-Edge Transcatheter Mitral Valve Repair Versus Optimal Medical Treatment in Nonresponders to Cardiac Resynchronization Therapy: The MITRA-CRT Trial. Circ Heart Fail 2022; 15:e009501. [PMID: 36124767 DOI: 10.1161/circheartfailure.121.009501] [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] [Indexed: 12/24/2022]
Affiliation(s)
- Xavier Freixa
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Jose María Tolosana
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Marco Hernández-Enríquez
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Laura Sanchis
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Mercè Roqué
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Maria José Carretero
- Anesthesiology Department (M.J.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Josep Rodés-Cabau
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain.,Quebec Heart and Lung Institute, Quebec City, Canada (J.R.-C.)
| | - Lluís Mont
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - M Ángeles Castel
- Cardiology Department, Cardiovascular Institute (ICCV) (X.F., J.M.T., P.L.C.-G., M.H.-E., L.S., E.F.-U., M.F., R.A., M.R., A.R., S.B., J.R.-C., L.M., M. Sitges, M. Sabaté, M.Á.C.), Hospital Clinic, IDIBAPS, University of Barcelona, Spain
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Flores-Umanzor E, Cepas-Guillen PL, Sanchis L, Regueiro A, Díaz-Ricart M, Freixa X. Spontaneous echo-contrast and prothrombotic status in patients undergoing left atrial appendage occlusion. Rev Esp Cardiol (Engl Ed) 2022; 75:963-965. [PMID: 35637089 DOI: 10.1016/j.rec.2022.04.008] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Eduardo Flores-Umanzor
- Departamento de Cardiología, Instituto Cardiovascular, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Departamento de Cardiología, Instituto Cardiovascular, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Sanchis
- Departamento de Cardiología, Instituto Cardiovascular, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Instituto Cardiovascular, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maribel Díaz-Ricart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Departamento de Hematopatología, Centro Diagnóstico Biomédico, Hospital Clinic, Barcelona, Spain
| | - Xavier Freixa
- Departamento de Cardiología, Instituto Cardiovascular, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Flores-Umanzor E, Cepas-Guillen PL, Sanchis L, Regueiro A, Díaz-Ricart M, Freixa X. Ecocontraste espontáneo y estado protrombótico en pacientes tratados con cierre percutáneo de la orejuela izquierda. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berenguel Senen A, Borrego Rodriguez J, Godoy Lopez JR, Gadella Fernandez A, De Cabo Porras C, Serrano Blanco A, Gallango Brejano M, Gigante Miravalles E, Morante Perea MC, Cepas-Guillen PL, Lazaro Salvador M, Villasante Felix ME, Fernandez-Vazquez F, Rodriguez Padial L. Impact of COVID-19 infection on a physically active population: evaluation functional using the Cardiopulmonar Exercise Test (CPET). Eur J Prev Cardiol 2022. [PMCID: PMC9384026 DOI: 10.1093/eurjpc/zwac056.206] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction An increase it is being seen in patients who are referred for consultation due to dyspnea persistent after having overcome COVID19. The cause for this sequel is still not entirely clear, but our group has observed -in another study- that the consumption of oxygen (VO2) determined by cardiopulmonar exercise test (CPET) in these patients is low with respect to its predicted (p50). The objective of the present work was to demonstrate this hypothesis against to a control group with similar characteristics, who have not suffered from COVID19. Methods We conducted a prospective study with military personnel who are part of a corps of army elite. All subjects have performed the same training daily during the last 2 years. They were divided into 3 groups: the first (G1) made up of those who had not suffered from the COVID19 disease; a second group (G2) that had suffered from it, but did not report impairment of functional class (CF); and a third group (G3) who maintained dyspnea persistent 3 months after suffering from the disease. Analytical with NT-proBNP, echocardiogram, basal spirometry, and CPET were performed. None required hospital admission. Results 36 subjects were included, distributed as follows: G1 (n = 14), G2 (n = 15), G3 (n = 7). The 3 groups had a similar age and BMI. None of the subjects presented alterations in baseline spirometry, neither structural heart disease in the echo, and nor relevant analytical alterations, being NT-proBNP less than 125 pg/ml in all of them. In relation to the response variables cardiovascular, statistical differences (p = 0.03) were observed in peak oxygen consumption predicted among the three groups (% predicted peak VO2), being significantly lower in the G3 subjects. In addition, a trend was observed -in absolute values- of peak VO2 to be lower in G3 -not significant probably due to the small sample size-. They were not objectified significant differences in PulseO2, nor in OUES. No patient presented alterations in the ventilatory efficiency parameters, or in final BR. Conclusions In our sample, patients who remained with persistent dyspnea after COVID-19, have a lower functional capacity compared to healthy subjects of the same characteristics, and with respect to subjects who after COVID19 do not present any symptoms. This subjective deterioration of the FC can be objectively quantified using CPET, thus reaffirming its value in this context.
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Affiliation(s)
| | | | - JR Godoy Lopez
- Escuela Central de Educación Física (ECEF) del Ejército de Tierra, Academia de Infantería, Toledo, Spain
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Flores-Umanzor EJ, Ortega-Paz L, Cepas-Guillen PL, Giacchi G, Padro T, Badimon L, Sabaté M, Brugaletta S. Endothelial Progenitor Cell Function in Patients With Coronary Chronic Total Occlusion and its Relationship With Collateral Circulation. J Invasive Cardiol 2021; 33:E809-E816. [PMID: 34544035] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To evaluate the relationship between endothelial progenitor cell (EPC) count and function and collateral circulation in coronary chronic total occlusions (CTOs). METHODS A total of 20 consecutive patients with successfully treated CTO lesions were included during a period of 12 months. EPC count and function were evaluated by flow cytometry and colony-forming unit (CFU) analysis at baseline (before percutaneous coronary intervention) and at 1-year follow-up. Patients were classified, according to Rentrop classification at the baseline angiography, as group 1 (Rentrop 3; n = 7) and group 2 (Rentrop <3; n = 13). Differences in EPC count and function were compared between groups. RESULTS The EPC count did not differ between the 2 groups, either at baseline or at follow-up. CFU was significantly lower at follow-up compared with baseline in the overall population (16.6 10^6/mL (IQR, 10.2-29.4 10^6/mL) vs 7.1 10^6/mL (IQR, 5.3-25.0 10^6/mL); P=.046). Group 1 had both higher basal and follow-up CFU values compared with group 2 (35.4 10^6/mL (IQR, 21.5-41.8 10^6/mL) vs 13.3 10^6/mL (IQR, 6.9-17.5 10^6/mL) and 32.1 10^6/mL (IQR, 13.9-40.5 10^6/mL) vs 5.9 10^6/mL (IQR, 4.4-9.8 10^6/mL), respectively; P=.01 for both). By linear regression analysis, Rentrop grade 3 flow was an independent predictor of both basal and follow-up CFU levels (odds ratio, 3.66; 95% confidence interval, 6.41-29.69; P<.01; and odds ratio, 5.24; 95% confidence interval, 9.78-25.85; P<.01, respectively). CONCLUSION Patients with Rentrop grade 3 collateral circulation exhibited higher EPC activity at baseline and at 1-year follow-up compared with those who had reduced collateral circulation. The role of this higher EPC activity in determining clinical endpoint should be investigated in a larger study.
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Affiliation(s)
| | | | | | | | | | | | | | - Salvatore Brugaletta
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
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Cepas-Guillen PL, Echarte-Morales J, Flores-Umanzor E, Fernandez-Valledor A, Caldentey G, Viana-Tejedor A, Martinez Gomez E, Tundidor-Sanz E, Borrego-Rodriguez J, Vidal P, Llagostera M, Quiroga X, Freixa X, Fernández-Vázquez F, Sabate M. Sex-gender disparities in nonagenarians with acute coronary syndrome. Clin Cardiol 2021; 44:371-378. [PMID: 33465269 PMCID: PMC7943909 DOI: 10.1002/clc.23545] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Acute coronary syndrome (ACS) remains one of the leading causes of mortality for women, increasing with age. There is an unmet need regarding this condition in a fast‐growing and predominantly female population, such as nonagenarians. Hypothesis Our aim is to compare sex‐based differences in ACS management and long‐term clinical outcomes between women and men in a cohort of nonagenarians. Methods We included consecutive nonagenarian patients with ACS admitted at four academic centers between 2005 and 2018. The study was approved by the Ethics Committee of each center. Results A total of 680 nonagenarians were included (59% females). Of them, 373 (55%) patients presented with non‐ST‐segment elevation ACS and 307 (45%) with ST‐segment elevation myocardial infarction (STEMI). Men presented a higher disease burden compared to women. Conversely, women were frailer with higher disability and severe cognitive impairment. In the STEMI group, women were less likely than men to undergo percutaneous coronary intervention (PCI) (60% vs. 45%; p = .01). Overall mortality rates were similar in both groups but PCI survival benefit at 1‐year was greater in women compared to their male counterparts (82% vs. 68%; p = .008), persisting after sensitivity analyses using propensity‐score matching (80% vs. 64%; p = .03). Conclusion Sex‐gender disparities have been observed in nonagenarians. Despite receiving less often invasive approaches, women showed better clinical outcomes. Our finding may help increase awareness and reduce the current gender gap in ACS management at any age.
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Affiliation(s)
- Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Ana Viana-Tejedor
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Elena Tundidor-Sanz
- Cardiology Department, Complejo Asistencial Universitario de León, León, Spain
| | | | - Pablo Vidal
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Xavier Quiroga
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Manel Sabate
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Flores-Umanzor EJ, Cepas-Guillen PL, Caldentey G, Pérez-Fuentes P, Arévalos V, Ivey-Miranda J, Regueiro A, Freixa X, Brugaletta S, Farrero M, Andrea R, Roquè M, Ferreira-González I, Martin-Yusté V, Sabaté M. Sex-based differences in chronic total occlusion management and long-term clinical outcomes. Int J Cardiol 2020; 319:46-51. [PMID: 32512058 DOI: 10.1016/j.ijcard.2020.05.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/06/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sex differences in coronary artery disease presentation and outcomes have been described. The aim of this study was to compare sex disparities in chronic total occlusion (CTO) management and long-term outcomes. METHODS All consecutive patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortality were assessed during a median follow-up of 4.03 years (IQR 2.6-4.8). RESULTS A total of 1248 patients (67.3 ± 10.9 years; 16% female) were identified. Women were older, had a higher prevalence of type 2 DM and a lower ventricle ejection fraction compared to men (p < .05). Although women had major proportion of positive result for severe ischemia-viability test (86% vs. 74%; p = .01), they were more often treated with MT alone compared to male (57% vs 51%; p = .02). During follow-up, 386 patients (31%) died. Women presented a higher rate of all-cause and cardiac mortality, and hospitalizations for heart failure independently of treatment strategy, compared to men (p < .001). In multivariable analysis female sex was associated with higher cardiac mortality [HR 1.67, 95% CI 1.10-2.57; p < .001]. Among women, the independent predictors for all-cause and cardiac mortalities were age, MT of the CTO and ACEF (age, creatinin and ejection fraction) score. CONCLUSIONS A significant sex gap regarding CTO treatment was observed. Female sex was an independent predictor for cardiac mortality at long-term follow-up. More data are needed to support these findings.
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Affiliation(s)
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Guillem Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain; Cardiology department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain
| | - Pedro Pérez-Fuentes
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Victor Arévalos
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Juan Ivey-Miranda
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Mercé Roquè
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'hebron Hospital, Barcelona and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Victoria Martin-Yusté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain; Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France.
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain.
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Flores-Umanzor EJ, Cepas-Guillen PL, Vázquez S, Fernandez-Valledor A, Ivey-Miranda J, Izquierdo M, Caldentey G, Jimenez-Britez G, Regueiro A, Freixa X, Farrero M, Ferreira-González I, Martin-Yuste V, Sabaté M. Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes. Catheter Cardiovasc Interv 2020; 97:376-383. [PMID: 32096926 DOI: 10.1002/ccd.28815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/26/2019] [Revised: 01/12/2020] [Accepted: 02/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) is common in patients with diabetes mellitus. Data on the long-term outcomes after treatment of CTOs in this high-risk population are scarce. AIM To compare the long-term clinical outcomes of CTO revascularization either by coronary artery bypass graft (CABG) or successful percutaneous coronary intervention (PCI) versus optimal medical treatment (MT) alone in patients with diabetes. METHODS AND RESULTS A total of 538 consecutive patients with diabetes and at least one CTO were identified from 2010 to 2014 in our center. In the present analysis, patients were stratified according to the CTO treatment strategy that was selected. MT was selected in 61% of patients whereas revascularization in the remaining 39%. Patients undergoing revascularization were younger, had higher left ventricular ejection fraction (LVEF), lower ACEF score, and more positive myocardial ischemia detection results compared to the MT group (p < .001).Patients referred for CABG had higher rates of left main disease compared to the PCI and MT groups (32% vs. 3% and 11%, respectively; p < .001). Complete revascularization was more often achieved in the CABG group, compared to the PCI group (62% vs. 32% p < .001). Multivariable analysis showed that revascularization with CABG was associated with lower rates of all-cause and cardiac mortality rates compared to MT, [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25-0.70, p < .001 and HR 0.40, 95% CI 0.20-81, p = .011, respectively]. Successful CTO-PCI showed a trend towards benefit in all-cause mortality (HR 0.58, 95% CI 0.33-1.04, p = .06). CONCLUSION In our registry, CTO revascularization in diabetic patients, especially with CABG, was associated with lower long-term mortality rates as compared to MT alone.
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Affiliation(s)
- Eduardo J Flores-Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Sara Vázquez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Ivey-Miranda
- Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
| | - Marc Izquierdo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Guillem Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain
| | - Gustavo Jimenez-Britez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Victoria Martin-Yuste
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Ivey-Miranda JB, Flores-Umanzor E, Farrero-Torres M, Santiago E, Cepas-Guillen PL, Perez-Villa F. Predictors of renal replacement therapy after heart transplantation and its impact on long-term survival. Clin Transplant 2018; 32:e13401. [PMID: 30176069 DOI: 10.1111/ctr.13401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/10/2018] [Revised: 07/24/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Renal replacement therapy (RRT) after heart transplant (HT) is associated with worse prognosis. We aimed to identify predictors of RRT and the impact of this complication on long-term survival. METHODS Cohort study of HT patients. Univariate and multivariate competing-risk regression was performed to identify independent predictors of RRT. The cumulative incidence function was plotted for RRT. The Kaplan-Meier method was used to compare long-term survival. RESULTS We included 103 patients. At multivariate analysis, only the emergency status of HT (short-term mechanical circulatory support as a bridge to transplant), chronic kidney disease, and low oxygen delivery were independent predictors of RRT (subhazard ratio [SHR] 4.11, 95% CI 1.84-9.14; SHR 3.17, 95% CI 1.29-7.77; SHR 2.86, 95% CI 1.14-7.19, respectively). Elective HT patients that required RRT showed a significantly reduced survival comparable to patients with emergency HT and RRT (75% ± 13% vs. 67% ± 16%). The absence of RRT implied an excellent survival in patients with an emergency status of HT and elective HT (100% vs. 93% ± 4%). CONCLUSION The emergency status of HT, chronic kidney disease, and low oxygen delivery were independent predictors of RRT. The occurrence of RRT increases the risk of death in elective HT as much as in patients with an emergency status.
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Affiliation(s)
- Juan Betuel Ivey-Miranda
- Department of Cardiology, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc, Mexico City, Mexico.,Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
| | - Marta Farrero-Torres
- Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
| | - Evelyn Santiago
- Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
| | - Felix Perez-Villa
- Department of Heart Failure and Heart Transplantation, Institute Clinic Cardiovascular, Hospital Clinic, Barcelona, Spain
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