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Tamargo M, Martínez-Legazpi P, Espinosa MÁ, Lyon A, Méndez I, Gutiérrez-Ibañes E, Fernández AI, Prieto-Arévalo R, González-Mansilla A, Arts T, Delhaas T, Mombiela T, Sanz-Ruiz R, Elízaga J, Yotti R, Tschöpe C, Fernández-Avilés F, Lumens J, Bermejo J. Increased Chamber Resting Tone Is a Key Determinant of Left Ventricular Diastolic Dysfunction. Circ Heart Fail 2023; 16:e010673. [PMID: 38113298 PMCID: PMC10729900 DOI: 10.1161/circheartfailure.123.010673] [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: 03/13/2023] [Accepted: 09/22/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Twitch-independent tension has been demonstrated in cardiomyocytes, but its role in heart failure (HF) is unclear. We aimed to address twitch-independent tension as a source of diastolic dysfunction by isolating the effects of chamber resting tone (RT) from impaired relaxation and stiffness. METHODS We invasively monitored pressure-volume data during cardiopulmonary exercise in 20 patients with hypertrophic cardiomyopathy, 17 control subjects, and 35 patients with HF with preserved ejection fraction. To measure RT, we developed a new method to fit continuous pressure-volume measurements, and first validated it in a computational model of loss of cMyBP-C (myosin binding protein-C). RESULTS In hypertrophic cardiomyopathy, RT (estimated marginal mean [95% CI]) was 3.4 (0.4-6.4) mm Hg, increasing to 18.5 (15.5-21.5) mm Hg with exercise (P<0.001). At peak exercise, RT was responsible for 64% (53%-76%) of end-diastolic pressure, whereas incomplete relaxation and stiffness accounted for the rest. RT correlated with the levels of NT-proBNP (N-terminal pro-B-type natriuretic peptide; R=0.57; P=0.02) and with pulmonary wedge pressure but following different slopes at rest and during exercise (R2=0.49; P<0.001). In controls, RT was 0.0 mm Hg and 1.2 (0.3-2.8) mm Hg in HF with preserved ejection fraction patients and was also exacerbated by exercise. In silico, RT increased in parallel to the loss of cMyBP-C function and correlated with twitch-independent myofilament tension (R=0.997). CONCLUSIONS Augmented RT is the major cause of LV diastolic chamber dysfunction in hypertrophic cardiomyopathy and HF with preserved ejection fraction. RT transients determine diastolic pressures, pulmonary pressures, and functional capacity to a greater extent than relaxation and stiffness abnormalities. These findings support antimyosin agents for treating HF.
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Affiliation(s)
- María Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED, Spain (P.M.-L.)
| | - M. Ángeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Irene Méndez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ana I. Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Raquel Prieto-Arévalo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Theo Arts
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Carsten Tschöpe
- Berlin Institute of Health/Center for Regenerative Therapy (BCRT) at Charite, and Department of Cardiology, Campus Virchow (CVK), Charité Universitätsmedizin, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany (C.T.)
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
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Pastor-Barriuso R, Pérez-Gómez B, Oteo-Iglesias J, Hernán MA, Pérez-Olmeda M, Fernández-de-Larrea N, Molina M, Fernández-García A, Martín M, Cruz I, Sanmartín JL, León-Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. Design and Implementation of a Nationwide Population-Based Longitudinal Survey of SARS-CoV-2 Infection in Spain: The ENE-COVID Study. Am J Public Health 2023; 113:525-532. [PMID: 36893375 PMCID: PMC10088947 DOI: 10.2105/ajph.2022.307167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 03/11/2023]
Abstract
Data System. The Spanish National Seroepidemiological Survey of SARS-CoV-2 (or ENE-COVID; SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] is the causative agent of COVID-19) was funded by the Spanish Ministry of Health, the Instituto de Salud Carlos III, and the Spanish National Health System. Data Collection/Processing. A stratified 2-stage probability sampling was used to select a representative cohort of the noninstitutionalized population of Spain. ENE-COVID collected longitudinal data from epidemiological questionnaires and 2 SARS-CoV-2 IgG antibody tests. From April 27 to June 22, 2020, 68 287 participants (77.0% of contacted persons) received a point-of-care test and 61 095 (68.9%) also underwent a laboratory immunoassay. A second follow-up phase was conducted between November 16 and 30, 2020. Data Analysis/Dissemination. Analyses use weights to adjust for oversampling and nonresponse and account for design effects of stratification and clustering. ENE-COVID data for research purposes will be available upon request from the official study Web page. Public Health Implications. ENE-COVID, a nationwide population-based study, allowed monitoring seroprevalence of antibodies against SARS-CoV-2 at the national and regional levels, providing accurate figures by gender, age (from babies to nonagenarians), and selected risk factors; characterizing symptomatic and asymptomatic infections; and estimating the infection fatality risk during the first pandemic wave. (Am J Public Health. 2023;113(5):525-532. https://doi.org/10.2105/AJPH.2022.307167).
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Affiliation(s)
- Roberto Pastor-Barriuso
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Beatriz Pérez-Gómez
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Jesús Oteo-Iglesias
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Miguel A Hernán
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mayte Pérez-Olmeda
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Nerea Fernández-de-Larrea
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marta Molina
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Aurora Fernández-García
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mariano Martín
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Israel Cruz
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José L Sanmartín
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José León-Paniagua
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Juan F Muñoz-Montalvo
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Faustino Blanco
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Raquel Yotti
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marina Pollán
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
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Pérez-Gómez B, Pastor-Barriuso R, Fernández-de-Larrea N, Hernán MA, Pérez-Olmeda M, Oteo-Iglesias J, Fernández-Navarro P, Fernández-García A, Martín M, Cruz I, Sanmartín JL, León-Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. SARS-CoV-2 Infection During the First and Second Pandemic Waves in Spain: the ENE-COVID Study. Am J Public Health 2023; 113:533-544. [PMID: 36893370 PMCID: PMC10088950 DOI: 10.2105/ajph.2023.307233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 03/11/2023]
Abstract
Objectives. To describe participant characteristics associated with severe acute respiratory syndrome coronavirus 2 infection in Spain's first 2 COVID-19 waves per the Spanish National Seroepidemiological Survey of SARS-CoV-2 Infection (ENE-COVID). Methods. A representative cohort of the noninstitutionalized Spanish population, selected through stratified 2-stage sampling, answered a questionnaire and received point-of-care testing April to June 2020 (first wave: n = 68 287); previously seronegative participants repeated the questionnaire and test November 2020 (second wave: n = 44 451). We estimated seropositivity by wave and participant characteristics, accounting for sampling weights, nonresponse, and design effects. Results. We found that 6.0% (95% confidence interval [CI] = 5.7%, 6.4%) of Spain's population was infected by June and 3.8% (95% CI = 3.5%, 4.1%) more by November 2020. Both genders were equally affected. Seroprevalence decreased with age in adults 20 years and older in the second wave; socioeconomic differences increased. Health care workers were affected at 11.1% (95% CI = 9.0%, 13.6%) and 6.1% (95% CI = 4.4%, 8.5%) in the first and second waves, respectively. Living with an infected person increased infection risk to 22.1% (95% CI = 18.9%, 25.6%) in the first and 35.0% (95% CI = 30.8%, 39.4%) in the second wave. Conclusions. ENE-COVID characterized the first 2 pandemic waves, when information from surveillance systems was incomplete. (Am J Public Health. 2023;113(5):533-544. https://doi.org/10.2105/AJPH.2023.307233).
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Affiliation(s)
- Beatriz Pérez-Gómez
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Roberto Pastor-Barriuso
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Nerea Fernández-de-Larrea
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Miguel A Hernán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mayte Pérez-Olmeda
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Jesús Oteo-Iglesias
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Pablo Fernández-Navarro
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Aurora Fernández-García
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mariano Martín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Israel Cruz
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José L Sanmartín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José León-Paniagua
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Juan F Muñoz-Montalvo
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Faustino Blanco
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Raquel Yotti
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marina Pollán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
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Tamargo M, Martinez-Legazpi P, Gutierrez E, Espinosa MA, Mendez I, Fernandez AI, Prieto-Arevalo R, Gonzalez-Mansilla A, Mombiela T, Sanz-Ruiz R, Elizaga J, Yotti R, Fernandez-Aviles F, Bermejo J. Exercise unmasks impaired vascular and cardiac hemodynamic in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Exertional dyspnea is a common finding in patients with Hypertrophic Cardiomyopathy (HCM), yet little data is available regarding the hemodynamic disturbances that lead to symptom development in this population.
Purpose
To investigate the mechanisms involved in the functional limitation of patients with HCM.
Methods
We prospectively studied 20 symptomatic patients with confirmed diagnosis of HCM. Assessment included NT-pro BNP levels, echocardiogram, and invasive characterization, where subjects also underwent invasive cardiopulmonary exercise testing.
Results
Median patient age was 57 (48–66) years old and 15 (75%) were male. Basal NT-pro BNP was elevated (748 pg/mL [406–1082]) and 8 (40%) subjects had NYHA functional Class III despite optimal medical treatment. Sarcomeric abnormal mutations were identified in 12 subjects (60%), most frequently in MYBPC3. Ultrasound imaging showed marked left ventricle (LV) hypertrophy (LV Mass Index 140 g/m2 [109–161]), with signs of LV outflow obstruction in 13 (65%) subjects. All patients displayed preserved ejection fraction (68% [61–73]). Significant mitral regurgitation was present in 5 subjects and median E/e' was 9.87 [6.43–13.14].
At rest, biventricular filling pressures were relatively normal, with upper limit mean Pulmonary Pressure (Table). Patients exercised for 6.4 (95% CI: 5.6–7.2) min, achieving a respiratory exchange ratio of 1.11 (1.02–1.17). All subjects displayed normal cardiac output at rest (5.6 L/min (3.7–7.5)), that increased during exertion, due mostly to a rise in heart rate (p<0.0001). Exercise doubled LV End-Diastolic Pressure from 15.3 (11.5–19.1) mmHg at baseline to 30.4 (26.6–34.3) mmHg at peak VO2 (p<0.0001), whereas mean pulmonary pressure increased from 21 (14–29) mmHg to 40 (33–47) mmHg (p<0.0001).
Remarkably, although arterial hemodynamics were relatively normal at baseline, exercise induced significant increases both in the continuous (systemic vascular resistance) and pulsatile components of vascular load (Impedances, p<0.05; Table 1) (Figure 1). This increase in afterload during exertion has not been previously documented in HCM. The decreased compliance derived, can also play a role in the elevated filling pressures documented on exertion.
Conclusion
Exercise unmasks adverse hemodynamics in HCM, severely increasing LV filling pressures and showing systemic arterial dysfunction.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spain.
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Affiliation(s)
- M Tamargo
- University Hospital Gregorio Maranon , Madrid , Spain
| | | | - E Gutierrez
- University Hospital Gregorio Maranon , Madrid , Spain
| | - M A Espinosa
- University Hospital Gregorio Maranon , Madrid , Spain
| | - I Mendez
- University Hospital Gregorio Maranon , Madrid , Spain
| | - A I Fernandez
- University Hospital Gregorio Maranon , Madrid , Spain
| | | | | | - T Mombiela
- University Hospital Gregorio Maranon , Madrid , Spain
| | - R Sanz-Ruiz
- University Hospital Gregorio Maranon , Madrid , Spain
| | - J Elizaga
- University Hospital Gregorio Maranon , Madrid , Spain
| | - R Yotti
- University Hospital Gregorio Maranon , Madrid , Spain
| | | | - J Bermejo
- University Hospital Gregorio Maranon , Madrid , Spain
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5
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Fernández AI, Bermejo J, Yotti R, Martínez-Gonzalez MÁ, Mira A, Gophna U, Karlsson R, Al-Daccak R, Martín-Demiguel I, Gutiérrez-Ibanes E, Charron D, Fernández-Avilés F. The impact of Mediterranean diet on coronary plaque vulnerability, microvascular function, inflammation and microbiome after an acute coronary syndrome: study protocol for the MEDIMACS randomized, controlled, mechanistic clinical trial. Trials 2021; 22:795. [PMID: 34772433 PMCID: PMC8588729 DOI: 10.1186/s13063-021-05746-z] [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] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background Primary prevention trials have demonstrated that the traditional Mediterranean diet is associated with a reduction in cardiovascular mortality and morbidity. However, this benefit has not been proven for secondary prevention after an acute coronary syndrome (ACS). We hypothesized that a high-intensity Mediterranean diet intervention after an ACS decreases the vulnerability of atherosclerotic plaques by complex interactions between anti-inflammatory effects, microbiota changes and modulation of gene expression. Methods The MEDIMACS project is an academically funded, prospective, randomized, controlled and mechanistic clinical trial designed to address the effects of an active randomized intervention with the Mediterranean diet on atherosclerotic plaque vulnerability, coronary endothelial dysfunction and other mechanistic endpoints. One hundred patients with ACS are randomized 1:1 to a monitored high-intensity Mediterranean diet intervention or to a standard-of-care arm. Adherence to diet is assessed in both arms using food frequency questionnaires and biomarkers of compliance. The primary endpoint is the change (from baseline to 12 months) in the thickness of the fibrous cap of a non-significant atherosclerotic plaque in a non-culprit vessel, as assessed by repeated optical coherence tomography intracoronary imaging. Indices of coronary vascular physiology and changes in gastrointestinal microbiota, immunological status and protein and metabolite profiles will be evaluated as secondary endpoints. Discussion The results of this trial will address the key effects of dietary habits on atherosclerotic risk and will provide initial data on the complex interplay of immunological, microbiome-, proteome- and metabolome-related mechanisms by which non-pharmacological factors may impact the progression of coronary atherosclerosis after an ACS. Trial registration ClinicalTrials.govNCT03842319. Registered on 13 May 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05746-z.
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Affiliation(s)
- Ana I Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain.
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Miguel Ángel Martínez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, CIBEROBN, Pamplona, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - Alex Mira
- Department of Health and Genomics, Center for Advanced Research in Public Health, CSISP-FISABIO, and CIBERESP, Valencia, Spain
| | - Uri Gophna
- Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Roger Karlsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy of the University of Gothenburg; Sweden Nanoxis Consulting AB; Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Reem Al-Daccak
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS-97f, Université Paris-Diderot, HLA et Médecine, Labex Transplantex, Hôpital Saint-Louis, Paris, France
| | - Irene Martín-Demiguel
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Enrique Gutiérrez-Ibanes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Dominique Charron
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS-97f, Université Paris-Diderot, HLA et Médecine, Labex Transplantex, Hôpital Saint-Louis, Paris, France
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
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Méndez I, Fernández AI, Espinosa MÁ, Cuenca S, Lorca R, Rodríguez JF, Tamargo M, García-Montero M, Gómez C, Vilches S, Vázquez N, Álvarez R, Medrano C, Yotti R, Fernández-Avilés F, Bermejo J. Founder mutation in myosin-binding protein C with an early onset and a high penetrance in males. Open Heart 2021; 8:openhrt-2021-001789. [PMID: 34588271 PMCID: PMC8483030 DOI: 10.1136/openhrt-2021-001789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE One of the challenges in hypertrophic cardiomyopathy (HCM) is to determine the pathogenicity of genetic variants and to establish genotype/phenotype correlations. This study aimed to: (1) demonstrate that MYBPC3 c.2149-1G>A is a founder pathogenic variant, (2) describe the phenotype and clinical characteristics of mutation carriers and (3) compare these patients with those with the most frequent pathogenic HCM variants: MYBPC3 p.Arg502Trp/Gln. METHODS We reviewed genetic tests performed in HCM probands at our institution. We carried out transcript analyses to demonstrate the splicing effect, and haplotype analyses to support the founder effect of MYBPC3 c.2149-1G>A. Carriers with this mutation were compared with those from MYBPC3 p.Arg502Trp/Gln in terms of presentation features, imaging and outcomes. RESULTS MYBPC3 c.2149-1G>A was identified in 8 of 570 probands and 25 relatives. Penetrance was age and sex dependent, 50.0% of the carriers over age 36 years and 75.0% of the carriers over 40 years showing HCM. Penetrance was significantly higher in males: in carriers older than 30 years old, 100.0% of males vs 50.0% of females had a HCM phenotype (p=0.01). Males were also younger at diagnosis (32±13 vs 53±10 years old, p<0.001). MYBPC3 c.2149-1G>A resulted in an abnormal transcript that led to haploinsufficiency and was segregated in two haplotypes. However, both came from one founder haplotype. Affected carriers showed a better functional class and higher left ventricular ejection fraction (LVEF) than patients with MYBPC3 p.Arg502Trp/Gln (p<0.05 for both). Nevertheless, the rate of major adverse outcomes was similar between the two groups. CONCLUSIONS MYBPC3 c.2149-1G>A splicing variant is a founder mutation. Affected males show an early onset of HCM and with higher penetrance than women. Carriers show better functional class and higher LVEF than MYBPC3 p.Arg502Trp/Gln carriers, but a similar rate of major adverse outcomes.
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Affiliation(s)
- Irene Méndez
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain .,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Ana Isabel Fernández
- CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Maria Ángeles Espinosa
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Sofía Cuenca
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Rebeca Lorca
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - José Fernando Rodríguez
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Maria Tamargo
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Marta García-Montero
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Cristina Gómez
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Silvia Vilches
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Nélida Vázquez
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Reyes Álvarez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain.,Pediatric Cardiology, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Constancio Medrano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain.,Pediatric Cardiology, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | | | - Francisco Fernández-Avilés
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Javier Bermejo
- Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBERCV, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Akhtar MM, Lorenzini M, Pavlou M, Ochoa JP, O’Mahony C, Restrepo-Cordoba MA, Segura-Rodriguez D, Bermúdez-Jiménez F, Molina P, Cuenca S, Ader F, Larrañaga-Moreira JM, Sabater-Molina M, Garcia-Alvarez MI, Arantzamendi LG, Truszkowska G, Ortiz-Genga M, Ruiz IS, Nielsen SK, Rasmussen TB, Robles Mezcua A, Alvarez-Rubio J, Eiskjaer H, Gautel M, Garcia-Pinilla JM, Ripoll-Vera T, Mogensen J, Limeres Freire J, Rodríguez-Palomares JF, Peña-Peña ML, Rangel-Sousa D, Palomino-Doza J, Arana Achaga X, Bilinska Z, Zamarreño Golvano E, Climent V, Peñalver MN, Barriales-Villa R, Charron P, Yotti R, Zorio E, Jiménez-Jáimez J, Garcia-Pavia P, Elliott PM. Association of Left Ventricular Systolic Dysfunction Among Carriers of Truncating Variants in Filamin C With Frequent Ventricular Arrhythmia and End-stage Heart Failure. JAMA Cardiol 2021; 6:891-901. [PMID: 33978673 PMCID: PMC8117057 DOI: 10.1001/jamacardio.2021.1106] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
Importance Truncating variants in the gene encoding filamin C (FLNCtv) are associated with arrhythmogenic and dilated cardiomyopathies with a reportedly high risk of ventricular arrhythmia. Objective To determine the frequency of and risk factors associated with adverse events among FLNCtv carriers compared with individuals carrying TTN truncating variants (TTNtv). Design, Setting, and Participants This cohort study recruited 167 consecutive FLNCtv carriers and a control cohort of 244 patients with TTNtv matched for left ventricular ejection fraction (LVEF) from 19 European cardiomyopathy referral units between 1990 and 2018. Data analyses were conducted between June and October, 2020. Main Outcomes and Measures The primary end point was a composite of malignant ventricular arrhythmia (MVA) (sudden cardiac death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator shock, and sustained ventricular tachycardia) and end-stage heart failure (heart transplant or mortality associated with end-stage heart failure). The secondary end point comprised MVA events only. Results In total, 167 patients with FLNCtv were studied (55 probands [33%]; 89 men [53%]; mean [SD] age at baseline evaluation, 43 [18] years). For a median follow-up of 20 months (interquartile range, 7-60 months), 29 patients (17.4%) reached the primary end point (19 patients with MVA and 10 patients with end-stage heart failure). Eight (44%) arrhythmic events occurred among individuals with baseline mild to moderate left ventricular systolic dysfunction (LVSD) (LVEF = 36%-49%). Univariable risk factors associated with the primary end point included proband status, LVEF decrement per 10%, ventricular ectopy (≥500 in 24 hours) and myocardial fibrosis detected on cardiac magnetic resonance imaging. The LVEF decrement (hazard ratio [HR] per 10%, 1.83 [95% CI, 1.30-2.57]; P < .001) and proband status (HR, 3.18 [95% CI, 1.12-9.04]; P = .03) remained independent risk factors on multivariable analysis (excluding myocardial fibrosis and ventricular ectopy owing to case censoring). There was no difference in freedom from MVA between FLNCtv carriers with mild to moderate or severe (LVEF ≤35%) LVSD (HR, 1.29 [95% CI, 0.45-3.72]; P = .64). Carriers of FLNCtv with impaired LVEF at baseline evaluation (n = 69) had reduced freedom from MVA compared with 244 TTNtv carriers with similar baseline LVEF (for mild to moderate LVSD: HR, 16.41 [95% CI, 3.45-78.11]; P < .001; for severe LVSD: HR, 2.47 [95% CI, 1.04-5.87]; P = .03). Conclusions and Relevance The high frequency of MVA among patients with FLNCtv with mild to moderate LVSD suggests that higher LVEF values than those currently recommended should be considered for prophylactic implantable cardioverter-defibrillator therapy in FLNCtv carriers.
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MESH Headings
- Adult
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Codon, Nonsense
- Connectin/genetics
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Filamins/genetics
- Heart Failure/genetics
- Heart Failure/mortality
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Transplantation/statistics & numerical data
- Humans
- Male
- Middle Aged
- Mutation
- Stroke Volume
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Mohammed Majid Akhtar
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Massimiliano Lorenzini
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | | | - Constantinos O’Mahony
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | | | | | - Pilar Molina
- Pathology Department, Institute of Legal Medicine and Forensic Sciences of Valencia and Faculty of Medicine of the Universitat de València, CAFAMUSME Research Group, IIS La Fe, Valencia, Spain
| | - Sofia Cuenca
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Flavie Ader
- APHP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Hôpitaux Universitaires de la Pitié- Salpêtrière- Charles Foix, 47-83 Bd de l’Hôpital, Paris, France
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Jose M. Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Maria Sabater-Molina
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
| | - Maria I. Garcia-Alvarez
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Grazyna Truszkowska
- Molecular Biology Laboratory, Department of Medical Biology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Itziar Solla Ruiz
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | | | | | - Ainhoa Robles Mezcua
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Jorge Alvarez-Rubio
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Hjertesygdomme, Aarhus, Denmark
| | - Mathias Gautel
- Randall Institute, King’s College London, London, United Kingdom
| | - José M. Garcia-Pinilla
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Javier Limeres Freire
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose F. Rodríguez-Palomares
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Luisa Peña-Peña
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Diego Rangel-Sousa
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Julian Palomino-Doza
- Hereditary Cardiopathies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de Investigación 12 de Octubre i+12, Madrid, Spain
| | - Xabier Arana Achaga
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | - Zofia Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Vincent Climent
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Philippe Charron
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
- APHP, Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department at Hospital Universitario y Politécnico La Fe and Research Group on Inherited Heart Diseases, Sudden Death and Mechanisms of Disease (CaFaMuSMe) from the Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Perry M. Elliott
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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Pérez-Gómez B, Pastor-Barriuso R, Pérez-Olmeda M, Hernán MA, Oteo-Iglesias J, Fernández de Larrea N, Fernández-García A, Martín M, Fernández-Navarro P, Cruz I, Sanmartín JL, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19. J Clin Epidemiol 2021; 139:240-254. [PMID: 34126206 PMCID: PMC8192836 DOI: 10.1016/j.jclinepi.2021.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/09/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022]
Abstract
Objectives To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. Study design and setting Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. Results Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals <20 and ≥80 years vs. those aged 40–59, 1.27 (1.03–1.55) for smokers vs. nonsmokers, and 1.91 (1.59–2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37–10.3), discrimination index of 0.79 (0.77–0.81), and sensitivity and specificity of 71.4% (68.1–74.4%) and 74.2% (73.1–75.2%) for a score ≥3. Conclusion The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
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Affiliation(s)
- Beatriz Pérez-Gómez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard T H Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, 677 Huntington Ave, Boston, MA 02115, USA
| | - Jesús Oteo-Iglesias
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain
| | - Mariano Martín
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Jose L Sanmartín
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Jose León Paniagua
- Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Juan F Muñoz-Montalvo
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Faustino Blanco
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Raquel Yotti
- Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Marina Pollán
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain.
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10
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Affiliation(s)
- Miguel A Hernán
- Miguel A. Hernán is with the departments of epidemiology and biostatistics of the Harvard T. H. Chan School of Public Health, Boston, MA. Raquel Yotti is with the Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Yotti
- Miguel A. Hernán is with the departments of epidemiology and biostatistics of the Harvard T. H. Chan School of Public Health, Boston, MA. Raquel Yotti is with the Instituto de Salud Carlos III, Madrid, Spain
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11
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Bermejo J, González-Mansilla A, Mombiela T, Fernández AI, Martínez-Legazpi P, Yotti R, García-Orta R, Sánchez-Fernández PL, Castaño M, Segovia-Cubero J, Escribano-Subias P, Alberto San Román J, Borrás X, Alonso-Gómez A, Botas J, Crespo-Leiro MG, Velasco S, Bayés-Genís A, López A, Muñoz-Aguilera R, Jiménez-Navarro M, González-Juanatey JR, Evangelista A, Elízaga J, Martín-Moreiras J, González-Santos JM, Moreno-Escobar E, Fernández-Avilés F. Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival. J Am Heart Assoc 2021; 10:e019949. [PMID: 33399006 PMCID: PMC7955299 DOI: 10.1161/jaha.120.019949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/24/2022]
Abstract
Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.
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Affiliation(s)
- Javier Bermejo
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Ana González-Mansilla
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Teresa Mombiela
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Ana I Fernández
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Pablo Martínez-Legazpi
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | | | | | | | | | | | | | | | - Xavier Borrás
- Hospital Santa Creu i San Pau and CIBERCV Barcelona Spain
| | | | - Javier Botas
- Hospital Universitario Fundación Alcorcón Alcorcón Spain
| | | | | | | | - Amador López
- Hospital Universitario Reina Sofía Córdoba Spain
| | | | | | | | | | - Jaime Elízaga
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | | | | | | | - Francisco Fernández-Avilés
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
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12
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Téllez L, Ibáñez-Samaniego L, Pérez Del Villar C, Yotti R, Martínez J, Carrión L, Rodríguez de Santiago E, Rivera M, González-Mansilla A, Pastor Ó, Bermejo J, Bañares R, Albillos A. Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites. J Hepatol 2020; 73:1404-1414. [PMID: 32446716 DOI: 10.1016/j.jhep.2020.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The safety of non-selective β-blockers (NSBBs) has been questioned in refractory ascites (RA). We studied the effects of NSBBs on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive ascites (DRA) and RA. METHODS We performed a prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBBs for variceal bleeding prophylaxis. Systolic function (by ejection intraventricular pressure difference [EIVPD]), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation were measured at baseline and after 4 weeks of propranolol. RESULTS EIVPD was elevated at baseline (RA 4.5 [2.8-5.7] and DRA 4.2 [3.1-5.7] mmHg; normal 2.4-3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBBs led to similar reductions in heart rate and HVPG in both groups. NSBBs reduced EIPVD in RA but not in DRA (-20% vs. -2%, p <0.01). In RA, the NSBB-induced reduction in EIPVD correlated with the severity of vasodilation and with higher plasma nitric oxide, norepinephrine and IL-6 (r >0.40, all p <0.05). NSBBs reduced RPP in both groups, but impaired renal function only in patients with RA. Reduced EIPVD correlated with decreases in RPP and estimated glomerular filtration rate (r >0.40, all p <0.01). After NSBB treatment, RPP dropped below the threshold of renal flow autoregulation in 11 of the 20 (55%) patients with RA, including the 4 fulfilling the criteria for HRS-AKI. CONCLUSION Renal perfusion and function depend critically on systolic function and sympathetic hyperactivation in RA. NSBBs blunt the sympathetic overdrive, hamper cardiac output, lower RPP below the critical threshold and impair renal function. β-blockade should be used cautiously or even avoided in patients with RA. LAY SUMMARY We have identified the mechanisms by which non-selective beta-blockers could impair survival in patients with refractory ascites. We show that peripheral vasodilation and sympathetic activation lead to increased left ventricle systolic function in patients with cirrhosis and ascites, which acts as an adaptive mechanism to maintain renal perfusion. When ascites becomes refractory, this compensatory cardiac response to vasodilation is critically dependent on sympathetic hyperactivation and is hardly able to maintain renal perfusion. In this setting, β-blockade blunts the sympathetic overdrive of cardiac function, hampers cardiac output, lowers renal perfusion pressure below the critical threshold and impairs renal function.
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Affiliation(s)
- Luis Téllez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Luis Ibáñez-Samaniego
- Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBEREHD, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBERCV, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBERCV, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Martínez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Laura Carrión
- Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBEREHD, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Maite Rivera
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBERCV, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Óscar Pastor
- Servicio de Bioquímica Clínica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEROBN, Universidad de Alcalá, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBERCV, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Rafael Bañares
- Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (iISGM), CIBEREHD, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain.
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Pastor-Barriuso R, Pérez-Gómez B, Hernán MA, Pérez-Olmeda M, Yotti R, Oteo-Iglesias J, Sanmartín JL, León-Gómez I, Fernández-García A, Fernández-Navarro P, Cruz I, Martín M, Delgado-Sanz C, Fernández de Larrea N, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Larrauri A, Pollán M. Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study. BMJ 2020; 371:m4509. [PMID: 33246972 PMCID: PMC7690290 DOI: 10.1136/bmj.m4509] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes. DESIGN Nationwide seroepidemiological study. SETTING First wave of covid-19 pandemic in Spain. PARTICIPANTS Community dwelling individuals of all ages. MAIN OUTCOME MEASURES The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020. RESULTS The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more. CONCLUSION The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.
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Affiliation(s)
- Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint first authors
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint first authors
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard TH Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Jesús Oteo-Iglesias
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Institute of Health Carlos III, Madrid, Spain
| | | | - Inmaculada León-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | | | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | | | | | - Amparo Larrauri
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint senior authors
| | - Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint senior authors
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Affiliation(s)
- Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Jesús Oteo
- National Centre for Microbiology, Institute of Health Carlos III, 28029 Madrid, Spain; Spanish Network for Research in Infectious Diseases, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Raquel Yotti
- Directorate, Institute of Health Carlos III, 28029 Madrid, Spain
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15
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Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, Sanmartín JL, Fernández-García A, Cruz I, Fernández de Larrea N, Molina M, Rodríguez-Cabrera F, Martín M, Merino-Amador P, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet 2020; 396:535-544. [PMID: 32645347 PMCID: PMC7336131 DOI: 10.1016/s0140-6736(20)31483-5] [Citation(s) in RCA: 1148] [Impact Index Per Article: 287.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.
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Affiliation(s)
- Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Jesús Oteo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Institute of Health Carlos III, Madrid, Spain
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Jose L Sanmartín
- Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Marta Molina
- General Secretary of Health, Ministry of Health, Madrid, Spain
| | | | - Mariano Martín
- Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain
| | | | | | | | - Faustino Blanco
- General Secretary of Health, Ministry of Health, Madrid, Spain
| | - Raquel Yotti
- Directorate, Institute of Health Carlos III, Madrid, Spain
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16
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Herkert JC, Verhagen JM, Yotti R, Haghighi A, Phelan DG, James PA, Brown NJ, Stutterd C, Macciocca I, Leong K, Bulthuis ML, van Bever Y, van Slegtenhorst MA, Boven LG, Roberts AE, Agarwal R, Seidman J, Lakdawala NK, Fernández-Avilés F, Burke MA, Pierpont ME, Braunlin E, Ḉağlayan AO, Barge-Schaapveld DQ, Birnie E, van Osch-Gevers L, van Langen IM, Jongbloed JD, Lockhart PJ, Amor DJ, Seidman CE, van de Laar IM. Expanding the clinical and genetic spectrum of ALPK3 variants: Phenotypes identified in pediatric cardiomyopathy patients and adults with heterozygous variants. Am Heart J 2020; 225:108-119. [PMID: 32480058 DOI: 10.1016/j.ahj.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Biallelic damaging variants in ALPK3, encoding alpha-protein kinase 3, cause pediatric-onset cardiomyopathy with manifestations that are incompletely defined. METHODS AND RESULTS We analyzed clinical manifestations of damaging biallelic ALPK3 variants in 19 pediatric patients, including nine previously published cases. Among these, 11 loss-of-function (LoF) variants, seven compound LoF and deleterious missense variants, and one homozygous deleterious missense variant were identified. Among 18 live-born patients, 8 exhibited neonatal dilated cardiomyopathy (44.4%; 95% CI: 21.5%-69.2%) that subsequently transitioned into ventricular hypertrophy. The majority of patients had extracardiac phenotypes, including contractures, scoliosis, cleft palate, and facial dysmorphisms. We observed no association between variant type or location, disease severity, and/or extracardiac manifestations. Myocardial histopathology showed focal cardiomyocyte hypertrophy, subendocardial fibroelastosis in patients under 4 years of age, and myofibrillar disarray in adults. Rare heterozygous ALPK3 variants were also assessed in adult-onset cardiomyopathy patients. Among 1548 Dutch patients referred for initial genetic analyses, we identified 39 individuals with rare heterozygous ALPK3 variants (2.5%; 95% CI: 1.8%-3.4%), including 26 missense and 10 LoF variants. Among 149 U.S. patients without pathogenic variants in 83 cardiomyopathy-related genes, we identified six missense and nine LoF ALPK3 variants (10.1%; 95% CI: 5.7%-16.1%). LoF ALPK3 variants were increased in comparison to matched controls (Dutch cohort, P = 1.6×10-5; U.S. cohort, P = 2.2×10-13). CONCLUSION Biallelic damaging ALPK3 variants cause pediatric cardiomyopathy manifested by DCM transitioning to hypertrophy, often with poor contractile function. Additional extracardiac features occur in most patients, including musculoskeletal abnormalities and cleft palate. Heterozygous LoF ALPK3 variants are enriched in adults with cardiomyopathy and may contribute to their cardiomyopathy. Adults with ALPK3 LoF variants therefore warrant evaluations for cardiomyopathy.
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17
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Barriales-Villa R, Ochoa JP, Larrañaga-Moreira JM, Salazar-Mendiguchía J, Díez-López C, Restrepo-Córdoba MA, Álvarez-Rubio J, Robles-Mezcua A, Olmo-Conesa MC, Nicolás-Rocamora E, Sanz J, Villacorta E, Gallego-Delgado M, Yotti R, Espinosa MÁ, Manovel A, Rincón-Díaz LM, Jiménez-Jaimez J, Bermúdez-Jiménez FJ, Basurte-Elorz MT, Climent-Payá V, García-Álvarez MI, Rodríguez-Palomares JF, Limeres-Freire J, Pérez-Guerrero A, Cantero-Pérez EM, Peña-Peña ML, Palomino-Doza J, Crespo-Leiro MG, García-Pinilla JM, Zorio E, Ripoll-Vera T, García-Pavía P, Ortiz-Genga M, Monserrat L. Risk predictors in a Spanish cohort with cardiac laminopathies. The REDLAMINA registry. ACTA ACUST UNITED AC 2020; 74:216-224. [PMID: 32616434 DOI: 10.1016/j.rec.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/16/2019] [Accepted: 03/03/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES According to sudden cardiac death guidelines, an implantable cardioverter-defibrillator (ICD) should be considered in patients with LMNA-related dilated cardiomyopathy (DCM) and ≥ 2 risk factors: male sex, left ventricular ejection fraction (LVEF) <45%, nonsustained ventricular tachycardia (NSVT), and nonmissense genetic variants. In this study we aimed to describe the clinical characteristics of carriers of LMNA genetic variants among individuals from a Spanish cardiac-laminopathies cohort (REDLAMINA registry) and to assess previously reported risk criteria. METHODS The relationship between risk factors and cardiovascular events was evaluated in a cohort of 140 carriers (age ≥ 16 years) of pathogenic LMNA variants (54 probands, 86 relatives). We considered: a) major arrhythmic events (MAE) if there was appropriate ICD discharge or sudden cardiac death; b) heart failure death if there was heart transplant or death due to heart failure. RESULTS We identified 11 novel and 21 previously reported LMNA-related DCM variants. LVEF <45% (P=.001) and NSVT (P <.001) were related to MAE, but not sex or type of genetic variant. The only factor independently related to heart failure death was LVEF <45% (P <.001). CONCLUSIONS In the REDLAMINA registry cohort, the only predictors independently associated with MAE were NSVT and LVEF <45%. Therefore, female carriers of missense variants with either NSVT or LVEF <45% should not be considered a low-risk group. It is important to individualize risk stratification in carriers of LMNA missense variants, because not all have the same prognosis.
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Affiliation(s)
- Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Juan P Ochoa
- Departamento de Cardiología, Health in Code, A Coruña, Spain
| | - José M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain
| | - Joel Salazar-Mendiguchía
- Departamento de Cardiología, Health in Code, A Coruña, Spain; Unidad de Genética Clínica y Biología Molecular, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Genética, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carles Díez-López
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Alejandra Restrepo-Córdoba
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Red Europea de Referencia para enfermedades del corazón raras, de baja prevalencia y complejas (ERN GUARD-Heart), Spain
| | - Jorge Álvarez-Rubio
- Instituto de Investigación Sanitaria de las Islas Baleares (iDisBA), Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Balearic Islands, Spain
| | - Ainhoa Robles-Mezcua
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - María C Olmo-Conesa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Red Europea de Referencia para enfermedades del corazón raras, de baja prevalencia y complejas (ERN GUARD-Heart), Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Elisa Nicolás-Rocamora
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Red Europea de Referencia para enfermedades del corazón raras, de baja prevalencia y complejas (ERN GUARD-Heart), Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Jorge Sanz
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Eduardo Villacorta
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - María Gallego-Delgado
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Ángeles Espinosa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Manovel
- Unidad de Hemodinámica y Ecocardiografía, Servicio de Cardiología, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Luis M Rincón-Díaz
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Jiménez-Jaimez
- Servicio de Cardiología, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Francisco J Bermúdez-Jiménez
- Servicio de Cardiología, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Vicente Climent-Payá
- Servicio de Cardiología, Hospital Universitario General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - María I García-Álvarez
- Servicio de Cardiología, Hospital Universitario General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - José Fernando Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Limeres-Freire
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ainhoa Pérez-Guerrero
- Servicio de Cardiología, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, Spain
| | - Eva M Cantero-Pérez
- Unidad de Cardiopatías Familiares y Unidad de Imagen, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María L Peña-Peña
- Unidad de Cardiopatías Familiares y Unidad de Imagen, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Julián Palomino-Doza
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María G Crespo-Leiro
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José M García-Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Tomás Ripoll-Vera
- Instituto de Investigación Sanitaria de las Islas Baleares (iDisBA), Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Balearic Islands, Spain
| | - Pablo García-Pavía
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Red Europea de Referencia para enfermedades del corazón raras, de baja prevalencia y complejas (ERN GUARD-Heart), Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain
| | | | - Lorenzo Monserrat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Health in Code, A Coruña, Spain
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18
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Fernández AI, Yotti R, González-Mansilla A, Mombiela T, Gutiérrez-Ibanes E, Pérez del Villar C, Navas-Tejedor P, Chazo C, Martínez-Legazpi P, Fernández-Avilés F, Bermejo J. The Biological Bases of Group 2 Pulmonary Hypertension. Int J Mol Sci 2019; 20:ijms20235884. [PMID: 31771195 PMCID: PMC6928720 DOI: 10.3390/ijms20235884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/07/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Pulmonary hypertension (PH) is a potentially fatal condition with a prevalence of around 1% in the world population and most commonly caused by left heart disease (PH-LHD). Usually, in PH-LHD, the increase of pulmonary pressure is only conditioned by the retrograde transmission of the left atrial pressure. However, in some cases, the long-term retrograde pressure overload may trigger complex and irreversible biomechanical and biological changes in the pulmonary vasculature. This latter clinical entity, designated as combined pre- and post-capillary PH, is associated with very poor outcomes. The underlying mechanisms of this progression are poorly understood, and most of the current knowledge comes from the field of Group 1-PAH. Treatment is also an unsolved issue in patients with PH-LHD. Targeting the molecular pathways that regulate pulmonary hemodynamics and vascular remodeling has provided excellent results in other forms of PH but has a neutral or detrimental result in patients with PH-LHD. Therefore, a deep and comprehensive biological characterization of PH-LHD is essential to improve the diagnostic and prognostic evaluation of patients and, eventually, identify new therapeutic targets. Ongoing research is aimed at identify candidate genes, variants, non-coding RNAs, and other biomarkers with potential diagnostic and therapeutic implications. In this review, we discuss the state-of-the-art cellular, molecular, genetic, and epigenetic mechanisms potentially involved in PH-LHD. Signaling and effective pathways are particularly emphasized, as well as the current knowledge on -omic biomarkers. Our final aim is to provide readers with the biological foundations on which to ground both clinical and pre-clinical research in the field of PH-LHD.
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Affiliation(s)
- Ana I. Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Enrique Gutiérrez-Ibanes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Candelas Pérez del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Paula Navas-Tejedor
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
- Correspondence: ; Tel.: +34-91-586-8279
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19
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Bermejo J, Yotti R, García-Orta R, Sánchez-Fernández PL, Castaño M, Segovia-Cubero J, Escribano-Subías P, San Román JA, Borrás X, Alonso-Gómez A, Botas J, Crespo-Leiro MG, Velasco S, Bayés-Genís A, López A, Muñoz-Aguilera R, de Teresa E, González-Juanatey JR, Evangelista A, Mombiela T, González-Mansilla A, Elízaga J, Martín-Moreiras J, González-Santos JM, Moreno-Escobar E, Fernández-Avilés F. Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial. Eur Heart J 2019; 39:1255-1264. [PMID: 29281101 PMCID: PMC5905634 DOI: 10.1093/eurheartj/ehx700] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [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] [Received: 10/09/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Aims We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P < 0.001]. The Kaplan–Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0–4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. Conclusion Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided. The trial is registered with ClinicalTrials.gov, number NCT00862043.
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Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | | | | | | | | | | | | | - Xavier Borrás
- Hospital Santa Creu i San Pau and CIBERCV, Barcelona
| | | | - Javier Botas
- Hospital Universitario Fundación Alcorcón, Alcorcón
| | | | | | | | | | | | | | | | | | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | | | | | | | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
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20
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Akhtar M, Rangel-Sousa D, Palomino-Doza J, Arana Achaga X, Bilinska Z, Zamarreno Golvano E, Climent V, Navarro Penalver M, Barriales-Villa R, Charron P, Yotti R, Zorio E, Jimenez-Jaimez J, Garcia-Pavia P, Elliott PM. 5163Predictors of adverse cardiovascular events in patients with truncating variants in the filamin c (flnc) gene. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Truncating variants in Filamin C (FLNCtv) are associated with arrhythmogenic (AC) and dilated cardiomyopathies (DCM). Affected patients are reported to demonstrate a high incidence of arrhythmic and heart-failure related cardiovascular events. The aim of this study was to determine factors that predict adverse events in mutation carriers.
Methods
The study cohort comprised 168 FLNCtv carriers followed at 19 European centres. Baseline and longitudinal follow-up clinical data were collected. The primary endpoint was a composite of sudden cardiac death (SCD), aborted SCD, appropriate implantable cardioverter-defibrillator (ICD) shock, cardiac transplantation (HTx) and mortality from end-stage heart failure (ESHF).
Results
47 different pathogenic or likely-pathogenic FLNCtv were identified in 60 unrelated probands. In those with baseline and longitudinal data (160 patients; 57 probands), 114 (71.3%) patients exhibited evidence of cardiac disease at initial evaluation. Gene penetrance was 85% by the age of 40 years. During a median follow-up of 1.5 years (IQR 4.1), 24 individuals (15%) reached the primary endpoint – 16 arrhythmic (SCD/aborted SCD/ICD shock) and 8 heart failure (ESHF/HTx) related-events. Univariable predictors at baseline evaluation of the composite primary endpoint included proband status (HR 4.0, 95% CI: 1.5–10.9, p=0.01), symptoms of dyspnoea (HR 2.8, 95% CI: 1.2–6.4, p=0.02), LV systolic dysfunction (LVSD) (HR 12.4, 95% CI: 2.9–53.2, p=0.001), frequent ventricular ectopy (VE>500) on 24-hour Holter (HR 9.3, 95% CI: 1.2–74.7, p=0.04) and the presence of late gadolinium enhancement on CMR (HR 8.9, 95% CI: 1.2–68.5, p=0.04).
Multivariable analysis identified LVSD (LVEF <50%) at baseline as an independent predictor of the primary endpoint with a hazard ratio of 8.6 (95% CI: 1.8–41.5, p=0.007). ROC analysis using LV systolic dysfunction to predict the primary endpoint demonstrated an area under the curve of 0.84 (95% CI: 0.76–0.91, p<0.001) and identified an optimal LVEF “cut-off” of 47% for predicting adverse events with a Youden's index of 0.61 (sensitivity 0.91; specificity 0.70).
Kaplan-Meier plot to demonstrate freedom
Conclusions
LVSD is associated with an over 8-fold increase in the hazard of a primary endpoint event in FLNCtv gene carriers indicating that these patients should be considered for implantable cardioverter-defibrillator (ICD) implantation, optimal heart failure medical therapy and close clinical follow-up.
Acknowledgement/Funding
NIHR Biomedical Research Centre; Instituto de Salud Carlos III; DETECTIN-HF project; Wellcome Trust;CIBERCV; EU Regional Development Fund; FEDER.
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Affiliation(s)
- M Akhtar
- Barts Health NHS Trust, London, United Kingdom
| | | | | | - X Arana Achaga
- University Hospital Donostia, Donostia-San Sebastian, Spain
| | - Z Bilinska
- The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - V Climent
- General University Hospital of Alicante, Alicante, Spain
| | | | - R Barriales-Villa
- Instituto de Investigaciόn Biomédica de A Coruña (INIBIC), A Coruna, Spain
| | - P Charron
- Hospital Pitie-Salpetriere, Paris, France
| | - R Yotti
- University Hospital Gregorio Maranon, Madrid, Spain
| | - E Zorio
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - P M Elliott
- University College London, London, United Kingdom
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21
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Fernández-Avilés F, Sanz-Ruiz R, Bogaert J, Casado Plasencia A, Gilaberte I, Belmans A, Fernández-Santos ME, Charron D, Mulet M, Yotti R, Palacios I, Luque M, Sádaba R, San Román JA, Larman M, Sánchez PL, Sanchís J, Jiménez MF, Claus P, Al-Daccak R, Lombardo E, Abad JL, DelaRosa O, Corcóstegui L, Bermejo J, Janssens S. Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With ST-Segment Elevation Myocardial Infarction and Left Ventricular Dysfunction. Circ Res 2019; 123:579-589. [PMID: 29921651 DOI: 10.1161/circresaha.118.312823] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Indexed: 01/17/2023]
Abstract
RATIONALE Allogeneic cardiac stem cells (AlloCSC-01) have shown protective, immunoregulatory, and regenerative properties with a robust safety profile in large animal models of heart disease. OBJECTIVE To investigate the safety and feasibility of early administration of AlloCSC-01 in patients with ST-segment-elevation myocardial infarction. METHODS AND RESULTS CAREMI (Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With STEMI and Left Ventricular Dysfunction) was a phase I/II multicenter, randomized, double-blind, placebo-controlled trial in patients with ST-segment-elevation myocardial infarction, left ventricular ejection fraction ≤45%, and infarct size ≥25% of left ventricular mass by cardiac magnetic resonance, who were randomized (2:1) to receive AlloCSC-01 or placebo through the intracoronary route at days 5 to 7. The primary end point was safety and included all-cause death and major adverse cardiac events at 30 days (all-cause death, reinfarction, hospitalization because of heart failure, sustained ventricular tachycardia, ventricular fibrillation, and stroke). Secondary safety end points included major adverse cardiac events at 6 and 12 months, adverse events, and immunologic surveillance. Secondary exploratory efficacy end points were changes in infarct size (percentage of left ventricular mass) and indices of ventricular remodeling by magnetic resonance at 12 months. Forty-nine patients were included (92% male, 55±11 years), 33 randomized to AlloCSC-01 and 16 to placebo. No deaths or major adverse cardiac events were reported at 12 months. One severe adverse events in each group was considered possibly related to study treatment (allergic dermatitis and rash). AlloCSC-01 elicited low levels of donor-specific antibodies in 2 patients. No immune-related adverse events were found, and no differences between groups were observed in magnetic resonance-based efficacy parameters at 12 months. The estimated treatment effect of AlloCSC-01 on the absolute change from baseline in infarct size was -2.3% (95% confidence interval, -6.5% to 1.9%). CONCLUSIONS AlloCSC-01 can be safely administered in ST-segment-elevation myocardial infarction patients with left ventricular dysfunction early after revascularization. Low immunogenicity and absence of immune-mediated events will facilitate adequately powered studies to demonstrate their clinical efficacy in this setting. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov . Unique identifier: NCT02439398.
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Affiliation(s)
- Francisco Fernández-Avilés
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Ricardo Sanz-Ruiz
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | | | - Ana Casado Plasencia
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Inmaculada Gilaberte
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Ann Belmans
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Maria Eugenia Fernández-Santos
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Dominique Charron
- HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (D.C., R.A.-D.)
| | - Miguel Mulet
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Raquel Yotti
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Itziar Palacios
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Manuel Luque
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Rafael Sádaba
- Department of Cardiac Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain (R.S.)
| | - J Alberto San Román
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain (J.A.S.R.)
| | - Mariano Larman
- Department of Cardiology, Policlínia Guipuzcoa, San Sebastián, Spain (M.L.)
| | - Pedro L Sánchez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Hospital Clínico Universitario, Salamanca, Spain (P.L.S.)
| | - Juan Sanchís
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain (J.S.)
| | - Manuel F Jiménez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, IBIMA, UMA, UGC Corazón Hospital Clínico Virgen de la Victoria, Málaga, Spain (M.F.J.)
| | - Piet Claus
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Reem Al-Daccak
- HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (D.C., R.A.-D.)
| | - Eleuterio Lombardo
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - José Luis Abad
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Olga DelaRosa
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Lucia Corcóstegui
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Javier Bermejo
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Stefan Janssens
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
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22
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Pérez Del Villar C, Martínez-Legazpi P, Mombiela T, Chazo C, Desco M, Rodríguez-Pérez D, Benito Y, Barrio A, Gutiérrez-Ibañes E, Del Álamo JC, Elízaga J, Antoranz JC, Fernández-Avilés F, Yotti R, Bermejo J. The natural matching of harmonic responses in the pulmonary circulation. J Physiol 2019; 597:3853-3865. [PMID: 31187875 PMCID: PMC9328395 DOI: 10.1113/jp278050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 12/05/2022] Open
Abstract
Key points The right ventricle of the mammal heart is highly sensitive to the afterload imposed by a combination of the pulmonary circulation and the retrograde contribution of the left heart. Right ventricular afterload can be analysed in terms of pulmonary artery input impedance, which we were able to decompose as the result of the harmonic frequency responses of the pulmonary vessels and the left heart attached in series. Using spectral methods, we found a natural matching between the pulmonary vasculature and the left chambers of the heart. This coupling implies that the upstream transmission of the left heart frequency‐response has favourable effects on the pulmonary tree. This physiological mechanism protects the right ventricle against acute changes in preload, and its impairment may be a relevant contribution to right ventricle dysfunction in pulmonary hypertension.
Abstract The right ventricle (RV) of the mammal heart is highly sensitive to the afterload imposed by the pulmonary circulation, and the left heart (LH) retrogradely contributes significantly to this vascular load. Transmission‐line theory anticipates that the degree of matching between the frequency responses of the pulmonary vasculature and the LH should modulate the global right haemodynamic burden. We measured simultaneous high‐fidelity flow (pulmonary artery) and pressure (pulmonary artery and left atrium) in 18 healthy minipigs under acute haemodynamic interventions. From these data, we decomposed the impedance spectra of the total right‐circulation system into the impedance of the pulmonary vessels and the harmonic response of the LH. For frequencies above the first harmonic, total impedance was below the pulmonary impedance during all phases (P < 0.001; pooled phases), demonstrating a favourable effect of the LH harmonic response on RV pulsatile load: the LH harmonic response was responsible for a 20% reduction of pulse pulmonary artery pressure (P < 0.001 vs. a theoretical purely‐resistive response) and a 15% increase of pulmonary compliance (P = 0.009). This effect on compliance was highest during acute volume overload. In the normal right circulation, the longitudinal impedance of the pulmonary vasculature is matched to the harmonic response of the LH in a way that efficiently reduces the pulmonary pulsatile vascular load. This source of interaction between the right and left circulations of mammals protects the RV against excessive afterload during acute volume transients and its disruption may be an important contributor to pulmonary hypertension. The right ventricle of the mammal heart is highly sensitive to the afterload imposed by a combination of the pulmonary circulation and the retrograde contribution of the left heart. Right ventricular afterload can be analysed in terms of pulmonary artery input impedance, which we were able to decompose as the result of the harmonic frequency responses of the pulmonary vessels and the left heart attached in series. Using spectral methods, we found a natural matching between the pulmonary vasculature and the left chambers of the heart. This coupling implies that the upstream transmission of the left heart frequency‐response has favourable effects on the pulmonary tree. This physiological mechanism protects the right ventricle against acute changes in preload, and its impairment may be a relevant contribution to right ventricle dysfunction in pulmonary hypertension.
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Affiliation(s)
- Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Desco
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Barrio
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, and the Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - José Carlos Antoranz
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria Gregorio Marañón; and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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23
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Benito Y, Martinez-Legazpi P, Rossini L, Pérez del Villar C, Yotti R, Martín Peinador Y, Rodríguez-Pérez D, Desco MM, Medrano C, Antoranz JC, Fernández-Avilés F, del Álamo JC, Bermejo J. Age-Dependence of Flow Homeostasis in the Left Ventricle. Front Physiol 2019; 10:485. [PMID: 31105588 PMCID: PMC6498893 DOI: 10.3389/fphys.2019.00485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and quantify these features in a wide population of healthy subjects and assess the relationships of these indices with age. Methods: We used color-Doppler echocardiography and custom post-processing methods to study 149 healthy volunteers from 26 days to 80 years old. From the intraventricular flow-velocity fields we obtained personalized maps of (1) the residence time of blood in the LV, and (2) the shear index, a metric accounting for the strongest occurrence of shear stresses inside the chamber. From these maps we derived quantitative indices of the overall intraventricular blood washout and shear exposure. We addressed the age-dependence of these indices and analyzed their relationship with age-related changes in filling-flow. Results: The entire intraventricular blood pool was replaced before 8 cycles. Average residence time of blood inside the LV was <3 cycles in all subjects and followed an inverse U-shape relationship with age, increasing from median (IQR) of 1.0 (0.7 to 1.2) cycles in the 1st year of life to 1.8 (1.4-2.2) cycles in young adults (17-30 years old), becoming shorter again thereafter. Shear index showed no relation with age and was bounded around 20 dyn·s/cm2. Regions with the longest residence time and highest shear index were identified near the apex. Differences in the degree of apical penetration of the filling waves and the duration of the late-filling phase explained the age-dependence of residence time (R adj 2 = 0.48, p < 0.001). Conclusions: In average, blood spends 1 to 3 beats inside the LV with very low shear stress rates. The apical region is the most prone to blood stasis, particularly in mid-aged adults. The washout of blood in the normal LV is age-dependent due to physiological changes in the degree of apical penetration of the filling waves.
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Affiliation(s)
- Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Pablo Martinez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Lorenzo Rossini
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Candelas Pérez del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Yolanda Martín Peinador
- Centro de Salud Goya, Dirección Asistencial Centro, Atención Primaria de Madrid, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - M. Mar Desco
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Constancio Medrano
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Jose Carlos Antoranz
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Juan C. del Álamo
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, La Jolla, CA, United States
- Institute for Engineering in Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
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24
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Abstract
Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are common heart muscle disorders that are caused by pathogenic variants in sarcomere protein genes. HCM is characterized by unexplained cardiac hypertrophy (increased chamber wall thickness) that is accompanied by enhanced cardiac contractility and impaired relaxation. DCM is defined as increased ventricular chamber volume with contractile impairment. In this review, we discuss recent analyses that provide new insights into the molecular mechanisms that cause these conditions. HCM studies have uncovered the critical importance of conformational changes that occur during relaxation and enable energy conservation, which are frequently disturbed by HCM mutations. DCM studies have demonstrated the considerable prevalence of truncating variants in titin and have discerned that these variants reduce contractile function by impairing sarcomerogenesis. These new pathophysiologic mechanisms open exciting opportunities to identify new pharmacological targets and develop future cardioprotective strategies.
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Affiliation(s)
- Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain; .,Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA; , .,Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA
| | - Jonathan G Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA; ,
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25
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González-Mansilla A, Martinez-Legazpi P, Prieto A, Gomá E, Haurigot P, Pérez Del Villar C, Cuadrado V, Delgado-Montero A, Prieto R, Mombiela T, Pérez-David E, Rodríguez González E, Benito Y, Yotti R, Pérez-Vallina M, Fernández-Avilés F, Bermejo J. Valve area and the risk of overestimating aortic stenosis. Heart 2019; 105:911-919. [PMID: 30772823 PMCID: PMC6582719 DOI: 10.1136/heartjnl-2018-314482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/15/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity. METHODS We prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration. RESULTS 16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation. CONCLUSIONS Normal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.
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Affiliation(s)
- Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Pablo Martinez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Andrea Prieto
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Elena Gomá
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Pilar Haurigot
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Victor Cuadrado
- Information and Communications Technology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Antonia Delgado-Montero
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Raquel Prieto
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Esther Pérez-David
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Elena Rodríguez González
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Manuel Pérez-Vallina
- Information and Communications Technology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
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26
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Affiliation(s)
- Javier Bermejo
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV, Dr Esquerdo 46, Madrid, Spain
| | - Raquel Yotti
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV, Dr Esquerdo 46, Madrid, Spain
| | - Francisco Fernández-Avilés
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV, Dr Esquerdo 46, Madrid, Spain
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27
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Oliver JM, Gallego P, Gonzalez AE, Garcia-Hamilton D, Avila P, Yotti R, Ferreira I, Fernandez-Aviles F. Risk factors for excess mortality in adults with congenital heart diseases. Eur Heart J 2018; 38:1233-1241. [PMID: 28077469 DOI: 10.1093/eurheartj/ehw590] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/09/2016] [Accepted: 11/16/2016] [Indexed: 12/19/2022] Open
Abstract
Aims To examine factors related to excess mortality in a cohort of adults with congenital heart disease (CHD). Methods and results We conducted a survival analysis using prospective data of 3311 adults with CHD [50.5% males, median age at entry 22.5 years (IQR 18-39), median follow-up time 10.5 years (IQR: 4.4-18)]. Survival status of each patient was further verified by cross checking with the Spanish National Death Index. During a total follow-up of 37608 person-years, 336 (10%) patients died. Annual death rate was 0.89% and standardized mortality ratio (SMR) 2.64 [95% confidence interval (CI) 2.3-3.0; P < 0.001]. Median age at death estimated by left-truncated Kaplan-Meier method was 75.1 years (95% CI 73-77). Survival was reduced compared with the general population whatever their level of complexity, repair status, or underlying CHD. Independent risk factors for excess mortality, including cyanosis, univentricular physiology, genetic disorders, ventricular dysfunction, residual haemodynamic lesions and acquired late complications, among others, were identified by left-truncated Cox regression model. SMR was 5.22 (95% CI 4.5-6.0; P < 0.001) and median age at death 55.6 years (95% CI 50-61) for 996 patients (30%) with at least one risk factor. In contrast, SMR was 1.14 (95% CI 0.9-1.5; P = 0.19) and median age at death 83.7 years (95% CI 82-87) in 2315 patients (70%) with no risk factors. Conclusions Clinical parameters, such as anatomical features, haemodynamic sequelae, or acquired complications, were independent predictors of excess mortality in adults with CHD. Survival of individuals with no risk factors did not differ from the reference population.
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Affiliation(s)
- Jose Maria Oliver
- Adult Congenital Heart Disease Unit, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Pastora Gallego
- Heart Area Clinical Management Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | - Ana Elvira Gonzalez
- Adult Congenital Heart Disease Unit, La Paz University Hospital, Madrid, Spain
| | | | - Pablo Avila
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.,Department of Cardiology, Gregorio Marañon University Hospital, Madrid, Spain
| | - Raquel Yotti
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.,Department of Cardiology, Gregorio Marañon University Hospital, Madrid, Spain
| | - Ignacio Ferreira
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francisco Fernandez-Aviles
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.,Department of Cardiology, Gregorio Marañon University Hospital, Madrid, Spain
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28
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Martinez-Legazpi P, Rossini L, Pérez del Villar C, Benito Y, Devesa-Cordero C, Yotti R, Delgado-Montero A, Gonzalez-Mansilla A, Kahn AM, Fernandez-Avilés F, del Álamo JC, Bermejo J. Stasis Mapping Using Ultrasound. JACC Cardiovasc Imaging 2018; 11:514-515. [DOI: 10.1016/j.jcmg.2017.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
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Charron P, Elliott PM, Gimeno JR, Caforio ALP, Kaski JP, Tavazzi L, Tendera M, Maupain C, Laroche C, Rubis P, Jurcut R, Calò L, Heliö TM, Sinagra G, Zdravkovic M, Kavoliūnienė A, Felix SB, Grzybowski J, Losi MA, Asselbergs FW, García-Pinilla JM, Salazar-Mendiguchia J, Mizia-Stec K, Maggioni AP, Anastasakis A, Biagini E, Bilinska Z, Castro FJ, Celutkiene J, Chakova N, Chmielewski P, Drago F, Frigy A, Frustaci A, Garcia-Pavia P, Hinic S, Kindermann I, Limongelli G, Medrano C, Monserrat L, Olusegun-Joseph A, Ripoll-Vera T, Rocha Lopes L, Saad A, Sala S, Seferovic PM, Sepp R, Urbano-Moral JA, Villacorta E, Wybraniec M, Yotti R, Zachara E, Zorio E. The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: baseline data and contemporary management of adult patients with cardiomyopathies. Eur Heart J 2018; 39:1784-1793. [DOI: 10.1093/eurheartj/ehx819] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 08/28/2017] [Accepted: 01/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philippe Charron
- Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, 47 Bvd de l’hôpital, 75013 Paris, France
- Université Versailles Saint Quentin & AP-HP, CESP, INSERM U1018, Hôpital Ambroise Paré, 9, Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Perry M Elliott
- University College London and Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, UK
| | - Juan R Gimeno
- Cardiac Department, Hospital Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena s/n, 30120 El Palmar Murcia, Spain
- CIBER in Cardiovascular Diseases, Instituto Carlos III, Av. de Monforte de Lemos 5, 28029 Madrid, Spain
| | - Alida L P Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padova, via N Giustiniani 2, 35100 Padova, Italy
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, WC1N 3JH London, UK
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Via Corriera, 1, 48010 Cotignola, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Diseases, School of Medicine in Katowice, Medical University of Silesia, Ziolowa Street 45/47, 40-635 Katowice, Poland
| | - Carole Maupain
- Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, 47 Bvd de l’hôpital, 75013 Paris, France
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, 2035 Route des colles, CS 80179 Biot, 06903 Sophia-Antipolis Cedex, France
| | - Pawel Rubis
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Pradnicka street 80, 31-202 Krakow, Poland
| | - Ruxandra Jurcut
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, UMF “Carol Davila”, Sos. Fundeni 258, 22328 Bucharest, Romania
| | - Leonardo Calò
- Policlinico Casilino, U.O. Cardiologia, Via Casilina, 1049, 00169 Roma, Italy
| | - Tiina M Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Cardiomyopathies, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Marija Zdravkovic
- University Hospital Medical Center Bezanijska kosa, Faculty of Medicine, University of Belgrade, Dragise Brasovana 13/8, 11077 Belgrade, Serbia
| | - Aušra Kavoliūnienė
- Lithuanian University of Health Sciences, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Stephan B Felix
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch Strasse, 17475 Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, UMC Utrecht, 3508 GA Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, WC1E 6BT London, UK
| | - José Manuel García-Pinilla
- CIBER in Cardiovascular Diseases, Instituto Carlos III, Av. de Monforte de Lemos 5, 28029 Madrid, Spain
- Heart failure and familial cardiomyopathies division, Cardiology department, Hospital Universitario Virgen de la Victoria, IBIMA, Campus Universitario Teatinos, 29010 Málaga, Spain
| | - Joel Salazar-Mendiguchia
- Cardiomyopathy, Heart Failure and Transplant Program, Hospital Universistari de Bellvitge, Heart Diseases Institute, Av. Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Ochojec, Ziolowa Street 45/47, 40-635 Katowice, Poland
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, 2035 Route des colles, CS 80179 Biot, 06903 Sophia-Antipolis Cedex, France
- ANMCO Research Center, Via La Marmora, 34 50121 Firenze, Italy
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Yotti R, Ripoll C, Bermejo J, Bañares R. Cardiac function, A key component in evaluation for liver transplant. Liver Transpl 2018; 24:7-8. [PMID: 29193630 DOI: 10.1002/lt.24987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Raquel Yotti
- Departments of Cardiology and Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) and
| | - Cristina Ripoll
- Digestive Diseases and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Javier Bermejo
- Departments of Cardiology and Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) and
| | - Rafael Bañares
- Digestive Diseases and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Marañón Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Affiliation(s)
- Cristina Ripoll
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Rafael Bañares
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Ávila P, Oliver JM, Gallego P, González-García A, Rodríguez-Puras MJ, Cambronero E, Ruiz-Cantador J, Campos A, Peinado R, Prieto R, Sarnago F, Yotti R, Fernández-Avilés F. Natural History and Clinical Predictors of Atrial Tachycardia in Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005396. [DOI: 10.1161/circep.117.005396] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 02/16/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Pablo Ávila
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José María Oliver
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Pastora Gallego
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana González-García
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - María José Rodríguez-Puras
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Esther Cambronero
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - José Ruiz-Cantador
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Ana Campos
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Rafael Peinado
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Prieto
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Fernando Sarnago
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Raquel Yotti
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
| | - Francisco Fernández-Avilés
- From the Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain (P.Á., J.M.O., R.P., F.S., R.Y., F.F.-A.); Adult Congenital Heart Disease Unit, Hospital Universitario La Paz, Madrid, Spain (J.M.O., A.G.-G., E.C., J.R.-C., R.P.); and Intercenter Congenital Heart Disease Unit, Hospital Virgen del Rocío y Virgen Macarena, Sevilla, Spain (P.G., M.J.R
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Tamargo M, Espinosa MÁ, Gómez-Carrillo V, Juárez M, Fernández-Avilés F, Yotti R. Sudden Death in a Young Patient with Atrial Fibrillation. Cardiogenetics 2017. [DOI: 10.4081/cardiogenetics.2017.6304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sudden cardiac death (SCD) in young patients without structural heart disease is frequently due to inherited channelopathies such as long QT syndrome (LQTS), Brugada syndrome or Catecholaminergic polymorphic ventricular tachycardia. Accordingly, the addition of genetic testing to clinical data may be useful to identify the cause of the sudden death in this population. Mutations in the KCNQ1 encoded Kv7.1 channel are related to type 1 LQTS, familial atrial fibrillation (AF), short QT syndrome, and SCD. We present a clinical case where the presence of AF after resuscitation in a young man with cardiac arrest was the key clinical data to suspect an inherited disorder and genetic testing was the main determinant for identifying the cause of the cardiac arrest. The KCNQ1 p.Arg231His mutation explained the combined phenotype of AF and susceptibility to ventricular arrhythmias. The case highlights the importance of continued research in genetics and molecular mechanisms of channelopathies.
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Tamargo Delpon M, Espinosa M, Maroto A, Cuenca S, Mendez I, Fernandez A, Zatarain E, Fernandez-Aviles F, Yotti R. P4507Genotype-phenotype correlations in a mediterranean cohort of hypertrophic cardiomyopathy with high prevalence of apical variant. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mademont-Soler I, Mates J, Yotti R, Espinosa MA, Pérez-Serra A, Fernandez-Avila AI, Coll M, Méndez I, Iglesias A, del Olmo B, Riuró H, Cuenca S, Allegue C, Campuzano O, Picó F, Ferrer-Costa C, Álvarez P, Castillo S, Garcia-Pavia P, Gonzalez-Lopez E, Padron-Barthe L, Díaz de Bustamante A, Darnaude MT, González-Hevia JI, Brugada J, Fernandez-Aviles F, Brugada R. Additional value of screening for minor genes and copy number variants in hypertrophic cardiomyopathy. PLoS One 2017; 12:e0181465. [PMID: 28771489 PMCID: PMC5542623 DOI: 10.1371/journal.pone.0181465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/30/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited heart disease. Next-generation sequencing (NGS) is the preferred genetic test, but the diagnostic value of screening for minor and candidate genes, and the role of copy number variants (CNVs) deserves further evaluation. METHODS Three hundred and eighty-seven consecutive unrelated patients with HCM were screened for genetic variants in the 5 most frequent genes (MYBPC3, MYH7, TNNT2, TNNI3 and TPM1) using Sanger sequencing (N = 84) or NGS (N = 303). In the NGS cohort we analyzed 20 additional minor or candidate genes, and applied a proprietary bioinformatics algorithm for detecting CNVs. Additionally, the rate and classification of TTN variants in HCM were compared with 427 patients without structural heart disease. RESULTS The percentage of patients with pathogenic/likely pathogenic (P/LP) variants in the main genes was 33.3%, without significant differences between the Sanger sequencing and NGS cohorts. The screening for 20 additional genes revealed LP variants in ACTC1, MYL2, MYL3, TNNC1, GLA and PRKAG2 in 12 patients. This approach resulted in more inconclusive tests (36.0% vs. 9.6%, p<0.001), mostly due to variants of unknown significance (VUS) in TTN. The detection rate of rare variants in TTN was not significantly different to that found in the group of patients without structural heart disease. In the NGS cohort, 4 patients (1.3%) had pathogenic CNVs: 2 deletions in MYBPC3 and 2 deletions involving the complete coding region of PLN. CONCLUSIONS A small percentage of HCM cases without point mutations in the 5 main genes are explained by P/LP variants in minor or candidate genes and CNVs. Screening for variants in TTN in HCM patients drastically increases the number of inconclusive tests, and shows a rate of VUS that is similar to patients without structural heart disease, suggesting that this gene should not be analyzed for clinical purposes in HCM.
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Affiliation(s)
- Irene Mademont-Soler
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jesus Mates
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Maria Angeles Espinosa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Alexandra Pérez-Serra
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Isabel Fernandez-Avila
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Monica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Irene Méndez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Bernat del Olmo
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Helena Riuró
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Sofía Cuenca
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Catarina Allegue
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Ferran Picó
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | | | | | | | - Pablo Garcia-Pavia
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Francisco de Vitoria University, Madrid, Spain
| | - Esther Gonzalez-Lopez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Francisco de Vitoria University, Madrid, Spain
| | - Laura Padron-Barthe
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Francisco de Vitoria University, Madrid, Spain
| | | | | | | | - Josep Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Arrhythmia Unit, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Fernandez-Aviles
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Cardiovascular Genetics Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain
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Alonso-Garcia A, Oliver J, Garcia-Hamilton D, Gallego P, Avila P, Gonzalez-Garcia A, Ruiz-Cantador J, Sarnago F, Peinado R, Prieto R, Yotti R, Fernandez-Aviles F. P2101Survival and causes of death in adults with congenital heart disease: impact of gender and ageing. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mates J, Mademont-Soler I, Campuzano O, Sarquella-Brugada G, Arbelo E, Brugada J, Garcia Pavia P, Yotti R, Gonzalez Hevia J, Borregan M, Trujillo F, Diaz F, Diaz Bustamante A, Lopez Granados A, Brugada R. P6400Role of copy number variants in sudden cardiac death: genetic analysis and translation into clinical practice. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mademont-Soler I, Mates J, Campuzano O, Sarquella-Brugada G, Arbelo E, Brugada J, Garcia-Pavia P, Yotti R, Gonzalez-Hevia J, Borregan M, Trujillo F, Diaz F, Diaz De Bustamante A, Lopez Granados A, Brugada R. 3869Targeted next-generation sequencing as a comprehensive test for patients with hypertrophic cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cuenca S, Mendez I, Espinosa M, Fernandez A, Vazquez N, Tamargo M, Zatarain E, Brugada R, Yotti R, Fernandez-Aviles F. 2836A hidden genetic cause of dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx495.2836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sanz-Ruiz R, Casado Plasencia A, Borlado LR, Fernández-Santos ME, Al-Daccak R, Claus P, Palacios I, Sádaba R, Charron D, Bogaert J, Mulet M, Yotti R, Gilaberte I, Bernad A, Bermejo J, Janssens S, Fernández-Avilés F. Rationale and Design of a Clinical Trial to Evaluate the Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction. Circ Res 2017; 121:71-80. [DOI: 10.1161/circresaha.117.310651] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/13/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023]
Abstract
Rationale:
Stem cell therapy has increased the therapeutic armamentarium in the fight against ischemic heart disease and heart failure. The administration of exogenous stem cells has been investigated in patients suffering an acute myocardial infarction, with the final aim of salvaging jeopardized myocardium and preventing left ventricular adverse remodeling and functional deterioration. However, phase I and II clinical trials with autologous and first-generation stem cells have yielded inconsistent benefits and mixed results.
Objective:
In the search for new and more efficient cellular regenerative products, interesting cardioprotective, immunoregulatory, and cardioregenerative properties have been demonstrated for human cardiac stem cells. On the other hand, allogeneic cells show several advantages over autologous sources: they can be produced in large quantities, easily administered off-the-shelf early after an acute myocardial infarction, comply with stringent criteria for product homogeneity, potency, and quality control, and may exhibit a distinctive immunologic behavior.
Methods and Results:
With a promising preclinical background, CAREMI (Cardiac Stem Cells in Patients With Acute Myocardial Infarction) has been designed as a double-blind, 2:1 randomized, controlled, and multicenter clinical trial that will evaluate the safety, feasibility, and efficacy of intracoronary delivery of allogeneic human cardiac stem cell in 55 patients with large acute myocardial infarction, left ventricular dysfunction, and at high risk of developing heart failure.
Conclusions:
This phase I/II clinical trial represents a novel experience in humans with allogeneic cardiac stem cell in a rigorously imaging-based selected group of acute myocardial infarction patients, with detailed safety immunologic assessments and magnetic resonance imaging–based efficacy end points.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02439398.
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Affiliation(s)
- Ricardo Sanz-Ruiz
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Ana Casado Plasencia
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Luis R. Borlado
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - María Eugenia Fernández-Santos
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Reem Al-Daccak
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Piet Claus
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Itziar Palacios
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Rafael Sádaba
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Dominique Charron
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Jan Bogaert
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Miguel Mulet
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Raquel Yotti
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Immaculada Gilaberte
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Antonio Bernad
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Javier Bermejo
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Stefan Janssens
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Franciso Fernández-Avilés
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
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Yotti R, Ripoll C, Benito Y, Catalina MV, Elízaga J, Rincón D, Fernández-Avilés F, Bermejo J, Bañares R. Left ventricular systolic function is associated with sympathetic nervous activity and markers of inflammation in cirrhosis. Hepatology 2017; 65:2019-2030. [PMID: 28195341 DOI: 10.1002/hep.29104] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/13/2017] [Accepted: 02/04/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED An accurate evaluation of cardiac function in patients with cirrhosis remains a challenge. We used robust echocardiographic indices to characterize left ventricular (LV) systolic function and its relationship to activation of the sympathetic nervous system and inflammation in 59 patients with cirrhosis and 59 age-matched controls. Additionally, in 11 patients we withdrew beta-blockers and diuretics and used phenylephrine and albumin infusion to evaluate the response to acute afterload and preload changes (interventional substudy). Measures of systolic LV function such as the ejection intraventricular pressure difference (EIVPD) and the systolic strain rate were higher in patients with cirrhosis than in controls (median [1st-3rd quartile], 4.0 [3.1-5.1] versus 2.9 [2.4-3.6] mm Hg and -1.3 [-1.6 to -1.1] versus -1.2 [-1.6 to -1.1)] s-1 , respectively; P < 0.05 for both). EIVPD was related to the severity of liver disease (Model for End-Stage Liver Disease, rho = 0.45, P < 0.001), the degree of sympathetic nervous system activation (noradrenaline, rho = 0.26, P = 0.05; heart rate variability, rho = -0.43, P = 0.003), and treatment with beta-blockers (P = 0.001). In the interventional substudy, EIVPD was higher in patients with ascites (6.5 [5.4-8.5] versus 4.0 [3.9-5.1] mm Hg, P = 0.045). The decrease in EIVPD induced by phenylephrine was inversely related to baseline systolic function (P < 0.05) and associated with markers of systemic vasodilatation (nitric oxide, rho = -0.66, P = 0.06; diastolic blood pressure, rho = 0.68, P = 0.04) and inflammation (interleukin-1beta, rho = -0.80, P = 0.009). CONCLUSION LV systolic function is enhanced in cirrhosis due to augmented adrenergic tone and modulated by treatment with beta-blockers; acute afterload stress induces a deeper impairment of systolic function in patients with more advanced degrees of vasodilatation and inflammation; these changes in LV function related to cirrhosis can be assessed using robust echocardiographic methods. (Hepatology 2017;65:2019-2030).
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Affiliation(s)
- Raquel Yotti
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Cristina Ripoll
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Yolanda Benito
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Maria Vega Catalina
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Jaime Elízaga
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Diego Rincón
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Rafael Bañares
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Pérez del Villar C, Savvatis K, López B, Kasner M, Martinez-Legazpi P, Yotti R, González A, Díez J, Fernández-Avilés F, Tschöpe C, Bermejo J. Impact of acute hypertension transients on diastolic function in patients with heart failure with preserved ejection fraction. Cardiovasc Res 2017; 113:906-914. [DOI: 10.1093/cvr/cvx047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/08/2017] [Indexed: 12/12/2022] Open
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Prieto R, Yotti R, Ávila P, Álvarez T, Gil-Jaurena JM, Fernández-Avilés F. Selection of the Best in 2016 in Congenital Heart Diseases. Rev Esp Cardiol (Engl Ed) 2017; 70:299-300. [PMID: 28347408 DOI: 10.1016/j.rec.2017.01.013] [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: 09/15/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Raquel Prieto
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Raquel Yotti
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Pablo Ávila
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Teresa Álvarez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Sección de Cardiología Pediátrica, Área del Corazón Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Miguel Gil-Jaurena
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Sección de Cirugía Cardiaca Infantil, Área del Corazón Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Rossini L, Martinez-Legazpi P, Benito Y, Del Villar CP, Gonzalez-Mansilla A, Barrio A, Borja MG, Yotti R, Kahn AM, Shadden SC, Fernández-Avilés F, Bermejo J, Del Álamo JC. Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy. Meccanica 2017; 52:563-576. [PMID: 31080296 PMCID: PMC6508690 DOI: 10.1007/s11012-015-0322-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/05/2015] [Indexed: 06/03/2023]
Abstract
In the healthy heart, left ventricular (LV) filling generates different flow patterns which have been proposed to optimize blood transport by coupling diastole and systole. This work presents a novel image-based method to assess how different flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Our approach is based on solving the advection equation for a passive scalar field from time-resolved blood velocity fields. Imposing time-varying inflow boundary conditions for the scalar field provides a straightforward method to distinctly track the transport of blood entering the LV in the different filling waves of a given cardiac cycle, as well as the transport barriers which couple filling and ejection. We applied this method to analyze flow transport in a group of patients with implanted CRT devices and a group of healthy volunteers. Velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular conduction delay, and to model tachycardia (100 bpm). Using this method, we show how CRT influences the transit of blood inside the left ventricle, contributes to conserving kinetic energy, and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract. These novel aspects of ventricular function are clinically accessible by quantitative analysis of color-Doppler echocardiograms.
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Affiliation(s)
- Lorenzo Rossini
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Pablo Martinez-Legazpi
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Yolanda Benito
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Candelas Pérez Del Villar
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Ana Gonzalez-Mansilla
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Alicia Barrio
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - María-Guadalupe Borja
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Raquel Yotti
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Andrew M Kahn
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Shawn C Shadden
- Mechanical Engineering Department, University of California Berkeley, Berkeley, CA, USA
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA, Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA, USA
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Pérez del Villar C, Yotti R, Espinosa MÁ, Gutiérrez-Ibañes E, Barrio A, Lorenzo MJ, Sánchez Fernández PL, Benito Y, Prieto R, Pérez David E, Martínez-Legazpi P, Fernández-Avilés F, Bermejo J. The Functional Significance of Paradoxical Low-Gradient Aortic Valve Stenosis. JACC Cardiovasc Imaging 2017; 10:29-39. [DOI: 10.1016/j.jcmg.2016.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
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Martinez-Legazpi P, Yotti R, Bermejo J. How heavy is the load? The ventricular mechanics of mitral regurgitation revisited in the era of percutaneous therapies. Heart 2016; 103:567-569. [PMID: 27815314 DOI: 10.1136/heartjnl-2016-310472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pablo Martinez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Sánchez PL, Fernández-Santos ME, Espinosa MA, González-Nicolas MA, Acebes JR, Costanza S, Moscoso I, Rodríguez H, García J, Romero J, Kren SM, Bermejo J, Yotti R, Del Villar CP, Sanz-Ruiz R, Elizaga J, Taylor DA, Fernández-Avilés F. Data from acellular human heart matrix. Data Brief 2016; 8:211-9. [PMID: 27331090 PMCID: PMC4900585 DOI: 10.1016/j.dib.2016.04.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 11/22/2022] Open
Abstract
Perfusion decellularization of cadaveric hearts removes cells and generates a cell-free extracellular matrix scaffold containing acellular vascular conduits, which are theoretically sufficient to perfuse and support tissue-engineered heart constructs. This article contains additional data of our experience decellularizing and testing structural integrity and composition of a large series of human hearts, “Acellular human heart matrix: a critical step toward whole heat grafts” (Sanchez et al., 2015) [1]. Here we provide the information about the heart decellularization technique, the valve competence evaluation of the decellularized scaffolds, the integrity evaluation of epicardial and myocardial coronary circulation, the pressure volume measurements, the primers used to assess cardiac muscle gene expression and, the characteristics of donors, donor hearts, scaffolds and perfusion decellularization process.
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Affiliation(s)
- Pedro L Sánchez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - M Eugenia Fernández-Santos
- Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Cell Production Unit, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - M Angeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - M Angeles González-Nicolas
- Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Cell Production Unit, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Judith R Acebes
- Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Cell Production Unit, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Salvatore Costanza
- Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Isabel Moscoso
- Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Spain
| | - Hugo Rodríguez
- Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón. Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Julio García
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Jesús Romero
- Photography & Comunication, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Stefan M Kren
- Center for Cardiovascular Repair, University of Minnesota, Minneapolis, USA
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Jaime Elizaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Doris A Taylor
- Regenerative Medicine Research, Texas Heart Institute, Houston, USA
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), 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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Pérez-David E, Sanz-Ruiz R, Yotti R, Bermejo J, Santos MEF, Cebada FS, Corrales JE, Avilés FF. Assessment of regional and global left ventricular function with electromechanical mapping: validation against MRI. A PRECISE substudy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328689 DOI: 10.1186/1532-429x-17-s1-p143] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rossini L, Martinez-Legazpi P, Vu V, Fernández-Friera L, Pérez Del Villar C, Rodríguez-López S, Benito Y, Borja MG, Pastor-Escuredo D, Yotti R, Ledesma-Carbayo MJ, Kahn AM, Ibáñez B, Fernández-Avilés F, May-Newman K, Bermejo J, Del Álamo JC. A clinical method for mapping and quantifying blood stasis in the left ventricle. J Biomech 2015; 49:2152-2161. [PMID: 26680013 DOI: 10.1016/j.jbiomech.2015.11.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 11/04/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
In patients at risk of intraventrcular thrombosis, the benefits of chronic anticoagulation therapy need to be balanced with the pro-hemorrhagic effects of therapy. Blood stasis in the cardiac chambers is a recognized risk factor for intracardiac thrombosis and potential cardiogenic embolic events. In this work, we present a novel flow image-based method to assess the location and extent of intraventricular stasis regions inside the left ventricle (LV) by digital processing flow-velocity images obtained either by phase-contrast magnetic resonance (PCMR) or 2D color-Doppler velocimetry (echo-CDV). This approach is based on quantifying the distribution of the blood Residence Time (TR) from time-resolved blood velocity fields in the LV. We tested the new method in illustrative examples of normal hearts, patients with dilated cardiomyopathy and one patient before and after the implantation of a left ventricular assist device (LVAD). The method allowed us to assess in-vivo the location and extent of the stasis regions in the LV. Original metrics were developed to integrate flow properties into simple scalars suitable for a robust and personalized assessment of the risk of thrombosis. From a clinical perspective, this work introduces the new paradigm that quantitative flow dynamics can provide the basis to obtain subclinical markers of intraventricular thrombosis risk. The early prediction of LV blood stasis may result in decrease strokes by appropriate use of anticoagulant therapy for the purpose of primary and secondary prevention. It may also have a significant impact on LVAD device design and operation set-up.
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Affiliation(s)
- Lorenzo Rossini
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | - Pablo Martinez-Legazpi
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States.
| | - Vi Vu
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | | | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sara Rodríguez-López
- Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María-Guadalupe Borja
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | | | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Andrew M Kahn
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Karen May-Newman
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA 92093, United States
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