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Vazirani R, Delia MA, Blanco-Ponce E, Martín-García AC, Fernández-Cordón C, Uribarri A, Andrés M, Vedia O, Sionis A, Corbí-Pascual M, Salamanca J, Pérez-Castellanos A, Carmona JDM, Raposeiras-Roubín S, Aritza-Conty D, Lopez-País J, Guillén-Marzo M, Lluch-Requerey C, Escudier JM, Martínez-Sellés M, Núñez-Gil IJ. Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort. Int J Cardiol 2024; 405:131971. [PMID: 38490270 DOI: 10.1016/j.ijcard.2024.131971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive. OBJECTIVE To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS. MATERIAL AND METHODS Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization. RESULTS The prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr <0.71), patients within Q4 (Cr > 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively). CONCLUSIONS TTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain.
| | | | | | - Aitor Uribarri
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Mireia Andrés
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Oscar Vedia
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, II-B Sant Pau, Universitat Autònoma de Barcleona, CIBER-CV, Barcelona, Spain.
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - José David Martínez Carmona
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Malaga, Spain, Instituto de Investigación Biomédica de Málaga-IBIMA, CIBERCV
| | | | - David Aritza-Conty
- Department of Cardiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Javier Lopez-País
- Department of Cardiology, Hospital Universitario de Orense, Orense, Spain
| | - Marta Guillén-Marzo
- Department of Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | | | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
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Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Correction to: Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024:10.1007/s10741-024-10401-1. [PMID: 38625655 DOI: 10.1007/s10741-024-10401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Moisés Rodríguez-González
- Pediatric Cardiology Division of Puerta del Mar University Hospital, Mar University, Hospital, Cadiz, Spain
| | - Ana Castellano-Martinez
- Pediatric Cardiology Division of Puerta del Mar University Hospital, Mar University, Hospital, Cadiz, Spain
| | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
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Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024:10.1007/s10741-024-10394-x. [PMID: 38483658 DOI: 10.1007/s10741-024-10394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/09/2024]
Abstract
Takotsubo syndrome (TTS) in the pediatric population is an infrequent but relevant cause of morbidity and mortality, with limited studies addressing its clinical course and prognosis. We aimed to analyze the clinical features and prognosis of pediatric TTS in a nation-wide multicenter registry and considering the published literature. We included a total of 54 patients from 4 different hospitals in Spain, as well as pediatric TTS patients from the published literature. Comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between pediatric and adult population features. Patients with pediatric TTS are more commonly male and exhibit a higher prevalence of physical triggers. The left ventricular ejection fraction (LVEF) was significantly lower in the pediatric population (30.5 + 10.4 vs 36.9 + 16.9, p < 0.05), resulting in more than fivefold rates of cardiogenic shock on admission compared to the general adult TTS population (Killip IV 74.1% vs 10.5%, p < 0.001) with similar rates of death and recurrence between groups. TTS in the pediatric population presents a distinctive clinical profile, with higher prevalence of atypical symptoms and physical triggers, as well as higher rates of cardiogenic shock on admission and similar mortality and recurrence rates than those of the adult population. This study provides valuable insights into understanding pediatric TTS and underscores the necessity for further research in this age group.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
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Vazirani R, Blanco-Ponce E, Almendro Delia M, Martín-Garcia AC, Fernández-Cordón C, Uribarri A, Vedia O, Sionis A, Salamanca J, Corbí-Pascual M, Pérez-Castellanos A, Martínez-Selles M, Manuel-Becerra V, Raposeiras-Roubín S, Aritza-Conty D, Lopez-País J, Guillén-Marzo M, Lluch-Requerey C, Núñez-Gil IJ. Peripartum Takotsubo Cardiomyopathy: A Review and Insights from a National Registry. J Cardiovasc Dev Dis 2024; 11:37. [PMID: 38392251 PMCID: PMC10889154 DOI: 10.3390/jcdd11020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Takotsubo syndrome (TTS) during the peripartum period is a relevant cause of morbidity in this population; its clinical course and prognosis, compared to the general TTS population, is yet to be elucidated. Our aim was to analyze the clinical features and prognosis of peripartum TTS in a nationwide prospective specifically oriented registry database and consider the published literature. Peripartum TTS patients from the prospective nationwide RETAKO registry-as well as peripartum TTS patients from the published literature-were included, and multiple comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between the groups. Patients with peripartum TTS exhibit a higher prevalence of secondary forms, dyspnea, atypical symptoms, and echocardiographic patterns, as well as less ST-segment elevation than the general TTS population. In the literature, patients with peripartum TTS had a higher Killip status on admission. TTS during the peripartum period has a higher prevalence of angina and dyspnea, as well as physical triggers, neither of which are related to a worse prognosis. Killip status on admission was higher in the literature for patients with TTS but with excellent mid- and long-term prognoses after the acute phase, despite mostly being secondary forms.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomedica (IRB), 25198 Lleida, Spain
| | | | - Agustín C Martín-Garcia
- Department of Cardiology, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain
| | | | - Aitor Uribarri
- Department of Cardiology, Hospital de Vall d'Hebron, 08035 Barcelona, Spain
| | - Oscar Vedia
- Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Alessandro Sionis
- Department of Cardiology, Hospital Sant Pau an Creu, 08025 Barcelona, Spain
| | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Miguel Corbí-Pascual
- Department of Cardiology, Hospital Universitario de Albacete, 02006 Albacete, Spain
| | | | | | | | | | - David Aritza-Conty
- Department of Cardiology, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Javier Lopez-País
- Department of Cardiology, Hospital Universitario de Orense, 32005 Orense, Spain
| | - Marta Guillén-Marzo
- Department of Cardiology, Hospital Universitario Joan XXIII, 43005 Tarragona, Spain
| | - Carmen Lluch-Requerey
- Department of Cardiology, Hospital Universitario Juan Ramón Jimenez, 21005 Huelva, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Lluch-Requerey C, Montilla-Garrido MA, Morgado-García-Polavieja JI, Gragera-Martínez Á, Gómez-Menchero A. Left ventricular hypertrophy. Is there only hypertrophic cardiomyopathy? Arch Cardiol Mex 2024; 94:123-126. [PMID: 38507316 DOI: 10.24875/acm.22000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/07/2023] [Indexed: 03/22/2024] Open
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Moriña-Vázquez P, Moraleda-Salas MT, López-Masjuan-Ríos Á, Esteve-Ruiz I, Arce-León Á, Lluch-Requerey C, Rodríguez-Albarrán A, Venegas-Gamero J, Gómez-Menchero AE. Improvement in electrocardiographic parameters of repolarization related to sudden death in patients with ventricular dysfunction and left bundle branch block after cardiac resynchronization through His bundle pacing. J Interv Card Electrophysiol 2023; 66:2003-2010. [PMID: 36930350 DOI: 10.1007/s10840-023-01526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) through permanent His bundle pacing (p-HBP) normalizes interventricular conduction disorders and QRS. Similarly, there are immediate and long-term changes in repolarization, which could be prognostic of a lower risk of sudden death (SD) at follow-up. We aimed to compare the changes in different electrocardiographic (ECG) repolarization parameters related to the risk of SD before and after CRT through p-HBP. METHODS In this prospective, descriptive single-center study (May 2019 to December 2021), we compared the ECG parameters of repolarization related to SD in patients with non-ischemic dilated cardiomyopathy, left bundle branch block (LBBB), and CRT indications, at baseline and after CRT through p-HBP. RESULTS Forty-three patients were included. Compared to baseline, after CRT through p-HBP, there were immediate significant changes in the QT interval (ms): 445 [407.5-480] vs 410 [385-440] (p = 0.006), QT dispersion (ms): 80 [60-100] vs 40 [40-65] (p < 0.001), Tp-Te (ms): 90 [80-110] vs 80 [60-95] (p < 0.001), Tp-Te/QT ratio: 0.22 [0.19-0.23] vs 0.19 [0.16-0.21] (p < 0.001), T wave amplitude (mm): 6.25 [4.88-10] vs - 2.5 [- 7-2.25] (p < 0.001), and T wave duration (ms): 190 [157.5-200] vs 140 [120-160] (p = 0.001). In the cases of the corrected QT (Bazzett and Friederichia) and the Tp-Te dispersion, changes only became significant at 1 month post-implant (468.5 [428.8-501.5] vs 440 [410-475.25] (p = 0.015); 462.5 [420.8-488.8] vs 440 [400-452.5] (p = 0.004), and 40 [30-52.5] vs 30 [20-40] (p < 0.001), respectively) (Table 1). Finally, two parameters did not improve until 6 months post-implant: the rdT/JT index, 0.25 [0.21-0.28] baseline vs 0.20 [0.19-0.23] 6 months post-implant (p = 0.011), and the JT interval, 300 [240-340] baseline vs 280 [257-302] 6 months post-implant (p = 0.027). Additionally, most of the parameters continued improving as compared with immediate post-implantation. CONCLUSIONS After CRT through His bundle pacing and LBBB correction, there was an improvement in all parameters of repolarization related to increased SD reported in the literature.
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Affiliation(s)
- Pablo Moriña-Vázquez
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | - María Teresa Moraleda-Salas
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain.
| | | | - Irene Esteve-Ruiz
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | - Álvaro Arce-León
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
| | | | | | - José Venegas-Gamero
- Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramón Jiménez (HJRJ), Ronda Norte S/N, Huelva, Spain
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Moriña-Vázquez P, Esteve-Ruiz I, Moraleda-Salas MT, Arce-León Á, Manovel-Sánchez AJ, Venegas-Gamero J, Lluch-Requerey C, López-Masjuán-Ríos Á, Gómez-Menchero AE. His bundle pacing success and electrical parameter stability regardless of three-dimensional transthoracic echocardiography lead localization. J Interv Card Electrophysiol 2023; 66:1867-1876. [PMID: 36763211 DOI: 10.1007/s10840-023-01503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND OR PURPOSE His bundle pacing (HBP) is the most physiological form of ventricular pacing. Few prospective studies have analyzed lead localization using imaging techniques and its relationship with electrical parameters and capture patterns. The objective of this study is to examine the correlation between electrical parameters and lead localization using three-dimensional transthoracic echocardiography (3D TTE). METHODS This single-center, prospective, nonrandomized clinical research study (January 2018 to June 2020) included patients with an indication of permanent pacing, in whom 3D TTE was performed to define lead localization as supravalvular or subvalvular. RESULTS A total of 92 patients were included: 56.5% of leads were supravalvular, and 43.5% were subvalvular, which resembles previous anatomic descriptions of autopsied hearts of His bundle localization within the triangle of Koch (ToK). R-wave sensing was higher when the His lead was localized subvalvular instead of supravalvular. His lead localization was not associated with HBP threshold or impedance differences, nor with the two different HBP patterns of capture, or with the ability of HBP to correct baseline BBB. The thresholds remained stable during follow-up visits, regardless of His lead localization. Higher R-wave sensing was observed during follow-up than at baseline, mainly in the subvalvular His leads. However, lead impedances in both positions decreased during follow-up. CONCLUSIONS Lead localization in relation to the tricuspid valve did not influence the electrical performance of HBPs. Wide anatomical variations of the His bundle within the ToK explain our findings, reinforcing the idea that the technique for HBP should be fundamentally guided by electrophysiological and not anatomical parameters.
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Affiliation(s)
- Pablo Moriña-Vázquez
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - Irene Esteve-Ruiz
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - María Teresa Moraleda-Salas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain.
| | - Álvaro Arce-León
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | | | - José Venegas-Gamero
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - Carmen Lluch-Requerey
- Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Huelva, Spain
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