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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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García-Guimarães M, Bastante T, Del Val D, Fernández-Rodríguez D, Guiberteau-Diaz T, Salamanca J, Rivero F, Alfonso F. Angiographic patterns in spontaneous coronary artery dissection: novel diagnostic insights. Expert Rev Cardiovasc Ther 2024; 22:167-175. [PMID: 38683109 DOI: 10.1080/14779072.2024.2349103] [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: 02/15/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Spontaneous coronary artery dissection (SCAD) is a rare but well-recognized cause of acute coronary syndrome, especially important in women. Invasive coronary angiography (ICA) is the fundamental diagnostic technique for the confirmation of SCAD. Knowing the angiographic patterns suggestive of SCAD is essential for the correct identification of patients with this entity. AREAS COVERED In this narrative review, the main angiographic characteristics of SCAD lesions as detected by ICA are presented and discussed. EXPERT OPINION In addition to the specific angiographic classification of SCAD, several authors have described complementary angiographic patterns suggestive of SCAD. Knowledge and correct identification of these angiographic patterns is essential for the correct diagnosis of patients with clinical suspicion of SCAD.
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Affiliation(s)
- Marcos García-Guimarães
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Teresa Bastante
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - David Del Val
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Diego Fernández-Rodríguez
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Cardiology Department, Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | | | - Jorge Salamanca
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Rivero
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department. Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. CIBER-CV, Madrid, Spain
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Camblor-Blasco A, Nuñez-Gil IJ, Duran Cambra A, Almendro-Delia M, Ródenas-Alesina E, Fernández-Cordon C, Vedia O, Corbí-Pascual M, Blanco-Ponce E, Raposeiras-Roubin S, Guillén Marzo M, Sanchez Grande Flecha A, Garcia Acuña JM, Salamanca J, Escudier-Villa JM, Martin-Garcia AC, Tomasino M, Vazirani R, Perez-Castellanos A, Uribarri A. Prognostic Utility of Society for Cardiovascular Angiography and Interventions Shock Stage Approach for Classifying Cardiogenic Shock Severity in Takotsubo Syndrome. J Am Heart Assoc 2024; 13:e032951. [PMID: 38471832 PMCID: PMC11010033 DOI: 10.1161/jaha.123.032951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is a significant complication of Takotsubo syndrome (TTS), contributing to heightened mortality and morbidity. Despite this, the Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks validation in patients with TTS and CS. This study aimed to characterize a patient cohort with TTS using the SCAI staging system and assess its utility in cases of TTS complicated by CS. METHODS AND RESULTS From a TTS national registry, 1591 consecutive patients were initially enrolled and stratified into 5 SCAI stages (A through E). Primary outcome was all-cause in-hospital mortality; secondary end points were TTS-related in-hospital complications and 1-year all-cause mortality. After exclusions, the final cohort comprised 1163 patients, mean age 71.0±11.8 years, and 87% were female. Patients were categorized across SCAI shock stages as follows: A 72.1%, B 12.2%, C 11.2%, D 2.7%, and E 1.8%. Significant variations in baseline demographics, comorbidities, clinical presentations, and in-hospital courses were observed across SCAI shock stages. After multivariable adjustment, each higher SCAI shock stage showed a significant association with increased in-hospital mortality (adjusted odds ratio: 1.77-29.31) compared with SCAI shock stage A. Higher SCAI shock stages were also associated with increased 1-year mortality. CONCLUSIONS In a large multicenter patient cohort with TTS, the functional SCAI shock stage classification effectively stratified mortality risk, revealing a continuum of escalating shock severity with higher stages correlating with increased in-hospital mortality. This study highlights the applicability and prognostic value of the SCAI staging system in TTS-related CS.
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Affiliation(s)
| | - Ivan J Nuñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense Madrid Spain
- Universidad Europea Madrid Spain
| | | | | | - Eduard Ródenas-Alesina
- Cardiology Department Hospital Universitari Vall d'Hebron Barcelona Spain
- CIBERCV Madrid Spain
| | | | - Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense Madrid Spain
- Universidad Europea Madrid Spain
| | | | | | | | | | | | - Jose Maria Garcia Acuña
- Cardiology Department Hospital Clinico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Jorge Salamanca
- Cardiology Department Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) Madrid Spain
| | | | | | - Marco Tomasino
- Cardiology Department Hospital Universitari Vall d'Hebron Barcelona Spain
| | - Ravi Vazirani
- Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense Madrid Spain
- Universidad Europea Madrid Spain
| | - Alberto Perez-Castellanos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Islas Baleares (IdISBa) Hospital Universitario Son Espases Palma Spain
| | - Aitor Uribarri
- Cardiology Department Hospital Universitari Vall d'Hebron Barcelona Spain
- CIBERCV Madrid Spain
- Vall d'Hebron Institut de Recerca (VHIR) Barcelona Spain
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Santoro F, Núñez Gil IJ, Arcari L, Vitale E, Martino T, El‐Battrawy I, Guerra F, Novo G, Mariano E, Musumeci B, Cacciotti L, Caldarola P, Montisci R, Ragnatela I, Cetera R, Vedia O, Blanco E, Pais JL, Martin A, Pérez‐Castellanos A, Salamanca J, Bartolomucci F, Akin I, Thiele H, Eitel I, Stiermaier T, Brunetti ND. Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes. J Am Heart Assoc 2024; 13:e032128. [PMID: 38353238 PMCID: PMC11010100 DOI: 10.1161/jaha.123.032128] [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: 09/02/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS-associated neurological phenotypes and outcome. METHODS AND RESULTS Patients with TTS enrolled in the international multicenter GEIST (German Italian Spanish Takotsubo) registry were analyzed. Prevalence, clinical characteristics, and short- and long-term outcomes of patients with TTS were recorded. A subgroup analysis of the 5 most represented neurological disorders was performed. In total, 400 (17%) of 2301 patients had neurological disorders. The most represented neurological conditions were previous cerebrovascular events (39%), followed by neurodegenerative disorders (30.7%), migraine (10%), epilepsy (9.5%), and brain tumors (5%). During hospitalization, patients with neurological disorders had longer in-hospital stay (8 [interquartile range, 5-12] versus 6 [interquartile range, 5-9] days; P<0.01) and more often experienced in-hospital complications (27% versus 16%; P=0.01) mainly driven by cardiogenic shock and in-hospital death (12% versus 7.6% and 6.5% versus 2.8%, respectively; both P<0.01). Survival analysis showed a higher mortality rate in neurological patients both at 60 days and long-term (8.8% versus 3.4% and 23.5% versus 10.1%, respectively; both P<0.01). Neurological disorder was an independent predictor of both the 60-day and long-term mortality rate (odds ratio, 1.78 [95% CI, 1.07-2.97]; P=0.02; hazard ratio, 1.72 [95% CI, 1.33-2.22]; both P<0.001). Patients with neurodegenerative disorders had the worst prognosis among the neurological disease subgroups, whereas patients with TTS with migraine had a favorable prognosis (long-term mortality rates, 29.2% and 9.7%, respectively). CONCLUSIONS Neurological disorders identify a high-risk TTS subgroup for enhanced short- and long-term mortality rate. Careful recognition of neurological disorders and phenotype is therefore needed.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Iván J. Núñez Gil
- Interventional; Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San CarlosMadridSpain
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini HospitalRomeItaly
| | - Enrica Vitale
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Tommaso Martino
- Department of Neuroscience, Neurology‐Stroke UnitUniversity HospitalFoggiaItaly
| | - Ibrahim El‐Battrawy
- Department of CardiologyUniversity of MannheimMannheimGermany
- DZHK (German Center for Cardiovascular Research), Partner Site MannheimMannheimGermany
- Department of Cardiology and AngiologyBergmannsheil University Hospitals, Ruhr University of BochumBochumGermany
| | - Federico Guerra
- Cardiology and Arrhythmology ClinicMarche Polytechnic University, University Hospital “Umberto I – Lancisi – Salesi”AnconaItaly
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology UnitUniversity of Palermo, University Hospital PPalermoItaly
| | - Enrica Mariano
- Division of Cardiology, University of Rome Tor VergataRomeItaly
| | - Beatrice Musumeci
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and PsychologySapienza University of RomeRomeItaly
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini HospitalRomeItaly
| | | | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public HealthUniversity of CagliariCagliariItaly
| | - Ilaria Ragnatela
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Rosa Cetera
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Oscar Vedia
- Interventional; Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San CarlosMadridSpain
| | - Emilia Blanco
- Department of CardiologyUniversity Hospital Arnau de VilanovaLleidaSpain
| | | | - Agustin Martin
- Department of Cardiology University hospitalSalamancaSpain
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital de La PrincesaMadridSpain
| | | | - Ibrahim Akin
- Department of CardiologyUniversity of MannheimMannheimGermany
- DZHK (German Center for Cardiovascular Research), Partner Site MannheimMannheimGermany
| | - Holger Thiele
- Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig and Leipzig Heart InstituteLeipzigGermany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/LübeckLübeckGermany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/LübeckLübeckGermany
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5
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Novo G, Arcari L, Stiermaier T, Alaimo C, El-Battrawy I, Cacciotti L, Guerra F, Musumeci B, Mariano E, Parisi G, Montisci R, Vazirani R, Perez Castellanos A, Uribarri A, Corbi-Pascual M, Salamanca J, Akin I, Thiele H, Brunetti ND, Eitel I, Núñez Gil IJ, Santoro F. Statin therapy and outcome in Takotsubo syndrome patients: Results from the multicenter international GEIST registry. Atherosclerosis 2024; 389:117421. [PMID: 38134646 DOI: 10.1016/j.atherosclerosis.2023.117421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND AIMS Several studies have shown that endothelial dysfunction plays a role in the pathogenesis of Takotsubo syndrome (TTS). Given the potential benefit of statin therapy on endothelial dysfunction, we hypothesized that such treatment could improve outcome. Aim of our study was to evaluate clinical characteristics and outcome of TTS patients treated with statin therapy. METHODS Patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Demographic data, clinical features and drug therapy at discharge were recorded. Primary study outcome was the occurrence of all-cause death at follow-up. RESULTS Study population included 2429 consecutive TTS patients: 1293 (53.2%) discharged on statin and 1136 (46.8%) without statin. Patients with statin were older (age 72 ± 11 vs 69 ± 13 years, p < 0.001), with higher prevalence of hypertension (74.3% vs 60.3%, p < 0.001), diabetes (21.1% vs 14.7%, p < 0.001), dyslipidemia (56.1% vs 23.3%, p < 0.001), history of coronary artery disease (13.3% vs 6.3%, p < 0.001) and lower rates of in-hospital complications (14.7% vs 19.3%, p = 0.003). Survival analysis showed similar mortality rates between groups (log rank p = 0.803). At univariable analysis, statin therapy at discharge was not associated with lower mortality (HR: 0.97, 95% CI 0.74-1.26, p = 0.803). At multivariable analysis age (HR: 1.06 95% CI 1.04-1.08, p < 0.001), male sex (HR: 1.83, 95% CI 1.20-2.80, p = 0.005), diabetes (HR: 2.55, 95% CI 1.83-3.54 p < 0.001), malignancies (HR: 2.41, 95% CI 1.68-3.44, p < 0.001) and physical trigger (HR: 2.24, 95% CI 1.62-3.10, p < 0.001) were associated with increased mortality. CONCLUSIONS Statin therapy after a TTS event was not associated with better prognosis at follow-up.
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Affiliation(s)
- Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Italy.
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy, Department of Cardiology; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Chiara Alaimo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Italy
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany; First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany; German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy, Department of Cardiology
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Beatrice Musumeci
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Enrica Mariano
- University of Rome Tor Vergata, Division of Cardiology, Rome, Italy
| | | | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ravi Vazirani
- Cardiovascular Institute. Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Alberto Perez Castellanos
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de la Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Iván J Núñez Gil
- Cardiovascular Institute. Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
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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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7
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Salamanca J, García-Guimaraes M, Sabaté M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizón-Marcos H, Velazquez M, Veiga G, Gamarra A, Aguilar R, Jiménez-Borreguero LJ, Díez-Villanueva P, Bastante T, Núñez-Gil I, Alfonso F. Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes. Coron Artery Dis 2024; 35:50-58. [PMID: 37990625 DOI: 10.1097/mca.0000000000001304] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions. METHODS We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS. RESULTS A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P <0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4-11.7, P <0.01) and long-term (median 36 vs. 31 months, P =0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5-8.2, P <0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P =0.01; and 12.6% vs. 0.7%, P <0.01) mainly driven by noncardiovascular deaths. CONCLUSION Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.
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Affiliation(s)
- Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Marcos García-Guimaraes
- Department of Cardiology, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida
| | - Manel Sabaté
- Department of Cardiology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge
| | | | | | | | - Maite Velazquez
- Department of Cardiology, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBER-CV, Madrid
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria IDIVAL, Santander, Spain
| | - Alvaro Gamarra
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Rio Aguilar
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Luis Jesús Jiménez-Borreguero
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Pablo Díez-Villanueva
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Iván Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
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Vazirani R, Martínez E, Uribarri A, Blanco-Ponce E, Martínez-Sellés M, Corbí-Pascual M, Sionis A, Salamanca J, Vedia O, Núñez-Gil IJ. Reply to the Editor: Inquiries about Tpe and ventricular arrhythmias in patients with takotsubo syndrome. Heart Rhythm O2 2024; 5:63-64. [PMID: 38312207 PMCID: PMC10837158 DOI: 10.1016/j.hroo.2023.11.011] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Ravi Vazirani
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Eduardo Martínez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Emilia Blanco-Ponce
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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9
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Salamanca J, Alfonso F. Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?-a narrative review. Cardiovasc Diagn Ther 2023; 13:1080-1103. [PMID: 38162098 PMCID: PMC10753233 DOI: 10.21037/cdt-23-283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background and Objective Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Methods Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. Key Content and Findings TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Conclusions Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.
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Affiliation(s)
- Jorge Salamanca
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
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10
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Núñez-Gil IJ, Santoro F, Vazirani R, Novo G, Blanco-Ponce E, Arcari L, Uribarri A, Cacciotti L, Guerra F, Salamanca J, Musumeci B, Vedia O, Mariano E, Fernández-Cordón C, Caldarola P, Montisci R, Brunetti ND, El-Battrawy I, Abumayyaleh M, Akin I, Eitel I, Stiermaier T. Smoking influence in Takotsubo syndrome: insights from an international cohort. Front Cardiovasc Med 2023; 10:1282018. [PMID: 38054096 PMCID: PMC10694470 DOI: 10.3389/fcvm.2023.1282018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023] Open
Abstract
Aims To assess the influence of tobacco on acute and long-term outcomes in Takotsubo syndrome (TTS). Methods Patients with TTS from the international multicenter German Italian Spanish Takotsubo registry (GEIST) were analyzed. Comparisons between groups were performed within the overall cohort, and an adjusted analysis with 1:1 propensity score matching was conducted. Results Out of 3,152 patients with TTS, 534 (17%) were current smokers. Smoker TTS patients were younger (63 ± 11 vs. 72 ± 11 years, p < 0.001), less frequently women (78% vs. 90%, p < 0.001), and had a lower prevalence of hypertension (59% vs. 69%, p < 0.01) and diabetes mellitus (16% vs. 20%, p = 0.04), but had a higher prevalence of pulmonary (21% vs. 15%, p < 0.01) and/or psychiatric diseases (17% vs. 12%, p < 0.01). On multivariable analysis, age less than 65 years [OR 3.85, 95% CI (2.86-5)], male gender [OR 2.52, 95% CI (1.75-3.64)], history of pulmonary disease [OR 2.56, 95% CI (1.81-3.61)], coronary artery disease [OR 2.35, 95% CI (1.60-3.46)], and non-apical ballooning form [OR 1.47, 95% CI (1.02-2.13)] were associated with smoking status. Propensity score matching (PSM) 1:1 yielded 329 patients from each group. Smokers had a similar rate of in-hospital complications but longer in-hospital stays (10 vs. 9 days, p = 0.01). During long-term follow-up, there were no differences in mortality rates between smokers and non-smokers (5.6% vs. 6.9% yearly in the overall, p = 0.02, and 6.6%, vs. 7.2% yearly in the matched cohort, p = 0.97). Conclusions Our findings suggest that smoking may influence the clinical presentation and course of TTS with longer in-hospital stays, but does not independently impact mortality.
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Affiliation(s)
- Iván J. Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ravi Vazirani
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Giuseppina Novo
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Emilia Blanco-Ponce
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitari Vall d´Hebron, Barcelona, Spain
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
- CIBER-CV, Barcelona, Spain
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital “Umberto I - Lancisi - Salesi”, Marche Polytechnic University, Ancona, Italy
| | - Jorge Salamanca
- Department of Cardiology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Beatrice Musumeci
- Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Enrica Mariano
- Cardiology Department, Tor Vergata University, Rome, Italy
| | | | | | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Cellular and Translational Physiology and Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg - Kiel - Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg - Kiel - Lübeck, Lübeck, Germany
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11
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Rivero F, Roquero P, Cuesta J, Bastante T, Del Val D, Aguilar R, Salamanca J, Díez-Villanueva P, Alfonso F. Improvement in the Infarct-Related Artery Coronary Flow by Impella Support. JACC Cardiovasc Interv 2023; 16:2191-2193. [PMID: 37565967 DOI: 10.1016/j.jcin.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023]
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12
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Vazirani R, Martínez E, Uribarri A, Blanco-Ponce E, Martínez-Sellés M, Corbí-Pascual M, Sionis A, Salamanca J, Vedia O, Núñez-Gil IJ. Repolarization parameters and ventricular arrhythmias in Takotsubo syndrome: A substudy from the RETAKO national registry. Heart Rhythm O2 2023; 4:517-519. [PMID: 37645263 PMCID: PMC10461195 DOI: 10.1016/j.hroo.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Ravi Vazirani
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Eduardo Martínez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Emilia Blanco-Ponce
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Universidad Europea de Madrid, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
| | - Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J. Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - RETAKO researchers
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Universidad Europea de Madrid, Universidad Complutense de Madrid, Madrid, Spain
- Servicio de Cardiología, Hospital Universitario de Albacete, Albacete, Spain
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain
- Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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13
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Ammirati E, Lupi L, Palazzini M, Ciabatti M, Rossi VA, Gentile P, Uribarri A, Vecchio CR, Nassiacos D, Cereda A, Conca C, Tumminello G, Piriou N, Lelarge C, Pedrotti P, Stucchi M, Peretto G, Galasso M, Huang F, Ianni U, Procopio A, Saponara G, Cimaglia P, Tomasoni D, Moroni F, Turco A, Sala S, Di Tano G, Bollano E, Moro C, Abbate A, Della Bona R, Porto I, Carugo S, Campodonico J, Pontone G, Grosu A, Bolognese L, Salamanca J, Diez-Villanueva P, Ozieranski K, Tyminska A, Sardo Infirri L, Bromage D, Cannatà A, Hong KN, Adamo M, Quattrocchi G, Foà A, Potena L, Garascia A, Giannattasio C, Adler ED, Sinagra G, Ruschitzka F, Camici PG, Metra M, Pieroni M. Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. Circ Heart Fail 2023; 16:e010315. [PMID: 37183708 DOI: 10.1161/circheartfailure.122.010315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Enrico Ammirati
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Laura Lupi
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Matteo Palazzini
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Michele Ciabatti
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Switzerland (V.A.R., F.R.)
| | - Piero Gentile
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.U.)
- Vall d'Hebron Institute de Recerca, Barcelona, Spain (A.U.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.)
| | - Chiara R Vecchio
- Department of Cardiology, Presidio Ospedaliero di Saronno, Azienda Socio-Sanitaria Territoriale Valle Olona, Saronno, Varese, Italy (C.R.V., D.N.)
| | - Daniele Nassiacos
- Department of Cardiology, Presidio Ospedaliero di Saronno, Azienda Socio-Sanitaria Territoriale Valle Olona, Saronno, Varese, Italy (C.R.V., D.N.)
| | - Alberto Cereda
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milano, Italy (A. Cereda, C.C.)
| | - Cristina Conca
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milano, Italy (A. Cereda, C.C.)
| | - Gabriele Tumminello
- Division of Cardiology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy (G.T., S.C.)
| | - Nicolas Piriou
- Nantes Université, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P., C.L.)
| | - Coline Lelarge
- Nantes Université, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P., C.L.)
| | - Patrizia Pedrotti
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Miriam Stucchi
- Cardiology Unit, Azienda Socio-Sanitaria Territoriale della Brianza (MB), Vimercate Hospital, Italy (M.S.)
| | - Giovanni Peretto
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Michele Galasso
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H.)
| | - Umberto Ianni
- Cardiology Unit, Madonna del Soccorso Hospital, Azienda Sanitaria Unica Regionale Marche 5, San Benedetto del Tronto, Italy (U.I.)
| | - Antonio Procopio
- Intensive Cardiac Care Unit, "F. Renzetti" Hospital, Lanciano, Chieti, Italy (A.P.)
| | - Gianluigi Saponara
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy (G.S.)
| | - Paolo Cimaglia
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy (P.C)
| | - Daniela Tomasoni
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Francesco Moroni
- Pauley Heart Center, Virginia Commonwealth University, Richmond (F.M., A.A.)
| | - Annalisa Turco
- Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (A. Turco)
| | - Simone Sala
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Giuseppe Di Tano
- Unità Operativa Cardiologia, Azienda Socio-Sanitaria Territoriale di Cremona, Ospedale OglioPo, Casalmaggiore, Cremona, Italy (G.D.T.)
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.B.)
| | - Claudio Moro
- Department of Cardiology, Azienda Socio-Sanitaria Territoriale Monza, Desio, Italy (C.M.)
| | - Antonio Abbate
- Pauley Heart Center, Virginia Commonwealth University, Richmond (F.M., A.A.)
| | - Roberta Della Bona
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy (R.D.B., I.P.)
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy (R.D.B., I.P.)
- Department of Internal Medicine and Medical Specialties, University of Genoa, Italy (I.P.)
| | - Stefano Carugo
- Division of Cardiology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy (G.T., S.C.)
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Italy (S.C., J.C.)
| | - Jeness Campodonico
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Italy (S.C., J.C.)
- Centro Cardiologico Monzino IRCCS, University of Milan, Italy (J.C., G. Pontone)
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Italy (J.C., G. Pontone)
| | - Aurelia Grosu
- Cardiovascular Department, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy (A. Grosu)
| | - Leonardo Bolognese
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Krzysztof Ozieranski
- First Department of Cardiology, Medical University of Warsaw, Poland (K.O., A. Tyminska)
| | - Agata Tyminska
- First Department of Cardiology, Medical University of Warsaw, Poland (K.O., A. Tyminska)
| | - Loren Sardo Infirri
- Ospedale di Circolo e fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette Laghi, Varese, Italy (L.S.I.)
| | - Daniel Bromage
- School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, King's College London, United Kingdom (D.B., A. Cannatà)
- Department of Cardiology, King's College Hospital London, United Kingdom (D.B., A. Cannatà)
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, King's College London, United Kingdom (D.B., A. Cannatà)
- Department of Cardiology, King's College Hospital London, United Kingdom (D.B., A. Cannatà)
| | - Kimberly N Hong
- Division of Cardiology, Department of Medicine, University of California San Diego (K.N.H., E.D.A.)
| | - Marianna Adamo
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Giuseppina Quattrocchi
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Alberto Foà
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy (A.F., L.P.)
| | - Luciano Potena
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy (A.F., L.P.)
| | - Andrea Garascia
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Cristina Giannattasio
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego (K.N.H., E.D.A.)
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Italy (G.S.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Switzerland (V.A.R., F.R.)
- Center for Translational and Experimental Cardiology, Department of Cardiology, University Hospital Zurich, University of Zurich, Schlieren, Switzerland (F.R.)
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Marco Metra
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
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14
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Salamanca J, Alfonso F. Novel Hemodynamic Insights in Takotsubo Syndrome. J Am Coll Cardiol 2023; 81:1992-1995. [PMID: 37197842 DOI: 10.1016/j.jacc.2023.03.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Jorge Salamanca
- Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBER-CV, Madrid, Spain.
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBER-CV, Madrid, Spain
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15
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Díez-Villanueva P, García-Guimarães M, Sanz-Ruiz R, Sabaté M, Macaya F, Roura G, Jimenez-Kockar M, Flores-Ríos X, Moreu J, Fuertes-Ferre G, Jimenez-Valero S, Tizón H, Nogales JM, Velázquez M, Lozano Í, Avanzas P, Salamanca J, Bastante T, Alfonso F. Prognostic implications of left ventricular systolic dysfunction in patients with spontaneous coronary artery dissection. Eur Heart J Acute Cardiovasc Care 2023; 12:299-305. [PMID: 37010101 DOI: 10.1093/ehjacc/zuad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management, and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown. METHODS AND RESULTS The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients, LVEF could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n = 295, 85%) were compared with those with reduced LVEF (LVEF <50%, n = 53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (STEMI) (62% vs. 36%, P < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, P = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia, and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, P = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, P < 0.001) and readmission rates for heart failure (HF) (4% vs. 0.3%, P = 0.01). CONCLUSION Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for HF during follow-up.
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Marcos García-Guimarães
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, CIBERCV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jose Moreu
- Servicio de Cardiología, Hospital General Universitario de Toledo, Toledo, Spain
| | | | | | - Helena Tizón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | | | - Maite Velázquez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
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16
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Osinalde EP, Bastante T, Cecconi A, Muñiz ÁM, García-Guimaraes M, Rivero F, Rojas-González A, Olivera MJ, Salamanca J, de Isla LP, De Agustín JA, Caballero P, Torres RA, Jiménez-Borreguero LJ, Alfonso F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy: the MATURE prospective study (MSCT to Assess ThrombUs REsolution). Coron Artery Dis 2023; 34:167-176. [PMID: 36762665 DOI: 10.1097/mca.0000000000001225] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. METHODS We systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa ( K ) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. RESULTS Thirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good ( K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. CONCLUSIONS Although CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.
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Affiliation(s)
- Eduardo Pozo Osinalde
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid
| | - Teresa Bastante
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Álvaro Montes Muñiz
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Marcos García-Guimaraes
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
- Cardiology Department, Hospital del Mar - Parc de Salut Mar, Barcelona
| | - Fernando Rivero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - Antonio Rojas-González
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | | | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rio Aguilar Torres
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid
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17
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Salamanca J, García-Guimarães M, Sabaté M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizón-Marcos H, Velazquez-Martín M, Veiga G, Camacho-Freire S, Pérez-Guerrero A, Flores-Rios X, Alvarado T, Díez-Villanueva P, Del Val D, Bastante T, Alfonso F. Multivessel spontaneous coronary artery dissection: Clinical features, angiographic findings, management, and outcomes. Int J Cardiol 2023; 370:65-71. [PMID: 36370874 DOI: 10.1016/j.ijcard.2022.11.011] [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: 06/19/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Multivessel (MV) SCAD is a challenging clinical presentation that might be associated to a worse prognosis compared with patients with single-vessel (SV) involvement. METHODS The Spanish multicentre nationwide prospective SCAD registry included 389 consecutive patients. Patients were classified, according to the number of affected vessels, in SV or MV SCAD. Major adverse events (MAE) were analyzed during hospital stay and major cardiac or cerebrovascular adverse events (MACCE) at long-term clinical follow-up. RESULTS A total of 41 patients (10.5%) presented MV SCAD. These patients had more frequently a previous history of hypothyroidism (22% vs 11%, p = 0.04) and anxiety disorder (32% vs 16%, p = 0.01). MV SCAD patients presented more often as non-ST segment elevation myocardial infarction (73% vs 52%, p = 0.01) and showed less frequently type 1 angiographic lesions (12% vs 21%, p = 0.04). An impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0-1 was less frequent (14% vs 29%, p < 0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p = NS). No differences were found regarding in-hospital MAE or MACCE at late follow-up (median 29 ± 11 months). However, the rate of stroke was higher in MV SCAD patients, both in-hospital (2.4% vs 0%, p < 0.01) and at follow-up (5.1% vs 0.6%, p = 0.01). CONCLUSIONS Patients with MV SCAD have some distinctive clinical and angiographic features. Although composite clinical outcomes, in-hospital and at long-term follow-up, were similar to those seen in patients with SV SCAD, stroke rate was significantly higher in patients with MV SCAD.
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Affiliation(s)
- Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marcos García-Guimarães
- Department of Cardiology, Hospital del Mar - Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar - Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), ISCIII, Madrid, Spain
| | - Maite Velazquez-Martín
- Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBER-CV, Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario de Marqués de Valdecilla, Cantabria, Spain
| | | | - Ainhoa Pérez-Guerrero
- Department of Cardiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Xacobe Flores-Rios
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña, Spain
| | - Teresa Alvarado
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Díez-Villanueva
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain.
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18
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Palazzini M, Ammirati E, Lupi L, Garascia A, Gentile P, Pedrotti P, Giannattasio C, Ciabatti M, Rossi V, Ruschitzka F, Uribarri A, Vecchio C, Nassiacos D, Cereda A, Tumminiello G, Piriou N, Stucchi M, Peretto G, Galasso M, Sala S, Camici P, Huang F, Ianni U, Procopio A, Saponara G, Cimaglia P, Tomasoni D, Moroni F, Turco A, Di Tano G, Bollano E, Moro C, Abbate A, Bona RD, Porto I, Carugo S, Campodonico J, Pontone G, Grosu A, Adamo M, Salamanca J, Ozieransky K, Infirri LS, Cannatà A, Adler E, Sinagra G, Metra M, Pieroni M. 138 OUTCOME AND MORPHO-FUNCTIONAL CHANGES ON CARDIAC MAGNETIC RESONANCE IN PATIENT WITH ACUTE MYOCARDITIS FOLLOWING MRNA COVID 19 VACCINATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.394] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
MessengerRNA (mRNA) COVID-19 vaccination has been associated with a higher-than-expected occurrence of acute myocarditis. Scarce information is available on mid-term prognosis and changes in cardiac function, volumes, and tissue characterization on cardiac magnetic resonance (CMR).
Methods
Retrospective, multicenter study including patients with a definite diagnosis of acute myocarditis within 30 days from mRNA COVID-19 vaccination, with a confirmed myocarditis diagnosis based on endomyocardial biopsy (EMB) or autopsy or by the coexistence of positive biomarkers (troponin >99th upper reference limit or elevated creatine kinase myocardial band [CK-MB]) and cardiac MRI findings consistent with AM according to the 2018 updated Lake Louise Criteria.
Results
77 patients (median age 25 years [IQR 20-35], 15% female) were included and followed-up for 147 days [IQR 74-215]. Follow-up CMR was available in n=49 patients and showed no changes in biventricular ejection fraction (EF) as compared to CMR at diagnosis (left ventricular EF: 59%[55-65]vs. 60%[57-64], p=0.507, right ventricular EF: 56%[52-62]vs. 57%[52-61], p=0.563, respectively). Late gadolinium enhancement was present in all patients at diagnosis and persisted in only n=39 (79.6%) at follow-up (p=0.001), generally sparing the anterior wall and the septum. N=10 (20.4%) had a persistent edema based on T2-weighted short tau inversion recovery (STIR) sequences, with predominant involvement of inferior or inferior-lateral walls. The proportion of patients with increased T1 and T2 mapping signals significantly decreased at follow-up (n=13 (68%) vs. n=4 (13%),p<0.001, and n=21 (84%) vs. n=3 (10%),p<0.001, respectively), as well as the presence of pericardial effusion (n=16 (33%) vs. n=3 (6%),p=0.004).
No differences in morpho-functional CMR parameters based on the type of vaccine administered were found (BNT162b2 Pfizer/BioNTech®, n=36, 73.5%, m-RNA-1273 Moderna®, n=13, 26.5%).
Among patients with available follow-up (N=75, 97.4%), no major adverse cardiovascular events nor myocarditis recurrence or death were reported.
Conclusions
At mid-term follow-up, patients who experienced an acute myocarditis after a mRNA COVID-19 vaccine had preserved biventricular EF. The rate and localization of residual scar or edema on CMR is in line with classic viral myocarditis with a good prognosis. This new piece of information should further reassure patients who experience acute myocarditis after mRNA COVID-19 vaccination.
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Affiliation(s)
| | - Enrico Ammirati
- De Gasperis Cardio Center, Niguarda Hospital , Milano , Italy
| | - Laura Lupi
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Sciences And Public Healt, University Of Brescia , Brescia , Italy
| | - Andrea Garascia
- De Gasperis Cardio Center, Niguarda Hospital , Milano , Italy
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital , Milano , Italy
| | | | | | | | - Valentina Rossi
- Universitatsspital Zurich , Klinik Fur Kardiologie, Zurich , Switzerland
| | - Frank Ruschitzka
- Universitatsspital Zurich , Klinik Fur Kardiologie, Zurich , Switzerland
| | - Aitor Uribarri
- Departamento De Cardiologia, Hospital Clinico Universitario , Valladolid , Spain
| | - Chiara Vecchio
- Department Of Cardiology , Presidio Ospedaliero Di Saronno, Asst Valle Olona, Saronno (Va) Italy
| | - Daniele Nassiacos
- Department Of Cardiology , Presidio Ospedaliero Di Saronno, Asst Valle Olona, Saronno (Va) Italy
| | - Alberto Cereda
- Cardiovascular Department , Asst Santi Paolo E Carlo, Milano , Italy
| | - Gabriele Tumminiello
- Fondazione Istituto Di Ricovero E Cura A Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Division Of Cardiology , Milan , Italy
| | - Nicolas Piriou
- Universite Nantes, Chu Nantes, Centre National De La Recherche Scientifique, Institute National De La Sant Et De La Recherche Medicale , Nantes , France
| | - Miriam Stucchi
- Unita Operativa Complessa Di Cardiologia, Azienda Socio Sanitaria Territoriale Della Brianza (Mb) Vimercate Hospital , Italy
| | - Giovanni Peretto
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Michele Galasso
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Simone Sala
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Paolo Camici
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Florent Huang
- Service De Cardiologie , Hopital Foch, Suresnes , France
| | - Umberto Ianni
- Institute Of Cardiology And Center Of Excellence On Aging- G. D’annunzio University , Chieti , Italy
| | - Antonio Procopio
- Institute Of Cardiology And Center Of Excellence On Aging- G. D’annunzio University , Chieti , Italy
| | - Gianluigi Saponara
- Department Of Cardiovascular And Thoracic Science, Fondazione Policlinico Universitario A. Gemelli , Istituto Di Ricovero E Cura A Carattere Scientifico, Roma , Italy
| | | | - Daniela Tomasoni
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Sciences And Public Healt, University Of Brescia , Brescia , Italy
| | - Francesco Moroni
- Cardiovascular Unit, Pauley Heart Center, Virginia Commonwealth University , Richmond, Va , Usa
| | - Annalisa Turco
- Cardiologia, Fondazione Irccs Policlinico S Matteo , Pavia
| | - Giuseppe Di Tano
- Azienda Socio Sanitaria Territoriale Di Cremona, Cremona Hospital , Italy
| | - Entela Bollano
- Department Of Cardiology, Sahlgrenska University Hospital , 41390, Gothenburg , Sweden
| | - Claudio Moro
- Department Of Cardiology , Azienda Socio Sanitaria Territoriale Monza, P.O Desio , Italy
| | - Antonio Abbate
- Cardiovascular Unit, Pauley Heart Center, Virginia Commonwealth University , Richmond, Va , Usa
| | - Roberta Dalla Bona
- Cardiology Unit, Cardiothoracic And Vascular Department, Istituto Di Ricovero E Cura A Carattere Scientifico S. Martino , Genoa , Italy , , Genoa , Italy
- Department Of Internal Medicine And Medical Specialties, University Of Genoa , Genoa , Italy , , Genoa , Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic And Vascular Department, Istituto Di Ricovero E Cura A Carattere Scientifico S. Martino , Genoa , Italy , , Genoa , Italy
- Department Of Internal Medicine And Medical Specialties, University Of Genoa , Genoa , Italy , , Genoa , Italy
| | - Stefano Carugo
- Fondazione Istituto Di Ricovero E Cura A Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Division Of Cardiology , Milan , Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino , Istituto Di Ricovero E Cura A Carattere Scientifico, Milano , Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino , Istituto Di Ricovero E Cura A Carattere Scientifico, Milano , Italy
| | - Aurelia Grosu
- Cardiovascular Department , Azienda Socio Sanitaria Territoriale, Papa Giovanni Xxiii, Bergamo , Italy
| | - Marianna Adamo
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Sciences And Public Healt, University Of Brescia , Brescia , Italy
| | - Jorge Salamanca
- Cardiology Department,Hospital Universitario De La Princesa , Madrid , Spain
| | | | - Loren Sardo Infirri
- Ospedale Di Circolo E Fondazione Macchi , Azienda Socio Sanitaria Territoriale Sette Laghi, Varese , Italy
| | - Antonio Cannatà
- School Of Cardiovascular Medicine And Science, King’s College London British Heart Foundation, Centre Of Excellence, James Black Center , London , UK
| | - Eric Adler
- Division Of Cardiology, Department Of Medicine, University Of California S Diego , Ca , Usa
| | - Gianfranco Sinagra
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And University Of Trieste , 34149, Trieste , Italy
| | - Marco Metra
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Sciences And Public Healt, University Of Brescia , Brescia , Italy
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19
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Palazzini M, Lupi L, Ammirati E, Giannattasio C, Soriano F, Pedrotti P, Briguglia D, Mapelli M, Campodonico J, Agostoni P, Leonardi S, Turco A, Guida S, Peretto G, Sala S, Camici PG, Marzo F, Grosu A, Senni M, Turrini F, Bramerio M, Marini M, Matassini MV, Rizzo S, Basso C, De Gaspari M, Hendren NS, Schmidt M, Bochaton T, Piriou N, Ubarri A, Van De Heyning C, Sole AA, Cannatà A, Salamanca J, Lehtonen J, Huang F, Adler ED, Metra M. 132 PREVALENCE CHARACTERISTICS AND OUTCOMES OF COVID 19 ASSOCIATED ACUTE MYOCARDITIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.393] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.
Methods
A total of 112 patients with suspected AM from 56963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM.
Results
AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty- one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%).
Conclusions
AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Affiliation(s)
- Matteo Palazzini
- De Gasperis Cardio Center And Transplant Center , Niguarda, Milano
| | - Laura Lupi
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Science And Public Healt, University Of Brescia
| | - Enrico Ammirati
- De Gasperis Cardio Center And Transplant Center , Niguarda, Milano
| | | | | | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Sergio Leonardi
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Annalisa Turco
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Stefania Guida
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Giovanni Peretto
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Simone Sala
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Paolo G Camici
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | | | - Aurelia Grosu
- Cardiovascular Department , Asst Papa Giovanni Xxiii, Bergamo , Italy
| | - Michele Senni
- Cardiovascular Department , Asst Papa Giovanni Xxiii, Bergamo , Italy
| | | | - Manuela Bramerio
- Department Of Histopathology, Niguarda Hospital , Milano , Italy
| | - Marco Marini
- Cardiology Division, Cardiovascular Department , Azienda Ospedaliero Universitaria Ospedali Riuniti Di Ancona, Umberto I, Gm Lancisi, G Salesi, Ancona , Italy
| | - Maria Vittoria Matassini
- Cardiology Division, Cardiovascular Department , Azienda Ospedaliero Universitaria Ospedali Riuniti Di Ancona, Umberto I, Gm Lancisi, G Salesi, Ancona , Italy
| | - Stefania Rizzo
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Cristina Basso
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Monica De Gaspari
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Nicholas S Hendren
- Division Of Cardiology, Department Of Internal Medicine, University Of Texas Southwestern Medical Center , Dallas
| | - Matthieu Schmidt
- Sorbonne Universitè, Umrs 1166, Institute Of Cardiometabolism And Nutrition, Service De Medecine Intensive-Reanimation, Institute De Cardiologie Assistant Publique-Hopitaux De Paris Hopital Pitie-Salpetriere , France
| | - Thomas Bochaton
- Urgences Et Soins Critiques Cardiologiques , Hopital Cardiologique, Hospices Civils De Lyon, Bron , France
| | - Nicolas Piriou
- Universite Nantes, Chu Nantes, Centre National De La Recherche Scientifique, Institute National De La Santè Et De La Recherche Medicale , France
| | - Aitor Ubarri
- Departamento De Cardiologia, Hospital Clinico Universitario , Valladolid , Spain
| | - Caroline Van De Heyning
- Department Of Cardiology, Antwerp University Hospital, Genetics, Pharmacology And Physiopathology Of Heart, Blood And Vessels And Skeleton Research Group, Antwerp University , Belgium
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital , Bioheart, Grup De Malalties Cardiovasculars, Institut De Investigacio Biomedica De Bellvitge, L’hospotalet Del Llobregat, Barcelona , Spain
| | - Antonio Cannatà
- School Of Cardiovascular Medicine And Science, King’s College, London, British Heart Foundation, Centre Of Excellence, James Black Centre , United Kingdom
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa , Madrid , Spain
| | - Jukka Lehtonen
- Heart And Lung Center, Department Of Cardiology, Helsinki University Hospital,Finland
| | - Florent Huang
- Service De Cardiologie , Hopital Foch, Suresnes , France
| | - Eric D Adler
- Division Of Cardiology, Department Of Medicine, University Of California San Diego
| | - Marco Metra
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Science And Public Healt, University Of Brescia
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20
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Fernández-Gallego N, Castillo-González R, Méndez-Barbero N, López-Sanz C, Obeso D, Villaseñor A, Escribese MM, López-Melgar B, Salamanca J, Benedicto-Buendía A, Jiménez-Borreguero LJ, Ibañez B, Sastre J, Belver MT, Vega F, Blanco C, Barber D, Sánchez-Madrid F, de la Fuente H, Martín P, Esteban V, Jiménez-Saiz R. The impact of type 2 immunity and allergic diseases in atherosclerosis. Allergy 2022; 77:3249-3266. [PMID: 35781885 DOI: 10.1111/all.15426] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 01/28/2023]
Abstract
Allergic diseases are allergen-induced immunological disorders characterized by the development of type 2 immunity and IgE responses. The prevalence of allergic diseases has been on the rise alike cardiovascular disease (CVD), which affects arteries of different organs such as the heart, the kidney and the brain. The underlying cause of CVD is often atherosclerosis, a disease distinguished by endothelial dysfunction, fibrofatty material accumulation in the intima of the artery wall, smooth muscle cell proliferation, and Th1 inflammation. The opposed T-cell identity of allergy and atherosclerosis implies an atheroprotective role for Th2 cells by counteracting Th1 responses. Yet, the clinical association between allergic disease and CVD argues against it. Within, we review different phases of allergic pathology, basic immunological mechanisms of atherosclerosis and the clinical association between allergic diseases (particularly asthma, atopic dermatitis, allergic rhinitis and food allergy) and CVD. Then, we discuss putative atherogenic mechanisms of type 2 immunity and allergic inflammation including acute allergic reactions (IgE, IgG1, mast cells, macrophages and allergic mediators such as vasoactive components, growth factors and those derived from the complement, contact and coagulation systems) and late phase inflammation (Th2 cells, eosinophils, type 2 innate-like lymphoid cells, alarmins, IL-4, IL-5, IL-9, IL-13 and IL-17).
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Affiliation(s)
- Nieves Fernández-Gallego
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Raquel Castillo-González
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Department of Pathology, Hospital 12 de Octubre, Madrid, Spain
| | - Nerea Méndez-Barbero
- Vascular Research Laboratory, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Celia López-Sanz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - David Obeso
- Department of Basic Medical Sciences, Faculty of Medicine, Institute of Applied Molecular Medicine Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.,Department of Chemistry and Biochemistry, Faculty of Pharmacy, Centre for Metabolomics and Bioanalysis (CEMBIO), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Alma Villaseñor
- Department of Basic Medical Sciences, Faculty of Medicine, Institute of Applied Molecular Medicine Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.,Department of Chemistry and Biochemistry, Faculty of Pharmacy, Centre for Metabolomics and Bioanalysis (CEMBIO), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - María M Escribese
- Department of Basic Medical Sciences, Faculty of Medicine, Institute of Applied Molecular Medicine Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Beatriz López-Melgar
- Department of Cardiology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Jorge Salamanca
- Department of Cardiology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Amparo Benedicto-Buendía
- Department of Cardiology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Borja Ibañez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Cardiology, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Joaquín Sastre
- Department of Allergy and Immunology, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Teresa Belver
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Francisco Vega
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Carlos Blanco
- Department of Allergy, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain
| | - Domingo Barber
- Department of Basic Medical Sciences, Faculty of Medicine, Institute of Applied Molecular Medicine Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Martín
- Vascular Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Faculty of Medicine and Biomedicine, Universidad Alfonso X El Sabio, Madrid, Spain
| | - Rodrigo Jiménez-Saiz
- Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain.,Faculty of Experimental Sciences, Universidad Francisco de Vitoria (UFV), Madrid, Spain.,Department of Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, Ontario, Canada
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21
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Vera A, Cecconi A, Martínez-Vives P, Olivera MJ, Hernández S, López-Melgar B, Rojas-González A, Díez-Villanueva P, Salamanca J, Tejelo J, Caballero P, Jiménez-Borreguero LJ, Alfonso F. Electrocardiogram and CMR to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure. Heart Vessels 2022; 37:1850-1858. [PMID: 35657427 DOI: 10.1007/s00380-022-02102-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/11/2022] [Indexed: 12/23/2022]
Abstract
In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant supraventricular tachyarrhythmia (SVT) it is a challenge to predict LVEF recovery and differentiate tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM). The role of the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) and in this acute setting remains unsettled. Forty-three consecutive patients admitted for HF due to SVT and LVEF < 50% undergoing CMR in the acute phase, were retrospectively included. Those who had LVEF > 50% at follow up were classified as TIC and those with LVEF < 50% were classified as DCM. Clinical, CMR and ECG findings were analyzed to predict LVEF recovery. Twenty-five (58%) patients were classified as TIC. Patients with DCM had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4%; p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DCM group (61 vs 16%; p = 0.004). On multivariate analysis, QRS duration ≥ 100 ms (p = 0.027), LVEF < 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were independent predictors of lack of LVEF recovery. Furthermore, during follow-up (median 60 months) DCM patients were admitted more frequently for HF (44 vs 0%; p < 0.001) than TIC patients. In patients with reduced LVEF admitted for HF due to SVT, QRS ≥ 100 ms, LVEF < 40% and LGE are independently associated with lack of LVEF recovery and worse clinical outcome.
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Affiliation(s)
- Alberto Vera
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Pablo Martínez-Vives
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Susana Hernández
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Beatriz López-Melgar
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Antonio Rojas-González
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Julio Tejelo
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
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22
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Ammirati E, Lupi L, Palazzini M, Hendren NS, Grodin JL, Cannistraci CV, Schmidt M, Hekimian G, Peretto G, Bochaton T, Hayek A, Piriou N, Leonardi S, Guida S, Turco A, Sala S, Uribarri A, Van de Heyning CM, Mapelli M, Campodonico J, Pedrotti P, Barrionuevo Sánchez MI, Ariza Sole A, Marini M, Matassini MV, Vourc'h M, Cannatà A, Bromage DI, Briguglia D, Salamanca J, Diez-Villanueva P, Lehtonen J, Huang F, Russel S, Soriano F, Turrini F, Cipriani M, Bramerio M, Di Pasquale M, Grosu A, Senni M, Farina D, Agostoni P, Rizzo S, De Gaspari M, Marzo F, Duran JM, Adler ED, Giannattasio C, Basso C, McDonagh T, Kerneis M, Combes A, Camici PG, de Lemos JA, Metra M. Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis. Circulation 2022; 145:1123-1139. [PMID: 35404682 PMCID: PMC8989611 DOI: 10.1161/circulationaha.121.056817] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [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: 12/15/2022]
Abstract
Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Laura Lupi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Matteo Palazzini
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Nicholas S Hendren
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Carlo V Cannistraci
- Center for Complex Network Intelligence, Tsinghua Laboratory of Brain and Intelligence, Department of Computer Science, Department of Biomedical Engineering, Tsinghua University, Beijing, China (C.V.C.).,Center for Systems Biology Dresden, Germany (C.V.C.)
| | - Matthieu Schmidt
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Guillaume Hekimian
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Giovanni Peretto
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Thomas Bochaton
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Ahmad Hayek
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P.)
| | - Sergio Leonardi
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Stefania Guida
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Annalisa Turco
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Simone Sala
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Aitor Uribarri
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain (A.U.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.)
| | - Caroline M Van de Heyning
- Department of Cardiology, Antwerp University Hospital, and Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton Research Group, Antwerp University, Belgium (C.M.V.d.H.)
| | - Massimo Mapelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Maria Isabel Barrionuevo Sánchez
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Marco Marini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Maria Vittoria Matassini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Mickael Vourc'h
- Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).,School of Medicine, UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, IRS2 Nantes Biotech, France (M.V.)
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | | | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Jukka Lehtonen
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital, Finland (J.L.)
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Stéphanie Russel
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Francesco Soriano
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | | | - Manlio Cipriani
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Manuela Bramerio
- Department of Histopathology, Niguarda Hospital, Milano, Italy (M.B.)
| | - Mattia Di Pasquale
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Davide Farina
- Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (D.F.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Francesca Marzo
- Department of Cardiology, Infermi Hospital, Rimini, Italy (F.M.)
| | - Jason M Duran
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Cristina Giannattasio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy (C.G.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Theresa McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale UMRS1166, Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (M.K.)
| | - Alain Combes
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
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23
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Alfonso F, García-Guimaraes M, Alvarado T, Sanz-Ruiz R, Roura G, Amat-Santos IJ, Abdul-Jawad Altisent O, Tizón-Marcos H, Flores-Ríos X, Masotti M, Pérez-de Prado A, Ferre GF, Ruiz-Poveda FL, Valero E, Portero-Portaz JJ, Diez-Villanueva P, Salamanca J, Bastante T, Rivero F. Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection. Coron Artery Dis 2022; 33:75-80. [PMID: 33878074 DOI: 10.1097/mca.0000000000001043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. OBJECTIVE This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. METHODS The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. RESULTS One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. CONCLUSION Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
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Affiliation(s)
- Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Marcos García-Guimaraes
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Teresa Alvarado
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Ricardo Sanz-Ruiz
- Cardiac Department, Hospital General Universitario Gregorio Marañón, IIS-GM, CIBERCV, Madrid
| | - Gerard Roura
- Cardiac Department, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona
| | | | | | - Helena Tizón-Marcos
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Xacobe Flores-Ríos
- Cardiac Department, Complexo Hospitalario Universitario de A Coruña, A Coruña
| | - Mónica Masotti
- Cardiac Department, Hospital Clinic de Barcelona, Barcelona
| | | | | | | | | | | | - Pablo Diez-Villanueva
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Jorge Salamanca
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Teresa Bastante
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
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24
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Salamanca J, Díez-Villanueva P, Canabal A, Reyes G, Ramasco F, Alfonso F. Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:129-133. [PMID: 35279416 DOI: 10.1016/j.redare.2021.09.002] [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] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program. METHODS Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS. RESULTS A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality. CONCLUSIONS A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.
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Affiliation(s)
- J Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | - P Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | - A Canabal
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - G Reyes
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - F Ramasco
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - F Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain.
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25
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Montes A, Pozo Osinalde E, Bastante T, Cecconi A, Garcia-Guimaraes M, Rivero F, De Rueda C, Rojas Gonzalez A, Olivera MJ, Salamanca J, De Agustin JA, Caballero P, Aguilar Torres R, Jimenez Borreguero LJ, Alfonso Manterola F. Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.416] [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
Funding Acknowledgements
Type of funding sources: None.
Background.
Cardiac computed tomography angiography (CCTA) is precise in non-invasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate the diagnostic accuracy of CCTA for intracoronary thrombus and stenosis detection in acute coronary syndromes (ACS) with high thrombus burden selected for a deferred stenting (DS) strategy.
Methods.
We systematically performed a CCTA in consecutive DS patients 24 hours before the scheduled repeated coronary angiography that also included optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both non-invasive and invasive diagnostic tests. Agreement was determined per lesion using weighted Kappa (K) coefficient and absolute intra-class correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed.
Results.
Thirty lesions in 28 consecutive patients with a large thrombus burden were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good (K= 0.554; p< 0.001), but both showed a poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs 33.3%; p= 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter stenosis (ICC= 0.85; p< 0.001), and was able to identify all the patients with severe residual stenosis.
Conclusion.
CCTA is able to assess intracoronary thrombus. Although CCTA showed just a good concordance with angiography in thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden CCTA may substitute repeat angiography in patients considered for DS. Abstract Figure.
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Affiliation(s)
- A Montes
- University Hospital De La Princesa, Madrid, Spain
| | - E Pozo Osinalde
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - T Bastante
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Madrid, Spain
| | | | - MJ Olivera
- University Hospital De La Princesa, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - JA De Agustin
- Hospital Clinico San Carlos, Cardiology Department, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
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26
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Salamanca J, Díez-Villanueva P, Rivero F, Sarraj A, Suarez-Sipmann F, Alfonso F. [Dispositivo de asistencia circulatoria Impella RP ® en shock poscardiotomía por fallo ventricular derecho]. Arch Cardiol Mex 2021; 91:525-527. [PMID: 33270621 PMCID: PMC8641453 DOI: 10.24875/acm.20000408] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | | | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Anas Sarraj
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, Madrid, España
| | | | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
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27
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Díez-Villanueva P, García-Guimaraes M, Sanz-Ruiz R, Roura G, Macaya F, Barahona Alvarado JC, Tizón-Marcos H, Flores-Ríos X, Masotti M, Lezcano-Pertejo C, Cortés C, Fuertes-Ferre G, Becerra-Muñoz VM, Lozano Ruiz-Poveda F, Valero E, Portero-Portaz JJ, Vera A, Salamanca J, Alfonso F. Spontaneous coronary artery dissection in old patients: clinical features, angiographic findings, management and outcome. Eur Heart J Acute Cardiovasc Care 2021; 10:926-932. [PMID: 33620451 DOI: 10.1093/ehjacc/zuaa029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/20/2020] [Accepted: 10/29/2020] [Indexed: 06/12/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome. Clinical features, angiographic findings, management and outcomes of SCAD in old patients (>65 years of age) remain unknown. METHODS AND RESULTS The Spanish multicentre prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. Data were collected between June 2015 and April 2019. All angiograms were analysed in a centralized corelab. For the purposes of this study, patients were classified according to age in two groups <65 and ≥65 years old and in-hospital outcomes were analysed. Fifty-five patients (17%) were ≥65 years old (95% women). Older patients had more often hypertension (76% vs. 29%, P < 0.01) and dyslipidaemia (56% vs. 30%, P < 0.01), and less previous (4% vs. 18%, P < 0.001) or current smoking habit (4% vs. 33%, P < 0.001). An identifiable trigger was less often present in old patients (27% vs. 43%, P = 0.028). They also had more often severe coronary tortuosity (36% vs. 11%, P = 0.036) and showed more frequently coronary ectasia (24% vs. 9%, P < 0.01). Older patients were more often managed conservatively (89% vs. 75%, P = 0.025), with no significant differences in major adverse cardiac events during index admission (7% vs. 8%, P = 0.858). There were no differences between groups in terms of in-hospital stay, new acute myocardial infarction, unplanned coronary angiography or heart failure. CONCLUSION Older patients with SCAD show different clinical and angiographic characteristics compared with younger patients. Initial treatment strategy was different between groups, though in-hospital outcomes do not significantly differ (NCT03607981).
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Affiliation(s)
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar - Parc de Salut Mar, Barcelona, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar - Parc de Salut Mar, Barcelona, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carlos Cortés
- Servicio de Cardiología, Hospital San Pedro de Logroño, Logroño, Spain
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | | | - Alberto Vera
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
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28
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Bastante T, García-Guimaraes M, Muñiz M, Cuesta J, Rivero F, Antuña P, De Rueda C, Hernández-Muñiz S, Aguilar R, Salamanca J, Pozo-Osinalde E, Jiménez-Borreguero J, Batlle M, Friera A, Alfonso F. <i class="fa fa-video-camera" aria-hidden="true"></i> Manejo contempor�neo de la disecci�n coronaria espont�nea. RECIC 2021. [DOI: 10.24875/recic.m20000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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29
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Alvarado T, Rivero F, Diego G, García-Guimaraes M, Salamanca J, Díez-Villanueva P, Cuesta J, Antuña P, Jiménez-Borreguero J, Alfonso F. Transcatheter aortic valve replacement using the new Evolut-Pro system: a prospective comparison with the Evolut-R device. J Thorac Dis 2021; 13:4023-4032. [PMID: 34422332 PMCID: PMC8339791 DOI: 10.21037/jtd-20-2409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/01/2020] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
Background Evolut Pro (EVP) is a novel self-expandable aortic valve. This prosthesis consists of an external porcine pericardial wrap designed to reduce paravalvular leak (PVL), maintaining the benefits of its predecessor, the Evolut R (EVR). The aim was to compare the functional and clinical results in the short and medium term of the new EVP with the EVR system. Methods Consecutive patients receiving either the EVR (n=50) or the EVP (n=33) from June 2015 to October 2018 were compared. Baseline characteristics, cardiovascular imaging, procedural outcomes, short and mid-term follow-up outcomes were prospectively collected and assessed. Results Residual mild PVL was common and comparable in the two groups (EVR 79% vs. EVP 70%; P=0.4). In the EVR group, the presence of PVL was directly related to prosthesis size, but this correlation was not observed in the EVP group. Conduction abnormalities were more prevalent with the EVP, but these did not translate into a higher need of permanent pacemaker implantation. Vascular and bleeding complications were infrequent in both groups. At mid-term clinical follow-up (median survival time: EVR 11±0.3 months, EVP 12±0.2 months), the 1-year rate of adverse events was similar (EVR: 24%, EVP: 33%; P=0.3). Conclusions Both protheses are effective for the treatment of severe aortic stenosis with excellent results at mid-term clinical follow up. The EVP remains associated with a significant rate of residual mild PVL that appears to be similar to that observed with EVR.
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Affiliation(s)
- Teresa Alvarado
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Diego
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Paula Antuña
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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de-la-Cuerda F, Díez-Villanueva P, Salamanca J, Acedo-Domínguez N, González E, Alfonso F. Multiple thrombosis with native coronary involvement secondary to heparin-induced thrombocytopenia. Arch Cardiol Mex 2021; 90:358-360. [PMID: 32952166 DOI: 10.24875/acm.20000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Jorge Salamanca
- Servicio de Cardiología. Hospital Universitario de la Princesa, Madrid, España
| | | | - Esther González
- Servicio de Cardiología. Hospital Universitario de la Princesa, Madrid, España
| | - Fernando Alfonso
- Servicio de Cardiología. Hospital Universitario de la Princesa, Madrid, España
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Vera Sainz A, Cecconi A, Martinez-Vives P, Olivera MJ, Hernandez S, Tejelo J, Lopez Melgar B, Rojas Gonzalez A, Diez-Villanueva P, Salamanca J, Caballero P, Alfonso F, Jimenez-Borreguero LJ. usefulness of the electrocardiogram and cardiac magnetic resonance to differentiate tachycardia induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.086] [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
Funding Acknowledgements
Type of funding sources: None.
Background
In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant high-rate supraventricular tachyarrhythmia (SVT) it is challenging to predict LVEF recovery after heart rate control and distinguish tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DC). The role of cardiac magnetic resonance (CMR) and the electrocardiogram (ECG) in this setting remains unsettled.
Methods
Forty-three consecutive patients admitted for HF due to high-rate SVT and LVEF <50% undergoing CMR in the acute phase were retrospectively included. Those who had LVEF >50% at follow up were classified as TIC and those with LVEF <50% were classified as DC. Clinical, laboratory, CMR and ECG findings were analyzed to predict LVEF recovery.
Results
Twenty-five (58%) patients were classified as TIC. Patients with DC had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4% p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DC group (61 vs 16% p = 0.004). On multivariate analysis, QRS duration ≥100 ms (p = 0.027), LVEF < 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were identified as independent predictors of lack of LVEF recovery. Furthermore, during clinical follow-up (median 60 months) DC patients were admitted more frequently for HF (44% vs 0%; p < 0.001) than TIC patients (Figure 1).
Conclusion
In patients with reduced LVEF admitted for HF due to high-rate SVT, QRS duration ≥100 ms, LVEF <40% on CMR and presence of LGE are independently associated with lack of LVEF recovery and worse clinical outcome.
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Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Madrid, Spain
| | | | - MJ Olivera
- University Hospital De La Princesa, Madrid, Spain
| | - S Hernandez
- University Hospital De La Princesa, Madrid, Spain
| | - J Tejelo
- University Hospital De La Princesa, Madrid, Spain
| | | | | | | | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Díez-Villanueva P, García-Guimaraes MM, Macaya F, Masotti M, Nogales JM, Jimenez-Kockar M, Velázquez M, Lozano Í, Moreu J, Avanzas P, Salamanca J, Alfonso F. Spontaneous Coronary Artery Dissection and Menopause. Am J Cardiol 2021; 148:53-59. [PMID: 33617813 DOI: 10.1016/j.amjcard.2021.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 01/28/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome in women. The role of sexual hormones has been related to the pathophysiology of SCAD. However, clinical features, angiographic findings, management and outcomes of SCAD women in relation to menopause status remain unknown. The Spanish multicenter prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. All coronary angiograms were analyzed in a centralized Corelab. In this substudy, 245 women were classified according to their menopause state (pre-menopausal and post-menopausal). In-hospital outcomes were analyzed: 148 patients (60.4%) were post-menopausal. These patients were older (57 [52 to 66] vs 49 [44 to 54] years, p <0.01) and had more often hypertension (49% vs 27%, p <0.01) and dyslipidemia (46% vs 25%, p <0.01). Post-menopausal women showed more often previous history of acute coronary syndrome, including previous SCAD (9% vs 3%, p = 0.046), and presented less frequently as ST-segment elevation myocardial infarction on admission, compared with premenopausal women (34% vs 49%, p = 0.014). On the other hand, premenopausal women showed more often proximal and multisegment involvement (24% vs 7%, and 32% vs 18%, respectively, both p <0.01). Post-menopausal women were more often managed conservatively (85% vs 71%, p <0.01) and presented less frequently left ventricular dysfunction (both, p <0.01). There were no differences between groups in terms of in-hospital stay or mortality, new acute myocardial infarction, unplanned coronary angiography or heart failure. In conclusion, post-menopausal women with SCAD show different clinical and angiographic characteristics compared with pre-menopausal SCAD patients. Initial treatment strategy was different between groups, though in-hospital outcomes did not significantly differ (NCT03607981).
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain
| | - Marcos Manuel García-Guimaraes
- Servicio de Cardiología. Hospital del Mar - Parc de Salut Mar, Barcelona. Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología. Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid. Spain
| | - Mónica Masotti
- Servicio de Cardiología. Hospital Clinic de Barcelona, Barcelona. Spain
| | | | | | - Maite Velázquez
- Servicio de Cardiología. Hospital Universitario 12 de Octubre, Madrid, Spain. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España. CIBERCV
| | - Íñigo Lozano
- Servicio de Cardiología. Hospital Universitario de Cabueñes, Gijón. Spain
| | - Jose Moreu
- Servicio de Cardiología. Hospital General Universitario de Toledo, Toledo, Spain
| | - Pablo Avanzas
- Servicio de Cardiología. Hospital Universitario Central de Asturias. Oviedo. Spain. Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain, University of Oviedo, Oviedo, Spain
| | - Jorge Salamanca
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain.
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Vera A, Rivero F, Salamanca J, Alvarado-Casas T, Alfonso F. Coronary Plaque Erosion after Abemaciclib Treatment Onset: An Unknown Side Effect? Thromb Haemost 2020; 121:976-978. [PMID: 33260247 DOI: 10.1055/a-1326-7028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current article describes a 72-year-old woman who suffered an acute myocardial infarction due to plaque erosion (PE) 2 weeks after abemaciclib treatment onset due to advanced breast cancer. Abemaciclib is a cyclin-dependent kinase 4 and 6 inhibitor that has recently demonstrated efficacy and safety in advanced breast cancer. Of major concern, however, reported thromboembolic rates in randomized clinical trials testing this drug range from 0.6 to 5%. To the best of our knowledge this is the first thrombotic coronary side effect ever reported. We suggest that a treatment that increases thromboembolic risk, such abemaciclib, may have triggered PE in our patient, 15 days after abemaciclib initiation. New molecules are promising in cancer treatment; however, care must be paid to their potential cardiotoxic effects.
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Affiliation(s)
- Alberto Vera
- Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, CIBERCV, Madrid, Spain
| | - Fernando Rivero
- Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, CIBERCV, Madrid, Spain
| | - Jorge Salamanca
- Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, CIBERCV, Madrid, Spain
| | - Teresa Alvarado-Casas
- Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Instituto de Investigación Sanitaria (IIS-IP), Hospital Universitario de la Princesa, CIBERCV, Madrid, Spain
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Diez Villanueva P, Garcia-Guimaraes M, Vera A, Moreu J, Ojeda S, Nogales J, Salamanca J, Veiga G, Masotti M, Camacho-Freire S, Jimenez-Valero S, Jimenez-Kockar M, Lozano I, Bastante T, Alfonso F. Spontaneous coronary artery dissection in the elderly: clinical features, angiographic findings, management and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3249] [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
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Clinical features, angiographic findings, management and outcomes of SCAD in elderly patients remain unknown.
Methods
The Spanish multicenter prospective SCAD registry included 318 consecutive patients with SCAD diagnosis. Patients were classified according to age in two groups: <65 and ≥65 years old.
Results
A total of 55 patients (17%) were 65 or older (Table). Elderly patients had more often hypertension (29% vs 76%, p<0.01) and dyslipidemia (30% vs 56%, p<0.01), and less smoking history (51% vs 7%, p<0.01). Previous history of coronary artery disease was also more frequent in older patients (4% vs 11%, p=0.044). Interestingly, an identifiable trigger was more often found among patients under 65. Coronary artery tortuosity (1±0.99 vs 1.4±1, p=0.027) and coronary artery ectasia (9% vs 24%, p<0.01) were both more frequent in elderly patients, who were more often managed conservatively (75% vs 89%, p=0.025). A trend toward a higher mortality rate was found among patients ≥65, with no differences in terms of in hospital stay, new acute myocardial infarction, unplanned coronariography or heart failure.
Conclusions
Elderly patients with SCAD show different clinical and angiographic characteristics and they receive distinct management. Short-term outcomes do not significantly differ from those seen in younger patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - A Vera
- Hospital Universitario La Princesa, Madrid, Spain
| | - J Moreu
- Hospital Virgen de la Salud, Cardiology, Toledo, Spain
| | - S Ojeda
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - J.M Nogales
- Hospital Infanta Cristina de Badajoz, Cardiology, Badajoz, Spain
| | - J Salamanca
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - G Veiga
- University Hospital Marques de Valdecilla, Cardiology, Santander, Spain
| | - M Masotti
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | | | | | - M Jimenez-Kockar
- Hospital de la Santa Creu i Sant Pau, Cardiology, Barcelona, Spain
| | - I Lozano
- Hospital de Cabuenes, Cardiology, Gijon, Spain
| | - T Bastante
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Salamanca J, Díez-Villanueva P, Martínez P, Cecconi A, González de Marcos B, Reyes G, Salas C, Segovia J, Jiménez-Borreguero LJ, Alfonso F. COVID-19 "Fulminant Myocarditis" Successfully Treated With Temporary Mechanical Circulatory Support. JACC Cardiovasc Imaging 2020; 13:2457-2459. [PMID: 32713771 PMCID: PMC7213962 DOI: 10.1016/j.jcmg.2020.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Salamanca J, Díez-Villanueva P, Jiménez-Borreguero L. Dilated phase of hypertrophic cardiomyopathy: A cardiac magnetic resonance evolutive assessment. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Salamanca J, Díez-Villanueva P, Jiménez-Borreguero L. Miocardiopatía hipertrófica en fase dilatada: valoración evolutiva mediante cardio-resonancia magnética. Rev Clin Esp 2020; 220:207-208. [DOI: 10.1016/j.rce.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/15/2019] [Indexed: 11/15/2022]
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Díez-Villanueva P, Vicent L, de la Cuerda F, Esteban-Fernández A, Gómez-Bueno M, de Juan-Bagudá J, Iniesta ÁM, Ayesta A, Rojas-González A, Bover-Freire R, Iglesias D, García-Aguado M, Perea-Egido JÁ, Salamanca J, Martínez-Sellés M. Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan. Cardiology 2020; 145:275-282. [PMID: 31940620 DOI: 10.1159/000505148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. METHODS We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). RESULTS After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). CONCLUSIONS In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.
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Affiliation(s)
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Ana Ayesta
- Servicio de Cardiología, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | | | - Ramón Bover-Freire
- Servicio de Cardiología, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Universidad Complutense, Universidad Europea, Madrid, Spain
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Vera Sainz A, Diez Villanueva P, Ariza Sole A, Formiga F, Lopez Palop R, Marin F, Vidan M, Martinez Selles M, Salamanca J, Sionis A, Garcia Pardo H, Bueno H, Sanchis J, Abu Assi E, Alfonso F. P6264Mitral regurgitation and prognosis after non-ST-segment elevation myocardial infarction in very old patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0864] [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
Mitral regurgitation (MR) after acute coronary syndromes is associated with adverse prognosis. However, the prognostic impact of MR in older patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI) has not been well addressed.
Methods
The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Echocardiography performed during admission quantified mitral valve parameters in 497 patients, who were classified according to mitral regurgitation (MR) status in two groups: significant (moderate or severe) or no significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6-months.
Results
Mean age was 84.3±4.1 years, 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with patients without significant MR these patients had lower systolic blood pressure (132±28 vs 141±27 mmHg), higher heart rate (82±21 vs 74±17 bpm), worse Killip class (≥II 49.5% vs 22.5%), lower ejection fraction (47±14% vs 55±11%), higher pulmonary pressure (42±15 vs 35±11 mmHg), as well as more frequent new onset atrial fibrillation (16.4% vs 7.2%) (all p values=0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs 1.3%, p=0.04) and longer hospital stay (median 8 [5–12] vs 6 [4–10] days, p=0.002),and higher mortality/readmission at 6 months (HR 1,54, 95% CI 1.09–2.18). However, after adjusting for potential confounders, this last association was not significant.
Conclusions
Significant MR is seen in about one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, which is mainly determined by their clinical characteristics.
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Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | | | - A Ariza Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | - R Lopez Palop
- University Hospital San Juan de Alicante, Alicante, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Vidan
- University Hospital Gregorio Maranon, Madrid, Spain
| | | | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
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Díez-Villanueva P, Salamanca J, Ariza-Solé A, Formiga F, Martín-Sánchez FJ, Bonanad Lozano C, Vidán MT, Martínez-Sellés M, Terres B, Jiménez Méndez C, Bueno H, Alfonso F. [Impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly ambulatory patients with heart failure. A prospective and multicentre study]. Rev Esp Geriatr Gerontol 2019; 55:29-33. [PMID: 31515087 DOI: 10.1016/j.regg.2019.08.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is a chronic disease that is often associated with ageing. There are predictive models based on variables that associate it with a poor prognosis, although those do not include common conditions in the elderly, such as frailty or comorbidity. The aim of this study is to determine the clinical and epidemiological characteristics of a cohort of elderly outpatients with HF followed-up by cardiologists. This will include a study of the prevalence of frailty and other geriatric syndromes, as well as their impact on the prognosis, and to evaluate whether these may improve predictive ability of such predictive models. MATERIAL AND METHODS Observational, prospective, and multicentre study that will include 400 patients ≥75years old with chronic HF followed-up in Spanish tertiary hospitals by cardiology specialists in HF. Patients will undergo a comprehensive geriatric assessment, and prediction of events will be performed based on MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and Barcelona-Bio HF calculator scores. The primary endpoint is cardiovascular and overall mortality at 1 and 3years follow-up. RESULTS This study will assess both the characteristics and prognosis of elderly patients with HF followed-up by cardiologists in Spain and the applicability in the elderly population of scores used in the general population with chronic HF. CONCLUSION This is the first prospective study that will systematically assess frailty and other geriatric syndromes in the elderly outpatient with HF in Spain and followed-up by cardiologists, thus contributing to improve knowledge about both its prevalence and impact on our patients.
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España.
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España
| | - Clara Bonanad Lozano
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, España
| | - Beatriz Terres
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - César Jiménez Méndez
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, CNIC, Madrid, España
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
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Vera Sainz A, De La Cuerda F, Navarrete G, Antuna P, Nogales MT, Salamanca J, Rivero F, Jimenez Borreguero LJ, Alfonso F, Aguilar R. 487Predictors of CMR confirmed microvascular damage after successfully reperfused STEMI. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez123.001] [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: 11/14/2022] Open
Affiliation(s)
- A Vera Sainz
- University Hospital De La Princesa, Madrid, Spain
| | | | - G Navarrete
- University Hospital De La Princesa, Madrid, Spain
| | - P Antuna
- University Hospital De La Princesa, Madrid, Spain
| | - M T Nogales
- University Hospital De La Princesa, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Madrid, Spain
| | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - R Aguilar
- University Hospital De La Princesa, Madrid, Spain
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Cecconi A, Salamanca J, Alvarado T, Antuña P, Pozo E, Viliani D, Nogales-Romo MT, Rivero F, Hernandez Muñiz S, Olivera MJ, Caballero P, Jimenez-Borreguero LJ, Alfonso F. Predictors of oedema in Tako-Tsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2019; 20:406-408. [DOI: 10.2459/jcm.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Cecconi A, Salamanca J, Antuna P, Alvarado T, Nogales-Romo MT, Pozo E, Viliani D, Veloso S, Montes A, De Rueda C, Olivera MJ, Hernandez-Muniz S, Caballero P, Jimenez-Borreguero LJ, Alfonso F. P183Appropriate quantification of myocardial edema extension in tako-tsubo syndrome: high correlation between visual and semi-quantitative method of T2 signal intensity ratio. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.045] [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: 11/13/2022] Open
Affiliation(s)
- A Cecconi
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - P Antuna
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - T Alvarado
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - E Pozo
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - D Viliani
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - S Veloso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - A Montes
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - C De Rueda
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - M J Olivera
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | | | - P Caballero
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Díez‐Villanueva P, Vera A, Ariza‐Solé A, Alegre O, Formiga F, López‐Palop R, Marín F, Vidán MT, Martínez‐Sellés M, Salamanca J, Sionis A, García‐Pardo H, Bueno H, Sanchís J, Abu‐Assi E, González‐Salvado V, Llaó I, Alfonso F. Mitral Regurgitation and Prognosis After Non‐ST‐Segment Elevation Myocardial Infarction in Very Old Patients. J Am Geriatr Soc 2019; 67:1641-1648. [DOI: 10.1111/jgs.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alberto Vera
- Hospital Universitario de La Princesa Madrid Spain
| | | | - Oriol Alegre
- Hospital Universitari de Bellvitge Barcelona Spain
| | | | - Ramon López‐Palop
- Cardiology Department Hospital Universitario San Juan Alicante Spain
| | | | - María T. Vidán
- Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Complutense, Universidad Europea Madrid Spain
| | - Manuel Martínez‐Sellés
- Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Complutense, Universidad Europea Madrid Spain
| | | | - Alessandro Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | | | - Héctor Bueno
- Hospital Doce de Octubre Madrid Spain
- Centro Nacional de Investigaciones Cardiovasculares Madrid Spain
| | - Juan Sanchís
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER‐CV Valencia Spain
| | | | | | - Isaac Llaó
- Hospital Universitari de Bellvitge Barcelona Spain
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45
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Alvarado T, Cecconi A, Antuna P, Salamanca J, Nogales-Romo MT, Viliani D, Pozo E, Diego G, Rojas-Gonzalez A, Rivero F, Hernandez Muniz S, Olivera MJ, Caballero P, Jimenez-Borreguero J, Alfonso F. P4394Diabetes paradox in Tako-Tsubo cardiomyopathy: beneficial effect of diabetes on myocardial edema. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Alvarado
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - A Cecconi
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - P Antuna
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - J Salamanca
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - D Viliani
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - E Pozo
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - G Diego
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - F Rivero
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - M J Olivera
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | - P Caballero
- University Hospital De La Princesa, Radiology, Madrid, Spain
| | | | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Vera A, Cecconi A, Nogales-Romo MT, de la Cuerda F, Salamanca J, Jimenez-Borreguero LJ, Alfonso F. Wide QRS Complex Tachycardia: What the Algorithms Fear. Circulation 2018; 137:1407-1409. [PMID: 29581367 DOI: 10.1161/circulationaha.118.033936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Affiliation(s)
- Alberto Vera
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Alberto Cecconi
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Maria Teresa Nogales-Romo
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Francisco de la Cuerda
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Luis Jesus Jimenez-Borreguero
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigacion Sanitaria, Madrid, Spain.
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47
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Alfonso F, Salamanca J, Pozo E. [Diagnosis of acute coronary syndrome in patients with chest pain in the emergency department: Changes on the horizon?]. Emergencias 2016; 28:6-8. [PMID: 29094819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Eduardo Pozo
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
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Alfonso F, Salamanca J, Del Pozo E. [Author's reply]. Emergencias 2016; 28:283-284. [PMID: 29105420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
| | - Eduardo Del Pozo
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
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Lozano Á, Bastante T, Salamanca J, Aguilar R, Montes de Oca R, Rodríguez D, Alfonso F. Tako-tsubo cardiomyopathy triggered by Influenza A virus infection. Int J Cardiol 2014; 174:e52-3. [DOI: 10.1016/j.ijcard.2014.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/02/2014] [Indexed: 11/26/2022]
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Avakian H, Bosted P, Burkert VD, Elouadrhiri L, Adhikari KP, Aghasyan M, Amaryan M, Anghinolfi M, Baghdasaryan H, Ball J, Battaglieri M, Bedlinskiy I, Biselli AS, Branford D, Briscoe WJ, Brooks W, Carman DS, Casey L, Cole PL, Collins P, Crabb D, Crede V, D'Angelo A, Daniel A, Dashyan N, De Vita R, De Sanctis E, Deur A, Dey B, Dhamija S, Dickson R, Djalali C, Dodge G, Doughty D, Dupre R, El Alaoui A, Eugenio P, Fegan S, Fersch R, Forest TA, Fradi A, Gabrielyan MY, Gavalian G, Gevorgyan N, Gilfoyle GP, Giovanetti KL, Girod FX, Gohn W, Gothe RW, Griffioen KA, Guidal M, Guler N, Guo L, Hafidi K, Hakobyan H, Hanretty C, Hassall N, Heddle D, Hicks K, Holtrop M, Ilieva Y, Ireland DG, Isupov EL, Jawalkar SS, Jo HS, Joo K, Keller D, Khandaker M, Khetarpal P, Kim W, Klein A, Klein FJ, Konczykowski P, Kubarovsky V, Kuhn SE, Kuleshov SV, Kuznetsov V, Livingston K, Lu HY, Markov N, Mayer M, Martinez D, McAndrew J, McCracken ME, McKinnon B, Meyer CA, Mineeva T, Mirazita M, Mokeev V, Moreno B, Moriya K, Morrison B, Moutarde H, Munevar E, Nadel-Turonski P, Nasseripour R, Niccolai S, Niculescu G, Niculescu I, Niroula MR, Osipenko M, Ostrovidov AI, Paremuzyan R, Park K, Park S, Pasyuk E, Pereira SA, Perrin Y, Pisano S, Pogorelko O, Price JW, Procureur S, Prok Y, Protopopescu D, Raue BA, Ricco G, Ripani M, Rosner G, Rossi P, Sabatié F, Saini MS, Salamanca J, Salgado C, Schumacher RA, Seder E, Seraydaryan H, Sharabian YG, Sober DI, Sokhan D, Stepanyan SS, Stepanyan S, Stoler P, Strauch S, Suleiman R, Taiuti M, Tedeschi DJ, Tkachenko S, Ungaro M, Vernarsky B, Vineyard MF, Voutier E, Watts DP, Weinstein LB, Weygand DP, Wood MH, Zhang J, Zhao B, Zhao ZW. Measurement of single- and double-spin asymmetries in deep inelastic pion electroproduction with a longitudinally polarized target. Phys Rev Lett 2010; 105:262002. [PMID: 21231647 DOI: 10.1103/physrevlett.105.262002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Indexed: 05/30/2023]
Abstract
We report the first measurement of the transverse momentum dependence of double-spin asymmetries in semi-inclusive production of pions in deep-inelastic scattering off the longitudinally polarized proton. Data have been obtained using a polarized electron beam of 5.7 GeV with the CLAS detector at the Jefferson Lab (JLab). Modulations of single spin asymmetries over the azimuthal angle between lepton scattering and hadron production planes ϕ have been measured over a wide kinematic range in Bjorken x and virtual photon squared four-momentum Q2. A significant nonzero sin2ϕ single spin asymmetry was observed for the first time indicating strong spin-orbit correlations for transversely polarized quarks in the longitudinally polarized proton.
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Affiliation(s)
- H Avakian
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
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