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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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Martínez-Sellés M, Prieto-Valiente L. Clinical study types and guidance for their correct post-pandemic interpretation. Rev Esp Quimioter 2024; 37:203-208. [PMID: 38404030 PMCID: PMC11094635 DOI: 10.37201/req/003.2024] [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: 01/11/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
Randomized clinical trials (RCTs) are key to the advancement of medicine and microbiology, but they are not the only option. Observational studies provide information on long-term efficacy and safety, are less expensive, allow the study of rare events, and obtain information more quickly than RCTs. On the other hand, they are more vulnerable to confounding factors. Prospective exploratory pilot studies share many aspects with RCTs but are not subject to supervision by external commissions or mandatory registration. Multitesting can pervert the balance of publications in favor of the desired effect. Bonferroni's reasoning shows that if 10 studies are performed with an ineffective antibiotic, the probability that at least one will show P <0.05 might be 40%. Scenarios in which there is intensive pressure to perform research, such as the recent pandemic, might result in many research teams trying to study the effect of an antimicrobial. Even if the drug has no efficacy, if 100 research teams conduct a study to assess its usefulness, it might be virtually certain that at least one will get a P value <0.05. If the other studies (with P >0.05) are not published, the scientific commu nity would consider that there is strong evidence in favor of its usefulness. In conclusion, RCTs are a very good source of clinical information, but are not the only one. The systematic registration of all research can and should be applied to all types of clinical studies.
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Affiliation(s)
- M Martínez-Sellés
- Manuel Martínez-Sellés. Cardiology Service, Hospital General Universitario Gregorio Marañón, C/ del Dr. Esquerdo 46, 28007, Madrid. Spain.
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Moreno G, Martínez-Sellés M, Vicente-Galán MJ, Vicent L. Pregnancy, Reproductive Factors, and Female Heart Failure Risk and Outcomes. Curr Heart Fail Rep 2024; 21:203-213. [PMID: 38507017 DOI: 10.1007/s11897-024-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of recent evidence on female-specific risk factors related to reproductive status or pregnancy. RECENT FINDINGS Pregnancy-related factors, including hypertensive disorders and gestational diabetes, increase the risk of heart failure in women, while breastfeeding and hormone therapy may offer protection. Hypertensive disorders of pregnancy, gestational diabetes, polycystic ovarian syndrome, placental abruption, younger maternal age at first live birth, younger maternal age at last live birth, number of stillbirths, number of pregnancies, onset of menstruation before 12 years of age, shorter reproductive age, ovariectomy, and prolonged absence of ovarian hormones may increase the risk of heart failure in women. Conversely, breastfeeding status and hormone therapy (for menopause or contraception) may serve as protective factors, while fertility treatments have no discernible effect on the risk of heart failure.
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Affiliation(s)
- Guillermo Moreno
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
- Grupo de Investigación Cardiovascular Multidisciplinar Traslacional (GICMT), Área de Investigación Cardiovascular, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - María Jesús Vicente-Galán
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
- Consulta de Insuficiencia Cardiaca, Hospital de Día/Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Lourdes Vicent
- Grupo de Investigación Cardiovascular Multidisciplinar Traslacional (GICMT), Área de Investigación Cardiovascular, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
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Álvarez Zaballos S, Vazquez Alen P, Muñoz P, de Alarcón A, Gutiérrez-Carretero E, Álvarez-Uría A, Fariñas MC, Rodríguez-García R, Goenaga MÁ, Cuervo G, Plata-Ciezar A, Hidalgo-Tenorio C, Aldamiz-Echevarría G, Martínez-Sellés M. Prevalence and Prognostic Impact of Stroke in a National Cohort of Infective Endocarditis. Int J Stroke 2024:17474930241255560. [PMID: 38708722 DOI: 10.1177/17474930241255560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national prospective cohort of IE. METHODS Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. RESULTS Out of 5667 IE cases, 1125 had acute stroke (19.8%): 811 ischemic strokes (618 cardioembolic strokes, 193 cardioembolic strokes with hemorrhagic transformation, 4 transient ischemic attacks, 3 lacunar infarctions), 125 intracranial hemorrhages, and 29 other neurological complications (cerebral abscesses, encephalitis, meningitis, seizures). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs. 63.7%, p=0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p=0.01), surgical indication (69.9% vs 65.9%, p=0.001), in-hospital mortality (40.9% vs. 22.0%, p<0.001), and one-year mortality (46.2% vs 27.9%, p<0.001). The following variables were independently associated with stroke: mitral location (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.34-1.8, p<0.001), vascular phenomenon (OR 2.9, 95% CI 2.4-3.6, p=0.0001), acute renal failure (OR 1.2, 95% CI 1.0-1.4, p=0.021), septic shock (OR 1.3, CI 1.1-1.6, p=0.007), sepsis (OR 1.3, CI 1.1-1.6, p=0.005), surgery indicated but not performed (OR 1.4, 95% CI 1.2-1.7, p<0.001), community-acquired IE (OR 1.2, 95% CI 1-1.4, p=0.017), and peripheral embolization (OR 1.6, CI 1.4-1.9, p <0.001). Stroke was an independent predictor of in-hospital (OR 2.1, 95% CI: 1.78-2.51, p<0.001) and one-year mortality (hazard ratio 1.9, 95% CI 1.6-2.5). CONCLUSIONS One fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.
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Affiliation(s)
- Sara Álvarez Zaballos
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV. Madrid, Spain
| | - Pilar Vazquez Alen
- Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Madrid. Spain
- Facultad de Medicina, Universidad Complutense de Madrid. Spain
| | - Arístides de Alarcón
- Infective Diseases, Microbiology and Parasitology Department, (UCEIMP), Hospital Virgen del Rocío Seville, Spain
- Grupo de Resistencias bacterianas y antimicrobianos CIBERINFEC. Madrid. Spain
- Institute of Biomedicine of Seville (IBiS). Seville, Spain
- University of Seville/CSIC/University
| | - Encarnación Gutiérrez-Carretero
- Institute of Biomedicine of Seville (IBiS). Seville, Spain
- University of Seville/CSIC/University
- Cardiac Surgery Service CIBERCV. Hospital Virgen del Rocío Seville, Spain
| | - Ana Álvarez-Uría
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
| | - Mª Carmen Fariñas
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla IDIVAL. Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Madrid, Spain
- University of Cantabria, Spain
| | - Raquel Rodríguez-García
- Intensive Medicine Department, Hospital Universitario Central de Asturias, Oviedo. Spain
- University of Oviedo, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Plata-Ciezar
- Infectious Diseases Department, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Regional Universitario de Málaga, IBIMA, Spain
| | - Carmen Hidalgo-Tenorio
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves. Granada. Spain
| | - Gonzalo Aldamiz-Echevarría
- Cardiac Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid. Universidad Autónoma de Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV. Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. Madrid. Spain
- Facultad de Medicina, Universidad Complutense de Madrid. Spain
- Universidad Europea. Madrid, Spain
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Álvarez-Zaballos S, Martínez-Sellés M. Impact of Sex and Diabetes in Patients with Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00666-w. [PMID: 38698294 DOI: 10.1007/s11897-024-00666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a complex clinical syndrome with a growing global health burden. This review explores the intersection of HF, diabetes mellitus, and sex, highlighting epidemiological patterns, pathophysiological mechanisms, and treatment implications. RECENT FINDINGS Despite similar HF prevalence in men and women, diabetes mellitus (DM) appears to exert a more pronounced impact on HF outcomes in women. Pathophysiological differences involve cardiovascular risk factors, severe left ventricular dysfunction, and coronary artery disease, as well as hormonal influences and inflammatory markers. Diabetic cardiomyopathy introduces a sex-specific challenge, with women experiencing common adverse outcomes related to increased fibrosis and myocardial remodeling. Treatment strategies, particularly sodium-glucose cotransporter 2 inhibitors, exhibit cardiovascular benefits, but their response may differ in women. The link between HF and DM is bidirectional, with diabetes significantly increasing the risk of HF, and vice versa. Additionally, the impact of diabetes on mortality appears more pronounced in women than in men, leading to a modification of the traditional gender gap observed in HF outcomes. A personalized approach is crucial, and further research to improve outcomes in the complex interplay of HF, diabetes, and sex is needed.
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Affiliation(s)
- Sara Álvarez-Zaballos
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Universidad Europea, Universidad Complutense, Madrid, Spain.
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Pascual-Figal DA, Hernández-Vicente A, Pastor-Pérez F, Martínez-Sellés M, Solé-González E, Alvarez-García J, García-Pavía P, Varela-Román A, Sánchez PL, Delgado JF, Noguera-Velasco JA, Bayes-Genis A. N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study. Eur J Heart Fail 2024. [PMID: 38606524 DOI: 10.1002/ejhf.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients. METHODS AND RESULTS Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.09), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group. CONCLUSIONS Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
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Affiliation(s)
- Domingo A Pascual-Figal
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | | | - Francisco Pastor-Pérez
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- CIBERCV, Madrid, Spain
| | - Manuel Martínez-Sellés
- CIBERCV, Madrid, Spain
- Hospital Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - Pablo García-Pavía
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Alfonso Varela-Román
- CIBERCV, Madrid, Spain
- Hospital Clínico Universitario de Santiago, A Coruña, Spain
| | - Pedro Luis Sánchez
- CIBERCV, Madrid, Spain
- Hospital Clinico de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Juan F Delgado
- CIBERCV, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose A Noguera-Velasco
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
| | - Antoni Bayes-Genis
- CIBERCV, Madrid, Spain
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Martínez-Sellés M. Indwelling urinary catheters: on associations with prognosis in acute heart failure and confounding factors. Emergencias 2024; 36:159. [PMID: 38597629 DOI: 10.55633/s3me/013.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense. Madrid, España
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González-Urbistondo F, Almenar-Bonet L, Gómez-Bueno M, Crespo-Leiro M, González-Vílchez F, García-Cosío MD, López-Granados A, Mirabet S, Martínez-Sellés M, Sobrino JM, Díez-López C, Farrero M, Díaz-Molina B, Rábago G, de la Fuente-Galán L, Garrido-Bravo I, Blasco-Peiró MT, García-Quintana A, Vázquez de Prada JA. Prognosis after heart transplant in patients with hypertrophic and restrictive cardiomyopathy. A nationwide registry analysis. Revista Española de Cardiología (English Edition) 2024; 77:304-313. [PMID: 37984703 DOI: 10.1016/j.rec.2023.10.006] [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: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Posttransplant outcomes among recipients with a diagnosis of hypertrophic cardiomyopathy (HCM) or restrictive cardiomyopathy (RCM) remain controversial. METHODS Retrospective analysis of a nationwide registry of first-time recipients undergoing isolated heart transplant between 1984 and 2021. One-year and 5-year mortality in recipients with HCM and RCM were compared with those with dilated cardiomyopathy (DCM). RESULTS We included 3703 patients (3112 DCM; 331 HCM; 260 RCM) with a median follow-up of 5.0 [3.1-5.0] years. Compared with DCM, the adjusted 1-year mortality risk was: HCM: HR, 1.38; 95%CI, 1.07-1.78; P=.01, RCM: HR, 1.48; 95%CI, 1.14-1.93; P=.003. The adjusted 5-year mortality risk was: HCM: HR, 1.17; 95%CI, 0.93-1.47; P=.18; RCM: HR, 1.52; 95%CI, 1.22-1.89; P<.001. Over the last 20 years, the RCM group showed significant improvement in 1-year survival (adjusted R2=0.95) and 5-year survival (R2=0.88); the HCM group showed enhanced the 5-year survival (R2=0.59), but the 1-year survival remained stable (R2=0.16). CONCLUSIONS Both RCM and HCM were linked to a less favorable early posttransplant prognosis compared with DCM. However, at the 5-year mark, this unfavorable difference was evident only for RCM. Notably, a substantial temporal enhancement in both early and late mortality was observed for RCM, while for HCM, this improvement was mainly evident in late mortality.
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Affiliation(s)
| | - Luis Almenar-Bonet
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Gómez-Bueno
- Departamento de Cardiología, Hospital Universitario Clínica Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Marisa Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biológicas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Francisco González-Vílchez
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - María Dolores García-Cosío
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación i+12, Madrid, Spain
| | | | - Sonia Mirabet
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain; Área de Medicina y Enfermería, Cardiología, Universidad Europea, Madrid, Spain
| | - José Manuel Sobrino
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carles Díez-López
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut de Investigació Bellvitge (IDIBELL), Barcelona, Spain
| | - Marta Farrero
- Institut Clínic del Tórax, Hospital Clínic Universitari, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Gregorio Rábago
- Servicio de Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Iris Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Spain
| | - Antonio García-Quintana
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - José Antonio Vázquez de Prada
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain; Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
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Martínez-Sellés M. Risk of ticagrelor versus clopidogrel discontinuation. Rev Esp Cardiol (Engl Ed) 2024; 77:356. [PMID: 38237662 DOI: 10.1016/j.rec.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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10
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Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Rodríguez Fernandez R, Kestler M, Bouza E. Respiratory syncytial virus: A new era. Rev Esp Quimioter 2024; 37:134-148. [PMID: 38205560 PMCID: PMC10945101 DOI: 10.37201/req/147.2023] [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: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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11
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Moraga-Llop F, Andradas E, Blesa-Baviera LC, Cantón R, González Del Castillo J, Martinón-Torres F, Moya E, Trilla A, Vazquez J, Villena RJ, Ruiz-Galiana J, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Bouza E. Meningococcal meningitis in Spain in the Horizon 2030: A position paper. Rev Esp Quimioter 2024:moraga22mar2024. [PMID: 38515374 DOI: 10.37201/req/023.2024] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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12
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Sanchis J, Bueno H, García-Blas S, Alegre O, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, Fernández-Cisnal A, Calvo E, Morales MJ, Elízaga J, Gómez I, Alfonso F, García del Blanco B, Formiga F, Núñez E, Núñez J, Ariza-Solé A. Invasive Treatment Strategy in Adults With Frailty and Non-ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240809. [PMID: 38446482 PMCID: PMC10918507 DOI: 10.1001/jamanetworkopen.2024.0809] [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] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024] Open
Abstract
Importance The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. Objective To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. Design, Setting, and Participants The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Interventions Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Main outcomes and measures The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Results Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. Conclusions and Relevance In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior. Trial registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Oriol Alegre
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria–Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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13
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Ducrocq G, Cachanado M, Simon T, Puymirat E, Lemesle G, Lattuca B, Ariza-Solé A, Silvain J, Ferrari E, Gonzalez-Juanatey JR, Martínez-Sellés M, Lermusier T, Coste P, Vanzetto G, Cottin Y, Dillinger JG, Calvo G, Steg PG. Restrictive vs Liberal Blood Transfusions for Patients with Acute Myocardial Infarction and Anaemia by Heart Failure Status: An RCT Subgroup Analysis. Can J Cardiol 2024:S0828-282X(24)00179-X. [PMID: 38408702 DOI: 10.1016/j.cjca.2024.02.013] [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] [Received: 10/25/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI). METHODS We used data from the randomized REALITY trial (https://www. CLINICALTRIALS gov/study/NCT02648113), comparing restrictive versus liberal transfusion strategies in patients with AMI and anaemia. HF was defined as history of HF or Killip class > 1 at randomization. Primary outcome was major adverse cardiovascular events (MACE: composite of all-cause death, non-recurrent AMI, stroke, or emergency revascularization prompted by ischaemia) at 30 days. RESULTS Among 658 randomized patients, 311 (47.3%) had HF. HF patients had higher rates of MACE at 30 days and 1 year, and higher rates of non-fatal new-onset HF. There was no interaction between HF and effect of randomized assignment on the primary outcome or non-fatal new-onset HF. A liberal transfusion strategy was associated with increased all-cause death at 30 days and at 1 year in HF patients (Pinteraction = 0.009 and P = 0.049, respectively). The main numerical difference in cause of death between restrictive and liberal strategies was death by HF at 30 days (4 vs 11). CONCLUSIONS HF is frequent in AMI patients with anaemia and is associated with higher risk of MACE (including all-cause death) and non-fatal new-onset HF. While there was no interaction of HF with effect of transfusion strategy on MACE, a liberal transfusion strategy was associated with higher all-cause death that appears driven by a higher risk of early death due to HF.
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Affiliation(s)
- Gregory Ducrocq
- Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), AP-HP, Hôpital St Antoine; Sorbonne-Université; French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), AP-HP, Hôpital St Antoine; Sorbonne-Université; French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Etienne Puymirat
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, French Alliance for Cardiovascular Trials (FACT), Institut Pasteur de Lille, Inserm U1011, F-59000 Lille, France; Paris, France
| | - Benoit Lattuca
- Cardiology department, Nimes University Hospital, Montpellier University, Nimes, France
| | - Albert Ariza-Solé
- Bellvitge University Hospital. Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge; IDIBELL; L'Hospitalet de Llobregat, Barcelona, Spain
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, INSERM UMRS 1166 Paris, France
| | - Emile Ferrari
- Université Côte d'Azur, and CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, French Alliance for Cardiovascular Trials (FACT), Nice, France
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Pierre Coste
- Cardiology Hospital, University of Bordeaux, Bordeaux, France
| | - Gerald Vanzetto
- Service de Cardiologie, CHU Grenoble Alpes; Université Grenoble Alpes; LRB INSERM U 1039, Grenoble, France
| | - Yves Cottin
- Centre Hospitalier Universitaire de Dijon; Université de Bourgogne, Dijon, France
| | - Jean G Dillinger
- Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, and INSERM U-942, Paris, France
| | - Gonzalo Calvo
- Àrea del Medicament, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Philippe Gabriel Steg
- Université Paris-Cité, INSERM-UMR1148; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials); and Institut Universitaire de France; all in Paris, France.
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14
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Martínez-Sellés M. Side effects of urea for the treatment of hyponatremia in heart failure. Med Clin (Barc) 2024:S0025-7753(24)00017-4. [PMID: 38378330 DOI: 10.1016/j.medcli.2023.11.036] [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] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Europea, Universidad Complutense, Madrid, España.
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15
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Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, García de Viedma D, Bouza E. COVID-19: On the threshold of the fifth year. The situation in Spain. Rev Esp Quimioter 2024; 37:17-28. [PMID: 38009431 PMCID: PMC10874674 DOI: 10.37201/req/123.2023] [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: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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16
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Martínez-Sellés M. Patisiran in Patients with Transthyretin Cardiac Amyloidosis. N Engl J Med 2024; 390:286. [PMID: 38231632 DOI: 10.1056/nejmc2313408] [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: 01/19/2024]
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17
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Martínez-Sellés M, Pombo M, Recio-Mayoral A, Ayesta A, Datino T. Considerations involved in elective generator replacement of implantable cardioverter-defibrillators: balancing risks, benefits, and individual factors. Rev Esp Cardiol (Engl Ed) 2024; 77:2-5. [PMID: 37776948 DOI: 10.1016/j.rec.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Marta Pombo
- Servicio de Cardiología, Hospital Costa del Sol, Málaga, Spain
| | | | - Ana Ayesta
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Tomás Datino
- Servicio de Cardiología, Hospitales Universitarios Quirónsalud Pozuelo y Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain.
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18
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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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19
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Cabezón-Villalba G, Barge-Caballero E, González-Vílchez F, Castel-Lavilla MÁ, Gómez-Bueno M, Almenar-Bonet L, González-Costello J, Lambert-Rodríguez JL, Martínez-Sellés M, de la Fuente-Galán L, Mirabet-Pérez S, García-Cosío Carmena MD, Hervás-Sotomayor D, Rangel-Sousa D, Blasco-Peiró T, Garrido-Bravo IP, Rábago Juan-Aracil G, Muñiz J, Crespo-Leiro MG. Use of a surgically implanted, nondischargeable, extracorporeal continuous flow circulatory support system as a bridge to heart transplant. Rev Esp Cardiol (Engl Ed) 2024; 77:39-49. [PMID: 37217134 DOI: 10.1016/j.rec.2023.05.002] [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: 02/01/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES We aimed to describe the clinical outcomes of the use of the CentriMag acute circulatory support system as a bridge to emergency heart transplantation (HTx). METHODS We conducted a descriptive analysis of the clinical outcomes of consecutive HTx candidates included in a multicenter retrospective registry who were treated with the CentriMag device, configured either for left ventricular support (LVS) or biventricular support (BVS). All patients were listed for high-priority HTx. The study assessed the period 2010 to 2020 and involved 16 transplant centers around Spain. We excluded patients treated with isolated right ventricular support or venoarterial extracorporeal membrane oxygenation without LVS. The primary endpoint was 1-year post-HTx survival. RESULTS The study population comprised 213 emergency HTx candidates bridged on CentriMag LVS and 145 on CentriMag BVS. Overall, 303 (84.6%) patients received a transplant and 53 (14.8%) died without having an organ donor during the index hospitalization. Median time on the device was 15 days, with 66 (18.6%) patients being supported for> 30 days. One-year posttransplant survival was 77.6%. Univariable and multivariable analyses showed no statistically significant differences in pre- or post-HTx survival in patients managed with BVS vs LVS. Patients managed with BVS had higher rates of bleeding, need for transfusion, hemolysis and renal failure than patients managed with LVS, while the latter group showed a higher incidence of ischemic stroke. CONCLUSIONS In a setting of candidate prioritization with short waiting list times, bridging to HTx with the CentriMag system was feasible and resulted in acceptable on-support and posttransplant outcomes.
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Affiliation(s)
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | | | - María Ángeles Castel-Lavilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Manuel Gómez-Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Politécnico La Fe, Valencia, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Institut d́Investigació Biomédica de Bellvitge (IDIBELL), ĹHospitalet de Llobregat, Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Universidad Complutense, Madrid, Spain
| | - Luis de la Fuente-Galán
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - María Dolores García-Cosío Carmena
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Doce de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Diego Rangel-Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Iris P Garrido-Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidade de A Coruña, A Coruña, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cirugía Cardiaca, Hospital Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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20
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Martínez-Solano J, Sousa-Casasnovas I, Santa-Teresa P, García-López JJ, Maestu LP, Martínez-Sellés M. Veno-venal extracorporeal membrane oxygenation to support whole-lung lavage in a severe case of pulmonary alveolar proteinosis. Rev Esp Anestesiol Reanim (Engl Ed) 2023:S2341-1929(23)00202-0. [PMID: 38142894 DOI: 10.1016/j.redare.2023.12.005] [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] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/29/2023] [Indexed: 12/26/2023]
Abstract
We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.
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Affiliation(s)
- J Martínez-Solano
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
| | - I Sousa-Casasnovas
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - P Santa-Teresa
- Servicio e Medicina Intensiva, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J J García-López
- Servicio de Neumología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - L P Maestu
- Servicio de Neumología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - M Martínez-Sellés
- Servicio de Cardiología, Instituto de Investigación Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid, Spain
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21
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Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Santiago B, Caminero JA, Barros C, García de Viedma D, Martín C, Bouza E. Tuberculosis in Spain: An opinion paper. Rev Esp Quimioter 2023; 36:562-583. [PMID: 37922367 DOI: 10.37201/req/115.2023] [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] [Indexed: 11/05/2023]
Abstract
This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Illustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapulmonary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observation in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal implications of this disease are not a minor issue and our situation in this regard has been reviewed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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22
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Enríquez-Vázquez D, Barge-Caballero E, González-Vílchez F, Almenar-Bonet L, García-Cosío Carmena MD, González-Costello J, Gómez-Bueno M, Castel-Lavilla MÁ, Díaz-Molina B, Martínez-Sellés M, Mirabet-Pérez S, De la Fuente-Galán L, Hervás-Sotomayor D, Rangel-Sousa D, Garrido-Bravo IP, Blasco-Peiró T, Juan-Aracil GR, Muñiz J, Crespo-Leiro MG. Sex, Temporary Mechanical Circulatory Support, and Heart Transplantation: Insights From a Multi-Institutional Spanish Registry. JACC Heart Fail 2023; 11:1763-1766. [PMID: 37715770 DOI: 10.1016/j.jchf.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Daniel Enríquez-Vázquez
- Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Eduardo Barge-Caballero
- Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | | | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Universitario Politécnico La Fe, Valencia, Spain
| | - María Dolores García-Cosío Carmena
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Universitario Doce de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - José González-Costello
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Universitari de Bellvitge, Institut d'investigació Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Manuel Gómez-Bueno
- Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), Spain
| | - María Ángeles Castel-Lavilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Luis De la Fuente-Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Iris P Garrido-Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Universidade de A Coruña, A Coruña, Spain
| | - María G Crespo-Leiro
- Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clínica Universidad de Navarra, Pamplona, Spain
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23
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Galar A, Juárez M, Sousa-Casasnovas I, Catalán P, Valerio M, Antunez-Muiños P, Barbeito-Castiñeiras G, Blanco-Alonso S, Folgueira MD, García-Acuña JM, Lalueza A, Lázaro-Perona F, López de Sá E, Martín L, Muñez E, Portero F, Ramos-Martínez A, Romero-Gómez MP, Rosillo S, Fernández-Avilés F, Martínez-Sellés M, Bouza E, Muñoz P. Systematic influenza screening in cardiac intensive care units during the influenza season: A prospective study in Spain. Int J Infect Dis 2023; 136:37-42. [PMID: 37669725 DOI: 10.1016/j.ijid.2023.08.027] [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] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Little is known about the incidence of influenza among admissions to the cardiac intensive care unit (C-ICU), accuracy of clinical suspicion, and influenza vaccination uptake. We evaluated the incidence of influenza at C-ICU admission during the influenza season, potential underdiagnosis, and vaccination uptake. METHODS Prospective study at five C-ICUs during the 2017-2020 influenza seasons. A nasopharyngeal swab was collected at admission from patients who consented (n = 788). Testing was with Xpert®XpressFlu/RSV. RESULTS Influenza was detected in 43 patients (5.5%) (40 FluA; 3 FluB) and clinically suspected in 27 (62.8%). Compared to patients without influenza, patients with influenza more frequently had heart failure (37.2% vs 22.8%, P = 0.031), previous contact with relatives with influenza-like illnesses (23.3% vs 12.5%, P = 0.042), antimicrobial use (67.4% vs 23.2%, P <0.01), and need for mechanical ventilation (25.6% vs 14.5%, P = 0.048). Patients received oseltamivir promptly. We found no differences in mortality (11.6% vs 5.2%, P = 0.076). Patients with influenza more frequently had myocarditis (9.3% vs 0.9%, P <0.01) and pericarditis (7.0% vs 0.8%, P = 0.01). Overall, 43.0% of patients (339/788) were vaccinated (51.9% of those with a clear indication [303/584]). CONCLUSION Influenza seems to be a frequently underdiagnosed underlying condition in admissions to the C-ICU. Influenza should be screened for at C-ICU admission during influenza epidemics.
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Affiliation(s)
- Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain.
| | - Miriam Juárez
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV - Madrid, Spain
| | - Iago Sousa-Casasnovas
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV - Madrid, Spain
| | - Pilar Catalán
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain
| | - Pablo Antunez-Muiños
- Cardiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Gema Barbeito-Castiñeiras
- Clinical Microbiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Silvia Blanco-Alonso
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - María Dolores Folgueira
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario Doce de Octubre - Madrid, Spain
| | - José María García-Acuña
- Cardiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Antonio Lalueza
- Internal Medicine Department, Hospital Universitario Doce de Octubre - Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12) - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III - Madrid, Spain
| | - Fernando Lázaro-Perona
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | | | - Lorena Martín
- Cardiology Department, Hospital Universitario La Paz - Madrid, Spain
| | - Elena Muñez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - Francisca Portero
- Clinical Microbiology Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain; Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA) - Majadahonda, Spain
| | - María Pilar Romero-Gómez
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | - Sandra Rosillo
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense - Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense - Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) - Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) - Madrid, Spain
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24
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Ayesta A, Valero-Masa MJ, Vidán MT, Segovia-Cubero J, García-Cosío MD, López-Ibor JV, Caravaca P, Luna-López R, Pérez-Gómez L, Nuche J, Martínez-Díaz J, Delgado J, Gómez-Bueno M, Fernández-Cordón C, López-Azor JC, Martínez-Sellés M. Frailty Is Common in Heart Transplant Candidates But Is Not Associated With Clinical Events and Is Reversible After Heart Transplantation. Am J Cardiol 2023; 205:28-34. [PMID: 37579657 DOI: 10.1016/j.amjcard.2023.07.110] [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: 04/27/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
Assessment of frailty before heart transplant (HT) is recommended but is not standard in most HT protocols. Our objective was to evaluate frailty at inclusion in HT list and during follow-up and to assess the influence of baseline frailty on prognosis. A prospective multicenter study in all adults included in the nonurgent HT waiting list. Frailty was defined as Fried's frailty phenotype score ≥3. Mean follow-up was 25.9 ± 1.2 months. Of 99 patients (mean age 54.8 [43.1 to 62.5] years, 70 men [70.7%]), 28 were frail (28.3%). A total of 85 patients received HT after 0.5 ± 0.01 years. Waiting time was shorter in frail patients (0.6 years [0.3 to 0.8] vs 0.2 years [0.1 to 0.4], p = 0.001) because of an increase in priority. Baseline frailty was not associated with overall mortality, (hazard ratio 0.99 [95% confidence interval 0.41 to 2.37, p = 0.98]). A total of 16 transplant recipients died (18.8%). Of the remaining 69 HT recipients, 65 underwent frailty evaluation during follow-up. Patients without baseline frailty (n = 49) did not develop it after HT. Of 16 patients with baseline frailty, only 2 were still frail at the end of follow-up. Frailty is common in HT candidates but is reversible in most cases after HT and is not associated with post-transplant mortality. Our results suggest that frailty should not be considered an exclusion criterion for HT.
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Affiliation(s)
- Ana Ayesta
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Valero-Masa
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - María Teresa Vidán
- Universidad Complutense, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Javier Segovia-Cubero
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - María Dolores García-Cosío
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Jorge V López-Ibor
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Pedro Caravaca
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Raquel Luna-López
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Laura Pérez-Gómez
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Jorge Nuche
- Universidad Complutense, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Juan Delgado
- Universidad Complutense, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Manuel Gómez-Bueno
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Clara Fernández-Cordón
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Juan Carlos López-Azor
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid, Spain.
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Del Romero J, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Gómez Castellá J, Palomo M, García Berrio R, Couso González A, Sotomayor C, Bouza E. Sexually transmitted infections in Spain: Current status. Rev Esp Quimioter 2023; 36:444-465. [PMID: 37335757 PMCID: PMC10586737 DOI: 10.37201/req/038.2023] [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: 05/06/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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26
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Díez-Villanueva P, Jiménez-Méndez C, López-Lluva MT, Wasniewski S, Solís J, Fernández-Friera L, Martínez-Sellés M. Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex. Curr Heart Fail Rep 2023; 20:321-332. [PMID: 37498496 DOI: 10.1007/s11897-023-00619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.
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Affiliation(s)
- Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006, Madrid, Spain.
| | | | | | - Samantha Wasniewski
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
| | - Jorge Solís
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernández-Friera
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea de Madrid, Madrid, Spain
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27
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Martínez-Sellés M. Venous-to-arterial CO2 difference as a possible prognostic biomarker in medical cardiogenic shock. Emergencias 2023; 35:323-324. [PMID: 37801412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, España. Universidad Europea, Universidad Complutense, Madrid, España
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28
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Martínez-Sellés M, Martín Sánchez FJ, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Molero García JM, Santiago B, Caminero JA, Barros C, García de Viedma D, Martín C, Bouza E. Advantages and disadvantages of maintaining the mandatory use of masks in health centers and nursing homes in Spain. How and when is it justified to maintain it? Rev Esp Quimioter 2023; 36:466-469. [PMID: 37368375 PMCID: PMC10586740 DOI: 10.37201/req/070.2023] [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: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 06/28/2023]
Abstract
We address the advantages and disadvantages of maintaining the mandatory use of masks in health centers and nursing homes in the current epidemiological situation in Spain and after the declaration of the World Health Organization on May 5, 2023 of the end of COVID-19 as public health emergency. We advocate for prudence and flexibility, respecting the individual decision to wear a mask and emphasizing the need for its use when symptoms suggestive of a respiratory infection appear, in situations of special vulnerability (such as immunosuppression), or when caring for patients with those infections. At present, given the observed low risk of severe COVID-19 and the low transmission of other respiratory infections, we believe that it is disproportionate to maintain the mandatory use of masks in a general way in health centers and nursing homes. However, this could change depending on the results of epidemiological surveillance and it would be necessary to reconsider returning to the obligation in periods with a high incidence of respiratory infections.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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29
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Martínez-Sellés M, Muñoz P. Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditis. J Clin Med 2023; 12:5705. [PMID: 37685770 PMCID: PMC10488693 DOI: 10.3390/jcm12175705] [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] [Received: 07/05/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Infective endocarditis (IE) has experienced enormous changes in recent decades [...].
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Affiliation(s)
- Manuel Martínez-Sellés
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, 28001 Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
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30
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Ronco D, Ariza-Solé A, Kowalewski M, Matteucci M, Di Mauro M, López-de-Sá E, Ranucci M, Sionis A, Bonaros N, De Bonis M, Russo CF, Uribarri A, Montero S, Fischlein T, Kowalówka A, Naito S, Obadia JF, Martín-Asenjo R, Aboal J, Thielmann M, Simon C, Andrea-Riba R, Parra C, Folliguet T, Martínez-Sellés M, Sanmartín Fernández M, Al-Attar N, Viana Tejedor A, Serraino GF, Burgos Palacios V, Boeken U, Raposeiras Roubin S, Solla Buceta MA, Sánchez Fernández PL, Scrofani R, Pastor Báez G, Jorge Pérez P, Actis Dato G, Garcia-Rubira JC, de Gea Garcia JH, Massimi G, Musazzi A, Lorusso R. The current clinical practice for management of post-infarction ventricular septal rupture: a European survey. Eur Heart J Open 2023; 3:oead091. [PMID: 37840585 PMCID: PMC10568658 DOI: 10.1093/ehjopen/oead091] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023]
Abstract
Aims Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Methods and results Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. Conclusion In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.
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Affiliation(s)
- Daniele Ronco
- Congenital Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Esteban López-de-Sá
- Department of Cardiology, IDIPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Aitor Uribarri
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Adam Kowalówka
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Roberto Martín-Asenjo
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Germany
| | - Caterina Simon
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rut Andrea-Riba
- Acute Cardiac Care Unit, Cardiology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Parra
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique–Hopitaux de Paris Créteil, Paris, France
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Ana Viana Tejedor
- Department of Cardiology, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - Roberto Scrofani
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gemma Pastor Báez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Jorge Pérez
- Cardiology Unit, University Hospital of the Canary Islands, La Laguna, Spain
| | | | | | - Jose H de Gea Garcia
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Andrea Musazzi
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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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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32
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Álvarez-Zaballos S, Martínez-Sellés M. Angiotensin-Converting Enzyme and Heart Failure. FRONT BIOSCI-LANDMRK 2023; 28:150. [PMID: 37525924 DOI: 10.31083/j.fbl2807150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/16/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 08/02/2023]
Abstract
Pharmacotherapy is the cornerstone treatment for patients with heart failure (HF) that uses drugs targeting the renin-angiotensin-aldosterone system (RAAS), including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan. This article reviews the pathophysiology of the RAAS and the neurohormonal changes seen in patients with HF as well as the targets and the mode of action of these drugs. We also assess the role of ACE in ventricular remodeling and summarize the main evidence for the use of ACE-related drugs in HF patients.
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Affiliation(s)
- Sara Álvarez-Zaballos
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
- School of Health and Biomedical Sciences, Universidad Europea, 28670 Madrid, Spain
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
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Velásquez-Rodríguez J, Vicent L, Díez-Delhoyo F, Valero Masa MJ, Bruña V, Sousa-Casasnovas I, Juárez-Fernández M, Fernández-Avilés F, Martínez-Sellés M. Prognostic Implications of High-Degree Atrio-Ventricular Block in Patients with Acute Myocardial Infarction in the Contemporary Era. J Clin Med 2023; 12:4834. [PMID: 37510949 PMCID: PMC10381467 DOI: 10.3390/jcm12144834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND High-degree atrioventricular block (HAVB) is a known complication of ST-segment elevation myocardial infarction (STEMI). We aimed to determine the prevalence and prognostic impact of HAVB in a contemporary cohort of STEMI. METHODS Data were collected from the DIAMANTE registry that included STEMI patients admitted to our cardiac intensive care unit treated with urgent reperfusion. We studied the clinical characteristics and evolution in patients with and without HAVB at admission. RESULTS From 1109 consecutive patients, HAVB was documented in 95 (8.6%). The right coronary artery was the culprit vessel in 84 patients with HAVB (88.4%). The independent predictors of HAVB were: male sex (OR 1.9, 95% CI 1.2-2.9), age (OR 1.03, 95% CI 1.01-1.05), involvement of right coronary artery (OR 12.4, 95% CI 7.6-20.2), and creatinine value (OR 1.5, 95% CI 1.1-2.0). A transient percutaneous pacemaker was used in 37 patients with HAVB (38.9%). Patients with HAVB had higher mortality that patients without HAVB (15.8% vs. 4.1%, p < 0.001); however, in multivariate analysis, HAVB was not an independent predictor of in-hospital mortality. CONCLUSIONS HAVB was seen in 9% of STEMI patients and was particularly frequent in elderly males with renal failure. Patients with HAVB had a poor prognosis during hospitalization, but HAVB was not an independent predictor of in-hospital mortality.
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Affiliation(s)
| | - Lourdes Vicent
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Felipe Díez-Delhoyo
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - María Jesús Valero Masa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Vanesa Bruña
- Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Iago Sousa-Casasnovas
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miriam Juárez-Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Facultad de Medicina, Universidad Complutense Madrid, 28040 Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Facultad de Medicina, Universidad Complutense Madrid, 28040 Madrid, Spain
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Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Bouza E. Status of Herpes Zoster and Herpes Zoster Vaccines in 2023: A position paper. Rev Esp Quimioter 2023; 36:223-235. [PMID: 36752132 DOI: 10.37201/req/004.2023] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Herpes zoster infection (HZ) is an important public health problem due to its high incidence and frequent complications, especially post-herpetic neuropathy . The incidence of HZ increases with age and is more frequent in immunocompromised patients. It is estimated that at least 60,000 people develop HZ each year in Spain. The usual forms of HZ are so clinically characteristic that they do not usually require microbiological confirmation, which is reserved for cases without cutaneous manifestations or with atypical presentation. There are currently two vaccines approved by the regulatory agencies and marketed in Spain to prevent the onset of HZ and its complications. The first (Zostavax®) was marketed by the company MSD and licensed in Europe in 2006 and is a live attenuated virus vaccine that is administered in a single dose, while the second (Shingrix®) is a recombinant vaccine, marketed in 2017 and requires two doses. While the former cannot be administered to immunocompromised persons, the latter can be prescribed to any group of adults. The criteria for the indication and financing of these vaccines have not been uniform in the various autonomous communities of Spain. These and other aspects of HZ have been discussed by a group of experts from the Illustrious Official College of Physicians of Madrid (ICOMEM) whose criteria and opinions are included in this paper.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Martínez-Sellés M, Hernández-Pérez FJ, Díaz J, Fernández-Avilés F. Cardiogenic sshock care in centers with an infarction code program but without cardiac surgery. Response. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00128-7. [PMID: 37201717 DOI: 10.1016/j.rec.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Universidad Europea, Madrid, España.
| | | | - José Díaz
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
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36
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Martin-Villen L, Martínez-Sellés M, Diaz-Fernandez JF, Zapata-Fenor L. Cardiogenic shock code 2023, towards a quality multidisciplinary organization. Med Intensiva 2023:S2173-5727(23)00046-2. [PMID: 37173216 DOI: 10.1016/j.medine.2023.04.001] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Luis Martin-Villen
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Lluis Zapata-Fenor
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Fernández MS, Silva Melchor L, Martínez-Sellés M, Viana Tejedor A, Aguilar R, Lopez de Sa Areses E, Martín Asenjo R. Early approach to LDL-related risk after acute coronary syndrome: The OPTA Project. Expert Rev Cardiovasc Ther 2023:1-6. [PMID: 37144281 DOI: 10.1080/14779072.2023.2211266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients. AREAS COVERED The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids. EXPERT OPINION Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets "the lower, the better" and "the earlier, the better".
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Affiliation(s)
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda-Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rio Aguilar
- Department of Cardiology. Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain
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Martínez-Solano J, Ortiz-Bautista C, Gutiérrez-Ibañes E, García-Cosío MD, Sarnago-Cebada F, Díaz-Molina B, Pascual I, Gómez-Bueno M, Calviño-Santos R, Gómez-Hospital JA, García-Lara J, de la Fuente-Galán L, Mirabet-Pérez S, Martínez-Sellés M. Optical coherence tomography assessment of pulmonary vascular remodeling in advanced heart failure. The OCTOPUS-CHF study. Rev Esp Cardiol (Engl Ed) 2023; 76:312-321. [PMID: 36155847 DOI: 10.1016/j.rec.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/06/2022] [Indexed: 04/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary vascular remodeling is common among patients with advanced heart failure. Right heart catheterization is the gold standard to assess pulmonary hypertension, but is limited by indirect measurement assumptions, a steady-flow view, load-dependency, and interpretation variability. We aimed to assess pulmonary vascular remodeling with intravascular optical coherence tomography (OCT) and to study its correlation with hemodynamic data. METHODS This observational, prospective, multicenter study recruited 100 patients with advanced heart failure referred for heart transplant evaluation. All patients underwent right heart catheterization together with OCT evaluation of a subsegmentary pulmonary artery. RESULTS OCT could be performed and properly analyzed in 90 patients. Median age was 57.50 [interquartile range, 48.75-63.25] years and 71 (78.88%) were men. The most frequent underlying heart condition was nonischemic dilated cardiomyopathy (33 patients [36.66%]). Vascular wall thickness significantly correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient (R coefficient=0.42, 0.27 and 0.32 respectively). Noninvasive estimation of pulmonary artery systolic pressure, acceleration time, and right ventricle-pulmonary artery coupling also correlated with wall thickness (R coefficient of 0.42, 0.27 and 0.49, respectively). Patients with a wall thickness over 0.25mm had significantly higher mean pulmonary pressures (37.00 vs 25.00mmHg; P=.004) and pulmonary vascular resistance (3.44 vs 2.08 WU; P=.017). CONCLUSIONS Direct morphological assessment of pulmonary vascular remodeling with OCT is feasible and is significantly associated with classic hemodynamic parameters. This weak association suggests that structural remodeling does not fully explain pulmonary hypertension.
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Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlos Ortiz-Bautista
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Enrique Gutiérrez-Ibañes
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - María Dolores García-Cosío
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Sarnago-Cebada
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Díaz-Molina
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Isaac Pascual
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Manuel Gómez-Bueno
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Majadahonda, Spain
| | - Ramón Calviño-Santos
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servizo de Cardioloxía, Complexo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan García-Lara
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Luis de la Fuente-Galán
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
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Sanchis J, Bueno H, Miñana G, Guerrero C, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, García-Blas S, Calvo E, Morales Gallardo MJ, Elízaga J, Gómez-Blázquez I, Alfonso F, García del Blanco B, Núñez J, Formiga F, Ariza-Solé A. Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non-ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:407-415. [PMID: 36877502 PMCID: PMC9989957 DOI: 10.1001/jamainternmed.2023.0047] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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] [Received: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023]
Abstract
Importance To our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non-ST-segment elevation acute myocardial infarction (NSTEMI). Objective To compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year. Design, Setting, and Participants This multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022. Interventions Patients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy. Main Outcomes and Measures The primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization. Results The study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, -7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, -63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78). Conclusions and Relevance In this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI. Trial Registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Carme Guerrero
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Madrid, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez-Blázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Vicent L, Álvarez-García J, Vazquez-Garcia R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Fernández-Avilés F, Ariza-Sole A, Martínez-Sellés M. Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction. J Clin Med 2023; 12:3028. [PMID: 37109365 PMCID: PMC10143946 DOI: 10.3390/jcm12083028] [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: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, 08025 Barcelona, Spain
| | | | - José R. González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago, CIBERCV, 15076 Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, 46026 Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, 28222 Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Department of Medicine, University of Murcia, 30120 Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Worner
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Cardiology Department, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Albert Ariza-Sole
- Cardiology Department, Bellvitge University Hospital General, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
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41
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Mornese Pinna S, Sousa Casasnovas I, Olmedo M, Machado M, Juàrez Fernández M, Devesa-Cordero C, Galar A, Alvarez-Uria A, Fernández-Avilés F, García Carreño J, Martínez-Sellés M, De Rosa FG, Corcione S, Bouza E, Muñoz P, Valerio M. Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit. Microorganisms 2023; 11:microorganisms11041079. [PMID: 37110503 PMCID: PMC10143322 DOI: 10.3390/microorganisms11041079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01-1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05-14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12-60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23-3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.
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Affiliation(s)
- Simone Mornese Pinna
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
| | - Iago Sousa Casasnovas
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - María Olmedo
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
| | - Marina Machado
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
| | - Miriam Juàrez Fernández
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Carolina Devesa-Cordero
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Alicia Galar
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
| | - Ana Alvarez-Uria
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
| | - Jorge García Carreño
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10124 Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10124 Turin, Italy
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Martínez-Sellés M, Marina-Breysse M. Current and Future Use of Artificial Intelligence in Electrocardiography. J Cardiovasc Dev Dis 2023; 10:jcdd10040175. [PMID: 37103054 PMCID: PMC10145690 DOI: 10.3390/jcdd10040175] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
Artificial intelligence (AI) is increasingly used in electrocardiography (ECG) to assist in diagnosis, stratification, and management. AI algorithms can help clinicians in the following areas: (1) interpretation and detection of arrhythmias, ST-segment changes, QT prolongation, and other ECG abnormalities; (2) risk prediction integrated with or without clinical variables (to predict arrhythmias, sudden cardiac death, stroke, and other cardiovascular events); (3) monitoring ECG signals from cardiac implantable electronic devices and wearable devices in real time and alerting clinicians or patients when significant changes occur according to timing, duration, and situation; (4) signal processing, improving ECG quality and accuracy by removing noise/artifacts/interference, and extracting features not visible to the human eye (heart rate variability, beat-to-beat intervals, wavelet transforms, sample-level resolution, etc.); (5) therapy guidance, assisting in patient selection, optimizing treatments, improving symptom-to-treatment times, and cost effectiveness (earlier activation of code infarction in patients with ST-segment elevation, predicting the response to antiarrhythmic drugs or cardiac implantable devices therapies, reducing the risk of cardiac toxicity, etc.); (6) facilitating the integration of ECG data with other modalities (imaging, genomics, proteomics, biomarkers, etc.). In the future, AI is expected to play an increasingly important role in ECG diagnosis and management, as more data become available and more sophisticated algorithms are developed.
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Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Europea, Villaviciosa de Odón, 28670 Madrid, Spain
- Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - Manuel Marina-Breysse
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- IDOVEN Research, 28013 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Myocardial Pathophysiology Area, 28029 Madrid, Spain
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Díez-Villanueva P, Jimenez-Mendez C, Pérez Á, Esteban-Fernández A, Datino T, Martínez-Sellés M, Ayesta A. Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events? Cardiology 2023; 148:195-206. [PMID: 37040727 DOI: 10.1159/000530424] [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: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. SUMMARY The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. KEY MESSAGES In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment.
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Affiliation(s)
| | | | - Ángel Pérez
- Cardiology Department, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | - Tomás Datino
- Cardiology Department, Hospital Universitario Quirón and Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea, Madrid, Spain
| | - Ana Ayesta
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Álvarez-García J, Cristo Ropero MJ, Iniesta Manjavacas ÁM, Díez-Villanueva P, Esteban-Fernández A, de Juan Bagudá J, Rivas-Lasarte M, Taibo Urquía M, Górriz-Magaña J, Cobo Marcos M, Goirigolzarri-Artaza J, Iglesias Del Valle D, Bover Freire R, Beltrán Herrera C, Villa A, Campuzano Ruiz R, Martínez-Sellés M. Do Women Physicians Accept and Follow Heart Failure Guidelines More Than Men? Curr Heart Fail Rep 2023:10.1007/s11897-023-00597-y. [PMID: 37022560 DOI: 10.1007/s11897-023-00597-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW Our aim was to assess the degree of acceptance of the European Clinical Practice Guidelines (CPG) on heart failure (HF) among Spanish physicians according to sex. This was a cross-sectional study, employing Google Forms, conducted by a group of HF experts from the Region of Madrid (Spain), between November 2021 and February 2022, among specialists and residents of Cardiology, Internal Medicine, and Primary Care from Spain. RECENT FINDINGS A total of 387 physicians-173 women (44.7%)-from 128 different centers completed the survey. Compared to men, women were significantly younger (38.2 ± 9.1 years vs. 40.6 ± 11.2 years; p = 0.024) and had fewer years of clinical practice (12.1 ± 8.1 years vs. 14.5 ± 10.7 years; p = 0.014). Briefly, women and men had a positive opinion of the guidelines and thought that implementing quadruple therapy is feasible in less than 8 weeks. Women followed more frequently than men the new paradigm of "4 pillars at lowest doses" and considered more frequently the establishment of quadruple therapy before implanting a cardiac device. Although they agreed about "low blood pressure" as the major limitation for achieving quadruple therapy in heart failure with reduced ejection fraction, there were discrepancies on the second most frequent barrier, and women were more proactive when initiating SGLT2 inhibitors. In a large survey including nearly 400 doctors from all over Spain to provide real-world opinion on 2021 ESC HF Guidelines and experience with SGLT2 inhibitors, women follow more frequently the new paradigm of "4 pillars at lowest doses", consider more frequently the establishment of quadruple therapy before implanting a cardiac device, and were more proactive when initiating SGLT2 inhibitors. Further studies confirming an association of sex with a better compliance of HF guidelines are needed.
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Affiliation(s)
- Jesús Álvarez-García
- Cardiology Department, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario Ramón Y Cajal, Madrid, Spain.
| | | | - Ángel Manuel Iniesta Manjavacas
- Cardiology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | - Javier de Juan Bagudá
- Cardiology Department, Hospital Universitario, Instituto de Investigación Sanitaria Hospital, 12 de Octubre12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain Department of Medicine, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, Madrid, Spain
| | - Mercedes Rivas-Lasarte
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Mikel Taibo Urquía
- Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Górriz-Magaña
- Cardiology Department, Hospital Central de La Defensa Gómez-Ulla, Madrid, Spain
| | - Marta Cobo Marcos
- Cardiology Department, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario Ramón Y Cajal, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | | | - Diego Iglesias Del Valle
- Cardiology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Ramón Bover Freire
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Adolfo Villa
- Cardiology Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. Rev Esp Quimioter 2023; 36:114-124. [PMID: 36510683 PMCID: PMC10066911 DOI: 10.37201/req/122.2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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46
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. Rev Esp Quimioter 2023. [PMID: 36510683 DOI: 10.3701/req/059.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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47
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Ariza-Solé A, Mateus-Porta G, Formiga F, Garcia-Blas S, Bonanad C, Núñez-Gil I, Vergara-Uzcategui C, Díez-Villanueva P, Bañeras J, Badia-Molins C, Aboal J, Carreras-Mora J, Gabaldón-Pérez A, Parada-Barcia JA, Martínez-Sellés M, Comín-Colet J, Raposeiras-Roubin S. Extended use of dual antiplatelet therapy among older adults with acute coronary syndromes and associated variables: a cohort study. Thromb J 2023; 21:32. [PMID: 36944967 PMCID: PMC10031931 DOI: 10.1186/s12959-023-00476-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Current guidelines recommend extending the use of dual antiplatelet therapy (DAPT) beyond 1 year in patients with an acute coronary syndrome (ACS) and a high risk of ischaemia and low risk of bleeding. No data exist about the implementation of this strategy in older adults from routine clinical practice. METHODS We conducted a Spanish multicentre, retrospective, observational registry-based study that included patients with ACS but no thrombotic or bleeding events during the first year of DAPT after discharge and no indication for oral anticoagulants. High bleeding risk was defined according to the Academic Research Consortium definition. We assessed the proportion of cases of extended DAPT among patients 65 ≥ years that went beyond 1 year after hospitalisation for ACS and the variables associated with the strategy. RESULTS We found that 48.1% (928/1,928) of patients were aged ≥ 65 years. DAPT was continued beyond 1 year in 32.1% (298/928) of patients ≥ 65; which was a similar proportion as with their younger counterparts. There was no significant correlation between a high bleeding risk and DAPT duration. Contrastingly, there was a strong correlation between the extent of coronary disease and DAPT duration (p < 0.001). Other variables associated with extended DAPT were a higher left ventricle ejection fraction, a history of heart failure and a prior stent thrombosis. CONCLUSION There was no correlation between age and extended use of DAPT beyond 1 year in older patients with ACS. DAPT was extended in about one-third of patients ≥ 65 years. The severity of the coronary disease, prior heart failure, left ventricle ejection fraction and prior stent thrombosis all correlated with extended DAPT.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain.
| | - Gemma Mateus-Porta
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
| | - Francesc Formiga
- Geriatrics Unit. Internal Medicine Department, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Garcia-Blas
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Jordi Bañeras
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | | | - Ana Gabaldón-Pérez
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense, Madrid, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
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Martínez-Solano J, Martínez-Sellés M. Sudden Death in Men Versus Women with Heart Failure. Curr Heart Fail Rep 2023; 20:129-137. [PMID: 36881322 DOI: 10.1007/s11897-023-00596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex differences in SCD mechanisms, prevention, and management in HF patients. RECENT FINDINGS Women with HF present a better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such a gap between men and women. Both HF drugs and ventricular arrhythmias ablation seems also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT-prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not been shown to be equally effective in women than men. Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and the under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.
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Affiliation(s)
- Jorge Martínez-Solano
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain. .,Universidad Europea, Universidad Complutense, Madrid, Spain.
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Raposeiras-Roubín S, Núñez-Gil IJ, Jamhour K, Abu-Assi E, Conty DA, Vedia O, Almendro-Delia M, Sionis A, Martin-Garcia AC, Corbí-Pascual M, Martínez-Sellés M, Uribarri A, Guillén M, Acuña JMG, País JL, Blanco E, Linares Vicente JA, Flecha ASG, Andrés M, Pérez-Castellanos A, Alonso J, Rosselló X, Romo AI, Feltes G. Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry. Rev Port Cardiol 2023; 42:237-246. [PMID: 36634757 DOI: 10.1016/j.repc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No evidence-based therapy has yet been established for Takotsubo syndrome (TTS). Given the putative harmful effects of catecholamines in patients with TTS, beta-blockers may potentially decrease the intensity of the detrimental cardiac effects in those patients. OBJECTIVE The purpose of this study was to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence. METHODS The cohort study used the national Spanish Registry on TakoTsubo Syndrome (RETAKO). A total of 970 TTS post-discharge survivors, without pheochromocytoma, left ventricular outflow tract obstruction, sustained ventricular arrhythmias, and significant bradyarrhythmias, between January 1, 2003, and July 31, 2018, were assessed. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were used to evaluate the association between beta-blocker therapy and survival free of TTS recurrence. RESULTS From 970 TTS patients, 582 (60.0%) received beta-blockers. During a mean follow-up of 2.5±3.3 years, there were 87 deaths (3.6 per 100 patients/year) and 29 TTS recurrences (1.2 per 100 patient/year). There was no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox analysis (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.59-1.27, and 0.95, 95% CI 0.57-1.13, respectively). After weighting and adjusting by IPW, differences in one-year survival free of TTS recurrence between patients treated and untreated with beta-blockers were not found (average treatment effect -0.01, 95% CI -0.07 to 0.04; p=0.621). CONCLUSIONS In this observational nationwide study from Spain, there was no significant association between beta-blocker therapy and follow-up survival free of TTS recurrence.
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Affiliation(s)
| | - Iván J Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Karim Jamhour
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Emad Abu-Assi
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Guillén
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | | | - Javier Lopez País
- Cardiology Department, Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | - Emilia Blanco
- Cardiology Department, Hospital Arnau de Vilanova, Lérida, Spain
| | | | | | - Mireia Andrés
- Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Joaquín Alonso
- Cardiology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Gisela Feltes
- Cardiology Department, Hospital Nuestra Señora de América, Madrid, Spain
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Durand-Zaleski I, Ducrocq G, Mimouni M, Frenkiel J, Avendano-Solá C, Gonzalez-Juanatey JR, Ferrari E, Lemesle G, Puymirat E, Berard L, Cachanado M, Arnaiz JA, Martínez-Sellés M, Silvain J, Ariza-Solé A, Calvo G, Danchin N, Paco S, Drouet E, Abergel H, Rousseau A, Simon T, Steg PG. Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses. Eur Heart J Qual Care Clin Outcomes 2023; 9:194-202. [PMID: 35612990 DOI: 10.1093/ehjqcco/qcac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 01/29/2023]
Abstract
AIMS To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia. METHODS AND RESULTS Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was €33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was €191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of €72 000 saved per additional MACE with the restrictive strategy. CONCLUSION In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02648113. ONE SENTENCE SUMMARY The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.
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Affiliation(s)
- Isabelle Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France.,INSERM UMR 1153 CRESS, Paris, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Maroua Mimouni
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Jerome Frenkiel
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, place du parvis de Notre Dame 75004, Paris, France
| | - Cristina Avendano-Solá
- Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Emile Ferrari
- Université Côte d'Azur, and CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, 06001, Nice, France
| | - Gilles Lemesle
- Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Faculté de Médecine de Lille, Université de Lille, Institut Pasteur de Lille, Inserm U1011, F-59000 Lille, France
| | - Etienne Puymirat
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Laurence Berard
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Joan Albert Arnaiz
- Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 75013, Paris, France
| | - Albert Ariza-Solé
- University Hospital Bellvitge, Heart Disease Institute, Barcelona, Spain
| | - Gonzalo Calvo
- Àrea del Medicament, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Nicolas Danchin
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), 75015, Paris, France
| | - Sandra Paco
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Elodie Drouet
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Helene Abergel
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, 75012, Paris, France
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, 75018, Paris, France
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