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Wade U, Pascual-Figal DA, Rabbani F, Ernst M, Albert A, Janssens I, Dierckxsens Y, Iqtadar S, Khokhar NA, Kanwal A, Khan A. The Possible Synergistic Pharmacological Effect of an Oral Berberine (BBR) and Curcumin (CUR) Complementary Therapy Alleviates Symptoms of Irritable Bowel Syndrome (IBS): Results from a Real-Life, Routine Clinical Practice Settings-Based Study. Nutrients 2024; 16:1204. [PMID: 38674895 DOI: 10.3390/nu16081204] [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: 03/12/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a prevalent chronic functional gastrointestinal disorder, characterised by recurrent abdominal discomfort and altered bowel movements. IBS cause a significantly negative impact on quality of life (QoL). Growing pharmacological evidence suggests that berberine (BBR) and curcumin (CUR) may mitigate IBS symptoms through multiple complementary synergistic mechanisms, resulting in the attenuation of intestinal inflammation and regulation of bowel motility and gut functions. In the present observational study conducted under real-life routine clinical practice settings, 146 patients diagnosed with IBS were enrolled by general practitioner clinics and pharmacies in Belgium. For the first time, this study assessed the potential synergistic pharmacological effect of a combined oral BBR/CUR supplement (Enterofytol® PLUS, containing 200 mg BBR and 49 mg CUR) (two tablets daily for 2 months), serving as complementary therapy in the management of IBS. Following the 2-month supplementation, significant improvements were observed in the patients' IBS severity index (IBSSI) (47.5%) and all the primary IBS symptoms, such as abdominal discomfort (47.2%), distension (48.0%), intestinal transit (46.8%), and QoL (48.1%) (all p < 0.0001). The improvement in the patients' IBSSI was independent of age, sex, and IBS sub-types. The patients' weekly maximum stool passage frequency decreased significantly (p < 0.0001), and the stool status normalized (p < 0.0001). The patients' need for concomitant conventional IBS treatment decreased notably: antispasmodics by 64.0% and antidiarrhoeals by 64.6%. Minor adverse effects were reported by a small proportion (7.1%) of patients, mostly gastrointestinal. The majority (93.1%) experienced symptom improvement or resolution, with a high satisfaction rate (82.6%) and willingness to continue the supplementation (79.0%). These findings support the potential synergistic pharmacological role of BBR and CUR in IBS, and their co-supplementation may alleviate IBS symptoms and improve QoL.
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Affiliation(s)
- Ursula Wade
- Department of Basic and Clinical Neuroscience, Kings College London, London SE5 9RT, UK
| | - Domingo A Pascual-Figal
- Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, 30120 Murcia, Spain
| | | | - Marie Ernst
- Biostatistics and Research Methods Center (B-STAT), CHU of Liège and University of Liège, 4000 Liège, Belgium
| | - Adelin Albert
- Biostatistics and Research Methods Center (B-STAT), CHU of Liège and University of Liège, 4000 Liège, Belgium
| | | | | | - Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Nisar A Khokhar
- Department of Medicine, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan
| | | | - Amjad Khan
- Department of Biochemistry, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK
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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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Pastor-Pérez FJ, Veas-Porlán M, Fernández-Villa N, Garrido-Bravo IP, Manzano-Fernández S, Pascual-Figal DA. Semi-quantitative pulmonary congestion score: prevalence and diuretic management implications after heart failure discharge. Rev Clin Esp 2024; 224:157-161. [PMID: 38355098 DOI: 10.1016/j.rceng.2024.02.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/16/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Persistent congestion after heart failure (HF) discharge is associated with a higher risk of readmissions. MATERIAL AND METHODS eighty-two patients included after HF discharge. The aim of the study was to characterize semiquantitatively the degree of pulmonary congestion and its changes, describing the relationship between these findings and diuretic management. RESULTS On the first visit, despite the absence of clinical congestion in the majority of patients, half of the had some degree of pulmonary congestion by ultrasound. After global assessment in this initial visit (clinical and ultrasound) the diuretic was lowered in 50 patients (60%), kept the same in 16 (20%) and it was increased in the rest. In the 45 patients without ultrasound congestion, diuretic reduction was attempted in 80%, being this strategy successful in the majority of them. CONCLUSIONS Lung ultrasound, using simple quantification methods, allows its real incorporation into clinical practice, helping us in the decision making process.
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Affiliation(s)
- F J Pastor-Pérez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - M Veas-Porlán
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - N Fernández-Villa
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - I P Garrido-Bravo
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - S Manzano-Fernández
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - D A Pascual-Figal
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Pascual-Figal DA, Zamorano JL, Domingo M, Morillas H, Nuñez J, Cobo Marcos M, Riquelme-Pérez A, Teis A, Santas E, Caro-Martinez C, Pinilla JM, Rodriguez-Palomares JF, Dobarro D, Restrepo-Córdoba MA, González-Juanatey JR, Bayés Genís A. Impact of dapagliflozin on cardiac remodelling in patients with chronic heart failure: The DAPA-MODA study. Eur J Heart Fail 2023; 25:1352-1360. [PMID: 37211950 DOI: 10.1002/ejhf.2884] [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: 04/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, specifically left atrial (LA) remodelling, is not well established. METHODS AND RESULTS The DAPA-MODA trial (NCT04707352) is a multicentre, single-arm, open-label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline-directed therapy, except for any sodium-glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core-lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2 ) and LA parameters were similar between LVEF-based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (-6.6% [95% confidence interval -11.1, -1.8], p = 0.008), primarily due to a decrease in reservoir volume (-13.8% [95% confidence interval -22.5, -4], p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (-13.9% [95% confidence interval -18.7, -8.7], p < 0.001), end-diastolic volume (-8.0% [95% confidence interval -11.6, -4.2], p < 0.001) and end-systolic volume (-11.9% [95% confidence interval -16.7, -6.8], p < 0.001) at 180 days. N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed a significant reduction at 180 days (-18.2% [95% confidence interval -27.1, -8.2], p < 0.001), without changes in filling Doppler measures. CONCLUSION Dapagliflozin administration in stable out-setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT-proBNP concentrations.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - J Luis Zamorano
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | | | - Julio Nuñez
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Riquelme-Pérez
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - Albert Teis
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cesar Caro-Martinez
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
| | - Jose Manuel Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jose F Rodriguez-Palomares
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Dobarro
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Álvaro Cunqueiro, IIS Galicia Sur, Vigo, Spain
| | | | - J Ramón González-Juanatey
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Bayés Genís
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
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McEwan P, Harrison C, Binnie R, Lewis RD, Cohen-Solal A, Lund LH, Ohlsson M, von Haehling S, Comin-Colet J, Pascual-Figal DA, Wächter S, Dorigotti F, de Arellano AR, Ponikowski P, Jankowska EA. Impact of ferric carboxymaltose for iron deficiency at discharge after heart failure hospitalization: a European multinational economic evaluation. Eur J Heart Fail 2023; 25:389-398. [PMID: 36718652 DOI: 10.1002/ejhf.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
AIMS Iron deficiency (ID) is comorbid in up to 50% patients with heart failure (HF) and exacerbates disease burden. Ferric carboxymaltose (FCM) reduced HF hospitalizations and improved quality of life when used to treat ID at discharge in patients hospitalized for acute HF with left ventricular ejection fraction <50% in the AFFIRM-AHF trial. We quantified the effect of FCM on burden of disease and the wider pharmacoeconomic implications in France, Germany, Poland, Spain and Sweden. METHODS AND RESULTS The per country eligible population was calculated, aligning with the 2021 European Society of Cardiology (ESC) HF guidelines and the AFFIRM-AHF trial. Changes in burden of disease with FCM versus standard of care (SoC) were represented by disability-adjusted life years (DALYs), hospitalization episodes and bed days, using AFFIRM-AHF data. A Markov model was adapted to each country to estimate cost-effectiveness and combined with epidemiology data to calculate the impact on healthcare budgets. Between 335 (Sweden) and 13 237 (Germany) DALYs were predicted to be avoided with FCM use annually. Fewer hospitalizations and shorter lengths of stay associated with FCM compared to SoC were projected to result in substantial annual savings in bed days, from 5215 in Sweden to 205 630 in Germany. In all countries, FCM was predicted to be dominant (cost saving with gains in quality-adjusted life years), resulting in net savings to healthcare budgets within 1 year. CONCLUSIONS This comprehensive evaluation of FCM therapy highlights the potential benefits that could be realized through implementation of the ESC HF guideline recommendations regarding ID treatment.
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Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Cale Harrison
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Rhona Binnie
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Ruth D Lewis
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Alain Cohen-Solal
- Hospital Lariboisière, AP-HP, INSERM U948 MASCOT, Université Paris Cité, Paris, France
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Internal Medicine, Malmö University Hospital, Malmö, Sweden
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Josep Comin-Colet
- Cardiology Department, Hospital Universitari Bellvitge, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Domingo A Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain; and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Ewa A Jankowska
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
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Iqtadar S, Khan A, Mumtaz SU, Pascual-Figal DA, Livingstone S, Abaidullah S. Tocilizumab therapy for severely-ill COVID-19 pneumonia patients: a single-centre retrospective study. J Physiol Pharmacol 2022; 73. [PMID: 36696245 DOI: 10.26402/jpp.2022.4.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 01/26/2023]
Abstract
Systemic hyperinflammation is a hallmark of severe coronavirus disease-2019 (COVID-19). Tocilizumab (TCZ) (an interleukin-6 receptor blocker) therapy is currently used as an anti-inflammatory intervention alongside corticosteroids to modulate the hyperinflammatory response (cytokine storm) in hospitalized patients with severe COVID-19 to prevent mortality. There is, however, a wide uncertainty about its pros and cons in patients with COVID-19, particularly, its possible immunosuppressive effect is of serious concern for the clinicians. The present study aimed to report response of a cohort of severely-ill hospitalized COVID-19 pneumonia patients who were treated with tocilizumab after the initial corticosteroids therapy failed to improve the patients' clinical condition. This was a single-arm retrospective study of 100 severely-ill COVID-19 pneumonia patients who were admitted to the specialized COVID-19 units of Mayo Hospital, Lahore, Pakistan from March 12, 2020, to May 25, 2021. These COVID-19 patients had progressed to cytokine storm with persistent hypoxia, associated with pneumonia, and markedly elevated serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, and ferritin. All the patients had received two separate doses of intravenous 400 mg (4 mg/kg) tocilizumab with an 8-hour interval alongside standard COVID-19 care which includes corticosteroid, antibiotics, and anticoagulants. Following tocilizumab intervention, 75 (75.0%) patients showed clinical improvement, continued to recover, and were safely discharged from the hospital, while in 25 (25.0%) patients, TCZ failed to prevent clinical deterioration, and patients eventually died in the hospital. Amongst the 25 (25.0%) deaths, 8 (32.0%) patients had a single comorbidity, while 9 (36.0%) had two or more comorbidities. The median IQR age for survivors was 57.0 (50.0, 60.0) years, and non-survivors was 60.0 (55.0, 70.0) years; and the period of hospitalization was 25 (20, 40) days and 20 (14, 34) days, respectively. Tocilizumab treatment improved serum inflammatory biomarker levels including CRP, D-dimer, and ferritin, by almost a similar magnitude in both survivors and non-survivors. Development of secondary infections were reported in 25 (25.0%) patients, including 21% patients with bacterial (Pseudomonas, Klebsiella, Acinetobacter) and 4% with fungal (Aspergillus) infection. The emergence of secondary infection was higher in patients who died (72.0%) as compared to those who survived (28.0%). In conclusion: in low- and middle-income countries in the presence of limited therapeutic options, a timely intervention of TCZ alongside corticosteroids may be a suitable anti-inflammatory therapy for severely-ill hospitalized COVID-19 pneumonia patients to prevent mortality. However, patients must be closely monitored for secondary bacterial/fungal infections. Early diagnosis and management of secondary infection can reduce morbidity and mortality.
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Affiliation(s)
- S Iqtadar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - A Khan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, UK. .,INEOS Oxford Institute for Antimicrobial Research, University of Oxford, UK
| | - S U Mumtaz
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - D A Pascual-Figal
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Espana.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Espana
| | | | - S Abaidullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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Díez-Díez M, Amorós-Pérez M, de la Barrera J, Vázquez E, Quintas A, Pascual-Figal DA, Dopazo A, Sánchez-Cabo F, Kleinman ME, Gordon LB, Fuster V, Andrés V, Fuster JJ. Clonal hematopoiesis is not prevalent in Hutchinson-Gilford progeria syndrome. GeroScience 2022; 45:1231-1236. [PMID: 35752705 PMCID: PMC9886702 DOI: 10.1007/s11357-022-00607-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023] Open
Abstract
Clonal hematopoiesis of indeterminate potential (CHIP), defined as the presence of somatic mutations in cancer-related genes in blood cells in the absence of hematological cancer, has recently emerged as an important risk factor for several age-related conditions, especially cardiovascular disease. CHIP is strongly associated with normal aging, but its role in premature aging syndromes is unknown. Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare genetic condition driven by the accumulation of a truncated form of the lamin A protein called progerin. HGPS patients exhibit several features of accelerated aging and typically die from cardiovascular complications in their early teens. Previous studies have shown normal hematological parameters in HGPS patients, except for elevated platelets, and low levels of lamin A expression in hematopoietic cells relative to other cell types in solid tissues, but the prevalence of CHIP in HGPS remains unexplored. To investigate the potential role of CHIP in HGPS, we performed high-sensitivity targeted sequencing of CHIP-related genes in blood DNA samples from a cohort of 47 HGPS patients. As a control, the same sequencing strategy was applied to blood DNA samples from middle-aged and elderly individuals, expected to exhibit a biological age and cardiovascular risk profile similar to HGPS patients. We found that CHIP is not prevalent in HGPS patients, in marked contrast to our observations in individuals who age normally. Thus, our study unveils a major difference between HGPS and normal aging and provides conclusive evidence that CHIP is not frequent in HGPS and, therefore, is unlikely to contribute to the pathophysiology of this accelerated aging syndrome.
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Affiliation(s)
- Miriam Díez-Díez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Marta Amorós-Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Jorge de la Barrera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Enrique Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Ana Quintas
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Domingo A. Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain ,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares, (CIBERCV) 28029 Madrid, Spain ,Hospital Virgen de La Arrixaca, Universidad de Murcia, 30120 Murcia, Spain
| | - Ana Dopazo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Fátima Sánchez-Cabo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain
| | - Monica E. Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Leslie B. Gordon
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115 USA ,Department of Pediatrics, Division of Genetics, Hasbro Children’s Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02903 USA ,The Progeria Research Foundation, Peabody, MA 01960 USA
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain ,Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Vicente Andrés
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029, Madrid, Spain. .,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares, (CIBERCV), 28029, Madrid, Spain.
| | - José J. Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3., 28029 Madrid, Spain ,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares, (CIBERCV) 28029 Madrid, Spain
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Khan A, Iqtadar S, Mumtaz SU, Heinrich M, Pascual-Figal DA, Livingstone S, Abaidullah S. Oral Co-Supplementation of Curcumin, Quercetin, and Vitamin D3 as an Adjuvant Therapy for Mild to Moderate Symptoms of COVID-19—Results From a Pilot Open-Label, Randomized Controlled Trial. Front Pharmacol 2022; 13:898062. [PMID: 35747751 PMCID: PMC9211374 DOI: 10.3389/fphar.2022.898062] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Curcumin, quercetin, and vitamin D3 (cholecalciferol) are common natural ingredients of human nutrition and reportedly exhibit promising anti-inflammatory, immunomodulatory, broad-spectrum antiviral, and antioxidant activities. Objective: The present study aimed to investigate the possible therapeutic benefits of a single oral formulation containing supplements curcumin, quercetin, and cholecalciferol (combinedly referred to here as CQC) as an adjuvant therapy for early-stage of symptomatic coronavirus disease 2019 (COVID-19) in a pilot open-label, randomized controlled trial conducted at Mayo Hospital, King Edward Medical University, Lahore, Pakistan. Methods: Reverse transcriptase polymerase chain reaction (RT-PCR) confirmed, mild to moderate symptomatic COVID-19 outpatients were randomized to receive either the standard of care (SOC) (n = 25) (control arm) or a daily oral co-supplementation of 168 mg curcumin, 260 mg quercetin, and 9 µg (360 IU) of cholecalciferol, as two oral soft capsules b.i.d. as an add-on to the SOC (n = 25) (CQC arm) for 14 days. The SOC includes paracetamol with or without antibiotic (azithromycin). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test, acute symptoms, and biochemistry including C-reactive protein (CRP), D-dimer, lactate dehydrogenase, ferritin, and complete blood count were evaluated at baseline and follow-up day seven. Results: Patients who received the CQC adjuvant therapy showed expedited negativization of the SARS-CoV-2 RT-PCR test, i.e., 15 (60.0%) vs. five (20.0%) of the control arm, p = 0.009. COVID-19- associated acute symptoms were rapidly resolved in the CQC arm, i.e., 15 (60.0%) vs. 10 (40.0%) of the control arm, p = 0.154. Patients in the CQC arm experienced a greater fall in serum CRP levels, i.e., from (median (IQR) 34.0 (21.0, 45.0) to 11.0 (5.0, 16.0) mg/dl as compared to the control arm, i.e., from 36.0 (28.0, 47.0) to 22.0 (15.0, 25.0) mg/dl, p = 0.006. The adjuvant therapy of co-supplementation of CQC was safe and well-tolerated by all 25 patients and no treatment-emergent effects, complications, side effects, or serious adverse events were reported. Conclusion: The co-supplementation of CQC may possibly have a therapeutic role in the early stage of COVID-19 infection including speedy negativization of the SARS-CoV-2 RT-PCR test, resolution of acute symptoms, and modulation of the hyperinflammatory response. In combination with routine care, the adjuvant co-supplementation of CQC may possibly help in the speedy recovery from early-stage mild to moderate symptoms of COVID-19. Further research is warranted. Clinical Trial Registration:Clinicaltrials.gov, identifier NCT05130671
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Affiliation(s)
- Amjad Khan
- INEOS Oxford Institute for AMR Research, University of Oxford, Oxford, United Kingdom
- Department of Biochemistry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
- *Correspondence: Amjad Khan,
| | - Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sami Ullah Mumtaz
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Michael Heinrich
- UCL School of Pharmacy, University of London, London, United Kingdom
| | - Domingo A. Pascual-Figal
- Department of Cardiology, University of Murcia Hospital Universitario Virgen de la Arrixaca Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Sajid Abaidullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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9
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Pascual-Figal DA, González-Juanatey JR. Environmental factors like air pollution: not to be forgotten in the 2021 ESC guidelines on heart failure. Response. Rev Esp Cardiol (Engl Ed) 2022; 75:539. [PMID: 35523667 DOI: 10.1016/j.rec.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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10
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Haroon MZ, Farooq U, Ashraf S, Zeb S, Gillani SY, Malik S, Ali R, Irshad R, Mehmood Z, Abbas Y, Masood A, Ghafoor A, Khalil AT, Asif H, Khan S, Ujjan ID, Nigar R, Livingstone S, Pascual-Figal DA, Togni S, Allergini P, Riva A, Khan A. Colchicine anti-inflammatory therapy for non-intensive care unit hospitalized COVID-19 patients: results from a pilot open-label, randomized controlled clinical trial. J Physiol Pharmacol 2022; 73. [PMID: 36302537 DOI: 10.26402/jpp.2022.3.09] [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] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.
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Affiliation(s)
- M Z Haroon
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - U Farooq
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - S Ashraf
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Zeb
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - S Y Gillani
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - S Malik
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Ali
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Irshad
- Department of Pathology, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - Z Mehmood
- Department of Neurology, Lady Reading Hospital, Peshawar, Pakistan
| | - Y Abbas
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Masood
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Ghafoor
- Department of Gastroenterology, Lady Reading Hospital, Peshawar, Pakistan
| | - A T Khalil
- Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan
| | - H Asif
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Khan
- Department of Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - I D Ujjan
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - R Nigar
- Department of Obstetrics and Gynecology, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - S Livingstone
- School of Medicine, University of Dundee, Dundee, UK
| | - D A Pascual-Figal
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - S Togni
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - P Allergini
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Riva
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Khan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- INEOS Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
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11
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Codina P, Domingo M, Barceló E, Gastelurrutia P, Casquete D, Vila J, Abdul-Jawad Altisent O, Spitaleri G, Cediel G, Santiago-Vacas E, Zamora E, Ruiz-Cueto M, Santesmases J, de la Espriella R, Pascual-Figal DA, Nuñez J, Lupón J, Bayes-Genis A. Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension. ESC Heart Fail 2022; 9:2170-2180. [PMID: 35588235 PMCID: PMC9288803 DOI: 10.1002/ehf2.13952] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/14/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor Blocker and Neprilysin Inhibitor in HFpEF Patients With CardioMEMS Device (ARNIMEMS-HFpEF) study is to assess pulmonary artery pressure (PAP) dynamics by means of implanted PAP monitors in patients with HFpEF-PH treated with sacubitril/valsartan. METHODS AND RESULTS This single-arm, investigator-initiated, interventional study included 14 consecutive ambulatory symptomatic HFpEF-PH patients who underwent CardioMEMS implantation prior to enrolment [mean ejection fraction 60.4 ± 7.2%, baseline mean PAP (mPAP) 33.9 ± 7.6 mmHg]. Daily PAP values were examined during three periods: a 6 week period after CardioMEMS implantation and before sacubitril/valsartan treatment (pre-ARNI), a 6 week period with sacubitril/valsartan treatment (ARNI ON), and a 6 week period of sacubitril/valsartan withdrawal (ARNI OFF). The primary endpoint was change in mPAP with and without sacubitril/valsartan. Secondary endpoints included changes in 6 min walking distance, B-line sum in lung ultrasound, and quality of life (QoL). During the study period, 1717 mPAP measurements were recorded. Between pre-ARNI vs. ARNI ON, mPAP significantly declined by -4.99 mmHg [95% confidence interval (CI) -5.55 to -4.43]. Between ARNI ON vs. ARNI OFF, mPAP significantly increased by +2.84 mmHg [95% CI +2.26 to +3.42]. Between pre-ARNI vs. ARNI ON, we found an improvement in 6 min walking distance, B-lines, and QoL. Mean loop diuretic management did not differ between periods. CONCLUSIONS Sacubitril/valsartan significantly reduced mPAP in patients with HFpEF-PH, independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and QoL. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH.
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Affiliation(s)
- Pau Codina
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Elena Barceló
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Paloma Gastelurrutia
- ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Daniel Casquete
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Joan Vila
- REGICOR Research Group, Hospital del Mar Medical Research (IMIM), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Giosafat Spitaleri
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Germán Cediel
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Zamora
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - María Ruiz-Cueto
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Javier Santesmases
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Domingo A Pascual-Figal
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain.,Centro Nacional de Investigaciones cardiovasculares (CNIC), Madrid, Spain
| | - Julio Nuñez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Josep Lupón
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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12
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Iqtadar S, Hashmat M, Chaudhry MNA, Mumtaz SU, Abaidullah S, Pascual-Figal DA, Khan A. Unnecessary Use of Corticosteroids for managing early mild symptoms of COVID-19 may lead to Rhino-ortibal-cerebral mucormycosis in Patients with Diabetes – a case series from Lahore, Pakistan. Ther Adv Infect Dis 2022; 9:20499361221097417. [PMID: 35547833 PMCID: PMC9083038 DOI: 10.1177/20499361221097417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Rhino-orbital-cerebral mucormycosis (ROCM), a rare but fatal fungal infection, has recently emerged as a serious complication after corticosteroids therapy in COVID-19 patients, predominantly in diabetic and immunocompromised patients. The World Health Organization (WHO) COVID-19 current guidelines recommend corticosteroids administration in hospitalized COVID-19 patients requiring supplementary oxygen or mechanical ventilation. Herein, we report a case series of seven patients with COVID-19; three mild, three moderate, and one severe, from Lahore, Pakistan; all were using corticosteroids for managing their early mild symptoms of COVID-19 at home for around 2–3 weeks without a physician’s advise, presented, and admitted with ROCM to Mayo hospital, Lahore, from March to June 2021. Out of the seven patients, five patients had uncontrolled diabetes mellitus (DM) as comorbidity. Eye pain, facial swelling and pain, nasal blockage, and black coloration around eyes, on palate, and oral mucosa were the presenting complaints at the time of admission. All the patients had radiographic imaging, including computed tomography (CT), paranasal sinuses (PNS), or brain magnetic resonance imaging (MRI) carried out at the hospital, which confirmed mucosal thickening and adjacent sinus bony erosions with intracranial extension. All the patients were treated with local debridement of the infected necrotic tissue along with intravenous liposomal Amphotericin B and Posaconazole or Amphotericin B depending on the case. Due to timely management, in six out of seven patients, prognosis was good due to early diagnosis and treatment, while one patient with severe COVID-19 illness deteriorated and died. The misuse of corticosteroids for managing early mild symptoms of COVID-19 in diabetic and other immunocompromised patients can lead to fatal ROCM, which can further increase their risk of developing severe COVID-19 and mortality. It is stressed that only physician’s recommended therapeutic advice should be followed for managing early mild symptoms of COVID-19 in self-isolation and avoid the unnecessary use of corticosteroids. This case series also emphasizes that COVID-19 diabetic patients treated with corticosteroids need more vigilant monitoring and high suspicion of early diagnosis and treatment of invasive fungal infection. Early diagnosis and management can reduce morbidity and mortality.
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Affiliation(s)
- Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Masooma Hashmat
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Sami Ullah Mumtaz
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sajid Abaidullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Amjad Khan
- INEOS Oxford Institute for AMR Research, University of Oxford, UK
- Nuffield Division of Clinical and Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, UK
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13
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Pascual-Figal DA, González-Juanatey JR. Factores ambientales como la contaminación del aire: no debe olvidarse en la guía de insuficiencia cardiaca de la ESC 2021. Respuesta. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, Delgado-Jiménez JF, Arizón del Prado JM, Sobrino-Márquez JM, Valero-Masa MJ, Cobo-Belaustegui M, Llano-Cardenal M, Vázquez de Prada JA, Nistal-Herrera F, Lambert-Rodríguez JL, Díaz-Molina B, Fidalgo-Muñiz C, Rangel-Sousa D, Grande-Trillo A, Brossa-Loidi V, Mirabet-Pérez S, López L, Zegrí I, de Antonio M, Castel MÁ, Farrero M, Manito N, Díez C, García-Romero E, Roca J, Castrodeza J, Sousa I, Blázquez Z, Zataraín E, García-Carreño J, Navas P, Juárez M, Ortiz C, Martínez-Sellés M, Cebrián M, López-Viella R, Sánchez-Lázaro I, Martínez S, Donoso V, Martínez L, López-Granados A, Segovia-Cubero J, Hernández-Pérez F, Mitroi C, Rivas-Lasarte M, García-Cosío MD, Morán-Fernández L, Caravaca P, López-Azor JC, Paniagua-Martín MJ, Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, Cuenca-Castillo J, Herrera-Noreña JM, García-Guereta Silva L, González-Fernández Ó, Ponz de Antonio I, Labrandero de Lera C, González-Rocafort Á, Polo-López L, Camino-López M, Gil-Villanueva N, de la Fuente-Galán L, Tobar-Ruiz J, Garrido-Bravo IP, Pascual-Figal DA, Pastor-Pérez FJ, Blasco-Peiró T, Pórtoles-Ocampo A, Lasala-Alastuey M, Rábago-Juan-Aracil G, Manrique-Antón R, Jimeno-San Martín L, García-Quintana A, Groba-Marco MDV, Galván-Ruiz M, Gran-Ipiña F, Dolader P. Registro Español de Trasplante Cardiaco. XXXII Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Elvira Ruiz G, Penafiel-Verdu P, Munoz-Esparza C, Martinez-Sanchez J, Sanchez-Munoz JJ, Garcia-Almagro F, Salar-Alcaraz M, Pastor-Perez FJ, Fernandez-Villa N, Veas-Porlan M, Martinez-Herrera M, Vazquez-Andres DJ, Jimenez-Aceituna A, Pascual-Figal DA, Garcia-Alberola A. Efficacy of left bundle branch area pacing in patients with indication for cardiac resynchronization therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated clinical benefits in heart failure patients with left bundle branch block (LBBB) and ventricular dysfunction. Left bundle branch area pacing (LBBAP) results in a relatively short QRS duration (QRSd) with fast left ventricular activation and could be considered as an alternative to conventional CRT.
Purpose
The aim of the present study was to evaluate the feasibility and outcomes of LBBAP in patients with indications for CRT.
Methods
Consecutive patients with indications for CRT were included. LBBAP was performed via transventricular septal approach (1–3). We aimed to achieve a paced QRS with right bundle branch conduction delay morphology, a stimulus to peak left ventricular activation time (S-LVAT) <100ms and/or a QRSd ≤130ms. AV delay programming was individualized in patients in sinus rhythm, taking consideration of the AV conduction, programming the one that generated the shortest QRSd at rest. Rate adaptive AV was also activated in these patients. Pacing electrical and echocardiographic parameters were recorded at baseline and during follow-up.
Results
LBBAP was achieved in 19 of 21 (90.5%) patients with indication for CRT. Indications were heart failure with LBBB and left ventricular ejection fraction (LVEF) ≤35% in 8 (42%), AV node ablation or AV block with LVEF <50% and high expected RV pacing burden in 9 (47%), 1 pacing-induced cardiomyopathy and 1 patient with biventricular pacemaker malfunction (high LV capture threshold).
The mean follow-up was 4.6±1.7 months and the percentage of ventricular pacing was 93.4±13.9%. There were no device-related complications during this period.
LBBA capture threshold was 0.6±0.3V at 0.4ms at the implantation, and remained stable (0.7±0.1 V, p=0.17). The lead impedance and R-wave amplitude at implantation were 636±106 ohms and 13.4±6.8 mV, and 541±88 ohms and 13.0±5.1 mV during the follow-up (p<0.001 and p=0.27, respectively).
Mean S-LVAT was 85.5±13.9 ms, and mean QRSd was 122±9 ms, that remained stable during follow-up (122 vs 124 ms, p=0.21). In patients with LBBB, a significant narrowing of paced QRSd was achieved (160.9±16.7 vs. 123.9±9.7 ms, p<0.001).
Mean LVEF increased by 15.9%, from 35.4±8.9% at baseline to 51.3±9.8% at follow-up (p<0.001) in the overall population, and 14.5% (from 32.7±4.8% to 47.2±10.7%, p=0.001) in patients with LBBB.
After one month, estimated time for elective replacement was 11.9±0.4 years.
Conclusions
LBBPA was successfully achieved in 90.5% of the patients with indication for CRT, with good and stable pacing electrical parameters, long estimated battery longevity and relatively narrow QRS, and was associated with improvement in cardiac function. LBBAP may be considered as a first-line option for patients with indications for CRT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Elvira Ruiz
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | - M Veas-Porlan
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
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Pascual-Figal DA, Roura-Piloto AE, Moral-Escudero E, Bernal E, Albendín-Iglesias H, Pérez-Martínez MT, Noguera-Velasco JA, Cebreiros-López I, Hernández-Vicente Á, Vázquez-Andrés D, Sánchez-Pérez C, Khan A, Sánchez-Cabo F, García-Vázquez E. Colchicine in Recently Hospitalized Patients with COVID-19: A Randomized Controlled Trial (COL-COVID). Int J Gen Med 2021; 14:5517-5526. [PMID: 34539185 PMCID: PMC8445096 DOI: 10.2147/ijgm.s329810] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background Colchicine has been proposed as a potential therapy in coronavirus disease 2019 (COVID-19) due to their anti-inflammatory actions. Methods The COL-COVID study was a prospective, randomized, controlled and open-label clinical trial that compared colchicine added to standard treatment vs standard treatment in hospitalized COVID-19 patients that do not need mechanical ventilatory support. Colchicine was initiated within the first 48 hours of admission at a 1.5 mg loading dose, followed by 0.5 mg b.i.d. for one week and 0.5 mg per day for 28 days. The study endpoints were clinical status (7-points WHO ordinal scale) and inflammatory biomarkers (IL-6 and CRP). Results A total of 103 patients (51±12 years, 52% male) were randomly allocated to colchicine arm (n=52) and control arm (n=51). At day 28, all patients in the colchicine group were alive and discharged, whereas in the control group, two patients died in-hospital and one patient remained hospitalized. Clinical improvement in terms of changes on WHO scale at day 14 and 28 and time to 1-point clinical improvement did not differ between the two groups. Clinical deterioration (increase of at least 1-point in WHO scale) was observed in a higher proportion of cases in colchicine group (13.8%) vs control group (5.8%) (p=0.303); after adjustment by baseline risk factors and concomitant therapies, colchicine therapy was associated with a lower risk of clinical deterioration (p=0.030). Inflammatory biomarkers CRP and IL-6 concentrations course did not differ between the two arms. Conclusion In hospitalized COVID-19 patients, colchicine treatment neither improved the clinical status, nor the inflammatory response, over the standard treatment. Nevertheless, a preventive effect for further clinical deterioration might be possible. Trial Registration NCT04350320.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Aychel E Roura-Piloto
- Infectious Diseases and Internal Medicine Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Encarnación Moral-Escudero
- Infectious Diseases and Internal Medicine Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Enrique Bernal
- Infectious Diseases and Internal Medicine Department, Hospital Universitario Reina Sofia, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Helena Albendín-Iglesias
- Infectious Diseases and Internal Medicine Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - M Teresa Pérez-Martínez
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Jose Antonio Noguera-Velasco
- Clinical Biochemistry Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Iria Cebreiros-López
- Clinical Biochemistry Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - David Vázquez-Andrés
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Carmen Sánchez-Pérez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Amjad Khan
- Department of Chemistry, University of Oxford, Oxford, UK
| | | | - Elisa García-Vázquez
- Infectious Diseases and Internal Medicine Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
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Blanco-Domínguez R, Sánchez-Díaz R, de la Fuente H, Jiménez-Borreguero LJ, Matesanz-Marín A, Relaño M, Jiménez-Alejandre R, Linillos-Pradillo B, Tsilingiri K, Martín-Mariscal ML, Alonso-Herranz L, Moreno G, Martín-Asenjo R, García-Guimaraes MM, Bruno KA, Dauden E, González-Álvaro I, Villar-Guimerans LM, Martínez-León A, Salvador-Garicano AM, Michelhaugh SA, Ibrahim NE, Januzzi JL, Kottwitz J, Iliceto S, Plebani M, Basso C, Baritussio A, Seguso M, Marcolongo R, Ricote M, Fairweather D, Bueno H, Fernández-Friera L, Alfonso F, Caforio ALP, Pascual-Figal DA, Heidecker B, Lüscher TF, Das S, Fuster V, Ibáñez B, Sánchez-Madrid F, Martín P. A Novel Circulating MicroRNA for the Detection of Acute Myocarditis. N Engl J Med 2021; 384:2014-2027. [PMID: 34042389 PMCID: PMC8258773 DOI: 10.1056/nejmoa2003608] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diagnosis of acute myocarditis typically requires either endomyocardial biopsy (which is invasive) or cardiovascular magnetic resonance imaging (which is not universally available). Additional approaches to diagnosis are desirable. We sought to identify a novel microRNA for the diagnosis of acute myocarditis. METHODS To identify a microRNA specific for myocarditis, we performed microRNA microarray analyses and quantitative polymerase-chain-reaction (qPCR) assays in sorted CD4+ T cells and type 17 helper T (Th17) cells after inducing experimental autoimmune myocarditis or myocardial infarction in mice. We also performed qPCR in samples from coxsackievirus-induced myocarditis in mice. We then identified the human homologue for this microRNA and compared its expression in plasma obtained from patients with acute myocarditis with the expression in various controls. RESULTS We confirmed that Th17 cells, which are characterized by the production of interleukin-17, are a characteristic feature of myocardial injury in the acute phase of myocarditis. The microRNA mmu-miR-721 was synthesized by Th17 cells and was present in the plasma of mice with acute autoimmune or viral myocarditis but not in those with acute myocardial infarction. The human homologue, designated hsa-miR-Chr8:96, was identified in four independent cohorts of patients with myocarditis. The area under the receiver-operating-characteristic curve for this novel microRNA for distinguishing patients with acute myocarditis from those with myocardial infarction was 0.927 (95% confidence interval, 0.879 to 0.975). The microRNA retained its diagnostic value in models after adjustment for age, sex, ejection fraction, and serum troponin level. CONCLUSIONS After identifying a novel microRNA in mice and humans with myocarditis, we found that the human homologue (hsa-miR-Chr8:96) could be used to distinguish patients with myocarditis from those with myocardial infarction. (Funded by the Spanish Ministry of Science and Innovation and others.).
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Affiliation(s)
- Rafael Blanco-Domínguez
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Raquel Sánchez-Díaz
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Hortensia de la Fuente
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Luis J Jiménez-Borreguero
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Adela Matesanz-Marín
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Marta Relaño
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Rosa Jiménez-Alejandre
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Beatriz Linillos-Pradillo
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Katerina Tsilingiri
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - María L Martín-Mariscal
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Laura Alonso-Herranz
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Guillermo Moreno
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Roberto Martín-Asenjo
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Marcos M García-Guimaraes
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Katelyn A Bruno
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Esteban Dauden
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Isidoro González-Álvaro
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Luisa M Villar-Guimerans
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Amaia Martínez-León
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Ane M Salvador-Garicano
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Sam A Michelhaugh
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Nasrien E Ibrahim
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - James L Januzzi
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Jan Kottwitz
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Sabino Iliceto
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Mario Plebani
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Cristina Basso
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Anna Baritussio
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Mara Seguso
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Renzo Marcolongo
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Mercedes Ricote
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - DeLisa Fairweather
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Héctor Bueno
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Leticia Fernández-Friera
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Fernando Alfonso
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Alida L P Caforio
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Domingo A Pascual-Figal
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Bettina Heidecker
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Thomas F Lüscher
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Saumya Das
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Valentín Fuster
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Borja Ibáñez
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Francisco Sánchez-Madrid
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
| | - Pilar Martín
- From the Vascular Pathophysiology Area (R.B.-D., R.S.-D., A.M.-M., M. Relaño, R.J.-A., B.L.-P., K.T., D.A.P.-F., V.F., F.S.-M., P.M.) and the Myocardial Pathophysiology Area (L.A.-H., M. Ricote, H.B., L.F.-F., B.I.), Centro Nacional de Investigaciones Cardiovasculares (CNIC), the Department of Immunology (H.F., F.S.-M.), the Department of Cardiology (L.J.J.-B., M.M.G.-G., F.A.), the Department of Dermatology (E.D.), and the Department of Rheumatology (I.G.-A.), Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Fundación Jiménez Díaz (M.L.M.-M., B.I.), the Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (G.M., R.M.-A., H.B.), the Department of Immunology, Hospital Ramón y Cajal (L.M.V.-G.), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares (L.F.-F.), and CIBER de Enfermedades Cardiovasculares (R.S.-D., H.F., L.J.J.-B., F.A., D.A.P.-F., B.I., F.S.-M., P.M.), Madrid, Hospital Universitario Central de Asturias, Oviedo (A.M.-L.), and the Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (D.A.P.-F.) - all in Spain; the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (K.A.B., D.F.); the Cardiovascular Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston (A.M.S.-G., S.A.M., N.E.I., J.L.J., S.D.); Kanntonsspital St. Gallen Klinik für Anesthesiologie und Intensivmedizin, St. Gallen, Switzerland (J.K.); Cardiology (S.I., A.B., A.L.P.C.) and the Cardiovascular Pathology Unit (C.B.), the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, the Department of Laboratory Medicine (M.P., M.S.), and the Department of Medicine, Hematology and Clinical Immunology (R.M.), University of Padua, Padua, Italy; Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin (B.H.); Imperial College and Royal Brompton and Harefield Hospital, London (T.F.L.); and the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (V.F.)
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Pascual-Figal DA, Bayes-Genis A, Díez-Díez M, Hernández-Vicente Á, Vázquez-Andrés D, de la Barrera J, Vazquez E, Quintas A, Zuriaga MA, Asensio-López MC, Dopazo A, Sánchez-Cabo F, Fuster JJ. Clonal Hematopoiesis and Risk of Progression of Heart Failure With Reduced Left Ventricular Ejection Fraction. J Am Coll Cardiol 2021; 77:1747-1759. [PMID: 33832602 DOI: 10.1016/j.jacc.2021.02.028] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clonal hematopoiesis driven by somatic mutations in hematopoietic cells, frequently called clonal hematopoiesis of indeterminate potential (CHIP), has been associated with adverse cardiovascular outcomes in population-based studies and in patients with ischemic heart failure (HF) and reduced left ventricular ejection fraction (LVEF). Yet, the impact of CHIP on HF progression, including nonischemic etiology, is unknown. OBJECTIVES The purpose of this study was to assess the clinical impact of clonal hematopoiesis on HF progression irrespective of its etiology. METHODS The study cohort comprised 62 patients with HF and LVEF <45% (age 74 ± 7 years, 74% men, 52% nonischemic, and LVEF 30 ± 8%). Deep sequencing was used to detect CHIP mutations with a variant allelic fraction >2% in 54 genes. Patients were followed for at least 3.5 years for various adverse events including death, HF-related death, and HF hospitalization. RESULTS CHIP mutations were detected in 24 (38.7%) patients, without significant differences in all-cause mortality (p = 0.151). After adjusting for risk factors, patients with mutations in either DNA methyltransferase 3 alpha (DNMT3A) or Tet methylcytosine dioxygenase 2 (TET2) exhibited accelerated HF progression in terms of death (hazard ratio [HR]: 2.79; 95% confidence interval [CI]: 1.31 to 5.92; p = 0.008), death or HF hospitalization (HR: 3.84; 95% CI: 1.84 to 8.04; p < 0.001) and HF-related death or HF hospitalization (HR: 4.41; 95% CI: 2.15 to 9.03; p < 0.001). In single gene-specific analyses, somatic mutations in DNMT3A or TET2 retained prognostic significance with regard to HF-related death or HF hospitalization (HR: 4.50; 95% CI: 2.07 to 9.74; p < 0.001, for DNMT3A mutations; HR: 3.18; 95% CI: 1.52 to 6.66; p = 0.002, for TET2 mutations). This association remained significant irrespective of ischemic/nonischemic etiology. CONCLUSIONS Somatic mutations that drive clonal hematopoiesis are common among HF patients with reduced LVEF and are associated with accelerated HF progression regardless of etiology.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain.
| | - Antoni Bayes-Genis
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain; Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Miriam Díez-Díez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Álvaro Hernández-Vicente
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain
| | - David Vázquez-Andrés
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain
| | | | - Enrique Vazquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ana Quintas
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María A Zuriaga
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Mari C Asensio-López
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain
| | - Ana Dopazo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - José J Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Pascual-Figal DA. Biochemical or clinical heart failure, not so simple. Eur J Heart Fail 2021; 23:465-467. [PMID: 33636054 DOI: 10.1002/ejhf.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
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Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Göhring UM, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Butler J, Friede T, Jensen KH, Pocock S, Jankowska EA. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet 2020; 396:1895-1904. [PMID: 33197395 DOI: 10.1016/s0140-6736(20)32339-4] [Citation(s) in RCA: 376] [Impact Index Per Article: 94.0] [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: 10/16/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. METHODS AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin <100 μg/L, or 100-299 μg/L with transferrin saturation <20%), and had a left ventricular ejection fraction of less than 50%. Before hospital discharge, participants were randomly assigned (1:1) to receive intravenous ferric carboxymaltose or placebo for up to 24 weeks, dosed according to the extent of iron deficiency. To maintain masking of patients and study personnel, treatments were administered in black syringes by personnel not involved in any study assessments. The primary outcome was a composite of total hospitalisations for heart failure and cardiovascular death up to 52 weeks after randomisation, analysed in all patients who received at least one dose of study treatment and had at least one post-randomisation data point. Secondary outcomes were the composite of total cardiovascular hospitalisations and cardiovascular death; cardiovascular death; total heart failure hospitalisations; time to first heart failure hospitalisation or cardiovascular death; and days lost due to heart failure hospitalisations or cardiovascular death, all evaluated up to 52 weeks after randomisation. Safety was assessed in all patients for whom study treatment was started. A pre-COVID-19 sensitivity analysis on the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT02937454, and has now been completed. FINDINGS Between March 21, 2017, and July 30, 2019, 1525 patients were screened, of whom 1132 patients were randomly assigned to study groups. Study treatment was started in 1110 patients, and 1108 (558 in the carboxymaltose group and 550 in the placebo group) had at least one post-randomisation value. 293 primary events (57·2 per 100 patient-years) occurred in the ferric carboxymaltose group and 372 (72·5 per 100 patient-years) occurred in the placebo group (rate ratio [RR] 0·79, 95% CI 0·62-1·01, p=0·059). 370 total cardiovascular hospitalisations and cardiovascular deaths occurred in the ferric carboxymaltose group and 451 occurred in the placebo group (RR 0·80, 95% CI 0·64-1·00, p=0·050). There was no difference in cardiovascular death between the two groups (77 [14%] of 558 in the ferric carboxymaltose group vs 78 [14%] in the placebo group; hazard ratio [HR] 0·96, 95% CI 0·70-1·32, p=0·81). 217 total heart failure hospitalisations occurred in the ferric carboxymaltose group and 294 occurred in the placebo group (RR 0·74; 95% CI 0·58-0·94, p=0·013). The composite of first heart failure hospitalisation or cardiovascular death occurred in 181 (32%) patients in the ferric carboxymaltose group and 209 (38%) in the placebo group (HR 0·80, 95% CI 0·66-0·98, p=0·030). Fewer days were lost due to heart failure hospitalisations and cardiovascular death for patients assigned to ferric carboxymaltose compared with placebo (369 days per 100 patient-years vs 548 days per 100 patient-years; RR 0·67, 95% CI 0·47-0·97, p=0·035). Serious adverse events occurred in 250 (45%) of 559 patients in the ferric carboxymaltose group and 282 (51%) of 551 patients in the placebo group. INTERPRETATION In patients with iron deficiency, a left ventricular ejection fraction of less than 50%, and who were stabilised after an episode of acute heart failure, treatment with ferric carboxymaltose was safe and reduced the risk of heart failure hospitalisations, with no apparent effect on the risk of cardiovascular death. FUNDING Vifor Pharma.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wroclaw, Poland; Center for Heart Diseases, University Hospital in Wrocław, Wroclaw, Poland.
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research, Nyon, Switzerland; London School of Hygiene & Tropical Medicine, University College London, London, UK
| | | | - Theresa McDonagh
- King's College Hospital, London, UK; School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Jarosław Drozdz
- Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Lodz, Poland
| | | | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andre Keren
- Hadassah Medical Center, Department of Cardiology, Jerusalem, Israel
| | | | - Hans Kragten
- Maastricht University Medical Center, Heerlen, Netherlands
| | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Córdoba, Argentina
| | - Marco Metra
- Department of Cardiology, University and Civil Hospital, Brescia, Italy
| | | | - José C Nicolau
- Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcus Ohlsson
- Department of Internal Medicine, Malmö University Hospital, Malmö, Sweden
| | | | | | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Zürich, Switzerland
| | - David Sim
- National Heart Center, Clinical Translational and Research Office, Singapore
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Beirut, Lebanon
| | - Peter van der Meer
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Clinical Cardiovascular Research Institute, Haifa, Israel
| | | | | | | | | | | | - Henry J Dargie
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Michael Motro
- Sheba Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Tim Friede
- University Medical Center Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Göttingen partner site, Göttingen, Germany
| | | | - Stuart Pocock
- Department of Clinical Research, SOCAR Research, Nyon, Switzerland
| | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wroclaw, Poland; Center for Heart Diseases, University Hospital in Wrocław, Wroclaw, Poland
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21
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Aimo A, Pascual-Figal DA, Barison A, Cediel G, Vicente ÁH, Saccaro LF, Emdin M, Bayes-Genis A. Colchicine for the Treatment of Coronary Artery Disease. Trends Cardiovasc Med 2020; 31:497-504. [PMID: 33096241 DOI: 10.1016/j.tcm.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
Inflammation plays an important role in atherosclerosis. Acute coronary syndromes (ACS), and particularly myocardial infarction (MI), are associated with a systemic inflammatory response that may accelerate coronary atherosclerotic processes, leading to plaque destabilization and increased risk of further cardiovascular events. These considerations provide a conceptual framework for the use of anti-inflammatory therapies in patients with chronic coronary syndrome or ACS. Following the diverging results of trials on canakinumab and methotrexate, the Colchicine Cardiovascular Outcomes Trial (COLCOT) and the Low-Dose Colchicine trial-2 (LoDoCo2) have sparked new interest in the perspective of an anti-inflammatory therapy for CAD by showing that colchicine confers a prognostic benefit in patients with a recent MI or CCS, respectively. Colchicine blocks multiple steps of the inflammatory cascade and modulates also platelet function and endothelial activation. It has a better safety profile than canakinumab and is a very inexpensive drug throughout the world. We deemed it useful to reappraise the available literature on colchicine and coronary artery disease to assess the likelihood that it might become part of the therapeutic armamentarium of this condition.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, University Hospital of Pisa, Pisa, Italy.
| | - Domingo A Pascual-Figal
- Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Germán Cediel
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Álvaro Hernández Vicente
- Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain
| | - Luigi F Saccaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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22
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Crespo-Leiro MG, Barge-Caballero E, Segovia-Cubero J, González-Costello J, López-Fernández S, García-Pinilla JM, Almenar-Bonet L, de Juan-Bagudá J, Roig-Minguell E, Bayés-Genís A, Sanz-Julve M, Lambert-Rodríguez JL, Lara-Padrón A, Pérez-Ruiz JM, Fernández-Vivancos Marquina C, de la Fuente-Galán L, Varela-Román A, Torres-Calvo F, Andrés-Novales J, Escudero-González A, Pascual-Figal DA, Ridocci-Soriano F, Sahuquillo-Martínez A, Bierge-Valero D, Epelde-Gonzalo F, Gallego-Page JC, Dalmau González-Gallarza R, Bover-Freire R, Quiles-Granado J, Maggioni AP, Lund LH, Muñiz J, Delgado-Jiménez J. Hiperpotasemia en pacientes con insuficiencia cardiaca en España y su impacto en las recomendaciones. Registro ESC-EORP-HFA Heart Failure Long-Term. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Ponikowski P, Kirwan BA, Anker SD, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Haboubi T, Keren A, Khintibidze I, Kragten H, Martinez FA, McDonagh T, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Jankowska EA. Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure. Eur J Heart Fail 2019; 21:1651-1658. [PMID: 31883356 DOI: 10.1002/ejhf.1710] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Iron deficiency (ID) is a common co-morbidity in heart failure (HF), associated with impaired functional capacity, poor quality of life and increased morbidity and mortality. Treatment with intravenous (i.v.) ferric carboxymaltose (FCM) has shown improvements in functional capacity, symptoms and quality of life in stable HF patients with reduced ejection fraction. The effect of i.v. iron supplementation on morbidity and mortality in patients hospitalised for acute HF (AHF) and who have ID has yet to be established. The objective of the present article is to present the rationale and design of the AFFIRM-AHF trial (ClinicalTrials.gov NCT02937454) which will investigate the effect of i.v. FCM (vs. placebo) on recurrent HF hospitalisations and cardiovascular (CV) mortality in iron-deficient patients hospitalised for AHF. METHODS AFFIRM-AHF is a multicentre, randomised (1:1), double-blind, placebo-controlled trial which recruited 1100 patients hospitalised for AHF and who had iron deficiency ID defined as serum ferritin <100 ng/mL or 100-299 ng/mL if transferrin saturation <20%. Eligible patients were randomised (1:1) to either i.v. FCM or placebo and received the first dose of study treatment just prior to discharge for the index hospitalisation. Patients will be followed for 52 weeks. The primary outcome is the composite of recurrent HF hospitalisations and CV mortality. The main secondary outcomes include the composite of recurrent CV hospitalisations and CV mortality, recurrent HF hospitalisations and safety-related outcomes. CONCLUSION The AFFIRM-AHF trial will evaluate, compared to placebo, the effect of i.v. FCM on morbidity and mortality in iron-deficient patients hospitalised for AHF.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland.,Center for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland.,London School of Hygiene and Tropical Medicine, University College London, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Jarosław Drozdz
- Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Lodz, Poland
| | | | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andre Keren
- Assuta Hashalom Heart Institute, Assuta Hospitals, Tel-Aviv, Israel
| | | | | | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Córdoba, Argentina
| | | | - Marco Metra
- Cardiology, University of Brescia and Civil Hospital, Brescia, Italy
| | | | - José C Nicolau
- Faculdade de Medicina FMUSP, Instituto do Coracao (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcus Ohlsson
- Department of Nephrology and Transplantation, Skane University Hospital Malmoe, Malmo, Sweden
| | | | | | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Zürich, Switzerland
| | - David Sim
- National Heart Centre, Clinical Translational and Research Office, Singapore, Singapore
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Beirut, Lebanon
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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Aimo A, Januzzi J, Mueller C, Miro' O, Pascual-Figal DA, Jacob J, Herrero-Puente P, Llorens P, Wussler D, Kozhuharov N, Sabti Z, Breidthardt T, Vergaro G, Passino C, Emdin M. P1653Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
High-sensitivity troponin T (hs-TnT) reflects the severity of ongoing myocardial damage and holds independent prognostic significance in chronic heart failure (HF). In acute HF (AHF), its additive prognostic value over natriuretic peptides is unclear.
Methods
Individual data of 1571 AHF patients with admission hs-TnT were collected from 3 cohorts.
Results
Patients were aged 78±10 years, and 51% were men. Median hs-TnT and N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) concentrations were 43 ng/L (interquartile interval 26–69) and 5660 (2693–12466), respectively. Patients experiencing in-hospital death (n=187, 13%) had significantly higher hs-TnT and NT-proBNP on admission (both p<0.001). The risk of in-hospital death increased by 45% per each doubling of hs-TnT (HR 1.45, 95% confidence interval - CI 1.31–1.59, p<0.001), and by 32% per each doubling of NT-proBNP (HR 1.32, 95% CI 1.17–1.50, p<0.001). Patients with hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L had a 2.7-fold higher risk of in-hospital death (relative risk - RR 2.7, 95% CI 1.7–4.5). Among the 1262 patients discharged, 1024 deaths occurred over a median 11-month follow-up (4–22). In a model including NT-proBNP, hs-TnT ≥43 ng/L was a strong, independent predictor of all-cause death at 6, 12 and 24 months, and the composite of cardiovascular death or HF hospitalization at 6 and 24 months. hs-TnT ≥43 ng/L also improved risk reclassification.
Conclusions
The risk of in-hospital death is almost 3 folds higher with admission hs-TnT ≥43 ng/L and NT-proBNP ≥5660 ng/L, and hs-TnT ≥43 ng/L holds strong independent prognostic significance for post-discharge outcome.
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Affiliation(s)
- A Aimo
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - J Januzzi
- Massachusetts General Hospital, Boston, United States of America
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
| | - O Miro'
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - J Jacob
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - P Llorens
- General University Hospital of Alicante, Alicante, Spain
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | | | - Z Sabti
- University Hospital Basel, Basel, Switzerland
| | | | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Martínez-Milla J, Raposeiras-Roubín S, Pascual-Figal DA, Ibáñez B. Papel de los bloqueadores beta en la enfermedad cardiovascular en 2019. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Martínez-Milla J, Raposeiras-Roubín S, Pascual-Figal DA, Ibáñez B. Role of Beta-blockers in Cardiovascular Disease in 2019. ACTA ACUST UNITED AC 2019; 72:844-852. [PMID: 31402328 DOI: 10.1016/j.rec.2019.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/20/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
Beta-blockers are the cornerstone of treatment for various cardiovascular conditions. Although their effects have classically been considered to be driven by their antagonistic and competitive action on beta-adrenergic receptors, nowadays it is known that their effect goes beyond that of mere competition with catecholamines on these receptors. Beta-blockers were discovered as antianginal drugs in the 1960s and are currently widely used in heart failure, arrhythmias, and ischemic heart disease. In this article, we review the evidence for the beneficial effects of beta-blockers in these conditions, as well as the current recommendations in clinical practice guidelines for their use. Surprisingly, despite having been prescribed for more than 4 decades, new, previously unnoticed mechanisms of action on cellular compartments are still being discovered, which continues to open up new horizons for their use. All in all, beta-blockers are one of the most fascinating drug groups in our therapeutic armamentarium.
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Affiliation(s)
- Juan Martínez-Milla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | | | - Domingo A Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Universidad de Murcia, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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27
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Ware JS, Amor-Salamanca A, Tayal U, Govind R, Serrano I, Salazar-Mendiguchía J, García-Pinilla JM, Pascual-Figal DA, Nuñez J, Guzzo-Merello G, Gonzalez-Vioque E, Bardaji A, Manito N, López-Garrido MA, Padron-Barthe L, Edwards E, Whiffin N, Walsh R, Buchan RJ, Midwinter W, Wilk A, Prasad S, Pantazis A, Baski J, O'Regan DP, Alonso-Pulpon L, Cook SA, Lara-Pezzi E, Barton PJ, Garcia-Pavia P. Genetic Etiology for Alcohol-Induced Cardiac Toxicity. J Am Coll Cardiol 2019; 71:2293-2302. [PMID: 29773157 PMCID: PMC5957753 DOI: 10.1016/j.jacc.2018.03.462] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Alcoholic cardiomyopathy (ACM) is defined by a dilated and impaired left ventricle due to chronic excess alcohol consumption. It is largely unknown which factors determine cardiac toxicity on exposure to alcohol. OBJECTIVES This study sought to evaluate the role of variation in cardiomyopathy-associated genes in the pathophysiology of ACM, and to examine the effects of alcohol intake and genotype on dilated cardiomyopathy (DCM) severity. METHODS The authors characterized 141 ACM cases, 716 DCM cases, and 445 healthy volunteers. The authors compared the prevalence of rare, protein-altering variants in 9 genes associated with inherited DCM. They evaluated the effect of genotype and alcohol consumption on phenotype in DCM. RESULTS Variants in well-characterized DCM-causing genes were more prevalent in patients with ACM than control subjects (13.5% vs. 2.9%; p = 1.2 ×10-5), but similar between patients with ACM and DCM (19.4%; p = 0.12) and with a predominant burden of titin truncating variants (TTNtv) (9.9%). Separately, we identified an interaction between TTN genotype and excess alcohol consumption in a cohort of DCM patients not meeting ACM criteria. On multivariate analysis, DCM patients with a TTNtv who consumed excess alcohol had an 8.7% absolute reduction in ejection fraction (95% confidence interval: -2.3% to -15.1%; p < 0.007) compared with those without TTNtv and excess alcohol consumption. The presence of TTNtv did not predict phenotype, outcome, or functional recovery on treatment in ACM patients. CONCLUSIONS TTNtv represent a prevalent genetic predisposition for ACM, and are also associated with a worse left ventricular ejection fraction in DCM patients who consume alcohol above recommended levels. Familial evaluation and genetic testing should be considered in patients presenting with ACM.
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Affiliation(s)
- James S Ware
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Almudena Amor-Salamanca
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Risha Govind
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Social Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Isabel Serrano
- Department of Cardiology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Rovira Virgili University, Tarragona, Spain
| | - Joel Salazar-Mendiguchía
- Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Bellvitge, Barcelona, Spain; Genetics Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Manuel García-Pinilla
- CIBER in Cardiovascular Diseases, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Domingo A Pascual-Figal
- CIBER in Cardiovascular Diseases, Madrid, Spain; Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Julio Nuñez
- CIBER in Cardiovascular Diseases, Madrid, Spain; Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia, Valencia, Spain
| | - Gonzalo Guzzo-Merello
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Alfredo Bardaji
- Department of Cardiology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Rovira Virgili University, Tarragona, Spain
| | - Nicolas Manito
- Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Bellvitge, Barcelona, Spain
| | - Miguel A López-Garrido
- CIBER in Cardiovascular Diseases, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Laura Padron-Barthe
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Elizabeth Edwards
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Roddy Walsh
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Rachel J Buchan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - William Midwinter
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Alicja Wilk
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Antonis Pantazis
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - John Baski
- Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Luis Alonso-Pulpon
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Stuart A Cook
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Division of Cardiovascular & Metabolic Disorders, Duke-National University of Singapore, Singapore
| | - Enrique Lara-Pezzi
- CIBER in Cardiovascular Diseases, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Paul J Barton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom.
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain; University Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain.
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Garcia-Pavia P, Kim Y, Restrepo-Cordoba MA, Lunde IG, Wakimoto H, Smith AM, Toepfer CN, Getz K, Gorham J, Patel P, Ito K, Willcox JA, Arany Z, Li J, Owens AT, Govind R, Nuñez B, Mazaika E, Bayes-Genis A, Walsh R, Finkelman B, Lupon J, Whiffin N, Serrano I, Midwinter W, Wilk A, Bardaji A, Ingold N, Buchan R, Tayal U, Pascual-Figal DA, de Marvao A, Ahmad M, Garcia-Pinilla JM, Pantazis A, Dominguez F, John Baksi A, O’Regan DP, Rosen SD, Prasad SK, Lara-Pezzi E, Provencio M, Lyon AR, Alonso-Pulpon L, Cook SA, DePalma SR, Barton PJ, Aplenc R, Seidman JG, Ky B, Ware JS, Seidman CE. Genetic Variants Associated With Cancer Therapy-Induced Cardiomyopathy. Circulation 2019; 140:31-41. [PMID: 30987448 PMCID: PMC6613726 DOI: 10.1161/circulationaha.118.037934] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer therapy-induced cardiomyopathy (CCM) is associated with cumulative drug exposures and preexisting cardiovascular disorders. These parameters incompletely account for substantial interindividual susceptibility to CCM. We hypothesized that rare variants in cardiomyopathy genes contribute to CCM. METHODS We studied 213 patients with CCM from 3 cohorts: retrospectively recruited adults with diverse cancers (n=99), prospectively phenotyped adults with breast cancer (n=73), and prospectively phenotyped children with acute myeloid leukemia (n=41). Cardiomyopathy genes, including 9 prespecified genes, were sequenced. The prevalence of rare variants was compared between CCM cohorts and The Cancer Genome Atlas participants (n=2053), healthy volunteers (n=445), and an ancestry-matched reference population. Clinical characteristics and outcomes were assessed and stratified by genotypes. A prevalent CCM genotype was modeled in anthracycline-treated mice. RESULTS CCM was diagnosed 0.4 to 9 years after chemotherapy; 90% of these patients received anthracyclines. Adult patients with CCM had cardiovascular risk factors similar to the US population. Among 9 prioritized genes, patients with CCM had more rare protein-altering variants than comparative cohorts ( P≤1.98e-04). Titin-truncating variants (TTNtvs) predominated, occurring in 7.5% of patients with CCM versus 1.1% of The Cancer Genome Atlas participants ( P=7.36e-08), 0.7% of healthy volunteers ( P=3.42e-06), and 0.6% of the reference population ( P=5.87e-14). Adult patients who had CCM with TTNtvs experienced more heart failure and atrial fibrillation ( P=0.003) and impaired myocardial recovery ( P=0.03) than those without. Consistent with human data, anthracycline-treated TTNtv mice and isolated TTNtv cardiomyocytes showed sustained contractile dysfunction unlike wild-type ( P=0.0004 and P<0.002, respectively). CONCLUSIONS Unrecognized rare variants in cardiomyopathy-associated genes, particularly TTNtvs, increased the risk for CCM in children and adults, and adverse cardiac events in adults. Genotype, along with cumulative chemotherapy dosage and traditional cardiovascular risk factors, improves the identification of patients who have cancer at highest risk for CCM. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01173341; AAML1031; NCT01371981.
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Affiliation(s)
- Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain (P.G.-P.)
| | - Yuri Kim
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Massachusetts General Hospital, Boston (Y.K.)
| | - Maria Alejandra Restrepo-Cordoba
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - Ida G. Lunde
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Oslo University Hospital and University of Oslo, Norway (I.G.L.)
| | - Hiroko Wakimoto
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Amanda M. Smith
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Christopher N. Toepfer
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- University of Oxford (C.N.T.)
| | - Kelly Getz
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Joshua Gorham
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Parth Patel
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Brigham and Women's Hospital, Boston MA (P.P., C.E.S.)
| | - Kaoru Ito
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Jonathan A. Willcox
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Zoltan Arany
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Jian Li
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Anjali T. Owens
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Risha Govind
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Beatriz Nuñez
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Spain (B.N., M.P.)
| | - Erica Mazaika
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Antoni Bayes-Genis
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain (A.B.-G., J. Lupon)
| | - Roddy Walsh
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Brian Finkelman
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Josep Lupon
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain (A.B.-G., J. Lupon)
| | - Nicola Whiffin
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Isabel Serrano
- Hospital Universitario de Tarragona Joan XXIII. IISPV, Rovira Virgili University, Spain (I.S., A.B.)
| | - William Midwinter
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Alicja Wilk
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Alfredo Bardaji
- Hospital Universitario de Tarragona Joan XXIII. IISPV, Rovira Virgili University, Spain (I.S., A.B.)
| | - Nathan Ingold
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Rachel Buchan
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Upasana Tayal
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Domingo A. Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Virgen de la Arrixaca, University of Murcia. Spain (D.A.P.-F.)
| | - Antonio de Marvao
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Mian Ahmad
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Jose Manuel Garcia-Pinilla
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain (J.M.G.-P.)
| | - Antonis Pantazis
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Fernando Dominguez
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - A. John Baksi
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Declan P. O’Regan
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Stuart D. Rosen
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Sanjay K. Prasad
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Enrique Lara-Pezzi
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (E.L.-P.)
| | - Mariano Provencio
- Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Spain (B.N., M.P.)
| | - Alexander R. Lyon
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Luis Alonso-Pulpon
- Hospital Universitario Puerta de Hierro, Madrid, Spain (P.G.-P., M.A.R.-C., F.D., L.A.-P.)
- Centro de Investigación Biomédica en Red Enfermedades in Cardiovascular Diseases (CIBERCV), Madrid, Spain (P.G.-P., M.A.R.-C., A.B.-G., J. Lupon, D.A.P.-F., J.M.G.-P., F.D., E.L.-P., L.A.-P.)
| | - Stuart A. Cook
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
- National Heart Centre Singapore and Duke-National University of Singapore (S.A.C.)
| | - Steven R. DePalma
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (S.R.D., C.E.S.)
| | - Paul J.R. Barton
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
| | - Richard Aplenc
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - Jonathan G. Seidman
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
| | - Bonnie Ky
- Perelman School of Medicine and University of Pennsylvania Health System, Philadelphia (A.M.S., K.G., Z.A., J. Li, A.T.O., B.F., R.A., B.K.)
| | - James S. Ware
- National Heart & Lung Institute, Imperial College London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., E.L.-P., A.R.L., S.A.C., P.J.R.B., J.S.W.)
- Royal Brompton & Harefield NHS Foundation Trust, London, UK (R.G., E.M., R.W., N.W., W.M., A.W., N.I., R.B., U.T., A.d.M., M.A., A.P., A.J.B., S.D.R., S.K.P., A.R.L., P.J.R.B., J.S.W.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
| | - Christine E. Seidman
- Harvard Medical School, Boston, MA (Y.K., I.G.L., H.W., C.N.T., J.G., P.P., K.I., J.A.W., S.R.D., J.G.S., C.E.S.)
- MRC London Institute of Medical Sciences, Imperial College UK (N.W., D.P.O., S.A.C., J.S.W., C.E.S., A.d.M.)
- Howard Hughes Medical Institute, Chevy Chase, MD (S.R.D., C.E.S.)
- Brigham and Women's Hospital, Boston MA (P.P., C.E.S.)
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Pascual-Figal DA, Bayes-Genis A, Asensio-Lopez MC, Hernández-Vicente A, Garrido-Bravo I, Pastor-Perez F, Díez J, Ibáñez B, Lax A. The Interleukin-1 Axis and Risk of Death in Patients With Acutely Decompensated Heart Failure. J Am Coll Cardiol 2019; 73:1016-1025. [DOI: 10.1016/j.jacc.2018.11.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
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Navarro-Peñalver M, Mohamed-Salem L, Domínguez F, de Haro-Del Moral FJ, Fernández-Lozano I, Pascual-Figal DA. Inervación simpática cardiaca y terapias apropiadas en pacientes portadores de desfibrilador automático implantado en prevención primaria. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Navarro-Peñalver M, Mohamed-Salem L, Domínguez F, de Haro-Del Moral FJ, Fernández-Lozano I, Pascual-Figal DA. Cardiac Sympathetic Innervation and Appropriate Therapies in Patients With an Implantable Cardioverter-defibrillator in Primary Prevention. Rev Esp Cardiol (Engl Ed) 2019; 72:180-182. [PMID: 29650449 DOI: 10.1016/j.rec.2018.01.014] [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: 12/12/2017] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Marina Navarro-Peñalver
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Laroussi Mohamed-Salem
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain
| | | | - Ignacio Fernández-Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain.
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Pastor-Pérez FJ, García-Alberola A, Navarro-Peñalver M, Goya-Esteban R, Garrido-Bravo IP, Barquero-Pérez O, Rojo-Álvarez JL, Pascual-Figal DA. Lack of improvement in autonomic cardiac tone after sacubitril/valsartan at lower than target doses. J Electrocardiol 2018; 52:99-100. [PMID: 30529813 DOI: 10.1016/j.jelectrocard.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/11/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Autonomic regulation plays a role in the progression of heart failure with reduced ejection fraction (HrEF).Twenty-one HFrEF patients, 60.8 ± 13.1 years, receiving angiotensin inhibition, were replaced by angiotensin receptor-neprilysin inhibitor (ARNI). A 24-hour Holter recording was performed before and after 3 months of the maximum tolerated dose of ARNi. We evaluated changes in autonomic tone using heart rate variability (SDNN, rMSSD, pNN50, LF, HF, LF/HF, α1, α2), and heart rate turbulence (TO and TS). ARNI was up-titrated to a maximum daily dose of 190 ± 102 mg, 47.5% of the target dose. ARNI therapy was not associated with any improvement in any of the parameters related with heart rate variability or heart rate turbulence (p > 0.05 for all). ARNI use at lower than target doses did not improve autonomic cardiac tone as evaluated by 24-hour Holter monitoring.
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Affiliation(s)
| | | | | | - Rebeca Goya-Esteban
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain; Department of Signal Theory and Communications, University Rey Juan Carlos, Madrid, Spain
| | - Iris P Garrido-Bravo
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Oscar Barquero-Pérez
- Department of Signal Theory and Communications, University Rey Juan Carlos, Madrid, Spain
| | - Jose Luis Rojo-Álvarez
- Department of Signal Theory and Communications, University Rey Juan Carlos, Madrid, Spain
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Pascual-Figal DA, Pérez-Martínez MT, Asensio-Lopez MC, Sanchez-Más J, García-García ME, Martinez CM, Lencina M, Jara R, Januzzi JL, Lax A. Pulmonary Production of Soluble ST2 in Heart Failure. Circ Heart Fail 2018; 11:e005488. [DOI: 10.1161/circheartfailure.118.005488] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 01/19/2023]
Affiliation(s)
- Domingo A. Pascual-Figal
- Department of Cardiology, Hospital Virgen de la Arrixaca, University of Murcia, Spain (D.A.P.-F., M.T.P.-M., M.C.A.-L., A.L.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (D.A.P.-F.)
- CIBERCV, Madrid, Spain (D.A.P.-F.)
| | - Maria T. Pérez-Martínez
- Department of Cardiology, Hospital Virgen de la Arrixaca, University of Murcia, Spain (D.A.P.-F., M.T.P.-M., M.C.A.-L., A.L.)
- IMIB-Arrixaca, University of Murcia, Spain (M.T.P.-M., M.C.A.-L., C.M.M., A.L.)
| | - Maria C. Asensio-Lopez
- Department of Cardiology, Hospital Virgen de la Arrixaca, University of Murcia, Spain (D.A.P.-F., M.T.P.-M., M.C.A.-L., A.L.)
| | - Jesús Sanchez-Más
- Departamento de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain (J.S.-M.)
| | - Maria E. García-García
- Servicio de Medicina Intensiva, Hospital Virgen de la Arrixaca, Hospital Virgen de la Arrixaca, Murcia, Spain (M.E.G.-G., R.J.)
| | - Carlos M. Martinez
- IMIB-Arrixaca, University of Murcia, Spain (M.T.P.-M., M.C.A.-L., C.M.M., A.L.)
| | - Miriam Lencina
- Department of Pathological Anatomy, Hospital Virgen de la Arrixaca, Murcia, Spain (M.L.)
| | - Ruben Jara
- Servicio de Medicina Intensiva, Hospital Virgen de la Arrixaca, Hospital Virgen de la Arrixaca, Murcia, Spain (M.E.G.-G., R.J.)
| | - James L. Januzzi
- Division of Cardiology, Massachusetts General Hospital, Baim Institute for Clinical Research, Boston (J.L.J.)
| | - Antonio Lax
- IMIB-Arrixaca, University of Murcia, Spain (M.T.P.-M., M.C.A.-L., C.M.M., A.L.)
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Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez JA, Abellán-Pérez MV, Hernández-Vicente Á, Pascual-Figal DA. Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival. ACTA ACUST UNITED AC 2018; 72:740-748. [PMID: 30262426 DOI: 10.1016/j.rec.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/22/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Affiliation(s)
- Lucía Fernández-Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Lauro Hernando-Arizaleta
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - María Victoria Abellán-Pérez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Asensio-Lopez MDC, Lax A, Fernandez Del Palacio MJ, Sassi Y, Hajjar RJ, Pascual-Figal DA. Pharmacological inhibition of the mitochondrial NADPH oxidase 4/PKCα/Gal-3 pathway reduces left ventricular fibrosis following myocardial infarction. Transl Res 2018; 199:4-23. [PMID: 29753686 DOI: 10.1016/j.trsl.2018.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/30/2022]
Abstract
Although the initial reparative fibrosis after myocardial infarction (MI) is crucial for preventing rupture of the ventricular wall, an exaggerated fibrotic response and reactive fibrosis outside the injured area are detrimental. Although metformin prevents adverse cardiac remodeling, as well as provides glycemic control, the underlying mechanisms remain poorly documented. This study describes the effect of mitochondrial NADPH oxidase 4 (mitoNox) and protein kinase C-alpha (PKCα) on the cardiac fibrosis and galectin 3 (Gal-3) expression. Randomly rats underwent MI, received metformin or saline solution. A model of biomechanical strain and co-culturewas used to enable cross talk between cardiomyocytes and fibroblasts. Long-term metformin treatment after MIwas associated with (1) a reduction in myocardial fibrosis and Gal-3 levels; (2) an increase in adenosine monophosphate-activated protein kinase (AMPK) α1/α2 levels; and (3) an inhibition of both mRNA expression and enzymatic activities of mitoNox and PKCα. These findings were replicated in the cellular model, where the silencing of AMPK expression blocked the ability of metformin to protect cardiomyocytes from strain. The use of specific inhibitors or small interference RNA provided evidence that PKCα is downstream of mitoNox, and that the activation of this pathway results in Gal-3 upregulation.The Gal-3 secreted by cardiomyocytes has a paracrine effect on cardiac fibroblasts, inducing their activation. In conclusion, a metformin-induced increase in AMPK improves myocardial remodeling post-MI, which is related to the inhibition of the mitoNox/PKCα/Gal-3 pathway. Manipulation of this pathway might offer new therapeutic options against adverse cardiac remodeling, in terms of preventing the activation of the present fibroblast population.
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Affiliation(s)
| | - Antonio Lax
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, Murcia, Spain.
| | | | - Yassine Sassi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Domingo A Pascual-Figal
- Cardiology Department, Clinic and Universitary Hospital Virgen de la Arrixaca, Murcia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Navarro-Peñalver M, Perez-Martinez MT, Gómez-Bueno M, García-Pavía P, Lupón-Rosés J, Roig-Minguell E, Comin-Colet J, Bayes-Genis A, Noguera JA, Pascual-Figal DA. Testosterone Replacement Therapy in Deficient Patients With Chronic Heart Failure: A Randomized Double-Blind Controlled Pilot Study. J Cardiovasc Pharmacol Ther 2018; 23:543-550. [PMID: 29929385 DOI: 10.1177/1074248418784020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Testosterone deficiency is associated with heart failure (HF) progression and poor prognosis. Testosterone therapy has been shown to improve exercise capacity in patients with chronic HF, but no trial has evaluated the impact of replacement in patients with demonstrated testosterone deficiency. METHODS Prospective, randomized, double-blind, placebo-controlled, and parallel-group trial comparing testosterone replacement with placebo in males with chronic HF with reduced ejection fraction (HFrEF) and testosterone deficiency (NCT01813201). Long-acting undecanoate testosterone at a fixed dose of 1000 mg was supplied by intramuscular injection at inclusion and then every 3 months. The placebo group received isotonic saline serum. Patients were randomly allocated 1:1 to testosterone or placebo while receiving optimal medical therapy, and the study was conducted for 12 months. RESULTS The final sample comprised 29 patients, 15 in the placebo group and 14 in the testosterone group (aged 65 ± 8, 62% with an ischemic etiology, left ventricular ejection fraction [LVEF] 30% ± 6%, 69% New York Heart Association functional [NYHA II]). After 12 months, testosterone replacement increased testosterone levels ( P = .002) but was not associated with benefit in terms of clinical symptoms and functional capacity including NYHA class, Framingham score, Minnesota Living Heart Failure Questionnaire, 6-minute walk test, or LVEF and N-terminal pro-B-type natriuretic peptide levels. No significant side effects associated with testosterone treatment were observed. No effects were found in other hormonal, metabolic, and bone turnover biomarkers. CONCLUSION In patients with HFrEF and testosterone deficiency, replacement therapy was not associated with any significant improvement.
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Affiliation(s)
| | | | - Manuel Gómez-Bueno
- 2 Hospital Universitario Puerta del Hierro, Madrid, Spain.,3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo García-Pavía
- 2 Hospital Universitario Puerta del Hierro, Madrid, Spain.,3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón-Rosés
- 4 Hospital Universitario Germans Trias i Pujol, Badalona, Spain.,5 Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Antoni Bayes-Genis
- 3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain.,4 Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Jose A Noguera
- 5 Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Domingo A Pascual-Figal
- 3 CIBERCV Instituto de Salud Carlos III, Madrid, Spain.,8 Department of Cardiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
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Mohamed-Salem L, Santos-Mateo JJ, Sanchez-Serna J, Hernández-Vicente Á, Reyes-Marle R, Castellón Sánchez MI, Claver-Valderas MA, Gonzalez-Vioque E, Haro-Del Moral FJ, García-Pavía P, Pascual-Figal DA. Prevalence of wild type ATTR assessed as myocardial uptake in bone scan in the elderly population. Int J Cardiol 2018; 270:192-196. [PMID: 29903517 DOI: 10.1016/j.ijcard.2018.06.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/20/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial uptake of bone tracers has emerged as useful tool for the early detection of transthyretin amyloidosis (ATTR). The prevalence of wild-type ATTR (ATTRwt) in individuals remains to be established. METHODS All whole body bone scans performed in individuals ≥ 75 years with no previous clinical suspicion of ATTR were revised in a population-based university hospital over a 7-year period (1509 studies corresponding to 1114 patients; 80.5 ± 4.1 years, 65% males). Positive cardiac uptake was defined according to Perugini score as grade 2 or 3. Heart failure (HF) hospitalizations during the follow-up were obtained from regional administrative databases. RESULTS Thirty-one patients ≥ 75 years (2.78%) showed cardiac uptake; compared with those without uptake, these patients were older (85 ± 5 vs. 80 ± 4, p < 0.001) and predominantly males (90% vs. 64%, p = 0.005). The prevalence of cardiac uptake was 3.88% in males and 0.77% in females, and increased with age, reaching 13.9% in males≥85 years (2.7% among females). The estimated prevalence for the European standard population ≥ 75 years was 4.15% in males, 1.03% in females and 2.59% in the general population. HF hospitalizations rates were 14% in patients without uptake and 29% in those with cardiac uptake (p = 0.034). After adjusting for age and gender, cardiac uptake was associated with a higher risk of HF hospitalization (OR 2.60, 95%CI 1.09-5.74, p = 0.022). CONCLUSIONS Myocardial uptake in bone scan is very prevalent with ageing, mainly affects males and is associated with an increased risk of HF hospitalization. These findings reinforce ATTRwt as a relevant cause of HF in the elderly.
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Affiliation(s)
| | | | - Juan Sanchez-Serna
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain; Facultad de Medicina, University of Murcia, Murcia, Spain.
| | - Rafael Reyes-Marle
- Nuclear Medicine Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta del Hierro, Madrid, Spain; Facultad de Ciencias de la Salud, University Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Domingo A Pascual-Figal
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain; Facultad de Medicina, University of Murcia, Murcia, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
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Sánchez-Serna J, Pérez-Martínez MT, Asensio-López MC, Casas T, Noguera JA, Pascual-Figal DA. Valores seriados de galectina-3 a corto plazo en pacientes hospitalizados por insuficiencia cardiaca aguda. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Sánchez-Serna J, Pérez-Martínez MT, Asensio-López MC, Casas T, Noguera JA, Pascual-Figal DA. Short-term Serial Measurement of Galectin-3 in Hospitalized Patients With Acute Heart Failure. Rev Esp Cardiol (Engl Ed) 2018; 71:401-402. [PMID: 28473265 DOI: 10.1016/j.rec.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/10/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Juan Sánchez-Serna
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María T Pérez-Martínez
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - M Carmen Asensio-López
- Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Teresa Casas
- Servicio de Laboratorio, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José A Noguera
- Servicio de Laboratorio, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar Rodríguez JA, Pascual-Figal DA. Análisis de los ingresos hospitalarios por insuficiencia cardiaca en registros sanitarios de diferentes comunidades autónomas. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar Rodríguez JA, Pascual-Figal DA. Analysis of Hospitalization Trends for Heart Failure in the Health Registries of Different Autonomous Communities. Rev Esp Cardiol (Engl Ed) 2018; 71:128-129. [PMID: 29191781 DOI: 10.1016/j.rec.2017.09.005] [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: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Affiliation(s)
- María L Fernández Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
| | | | | | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Universidad de Murcia, Murcia, Spain
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Affiliation(s)
- Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Tendencia y características de la hospitalización por insuficiencia cardiaca en un marco poblacional durante el periodo 2003-2013. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sanchez-Mas J, Lax A, Asensio-Lopez MC, Lencina M, Fernandez-Del Palacio MJ, Soriano-Filiu A, de Boer RA, Pascual-Figal DA. Early Anti-inflammatory and Pro-angiogenic Myocardial Effects of Intravenous Serelaxin Infusion for 72 H in an Experimental Rat Model of Acute Myocardial Infarction. J Cardiovasc Transl Res 2017; 10:460-469. [PMID: 28718055 DOI: 10.1007/s12265-017-9761-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023]
Abstract
Sprague Dawley rats were subjected to acute myocardial infarction (AMI) by permanent ligation of the left anterior descending coronary artery. At the time of AMI, a subcutaneous mini-osmotic pump was implanted and animals were randomized into three groups, according to the intravenous therapy received during the first 72 h: placebo-treated (saline), serelaxin10-treated (SRLX10 = 10 μg/kg/day), or serelaxin30-treated (SRLX30 = 30 μg/kg/day). Treatment with SRLX30 reduced the expression of inflammatory cytokines and chemokines, as well as the infiltration of macrophages, and increased the expression of pro-angiogenic markers and vessel density in the infarcted myocardium after 7 days. SRLX30 did not reduce early myocardial fibrosis but reduced myocardial levels of sST2 and galectin-3. No significant effects were observed with SRLX10 treatment. A significant correlation was observed between plasma levels of serelaxin and effect measures. The results suggest serelaxin has a protective effect in early processes of cardiac remodeling after AMI.
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Affiliation(s)
- Jesus Sanchez-Mas
- Instituto Murciano de Investigación Biomédica (IMIB), Facultad de Medicina, University of Murcia, Murcia, Spain.,Departamento de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Moncada, Spain
| | - Antonio Lax
- Instituto Murciano de Investigación Biomédica (IMIB), Facultad de Medicina, University of Murcia, Murcia, Spain
| | - Mari C Asensio-Lopez
- Instituto Murciano de Investigación Biomédica (IMIB), Facultad de Medicina, University of Murcia, Murcia, Spain
| | - Miriam Lencina
- Pathological Anatomy Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Angela Soriano-Filiu
- Instituto Murciano de Investigación Biomédica (IMIB), Facultad de Medicina, University of Murcia, Murcia, Spain
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Domingo A Pascual-Figal
- Instituto Murciano de Investigación Biomédica (IMIB), Facultad de Medicina, University of Murcia, Murcia, Spain. .,Cardiology Department, Hospital Universitario Virgen de la Arrixaca, LAIB, Room 2.52, Av. Buenavista s/n, 30120, Murcia, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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45
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Pascual-Figal DA. Acute heart failure and biomarkers: time also matters, don't relax. Eur J Heart Fail 2017; 19:1011-1013. [DOI: 10.1002/ejhf.880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Domingo A. Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca; University of Murcia; IMIB-Arrixaca CIBER-CV Murcia Spain
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Gómez-Otero I, Ferrero-Gregori A, Varela Román A, Seijas Amigo J, Pascual-Figal DA, Delgado Jiménez J, Álvarez-García J, Fernández-Avilés F, Worner Diz F, Alonso-Pulpón L, Cinca J, Gónzalez-Juanatey JR. La fracción de eyección intermedia no permite estratificar el riesgo de los pacientes hospitalizados por insuficiencia cardiaca. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Trends and Characteristics of Hospitalization for Heart Failure in a Population Setting From 2003 to 2013. Rev Esp Cardiol (Engl Ed) 2017; 70:720-726. [PMID: 28363708 DOI: 10.1016/j.rec.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/31/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Population-based studies in other countries have reported a reduction of standardized rates of hospitalization for heart failure (HF) but data from a well-defined population are lacking in Spain. METHODS All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained from the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. Health care episodes were identified by the individual health card (27 158 episodes). For each year, we studied the following parameters: crude, age-standardized and sex-standardized hospitalization rates for HF, length of stay, mortality, clinical variables, and the Elixhauser index. Time trends were analyzed using joinpoint regression. RESULTS Hospitalization rates increased by 76.7%, from 1.28‰ to 2.26‰ (crude) and 1.06‰ to 1.77‰ (standardized); the mean annual percentage of change (APC) was 8.2% until 2007 and was subsequently 1.9% (P < .05). Rates doubled in persons ≥ 75 years, reaching 19.9‰ in those aged 75 to 84 years (APC, 5.4%) and 32.5‰ in those aged ≥ 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The hospitalization rate was 36% higher in women than in men but was equal after age-standardization and showed no temporal change. The Elixhauser comorbidity index increased by almost 1 point during the study period and episodes > 6 points increased by 2-fold. Length of stay and mortality were unchanged during the study period. CONCLUSIONS Between 2003 and 2013, there was a sustained increase in standardized rates of hospitalization for HF, which affected persons ≥ 75 years and was associated with a rise in comorbidity. There is a need for strategies focused on this population.
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Affiliation(s)
| | | | | | - Federico Soria-Arcos
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, El Palmar, Murcia, Spain.
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Pascual-Figal DA, Ferrero-Gregori A, Gomez-Otero I, Vazquez R, Delgado-Jimenez J, Alvarez-Garcia J, Gimeno-Blanes JR, Worner-Diz F, Bardají A, Alonso-Pulpon L, Gonzalez-Juanatey JR, Cinca J. Mid-range left ventricular ejection fraction: Clinical profile and cause of death in ambulatory patients with chronic heart failure. Int J Cardiol 2017; 240:265-270. [PMID: 28318662 DOI: 10.1016/j.ijcard.2017.03.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/01/2017] [Accepted: 03/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The intermediate group of patients with heart failure (HF) and mid-range left ventricular ejection fraction (HFmrEF) may constitute a specific phenotype, but a direct evidence is lacking. This study aimed to know whether this HF category is accompanied by a particular clinical phenotype and prognosis. METHODS AND RESULTS This study includes 3446 ambulatory patients with chronic HF from two national registries. According to EF at enrollment, patients were classified as reduced (HFrEF, <40%), mid-range (HFmrEF, 40-49%) or preserved (HFpEF, ≥50%). Patients were followed-up for a median of 41months and the specific cause of death was prospectively registered. Patients with HFmrEF represented 13% of population and they exhibited a phenotype closer to HFrEF, except for a higher rate of coronary revascularization and diabetes, and a less advanced HF syndrome. The observed all-cause mortality was higher among HFrEF (33.0%), and similar between HFmrEF (27.8%) and HFpEF (28.0%) (p=0.012); however, the contribution of each cause of death differed significantly between categories (p<0.001). After propensity score matching, the risk of cardiovascular death, HF death or sudden cardiac death did not differ between HFmrEF and HFrEF in paired samples; however, patients with HFmrEF were at higher risk of cardiovascular death (sHR 1.71, 95% CI 1.13-2.57, p=0.011) and sudden cardiac death (sHR 2.73, 95% CI 1.07-6.98, p=0.036) than patients with HFpEF. CONCLUSIONS Patients in the intermediate category of HFmrEF conform a phenotype closer to the clinical profile of HFrEF, and associated to higher risk of sudden cardiac death and cardiovascular death than patients with HFpEF.
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Affiliation(s)
- Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, CIBERCV, Murcia, Spain.
| | - Andreu Ferrero-Gregori
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Ines Gomez-Otero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Rafael Vazquez
- Servicio de Cardiologia, Hospital Puerta del Mar, Cadiz, Spain
| | - Juan Delgado-Jimenez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, CIBERCV, Madrid, Spain
| | - Jesus Alvarez-Garcia
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Juan R Gimeno-Blanes
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, CIBERCV, Murcia, Spain
| | | | - Alfredo Bardají
- Servico de Cardiologia, Hospital Juan XXIII, Tarragona, Spain
| | - Luis Alonso-Pulpon
- Servico de Cardiologia, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jose Ramon Gonzalez-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
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Pérez-Calvo JI, Morales-Rull JL, Gimeno-Orna JA, Lasierra-Díaz P, Josa-Laorden C, Puente-Lanzarote JJ, Bettencourt P, Pascual-Figal DA. Usefulness of the Hepatocyte Growth Factor as a Predictor of Mortality in Patients Hospitalized With Acute Heart Failure Regardless of Ejection Fraction. Am J Cardiol 2016; 118:543-9. [PMID: 27338207 DOI: 10.1016/j.amjcard.2016.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/22/2015] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
Hepatocyte growth factor (HGF) plays a role in the improvement of cardiac function and remodeling. Their serum levels are strongly related with mortality in chronic systolic heart failure (HF). The aim of this study was to study prognostic value of HGF in acute HF, interaction with ejection fraction, renal function, and natriuretic peptides. We included 373 patients (age 76 ± 10 years, left ventricular ejection fraction [LVEF] 46 ± 14%, 48% men) consecutively admitted for acute HF. Blood samples were obtained at admission. All patients were followed up until death or close of study (>1 year, median 371 days). HGF concentrations were determined using a commercial enzyme-linked immunosorbent assay (human HGF immunoassay). The predictive power of HGF was estimated by Cox regression with calculation of Harrell C-statistic. HGF had a median of 1,942 pg/ml (interquartile rank 1,354). According to HGF quartiles, mortality rates (per 1,000 patients/year) were 98, 183, 375, and 393, respectively (p <0.001). In Cox regression analysis, HGF (hazard ratio1SD = 1.5, 95% confidence interval 1.1 to 2.1, p = 0.002) and N-terminal pro b-type natriuretic peptide (NT-proBNP; hazard ratio1SD = 1.8, 95% confidence interval 1.2 to 2.6, p = 0.002) were independent predictors of mortality. Interaction between HGF and LVEF, origin, and renal function was nonsignificant. The addition of HGF improved the predictive ability of the models (C-statistic 0.768 vs 0.741, p = 0.016). HGF showed a complementary value over NT-proBNP (p = 0.001): mortality rate was 490 with both above the median versus 72 with both below. In conclusion, in patients with acute HF, serum HGF concentrations are elevated and identify patients at higher risk of mortality, regardless of LVEF, ischemic origin, or renal function. HGF had independent and additive information over NT-proBNP.
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Affiliation(s)
- Juan-Ignacio Pérez-Calvo
- Servicio de Medicina Interna, Facultad de Medicina, Instituto de Investigación Sanitaria de Aragón, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.
| | - José-Luis Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario "Arnau de Villanova", Lleida, Spain
| | - José-Antonio Gimeno-Orna
- Servicio de Endocrinología y Metabolismo, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Pilar Lasierra-Díaz
- Laboratorio de Inmunología, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Claudia Josa-Laorden
- Servicio de Medicina Interna, Facultad de Medicina, Instituto de Investigación Sanitaria de Aragón, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | | | - Paulo Bettencourt
- Serviço de Medicina Interna, Hospital CUF-Porto, Faculdade Medicina Porto, Portugal
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario "Virgen de la Arrixaca", Facultad de Medicina, Murcia, Spain
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Asensio-Lopez MC, Lax A, Sanchez-Mas J, Avellaneda A, Planes J, Pascual-Figal DA. Reformulated meat products protect against ischemia-induced cardiac damage. Food Funct 2016; 7:992-1001. [PMID: 26751429 DOI: 10.1039/c5fo01189b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The protective effects of the antioxidants present in food are of great relevance for cardiovascular health. This study evaluates whether the extracts from reformulated meat products with a reduction in fat and/or sodium content exert a cardioprotective effect against ischemia-induced oxidative stress in cardiomyocytes, compared with non-meat foods. Ischemic damage caused loss of cell viability, increased reactive oxygen species and lipid peroxidation and decreased the antioxidant activity. Pretreatment for 24 h with digested or non-digested extracts from reformulated meat products led to protection against ischemia-induced oxidative damage: increased cell viability, reduced oxidative stress and restored the antioxidant activity. Similar results were obtained using extracts from tuna fish, but not with the extracts of green peas, salad or white beans. These results suggest that reformulated meat products have a beneficial impact in protecting cardiac cells against ischemia, and they may represent a source of natural antioxidants with benefits for cardiovascular health.
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Affiliation(s)
- M C Asensio-Lopez
- Cardiology Department, University Hospital Virgen de la Arrixaca and Department of Internal Medicine, School of Medicine, University of Murcia, Spain.
| | - A Lax
- Cardiology Department, University Hospital Virgen de la Arrixaca and Department of Internal Medicine, School of Medicine, University of Murcia, Spain.
| | - J Sanchez-Mas
- Cardiology Department, University Hospital Virgen de la Arrixaca and Department of Internal Medicine, School of Medicine, University of Murcia, Spain.
| | - A Avellaneda
- R&D Department, ElPozo Alimentación S.A., Alhama de Murcia, Spain
| | - J Planes
- R&D Department, ElPozo Alimentación S.A., Alhama de Murcia, Spain
| | - D A Pascual-Figal
- Cardiology Department, University Hospital Virgen de la Arrixaca and Department of Internal Medicine, School of Medicine, University of Murcia, Spain.
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