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Palau P, de la Espriella R, Seller J, Santas E, Domínguez E, Bodí V, Sanchis J, Núñez E, Bayés-Genís A, Bertomeu-González V, Meyer M, Núñez J. β-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Cardiol 2024; 9:392-396. [PMID: 38324280 PMCID: PMC10851133 DOI: 10.1001/jamacardio.2023.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Importance Increasing the patient's heart rate (HR) has emerged as a therapeutic option in patients with heart failure with preserved ejection fraction (HFpEF). However, the evidence is conflicting, and the profile of patients who benefit most from this strategy remains unclear. Objective To assess the association of β-blocker treatment withdrawal with changes in the percentage of predicted peak oxygen consumption (VO2) across indexed left ventricular diastolic (iLVEDV) and indexed left ventricular systolic volumes (iLVESV), and left ventricular ejection fraction (LVEF) in patients with HFpEF and chronotropic incompetence. Design, Setting, and Participants This post hoc analysis was conducted using data from the investigator-blinded multicenter, randomized, and crossover clinical trial, PRESERVE-HR, that took place from October 1, 2018, through December 31, 2020, to investigate the short-term effects (2 weeks) of β-blocker withdrawal on peak oxygen consumption (peak VO2). Patients with stable HFpEF (New York Heart Association functional class II to III) receiving treatment with β-blocker and chronotropic incompetence were included. Intervention Participants in the PRESERVE-HR trial were randomized to withdraw vs continue with β-blocker treatment. After 2 weeks, they were crossed over to receive the opposite intervention. This crossover randomized clinical trial examined the short-term effect of β-blocker withdrawal on peak VO2. Main Outcomes and Measures The primary outcome was to evaluate the association between β-blocker withdrawal and short-term changes in percentage of peak VO2 across iLVEDV, iLVESV, and LVEF in patients with HFpEF and chronotropic incompetence treated with β-blocker. Results A total of 52 patients (mean age, 73 [SD, 13] years; 60% female) were randomized. The mean resting HR, peak HR, peak VO2, and percentage of peak VO2 were 65 (SD, 9) beats per minute (bpm), 97 (SD, 15) bpm, 12.4 (SD, 2.9) mL/kg per minute, and 72.4% (SD, 17.7%), respectively. The medians (minimum-maximum) of iLVEDV, iLVESV, and LVEF were 44 mL/m2 (IQR, 19-82), 15 mL/m2 (IQR, 7-32), and 64% (IQR, 52%-78%), respectively. After stopping β-blocker treatment, the median increase in peak HR was plus 30 bpm (95% CI, 25-35; P < .001). β-Blocker cessation was differentially associated with change of percentage of peak VO2 across the continuum of iLVESV (P for interaction = .02), indicating a greater benefit in those with lower iLVESV. Conclusions and Relevance In this study, results showed that in patients with HFpEF and chronotropic incompetence receiving treatment with β-blocker, lower iLVESV may identify those with a greater short-term improvement in maximal functional capacity after stopping β-blocker treatment. Further studies are warranted for further investigation. Trial Registration ClinicalTrials.gov (NCT03871803).
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Eloy Domínguez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
- Universitat Jaume I, Castellón, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
- CIBER Cardiovascular
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
- CIBER Cardiovascular
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Markus Meyer
- Lillehei Heart Institute, Department of Medicine, University of Minnesota College of Medicine, Minneapolis, Minnesota
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
- CIBER Cardiovascular
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Sanchis J, Bueno H, García-Blas S, Alegre O, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, Fernández-Cisnal A, Calvo E, Morales MJ, Elízaga J, Gómez I, Alfonso F, García del Blanco B, Formiga F, Núñez E, Núñez J, Ariza-Solé A. Invasive Treatment Strategy in Adults With Frailty and Non-ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240809. [PMID: 38446482 PMCID: PMC10918507 DOI: 10.1001/jamanetworkopen.2024.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024] Open
Abstract
Importance The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. Objective To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. Design, Setting, and Participants The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Interventions Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Main outcomes and measures The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Results Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. Conclusions and Relevance In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior. Trial registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Oriol Alegre
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria–Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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de la Espriella R, Núñez-Marín G, Cobo M, de Castro Campos D, Llácer P, Manzano L, Zegrí I, Rodriguez-Pérez Á, Santas E, Lorenzo M, Miñana G, Núñez E, Górriz JL, Bayés-Genís A, Fudim M, Mullens W, Núñez J. Intrarenal Venous Flow Pattern Changes Do Relate With Renal Function Alterations in Acute Heart Failure. JACC Heart Fail 2024; 12:304-318. [PMID: 37676214 DOI: 10.1016/j.jchf.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND There is scarce evidence supporting the clinical utility of congestive intrarenal venous flow (IRVF) patterns in patients with acute heart failure. OBJECTIVES This study aims to: 1) investigate the association between IRVF patterns and the odds of worsening renal function (WRF); 2) track the longitudinal changes of serum creatinine (sCr) across IRVF at predetermined points and its association with decongestion; and 3) explore the relationship between IRVF/WRF categories and patient outcomes. METHODS IRVF was assessed at baseline (pre-decongestive therapy), 72 hours, and 30 and 90 days postdischarge. Changes in sCr trajectories across dynamic IRVF variations and parameters of decongestion were assessed using linear mixed effect models. The association between IRVF/WRF categories and outcomes was evaluated using univariable/multivariable models. RESULTS In this prospective, multicenter study with 188 participants, discontinuous IRVF patterns indicated higher odds of WRF (OR: 3.90 [95% CI: 1.24-12.20]; P = 0.020 at 72 hours; and OR: 5.76 [95% CI: 1.67-19.86]; P = 0.006 at 30 days) and an increase in sCr (Δ-72 hours 0.14 mg/dL [95% CI: 0.06-0.22]; P = 0.001; Δ-discharge 0.13 mg/dL [95% CI: 0.03-0.23]; P = 0.007). However, the diuretic response and decongestion significantly influenced the magnitude of these changes. Patients exhibiting both WRF and discontinuous IRVF at 30 days experienced an increased hazard of adverse events (HR: 5.96 [95% CI: 2.63-13.52]; P < 0.001). CONCLUSIONS Discontinuous IRVF identifies patients with higher odds of WRF during admission and postdischarge periods. Nonetheless, adequate diuretic response and decongestion could modify this association. Patients showing both WRF and discontinuous IRVF at 30 days had increased rates of adverse events.
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Affiliation(s)
- Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Gonzalo Núñez-Marín
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Marta Cobo
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Daniel de Castro Campos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Pau Llácer
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis Manzano
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Isabel Zegrí
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Enrique Santas
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Miguel Lorenzo
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Gema Miñana
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Eduardo Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jose Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, Universitat de València. Valencia, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg, Genk and Hasselt University, Hasselt, Belgium
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain; Department of Medicine, Universitat de València. Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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de la Espriella R, Wahlberg KJ, Infeld M, Palau P, Núñez E, Sanchis J, Meyer M, Núñez J. Effect of paced heart rate on quality of life and natriuretic peptides for stage B or C heart failure with preserved ejection fraction: A secondary analysis of the myPACE trial. Eur J Heart Fail 2024; 26:167-176. [PMID: 38124404 DOI: 10.1002/ejhf.3107] [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: 08/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
AIM Emerging evidence suggests a beneficial effect of higher heart rates in some patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to evaluate the impact of higher backup pacing rates in HFpEF patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony across left ventricular (LV) volumes and LV ejection fraction (LVEF). METHODS AND RESULTS This is a post-hoc analysis of the myPACE clinical trial that evaluated the effects of personalized accelerated pacing setting (myPACE) versus standard of care on changes in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), pacemaker-detected activity levels, and atrial fibrillation (AF) burden in patients with HFpEF with preexisting pacemakers. Between-treatment comparisons were performed using linear regression models adjusting for the baseline value of the exposure (ANCOVA design). This study included 93 patients with pre-trial transthoracic echocardiograms available (usual care n = 49; myPACE n = 44). NT-proBNP levels and MLHFQ scores improved in a higher magnitude in the myPACE group at lower indexed LV end-diastolic volumes (iLVEDV) (NT-proBNP-iLVEDV interaction p = 0.006; MLHFQ-iLVEDV interaction p = 0.068). In addition, personalized accelerated pacing led to improved changes in activity levels and NT-proBNP, especially at higher LVEF (activity levels-LVEF interaction p = 0.009; NT-proBNP-LVEF interaction p = 0.058). No evidence of heterogeneity was found across LV volumes or LVEF for pacemaker-detected AF burden. CONCLUSIONS In the post-hoc analysis of the myPACE trial, we observed that the benefits of a personalized accelerated backup pacing on MLHFQ score, NT-proBNP, and pacemaker-detected activity levels appear to be more pronounced in patients with smaller iLVEDV and higher LVEF.
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Affiliation(s)
- Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Kramer J Wahlberg
- University of Vermont, Larner College of Medicine, Department of Medicine, Burlington, VT, USA
| | - Margaret Infeld
- Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Patricia Palau
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Markus Meyer
- Lillehei Heart Institute, Department of Medicine, University of Minnesota College of Medicine, Minneapolis, MN, USA
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Lorenzo M, Jacobs-Cachá C, Palau P, Amiguet M, Seller J, Núñez E, Espriella RDL, Górriz JL, Miñana G, Sanchis J, Bayés-Genis A, Soler MJ, Packer M, Núñez J. Short-Term Changes in Peak VO 2 After Initiation of Dapagliflozin in Heart Failure Across Iron Status. JACC Heart Fail 2023; 11:1611-1622. [PMID: 37676213 DOI: 10.1016/j.jchf.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Some studies have indicated that sodium-glucose cotransporter-2 (SGLT2) inhibitors promote an increase in cell iron use. OBJECTIVES The aim of this study was to examine, in patients with stable heart failure with reduced left ventricular ejection fraction (HFrEF), the effect of dapagliflozin on ferrokinetic parameters and whether short-term changes in peak oxygen consumption (Vo2) after dapagliflozin treatment are influenced by baseline and serial ferrokinetic status. METHODS This was an exploratory analysis of a randomized, double-blind clinical trial that evaluated the effect of dapagliflozin vs placebo on peak Vo2 in patients with HFrEF (NCT04197635) and included 76 of the 90 patients initially enrolled in the trial. Changes in peak Vo2 at 1 and 3 months were explored according to baseline and longitudinal ferrokinetic parameters (natural logarithm [ln] ferritin, transferrin saturation index [TSAT], soluble transferrin receptor, and hepcidin). Linear mixed-effect regression was used for the analyses. RESULTS Compared with placebo, dapagliflozin led to a significant decrease in 3-month ln ferritin (P = 0.040) and an increase in 1-month ln soluble transferrin receptor (P = 0.023). Between-treatment comparisons revealed a stepwise increase in peak Vo2 in the dapagliflozin group at 1 and 3 months, which was especially apparent at lower baseline values of TSAT and ferritin (P < 0.05). Lower time-varying values of TSAT (1 and 3 months) also identified patients with greater improvements in peak Vo2. CONCLUSIONS In patients with stable HFrEF, treatment with dapagliflozin resulted in short-term increases in peak Vo2, which were most marked in patients with surrogates of greater iron deficiency at baseline and during treatment. (Short-Term Effects of Dapagliflozin on Peak Vo2 in HFrEF [DAPA-VO2]; NCT04197635).
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | | | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | - Martina Amiguet
- Cardiology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Dénia-Marina Salud, Alicante, Spain; Fundación Para Fomento de Investigación Sanitaria y Biomédica CV-Fisabio, Valencia, Spain
| | | | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain; Nephrology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genis
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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Miñana G, de la Espriella R, Palau P, Amiguet M, Seller J, García Pinilla JM, Núñez E, Górriz JL, Valle A, Sanchis J, Bayés-Genís A, Núñez J. Early glomerular filtration rate decline is associated with hemoglobin rise following dapagliflozin initiation in heart failure with reduced ejection fraction. Rev Esp Cardiol (Engl Ed) 2023; 76:783-792. [PMID: 36958534 DOI: 10.1016/j.rec.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION AND OBJECTIVES Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF). METHODS This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms. RESULTS A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides. CONCLUSIONS In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months.
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Affiliation(s)
- Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España
| | - Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España
| | - Martina Amiguet
- Departamento de Medicina, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Universitat Jaume I, Castellón, España
| | - Julia Seller
- Servicio de Cardiología, Hospital de Denia, Alicante, España
| | - José Manuel García Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España.
| | - José Luis Górriz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España
| | - Alfonso Valle
- Servicio de Cardiología, Hospital de Denia, Alicante, España
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Germans Trias i Pujol, Universitat de Barcelona, Badalona, Barcelona, España
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
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Miñana G, González-Rico M, de la Espriella R, González-Sánchez D, Montomoli M, Núñez E, Fernández-Cisnal A, Villar S, Górriz JL, Núñez J. Peritoneal and Urinary Sodium Removal in Refractory Congestive Heart Failure Patients Included in an Ambulatory Peritoneal Dialysis Program: Valuable for Monitoring the Course of the Disease. Cardiorenal Med 2023; 13:211-220. [PMID: 37586337 PMCID: PMC10664341 DOI: 10.1159/000531631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF). METHODS We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF. RESULTS At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF. CONCLUSIONS CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Miguel González-Rico
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Marco Montomoli
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
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8
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Lorenzo M, Miñana G, Palau P, Amiguet M, Seller J, Garcia Pinilla JM, Domínguez E, Villar S, DE LA Espriella R, Núñez E, Górriz JL, Valle A, Bodí V, Sanchis J, Bayés-Genis A, Núñez J. Short-term Changes in Hemoglobin and Changes in Functional Status, Quality of Life, and Natriuretic Peptides after initiation of Dapagliflozin in Heart Failure with Reduced Ejection Fraction. J Card Fail 2023; 29:849-854. [PMID: 36871614 DOI: 10.1016/j.cardfail.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND We aimed to evaluate the effect of dapagliflozin on short-term changes in hemoglobin in patients with stable heart failure with reduced ejection fraction (HFrEF) and whether these changes mediated the effect of dapagliflozin on functional capacity, quality of life, and NT-proBNP. METHODS It is an exploratory analysis of a randomized, double-blinded clinical trial in which 90 stable patients with HFrEF were randomly allocated to dapagliflozin or placebo to evaluate short-term changes in peak oxygen consumption (peak VO2) (NCT04197635). This substudy evaluated 1 and 3-month changes in hemoglobin and whether these changes mediated the effects of dapagliflozin on peak VO2, Minnesota Living-With-Heart-Failure test (MLHFQ), and NT-proBNP. RESULTS At baseline, mean hemoglobin was 14.3 ± 1.7 g/dL. Hemoglobin significantly increased in those on dapagliflozin [1-month: +0.45 g/dL (p=0.037), and 3-month:+0.55 g/dL, (p=0.012)]. Changes in hemoglobin positively mediated the changes in peak VO2 at 3-month (59.5%, p<0.001). Changes in hemoglobin significantly mediated the effect of dapagliflozin in MLHFQ at 3-month (-53.2% and -48.7%, p=0.017) and NT-proBNP at 1 and 3-month (-68.0%, p=0.048 and -62.7%, p=0.029, respectively). CONCLUSIONS In patients with stable HFrEF, dapagliflozin caused a short-term increase in hemoglobin, identifying patients with a greater improvement in maximal functional capacity, QoL, and reduction of NT-proBNP.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Martina Amiguet
- Fundación para Fomento de Investigación Sanitaria y Biomédica CV-Fisabio, Valencia, Spain
| | - Julia Seller
- Fundación para Fomento de Investigación Sanitaria y Biomédica CV-Fisabio, Valencia, Spain; Cardiology Department, Hospital de Dénia-MarinaSalud, Alicante, Spain
| | - Jose Manuel Garcia Pinilla
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Eloy Domínguez
- Fundación para Fomento de Investigación Sanitaria y Biomédica CV-Fisabio, Valencia, Spain; Universitat Jaume I, Castellón, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Rafael DE LA Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | | | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genis
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Germans Trias i Pujol, Universitat de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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9
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Núñez J, Lorenzo M, Miñana G, Palau P, Monmeneu JV, López‐Lereu MP, Gavara J, Marcos‐Garcés V, Rios‐Navarro C, Pérez N, de Dios E, Núñez E, Sanchis J, Chorro FJ, Bayés‐Genís A, Bodí V. Risk of death associated with incident heart failure in patients with known or suspected chronic coronary syndrome. ESC Heart Fail 2022; 10:264-273. [PMID: 36196583 PMCID: PMC9871680 DOI: 10.1002/ehf2.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/21/2022] [Accepted: 09/15/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Traditional adverse events in chronic coronary syndrome (CCS) include atherothrombotic events but usually exclude heart failure (HF). Data are scarce about how new-onset HF modifies mortality risk. We aimed to determine the incidence of HF and compare its long-term mortality risk with myocardial infarction (MI) and stroke in patients with known or suspected CCS. METHODS We prospectively evaluated 5811 consecutive HF-free patients submitted to vasodilator stress cardiac magnetic resonance (CMR) for known or suspected CCS. Ischaemic burden and left ventricular ejection fraction were assessed by CMR. HF included outpatient diagnosis or acute HF hospitalization. The mortality risk for the incident events and their cross-comparisons were evaluated using a Markov illness-death model with transition-specific survival models. RESULTS The mean age was 55 ± 11 years, and 38.9% were female. At a median follow-up of 5.44 (IQR = 2.53-8.55) years, 591 deaths were registered (1.79 per 100 P-Y). The rates of new-onset HF were higher compared with MI and stroke [1.02, 0.62, and 0.51, respectively (P < 0.05)]. The adjusted association between new-onset HF, MI, and stroke, and subsequent mortality was time dependent. The risk increased almost linearly for HF and became significant by the third year. By Year 10, the mortality risk attributable to new-onset HF was more than 2.5-fold (HR: 2.68, 95% CI = 1.74-4.12). For MI, there was a significant increase in mortality risk up to the second year, followed by a monotonic decrease. For stroke, the mortality risk increased for the entire follow-up but became significant by the third year. A cross-comparison among incident endpoints HF outnumbers risk for those with MI by the sixth year (HRyear6.3 : 1.88, 95% CI = 1.03-3.43). There was no difference in mortality risk between incident HF and stroke. CONCLUSIONS In patients with CCS, long-term rates of incident HF were higher than MI and stroke. Patients with new-onset HF showed a higher risk of long-term mortality.
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Affiliation(s)
- Julio Núñez
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
| | - Miguel Lorenzo
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain
| | - Gema Miñana
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
| | - Patricia Palau
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
| | - Jose V. Monmeneu
- Cardiovascular Magnetic Resonance UnitExploraciones Radiológicas Especiales (ERESA)ValenciaSpain
| | - Maria P. López‐Lereu
- Cardiovascular Magnetic Resonance UnitExploraciones Radiológicas Especiales (ERESA)ValenciaSpain
| | - Jose Gavara
- Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Center for Biomaterials and Tissue EngineeringUniversitat Politècnica de ValènciaValenciaSpain
| | - Víctor Marcos‐Garcés
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain
| | | | - Nerea Pérez
- Instituto de Investigación Sanitaria INCLIVAValenciaSpain
| | - Elena de Dios
- Instituto de Investigación Sanitaria INCLIVAValenciaSpain
| | - Eduardo Núñez
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain
| | - Juan Sanchis
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
| | - Francisco J. Chorro
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
| | - Antoni Bayés‐Genís
- Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Cardiology DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Vicent Bodí
- Cardiology DepartmentHospital Clínico Universitario de ValenciaValenciaSpain,Instituto de Investigación Sanitaria INCLIVAValenciaSpain,Centro de Investigación Biomédica en Red ‐ Cardiovascular (CIBER‐CV)MadridSpain,Department of Medicine, School of Medicine and OdontologyUniversity of ValenciaValenciaSpain
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10
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Civera J, Miñana G, de la Espriella R, Santas E, Sastre C, Mollar A, Conesa A, Martínez A, Núñez E, Bayés-Genís A, Núñez J. Venous Leg Compression for Tissue Decongestion in Patients With Worsening Congestive Heart Failure. Front Cardiovasc Med 2022; 9:847450. [PMID: 35872894 PMCID: PMC9304621 DOI: 10.3389/fcvm.2022.847450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
AimsVenous leg compression (VLC) with elastic bandages has been proposed as a potentially useful strategy for decreasing tissue congestion. We aimed to evaluate the effect of VLC on short-term changes on intravascular refill, assessed by inferior vena cava (IVC) diameter in patients with worsening heart failure (WHF) requiring parenteral furosemide. Additionally, we sought to evaluate whether early changes in IVC were related to short-term decongestion.MethodsThis is a prospective study in which we included 20 consecutive ambulatory patients with WHF treated with subcutaneous furosemide and VLC for at least 72 h. The endpoints were (a) short-term changes in IVC, (b) the association between decongestion and 3-h IVC changes following VLC. Changes in continuous endpoints and their longitudinal trajectories were estimated with linear mixed regression models. All analyses were adjusted for multiple comparisons.ResultsFollowing administration of subcutaneous furosemide and VLC, we found a significant increase in 3-h IVC diameter (ΔIVC = 1.6 mm, CI 95%: 0.7–2.5; p < 0.001), with a greater increase in those with baseline IVC≤21 mm (2.4 vs. 0.8 mm; p < 0.001). 3-h intravascular refill (increase in IVC≥2 mm) was associated with greater decongestion (natriuresis, weight, peripheral edemas, and dyspnea) in those with baseline IVC≤21 mm but not when IVC>21 mm (p < 0.05 for all comparisons).ConclusionsIn this cohort of patients with congestive WHF treated with subcutaneous furosemide and VLC, we found a greater increase in short-term IVC in those with IVC ≤21 mm at baseline. In this subset of patients, a 3-h increase in IVC≥2 mm was associated with greater short-term decongestion.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Heart Failure Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- *Correspondence: Julio Núñez ; ; orcid.org/0000-0003-1672-7119
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11
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Pernias V, García Acuña JM, Raposeiras-Roubín S, A. Barrabés J, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A, Sanchis J. [camara] Influencia de las comorbilidades en la decisi�n del tratamiento invasivo en ancianos con SCASEST. RECIC 2022. [DOI: 10.24875/recic.m20000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Cerro-Pardo I, Lindholt J, Núñez E, Roldan-Montero R, Ortega-Villanueva L, Vegas-Dominguez C, Gomez-Guerrero C, Michel JB, Blanco-Colio L, Vázquez J, Martín-Ventura J. Combined Immunoglobulin Free Light Chains Are Novel Predictors of Cardiovascular Events in Patients With Abdominal Aortic Aneurysm. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.04.019] [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: 11/28/2022]
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13
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Miñana G, Lorenzo M, Ramirez de Arellano A, Wächter S, de la Espriella R, Sastre C, Mollar A, Núñez E, Bodí V, Sanchis J, Bayés-Genís A, Núñez J. Incidence, Treatment and Clinical Impact of Iron Deficiency in Chronic Heart Failure: A Longitudinal Analysis. J Clin Med 2022; 11:jcm11092559. [PMID: 35566684 PMCID: PMC9100536 DOI: 10.3390/jcm11092559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
In patients with heart failure (HF), iron deficiency (ID) is a well-recognized therapeutic target; information about its incidence, patterns of iron repletion, and clinical impact is scarce. This single-centre longitudinal cohort study assessed the rates of ID testing and diagnosis in patients with stable HF, patterns of treatment with intravenous iron, and clinical impact of intravenous iron on HF rehospitalization risk. We included 711 consecutive outpatients (4400 visits) with stable chronic HF from 2014 to 2019 (median [interquartile range] visits per patient: 2 [2−7]. ID was defined as serum ferritin <100 µg/L, or 100−299 µg/L with transferrin saturation (TSAT) < 20%. During a median follow-up of 2.20 (1.11−3.78) years, ferritin and TSAT were measured at 2230 (50.7%) and 2183 visits (49.6%), respectively. ID was found at 846 (37.9%) visits, with ferritin and TSAT available (2230/4400), and intravenous iron was administered at 321/4400 (7.3%) visits; 233 (32.8%) patients received intravenous iron during follow-up. After multivariate analyses, iron repletion at any time during follow-up was associated with a lower risk of recurrent HF hospitalization (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.28−0.88; p = 0.016). Thus, ID was a frequent finding in patients with HF, and its repletion reduced the risk of recurrent HF hospitalizations.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | | | - Sandra Wächter
- Medical Department, Viforpharma Group, 8152 Zurich, Switzerland;
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, 28029 Madrid, Spain;
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, 46010 Valencia, Spain; (G.M.); (M.L.); (R.d.l.E.); (C.S.); (A.M.); (E.N.); (V.B.); (J.S.)
- CIBER Cardiovascular, 28029 Madrid, Spain;
- Correspondence: or ; Tel.: +34-617551562; Fax: +34-963862658
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Núñez J, Bayés-Genís A, Revuelta-López E, Miñana G, Santas E, Ter Maaten JM, de la Espriella R, Carratalá A, Lorenzo M, Palau P, Llàcer P, Valle A, Bodi V, Núñez E, Lupón J, Lang C, Ng LL, Metra M, Sanchis J, Voors AA. Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure. Rev Esp Cardiol (Engl Ed) 2022; 75:316-324. [PMID: 33745912 DOI: 10.1016/j.rec.2021.02.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF. METHODS The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a cohort of patients hospitalized from BIOSTAT-CHF (n=1583). RESULTS In the derivation cohort, the median [IQR] CA125 was 57 [25.3-157] U/mL. The optimal cutoff value was <23 U/mL (21.5% of patients), with NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. On multivariate survival analyses, CA125 <23 U/mL was independently associated with a lower risk of death (HR, 0.20; 95%CI, 0.08-0.50; P <.001), and the combined endpoint (HR, 0.63; 95%CI, 950.45-0.90; P=.009). The ability of this cutpoint to discriminate patients at a low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for death and the composite endpoint). The predicted ability of this cutoff remained significant at 6 months of follow-up. CONCLUSIONS In patients admitted with AHF, CA125 <23 U/mL identified a subgroup at low risk of short-term adverse events, a population that may not require intense postdischarge monitoring.
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Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universitat de Valencia, València, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Revuelta-López
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Campus Can Ruti, Badalona, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universitat de Valencia, València, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Jozine M Ter Maaten
- Cardiology Department, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Arturo Carratalá
- Servicio de Bioquímica, Hospital Clínico Universitario de València, Universitat de València, INCLIVA, Valencia, Spain
| | - Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Patricia Palau
- Departamento de Medicina, Universitat de Valencia, València, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alfonso Valle
- Servicio de Cardiología, Hospital Marina Salud, Denia, Alicante, Spain
| | - Vicent Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universitat de Valencia, València, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chim Lang
- Division of Molecular and Clinical Medicine School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Cardiology Department, Clinical Sciences Wing Glenfield General Hospital Leicester, Leicester, United Kingdom
| | - Marco Metra
- Cardiology Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universitat de Valencia, València, Spain
| | - Adriaan A Voors
- Cardiology Department, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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Núñez J, Bayés-Genís A, Revuelta-López E, Miñana G, Santas E, ter Maaten JM, de la Espriella R, Carratalá A, Lorenzo M, Palau P, Llàcer P, Valle A, Bodi V, Núñez E, Lupón J, Lang C, Ng LL, Metra M, Sanchis J, Voors AA. Punto de corte óptimo del antígeno carbohidrato 125 para la identificación de pacientes con bajo riesgo tras un ingreso por insuficiencia cardiaca aguda. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.01.023] [Citation(s) in RCA: 3] [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: 12/17/2022]
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16
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Lorenzo M, Palau P, Llàcer P, Domínguez E, Ventura B, Núñez G, Miñana G, Solsona J, Santas E, De La Espriella R, Bodí V, Núñez E, Sanchis J, Bayés-Genís A, Núñez J. Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure. Eur J Intern Med 2021; 92:94-99. [PMID: 34130879 DOI: 10.1016/j.ejim.2021.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal length of stay (LOS) in patients hospitalized for acute heart failure (AHF) remains controversial. Plasma antigen carbohydrate 125 (CA125) has emerged as a reliable proxy of congestion. We aimed to evaluate whether there is a differential impact of LOS on the risk of 6-month AHF readmission across CA125 levels. METHODS This is a retrospective study that included 1,387 patients discharged for AHF in two third-level centers. CA125 was measured 48±24 h after admission. The association between CA125 and LOS with the risk of subsequent AHF readmission at 6 months was analyzed by Cox regression analysis accounting for death as a competing event. RESULTS The median (IQR) age of the sample was 78 (69-83) years, 625 (41.1%) patients were women, and 832 (60%) exhibited preserved left ventricular ejection fraction. The median LOS and CA125 were 6 (4-9) days and 36 (17-83) U/mL, respectively. A total of 707 (51%) patients displayed high CA125 levels (≥35 U/mL). At 6 months, 87 deaths (6,3%) and 304 AHF readmissions (21,9%) were registered, respectively. A multivariate analysis revealed a differential effect of LOS on 6-month AHF readmission across CA125 levels (p-value for interaction=0.010). In those with CA125<35 U/mL, LOS≥7 days did not modify the risk (HR:1.31; 95% CI: 0.92-1.87, p=0.131). Conversely, in those with CA125≥35 U/mL, LOS≥7 days was associated with a lower risk of AHF readmission (HR:0.70; 95% CI: 0.51-0.98, p=0.036). CONCLUSIONS In patients with AHF, high CA125 levels may identify those patients that benefit from a more prolonged hospitalization in terms of reducing the risk of mid-term AHF readmissions.
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Affiliation(s)
- Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna. Hospital Universitario Ramón y Cajal. Madrid, Spain
| | | | | | - Gonzalo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular. Madrid, Spain
| | | | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Rafael De La Espriella
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular. Madrid, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular. Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular. Madrid, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona. Universitat Autònoma de Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular. Madrid, Spain.
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Díez-Villanueva P, García-Acuña JM, Raposeiras-Roubin S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Cid-Alvárez B, Abu Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A, Sanchis J. Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10194403. [PMID: 34640420 PMCID: PMC8509190 DOI: 10.3390/jcm10194403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 01/30/2023] Open
Abstract
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.
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Affiliation(s)
| | - Jose María García-Acuña
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, CIBERCV, 15706 Santiago de Compostela, A Coruña, Spain; (J.M.G.-A.); (B.C.-A.)
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología, Hospital Álvaro Cunqueiro de Vigo, 36213 Vigo, Pontevedra, Spain; (S.R.-R.); (E.A.A.)
| | - Jose A. Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, CIBERCV, 08035 Barcelona, Spain;
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Clínico Universitario de San Juan, 03550 Alicante, Spain;
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, 28007 Madrid, Spain;
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, 43005 Tarragona, Spain;
| | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, 30120 Murcia, Spain;
| | - Juan M. Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | | | - Gonzalo L. Alonso Salinas
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal de Madrid, CIBERCV, 28034 Madrid, Spain;
| | - Belén Cid-Alvárez
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, CIBERCV, 15706 Santiago de Compostela, A Coruña, Spain; (J.M.G.-A.); (B.C.-A.)
| | - Emad Abu Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro de Vigo, 36213 Vigo, Pontevedra, Spain; (S.R.-R.); (E.A.A.)
| | - Frances Formiga
- Servicio de Medicina Interna, Hospital Bellvitge, L’Hospitalet de Llobregat, 08097 Barcelona, Spain;
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L’Hospitalet de Llobregat, 08097 Barcelona, Spain;
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46014 Valencia, Spain; (J.N.); (E.N.)
- Correspondence:
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18
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Sanchis J, García Acuña JM, Raposeiras S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A. Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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Fajardo J, Núñez E, Szafranska J, Poca M, Lobo D, Martín B, Hernández D, Roig C, Huerta A, Corominas H, Sánchez‐Cabús S, Soriano G. We report a patient who presented intrahepatic cholangitis and cholecystitis after SARS-CoV-2 infection. J Gastroenterol Hepatol 2021; 36:2037. [PMID: 34105805 PMCID: PMC8242606 DOI: 10.1111/jgh.15537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 12/09/2022]
Affiliation(s)
- J Fajardo
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - E Núñez
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - J Szafranska
- Department of PathologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - M Poca
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - D Lobo
- Department of RheumatologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - B Martín
- Department of SurgeryHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - D Hernández
- Department of RadiologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - C Roig
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - A Huerta
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - H Corominas
- Department of RheumatologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - S Sánchez‐Cabús
- Department of SurgeryHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - G Soriano
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain,CIBERehd, Instituto de Salud Carlos IIIMadridSpain
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20
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Núñez J, de la Espriella R, Miñana G, Santas E, Llácer P, Núñez E, Palau P, Bodí V, Chorro FJ, Sanchis J, Lupón J, Bayés-Genís A. Antigen carbohydrate 125 as a biomarker in heart failure: a narrative review. Eur J Heart Fail 2021; 23:1445-1457. [PMID: 34241936 DOI: 10.1002/ejhf.2295] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 01/22/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022] Open
Abstract
Congestion explains many of the signs and symptoms of acute heart failure (AHF) and disease progression. However, accurate quantification of congestion is challenging in daily practice. Antigen carbohydrate 125 (CA125) or mucin 16 (MUC16), a large glycoprotein synthesized by mesothelial cells, has emerged as a reliable proxy of congestion and inflammation in patients with heart failure (HF). In AHF syndromes, CA125 is strongly associated with right-sided HF parameters and a higher risk of adverse clinical events beyond standard prognostic factors, including natriuretic peptides. Furthermore, CA125 has the potential for both monitoring and guide HF treatment following a decompensated HF event. The wide availability of CA125 in most clinical laboratories, together with its standardized measurement and reduced cost, makes this marker attractive for routine use in decompensated HF. Further research is required to understand better its biological role and its promising utility as a tool to guide decongestive therapy in HF.
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Affiliation(s)
- Julio Núñez
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Enrique Santas
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Vicent Bodí
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Francisco J Chorro
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Josep Lupón
- CIBER Cardiovascular, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
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21
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de la Espriella R, Núñez E, Llàcer P, García-Blas S, Ventura S, Núñez JM, Sánchez R, Fácila L, Vaquer JM, Bodí V, Santas E, Miñana G, Mollar A, Núñez G, Chorro FJ, Górriz JL, Sanchis J, Bayés-Genis A, Núñez J. Trayectoria precoz del sodio urinario y riesgo de eventos adversos en insuficiencia cardiaca aguda y disfunción renal. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.05.036] [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: 10/23/2022]
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22
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de la Espriella R, Núñez E, Llàcer P, García-Blas S, Ventura S, Núñez JM, Sánchez R, Fácila L, Vaquer JM, Bodí V, Santas E, Miñana G, Mollar A, Núñez G, Chorro FJ, Górriz JL, Sanchis J, Bayés-Genis A, Núñez J. Early urinary sodium trajectory and risk of adverse outcomes in acute heart failure and renal dysfunction. Rev Esp Cardiol (Engl Ed) 2021; 74:616-623. [PMID: 32624444 DOI: 10.1016/j.rec.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24hours (ΔUNa24h) adds any additional prognostic information over baseline values. METHODS This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. RESULTS The mean age was 78±8 years, and the mean glomerular filtration rate was 34.0±8.5mL/min/1.73 m2. The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P <.001) and all-cause readmissions (HR, 0.92; 95%CI, 0.88-0.96; P <.001). The prognostic usefulness of the ΔUNa24h varied according to UNa+ at admission (P for interaction <.05). The ΔUNa24h was inversely associated with both end points only in the group with UNa+ ≤ 50 mmol/L. Conversely, no effect was found in the group with UNa+> 50 mmol/L. CONCLUSIONS In patients with AHF and renal dysfunction, a single early determination of UNa+ ≤ 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The ΔUNa24h adds prognostic information over baseline values only when UNa+ at admission is ≤ 50 mmol/L.
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Affiliation(s)
- Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, Spain
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Silvia Ventura
- Servicio de Medicina Interna, Hospital de La Plana, Villa-Real, Castellón, Spain
| | - José María Núñez
- Unidad de Cuidados Intensivos, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Ruth Sánchez
- Servicio de Medicina Interna, Hospital Virgen de Los Lirios, Alcoy, Alicante, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | - Juana María Vaquer
- Servicio de Bioquímica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Gonzalo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - José L Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antoni Bayés-Genis
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología y Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Departamento de Medicina, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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23
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de la Espriella R, Miñana G, Santas E, Núñez G, Lorenzo M, Núñez E, Bayés-Genís A, Núñez J. Effects of empagliflozin on CA125 trajectory in patients with chronic congestive heart failure. Int J Cardiol 2021; 339:102-105. [PMID: 34216708 DOI: 10.1016/j.ijcard.2021.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We aimed to evaluate the trajectory of two surrogates of fluid overload -antigen carbohydrate 125 (CA125) and amino-terminal pro-brain natriuretic peptide (NT-proBNP)- after the addition of oral empagliflozin to usual care in a cohort of patients with chronic heart failure (CHF) and type 2 diabetes (T2D). METHODS AND RESULTS From October 2015 to February 2019, 60 ambulatory patients with CHF and T2D were retrospectively included. The primary endpoint was to assess the longitudinal trajectory of plasma levels of CA125 and NT-proBNP after empagliflozin initiation. Changes in quantitative variables were evaluated using linear mixed regression. Median CA125 and NT-proBNP at baseline were 17 (11-75) U/mL and 1662 (647-4230) pg/mL, respectively. A total of 510 outpatient visits were recorded [median (interquartile range) of visits per patient: 6 (4-11)] during a median of 1.78 years. We found a significant and steady decrease in the log of CA125 after empagliflozin initiation (p < 0.001). Conversely, the log of NT-proBNP predicted trajectory did not significantly change (p = 0.425). CONCLUSION In this cohort of patients with CHF and T2D, empagliflozin initiation was associated with a significant decrease in CA125 levels without modifying the trajectory of NT-proBNP. Considering that CA125 has emerged as a surrogate marker of tissue congestion, we hypothesize that empagliflozin might predominantly promote extravascular decongestion.
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain; Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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24
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Miñana G, Núñez J, Monmeneu JV, López-Lereu MP, Gavara J, Marcos-Garcés V, Ríos-Navarro C, Pérez N, de Dios E, Fernández-Cisnal A, Núñez E, Chorro FJ, Sanchis J, Bodi V. Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Open Heart 2021; 8:openhrt-2021-001619. [PMID: 34001655 PMCID: PMC8130753 DOI: 10.1136/openhrt-2021-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We assessed the influence of the ischaemic burden (IB) as derived from vasodilator stress cardiovascular magnetic resonance (CMR) on the risk of death and the effect of revascularisation across sex. METHODS We evaluated 6237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischaemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used. RESULTS A total of 2371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularisation. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived IB across sex (p value for interaction=0.039). Women exhibited an adjusted lower risk of death and only equaled men's risk when extensive ischaemia was present. Likewise, CMR-related revascularisation was shown to be differentially associated with the risk of mortality across sex (p value for interaction=0.025). In patients with non-extensive ischaemia, revascularisation was associated with a higher risk of death, with a greater extent in women. At higher IB, revascularisation was associated with a lower risk in men, with more uncertain results in women. CONCLUSIONS CMR-derived IB allows predicting the risk of death and gives insight into the potential effect of revascularisation in men and women with CCS. Compared with men, women with non-extensive ischaemia displayed a lower risk and a similar risk with a higher IB. The impact of CMR-related revascularisation on mortality risk was also significantly different according to IB and sex. Further research will be needed to confirm these hypothesis-generating findings.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Jose V Monmeneu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Maria P López-Lereu
- Cardiac Imaging Unit, ERESA, Unidad de Imagen Cardiaca Valencia, ES, Valencia, Spain
| | - Jose Gavara
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | | | - Nerea Pérez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Elena de Dios
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Vicente Bodi
- Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
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25
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Núñez J, Lorenzo M, Miñana G, Palau P, Monmeneu JV, López-Lereu MP, Gavara J, Marcos-Garcés V, Ríos-Navarro C, Pérez N, de Dios E, Núñez E, Sanchis J, Chorro FJ, Bayés-Genís A, Bodí V. Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease. Eur J Prev Cardiol 2021; 28:1711-1719. [PMID: 33970216 DOI: 10.1093/eurjpc/zwab078] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/03/2021] [Revised: 04/03/2021] [Indexed: 12/13/2022]
Abstract
AIMS The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR). METHODS AND RESULTS We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional hazards regression model adjusted for competing events [death, myocardial infarction (MI), and revascularization]. A total of 2289 (38.8%) patients were women. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered an MI, 905 (15.3%) underwent revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs. 0.83 per 100 person-years, P = 0.001). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (hazard ratio 1.58, 95% confidence interval 1.18-2.10; P = 0.002). We found a sex-differential effect along the continuum of LVEF (P-value for interaction = 0.007). At lower LVEF, there was an increased risk in both sexes. However, compared with men, the risk of new-onset HF was higher in women with LVEF >55%. CONCLUSION Women with known or suspected CAD are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiológicas Especiales (ERESA), Colón, 1, 46004 Valencia, Spain
| | - Maria P López-Lereu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiológicas Especiales (ERESA), Colón, 1, 46004 Valencia, Spain
| | - Jose Gavara
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Victor Marcos-Garcés
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Cesar Ríos-Navarro
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Nerea Pérez
- Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain
| | - Elena de Dios
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Av. Blasco Ibañez, 17, 46010, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Menéndez y Pelayo, 4, 46010, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
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26
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Núñez-Marín G, de la Espriella R, Santas E, Lorenzo M, Miñana G, Núñez E, Bodí V, González M, Górriz JL, Bonanad C, Sanchis J, Bayés-Genís A, Núñez J. CA125 but not NT-proBNP predicts the presence of a congestive intrarenal venous flow in patients with acute heart failure. Eur Heart J Acute Cardiovasc Care 2021; 10:475-483. [PMID: 33829233 DOI: 10.1093/ehjacc/zuab022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intrarenal venous flow (IRVF) measured by Doppler ultrasound has gained interest as a potential surrogate marker of renal congestion and adverse outcomes in heart failure. In this work, we aimed to determine if antigen carbohydrate 125 (CA125) and plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with congestive IRVF patterns (i.e., biphasic and monophasic) in acute heart failure (AHF). METHODS AND RESULTS We prospectively enrolled a consecutive cohort of 70 patients hospitalized for AHF. Renal Doppler ultrasound was assessed within the first 24-h of hospital admission. The mean age of the sample was 73.5 ± 12.3 years; 47.1% were female, and 42.9% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for NT-proBNP and CA125 were 6149 (3604-12 330) pg/mL and 64 (37-122) U/mL, respectively. The diagnostic performance of both exposures for identifying congestive IRVF patterns was tested using the receiving operating curve (ROC). The cut-off for CA125 of 63.5 U/mL showed a sensibility and specificity of 67% and 74% and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with congestive IRVF (P-value = 0.008) and emerged as the most important covariate explaining the variability of the model (R2: 47.5%). Under the same multivariate setting, NT-proBNP did not show to be associated with congestive IRVF patterns (P-value = 0.847). CONCLUSIONS CA125 and not NT-proBNP is a useful marker for identifying patients with AHF and congestive IRVF patterns.
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Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Miguel González
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - José Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Avda. Blasco Ibáñez 17, Valencia 46010, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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27
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Mollar A, Marrachelli VG, Núñez E, Monleon D, Bodí V, Sanchis J, Navarro D, Núñez J. Bacterial metabolites trimethylamine N-oxide and butyrate as surrogates of small intestinal bacterial overgrowth in patients with a recent decompensated heart failure. Sci Rep 2021; 11:6110. [PMID: 33731747 PMCID: PMC7969616 DOI: 10.1038/s41598-021-85527-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
In patients with heart failure (HF), the exhaled concentrations of hydrogen after a breath test-a non-invasive assessment of small intestinal overgrowth- has been related to HF severity and higher risk of adverse outcomes. Indeed, two intestinal bacterial metabolites-blood Trimethylamine N-Oxide (TMAO) and butyrate-have been related to a worse prognosis in HF. However, the relationship between the exhaled concentrations of hydrogen after a breath test and these two metabolites remains unknown. Thus, in this post-hoc analysis, we sought to evaluate whether these two metabolites are associated with the exhaled concentrations of hydrogen after a breath test in patients with a recent admission for HF. We included 60 patients with a recent hospitalization for HF. Cumulative hydrogen over time was integrated into a single measurement by the area under the concentration curve (AUC-H2). A linear regression multivariable analysis was used to evaluate the associations. A 2-sided p-value < 0.05 was considered to be statistically significant. The median (p25-p75) amino-terminal pro-brain natriuretic peptide, AUC-H2, TMAO, and Butyrate were 4789 pg/ml (1956-11149), 1615 (700-2585), 0.68 (0.42-1.12), and 0.22 ± 13, respectively. After multivariate adjustment, TMAO and butyrate were significantly associated with AUC-H2 (p = 0.027 and p = 0.009, respectively). For TMAO, this association was positive and for butyrate, negative. Bacterial-origin metabolites TMAO and Butyrate were independently related to AUC-H2 in patients with a recent hospitalization for acute HF.
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Affiliation(s)
- Anna Mollar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Vannina G Marrachelli
- Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain.,Physiology Department, Universitat de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Daniel Monleon
- Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain.,Physiology Department, Universitat de Valencia, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - David Navarro
- Microbiology Department. Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Avda. Blasco Ibáñez 17, 46010, Valencia, Spain. .,CIBER Cardiovascular, Madrid, Spain.
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28
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Palau P, Llàcer P, Domínguez E, Tormo JP, Zakarne R, Mollar A, Martínez A, Miñana G, Santas E, Almenar L, Fácila L, De La Espriella R, Núñez E, Manzano L, Bayés-Genís A, Núñez J. Iron deficiency and short-term adverse events in patients with decompensated heart failure. Clin Res Cardiol 2021; 110:1292-1298. [PMID: 33721056 DOI: 10.1007/s00392-021-01832-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/22/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology's (ESC) current definition of ID (ferritin < 100 μg/L or TSAT < 20% if ferritin is 100-299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF. METHODS We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24-72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint. RESULTS Participants' median (quartiles) age was 76 (68-82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction > 50%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900-8764), 14.1% (9.0-20.3), and 103 ug/L (54-202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p = 0.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99-1.00, p = 0.347). CONCLUSIONS Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Pau Llàcer
- Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | | | | | - Rim Zakarne
- FISABIO, Universitat Jaume I, Castellón, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Ana Martínez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Luis Almenar
- Servicio de Cardiología, Hospital La Fe. Universitat de València, Valencia, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Hospital General Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Rafael De La Espriella
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain
| | - Luis Manzano
- Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias I Pujol, Badalona. Universitat Autònoma de Barcelona, Badalona, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain. .,CIBER Cardiovascular, Madrid, Spain.
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Miñana G, Gil-Cayuela C, Fácila L, Bodi V, Valero E, Mollar A, Marco M, García-Ballester T, Zorio B, Martí-Cervera J, Núñez E, Chorro FJ, Sanchis J, Núñez J. Homocysteine and long-term recurrent infarction following an acute coronary syndrome. Cardiol J 2020; 28:598-606. [PMID: 33346372 DOI: 10.5603/cj.a2020.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoint was to assess the relationship between homocysteine at discharge and very long-term recurrent myocardial infarction (MI). METHODS 1306 consecutive patients with ACS were evaluated (862 with non-ST-segment elevation ACS [NSTEACS] and 444 with ST-segment elevation myocardial infarction [STEMI]) discharged from October 2000 to June 2003 in a single teaching-center. The relationship between homocysteine at discharge and recurrent MI was evaluated through bivariate negative binomial regression accounting for mortality as a competitive event. RESULTS The mean age was 66.8 ± 12.4 years, 69.1% were men, and 32.2% showed prior diabetes mellitus. Most of the patients were admitted for an NSTEACS (66.0%). The median (interquartile range) GRACE risk score, Charlson comorbidity index, and homocysteine were 144 (122-175) points, 1 (1-2) points, and 11.9 (9.3-15.6) μmol/L, respectively. In-hospital revascularization was performed in 26.3% of patients. At a median follow-up of 9.7 (4.5-15.1) years, 709 (54.3%) deaths were registered and 779 recurrent MI in 478 (36.6%) patients. The rates of recurrent MI were higher in patients in the upper homocysteine quartiles (p < 0.001). After a multivariate adjustment, homocysteine along its continuum remained almost linearly associated with a higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001). CONCLUSIONS In patients with ACS, higher homocysteine levels identified those at a higher risk of recurrent MI at very long-term follow-up.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain
| | - Carolina Gil-Cayuela
- Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain.,Cardiocirculatory Unit, Health Research Institute of L a Fe University Hospital (IIS L a Fe), Valencia, Spain
| | - Lorenzo Fácila
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vicent Bodi
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Maria Marco
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Teresa García-Ballester
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Begoña Zorio
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain. .,Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain.
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30
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Bertomeu‐Gonzalez V, Fácila L, Palau P, Miñana G, Núñez G, Espriella R, Santas E, Núñez E, Bodí V, Chorro FJ, Cordero A, Sanchis J, Lupón J, Bayés‐Genís A, Núñez J. Effect of insulin on readmission for heart failure following a hospitalization for acute heart failure. ESC Heart Fail 2020; 7:3320-3328. [PMID: 32790113 PMCID: PMC7754754 DOI: 10.1002/ehf2.12944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/18/2020] [Accepted: 07/19/2020] [Indexed: 01/10/2023] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia—all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1 year readmission for HF in patients discharged for acute HF. Methods and results We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and 1 year readmission for HF in patients discharged after acute HF. Participants' mean age was 73.4 ± 11.2 years, 50.8% were women, 44.7% had T2DM [including 527 (18.2%) on insulin therapy], and 52.7% had preserved ejection fraction. At 1 year follow‐up, 518 (17.9%) patients had died and 693 (23.9%) were readmitted for HF. The crude risk of readmission for HF was higher in patients on insulin, with no differences in 1 year mortality. After multivariable adjustment, patients on insulin were at significantly higher risk of 1 year readmission for HF than patients with diabetes who were not on insulin (hazard ratio 1.28; 95% confidence interval 1.04–1.59, P = 0.022) and patients without diabetes (hazard ratio 1.26; 95% confidence interval 1.02–1.55, P = 0.035). Conclusion Following acute HF, patients with T2DM on insulin therapy are at increased risk of readmission for HF. Further studies unravelling the mechanisms behind this association are warranted.
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Affiliation(s)
- Vicente Bertomeu‐Gonzalez
- Cardiology Service Hospital Universitario San Juan de Alicante Alicante Spain
- Clinical Medicine Department Universidad Miguel Hernández Alicante Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
| | - Lorenzo Fácila
- Cardiology Service Hospital General Universitario de Valencia Valencia Spain
| | - Patricia Palau
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
- Department of Medicine Universitat de València Valencia Spain
| | - Gema Miñana
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
| | - Gonzalo Núñez
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
| | - Rafael Espriella
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
| | - Enrique Santas
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
| | - Eduardo Núñez
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
| | - Vicent Bodí
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
- Department of Medicine Universitat de València Valencia Spain
| | - Francisco Javier Chorro
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
- Department of Medicine Universitat de València Valencia Spain
| | - Alberto Cordero
- Cardiology Service Hospital Universitario San Juan de Alicante Alicante Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
- Department of Medicine Universitat de València Valencia Spain
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Heart Failure Unit, Cardiology Service Hospital Universitari Germans Trias i Pujol Barcelona Spain
- Department of Medicine Autonomous University of Barcelona Barcelona Spain
| | - Antoni Bayés‐Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Heart Failure Unit, Cardiology Service Hospital Universitari Germans Trias i Pujol Barcelona Spain
- Department of Medicine Autonomous University of Barcelona Barcelona Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Cardiology Service Hospital Clínico Universitario, INCLIVA Valencia Spain
- Department of Medicine Universitat de València Valencia Spain
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31
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Miñana G, Santas E, de la Espriella R, Núñez E, Lorenzo M, Núñez G, Valero E, Bodí V, Chorro FJ, Sanchis J, Cohen-Solal A, Bayés-Genís A, Núñez J. Right ventricular function and iron deficiency in acute heart failure. Eur Heart J Acute Cardiovasc Care 2020; 10:406-414. [PMID: 33620455 DOI: 10.1093/ehjacc/zuaa028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
AIMS Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF. METHODS AND RESULTS We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was defined, according to European Society of Cardiology criteria, as serum ferritin <100 mg/dL (absolute ID) or ferritin 100-299 mg/dL and transferrin saturation (TSAT) <20% (functional ID). The relationships among the exposures with right ventricular systolic function were evaluated by multivariate linear regression analyses. The mean age of the sample was 74.3 ± 10.6 years, 441 (48.8%) were female, 471 (52.2%) exhibited heart failure with preserved ejection fraction, and 677 (75.0%) showed ID. The mean LVEF, TAPSE, and TAPSE/PASP were 49 ± 15%, 18.6 ± 3.9 mm, and 0.45 ± 0.18, respectively. The median (interquartile range) amino-terminal pro-brain natriuretic peptide was 4015 (1807-8775) pg/mL. In a multivariable setting, lower TSAT and ferritin were independently associated with lower TAPSE (P < 0.05 for both comparisons). Transferrin saturation (P = 0.017), and not ferritin (P = 0.633), was independently associated with TAPSE/PASP. CONCLUSION In AHF, proxies of ID were associated with right ventricular dysfunction. Further studies should confirm these findings and evaluate the pathophysiological facts behind this association.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Alain Cohen-Solal
- Cardiology Department, UMR-S942, University of Paris, Lariboisiere Hospital, AP-HP, 2 rue ambroise pare, Paris 75010, France
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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32
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Lorenzo M, de la Espriella R, Miñana G, Núñez G, Santas E, Núñez E, Heredia R, Mollar A, Civera J, Villaescusa A, Sastre C, Conesa A, Bonanad C, Bayés-Genís A, Núñez J. Clinical profile and 1-year clinical outcomes of super elderly patients admitted with acute heart failure. Eur J Intern Med 2020; 81:78-82. [PMID: 32553586 DOI: 10.1016/j.ejim.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is scarce information about the clinical profile and prognosis of acute heart failure (AHF) at the extreme ranges of age. We aimed to evaluate the 1-year death (all-cause mortality and HF-death) and HF-rehospitalizations of patients ≥85 years admitted for AHF. METHODS We prospectively evaluated a cohort of 3054 patients admitted with AHF from 2007 to 2018 in a third-level center. Age was categorized per 10-year categories (<65 years; 65-74 years, 75-84 years, and ≥85 years). The risk of mortality and HF-rehospitalizations across age categories was evaluated with Cox regression analysis and Cox regression adapted for competing events as appropriate. RESULTS The mean age was 73.6 ± 11.2 years, 48.9% were female, and 52.8% had preserved left ventricular ejection fraction (HFpEF). A total of 414 (13.6%) patients were ≥85 years. Among this group of age, female sex and HFpEF phenotype were more frequent. At 1-year follow-up 667 all-cause deaths (22,1%), 311 HF-deaths (10.1%) and 693 HF-hospitalizations (22,7%) were recorded. After multivariable adjustment, and compared to patients <65 years, a stepwise increased risk of all-cause mortality and HF-death was found for each decade increase in age, especially for patients ≥85 years (HR=3.47; 95% CI: 2.49 - 4.84, p<0.001, HR=3.31; 95% CI: 1.95 - 5.63; p<0.001, respectively). This subgroup of patients also showed an increased risk of HF-rehospitalization (HR=1.58; 95% CI: 1.16 - 2.16, p=0.004). CONCLUSIONS Super elderly patients admitted with AHF showed a dramatically increased risk of 1-year death. This subset of patients also shown an increased risk of 1-year HF-readmission.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain; CIBER Cardiovascular
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Jose Civera
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario. Universitat de Valencia. INCLIVA. Valencia-Spain; CIBER Cardiovascular.
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de la Espriella R, Bayés-Genís A, Morillas H, Bravo R, Vidal V, Núñez E, Santas E, Miñana G, Sanchis J, Fácila L, Torres F, Górriz JL, Valle A, Núñez J. Renal function dynamics following co-administration of sacubitril/valsartan and empagliflozin in patients with heart failure and type 2 diabetes. ESC Heart Fail 2020; 7:3792-3800. [PMID: 32964683 PMCID: PMC7754982 DOI: 10.1002/ehf2.12965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/09/2020] [Revised: 06/05/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
Aims The aim of this study was to evaluate the safety profile in terms of changes in renal function after co‐treatment with sacubitril/valsartan and empagliflozin in patients with type 2 diabetes (T2D) and heart failure with reduced ejection fraction (HFrEF). Methods and results This multicentre observational analysis included 108 patients with T2D and HFrEF treated with both agents: baseline sacubitril/valsartan (Group A; n = 43), baseline empagliflozin (Group B; n = 42), or both agents initiated simultaneously (Group C; n = 23). The primary endpoint was estimated glomerular filtration rate (eGFR) dynamics across treatment groups. A binary characterization of worsening renal function (WRF)/improved renal function (IRF) was included in the primary endpoint. WRF and IRF were defined as an increase/decrease in serum creatinine ≥ 0.3 mg/dL or GFR ≥ 20%. Changes in quantitative variables were evaluated using joint modelling of survival and longitudinal data (JM). Rates and their treatment differences were determined by Poisson regression. The mean left ventricle ejection fraction and eGFR were 32 ± 6% and 70 ± 28 mL/min/1.73 m2, respectively. At a median follow‐up of 1.01 years (inter‐quartile range 0.71–1.50), 377 outpatient visits were recorded. Although there were differences in GFR trajectories over time within each treatment, they did not achieve statistical significance (omnibus P = 0.154). However, when these differences were contrasted among groups, there was a significant decrease in GFR in Group A as compared with Group B (P = 0.002). The contrast between Groups C and B was not significant (P = 0.430). These differences were also reflected when the rates for WRF and IRF were contrasted among treatments. Conclusions The co‐administration of sacubitril/valsartan and empagliflozin in patients with HFrEF and concomitant T2D appears to be safe in terms of renal function.
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Rafael Bravo
- Cardiology Department, Hospital Costa del Sol, Marbella, Spain
| | - Verónica Vidal
- Cardiology Department, Hospital General de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Lorenzo Fácila
- Cardiology Department, Hospital General de Valencia, Valencia, Spain
| | - Francisco Torres
- Cardiology Department, Hospital de Dénia-MarinaSalud, Dénia, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Dénia-MarinaSalud, Dénia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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Sanchis J, García Acuña JM, Raposeiras S, Barrabés JA, Cordero A, Martínez-Sellés M, Bardají A, Díez-Villanueva P, Marín F, Ruiz-Nodar JM, Vicente-Ibarra N, Alonso Salinas GL, Rigueiro P, Abu-Assi E, Formiga F, Núñez J, Núñez E, Ariza-Solé A. Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome. ACTA ACUST UNITED AC 2020; 74:765-772. [PMID: 32778402 DOI: 10.1016/j.rec.2020.06.015] [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] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. RESULTS In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P=.0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction=.004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P=.74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P=.016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. CONCLUSIONS In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jose María García Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Jose A Barrabés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Clínico Universitario de San Juan, Alicante, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Juan M Ruiz-Nodar
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Gonzalo L Alonso Salinas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Ramón y Cajal de Madrid, Madrid, Spain
| | - Pedro Rigueiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología. Hospital Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Frances Formiga
- Servicio de Medicina Interna, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Miñana G, de la Espriella R, Mollar A, Santas E, Núñez E, Valero E, Bodí V, Chorro FJ, Fernández-Cisnal A, Martí-Cervera J, Sanchis J, Bayés-Genís A, Núñez J. Factors associated with plasma antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide concentrations in acute heart failure. European Heart Journal. Acute Cardiovascular Care 2020; 9:437-447. [DOI: 10.1177/2048872620908033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Plasma amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 levels are positively associated with a higher risk of adverse clinical outcomes in acute heart failure. As a proxy of congestion, antigen carbohydrate 125 has also been proposed as a right-sided heart failure marker. Thus, we aimed to determine in this population the main factors – including echocardiographic right-sided heart failure parameters – associated with antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide.
Methods and results:
We prospectively included 2949 patients admitted with acute heart failure. Amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were used as dependent variables in a multivariable linear regression analysis. The mean age of the sample was 73.9±11.1 years; 48.9% were female, 35.8% showed ischaemic aetiology, and 51.6% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were 4840 (2111–9204) pg/ml and 58 (26–129) U/ml, respectively. In a multivariable setting, and ranked in order of importance (R2), estimated glomerular filtration rate (43.7%), left ventricle ejection fraction (15.1%), age (12.4%) and high-sensitivity troponin T (10.9%) emerged as the most important factors associated with amino-terminal pro-B-type natriuretic peptide. The five main factors associated with antigen carbohydrate 125 were, in order of importance: the presence of pleural effusion (36.8%), tricuspid regurgitation severity (25.1%), age (11.9%), amino-terminal pro-B-type natriuretic peptide (6.5%) and peripheral oedema (4.3%).
Conclusion:
In patients with acute heart failure the main factors associated with amino-terminal pro-B-type natriuretic peptide were renal dysfunction, left ventricle ejection fraction and age. For antigen carbohydrate 125, clinical parameters of congestion and the severity of tricuspid regurgitation were the most important predictors. These results endorse the value of antigen carbohydrate 125 as a useful marker of right-sided heart failure.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | | | - Anna Mollar
- Cardiology Department, Universitat de Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Universitat de Valencia, Spain
| | - Ernesto Valero
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Vicent Bodí
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Francisco J Chorro
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | | | | | - Juan Sanchis
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Autonomous University of Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
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Palau P, Bertomeu-González V, Sanchis J, Soler M, de la Espriella R, Domínguez E, Santas E, Núñez E, Chorro FJ, Miñana G, Bayés-Genís A, Núñez J. Efecto pronóstico diferencial de la diabetes mellitus tipo 2 en mujeres y varones con insuficiencia cardiaca y fracción de eyección conservada. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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37
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Núñez J, Bayés-Genís A, Revuelta-López E, ter Maaten JM, Miñana G, Barallat J, Cserkóová A, Bodi V, Fernández-Cisnal A, Núñez E, Sanchis J, Lang C, Ng LL, Metra M, Voors AA. Clinical Role of CA125 in Worsening Heart Failure. JACC: Heart Failure 2020; 8:386-397. [DOI: 10.1016/j.jchf.2019.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022]
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Revuelta-López E, Núñez J, Gastelurrutia P, Cediel G, Januzzi JL, Ibrahim NE, Emdin M, VanKimmenade R, Pascual-Figal D, Núñez E, Gommans F, Lupón J, Bayés-Genís A. Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study. ESC Heart Fail 2020; 7:559-566. [PMID: 32045114 PMCID: PMC7160502 DOI: 10.1002/ehf2.12607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Sacubitril/valsartan is a first‐in‐class angiotensin receptor‐neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short‐term changes in serum endorphin (EP) values and their relation with patients' physical functioning after initiation of sacubitril/valsartan treatment. Methods and results A total of 105 patients with heart failure with reduced ejection fraction, who were candidates for sacubitril/valsartan treatment, were included in this prospective, observational, multicentre, and international study. In a first visit, and in agreement with current guidelines, treatment with angiotensin‐converting enzyme inhibitors or angiotensin receptor blocker was replaced by sacubitril/valsartan because of clinical indication by the responsible physician. By protocol, patients were reevaluated at 30 days after the start of sacubitril/valsartan. Serum levels of α‐ (α‐EP), γ‐Endorphin (γ‐EP), and soluble NEP (sNEP) were measured using enzyme‐linked immunoassays. New York Heart Association (NYHA) functional class was used as an indicator of patient's functional status. Baseline median levels of circulating α‐EP, γ‐EP, and sNEP were 582 (160–772), 101 (37–287), and 222 pg/mL (124–820), respectively. There was not a significant increase in α‐EP nor γ‐EP serum values after sacubitril/valsartan treatment (P value = 0.194 and 0.102, respectively). There were no significant differences in sNEP values between 30 days and baseline (P value = 0.103). Medians (IQR) of Δα‐EP, Δγ‐EP, and ΔsNEP between 30 days and baseline were 9.3 (−34 − 44), −3.0 (−46.0 − 18.9), and 0 units (−16.4 − 157.0), respectively. In a pre–post sacubitril/valsartan treatment comparison, there was a significant improvement in NYHA class, with 36 (34.3%) patients experiencing improvement by at least one NYHA class category. Δα‐EP and ΔsNEP showed to be significantly associated with NYHA class after 30 days of treatment (P = 0.014 and P < 0.001, respectively). Δα‐EP was linear and significantly associated with NYHA class improvement after 30 days of sacubitril/valsartan treatment. Conclusions These preliminary data suggest that beyond the haemodynamic benefits achieved with sacubitril/valsartan, the altered cleavage of endorphin peptides by NEP inhibition may participate in patients' symptoms improvement.
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Affiliation(s)
- Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Paloma Gastelurrutia
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Germán Cediel
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roland VanKimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Instituto de Salud Carlos IIIC, Monforte de Lemos 3–5, Pabellón 11, Planta 028029, Madrid
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos IIIC, Monforte de Lemos 3–5, Pabellón 11, Planta 028029, Madrid
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40
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Miñana G, Núñez J, Bayés-Genís A, Revuelta-López E, Ríos-Navarro C, Núñez E, Chorro FJ, López-Lereu MP, Monmeneu JV, Lupón J, Sanchis J, Bodí V. Role of PCSK9 in the course of ejection fraction change after ST-segment elevation myocardial infarction: a pilot study. ESC Heart Fail 2020; 7:117-122. [PMID: 31903686 PMCID: PMC7083416 DOI: 10.1002/ehf2.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/20/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = -0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002). CONCLUSIONS In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Revuelta-López
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - César Ríos-Navarro
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | | | | | - Josep Lupón
- CIBER Cardiovascular, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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Núñez J, Palau P, Sastre C, D'Ascoli G, Ruiz V, Bonanad C, Miñana G, Núñez E, Sanchis J. Sex-differential effect of frailty on long-term mortality in elderly patients after an acute coronary syndrome. Int J Cardiol 2019; 302:30-33. [PMID: 31924393 DOI: 10.1016/j.ijcard.2019.12.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The potential sex-differential effect of frailty in patients with acute coronary syndromes (ACS) has not been well-evaluated. We sought to examine the sex-differential association between frailty status on long-term mortality in elderly patients with an ACS. METHODS AND RESULTS This is a prospective observational single-center study that included 488 elderly patients (>65 years) hospitalized for ACS who survived the index hospitalization. Multivariate Cox regression was used to determine the association among the exposures (interaction of sex with Fried score and sex with Fried ≥ 3) and all-cause mortality. The mean age of the sample was 78 ± 7 years; 41% were female and the median Fried score was higher in women [3 (2-3) vs. 2 (1-2) points, p < 0.001]. At a median follow-up of 3.12 years (IQR:1.38-5.13), 182 deaths (37.3%) were registered. The association of Fried ≥ 3 with mortality varied across sex (p-value for interaction = 0.022). In males, Fried ≥ 3 was independently associated with all-cause death (HR = 1.89; CI 95%:1.25-2.85, p = 0.003). However, it showed a neutral effect on women (HR = 0.92; CI 95%:0.57-1.49, p = 0.726). CONCLUSIONS In this work, we found that the frailty status assessed by Fried score was independently associated with mortality in elderly males but not in females with ACS.
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Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular
| | - Patricia Palau
- Servicio de Cardiología, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular
| | - Giulio D'Ascoli
- Division of Cardiology, University of Rome Tor Vergata, Italy
| | - Vicente Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular.
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de la Rocha-Muñoz A, Núñez E, Arribas-González E, López-Corcuera B, Aragón C, de Juan-Sanz J. E3 ubiquitin ligases LNX1 and LNX2 are major regulators of the presynaptic glycine transporter GlyT2. Sci Rep 2019; 9:14944. [PMID: 31628376 PMCID: PMC6802383 DOI: 10.1038/s41598-019-51301-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/27/2019] [Indexed: 12/15/2022] Open
Abstract
The neuronal glycine transporter GlyT2 is an essential regulator of glycinergic neurotransmission that recaptures glycine in presynaptic terminals to facilitate transmitter packaging in synaptic vesicles. Alterations in GlyT2 expression or activity result in lower cytosolic glycine levels, emptying glycinergic synaptic vesicles and impairing neurotransmission. Lack of glycinergic neurotransmission caused by GlyT2 loss-of-function mutations results in Hyperekplexia, a rare neurological disease characterized by generalized stiffness and motor alterations that may cause sudden infant death. Although the importance of GlyT2 in pathology is known, how this transporter is regulated at the molecular level is poorly understood, limiting current therapeutic strategies. Guided by an unbiased screening, we discovered that E3 ubiquitin ligase Ligand of Numb proteins X1/2 (LNX1/2) modulate the ubiquitination status of GlyT2. The N-terminal RING-finger domain of LNX1/2 ubiquitinates a cytoplasmic C-terminal lysine cluster in GlyT2 (K751, K773, K787 and K791), and this process regulates the expression levels and transport activity of GlyT2. The genetic deletion of endogenous LNX2 in spinal cord primary neurons causes an increase in GlyT2 expression and we find that LNX2 is required for PKC-mediated control of GlyT2 transport. This work identifies, to our knowledge, the first E3 ubiquitin-ligases acting on GlyT2, revealing a novel molecular mechanism that controls presynaptic glycine availability. Providing a better understanding of the molecular regulation of GlyT2 may help future investigations into the molecular basis of human disease states caused by dysfunctional glycinergic neurotransmission, such as hyperekplexia and chronic pain.
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Affiliation(s)
- A de la Rocha-Muñoz
- Centro de Biología Molecular "Severo Ochoa", Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain
- IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - E Núñez
- Centro de Biología Molecular "Severo Ochoa", Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain
- IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - E Arribas-González
- Instituto Cajal, Consejo Superior de Investigaciones Científicas, 28002, Madrid, Spain
| | - B López-Corcuera
- Centro de Biología Molecular "Severo Ochoa", Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain
- IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - C Aragón
- Centro de Biología Molecular "Severo Ochoa", Universidad Autónoma de Madrid, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain.
- IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
| | - J de Juan-Sanz
- Sorbonne Université and Institut du Cerveau et de la Moelle Epinière (ICM) - Hôpital Pitié-Salpêtrière, Inserm, CNRS, Paris, France.
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Palau P, Bertomeu-González V, Sanchis J, Soler M, de la Espriella R, Domínguez E, Santas E, Núñez E, Chorro FJ, Miñana G, Bayés-Genís A, Núñez J. Differential prognostic impact of type 2 diabetes mellitus in women and men with heart failure with preserved ejection fraction. ACTA ACUST UNITED AC 2019; 73:463-470. [PMID: 31629690 DOI: 10.1016/j.rec.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/06/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. METHODS We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). RESULTS The mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P <.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). CONCLUSIONS After an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital General de Castellón, Castellón, Spain; Unitat Predepartamental de Medicina, Universitat Jaume I, Castellón, Spain
| | - Vicente Bertomeu-González
- Servicio de Cardiología, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Departamento de Medicin a, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Meritxell Soler
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | | | - Eloy Domínguez
- Servicio de Cardiología, Hospital General de Castellón, Castellón, Spain; Unitat Predepartamental de Medicina, Universitat Jaume I, Castellón, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Departamento de Medicin a, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Antoni Bayés-Genís
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Departamento de Medicin a, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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44
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Núñez E, Ruiz de Adana R. [Incorporate hemodialysis patient's satisfaction to quality management]. J Healthc Qual Res 2019; 34:266-271. [PMID: 31713523 DOI: 10.1016/j.jhqr.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Application of Quality Function Deployment (QFD) methodology can be used to identify the requirements that determine patient perception of health care quality. The objective was to identify patient requirements in a Hemodialysis unit using QFD. MATERIAL AND METHODS Setting was Hemodialysis unit at the Infanta Sofia Hospital (Madrid). Matrix analysis based on the QFD method was performed from the qualitative approaches of the patient satisfaction. This was expressed by the Donabedian quality measurement model with a focus group for qualitative data. RESULTS The analysis of the matrix revealed the characteristics of the process which have a major influence on the service quality, related to patient satisfaction, this were recorded for future designs, services and improvements of the process, through a reliable healthcare monitoring service. CONCLUSIONS QFD allows understanding patients requirements and to include them for continuous improvement of quality in services.
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Affiliation(s)
- E Núñez
- Hospital Universitario Infanta Sofía, Madrid, España.
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45
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Sanchis J, Ruiz V, Bonanad C, Sastre C, Ruescas A, Díaz M, Rodríguez E, Valero E, García-Blas S, Carratalá A, Núñez E, Núñez J. Growth differentiation factor 15 and geriatric conditions in acute coronary syndrome. Int J Cardiol 2019; 290:15-20. [PMID: 31130280 DOI: 10.1016/j.ijcard.2019.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) is a marker of cell senescence. Age is a well-known determinant of GDF-15 levels, yet no study has analyzed the relationship between geriatric conditions and GDF-15. We hypothesize that geriatric conditions reflecting biological age might be stronger determinants of GDF-15 than chronological age in elderly patients with acute coronary syndrome. METHODS A total of 208 patients (mean age = 78.3 ± 7.0 years) were included. Prior to discharge, a thorough geriatric assessment was performed and GDF-15 measured. Predictors of GDF-15 (transformed by its natural logarithm) were determined with linear regression. Furthermore, Cox regression was used for the analysis of all-cause mortality. The median follow-up was 728 days. RESULTS Median GDF-15 concentration was 2432 pg/ml. In multivariate analysis, frailty (Fried score, p = 0.001), and comorbidity (Charlson index, p = 0.003) were independent determinants of lnGDF-15 while age was not significant (p = 0.17). Other covariates included in the model were male gender (p = 0.017), diabetes (p = 0.169), Killip class ≥2 (p = 0.046) and glomerular filtration rate (p = 0.001). The Fried score and Charlson index provided significant incremental value in the R2 model (0.362 vs 0.447; p = 0.0001). A total of 66 (32%) patients died. LnGDF-15 was a significant mortality predictor (HR = 1.82, 95% CI 1.12-2.94, p = 0.015) along with the Fried score (p = 0.013) and the Charlson index (p = 0.030). CONCLUSIONS Geriatric conditions are strong determinants of GDF-15 levels on top of age in acute coronary syndromes. Furthermore, GDF-15 was associated with mortality independently of geriatric status. Geriatric assessment and GDF-15 are complementary tools.
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Affiliation(s)
- Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
| | - Vicente Ruiz
- Facultat d'Infermeria, Universitat de València, València, Spain
| | - Clara Bonanad
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Clara Sastre
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arantxa Ruescas
- Departament de Fisioteràpia, Universitat de València, València, Spain
| | - Macarena Díaz
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Enrique Rodríguez
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Ernesto Valero
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Sergio García-Blas
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Arturo Carratalá
- Servei de Bioquímica Clínica, Hospital Clínic Universitari de València, València, Spain
| | - Eduardo Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
| | - Julio Núñez
- Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain
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46
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De la Espriella R, Santas E, Chorro FJ, Miñana G, Soler M, Bodí V, Valero E, Núñez E, Bayés-Genis A, Lupón J, Sanchis J, Núñez J. Functional tricuspid regurgitation and recurrent admissions in patients with acute heart failure. Int J Cardiol 2019; 291:83-88. [PMID: 30955879 DOI: 10.1016/j.ijcard.2019.03.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/05/2018] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) is a common echocardiographic finding in patients with heart failure (HF), and its role in disease progression and prognosis stratification is becoming increasingly relevant in recent years. However, data regarding its association with the burden of HF-readmission is scarce. In this work, we sought to evaluate the association between TR severity and HF-related readmissions following a hospitalization for acute heart failure (AHF). METHODS We prospectively included a cohort of 2101 patients admitted with the diagnosis of AHF. TR severity was assessed using a multiparametric integrative approach, and classified as none, mild, moderate, and severe. We used negative binomial regression to identify the association between TR grade and HF-related recurrent admissions. The risk associated to severity of TR was expressed as incidence rate ratio (IRR). RESULTS At a median follow-up of 2.53 years (IQR: 1.03-4.36), 978 (46.5%) patients died, and 1657 HF-readmissions occurred in 842 patients (40.0%). The proportion of patients with two or more admissions was 18.4%. The proportion of patients with moderate to severe TR was 17.2%. There was a stepwise increase in the incidence of readmissions from none to severe TR. After multivariable adjustment, only patients with severe TR were independently associated with higher risk of recurrent HF admissions (IRR = 1.34, CI 95%: 1.05-1.71; p = .019). CONCLUSIONS In patients with AHF, severe functional TR is independently associated with an increased risk of long-term recurrent HF hospitalizations.
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Affiliation(s)
- Rafael De la Espriella
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Meritxell Soler
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Antoni Bayés-Genis
- CIBER Cardiovascular, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Lupón
- CIBER Cardiovascular, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain; INCLIVA, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Spain.
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47
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Li S, Marcus P, Núñez J, Núñez E, Sanchis J, Levy WC. Validity of the Seattle Heart Failure Model after heart failure hospitalization. ESC Heart Fail 2019; 6:509-515. [PMID: 30825268 PMCID: PMC6487734 DOI: 10.1002/ehf2.12427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/04/2018] [Accepted: 02/08/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS Heart failure hospitalization is a sentinel event associated with increased mortality risk. Whether long-term heart failure risk models such as the Seattle Heart Failure Model (SHFM) accurately assess risk in the post-hospital setting is unknown. METHODS AND RESULTS The SHFM was applied to a cohort of 2242 consecutive patients (50% women; mean age 73) on discharge after acute heart failure hospitalization and analysed for the primary endpoint of all-cause mortality. Model discrimination and calibration were assessed. Direct patient-level comparison between our study cohort and the original SHFM cohorts was also performed to confirm and quantify the degree and extent of increased mortality risk attributable to post-hospital status. The SHFM demonstrated good overall risk discrimination (area under the receiver operating characteristic curve 0.704) and was well calibrated in patients <65 years old. The SHFM significantly underestimated mortality risk in patients ≥65 years old post-hospitalization. Direct patient-level comparison revealed a stepwise increase in adjusted mortality risk attributable to post-hospital status for each advancing age group ≥65 years old. This heightened mortality risk showed a diminishing trend over 18 months after discharge. CONCLUSIONS The SHFM accurately predicts mortality risk in younger patients after acute heart failure hospitalization. However, patients ≥65 years old had increased adjusted mortality risk for up to 18 months after discharge compared with ambulatory heart failure patients, a pattern consistent with the well-described post-hospital syndrome.
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Affiliation(s)
- Song Li
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Patrick Marcus
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA, USA
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48
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Miñana G, Núñez J, Bayés-Genís A, Revuelta-López E, Ríos-Navarro C, Núñez E, Chorro FJ, López-Lereu MP, Monmeneu JV, Lupón J, Bodí V. ST2 and left ventricular remodeling after ST-segment elevation myocardial infarction: A cardiac magnetic resonance study. Int J Cardiol 2018; 270:336-342. [DOI: 10.1016/j.ijcard.2018.06.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/04/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
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Núñez J, Núñez E, Sanchis J, Bayés-Genís A. Response by Núñez et al to Letter Regarding Article, "Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality". Circulation 2018; 138:1613-1614. [PMID: 30354511 DOI: 10.1161/circulationaha.118.036024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Spain (J.N., E.N., J.S.).,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., J.S., A.B.-G.)
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Spain (J.N., E.N., J.S.)
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Spain (J.N., E.N., J.S.).,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., J.S., A.B.-G.)
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., J.S., A.B.-G.).,Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, Autonomous University of Barcelona, Spain (A.B.-G.)
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de la Espriella-Juan R, Núñez E, Miñana G, Sanchis J, Bayés-Genís A, González J, Chorro J, Núñez J. Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness. ESC Heart Fail 2018; 5:1173-1175. [PMID: 30295431 PMCID: PMC6300820 DOI: 10.1002/ehf2.12362] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 11/08/2022] Open
Abstract
The aim of this case report is to assess the potential role of intrarenal Doppler ultrasonography as a non-invasive method to evaluate intrarenal venous flow (IRVF) in acute heart failure (AHF) and concomitant renal dysfunction. We report a case of an 81-year-old woman with valvular heart disease (previous mitral valve replacement) that presented with acutely decompensated heart failure and concomitant worsening renal function (WRF). In addition to complete physical examination, laboratory analysis, and echocardiography, IRVF was assessed at baseline and 48 h after the administration of diuretic treatment. At admission, physical examination and echocardiography revealed signs of intravascular congestion (jugular venous distension and severely dilated inferior vena cava). In addition, a significant increase in serum creatinine from 1.23 to 1.81 mg/dL was noted without signs of hypoperfusion at clinical evaluation. At baseline, intrarenal Doppler ultrasonography showed a monophasic IRVF pattern indicating a severely elevated interstitial renal pressure. After aggressive decongestion, a dynamic behaviour was found in IRVF changing from monophasic to biphasic pattern in parallel with an improvement in clinical parameters and renal function (serum creatinine changed from 1.81 to 1.44 mg/dL). In this case of a patient with AHF and WRF, IRVF changed after aggressive decongestion in agreement with clinical evolution. According to these findings, this technique could provide valuable information for identifying patients with a 'congestion kidney failure' phenotype. Further studies are needed confirming this observation and evaluating the potential role of this technique for guiding decongestive therapy in patients with AHF and WRF.
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Affiliation(s)
- Rafael de la Espriella-Juan
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jessika González
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Javier Chorro
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
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