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Núñez E, Santas E, Merenciano H, Lorenzo-Hernández M, Mollar A, Miñana G, Palau P, Fuertes L, Valero E, de la Espriella R, Bodí V, Sanchis J, Bayés-Genís A, Núñez J. Differential sex-related effect of left ventricular ejection fraction trajectory on the risk of mortality and heart failure readmission following hospitalization for acute heart failure: A longitudinal study. Eur J Heart Fail 2024. [PMID: 38679819 DOI: 10.1002/ejhf.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/18/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
AIMS There is limited information on the sex-specific longitudinal changes of left ventricular ejection fraction (LVEF) after an acute heart failure (AHF) hospitalization. We aimed to investigate whether LVEF trajectories over time and their impact on mortality and AHF readmission rates differ between men and women. METHODS AND RESULTS We conducted a retrospective sex-specific analysis of longitudinal LVEF measurements (n = 9581) in 3383 patients with an index hospitalization for AHF in a single tertiary-level hospital. Statistical techniques suited for longitudinal data analysis were used. The mean age of the sample was 73.8 ± 11.2 years, and 47.9% were women. The mean LVEF was 49.4 ± 15.3%. At a median follow-up of 2.58 years (interquartile range 0.77-5.62), we registered 2197 deaths (64.9%) and 2597 AHF readmissions in 1302 (38.5%) patients. The longitudinal analysis showed that women had consistently higher LVEF values throughout the follow-up with both trajectories characterized by an early peak-approximately at 1 year-followed by decreasing values in men but a plateau in women. Multivariate between-sex comparisons across LVEF categories revealed that women had lower rates of AHF readmissions when LVEF ≤40%. On the contrary, women displayed an excess risk of AHF readmissions when LVEF >60%. A trend in the same direction was found for cardiovascular and all-cause mortality. CONCLUSION Sex was a significant factor in determining the follow-up trajectory of LVEF and predicting differences in outcomes after an AHF admission. The findings suggest that women have a higher risk of AHF readmissions at higher LVEF values, while men have a higher risk at lower LVEF values. For all-cause and cardiovascular mortality, the same direction of the association was inferred but they were not significant.
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Affiliation(s)
- Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Hector Merenciano
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Miguel Lorenzo-Hernández
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Laura Fuertes
- Cardiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
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Santas E, Del Canto I, Cardells I, Miñana G, Llàcer P, Almenar L, Fácila L, Maceira AM, Sanchis J, Núñez J. Improvement in left atrial strain following ferric carboxymaltose in heart failure: an analysis of the Myocardial-IRON trial. ESC Heart Fail 2024; 11:1258-1262. [PMID: 38115745 DOI: 10.1002/ehf2.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS Iron deficiency (ID) is associated with an impaired cardiac function and remodelling in heart failure (HF). Treatment with ferric carboxymaltose (FCM) has been showed recently to improve biventricular systolic function and ventricular strain parameters in patients with HF with reduced ejection fraction and ID, but there is no evidence on the benefit of FCM on the left atrium (LA). In this study, we aimed to evaluate the effect of FCM on LA longitudinal strain (LA-LS). METHODS AND RESULTS This is a post hoc subanalysis of a double-blind, placebo-controlled, randomized clinical trial that enrolled 53 ambulatory patients with HF, left ventricular ejection fraction (LVEF) < 50%, and ID [Myocardial-IRON trial (NCT03398681)], treated with FCM or placebo. Cardiac magnetic resonance-featured tracking (CMR-FT) strain changes were evaluated before and 7 and 30 days after randomization using linear mixed regression analysis. The median age of the sample was 68 years (interquartile range: 64-76), and 20 (69%) were men. Mean ± standard deviation of LVEF was 39 ± 11%, and most (97%) were in stable New York Heart Association class II. At baseline, mean LA-LS was -8.9 ± 3.5%. At 30 days, and compared with placebo, LA-LS significantly improved in those allocated to FCM treatment arm (LA-LS = -12.0 ± 0.5 and -8.5 ± 0.6, respectively; - ∆ 3.55%, P < 0.001). CONCLUSIONS In patients with stable HF, LVEF < 50%, and ID, treatment with FCM was associated with short-term improvements in LA-LS assessed by CMR-FT. Future works should assess the potential benefit of iron repletion on LA function.
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Affiliation(s)
- Enrique Santas
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Irene Del Canto
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Ingrid Cardells
- Department of Cardiology, Hospital de Manises, Valencia, Spain
| | - Gema Miñana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Valencia, Spain
| | - Pau Llàcer
- Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain
| | - Luis Almenar
- Department of Cardiology, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - Lorenzo Fácila
- Department of Cardiology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Alicia M Maceira
- Cardiovascular Imaging Unit, Ascires Biomedical Group, Valencia, Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Valencia, Spain
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
- CIBER Cardiovascular, Valencia, Spain
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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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Santas E, Llácer P, Palau P, de la Espriella R, Miñana G, Lorenzo M, Núñez-Marín G, Miró Ò, Chorro FJ, Bayés-Genís A, Sanchis J, Núñez J. Noncardiovascular morbidity and mortality across left ventricular ejection fraction categories following hospitalization for heart failure. Rev Esp Cardiol (Engl Ed) 2024; 77:206-214. [PMID: 37315921 DOI: 10.1016/j.rec.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Noncardiovascular events represent a significant proportion of the morbidity and mortality burden in patients with heart failure (HF). However, the risk of these events appears to differ by left ventricular ejection fraction (LVEF) status. In this study, we sought to evaluate the risk of noncardiovascular death and recurrent noncardiovascular readmission by LVEF status following an admission for acute HF. METHODS We retrospectively assessed a cohort of 4595 patients discharged after acute HF in a multicenter registry. We evaluated LVEF as a continuum, stratified in 4 categories (LVEF ≤ 40%, 41%-49%, 50%-59%, and ≥ 60%). Study endpoints were the risks of noncardiovascular mortality and recurrent noncardiovascular admissions during follow-up. RESULTS At a median follow-up of 2.2 [interquartile range, 0.76-4.8] years, we registered 646 noncardiovascular deaths and 4014 noncardiovascular readmissions. After multivariable adjustment including cardiovascular events as a competing event, LVEF status was associated with the risk of noncardiovascular mortality and recurrent noncardiovascular admissions. When compared with patients with LVEF ≤ 40%, those with LVEF 51%-59%, and especially those with LVEF ≥ 60%, were at higher risk of noncardiovascular mortality (HR, 1.31; 95%CI, 1.02-1,68; P=.032; and HR, 1.47; 95%CI, 1.15-1.86; P=.002; respectively), and at higher risk of recurrent noncardiovascular admissions (IRR, 1.17; 95%CI, 1.02-1.35; P=.024; and IRR, 1.26; 95%CI, 1.11-1.45; P=.001; respectively). CONCLUSIONS Following an admission for HF, LVEF status was directly associated with the risk of noncardiovascular morbidity and mortality. Patients with HFpEF were at higher risk of noncardiovascular death and total noncardiovascular readmissions, especially those with LVEF ≥ 60%.
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Affiliation(s)
- Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Pau Llácer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Gonzalo Núñez-Marín
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genís
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), 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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Lorenzo M, Núñez G, Fuertes-Kenneally L, de la Espriella R, Villar S, Miró O, Llorens P, Santas E, Miñana G, Bodí V, Sanchis J, Carratalá A, Bayés-Genís A, Núñez J. Early glomerular filtration rates changes and risk of mortality in acute heart failure. The modifying role of admission renal function and decongestion. Eur J Intern Med 2023; 115:96-103. [PMID: 37316355 DOI: 10.1016/j.ejim.2023.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The pathophysiology of changes in estimated glomerular filtration rate (eGFR) in acute heart failure (AHF) is complex and multifactorial. We evaluated the associated mortality risk of early changes in eGFR across baseline renal function on admission and early changes in natriuretic peptides in patients admitted with AHF. METHODS We retrospectively evaluated 2,070 patients admitted with AHF. Renal dysfunction on admission was defined as eGFR<60 ml/min/1.73m2 and successful decongestion as NT-proBNP decreased >30% from baseline. We assessed the mortality risk associated with eGFR changes from baseline at 48-72 h after admission (ΔeGFR%) according to baseline renal function, and NT-proBNP changes at 48-72 h through Cox regression analyses. RESULTS The mean age was 74.4 ± 11.2 years, and 930 (44.9%) were women. The proportion of admission eGFR<60 ml/min/1.73m2 and 48-72 h changes in NT-proBNP>30% were 50.5% and 32.8%, respectively. At a median follow-up of 1.75 years, 928 deaths were registered. In the whole sample, changes in renal function were not associated with mortality (p = 0.208). The adjusted analysis revealed that the risk of mortality related to ΔeGFR% was heterogeneous across baseline renal function and changes in NT-proBNP (p-value for interaction=0.003). ΔeGFR% was not associated with mortality in patients with baseline eGFR≥60 ml/min/1.73m2. In those with eGFR<60 ml/min/1.73m2, a decrease in eGFR was associated with higher mortality, particularly in those with a reduction in NT-proBNP<30%. CONCLUSION In patients with AHF, early ΔeGFR% was associated with the risk of long-term mortality only in patients with renal dysfunction on admission and no early decline in NT-proBNP.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Oscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Arturo Carratalá
- Department of Clinical Chemistry, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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7
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Pascual-Figal DA, Zamorano JL, Domingo M, Morillas H, Nuñez J, Cobo Marcos M, Riquelme-Pérez A, Teis A, Santas E, Caro-Martinez C, Pinilla JM, Rodriguez-Palomares JF, Dobarro D, Restrepo-Córdoba MA, González-Juanatey JR, Bayés Genís A. Impact of dapagliflozin on cardiac remodelling in patients with chronic heart failure: The DAPA-MODA study. Eur J Heart Fail 2023; 25:1352-1360. [PMID: 37211950 DOI: 10.1002/ejhf.2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, specifically left atrial (LA) remodelling, is not well established. METHODS AND RESULTS The DAPA-MODA trial (NCT04707352) is a multicentre, single-arm, open-label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline-directed therapy, except for any sodium-glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core-lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2 ) and LA parameters were similar between LVEF-based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (-6.6% [95% confidence interval -11.1, -1.8], p = 0.008), primarily due to a decrease in reservoir volume (-13.8% [95% confidence interval -22.5, -4], p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (-13.9% [95% confidence interval -18.7, -8.7], p < 0.001), end-diastolic volume (-8.0% [95% confidence interval -11.6, -4.2], p < 0.001) and end-systolic volume (-11.9% [95% confidence interval -16.7, -6.8], p < 0.001) at 180 days. N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed a significant reduction at 180 days (-18.2% [95% confidence interval -27.1, -8.2], p < 0.001), without changes in filling Doppler measures. CONCLUSION Dapagliflozin administration in stable out-setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT-proBNP concentrations.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - J Luis Zamorano
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | | | - Julio Nuñez
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Riquelme-Pérez
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - Albert Teis
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cesar Caro-Martinez
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
| | - Jose Manuel Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jose F Rodriguez-Palomares
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Dobarro
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Álvaro Cunqueiro, IIS Galicia Sur, Vigo, Spain
| | | | - J Ramón González-Juanatey
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Bayés Genís
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
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Núñez-Marín G, Iraola D, Lorenzo M, de la Espriella R, Villar S, Santas E, Miñana G, Sanchis J, Carratalá A, Miró Ò, Bayés-Genís A, Núñez J. An update on utilising brain natriuretic peptide for risk stratification, monitoring and guiding therapy in heart failure. Expert Rev Mol Diagn 2023:1-13. [PMID: 37216616 DOI: 10.1080/14737159.2023.2216386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Heart failure (HF) is a dominant health problem with an overall poor prognosis. Natriuretic peptides (NPs) are upregulated in HF as a compensatory mechanism. They have extensively been used for diagnosis and risk stratification. AREAS COVERED This review addresses the history and physiology of NPs in order to understand their current role in clinical practice. It further provides a detailed and updated narrative review on the utility of those biomarkers for risk stratification, monitoring, and guiding therapy in HF. EXPERT OPINION NPs show excellent predictive ability in heart failure patients, both in acute and chronic settings. Understanding their pathophysiology and their modifications in specific situations is key for an adequate interpretation in specific clinical scenarios in which their prognostic value may be weaker or less well evaluated. To better promote risk stratification in HF, NPs should be integrated with other predictive tools to develop multiparametric risk models. Both inequalities of access to NPs and evidence caveats and limitations will need to be addressed by future research in the coming years.
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Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Diego Iraola
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Arturo Carratalá
- Clinical Chemistry Department, Hospital Clínico Universitario, INCLIVA
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germas Trias i Pujol. Badalona, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Palau P, Mendez J, Santas E, Núñez J, López L, Briatore A, Domínguez E. Maximal functional capacity in subjects with isolated left bundle branch block: A pilot study. Clin Cardiol 2023; 46:386-389. [PMID: 36756685 PMCID: PMC10106657 DOI: 10.1002/clc.23977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/12/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) has been commonly associated with adverse cardiovascular (CV) events, but the effect of an isolated LBBB on maximal functional capacity is not well characterized. OBJECTIVE To evaluate maximal functional capacity in adults with isolated LBBB and compare it to healthy population-derived predicted values (adjusted for sex, age, weight, and height). METHODS This descriptive pilot study included subjects with isolated LBBB derived from outpatient clinics of two academic hospitals. All subjects underwent maximal cardiopulmonary exercise testing (CPET) and a Global Physical Activity Questionnaire (GPAQ). The primary outcome was to evaluate maximal functional capacity according to population-derived predicted values of peak oxygen consumption (peakVO2 ): pp-peakVO2 . The secondary outcome was to report adverse CV events (CV deaths or hospitalizations) at follow-up. RESULTS A total of 27 (18 women and 9 men) participants were included. The median (interquartile range) age of the sample and time to screening from the first LBBB diagnosis were 62 (51-71) and 3.4 (1.1-8.4) years, respectively. The results of the GPAQ score showed that 19 patients were highly active, and 8 were moderately active. The median of peakVO2 and pp-peakVO2 were 19.3 (15-22.5) ml/kg/min and 88% (79.3%-104.4%), respectively. There were no adverse CV events at a median follow-up after CPET of 3.1 (2.7-3.4) years. CONCLUSION In this pilot study, adults with isolated LBBB showed reduced maximal functional capacity, despite the absence of cardiac disease and a baseline moderate to highly active lifestyle.
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Jose Mendez
- Cardiology Department, IMED Elche, Alicante, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Laura López
- Facultad de Fisioterapia, Universitat de València, Valencia, Spain
| | | | - Eloy Domínguez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.,Fisabio, Universitat Jaume I, Castellón, Spain
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de la Espriella R, Amiguet M, Miñana G, Rodríguez JC, Moyano P, Segarra D, Fernández J, Santas E, Núñez G, Lorenzo M, Bonanad C, Alania E, Valle A, Sanchis J, Bodí V, Górriz JL, Navarro J, Codina P, Voors AA, Bayés-Genís A, Núñez J. Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure. Eur J Heart Fail 2022; 24:2108-2117. [PMID: 36054502 DOI: 10.1002/ejhf.2651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Bendopnea is a clinical symptom of advanced heart failure with uncertain prognostic value. We aimed to evaluate whether bendopnea and the change in oxygen saturation when bending forward (bending oxygen saturation index [BOSI]) are associated with adverse outcomes in ambulatory chronic heart failure (CHF) patients. METHODS AND RESULTS We prospectively evaluated 440 subjects with symptomatic CHF. BOSI was defined as the difference between sitting and bending oxygen saturation (SpO2 ). The endpoint was the total number of worsening heart failure (WHF) events (heart failure hospitalization or urgent heart failure visit requiring parenteral diuretic therapy). The mean age was 74 ± 10 years, 257 (58.6%) were male, and 226 (51.4%) had a left ventricular ejection fraction <50%. Bendopnea was present in 94 (21.4%) patients, and 120 (27.3%) patients had a BOSI ≥-3%. The agreement between BOSI ≥-3% and bendopnea was moderate (Gwet's AC 0.482, p < 0.001). At a median (p25%-p75%) follow-up of 2.17 years (0.88-3.16), we registered 441 WHF events in 148 patients. After multivariable adjustment, BOSI was independently associated with the risk for total WHF episodes (overall, p < 0.001). Compared to improvement/no change in SpO2 when bending (BOSI 0%), those with BOSI ≥-3% showed an increased risk of WHF events (incidence rate ratio [IRR] 2.16, 95% confidence interval [CI] 1.67-2.79; p < 0.001). In contrast, bendopnea was not associated with the risk of total WHF episodes (IRR 1.04, 95% CI 0.83-1.31; p = 0.705). CONCLUSIONS In ambulatory and stable CHF patients, BOSI ≥-3% and not bendopnea was independently associated with an increased risk of total (first and recurrent) WHF episodes. Awareness of SpO2 while assessing bendopnea may be a useful tool for predicting heart failure decompensations.
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Martina Amiguet
- Cardiology Department, Hospital General de Castellón, Castellón, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Juan Carlos Rodríguez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Patricia Moyano
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Daniel Segarra
- Hospital Politécnico Universitario La Fe, Valencia, Spain
| | - Julio Fernández
- Gestión Sanitaria, Conselleria de Sanidad, Generalitat Valenciana, Valencia, Spain.,Departamento de Enfermería, Universidad de Valencia, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Edgardo Alania
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Jose Luis Górriz
- Department of Medicine, Universitat de Valencia, Valencia, Spain.,Nephrology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jorge Navarro
- Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Pau Codina
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Adriaan A Voors
- Department of Cardiology University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain.,Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
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de la Espriella R, Navarro J, Mollar A, D'Marco L, Palau P, Miñana G, Llácer P, Santas E, Heredia R, González M, Górriz JL, Codina P, Díez J, Bayés-Genís A, Núñez J. Long-Term Prognostic Impact of Estimated Glomerular Filtration Rate on Admission in Patients Hospitalized for Acute Heart Failure. Cardiorenal Med 2022; 12:179-188. [PMID: 36282062 DOI: 10.1159/000526105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/15/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Although small-sample size studies have shown that basal alterations of estimated glomerular filtration rate (eGFR) are related to short- and mid-term higher mortality in acute heart failure (AHF), there is scarce information on the influence of an altered eGFR on long-term mortality and readmissions. Therefore, this multicenter study sought to investigate the relationship between eGFR on admission for AHF and both long-term mortality and readmissions in a large sample of patients. METHODS We retrospectively evaluated 4,595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 1, 2008, to January 1, 2020. To investigate the effect of eGFR on admission with long-term morbimortality, we stratified the patients according to four eGFR categories: <30 mL·min-1·1.73 m-2 (G4 and G5 patients, n = 534), 30-44 mL·min-1·1.73 m-2 (G3b patients, n = 882), 45-59 mL·min-1·1.73 m-2 (G3a patients, n = 1,080), and ≥60 mL·min-1·1.73 m-2 (G1 and G2 patients, n = 2,099). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation within the first 24 h following admission. RESULTS At a median follow-up of 2.20 years, multivariate analyses revealed that compared to G1 and G2 patients, G4 and G5 patients exhibited a higher risk of all-cause (HR = 1.15, 95% CI: 01.02-1.30, p = 0.020) and cardiovascular (CV) (HR = 1.20, 95% CI: 1.04-1.39, p = 0.013) mortality. Similarly, multivariate analyses also showed that the lower the eGFR, the higher the risk of readmissions. In fact, compared to G1 and G2 patients, G4 and G5 patients displayed significantly increased incident rate ratios of total all-cause (28%), CV (26%), and HF-related (30%) readmissions. CONCLUSION Data from this large study provide evidence that an eGFR below 30 mL·min-1·1.73 m-2 on admission could be an independent predictor for long-term mortality and readmissions in patients with AHF.
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Affiliation(s)
| | - Jorge Navarro
- Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Luis D'Marco
- Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Miguel González
- Department of Medicine, Universitat de Valencia, Valencia, Spain.,Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - José Luis Górriz
- Department of Medicine, Universitat de Valencia, Valencia, Spain.,Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - Pau Codina
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Center of Applied Medical Research, University of Navarra, Pamplona, Spain.,Centro de investigación biomédica en red (CIBER) Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genís
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centro de investigación biomédica en red (CIBER) Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de investigación biomédica en red (CIBER) Cardiovascular, Madrid, Spain
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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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Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
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Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
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14
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Palau P, Amiguet M, Domínguez E, Sastre C, Mollar A, Seller J, Pinilla JMG, Larumbe A, Valle A, Doblas JJG, de la Espriella R, Miñana G, Mezcua AR, Santas E, Bodí V, Sanchis J, Pascual-Figal D, Górriz JL, Baýes-Genís A, Núñez J. Short-term Effects of Dapagliflozin on Maximal Functional Capacity in Heart Failure with Reduced Ejection Fraction (DAPA-VO 2 ): A Randomized Clinical Trial. Eur J Heart Fail 2022; 24:1816-1826. [PMID: 35604416 DOI: 10.1002/ejhf.2560] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS This study aimed to evaluate the effect of dapagliflozin on 1 and 3-month maximal functional capacity in patients with stable heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS In this multicenter, randomized, double-blinded clinical trial, 90 stable patients with HFrEF were randomly assigned to receive either dapagliflozin (n=45) or placebo (n=45) (http://clinicaltrials.gov identifier: NCT04197635). The primary outcome was a change in peak oxygen consumption (peakVO2 ) at 1 and 3-month. Secondary endpoints were changes at 1 and 3-month in the distance walked in 6 minutes (6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire -MLHFQ-), and echocardiographic parameters (diastolic function, left chambers volumes, and left ventricular ejection fraction). We used linear mixed regression analysis to compare endpoints changes. Estimates were adjusted for multiple comparisons. The mean age was 67.1 ± 10.7 years, 63 (76.7%) were men, 29 (32.2%) had type-2 diabetes, and 80 (89.9%) were on NYHA II. The baseline means of peakVO2 , 6MWT and MLHFQ were 13.2±3.5 mL/kg/min, 363±110 meters, and 23.1±16.2, respectively. The median (p25%-p75%) of N-terminal pro-brain natriuretic peptide was 1221 pg/ml (889-2100). Most patients were on treatment with sacubitril/valsartan (88.9%), beta-blockers (91.1%), and aldosterone receptor antagonists (74.4%). PeakVO2 significantly increased in patients on treatment with dapagliflozin (1-month: +Δ 1.09 mL/kg/min, CI 95%=0.14-2.04; p=0.021 and 3-month: +Δ 1.06 mL/kg/min, CI 95%=0.07-2.04; p=0.032). Similar positive findings were found when evaluating changes from baseline. We did not find significant differences in secondary endpoints. CONCLUSIONS Among patients with stable HFrEF, dapagliflozin resulted in a significant improvement in peakVO2 at 1 and 3-month.
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | | | | | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Jose Manuel Garcia Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Ainoha Larumbe
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Jose Gómez Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Rafael de la Espriella
- 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
| | - Ainhoa Robles Mezcua
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Enrique Santas
- Cardiology 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
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jose Luis Górriz
- Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Antonio Baýes-Genís
- CIBER Cardiovascular.,Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
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15
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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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16
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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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17
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Del Canto I, Santas E, Cardells I, Miñana G, Palau P, Llàcer P, Fácila L, López-Vilella R, Almenar L, Bodí V, López-Lereu MP, Monmeneu JV, Sanchis J, Moratal D, Maceira AM, de la Espriella R, Chorro FJ, Bayés-Genís A, Núñez J. Short-Term Changes in Left and Right Ventricular Cardiac Magnetic Resonance Feature Tracking Strain Following Ferric Carboxymaltose in Patients With Heart Failure: A Substudy of the Myocardial-IRON Trial. J Am Heart Assoc 2022; 11:e022214. [PMID: 35301854 PMCID: PMC9075490 DOI: 10.1161/jaha.121.022214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The mechanisms explaining the clinical benefits of ferric carboximaltose (FCM) in patients with heart failure, reduced or intermediate left ventricular ejection fraction, and iron deficiency remain not fully clarified. The Myocardial‐IRON trial showed short‐term cardiac magnetic resonance (CMR) changes suggesting myocardial iron repletion following administration of FCM but failed to find a significant increase in left ventricular ejection fraction in the whole sample. Conversely, the strain assessment could evaluate more specifically subtle changes in contractility. In this subanalysis, we aimed to evaluate the effect of FCM on the short‐term left and right ventricular CMR feature tracking derived strain. Methods and Results This is a post hoc subanalysis of the double‐blind, placebo‐controlled, randomized clinical trial that enrolled 53 ambulatory patients with heart failure and left ventricular ejection fraction <50%, and iron deficiency [Myocardial‐IRON trial (NCT03398681)]. Three‐dimensional left and 2‐dimensional right ventricular CMR tracking strain (longitudinal, circumferential, and radial) changes were evaluated before, 7 and 30 days after randomization using linear mixed‐effect analysis. The median (interquartile range) age of the sample was 73 years (65–78), and 40 (75.5%) were men. At baseline, there were no significant differences in CMR feature tracking strain parameters across both treatment arms. At 7 days, the only global 3‐dimensional left ventricular circumferential strain was significantly higher in the FCM treatment‐arm (difference: −1.6%, P=0.001). At 30 days, and compared with placebo, global 3‐dimensional left ventricular strain parameters significantly improved in those allocated to FCM treatment‐arm [longitudinal (difference: −2.3%, P<0.001), circumferential (difference: −2.5%, P<0.001), and radial (difference: 4.2%, P=0.002)]. Likewise, significant improvements in global right ventricular strain parameters were found in the active arm at 30 days (longitudinal [difference: −3.3%, P=0.010], circumferential [difference: −4.5%, P<0.001], and radial [difference: 4.5%, P=0.027]). Conclusions In patients with stable heart failure, left ventricular ejection fraction <50%, and iron deficiency, treatment with FCM was associated with short‐term improvements in left and right ventricular function assessed by CMR feature tracking derived strain parameters. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03398681.
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Affiliation(s)
- Irene Del Canto
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain.,Center for Biomaterials and Tissue Engineering Universitat Politècnica de València Valencia Spain
| | - Enrique Santas
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | | | - Gema Miñana
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | - Patricia Palau
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | - Pau Llàcer
- Internal Medicine Department Hospital de Manises Manises Spain
| | - Lorenzo Fácila
- Cardiology Department Hospital General Universitario de Valencia Valencia Spain
| | | | - Luis Almenar
- Cardiology Department Hospital Universitario La Fe de Valencia Valencia Spain
| | - Vicent Bodí
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | | | - Jose V Monmeneu
- Cardiovascular Imaging Unit Ascires Biomedical GroupValencia Spain
| | - Juan Sanchis
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering Universitat Politècnica de València Valencia Spain
| | - Alicia M Maceira
- Cardiovascular Imaging Unit Ascires Biomedical GroupValencia Spain
| | - Rafael de la Espriella
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
| | - Francisco J Chorro
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA 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.,Universitat Autonoma de Barcelona Barcelona Spain
| | - Julio Núñez
- Cardiology Department Hospital Clínico Universitario de ValenciaUniversitat de ValenciaINCLIVA Valencia Spain.,CIBER Cardiovascular Madrid Spain
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18
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de la Espriella R, Santas E, Zegri Reiriz I, Górriz JL, Cobo Marcos M, Núñez J. Quantification and treatment of congestion in heart failure: A clinical and pathophysiological overview. Nefrologia 2022; 42:145-162. [PMID: 36153911 DOI: 10.1016/j.nefroe.2021.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 06/16/2023] Open
Abstract
Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion assessment, monitoring, and treatment represent a real challenge in daily clinical practice. This document reviewed historical and contemporary evidence of available methods for determining volume status and discuss pharmacological aspects and pathophysiological principles that underlie diuretic use.
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Affiliation(s)
- Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain
| | - Isabel Zegri Reiriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Luis Górriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; Departamento de Medicina, Universidad de Valencia, Spain
| | - Marta Cobo Marcos
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; CIBER Cardiovascular, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Spain.
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19
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Marcos-Garces V, Gabaldon-Perez A, Merenciano-Gonzalez H, Soler M, Lorenzo-Hernandez M, Nuñez-Marin G, de la Espriella R, Bonanad C, Nuñez J, Chorro FJ, Bodi V, Santas E. Applicability of Echocardiographic Strict Negative Criteria for Suspected Infective Endocarditis. Am J Cardiol 2022; 162:156-162. [PMID: 34728063 DOI: 10.1016/j.amjcard.2021.09.012] [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: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
Echocardiography is the cornerstone imaging technique in the diagnosis of infective endocarditis (IE) but is often misused in clinical practice. Recently, strict negative criteria have been proposed to avoid unnecessary follow-up echocardiograms. We aimed to evaluate the use of echocardiography in real-world clinical daily practice and the usefulness of these criteria in the diagnosis of IE. We retrospectively retrieved every echocardiogram performed in our center for suspected IE between 2014 and 2018, including 905 transthoracic echocardiograms (TTEs). Of these, 451 (49.8%) fulfilled the strict negative criteria (group 1). In this group, IE was seldom diagnosed (n = 4, 0.9%). In 338 patients (37.4%) no signs of IE were evident, but they did not fulfill the strict negative criteria (group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n = 48, 14.2% and n = 20, 5.9%). Finally, in 116 patients (12.8%) the initial TTE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 patients (41.4%). A definitive diagnosis of IE was established in a minority of the study population (n = 72, 8%). Only 1 readmission for underdiagnosis of IE was noted on group 2. We conclude that in a real-life setting only a minority of patients in whom IE was suspected had a definitive diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain
| | - Ana Gabaldon-Perez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | - Meritxell Soler
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | - Gonzalo Nuñez-Marin
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Enrique Santas
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain.
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20
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de la Espriella R, Bayés-Genís A, Llàcer P, Palau P, Miñana G, Santas E, Pellicer M, González M, Górriz JL, Bodi V, Sanchis J, Núñez J. Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure. Eur J Intern Med 2022; 95:67-73. [PMID: 34507853 DOI: 10.1016/j.ejim.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to evaluate whether glomerular filtration rate (eGFR) during admission modifies the predictive value of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) in patients hospitalized for acute heart failure (AHF). METHODS We retrospectively evaluated 4595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 2008 through October 2019. To investigate the effect of kidney function on the association of NT-proBNP and CA125 with 1-year mortality (all-cause and cardiovascular mortality), we stratified patients according to four eGFR categories: <30 mL•min-1•1.73 m-2, 30-44 mL•min-1•1.73 m-2, 44-59 mL•min-1•1.73 m-2, and ≥60 mL•min-1•1.73 m-2. Biomarkers were assessed within the first 24 hours following admission. RESULTS At 1-year follow-up, 748 of 4595 (16.3%) patients died after discharge (of all deaths, 575 [12.5%] were cardiovascular). After multivariate adjustment, both NT-proBNP and CA125 remained independently associated with a higher risk of death when modeled as main effects (P<0.001). However, we found a differential prognostic effect of NT-proBNP across eGFR categories for both endpoints (all-cause mortality, P-value for interaction=0.002; CV mortality, P-value for interaction=0.001). Whereas NT-proBNP was positively and linearly associated with mortality in the subset of patients with normal or mildly reduced eGFR, its predictive ability progressively decreased at the lower extreme of eGFR (<45 mL•min-1•1.73 m-2). In contrast, the association between CA125 and survival remained consistent across all eGFR categories (all-cause mortality, P-value for interaction=0.559; CV mortality, P-value for interaction=0.855). CONCLUSIONS In patients with AHF and severely reduced eGFR, CA125 outperforms NT-proBNP in predicting 1-year mortality.
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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, Madrid, Spain; Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Mauricio Pellicer
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Miguel González
- Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - José Luis Górriz
- Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - Vicent Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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21
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Santas E, Palau P, Llácer P, de la Espriella R, Miñana G, Núñez‐Marín G, Lorenzo M, Heredia R, Sanchis J, Chorro FJ, Bayés‐Genís A, Núñez J. Sex-Related Differences in Mortality Following Admission for Acute Heart Failure Across the Left Ventricular Ejection Fraction Spectrum. J Am Heart Assoc 2021; 11:e022404. [PMID: 34927464 PMCID: PMC9075214 DOI: 10.1161/jaha.121.022404] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Following a heart failure (HF)‐decompensation, there is scarce data about sex‐related prognostic differences across left ventricular ejection fraction (LVEF) status. We sought to evaluate sex‐related differences in 6‐month mortality risk across LVEF following admission for acute HF. Methods and Results We retrospectively evaluated 4812 patients consecutively admitted for acute HF in a multicenter registry from 3 hospitals. Study end points were all‐cause, cardiovascular, and HF‐related mortality at 6‐month follow‐up. Multivariable Cox regression models were fitted to investigate sex‐related differences across LVEF. A total of 2243 (46.6%) patients were women, 2569 (53.4%) were men, and 2608 (54.2%) showed LVEF≥50%. At 6‐month follow‐up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) cardiovascular and HF‐related deaths, respectively. LVEF was not independently associated with mortality (HR, 1.02; 95% CI 0.99–1.05; P=0.135). After multivariable adjustment, we found no sex‐related differences in all‐cause mortality (P value for interaction=0.168). However, a significant interaction between sex and cardiovascular and HF mortality risks was found across LVEF (P value for interaction=0.030 and 0.007, respectively). Compared with men, women had a significantly lower risk of cardiovascular and HF‐mortality at LVEF<25% and <43%, respectively. On the contrary, women showed a higher risk of HF‐mortality at the upper extreme of LVEF (>80%). Conclusions Following an admission for acute HF, no sex‐related differences were found in all‐cause mortality risk. However, when compared with men, women showed a lower risk of cardiovascular and HF‐mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF death at the upper extreme.
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Affiliation(s)
- Enrique Santas
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Patricia Palau
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Pau Llácer
- Servicio de Medicina InternaHospital Universitario Ramón y CajalMadridSpain
| | - Rafael de la Espriella
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Gema Miñana
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Gonzalo Núñez‐Marín
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Miguel Lorenzo
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Raquel Heredia
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Juan Sanchis
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
- CIBERCVMadridSpain
| | - Francisco Javier Chorro
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Antoni Bayés‐Genís
- CIBERCVMadridSpain
- Servicio de CardiologíaHospital Germans Trias i PujolUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Julio Núñez
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
- CIBERCVMadridSpain
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22
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Gabaldón-Pérez A, De la Espriella R, Merenciano-Gonzalez H, Santas E, Chorro FJ. Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography. Rev Port Cardiol 2021; 40:803-804. [PMID: 34857121 DOI: 10.1016/j.repce.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ana Gabaldón-Pérez
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain.
| | | | | | - Enrique Santas
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain
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23
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Palau P, Seller J, Domínguez E, Sastre C, Ramón JM, de La Espriella R, Santas E, Miñana G, Bodí V, Sanchis J, Valle A, Chorro FJ, Llácer P, Bayés-Genís A, Núñez J. Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol 2021; 78:2042-2056. [PMID: 34794685 DOI: 10.1016/j.jacc.2021.08.073] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart failure with preserved ejection fraction (HFpEF), yet β-blockers are commonly used in HFpEF despite the lack of robust evidence. OBJECTIVES This study aimed to evaluate the effect of β-blocker withdrawal on peak oxygen consumption (peak Vo2) in patients with HFpEF and chronotropic incompetence. METHODS This is a multicenter, randomized, investigator-blinded, crossover clinical trial consisting of 2 treatment periods of 2 weeks separated by a washout period of 2 weeks. Patients with stable HFpEF, New York Heart Association functional classes II and III, previous treatment with β-blockers, and chronotropic incompetence were first randomized to withdrawing from (arm A: n = 26) versus continuing (arm B: n = 26) β-blocker treatment and were then crossed over to receive the opposite intervention. Changes in peak Vo2 and percentage of predicted peak Vo2 (peak Vo2%) measured at the end of the trial were the primary outcome measures. To account for the paired-data nature of this crossover trial, linear mixed regression analysis was used. RESULTS The mean age was 72.6 ± 13.1 years, and most of the patients were women (59.6%) in New York Heart Association functional class II (66.7%). The mean peakVo2 and peak Vo2% were 12.4 ± 2.9 mL/kg/min, and 72.4 ± 17.8%, respectively. No significant baseline differences were found across treatment arms. Peak Vo2 and peak Vo2% increased significantly after β-blocker withdrawal (14.3 vs 12.2 mL/kg/min [Δ +2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4% [Δ +11.7%]; P < 0.001, respectively). CONCLUSIONS β-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic incompetence. β-blocker use in HFpEF deserves profound re-evaluation. (β-blockers Withdrawal in Patients With HFpEF and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; NCT03871803; 2017-005077-39).
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | | | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Jose María Ramón
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Rafael de La Espriella
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - F Javier Chorro
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Pau Llácer
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain; Internal Medicine Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain.
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24
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Civera J, de la Espriella R, Heredia R, Miñana G, Santas E, Conesa A, Mollar A, Sastre C, Martínez A, Villaescusa A, Núñez J. Efficacy and Safety of Subcutaneous Infusion of Non-formulated Furosemide in Patients with Worsening Heart Failure: a Real-World Study. J Cardiovasc Transl Res 2021; 15:644-652. [PMID: 34642870 PMCID: PMC9213343 DOI: 10.1007/s12265-021-10173-1] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the efficacy (short-term changes in surrogates of decongestion) and safety following the ambulatory administration of subcutaneous furosemide (SCF) in patients with WHF. Fifty-five ambulatory patients were treated with SCF administered by an elastomeric pump for at least 72 h. Surrogates of congestion were assessed at baseline, 72 h, and 30 days. Spot urinary sodium (uNa+) was assessed at baseline, 24-48-72 h, and 30 days. The median (IQI) of NT-proBNP and uNa+ at baseline was 5218 pg/mL (2856-10878) and 68±3 mmol/L, respectively. Following administration of SCF (median dose of 100 mg/daily), we found a sustained increase in uNa+ during the first 72 h of treatment compared to baseline, paralleled with evidence of decongestion at 72 h, and 30 days. No significant safety concerns were observed. SCF was an effective and safe diuretic strategy for outpatient congestion management.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain. .,Departamento de Medicina, Universitat de València, Valencia, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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25
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Marcos Garces V, Gabaldon-Perez A, Merenciano-Gonzalez H, Soler M, Lorenzo-Hernandez M, Nunez-Marin G, Bonanad C, De La Espriella R, Chorro FJ, Bodi V, Santas E. Clinical applicability of echocardiographic strict negative criteria for suspected infective endocarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Infective endocarditis (IE) is an uncommon but potentially lethal disease that requires a timely diagnosis. Echocardiography has a pivotal role in EI diagnosis, but this may lead to an overuse of this technology in clinical daily practice, and it is unclear which patients can benefit from a follow-up study if the initial transthoracic echocardiogram (TTE) shows no signs of IE. The strict negative criteria (good ultrasound quality and no high-risk features such as significant valvular regurgitations or stenosis, pericardial effusion or intracardiac devices) have been recently proposed to avoid unnecessary follow-up echocardiograms.
Purpose
The objective of this study is to review the contemporary, real-world use of echocardiography in patients with suspected IE and analyze the potential applicability of the strict negative criteria.
Methods
We retrieved all the echocardiograms that were performed in our center for suspected or confirmed IE between January 2014 and December 2018. We defined different groups according to the strict negative criteria and reviewed the electronic clinical history to check if a definitive diagnosis of IE was established or not.
Results
We included a total of 905 TTEs. 451 (49.8%) of them fulfilled the strict negativity criteria (Group 1). In this group, IE was seldom diagnosed (n=4, 0.9%). In 338 (37.4%) patients no signs of IE were evident but they didn't fulfill the strict negative criteria (Group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n=48, 14.2% and n=20, 5.9%). Finally, in 116 (12.8%) patients the initial TEE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 (41.4%). The independent predictors of follow-up echocardiography were the previous history of valvular heart disease (HR 2.38 [1.39–3.89], p=0.001) or cancer (HR 0.47 [0.27–0.84], p=0.01), positive blood cultures for Enterococcus (HR 5.01 [2.34–10.73], p<0.001), methicillin-sensitive Staphylococcus aureus (HR 2.8 [1.27–6.17], p=0.011) or Streptococcus (HR 2.36 [1.12–5], p=0.024), and the presence of typical or suggestive signs of infective endocarditis on initial TTE (HR 13.77 [8.6–22.05], p<0.001). A definitive diagnosis of IE was confirmed in a minority of the study population (n=72, 8%). Only one readmission for underdiagnosis of IE during index hospitalization was noted on Group 2.
Conclusions
In a real-life, observational setting only a minority of patients in whom IE was suspected had a definite diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE. Further research should be performed to rationalize echocardiogram requests for suspected IE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - A Gabaldon-Perez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | | | - M Soler
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - M Lorenzo-Hernandez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - G Nunez-Marin
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - R De La Espriella
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - E Santas
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
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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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Gabaldón-Pérez A, De la Espriella R, Merenciano-Gonzalez H, Santas E, Chorro FJ. Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography. Rev Port Cardiol 2021; 40:S0870-2551(21)00345-0. [PMID: 34474955 DOI: 10.1016/j.repc.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/05/2020] [Accepted: 06/11/2020] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ana Gabaldón-Pérez
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain.
| | | | | | - Enrique Santas
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain
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de la Espriella R, Santas E, Zegri Reiriz I, Górriz JL, Cobo Marcos M, Núñez J. Quantification and Treatment of Congestion in Heart Failure: A Clinical and Pathophysiological Overview. Nefrologia 2021; 42:S0211-6995(21)00114-4. [PMID: 34289940 DOI: 10.1016/j.nefro.2021.04.006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/27/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023] Open
Abstract
Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion assessment, monitoring, and treatment represent a real challenge in daily clinical practice. This document reviewed historical and contemporary evidence of available methods for determining volume status and discuss pharmacological aspects and pathophysiological principles that underlie diuretic use.
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Affiliation(s)
- Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España
| | - Isabel Zegri Reiriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - José Luis Górriz
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Departamento de Medicina, Universidad de Valencia, España
| | - Marta Cobo Marcos
- Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; CIBER Cardiovascular, España
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España; Grupo de Trabajo Cardiorrenal, Asociación de Insuficiencia Cardiaca, Sociedad Española de Cardiología, España; Departamento de Medicina, Universidad de Valencia, España; CIBER Cardiovascular, España.
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Santas E, Miñana G, Palau P, Espriella RDL, Lorenzo M, Núñez G, Sanchis J, Chorro FJ, Bayes-Genís A, Núñez J. Right Heart Dysfunction and Readmission Risk Across Left Ventricular Ejection Fraction Status in Patients With Acute Heart Failure. J Card Fail 2021; 27:1090-1098. [PMID: 34273477 DOI: 10.1016/j.cardfail.2021.06.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Right heart dysfunction (RHD) parameters are increasingly important in heart failure (HF). This study aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF). METHODS AND RESULTS We included 3383 consecutive patients discharged for acute HF. Of them, in 1435 patients (42.4%), the pulmonary artery systolic pressure could not be measured accurately, leaving a final sample size of 1948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure of less than 0.36 and significant tricuspid regurgitation (n = 196, 10.2%). Negative binomial regression analyses were used to evaluate the risk of recurrent admissions. At a median follow-up of 2.2 years (interquartile range 0.63-4.71), 3782 readmissions were registered in 1296 patients (66.5%). Patients with advanced RHD showed higher readmission rates, but only if the LVEF was 40% or greater (P < .001). In multivariable analyses, this differential association persisted for cardiovascular and HF recurrent admissions (P value for interaction = .015 and P = .016; respectively). Advanced RHD was independently associated with the risk of recurrent cardiovascular and HF admissions if HF with an LVEF of 40% or greater (incidence rate ratio 1.64, 95% confidence interval 1.18-2.26, P = .003; and incidence rate ratio 1.73; 95% confidence interval 1.25-2.41, P = .001;respectively). In contrast, it was not associated with readmission risks if the LVEF was less than 40%. CONCLUSIONS After an admission for acute HF, advanced RHD was strongly associated with a higher risk of recurrent cardiovascular and HF admissions, but only in patients with an LVEF of 40% or greater.
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Affiliation(s)
- Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain
| | | | - Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Gonzalo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBERCV, Madrid, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBERCV, Madrid, Spain
| | - Antoni Bayes-Genís
- CIBERCV, Madrid, Spain; Servicio de Cardiología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBERCV, Madrid, Spain.
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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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31
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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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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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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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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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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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36
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Núñez J, Merenciano-González H, Santas E, López-Lereu MP, Monmeneu JV, Valero E. Prognostic value of indexed pulmonary artery diameter assessed by cardiac magnetic resonance imaging in patients with acute heart failure. Rev Esp Cardiol (Engl Ed) 2021; 74:267-269. [PMID: 32978097 DOI: 10.1016/j.rec.2020.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain
| | | | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain
| | | | | | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain.
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Núñez J, Merenciano-González H, Santas E, López-Lereu MP, Monmeneu JV, Valero E. Valor pronóstico del diámetro indexado de la arteria pulmonar mediante resonancia magnética cardiaca en pacientes con insuficiencia cardiaca aguda. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.06.034] [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: 11/29/2022]
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Marcos-Garces V, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Perez N, Cànoves J, Gonzalez J, Minana G, Nunez J, de la Espriella R, Santas E, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Rodríguez-Palomares JF, Ortiz-Pérez JT, Bodi V. Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction. Circ Cardiovasc Imaging 2020; 13:e011491. [PMID: 33297764 DOI: 10.1161/circimaging.120.011491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF<40% (≥50%: 7%, 40%-49%: 9%, <40%: 27%, P<0.001). Most patients displayed echocardiography-LVEF≥50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF<50% (n=490, 44%), the MACE rate was also low in those with CMR-LVEF≥40% (24/278, 9%) but significantly increased in patients with CMR-LVEF<40% (55/212, 26%; P<0.001). Compared with echocardiography-LVEF, CMR-LVEF significantly improved MACE prediction in the group of patients with echocardiography-LVEF<50% (C statistic, 0.80 versus 0.72; net reclassification improvement index, 0.73; integrated discrimination improvement index, 0.10) but not in those with echocardiography-LVEF≥50% (C statistic 0.66 versus 0.66; net reclassification improvement index, 0.17; integrated discrimination improvement index, 0.01). Conclusions A straightforward strategy based on a selective use of CMR for risk prediction in ST-segment-elevation myocardial infarction patients with echocardiography-LVEF<50% can provide insights into patient care. The cost-effectiveness of this approach, as well as the direct implications in clinical management, should be further explored.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Jose Gavara
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Elena de Dios
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Nerea Perez
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Jessika Gonzalez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Enrique Santas
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Spain (D.M.)
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Filipa Valente
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (F.V., J.F.R.-P.)
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.)
| | | | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.).,Cardiovascular Institute, Hospital Clínic, Barcelona, Spain (J.T.O.-P.)
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
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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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40
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Santas E, Miñana G, Cardells I, Palau P, Llàcer P, Fácila L, Almenar L, López‐Lereu MP, Monmeneu JV, Sanchis J, Maceira AM, Bayés‐Genís A, Núñez J. Short-term changes in left and right systolic function following ferric carboxymaltose: a substudy of the Myocardial-IRON trial. ESC Heart Fail 2020; 7:4222-4230. [PMID: 33040491 PMCID: PMC7754736 DOI: 10.1002/ehf2.13053] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/22/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS The mechanisms underlying the beneficial effect of ferric carboxymaltose (FCM) in patients with heart failure (HF) and iron deficiency (ID) have not been completely characterized. The Myocardial-IRON trial was a double-blind, randomized trial that evaluated myocardial iron repletion following FCM vs. placebo in 53 patients with HF and ID. In this post hoc analysis, we evaluated whether treatment with FCM was associated with cardiac magnetic resonance changes in left and right ventricular function (LVEF and RVEF, respectively) at different points of systolic dysfunction. METHODS AND RESULTS We included patients from the Myocardial-IRON trial with left and right ventricular systolic dysfunction (LVSD and RVSD, respectively) at enrolment. Linear mixed regression models were used to evaluate changes at 7 and 30 days on LVEF and RVEF at cardiac magnetic resonance. At enrolment, 27 (50.9%) and 38 (71.7%) patients had LVEF < 40% (LVSD1 ) or <45% (LVSD2 ), respectively, and 10 (18.9%) and 17 (32.1%) patients had RVEF < 45% (RVSD1 ) or <51% in women and <52% in men (RVSD2) , respectively. Treatment with FCM was associated with a significant improvement in LVEF at 30 days (LVSD1 : Δ2.3%, P < 0.001; LVSD2 : Δ4.1, P = 0.014). FCM was also associated with a significant and early improvement in RVEF at 7 days (RVSD1 : Δ6.9%, P = 0.003; RVSD2 : Δ3.2%, P = 0.003) that persisted at 30 days (RVSD1 : Δ8.1%, P < 0.001; RVSD2 : Δ4.7%, P < 0.001). CONCLUSIONS In patients with HF and systolic dysfunction with ID, FCM was associated with short-term improvement in LVEF and, especially, in RVEF.
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Affiliation(s)
- Enrique Santas
- Cardiology DepartmentHospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVAValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Gema Miñana
- Cardiology DepartmentHospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVAValenciaSpain
- CIBER CardiovascularMadridSpain
| | | | - Patricia Palau
- Cardiology DepartmentHospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVAValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Pau Llàcer
- Internal Medicine DepartmentHospital Universitario Ramón y CajalMadridSpain
| | - Lorenzo Fácila
- Cardiology DepartmentHospital General Universitario de ValenciaValenciaSpain
| | - Luis Almenar
- Cardiology DepartmentHospital Universitario La Fe de ValenciaValenciaSpain
| | | | - Jose V. Monmeneu
- Cardiovascular Imaging UnitERESA‐Ascires Biomedical GroupValenciaSpain
| | - Juan Sanchis
- Cardiology DepartmentHospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVAValenciaSpain
- CIBER CardiovascularMadridSpain
| | - Alicia M. Maceira
- Cardiovascular Imaging UnitERESA‐Ascires Biomedical GroupValenciaSpain
| | - Antoni Bayés‐Genís
- CIBER CardiovascularMadridSpain
- Cardiology Department and Heart Failure UnitHospital Universitari Germans Trias i Pujol, Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Julio Núñez
- Cardiology DepartmentHospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVAValenciaSpain
- CIBER CardiovascularMadridSpain
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41
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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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42
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Gabaldon-Perez A, Marcos-Garces V, Santas E, Lorenzo-Hernandez M, Soler M, Nunez-Marin G, Merenciano-Gonzalez H, Bonanad C, Bodi V, Chorro F. Echocardiographic strict negative criteria for suspected infective endocarditis. Can we avoid unnecessary echocardiograms? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) is an uncommon but potentially lethal disease that require a timely diagnosis. Transthoracic echocardiography (TTE) has a pivotal role in diagnosis and follow-up and should be requested if there is a clinical suspicion of IE. However, it is unclear which patients can benefit from a follow-up echocardiogram if the initial TTE shows no signs of IE. The strict negative criteria (SNC) have been recently proposed to avoid unnecessary follow-up echocardiograms.
Purpose
The objective of this study is to review the contemporary, real-world use of echocardiography in patients with suspected IE and analyze the possible effect that incorporating the SNC would have in our clinical practice.
Methods
We searched the echocardiography database for the words “endoc” and “veget” to find the tests that were performed for suspected or confirmed IE between January 2014 and December 2018. We extracted and manually reviewed all the echocardiographic data and applied the SNC to patients with an initial negative TTE. We reviewed the electronic clinical history to check if a final diagnosis of IE was established or not.
Results
We included a total of 957 echocardiograms in our registry. 493 (51.5%) did not meet the SNC. The main reasons for exclusion were the occurrence of more than mild valvular regurgitation (n=293, 30.6%), the presence of typical or suggestive signs of IE (n=128, 13.3%), the evidence of more than mild valvular stenosis or sclerosis (n=105, 10.9%) and a suboptimal ultrasound quality (n=90, 9.4%). Globally, a follow-up echocardiogram was performed in 143 (14.9%) patients. Only in 25 (5.4%) of patients which fulfilled the SNC a follow-up echocardiogram was requested, compared to 60 (16%) patients which neither fulfilled the SNC nor showed echocardiographic signs of IE and 68 (53.5%) patients in which the SNC weren't met but showed echocardiographic signs of IE (p<0.001). After performing a binary logistic regression model, the only independent predictor of follow-up echocardiography in patients who didn't met the SNC was the presence of typical or suggestive signs of infective endocarditis on initial TTE (HR 2.84 [2.17–3.71], p<0.001).
Conclusions
1. In a real-life, observational setting an initial TTE for suspected IE that fulfilled the defined SNC predicts a low probability of requesting a follow-up echocardiography (5.4%), even though these criteria were neither reported by the echocardiographist nor probably known by the clinician in charge of the patient.
2. The number of echocardiograms avoided by applying these criteria in this context is low.
3. A follow-up echocardiogram was requested more frequently if the SNC weren't met, especially when typical or suggestive signs of IE were described in the initial TTE (53.5% vs 16%). This factor seems to be the only independent echocardiographic variable that predicts the probability of requesting a follow-up echocardiogram in this subgroup of patients.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Gabaldon-Perez
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - V Marcos-Garces
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - E Santas
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - M Lorenzo-Hernandez
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - M Soler
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - G Nunez-Marin
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | | | - C Bonanad
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
| | - F.J Chorro
- University Hospital Clinic of Valencia, Cardiology Department, Valencia, Spain
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43
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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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44
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Gabaldón-Pérez A, Marcos-Garcés V, Muñoz Gil J, Chorro Gascó FJ, Santas E. Hypoplasia of the posterior mitral valve leaflet: Don't forget to look beyond the mitral valve. Echocardiography 2020; 38:142-143. [PMID: 33107084 DOI: 10.1111/echo.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022] Open
Abstract
Hypoplasia of the posterior mitral valve leaflet (PMVL) is a very rare finding in adulthood and can coexist with other congenital heart defects. In this image, a transesophageal echocardiography (TOE) carried out on a 59-year-old woman with a 2-month history of dyspnea revealed a hypoplastic PMVL causing severe mitral regurgitation associated with a secundum-type atrial septal defect (ASD) with left-to-right shunting. This case demonstrates how essential 3-dimensional TOE is for a comprehensive assessment of the mitral valve and to improve the diagnostic accuracy of concomitant congenital heart abnormalities.
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Affiliation(s)
| | | | - Jaime Muñoz Gil
- Department of Cardiology, University Clinical Hospital, Valencia, Spain
| | - Francisco Javier Chorro Gascó
- Department of Cardiology, University Clinical Hospital, Valencia, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Enrique Santas
- Department of Cardiology, University Clinical Hospital, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain
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45
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Espriella RDL, Bayés-Genis A, Revuelta-LóPEZ E, Miñana G, Santas E, Llàcer P, García-Blas S, Fernández-Cisnal A, Bonanad C, Ventura S, Sánchez R, Bodí V, Cordero A, Fácila L, Mollar A, Sanchis J, Núñez J. Soluble ST2 and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction. J Card Fail 2020; 27:427-434. [PMID: 33038531 DOI: 10.1016/j.cardfail.2020.10.002] [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: 05/17/2020] [Revised: 07/27/2020] [Accepted: 10/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying patients at risk of poor diuretic response in acute heart failure (AHF) is critical to make prompt adjustments in therapy. The objective of this study was to investigate whether the circulating levels of soluble ST2 predict the cumulative diuretic efficiency (DE) at 24 and 72 hours in patients with AHF and concomitant renal dysfunction. METHODS AND RESULTS This is a post hoc analysis of the IMPROVE-HF trial, in which we enrolled 160 patients with AHF and renal dysfunction (estimated glomerular filtrate rate of <60 mL/min/1.73 m2). DE was calculated as the net fluid output produced per 40 mg of furosemide equivalents. The association between sST2 and DE was evaluated by using multivariate linear regression analysis. The median cumulative DE at 24 and 72 hour was 747 mL (interquartile range 490-1167 mL) and 1844 mL (interquartile range 1142-2625 mL), respectively. The median sST2 and mean estimated glomerular filtrate rate were 72 ng/mL (interquartile range 47-117 ng/mL), and 34.0 ± 8.5 mL/min/1.73 m2, respectively. In a multivariable setting, higher sST2 were significant and nonlinearly related to lower DE both at 24 and 72 hours (P = .002 and P = .019, respectively). CONCLUSIONS In patients with AHF and renal dysfunction at presentation, circulating levels of sST2 were independently and negatively associated with a poor diuretic response, both at 24 and 72 hours.
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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-Genis
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Revuelta-LóPEZ
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Silvia Ventura
- Internal Medicine Department, Hospital de La Plana, Villa-Real, Castellón, Spain
| | - Ruth Sánchez
- Internal Medicine Department, Hospital Virgen de Los Lirios, Alcoy, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Alberto Cordero
- Cardiology Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Lorenzo Fácila
- Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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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: 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: 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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47
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Santas E, Núñez J. Abnormal renal function in acute heart failure: the same side of different coins. Emergencias 2020; 32:311-313. [PMID: 33006830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA, Valencia, España
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48
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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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49
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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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50
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Barón-Esquivias G, Roldán Rabadán I, García Quintana A, Cerezo Manchado JJ, Antorrena Miranda I, Gómez-Barrado JJ, Pérez Paredes M, Santas E, Pindado Rodríguez J, Muñoz-Robles JA, Oliver-Miñarro D, Santamaría A. Use of edoxaban in clinical practice: Comparison of data from the Spanish population in the ETNA-AF-Europe registry. Future Cardiol 2020; 16:469-480. [PMID: 32228182 DOI: 10.2217/fca-2020-0024] [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] [Indexed: 12/31/2022] Open
Abstract
Aim: To ascertain the clinical profile and management of edoxaban in clinical practice. Materials & methods: Prospective, noninterventional postauthorization study of nonselected patients with atrial fibrillation treated with edoxaban from 12 European countries. Patients' baseline characteristics are presented. Results: A total of 13,638 patients (73.6 ± 9.5 years; 76.6/23.4% edoxaban 60/30 mg; CHA2DS2-VASc 3.1; 838 [6.1%] from Spain) were included. In Spain, the percentage of very elderly and fragile patients was greater and the risk of thromboembolism (CHA2DS2-VASc ≥2, 98.0 vs 87.3%; p < 0.001) and bleeding (HAS-BLED, 3.2 vs 2.7; p < 0.001) was greater in patients treated with edoxaban 30 mg. The proportion of patients taking edoxaban 30 mg was similar than in ENGAGE AF-TIMI 48. Conclusion: In Spain, patients treated with edoxaban were older and fragile.
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Affiliation(s)
| | | | - Antonio García Quintana
- Cardiology Service, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Matías Pérez Paredes
- Cardiology Service, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Enrique Santas
- Cardiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | | | | | - Amparo Santamaría
- Hematology service, Hospital Universitario del Vinalopó, Torrevieja, Spain
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