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González-Vílchez F, Crespo-Leiro MG, Delgado-Jiménez J, Pérez-Villa F, Segovia-Cubero J, Díaz-Molina B, Mirabet-Pérez S, Arizón del Prado JM, Blasco-Peiró T, Martínez-Sellés M, Almenar-Bonet L, Garrido-Bravo I, Rábago G, Vázquez de Prada JA. Impacto de la variabilidad intrapaciente en la concentración sanguínea de anticalcineurínicos en los resultados del trasplante cardiaco. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Solla-Buceta M, González-Vílchez F, Almenar-Bonet L, Lambert-Rodríguez JL, Segovia-Cubero J, González-Costello J, Delgado JF, Pérez-Villa F, Crespo-Leiro MG, Rangel-Sousa D, Martínez-Sellés M, Rábago-Juan-Aracil G, De-la-Fuente-Galán L, Blasco-Peiró T, Hervás-Sotomayor D, Garrido-Bravo IP, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Complicaciones infecciosas relacionadas con la asistencia circulatoria mecánica de corta duración en candidatos a trasplante cardiaco urgente. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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González-Vílchez F, Crespo-Leiro MG, Delgado-Jiménez J, Pérez-Villa F, Segovia-Cubero J, Díaz-Molina B, Mirabet-Pérez S, Arizón Del Prado JM, Blasco-Peiró T, Martínez-Sellés M, Almenar-Bonet L, Garrido-Bravo I, Rábago G, Vázquez de Prada JA. Impact of intrapatient blood level variability of calcineurin inhibitors on heart transplant outcomes. Rev Esp Cardiol (Engl Ed) 2022; 75:129-140. [PMID: 33744197 DOI: 10.1016/j.rec.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. METHODS We retrospectively studied patients aged ≥18 years, with a first heart transplant performed between 2000 and 2014 and surviving≥ 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. RESULTS The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation> 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P=.056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P=.065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P=.011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. CONCLUSIONS IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients.
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Affiliation(s)
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Juan Delgado-Jiménez
- Servicio Cardiología y Fundación Investigación Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Félix Pérez-Villa
- Servicio de Cardiología, Hospital Clínic Universitari, Barcelona, Spain
| | - Javier Segovia-Cubero
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Beatriz Díaz-Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Sonia Mirabet-Pérez
- Servei de Cardiologia, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Luis Almenar-Bonet
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Iris Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Gregorio Rábago
- Servicio de Cirugía Cardiaca, Clínica Universitaria de Navarra, Pamplona, Spain
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Salterain-González N, Rábago Juan-Aracil G, Gómez-Bueno M, Almenar-Bonet L, Crespo-Leiro MG, Arizón del Prado JM, García-Cosío MD, Martínez-Sellés M, Mirabet-Pérez S, Sobrino-Márquez JM, González-Costello J, Pérez-Villa F, Díaz-Molina B, de la Fuente-Galán L, Blasco-Peiró T, Garrido-Bravo IP, García-Guereta Silva L, Gil-Villanueva N, Gran F, González-Vilchez F. Resultados del retrasplante cardiaco: subanálisis del Registro Español de Trasplante Cardiaco. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Salterain-González N, Rábago Juan-Aracil G, Gómez-Bueno M, Almenar-Bonet L, Crespo-Leiro MG, Arizón Del Prado JM, García-Cosío MD, Martínez-Sellés M, Mirabet-Pérez S, Sobrino-Márquez JM, González-Costello J, Pérez-Villa F, Díaz-Molina B, de la Fuente-Galán L, Blasco-Peiró T, Garrido-Bravo IP, García-Guereta Silva L, Gil-Villanueva N, Gran F, González-Vilchez F. Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry. Rev Esp Cardiol (Engl Ed) 2022; 75:60-66. [PMID: 34253459 DOI: 10.1016/j.rec.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain. METHODS We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT. RESULTS A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001). CONCLUSIONS ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
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Affiliation(s)
| | | | - Manuel Gómez-Bueno
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Universitat de València, Valencia, Spain
| | - María Generosa Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | | | - María Dolores García-Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Programa de Trasplante Cardiaco, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José González-Costello
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Félix Pérez-Villa
- Unidad de Insuficiencia Cardiaca, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardico, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Luis de la Fuente-Galán
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Iris P Garrido-Bravo
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Nuria Gil-Villanueva
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Ferrán Gran
- Servicio Cardiología pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Francisco González-Vilchez
- Unidad de Insuficiencia Cardiaca y Transplante, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Jordà P, Martínez D, Farrero M, Marcos MÁ, Sandoval E, Castel MÁ, Pereda D, Quintana E, Arbelo E, Sánchez A, Campuzano Ò, Tirón de Llano C, Brugada R, Brugada J, Castellá M, Pérez-Villa F, García-Álvarez A. BAG3
Genetic Cardiomyopathy May Overlap Fulminant Myocarditis Clinical Findings. Circ Heart Fail 2021; 15:e008443. [PMID: 35290091 DOI: 10.1161/circheartfailure.121.008443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paloma Jordà
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Daniel Martínez
- Pathology Department (D.M.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Marta Farrero
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | | | - Elena Sandoval
- Cardiovascular Surgery Department, Institut Clínic Cardiovascular (E.S., D.P., E.Q., M.C.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - María Ángeles Castel
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (M.A.C., E.A., Ò.C., R.B., J.B.)
| | - Daniel Pereda
- Cardiovascular Surgery Department, Institut Clínic Cardiovascular (E.S., D.P., E.Q., M.C.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Eduard Quintana
- Cardiovascular Surgery Department, Institut Clínic Cardiovascular (E.S., D.P., E.Q., M.C.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Elena Arbelo
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (M.A.C., E.A., Ò.C., R.B., J.B.)
| | - Aurora Sánchez
- Department of Genetics, Institut de Bioquímica i Genètica Molecular (A.S.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Òscar Campuzano
- Universitat de Girona, Spain (Ò.C., R.B.)
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Spain (Ò.C., C.T.d.L., R.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (M.A.C., E.A., Ò.C., R.B., J.B.)
| | - Coloma Tirón de Llano
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Spain (Ò.C., C.T.d.L., R.B.)
- Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain (C.T.d.L., R.B.)
| | - Ramon Brugada
- Universitat de Girona, Spain (Ò.C., R.B.)
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Spain (Ò.C., C.T.d.L., R.B.)
- Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain (C.T.d.L., R.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (M.A.C., E.A., Ò.C., R.B., J.B.)
| | - Josep Brugada
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (M.A.C., E.A., Ò.C., R.B., J.B.)
| | - Manuel Castellá
- Cardiovascular Surgery Department, Institut Clínic Cardiovascular (E.S., D.P., E.Q., M.C.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Félix Pérez-Villa
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
| | - Ana García-Álvarez
- Cardiology Department, Institut Clínic Cardiovascular (P.J., M.F., M.A.C., E.A., J.B., F.P.-V., A.G.-Á.)
- Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (P.J., D.M., M.F., E.S., M.A.C., D.P., E.Q., E.A., A.S., J.B., M.C., F.P.-V., A.G.-Á)
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7
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Álvarez-García J, García-Osuna Á, Vives-Borrás M, Ferrero-Gregori A, Martínez-Sellés M, Vázquez R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Bascompte R, Delgado J, Grau Sepúlveda A, Bardají A, Pérez-Villa F, Zamorano JL, Crespo-Leiro M, Sánchez PL, Ordoñez-Llanos J, Cinca J. A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure. Front Physiol 2021; 12:708890. [PMID: 34744758 PMCID: PMC8569896 DOI: 10.3389/fphys.2021.708890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.
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Affiliation(s)
- Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Álvaro García-Osuna
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Miquel Vives-Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Puerta del Mar, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Cádiz, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clínico, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, Hospital La Fe, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Puerta de Hierro-Majadahonda, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Murcia, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ramón Bascompte
- Cardiology Department, Hospital Arnau de Vilanova, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Lleida, Spain
| | - Juan Delgado
- Cardiology Department, Hospital 12 de Octubre, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrés Grau Sepúlveda
- Cardiology Department, Hospital Universitario Son Espases, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Palma de Mallorca, Spain
| | - Alfredo Bardají
- Cardiology Department, Hospital Juan XXIII, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Tarragona, Spain
| | - Félix Pérez-Villa
- Cardiology Department, Hospital Clinic, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - José Luis Zamorano
- Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marisa Crespo-Leiro
- Cardiology Department, Hospital Universitario A Coruna, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), A Coruna, Spain
| | - Pedro Luis Sánchez
- Cardiology Department, Hospital Clínico Universitario, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Jordi Ordoñez-Llanos
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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8
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, Delgado-Jiménez JF, Arizón del Prado JM, Sobrino-Márquez JM, Valero-Masa MJ, Cobo-Belaustegui M, Llano-Cardenal M, Vázquez de Prada JA, Nistal-Herrera F, Lambert-Rodríguez JL, Díaz-Molina B, Fidalgo-Muñiz C, Rangel-Sousa D, Grande-Trillo A, Brossa-Loidi V, Mirabet-Pérez S, López L, Zegrí I, de Antonio M, Castel MÁ, Farrero M, Manito N, Díez C, García-Romero E, Roca J, Castrodeza J, Sousa I, Blázquez Z, Zataraín E, García-Carreño J, Navas P, Juárez M, Ortiz C, Martínez-Sellés M, Cebrián M, López-Viella R, Sánchez-Lázaro I, Martínez S, Donoso V, Martínez L, López-Granados A, Segovia-Cubero J, Hernández-Pérez F, Mitroi C, Rivas-Lasarte M, García-Cosío MD, Morán-Fernández L, Caravaca P, López-Azor JC, Paniagua-Martín MJ, Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, Cuenca-Castillo J, Herrera-Noreña JM, García-Guereta Silva L, González-Fernández Ó, Ponz de Antonio I, Labrandero de Lera C, González-Rocafort Á, Polo-López L, Camino-López M, Gil-Villanueva N, de la Fuente-Galán L, Tobar-Ruiz J, Garrido-Bravo IP, Pascual-Figal DA, Pastor-Pérez FJ, Blasco-Peiró T, Pórtoles-Ocampo A, Lasala-Alastuey M, Rábago-Juan-Aracil G, Manrique-Antón R, Jimeno-San Martín L, García-Quintana A, Groba-Marco MDV, Galván-Ruiz M, Gran-Ipiña F, Dolader P. Registro Español de Trasplante Cardiaco. XXXII Informe Oficial de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, Delgado-Jiménez JF, Arizón Del Prado JM, Sobrino-Márquez JM, Valero-Masa MJ. Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2021; 74:962-970. [PMID: 34509416 DOI: 10.1016/j.rec.2021.08.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The present report updates the main characteristics and outcomes of heart transplants in Spain to 2020. METHODS We describe the main features of recipients, donors, surgical procedure, and immunosuppression in 2020. We also analyze the temporal trends of these characteristics and outcomes (survival) for the period 2011 to 2019. RESULTS In 2020, 278 heart transplants were performed (7.3% decrease vs 2019). The findings in 2020 confirmed previous observations of an increase in pretransplant sternotomy, a slight decrease in urgent transplants carried out with ventricular assist devices, a slight decrease in donor age, an increase in the use of allografts with previous arrest, and a decrease in ischemia time. Survival continued to improve in recent triennia, reaching 82.0% at 1 year in the period 2017 to 2019. CONCLUSIONS The slight decrease in the number of heart transplants performed in 2020 in Spain, most likely due to the SARS-CoV-2 pandemic, did not change the main characteristics of the procedure. No change was observed in the tendency to improved survival.
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Affiliation(s)
| | - Luis Almenar-Bonet
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Universidade da Coruña (UDC), Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Gómez-Bueno
- Departamento de Cardiología, Hospital Universitario Clínica Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - José González-Costello
- Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Félix Pérez-Villa
- Servei de Cardiologia, Hospital Clínic Universitari, Barcelona, Spain
| | - Juan F Delgado-Jiménez
- Servicio de Cardiología, Fundación Investigación Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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10
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López-Vilella R, González-Vílchez F, Crespo-Leiro MG, Segovia-Cubero J, Cobo M, Delgado-Jiménez J, Arizón del Prado JM, Martínez-Sellés M, Sobrino Márquez JM, Mirabet-Pérez S, González-Costello J, Pérez-Villa F, Lambert-Rodríguez JL, Rábago-Aracil G, Blasco-Peiró MT, de la Fuente-Galán L, Garrido-Bravo I, Otero D, Almenar-Bonet L. Impacto de la edad del donante-receptor en la supervivencia al trasplante cardiaco. Subanálisis del Registro Español de Trasplante Cardiaco. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Castel M, Arguis M, Gimeno-Santos E, Pérez-Villa F, Sandoval E, Navarro-Ripoll R, Farrero M, García-Álvarez A, Martinez-Palli G. Prehabilitation Prior to Heart Transplantation: Feasibility and Cost-Effectiveness. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.721] [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: 10/21/2022] Open
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12
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Bofarull JG, Castrillo L, Milisenda J, García Álvarez A, Castel M, Sandoval E, Sobrino TL, Farrero M, Pérez-Villa F. Severe Myopathy Following Heart Transplantation in a Patient with Danon Disease. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2004] [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: 11/16/2022] Open
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13
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Minguito-Carazo C, Gómez-Bueno M, Almenar-Bonet L, Barge-Caballero E, González-Vílchez F, Delgado-Jiménez JF, María Arizón Del Prado J, Sousa-Casasnovas I, Mirabet-Pérez S, González-Costello J, Sobrino-Márquez JM, Pérez-Villa F, Díaz-Molina B, Rábago Juan-Aracil G, Blasco-Peiró T, De la Fuente Galán L, Garrido-Bravo I, García-Guereta L, Camino M, Albert-Brotons DC, Muñiz J, Crespo-Leiro MG. Malignancy following heart transplantation: differences in incidence and prognosis between sexes - a multicenter cohort study. Transpl Int 2021; 34:882-893. [PMID: 33482021 DOI: 10.1111/tri.13827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022]
Abstract
Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.
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Affiliation(s)
| | - Manuel Gómez-Bueno
- Heart Failure, Heart Transplant and Pulmonary Hypertension Unit, University Hospital of Puerta de Hierro, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar-Bonet
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department of Complexo Hospitalario Universitario de A Coruña (CHUAC) Sergas, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Francisco González-Vílchez
- Advanced Heart Failure and Transplant Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan F Delgado-Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of University Hospital 12 de Octubre, Facultad de Medicina UCM, Madrid, Spain
| | - José María Arizón Del Prado
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Iago Sousa-Casasnovas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sónia Mirabet-Pérez
- Heart Failure and Transplant Unit, Cardiology Department of Hospital de Sant Pau, Barcelona, Spain
| | | | - José Manuel Sobrino-Márquez
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Félix Pérez-Villa
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Clínic, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Teresa Blasco-Peiró
- Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis De la Fuente Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Iris Garrido-Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Transplant Unit, Cardiology Department of Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis García-Guereta
- Pediatric Heart Transplant Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Manuela Camino
- Pediatric Heart Transplant Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Universidade da Coruña (UDC), Instituto Universitario de Ciencias de la Salud, A Coruña, Spain
| | - Maria G Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department of Complexo Hospitalario Universitario de A Coruña (CHUAC) Sergas, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Universidade da Coruña (UDC), Instituto Universitario de Ciencias de la Salud, A Coruña, Spain
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14
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Solla-Buceta M, González-Vílchez F, Almenar-Bonet L, Lambert-Rodríguez JL, Segovia-Cubero J, González-Costello J, Delgado JF, Pérez-Villa F, Crespo-Leiro MG, Rangel-Sousa D, Martínez-Sellés M, Rábago-Juan-Aracil G, De-la-Fuente-Galán L, Blasco-Peiró T, Hervás-Sotomayor D, Garrido-Bravo IP, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Infectious complications associated with short-term mechanical circulatory support in urgent heart transplant candidates. ACTA ACUST UNITED AC 2021; 75:141-149. [PMID: 33648882 DOI: 10.1016/j.rec.2020.11.019] [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: 06/16/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. METHODS Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. RESULTS We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n=47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n=58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P=.009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P=.025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P=.471). CONCLUSIONS Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period.
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Affiliation(s)
- Miguel Solla-Buceta
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | | | - Luis Almenar-Bonet
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Universitat de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Luis Lambert-Rodríguez
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Fundación de Investigación I+12, Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Félix Pérez-Villa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - María G Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Diego Rangel-Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | | | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris P Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Sonia Mirabet-Pérez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidade da Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
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15
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García-Cosío MD, González-Vilchez F, López-Vilella R, Barge-Caballero E, Gómez Bueno M, Martínez-Selles M, María Arizón J, Rangel Sousa D, González-Costello J, Mirabet S, Pérez-Villa F, Molina BD, Rábago G, Portolés Ocampo A, de la Fuente Galán L, Garrido I, Delgado JF. Influence of Gender in Advanced Heart Failure Therapies and Outcome Following Transplantation. Front Cardiovasc Med 2021; 8:630113. [PMID: 33718453 PMCID: PMC7946818 DOI: 10.3389/fcvm.2021.630113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.
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Affiliation(s)
- María Dolores García-Cosío
- Servicio de Cardiología, Hospital 12 de Octubre Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | | | - Raquel López-Vilella
- Servicio de Cardiología, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Gómez Bueno
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Manuel Martínez-Selles
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Jose María Arizón
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Diego Rangel Sousa
- Servicio de Cardiología, Hospital Universitario Virgen Del Rocío, Seville, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitari De Bellvitge, Hospitalet de Llobregat, Spain
| | - Sonia Mirabet
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Félix Pérez-Villa
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central De Asturias, Oviedo, Spain
| | - Gregorio Rábago
- Servicio de Cirugía Cardiaca, Clínica Universidad De Navarra, Navarra, Spain
| | - Ana Portolés Ocampo
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris Garrido
- Servicio de Cardiología, Hospital Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Juan F. Delgado
- Servicio de Cardiología, Hospital 12 de Octubre Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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16
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García-Cosío MD, González-Vilchez F, López-Vilella R, Barge-Caballero E, Gómez-Bueno M, Martínez-Selles M, Arizón JM, Rangel Sousa D, González-Costello J, Mirabet S, Pérez-Villa F, Díaz-Molina B, Rábago G, Portolés Ocampo A, de la Fuente-Galán L, Garrido I, Delgado-Jiménez JF. Gender differences in heart transplantation: Twenty-five year trends in the nationwide Spanish heart transplant registry. Clin Transplant 2020; 34:e14096. [PMID: 32978995 DOI: 10.1111/ctr.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022]
Abstract
The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993-2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25-year study period. HT rate was higher in men, although this decreased over the 25-year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1% p < .001), hypertensives (33.1% vs. 24% p < .001), and smokers (21.7% vs. 12.9% p < .001), respectively. Women had more pre-HT malignancies (7.1% vs. 2.8% p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality-related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1% p < .001) and primary failure (18.2% vs. 12.5% p < .001) and in men due to malignancies (15.1% vs. 6.6% p < .001).
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Affiliation(s)
- María D García-Cosío
- Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | | | - Raquel López-Vilella
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | | | - Manuel Gómez-Bueno
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Manuel Martínez-Selles
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Jose M Arizón
- Department of Cardiology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Diego Rangel Sousa
- Department of Cardiology, Hospital Universitario Virgen Del Rocío, Sevilla, Spain
| | - José González-Costello
- Department of Cardiology, Hospital Universitari De Bellvitge, Hospitalet de Llobregat, Spain
| | - Sonia Mirabet
- Department of Cardiology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - Félix Pérez-Villa
- Department of Cardiology, Hospital Clínic I Provincial, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Department of Cardiology, Hospital Universitario Central De Asturias, Oviedo, Spain
| | - Gregorio Rábago
- Department of Cardiac Surgery, Clínica Universidad De Navarra, Navarra, Spain
| | - Ana Portolés Ocampo
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris Garrido
- Department of Cardiology, Hospital Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Juan F Delgado-Jiménez
- Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
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17
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González-Vilchez F, Almenar-Bonet L, Crespo-Leiro MG, Gómez-Bueno M, González-Costello J, Pérez-Villa F, Delgado-Jiménez J, Arizón Del Prado JM, Sobrino-Márquez JM, Sousa Casasnovas I, Segovia-Cubero J, Hernández-Pérez F, Martínez Penades S, Cebrián Pinar M, López Vilella R, Sánchez-Lázaro I, Martínez-Dolz L, Paniagua-Martín MJ, Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, López Granados A, Segura Saintgerons C, Menjíbar Pareja V, Carrasco Ávalos F, Cobo M, Llano-Cardenal M, Vázquez de Prada JA, Nistal Herrera F, Blázquez Z, Jesús Valero M, Ortiz C, Zataraín E, Villa A, Navas P, Martínez-Sellés M, Dolores García Cosío M, Morán Fernández L, Caravaca P, Brossa Loidi V, Roig Minguell E, Mirabet Pérez S, López López L, Zegrí I, Rangel Sousa D, Manito Lorite N, Díez Lopez C, Roca Elias J, García Romero E, Rábago Juan-Aracil G, Castel MÁ, Farrero M, Lambert Rodríguez JL, Díaz Molina B, Bernardo Rodríguez MJ, Fidalgo Muñiz C, Camino López M, Gil Jaurena JM, Gil Villanueva N, Garrido-Bravo I, Pascual Figal DA, Pastor Pérez FJ, Blasco-Peiró T, Portoles Ocampo A, Sanz Julve M, de la Fuente Galán L, Tobar Ruiz J, Recio Platero A, García-Guereta Silva L, González Rocafort Á, Labradero de Lera C, Polo López L, Gran Ipiña F, Albert Brotons DC, Abella Antón R, García Quintana A, Groba Marco MDV. Spanish Heart Transplant Registry. 31th Official Report of the Heart Failure Association of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2020; 73:919-926. [PMID: 33041239 DOI: 10.1016/j.rec.2020.06.035] [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: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. METHODS We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. RESULTS In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P=.34). Survival in both these periods was better than that from 2010 to 2012 (P=.002 and P=.01, respectively). CONCLUSIONS Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.
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Affiliation(s)
| | - Luis Almenar-Bonet
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Universidade da Coruña (UDC), Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Gómez-Bueno
- Departamento de Cardiología, Hospital Universitario Clínica Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Félix Pérez-Villa
- Servei de Cardiologia, Hospital Clínic Universitari, Barcelona, Spain
| | - Juan Delgado-Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Fundación Investigación Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Cobo
- Hospital Universitario Marqués de Valdecilla, Santander, Cantabria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carles Díez Lopez
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Josep Roca Elias
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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18
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Domínguez JM, Keller B, Moisés J, Spitaleri G, Farrero M, Casal J, Pérez-Villa F, Castel MA. Changes in Pulmonary Function in Patients With Advanced Heart Failure Listed for Heart Transplantation. Transplant Proc 2019; 51:3424-3427. [PMID: 31810509 DOI: 10.1016/j.transproceed.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) are often impaired in patients with advanced heart failure. There is limited data about their impact on survival after heart transplantation (HT). We sought to assess the prevalence and type of PFT abnormalities in patients on HT waiting list and their impact on outcomes. METHODS We performed a retrospective analysis of a prospective registry of consecutive patients undergoing HT between 2012 and 2018. Patients were classified into 4 groups according to pre-HT PFT results: 1. normal pattern: forced vital capacity (FVC) ≥ 80% and forced expiratory volume in 1 second (FEV1) to FVC ratio (FEV1/FVC) ≥ 0.7; 2. obstructive: FEV1/FVC < 0.7; 3. nonobstructive: FEV1/FVC ≥ 0.7 and FVC < 80% when total lung capacity value was not available; and 4. restrictive: FEV1/FVC ≥ 0.7 and total lung capacity < 80%. The prevalence of impaired carbon monoxide diffusing capacity corrected for hemoglobin < 80% and FEV1 < 70% was also analyzed. High-urgency HT patients and those referred from other centers without quantitative pulmonary evaluation were excluded. RESULTS Among 123 patients who underwent HT, 83 patients with complete PFT were included. Median follow-up was 2.7 ± 1.9 years. Of these, 29 (34.9%) had an obstructive pattern, 20 (24.1%) a nonobstructive, 18 (21.7%) a restrictive, and 16 (19.3%) a normal pattern. Fifty-one (61.4%) patients had FEV1 < 70% and 58 (69.9%) a carbon monoxide diffusing capacity corrected for hemoglobin < 80%. There was a tendency to lower survival in all altered PFT groups compared with normal (P = .054) but not within the other groups. Patients with an impaired FEV1 had significantly higher mortality than patients with normal values (P = .008). Area under receiver operating characteristic curve for FEV1 was 0.73 (95% confidence interval [0.60-0.86]). A cutoff value of FEV1 (60.5) predicts mortality with 66% sensitivity and 64% specificity. CONCLUSIONS PFT alterations have a very high prevalence on HT waiting list patients. Patients with impaired FEV1 had worse outcomes after heart transplantation.
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Affiliation(s)
- J M Domínguez
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - B Keller
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J Moisés
- Pneumology department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - G Spitaleri
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - M Farrero
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J Casal
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - M A Castel
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Segovia-Cubero J, González-Costello J, Arizón del Prado JM, Sousa-Casasnovas I, Sobrino-Márquez JM, Delgado-Jiménez J, Pérez-Villa F. Registro Español de Trasplante Cardiaco. XXX Informe Oficial de la Sección de Insuficiencia Cardiaca de la Sociedad Española de Cardiología (1984–2018). Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Segovia-Cubero J, González-Costello J, Arizón Del Prado JM, Sousa-Casasnovas I, Sobrino-Márquez JM, Delgado-Jiménez J, Pérez-Villa F. Spanish Heart Transplant Registry. 30th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2018). ACTA ACUST UNITED AC 2019; 72:954-962. [PMID: 31611149 DOI: 10.1016/j.rec.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The present report updates the clinical characteristics and outcomes of heart transplant in Spain to 2018. METHODS Prospective registry of all the heart transplants performed between 1984 and 2018 in Spain. Specifically, temporal trends in clinical characteristics and outcomes are described for the period from 2009 to 2017. RESULTS In 2018, 321 transplants were performed (8494 since 1984; 2719 between 2009 and 2018). Compared with the previous year, the number of transplants performed in 2018 rose by 52% in recipients younger than 16 years and by 42% in those older than 60 years. In the last decade, significant temporal trends were observed in recipient characteristics (better pretransplant renal function, higher rates of diabetes, more urgent transplants, and greater use of pretrasplant circulatory support, particularly ventricular assist devices), donor characteristics (higher donor age, more female donors, and higher frequencies of cerebrovascular cause of death and predonation cardiac arrest and lower ischemia time). Survival significantly improved in the last decade, mainly due to lower mortality due to primary graft failure. CONCLUSIONS The number of heart transplants is increasing in Spain, with a progressive improvement in survival.
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Affiliation(s)
- Francisco González-Vílchez
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
| | - Luis Almenar-Bonet
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Javier Segovia-Cubero
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Clínica Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José María Arizón Del Prado
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Iago Sousa-Casasnovas
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Manuel Sobrino-Márquez
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Juan Delgado-Jiménez
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Félix Pérez-Villa
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Clínic Universitari, Barcelona, Spain
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Barge-Caballero E, González-Vílchez F, Delgado JF, Mirabet-Pérez S, González-Costello J, Pérez-Villa F, Martínez-Sellés M, Segovia-Cubero J, Hervás-Sotomayor D, Blasco-Peiró T, De la Fuente-Galán L, Lambert-Rodríguez JL, Rangel-Sousa D, Almenar-Bonet L, Garrido-Bravo IP, Rábago-Juan-Aracil G, Muñiz J, Crespo-Leiro MG. Empleo del balón de contrapulsación intraaórtico como puente al trasplante cardiaco en España: resultados del estudio ASIS-TC. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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González-Vílchez F, Delgado JF, Palomo J, Mirabet S, Díaz-Molina B, Almenar L, Arizón JM, Rangel-Sousa D, Pérez-Villa F, Garrido IP, de la Fuente L, Gómez-Bueno M, Sanz ML, Crespo-Leiro MG. Conversion From Immediate-Release Tacrolimus to Prolonged-Release Tacrolimus in Stable Heart Transplant Patients: A Retrospective Study. Transplant Proc 2019; 51:1994-2001. [PMID: 31227301 DOI: 10.1016/j.transproceed.2019.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lifelong adherence with post-transplant immunosuppression is challenging, with nonadherence associated with greater acute rejection (AR) risk. METHODS This retrospective study evaluated conversion from immediate-release tacrolimus (IRT) to prolonged-release tacrolimus (PRT), between January 2008 and December 2012 in stable adult heart transplant recipients. Cumulative incidence rate (IR) of AR and infection pre- and postconversion, safety, tacrolimus dose and trough levels, concomitant immunosuppression, and PRT discontinuation were analyzed (intention-to-treat population). RESULTS Overall, 467 patients (mean age, 59.3 [SD, 13.3] years) converted to PRT at 5.1 (SD, 4.9) years post transplant and were followed for 3.4 (SD, 1.5) years. During the 6 months post conversion, 5 patients (1.1%; 95% CI, 0.35%-2.48%) had an AR episode and IR was 2.2/100 patient-years (95% CI, 0.91-5.26). Incidence of rejection preconversion varied by time from transplant to conversion. Infection IR was similar post- and preconversion (9.2/100 patient-years [95% CI, 7.4-11.3] vs 10.6/100 patient-years [95% CI, 8.8-12.3], respectively; P = .20). Safety variables remained similar post conversion. The IR of mortality/graft loss was 2.3/100 patient-years (95% CI, 1.7-3.1). CONCLUSIONS Conversion from IRT to PRT in heart transplant recipients in Spain was associated with no new safety concerns and appropriate immunosuppressive effectiveness.
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Affiliation(s)
- Francisco González-Vílchez
- Registro Español de Transplante Cardiaco, Sección de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Transplante Cardiaco, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Juan F Delgado
- Hospital Universitario 12 de Octubre, CIBERCV, UCM, Madrid, Spain
| | - Jesús Palomo
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Luis Almenar
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Iris P Garrido
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis de la Fuente
- Hospital Universitario Clínico de Valladolid, CIBERCV, Valladolid, Spain
| | | | - María L Sanz
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Transplante Cardiaco, Servicio de Cardiologia, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), CIBERCV, As Xubias, A Coruña, Spain
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Alonso-Pulpón L, González-Costelo J, Sobrino-Márquez JM, Arizón del Prado JM, Sousa-Casasnovas I, Delgado-Jiménez J, Pérez-Villa F. Registro Español de Trasplante Cardiaco. XXIX Informe Oficial de la Sección de Insuficiencia Cardiaca de la Sociedad Española de Cardiología (1984-2017). Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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González-Vílchez F, Almenar-Bonet L, Crespo-Leiro MG, Alonso-Pulpón L, González-Costelo J, Sobrino-Márquez JM, Arizón Del Prado JM, Sousa-Casasnovas I, Delgado-Jiménez J, Pérez-Villa F. Spanish Heart Transplant Registry. 29th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure. ACTA ACUST UNITED AC 2018; 71:952-960. [PMID: 30297276 DOI: 10.1016/j.rec.2018.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The present report updates the characteristics and results of heart transplantation in Spain, mainly focused in the 2008-2017 period. METHODS We describe the recipient and donor characteristics, surgical procedures, and outcomes of heart transplants performed in 2017. The 2017 data were compared with those obtained from 2008 to 2016. RESULTS A total of 304 cardiac transplants were performed in 2017. Between 1984 and 2017, 8173 procedures were performed, 2689 of them after 2008. Significant temporal trends were observed in recipient characteristics (lower pulmonary vascular resistance, lower use of mechanical ventilation, and a higher percentage of diabetic patients and those with previous cardiac surgery), donor characteristics (older donor age and a higher percentage of female donors and those with a prior cardiac arrest) and procedures (lower ischemia time). In 2017, 27% of patients were transplanted after undergoing mechanical ventricular assistance (P <.001 for trend). In the last decade, there was a trend to better survival. CONCLUSIONS Around 300 transplants per year were performed in Spain in the last decade. There was a significant increase in the use of pretransplant mechanical circulatory support and a trend to improved survival.
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Affiliation(s)
| | | | | | - Luis Alonso-Pulpón
- Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Barge-Caballero E, González-Vílchez F, Delgado JF, Mirabet-Pérez S, González-Costello J, Pérez-Villa F, Martínez-Sellés M, Segovia-Cubero J, Hervás-Sotomayor D, Blasco-Peiró T, De la Fuente-Galán L, Lambert-Rodríguez JL, Rangel-Sousa D, Almenar-Bonet L, Garrido-Bravo IP, Rábago-Juan-Aracil G, Muñiz J, Crespo-Leiro MG. Use of Intra-aortic Balloon Pump as a Bridge to Heart Transplant in Spain: Results From the ASIS-TC Study. ACTA ACUST UNITED AC 2018; 72:835-843. [PMID: 30115570 DOI: 10.1016/j.rec.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/05/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES In Spain, intra-aortic balloon pump (IABP) has been used frequently as a bridge to urgent heart transplant (HT). We sought to analyze the clinical outcomes of this strategy. METHODS We conducted a case-by-case, retrospective review of clinical records of 281 adult patients listed for urgent HT under IABP support in 16 Spanish institutions from 2010 to 2015. Pre- and post-transplant survival and adverse clinical events were analyzed. RESULTS A total of 194 (69%, 95%CI, 63.3-74.4) patients were transplanted and 20 (7.1%, 95%CI, 4.4-10.8) died during a mean period of IABP support of 10.9±9.7 days. IABP support was withdrawn before an organ became available in 32 (11.4%) patients. Thirty-five (12.5%, 95%CI, 8.8-16.9) patients transitioned from IABP to full-support mechanical devices. Mean urgent waiting list time increased from 5.9±6.3 days in 2010 to 15±11.7 days in 2015 (P=.001). Post-transplant survival rates at 30-days, 1-year, and 5-years were 88.1% (95%CI, 85.7-90.5), 76% (95%CI, 72.9-79.1), and 67.8% (95%CI, 63.7-71.9), respectively. The incidence rate of major adverse clinical outcomes-device dysfunction, stroke, bleeding or infection-during IABP support was 26 (95%CI, 20.6-32.4) episodes per 1000 patient-days. The incidence rate of IABP explantation due to complications was 7.2 (95%CI, 4.5-10.8) cases per 1000 patient-days. CONCLUSIONS In a setting of short waiting list times, IABP can be used to bridge candidates to urgent HT with acceptable postoperative results, but there were significant rates of adverse clinical events during support.
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Affiliation(s)
- Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - José González-Costello
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Félix Pérez-Villa
- Servicio de Cardiología, Hospital Clinic i Provincial, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - José Luis Lambert-Rodríguez
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Universidad Católica San Antonio, Murcia, Spain
| | - Diego Rangel-Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis Almenar-Bonet
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Iris P Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Batlle M, Campos B, Farrero M, Cardona M, González B, Castel MA, Ortiz J, Roig E, Pulgarín MJ, Ramírez J, Bedini JL, Sabaté M, García de Frutos P, Pérez-Villa F. Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in heart failure patients with reduced ejection fraction: Comparison with soluble AXL and BNP. Int J Cardiol 2016; 225:113-119. [PMID: 27718443 DOI: 10.1016/j.ijcard.2016.09.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic biomarkers are needed to improve the management of the heart failure (HF) epidemic, being the brain natriuretic peptides the most valuable. Here we evaluate 3 biomarkers, high sensitivity troponin T (hs-TnT), galectin-3 (Gal-3) and C-terminal propeptide of type I procollagen (CICP), compare them with a recently described new candidate (sAXL), and analyze their relationship with BNP. METHODS HF patients with reduced ejection fraction (n=192) were included in this prospective observational study, with measurements of candidate biomarkers, functional, clinical and echocardiographic variables. A Cox regression model was used to determine predictors for clinical events, i.e. all-cause mortality and heart transplantation. RESULTS Hs-TnT circulating values were correlated to clinical characteristics indicative of more advanced HF. When analyzing the event-free survival at a mean follow-up of 3.6years, patients in the higher quartile of either BNP, hs-TnT, CICP and sAXL had increased risk of suffering a clinical event, but not Gal-3. Combination of high sAXL and BNP values had greater predictive value (HR 6.8) than high BNP alone (HR 4.9). In a multivariate Cox regression analysis, BNP, sAXL and NYHA class were independent risk factors for clinical events. CONCLUSIONS In this HF cohort, hs-TnT is a good HF marker and has a very significant prognostic value. The prognostic value of CICP and sAXL was of less significance. However, hs-TnT did not add predictive value to BNP, while sAXL did. This suggests that elevated troponin has a common origin with BNP, while sAXL could represent an independent pathological mechanism.
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Affiliation(s)
- M Batlle
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain.
| | - B Campos
- Department of Public Health, Universitat de Barcelona, Spain
| | - M Farrero
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - M Cardona
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - B González
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M A Castel
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - J Ortiz
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - E Roig
- Heart Failure Unit at the Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain
| | - M J Pulgarín
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - J Ramírez
- Pathological Anatomy Department, Hospital Clínic de Barcelona, Spain
| | - J L Bedini
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M Sabaté
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - P García de Frutos
- Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC) and IDIBAPS, Spain
| | - F Pérez-Villa
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
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Tarradas A, Pinsach-Abuin ML, Mackintosh C, Llorà-Batlle O, Pérez-Serra A, Batlle M, Pérez-Villa F, Zimmer T, Garcia-Bassets I, Brugada R, Beltran-Alvarez P, Pagans S. Transcriptional regulation of the sodium channel gene (SCN5A) by GATA4 in human heart. J Mol Cell Cardiol 2016; 102:74-82. [PMID: 27894866 DOI: 10.1016/j.yjmcc.2016.10.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 06/03/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/12/2023]
Abstract
Aberrant expression of the sodium channel gene (SCN5A) has been proposed to disrupt cardiac action potential and cause human cardiac arrhythmias, but the mechanisms of SCN5A gene regulation and dysregulation still remain largely unexplored. To gain insight into the transcriptional regulatory networks of SCN5A, we surveyed the promoter and first intronic regions of the SCN5A gene, predicting the presence of several binding sites for GATA transcription factors (TFs). Consistent with this prediction, chromatin immunoprecipitation (ChIP) and sequential ChIP (Re-ChIP) assays show co-occupancy of cardiac GATA TFs GATA4 and GATA5 on promoter and intron 1 SCN5A regions in fresh-frozen human left ventricle samples. Gene reporter experiments show GATA4 and GATA5 synergism in the activation of the SCN5A promoter, and its dependence on predicted GATA binding sites. GATA4 and GATA6 mRNAs are robustly expressed in fresh-frozen human left ventricle samples as measured by highly sensitive droplet digital PCR (ddPCR). GATA5 mRNA is marginally but still clearly detected in the same samples. Importantly, GATA4 mRNA levels are strongly and positively correlated with SCN5A transcript levels in the human heart. Together, our findings uncover a novel mechanism of GATA TFs in the regulation of the SCN5A gene in human heart tissue. Our studies suggest that GATA5 but especially GATA4 are main contributors to SCN5A gene expression, thus providing a new paradigm of SCN5A expression regulation that may shed new light into the understanding of cardiac disease.
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Affiliation(s)
- Anna Tarradas
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain
| | - Mel Lina Pinsach-Abuin
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain; School of Medicine, University of California San Diego, La Jolla, CA 92093-0648, USA
| | - Carlos Mackintosh
- School of Medicine, University of California San Diego, La Jolla, CA 92093-0648, USA
| | - Oriol Llorà-Batlle
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain
| | - Alexandra Pérez-Serra
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain
| | - Montserrat Batlle
- Thorax Institute, Cardiology Department, Hospital Clínic, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, 08036 Barcelona, Spain
| | - Félix Pérez-Villa
- Thorax Institute, Cardiology Department, Hospital Clínic, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, 08036 Barcelona, Spain
| | - Thomas Zimmer
- Institute for Physiology II, University Hospital, 07743 Jena, Germany
| | - Ivan Garcia-Bassets
- School of Medicine, University of California San Diego, La Jolla, CA 92093-0648, USA
| | - Ramon Brugada
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain; Hospital Universitari Dr. Josep Trueta, 17001 Girona, Spain
| | - Pedro Beltran-Alvarez
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain; School of Biological, Biomedical, and Environmental Sciences, University of Hull, HU6 7RX, Hull, UK.
| | - Sara Pagans
- Medical Sciences Department, School of Medicine, University of Girona, 17071 Girona, Spain; Institut d'Investigació Biomèdica de Girona, 17190 Salt, Spain.
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Cardona M, Martín V, Prat-Gonzalez S, Ortiz JT, Perea RJ, de Caralt TM, Masotti M, Pérez-Villa F, Sabaté M. Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:78. [PMID: 27814739 PMCID: PMC5097417 DOI: 10.1186/s12968-016-0287-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF). These benefits were not assessed in populations with heart failure with reduced ejection fraction (HFrEF). We studied the effect of CTO-PCI on left ventricular function and clinical parameters in patients with HFrEF. METHODS Using cardiovascular magnetic resonance (CMR), we studied 29 patients with HFrEF and evidence of viability and/or ischemia in the territory supplied by a CTO who were successfully treated with CTO-PCI. In patients with multi-vessel disease, non-CTO PCI was also performed. Imaging parameters, clinical status, and brain natriuretic peptide (BNP) levels were evaluated before and 6 months after CTO-PCI. RESULTS A decrease in left ventricular end-systolic volume (160 ± 54 ml vs. 143 ± 58 ml; p = 0.029) and an increase in LVEF (31.3 ± 7.4 % vs. 37.7 ± 8 %; p < 0.001) were observed. There were no differences in LVEF improvement between patients who underwent non-CTO PCI (n = 11) and those without this intervention (n = 18); (p = 0.73). The number of segments showing perfusion defects was significantly reduced (0.5 ± 1 vs. 0.2 ± 0.5; p = 0.043). Angina (p = 0.002) and NYHA functional class (p = 0.004) improved, and BNP levels decreased (p = 0.004) after CTO-PCI. CONCLUSIONS In this group of patients with HFrEF showing CMR evidence of viability and/or ischemia within the territory supplied by the CTO, an improvement in ejection fraction, left ventricular end-systolic volume and ischemia burden was observed after CTO-PCI. Clinical and laboratory parameters also improved. TRIAL REGISTRATION ClinicalTrials.gov NCT02570087 . Registered 6 October 2015.
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Affiliation(s)
- Montserrat Cardona
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Victoria Martín
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Susanna Prat-Gonzalez
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - José Tomás Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Rosario Jesús Perea
- Department of Radiodiagnosis, Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Teresa Maria de Caralt
- Department of Radiodiagnosis, Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mónica Masotti
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Félix Pérez-Villa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
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Batlle M, Campos B, Farrero M, Cardona M, González B, Castel MA, Ortiz J, Roig E, Pulgarín MJ, Ramírez J, Bedini JL, Sabaté M, de Frutos PG, Pérez-Villa F. Data on clinical characteristics of a heart failure patients' cohort with reduced ejection fraction and analysis of the circulating values of five different heart failure biomarkers; high sensitivity troponin T, galectin-3, C-terminal propeptide of type I procollagen, soluble AXL and BNP. Data Brief 2016; 9:876-882. [PMID: 27872884 PMCID: PMC5109253 DOI: 10.1016/j.dib.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 11/13/2022] Open
Abstract
In this article, the full description of a heart failure with reduced ejection fraction (HF_REF) cohort of 192 patients is provided. Tables with the baseline demographic, prior history, ECG parameters, echocardiographic parameters, laboratory values and pharmacological treatment of these patients are included. Also, the quartile values of the analyzed circulating biomarkers: high sensitivity Troponin T (hs-TnT), galectin-3 (Gal-3), C-terminal propeptide of type I procollagen (CICP), soluble AXL (sAXL) and Brain Natriuretic Peptide (BNP) are given. The main demographic and clinical features of the patients’ subgroups that have hs-TnT, Gal-3, CICP or BNP above the third quartile are described. Tables with Pearson correlation analysis of the HF_REF patients’ biomarker levels are included. And Pearson correlation analysis of the HF_REF patients’ hs-TnT, Gal-3, CICP levels with patients’ biochemical parameters, blood count and inflammation parameters are also described. These data are related to the research articles (AXL receptor tyrosine kinase is increased in patients with heart failure (M. Batlle, P. Recarte-Pelz, E. Roig, M.A. Castel, M. Cardona, M. Farrero, et al., 2014) [1] and Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in Heart Failure patients with reduced ejection fraction: comparison with soluble AXL and BNP (M. Batlle, B. Campos, M. Farrero, M. Cardona, B. González, M.A. Castel, et al., 2016) [2].
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Affiliation(s)
- M Batlle
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - B Campos
- Department of Public Health, Universitat de Barcelona, Spain
| | - M Farrero
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Cardona
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B González
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M A Castel
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Ortiz
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E Roig
- Heart Failure Unit at the Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J Pulgarín
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - J Ramírez
- Pathological Anatomy Department, Hospital Clínic de Barcelona, Spain
| | - J L Bedini
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M Sabaté
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - P García de Frutos
- Department of Cell Death and Proliferation at Institut d´Investigacions Biomèdiques de Barcelona (IIBB-CSIC) and IDIBAPS, Barcelona, Spain
| | - F Pérez-Villa
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Sánchez R, Baillès E, Bastidas A, Serrano L, Pérez-Villa F, Castel MÁ, Pintor L. A New Quantitative Approach to Assessing Noncompliance With Medical Recommendations in Heart Transplant Recipients. Transplant Proc 2016; 48:2178-80. [PMID: 27569967 DOI: 10.1016/j.transproceed.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure of compliance with medical regimen is one of the major risk factors associated with morbidity and mortality in heart transplant (HT) recipients. Nevertheless, to date, there is no specific, gold-standard, comprehensive set of tools for assessing compliance in these patients. OBJECTIVE The objective of the present study was to develop a specific instrument for the assessment of noncompliance with medical recommendations in HT recipients. METHODS This prospective observational study used a nonprobability sampling method, which was performed from January 2006 to December 2012. All of the patients met clinical criteria for being included on the waiting list for a HT. We designed a scale for measuring the compliance degree at 12 months after heart transplantation. This scale included the most important aspects of the medical regimen, using nine discrete quantitative variables. The total score was described as the patient's Noncompliance Factor (NCF). The results were analysed by mean, ranks, and percentages. RESULTS The sample was constituted of 61 participants who underwent surgical HT intervention and completed the 12-month follow-up assessment. The overall incidence of noncompliance was around 30% and only 43.1% of the recipients had an acceptable degree of compliance. CONCLUSIONS The overall incidence of noncompliance in HT recipients is high and this can generate worse clinical outcomes. Evaluation by specific screening instruments like the one proposed in the present study can be useful for a systematic detection of this phenomenon.
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Affiliation(s)
- R Sánchez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain.
| | - E Baillès
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - A Bastidas
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - L Serrano
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Department of Cardiology, Heart Transplantation Division, Instituto Clínico del Tórax, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - M Á Castel
- Department of Cardiology, Heart Transplantation Division, Instituto Clínico del Tórax, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - L Pintor
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Crespo-Leiro M, Segovia Cubero J, Delgado-Jiménez J, Roig-Minguell E, Barge-Caballero E, Sousa-Casasnovas I, Almenar-Bonet L, González-Vilchez F, González-Costello J, Díaz-Molina B, Sobrino-Márquez J, Rábago G, Arizón del Prado J, Pérez-Villa F, Blasco Peiró T, de la Fuente-Galán L, Garrido Bravo I, Muñiz J. Neoplasia after Heart Transplantation. Differences in Incidence and Prognosis between Genders. Data from the Spanish Post-Heart Transplant Tumor Registry. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.312] [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: 10/21/2022] Open
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Agüero F, Castel MA, Cocchi S, Moreno A, Mestres CA, Cervera C, Pérez-Villa F, Tuset M, Cartañà R, Manzardo C, Guaraldi G, Gatell JM, Miró JM. An Update on Heart Transplantation in Human Immunodeficiency Virus-Infected Patients. Am J Transplant 2016; 16:21-8. [PMID: 26523614 DOI: 10.1111/ajt.13496] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/16/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.
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Affiliation(s)
- F Agüero
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M A Castel
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - S Cocchi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Tuset
- Pharmacy Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Cartañà
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - G Guaraldi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Sánchez R, Baillès E, Peri JM, Bastidas A, Pérez-Villa F, Bulbena A, Pintor L. Assessment of psychosocial factors and predictors of psychopathology in a sample of heart transplantation recipients: a prospective 12-month follow-up. Gen Hosp Psychiatry 2016; 38:59-64. [PMID: 26633863 DOI: 10.1016/j.genhosppsych.2015.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 10/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES In the last decades, researchers of heart transplantation (HT) programs have attempted to identify the existence of psychosocial factors that might influence the clinical outcome before and after the transplantation. The first objective of this study is the prospective description of changes in psychiatric and psychosocial factors in a sample of HT recipients through a 12-month follow-up. The second goal is to identify predictors of psychopathology 1 year after HT. METHODS Pretransplant baseline assessment consisted of clinical form; Hospital Anxiety and Depression Scale (HADS); Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Structured Clinical Interview; Coping questionnaire (COPE); Five Factors Inventory Revised; Apgar-Family questionnaire and Multidimensional Health Locus of Control (MHLC). The assessment 1 year after HT consisted of HADS, COPE, Apgar-Family and MHLC. RESULTS The sample included 78 recipients. During the waiting list period, 32.1% of them had a psychiatric disorder; personality factors profile was similar to the general population, and they showed adaptive coping strategies. Some changes in psychosocial factors were observed at 12 months after the surgery: lower scores of anxiety and depression, less necessity of publicly venting of feelings and a trend to an internal locus of control. Neuroticism and Disengagement pre-HT were predictors of psychopathology in the follow-up assessment. CONCLUSIONS Pretransplant psychosocial screening is important and enables to find out markers of emotional distress like Neuroticism or Disengagement coping styles to identify patients who might benefit from psychiatric and psychological interventions. Successful HT involved some positive changes in psychosocial factors 12 months after the surgery beyond physical recovery.
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Affiliation(s)
- Roberto Sánchez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | - Eva Baillès
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Peri
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Anna Bastidas
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Félix Pérez-Villa
- Department of Cardiology, Heart Transplantation Division, Instituto Clínico del Tórax, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Bulbena
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Luis Pintor
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Méndez AB, Ordonez-Llanos J, Farrero M, Mirabet S, Brossa V, López L, Bonet R, Sionis A, Pérez-Villa F, Roig E. Cost-Effectiveness of Highly Sensitive Cardiac Troponin T to Rule Out Acute Rejection After Heart Transplantation. Transplant Proc 2015; 47:2395-6. [PMID: 26518938 DOI: 10.1016/j.transproceed.2015.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endomyocardial biopsy (EMB) remains the gold standard for detecting acute rejection (AR) after heart transplantation (HTx). Non-invasive detection of AR thus far remains a challenge. Several studies have demonstrated that highly sensitive cardiac troponin T (hs-cTnT) concentrations have a low positive predictive value for diagnosing AR. Nevertheless, hs-cTnT proved to be useful for ruling out AR after HTx. An hs-cTnT concentration <17 ng/L, a value close to that used for rule-in or rule-out myocardial infarction, was associated with a 100% negative predictive value of AR. However, the cost-effectiveness of a strategy with the use of hs-cTnT for ruling out AR in HTx patients remains to be proven. METHODS The cost-effectiveness of hs-cTnT determination for ruling out AR was assessed, comparing the costs of hs-cTnT measurements in 305 blood samples obtained at the time of EMB. Eighteen samples were excluded because the EMB was not assessable. RESULTS Hs-cTnT determination cost 16.00€ per sample, whereas EMB cost 1752.00€ per biopsy; cost estimations included direct and indirect (30%) charges. Thirty-nine (13.6%) of the 287 blood samples presented hs-cTnT concentrations <17 ng/L; in none of them was an AR >2R degree found in the EMB. The cost of the assessment in the 287 blood samples and biopsies was of 4592.00€ for hs-cTnT and 502,824.00€ for EMB. Hs-cTnT systematic measurement would have avoided 39 EMB, with a saving of 68,328.00€, which represents the 13.5% of the total budget expended in these cases. CONCLUSIONS The use of hs-cTnT values to rule out the need of EMB for AR diagnosis after HTx appears to be a cost-effective procedure.
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Affiliation(s)
- A B Méndez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Ordonez-Llanos
- Departamento de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Farrero
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - S Mirabet
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Brossa
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - L López
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Bonet
- Departamento de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Sionis
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Pérez-Villa
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - E Roig
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Paniagua MJ, Almenar L, Palomo J, Segovia J, Delgado J, Lage E, González F, Pérez-Villa F, Arizón JM, Manito N, Brossa V, Díaz-Molina B, Blasco T, de la Fuente L, Pascual D, Rábago G, García-Guereta L, Albert DC, Crespo-Leiro MG. Influencia del perfil clínico del donante, receptor y tiempo de isquemia en la supervivencia del trasplante cardíaco. Subanálisis del Registro Español de Trasplante Cardíaco. Cirugía Cardiovascular 2015. [DOI: 10.1016/j.circv.2015.02.007] [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] Open
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36
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Sanchis L, Andrea R, Falces C, Llopis J, Morales-Ruiz M, López-Sobrino T, Pérez-Villa F, Sitges M, Sabate M, Brugada J. Prognosis of new-onset heart failure outpatients and collagen biomarkers. Eur J Clin Invest 2015; 45:842-9. [PMID: 26077878 DOI: 10.1111/eci.12479] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prognosis of heart failure patients has been defined in hospital-based or retrospective studies. This study aimed to characterize prognosis of outpatients with new-onset preserved or reduced ejection fraction heart failure; to explore the role of collagen turnover biomarkers (MMP2, MMP9, TIMP1) in predicting prognosis; and to analyse their relationship with echocardiographic parameters and final diagnosis. METHODS This is an observational, prospective, longitudinal study. Outpatients with new-onset heart failure symptoms referred to a one-stop clinic were included. Echocardiography and biomarkers plasma levels determination were performed at the inclusion. A prospective follow-up was conducted to report cardiovascular events. The discriminant analysis was applied to identify the parameters related to cardiovascular outcomes. RESULTS A total of 172 patients (75 ± 9 years) were included, 67% with heart failure (64% preserved and 36% with reduced ejection fraction). During follow-up (median 34.5 months), 32.6% had at least one cardiovascular event and 9.9% died. Heart failure groups showed no differences in cardiovascular outcomes with a higher rate of events than nonheart failure patients. MMP2 and TIMP1 were correlated with diastolic dysfunction (Rho 0.349 and 0.294, P < 0.001). In the discriminant analysis, the combination of biomarkers with clinical, biochemical and echocardiographic parameters was useful to predict cardiovascular outcomes (AUC ROC 0.806, Wilks lambda 0.7688, P < 0.001). CONCLUSIONS Prognosis of outpatients with new-onset heart failure symptoms is comparable between heart failure with preserved or reduced subgroups. The addition of biomarkers specially MMP2 and high sensitive troponin I to other clinical, biochemical and echocardiographic variables can predict cardiovascular prognosis at the time of diagnosis.
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Affiliation(s)
- Laura Sanchis
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Falces
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Statistics, University of Barcelona, Barcelona, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Teresa López-Sobrino
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Félix Pérez-Villa
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Manel Sabate
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Benito N, García-Vázquez E, Horcajada JP, González J, Oppenheimer F, Cofán F, Ricart MJ, Rimola A, Navasa M, Rovira M, Roig E, Pérez-Villa F, Cervera C, Moreno A. Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study. Clin Microbiol Infect 2015; 21:651-8. [PMID: 25882369 DOI: 10.1016/j.cmi.2015.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 11/26/2014] [Revised: 02/28/2015] [Accepted: 03/21/2015] [Indexed: 02/08/2023]
Abstract
There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - E García-Vázquez
- Infectious Diseases Service, Hospital Clínico Universitario Virgen de la Arrixaca. University of Murcia, Murcia, Spain
| | - J P Horcajada
- Infectious Diseases Service, Parc de Salut Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - J González
- Microbiology Service, Hospital Clínic Universitari - Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - F Oppenheimer
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - F Cofán
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - M J Ricart
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Rimola
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Navasa
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Rovira
- Haematology Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - E Roig
- Cardiology Service, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Cardiology Service, Hospital Clínic Universitari - IDIBAPS, University of Barcelona Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Moreno
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
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38
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Barge-Caballero E, Segovia-Cubero J, González-Vilchez F, Delgado-Jiménez J, Pérez-Villa F, Almenar-Bonet L, Arizón-Del Prado JL, Lage-Gallé E, De La Fuente-Galán L, Manito-Lorite N, Sanz-Julve M, Villa-Arranz A, Lambert Rodríguez JL, Brossa-Loidi V, Pascual-Figal D, Muñiz-García J, Crespo-Leiro M. Evaluation of the preoperative vasoactive-inotropic score as a predictor of postoperative outcomes in patients undergoing heart transplantation. Int J Cardiol 2015; 185:192-4. [DOI: 10.1016/j.ijcard.2015.03.098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/08/2015] [Indexed: 11/15/2022]
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Castel M, Cartaña R, Cardona M, Pereda D, Sandoval E, Castella M, Farrero M, Pérez-Villa F. Outcomes After Heart Transplantation of Patients Bridged to Transplant With Short Term Assist Device Support. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.530] [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] Open
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40
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Martinez-Selles M, Almenar L, Paniagua-Martin MJ, Segovia J, Delgado JF, Arizón JM, Ayesta A, Lage E, Brossa V, Manito N, Pérez-Villa F, Diaz-Molina B, Rábago G, Blasco-Peiró T, De La Fuente Galán L, Pascual-Figal D, Gonzalez-Vilchez F. Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry. Transpl Int 2014; 28:305-13. [PMID: 25399778 DOI: 10.1111/tri.12488] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2014] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 ± 4.1 vs. 24.3 ± 3.7; P < 0.01), and male donors were younger than female donors (33.4 ± 12.7 vs. 38.2 ± 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.
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Crespo-Leiro MG, Delgado-Jiménez J, López L, Alonso-Pulpón L, González-Vilchez F, Almenar-Bonet L, Rábago G, Pérez-Villa F, Paniagua Martín MJ, Arizón del Prado JM, Sousa-Casasnovas I, Manito-Lorite N, Díaz-Molina B, Pascual-Figal D, Lage-Galle E, Blasco-Peiró T, De la Fuente-Galán L, Muñiz J. The falling incidence of hematologic cancer after heart transplantation. Clin Transplant 2014; 28:1142-7. [DOI: 10.1111/ctr.12432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - L. López
- Hospital Santa Creu i Sant Pau; Barcelona Spain
| | | | | | | | - G. Rábago
- Clínica Universidad de Navarra; Pamplona Spain
| | | | | | | | | | | | - B. Díaz-Molina
- Hospital Universitario Central de Asturias; Oviedo Spain
| | | | - E. Lage-Galle
- Hospital Universitario Virgen del Rocío; Sevilla Spain
| | | | | | - J. Muñiz
- Instituto Universitario de Ciencias de la Salud Universidad de A Coruña; A Coruña Spain
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Beltran-Alvarez P, Tarradas A, Chiva C, Pérez-Serra A, Batlle M, Pérez-Villa F, Schulte U, Sabidó E, Brugada R, Pagans S. Identification of N-terminal protein acetylation and arginine methylation of the voltage-gated sodium channel in end-stage heart failure human heart. J Mol Cell Cardiol 2014; 76:126-9. [PMID: 25172307 DOI: 10.1016/j.yjmcc.2014.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 07/04/2014] [Revised: 07/25/2014] [Accepted: 08/15/2014] [Indexed: 11/30/2022]
Abstract
The α subunit of the cardiac voltage-gated sodium channel, NaV1.5, provides the rapid sodium inward current that initiates cardiomyocyte action potentials. Here, we analyzed for the first time the post-translational modifications of NaV1.5 purified from end-stage heart failure human cardiac tissue. We identified R526 methylation as the major post-translational modification of any NaV1.5 arginine or lysine residue. Unexpectedly, we found that the N terminus of NaV1.5 was: 1) devoid of the initiation methionine, and 2) acetylated at the resulting initial alanine residue. This is the first evidence for N-terminal acetylation in any member of the voltage-gated ion channel superfamily. Our results open the door to explore NaV1.5 N-terminal acetylation and arginine methylation levels as drivers or markers of end-stage heart failure.
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Affiliation(s)
- Pedro Beltran-Alvarez
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, 17003 Girona, Spain.
| | - Anna Tarradas
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, 17003 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Cristina Chiva
- Proteomics Unit, Centre for Genomic Regulation (CRG), 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
| | - Alexandra Pérez-Serra
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, 17003 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Montserrat Batlle
- Thorax Institute, Cardiology Department, Hospital Clínic, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, 08036 Barcelona, Spain
| | - Félix Pérez-Villa
- Thorax Institute, Cardiology Department, Hospital Clínic, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, 08036 Barcelona, Spain
| | - Uwe Schulte
- Logopharm GmbH, 79232 March-Buchheim, Germany
| | - Eduard Sabidó
- Proteomics Unit, Centre for Genomic Regulation (CRG), 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, 17003 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, 17003 Girona, Spain.
| | - Sara Pagans
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, 17003 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, 17003 Girona, Spain.
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43
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Batlle M, Recarte-Pelz P, Roig E, Castel MA, Cardona M, Farrero M, Ortiz JT, Campos B, Pulgarín MJ, Ramírez J, Pérez-Villa F, García de Frutos P. AXL receptor tyrosine kinase is increased in patients with heart failure. Int J Cardiol 2014; 173:402-9. [PMID: 24681018 DOI: 10.1016/j.ijcard.2014.03.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/01/2014] [Accepted: 03/09/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AXL is a membrane receptor tyrosine kinase highly expressed in the heart and has a conspicuous role in cardiovascular physiology. The role of AXL in heart failure (HF) has not been previously addressed. METHODS AND RESULTS AXL protein was enhanced 6-fold in myocardial biopsies of end-stage HF patients undergoing heart transplantation compared to controls from heart donors (P<0.0001). Next, we performed a transversal study of patients with chronic HF (n=192) and a group of controls with no HF (n=67). sAXL and BNP circulating levels were quantified and clinical and demographic data were collected. sAXL levels in serum were higher in HF (86.3 ± 2.0 ng/mL) than in controls (67.8 ± 2.0 ng/mL; P<0.0001). Also, sAXL correlated with several parameters associated with worse prognosis in HF. Linear regression analysis indicated that serum creatinine, systolic blood pressure and atrial fibrillation, but not BNP levels, were predictive of sAXL levels. Cox regression analysis indicated that high sAXL values at enrollment time were related to the major HF events (all-cause mortality, heart transplantation and HF hospitalizations) at one year follow-up (P<0.001), adding predictive value to high BNP levels. CONCLUSIONS Myocardial expression and serum concentration of AXL is elevated in HF patients compared to controls. Furthermore, peripheral sAXL correlates with parameters associated with the progression of HF and with HF events at short term follow-up. All together these results suggest that sAXL could belong to a new molecular pathway involved in myocardial damage in HF, independent from BNP.
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Affiliation(s)
- M Batlle
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain.
| | - P Recarte-Pelz
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Spain
| | - E Roig
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain
| | - M A Castel
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - M Cardona
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - M Farrero
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - J T Ortiz
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - B Campos
- Department of Public Health, Universitat de Barcelona, Spain
| | - M J Pulgarín
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - J Ramírez
- Pathological Anatomy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - P García de Frutos
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Spain
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44
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González-Vílchez F, Arizón J, Segovia J, Almenar L, Crespo-Leiro M, Palomo J, Delgado J, Mirabet S, Rábago G, Pérez-Villa F, Díaz B, Sanz M, Pascual D, de la Fuente L, Guinea G. Chronic Renal Dysfunction in Maintenance Heart Transplant Patients: The ICEBERG Study. Transplant Proc 2014; 46:14-20. [DOI: 10.1016/j.transproceed.2013.09.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
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45
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González-Vílchez F, Vázquez de Prada JA, Paniagua MJ, Almenar L, Mirabet S, Gómez-Bueno M, Díaz-Molina B, Arizón JM, Delgado J, Pérez-Villa F, Crespo-Leiro MG, Martínez-Dolz L, Roig E, Segovia J, Lambert JL, Lopez-Granados A, Escribano P, Farrero M. Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation. Clin Transplant 2013; 27:E649-58. [PMID: 24025040 DOI: 10.1111/ctr.12241] [Citation(s) in RCA: 5] [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] [Accepted: 08/06/2013] [Indexed: 01/10/2023]
Abstract
We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies.
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Affiliation(s)
- Francisco González-Vílchez
- Heart Failure and Cardiac Transplantation Unit, Cardiology Service, Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), University Hospital Marques de Valdecilla, Santander, Spain
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46
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Cardona M, Castel MÁ, Farrero M, Pérez-Villa F. [Association of everolimus with tacrolimus during the first year after heart transplantation: initial experience]. Med Clin (Barc) 2013; 141:87-8. [PMID: 23384432 DOI: 10.1016/j.medcli.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/03/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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47
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Affiliation(s)
- F Pérez-Villa
- Servicio de Cardiología (IMCV). Hospital Clínico. Universidad de Barcelona. Barcelona
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48
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Castel MÁ, Roig E, Rios J, Tomas C, Mirabet S, Cardona M, Brossa V, López L, Vargas L, Sionis A, Vallejos I, Pérez-Villa F. Long-term prognostic value of elevated heart rate one year after heart transplantation. Int J Cardiol 2013; 168:2003-7. [PMID: 23336956 DOI: 10.1016/j.ijcard.2012.12.089] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 09/07/2012] [Revised: 11/30/2012] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevated heart rate (HR) is associated with adverse cardiovascular outcome in the general population and in patients with cardiovascular disease. Elevated HR due to graft denervation is often found in heart transplantation (HTx) patients; the effect on graft survival and vasculopathy is unclear. Thus, the aim of this study was to evaluate the role of elevated HR at 12 months post-HTx and its power to predict HTx long-term outcome. METHODS We evaluated retrospectively a prospective database of 312 patients undergoing HTx at two centers. HR was registered at 12 months post-HTx. The median HR was used as a cutoff point. Cox regression analysis was performed with variables known to be clinically relevant to mortality and those selected from the univariate analysis. RESULTS During a mean follow-up of 5.5 ± 2.8 years there were 58 deaths (19%). Patients with a HR ≥ 90 bpm (median HR) at 12 months had an increased risk for all-cause mortality (Hazard Ratio=2.4, 95% CI 1.2 to 4.5, p=0.009) and mortality related to coronary allograft vasculopathy (CAV) (Hazard Ratio=3.0, 95% CI 1.25-7.14, p=0.01). Multivariate analysis showed that a HR ≥ 90 bpm independently predicted mortality (HR 3.2, 95% CI 1.4-7.1, p=0.004). CONCLUSIONS Elevated HR measured at 12 months after HTx is an independent predictor of all-cause mortality in HTx recipients. A HR ≥ 90 bpm identifies a group of patients at high risk of death and CAV-related mortality at mid- to long-term.
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Affiliation(s)
- María Ángeles Castel
- Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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49
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Castel M, Cartañá R, Cardona M, Pereda D, Hernández M, Sandoval E, Castella M, Pérez-Villa F. Long-term Outcome of High-urgency Heart Transplant Patients With and Without Temporary Ventricular Assist Device Support. Transplant Proc 2012; 44:2642-4. [DOI: 10.1016/j.transproceed.2012.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Díaz-Molina B, Brossa V, Rábago G, Alonso-Pulpón L, Vilchez F, Palomo J, Manito N, Almenar L, Delgado J, Arizón J, Lage E, Lambert J, Pérez-Villa F, Blasco T, Pascual D, Fuente L, Crespo-Leiro M. 666 Prostate Cancer after Heart Transplantation: Incidence and Prognosis. Data from the Spanish Post-Heart-Transplant Tumour Registry. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.681] [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] Open
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