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Olivella A, Almenar-Bonet L, Moliner P, Coloma E, Martínez-Rubio A, Paz Bermejo M, Boixeda R, Cediel G, Méndez Fernández AB, Facila Rubio L. Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode. ESC Heart Fail 2024; 11:628-636. [PMID: 38158630 DOI: 10.1002/ehf2.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024] Open
Abstract
Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.
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Affiliation(s)
- Aleix Olivella
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar-Bonet
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pedro Moliner
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Community Heart Failure Program (UMICO), Department of Cardiology, Bellvitge University Hospital, Barcelona, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emmanuel Coloma
- Heart Failure and Transplantation Unit, Internal Medicine Department and Hospital at Home Unit, Hospital Clinic, Barcelona, Spain
- Instituto de Investigaciones Médicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antoni Martínez-Rubio
- Department of Cardiology, Hospital Universitario de Sabadell, Sabadell, Spain
- Universidad Autonoma de Barcelona, Sabadell, Spain
| | | | - Ramon Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - German Cediel
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ana Belén Méndez Fernández
- Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Facila Rubio
- Department of Cardiology, Hospital General de Valencia, Universitat de Valencia, Avda. Tres Cruces 2, 46014, Valencia, Spain
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Bayes-Genis A, Gastelurrutia P, Monguió-Tortajada M, Cámara ML, Prat-Vidal C, Cediel G, Rodríguez-Gómez L, Teis A, Revuelta-López E, Ferrer-Curriu G, Roura S, Gálvez-Montón C, Bisbal F, Vives J, Vilarrodona A, Muñoz-Guijosa C, Querol S. Implantation of a double allogeneic human engineered tissue graft on damaged heart: insights from the PERISCOPE phase I clinical trial. EBioMedicine 2024; 102:105060. [PMID: 38490102 PMCID: PMC10955661 DOI: 10.1016/j.ebiom.2024.105060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In preclinical studies, the use of double allogeneic grafts has shown promising results in promoting tissue revascularization, reducing infarct size, preventing adverse remodelling and fibrosis, and ultimately enhancing cardiac function. Building upon these findings, the safety of PeriCord, an engineered tissue graft consisting of a decellularised pericardial matrix and umbilical cord Wharton's jelly mesenchymal stromal cells, was evaluated in the PERISCOPE Phase I clinical trial (NCT03798353), marking its first application in human subjects. METHODS This was a double-blind, single-centre trial that enrolled patients with non-acute myocardial infarction eligible for surgical revascularization. Seven patients were implanted with PeriCord while five served as controls. FINDINGS Patients who received PeriCord showed no adverse effects during post-operative phase and one-year follow-up. No significant changes in secondary outcomes, such as quality of life or cardiac function, were found in patients who received PeriCord. However, PeriCord did modulate the kinetics of circulating monocytes involved in post-infarction myocardial repair towards non-classical inflammation-resolving macrophages, as well as levels of monocyte chemoattractants and the prognostic marker Meteorin-like in plasma following treatment. INTERPRETATION In summary, the PeriCord graft has exhibited a safe profile and notable immunomodulatory properties. Nevertheless, further research is required to fully unlock its potential as a platform for managing inflammatory-related pathologies. FUNDING This work was supported in part by grants from MICINN (SAF2017-84324-C2-1-R); Instituto de Salud Carlos III (ICI19/00039 and Red RICORS-TERAV RD21/0017/0022, and CIBER Cardiovascular CB16/11/00403) as a part of the Plan Nacional de I + D + I, and co-funded by ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER) and AGAUR (2021-SGR-01437).
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain.
| | - Paloma Gastelurrutia
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain
| | - Marta Monguió-Tortajada
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain
| | - Maria Luisa Cámara
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain
| | | | - German Cediel
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Albert Teis
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain
| | - Elena Revuelta-López
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain
| | | | - Santiago Roura
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Victoria, Spain
| | - Carolina Gálvez-Montón
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute (IGTP), Spain
| | - Felipe Bisbal
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquim Vives
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Cell Therapy Service, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
| | - Christian Muñoz-Guijosa
- Heart Institute and Heart Failure Unit (iCor), Germans Trias i Pujol University Hospital (HUGTiP), Badalona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Querol
- Cell Therapy Service, Banc de Sang i Teixits (BST), Barcelona, Spain.
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Weerts J, Bisbal F, Bayés-Genís A, Delgado V, Cediel G, Teis A. Simplified left atrial sphericity evaluation by cardiac magnetic resonance. Rev Esp Cardiol (Engl Ed) 2024; 77:178-181. [PMID: 37783369 DOI: 10.1016/j.rec.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Jerremy Weerts
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre + (MUMC +), Maastricht, The Netherlands
| | - Felipe Bisbal
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Centre de Medicina Comparativa i Bioimatge (CMCiB), Badalona, Barcelona, Spain
| | - German Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Albert Teis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
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Kasa G, Teis A, Juncà G, Aimo A, Lupón J, Cediel G, Santiago-Vacas E, Codina P, Ferrer-Sistach E, Vallejo-Camazón N, López-Ayerbe J, Bayés-Genis A, Delgado V. Clinical and prognostic implications of left ventricular dilatation in heart failure. Eur Heart J Cardiovasc Imaging 2024:jeae025. [PMID: 38246859 DOI: 10.1093/ehjci/jeae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
AIMS To assess the agreement between left ventricular end-diastolic diameter index (LVEDDi) and volume index (LVEDVi) to define LV dilatation and to investigate the respective prognostic implications in patients with heart failure (HF). METHODS AND RESULTS Patients with HF symptoms and LV ejection fraction (LVEF) < 50% undergoing cardiac magnetic resonance (CMR) were evaluated retrospectively. LV dilatation was defined as LVEDDi or LVEDVi above the upper normal limit according to published reference values. Patients were followed-up for the combined endpoint of cardiovascular death or HF hospitalization during 5 years. A total of 564 patients (median age 64 years; 79% men) were included. LVEDDi had a modest correlation with LVEDVi (r = 0.682, p < 0.001). LV dilatation was noted in 84% of patients using LVEDVi-based definition and in 73% using LVEDDi-based definition, whereas 20% of patients displayed discordant definitions of LV dilatation. During a median follow-up of 2.8 years, patients with both dilated LVEDDi and LVEDVi had the highest cumulative event rate (HR 3.00, 95% CI 1.15-7.81, p = 0.024). Both LVEDDi and LVEDVi were independently associated with the primary outcome (hazard ratio 3.29, 95%, p < 0.001 and 2.8, p = 0.009; respectively). CONCLUSIONS The majority of patients with HF and LVEF < 50% present both increased LVEDDi and LVEDVi whereas 20% show discordant linear and volumetric definitions of LV dilatation. Patients with increased LVEDDi and LVEDVi have the worst clinical outcomes suggesting that the assessment of these two metrics is needed for better risk stratification.
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Affiliation(s)
- Gizem Kasa
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Albert Teis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Gladys Juncà
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Pau Codina
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Jorge López-Ayerbe
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Centre for Comparative Medicine and Bioimage (CMCiB); Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
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5
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Rodriguez-Leor O, Toledano B, López-Palop R, Rivero F, Brugaletta S, Linares JA, Benito T, Carrillo P, Puigfel M, Cediel G, Sadaba M, Vaquerizo B, Rondán J, Gómez I, Alfonso F, Sáez R, Planas A, Lozano F, Hernández F, Sabaté M, Ruíz-Arroyo JR, Torres F, de la Torre Hernández JM, Gutiérrez E, Cid-Álvarez AB, Díez JL, Fernández L, Moreu J, Ojeda S, Cerrato P, Ruiz-Quevedo V, Sanchis J, Gómez-Menchero A, Ocaranza R, Mohandes M, Hernández JM, Alfageme MM, Aguiar P, López Mínguez JR, Pérez de Prado A. Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry. Cardiovasc Revasc Med 2023; 51:55-64. [PMID: 36822975 DOI: 10.1016/j.carrev.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. AIMS To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. METHODS Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. RESULTS 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). CONCLUSIONS The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
| | - Beatriz Toledano
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Fernando Rivero
- Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
| | - Salvatore Brugaletta
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Tomás Benito
- Servicio de Cardiología, Hospital de León, León, Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital de Sant Joan, Alacant, Spain
| | - Martí Puigfel
- Servicio de Cardiología, Hospital Josep Trueta de Girona, Girona, Spain
| | - German Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Sadaba
- Servicio de Cardiología, Hospital de Galdakao, Galdakao, Spain
| | | | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Spain
| | - Iván Gómez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Roberto Sáez
- Servicio de Cardiología, Hospital de Basurto, Basurto, Spain
| | - Ana Planas
- Servicio de Cardiología, Hospital de Castellón, Castellón de la Plana, Spain
| | - Fernando Lozano
- Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Felipe Hernández
- Servicio de Cardiología, Clínica Universitaria de Navarra, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | | | | | - Enrique Gutiérrez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - José Luís Díez
- Servicio de Cardiología, Hospital Universitari de la Fe, Valencia, Spain
| | - Luis Fernández
- Servicio de Cardiología, Hospital de Cruces, Barakaldo, Spain
| | - José Moreu
- Servicio de Cardiología, Hospital de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo Cerrato
- Servicio de Cardiología, Hospital de Mérida, Mérida, Spain
| | | | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Mohsen Mohandes
- Servicio de Cardiología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Pablo Aguiar
- Servicio de Cardiología, Hospital San Pedro de Logroño, Logroño, Spain
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Delgado-Ramis L, Llorens A, Berastegui E, Cediel G, Fernandez C, Muñoz C. Reparación de la insuficiencia mitral por prolapso del velo posterior. ¿Qué ha cambiado? Cirugía Cardiovascular 2023. [DOI: 10.1016/j.circv.2022.11.003] [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] [Indexed: 02/16/2023] Open
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7
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Martinez Steele E, Marrón Ponce JA, Cediel G, Louzada MLC, Khandpur N, Machado P, Moubarac JC, Rauber F, Corvalán C, Levy RB, Monteiro CA. Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries. Nutr Metab Cardiovasc Dis 2022; 32:2739-2750. [PMID: 36163210 DOI: 10.1016/j.numecd.2022.08.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies. We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies. METHODS AND RESULTS Using nationally-representative cross-sectional surveys from Brazil (2008-09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015), and the US (2015-16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified. Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies. CONCLUSIONS Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles.
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Affiliation(s)
- E Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
| | - J A Marrón Ponce
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - G Cediel
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil; School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia.
| | - M L C Louzada
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
| | - N Khandpur
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - P Machado
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil; Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - J-C Moubarac
- Département de Nutrition, Université de Montréal, Montréal, Canada.
| | - F Rauber
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil; Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - C Corvalán
- CIAPEC, Unidad de Nutrición Pública, INTA, Universidad de Chile, Chile.
| | - R B Levy
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil; Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - C A Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil.
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8
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Domingo M, Teis A, Alonso N, Julian T, Bares D, Barcelo E, Revuelta-Lopez E, Gonzalez B, Codina P, Cediel G, Santiago-Vacas E, Santesmases J, Zamora E, Lupon J, Bayes-Genis A. Effect of diuretic down-titration on pulmonary congestion assessed by lung ultrasound when introducing sodium-glucose cotransporter 2 inhibitors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mechanistic pathways of sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefits in heart failure (HF) remain unclear.
Purpose
To investigate the effects of SGLT2i and simultaneous diuretic down-titration on pulmonary congestion assessed by lung ultrasound (LUS) and by HF biomarkers.
Methods
Prospective observational study in outpatients with HF and type 2 diabetes assigned to a SGLT2i. LUS was performed at baseline (just before starting SGLT2i), at 15 days and at 3-months of follow-up. Eight thoracic areas were examined. Diuretic regime was reduced at baseline, when LUS and clinical assessment allowed. The main outcome was short-time change in B-lines sum. Secondary endpoints evaluated N-terminal pro-B-type natriuretic peptide (NTproBNP), cancer antigen 125 (CA125) and interleukin-1 receptor-like 1 (ST2)
Results
88 patients were included (age, 66.8±9.9 years; 93.2% male; 77.3% in NYHA II functional class; 75% treated with loop diuretics). The median of lines B was 2 (RIQ 1–4), 2 (RIQ 1–4) and 2 (RIQ 0–4) at the initial visit, 15 days and 3 months, respectively (initial vs. 3 months, p=0.21) (Table 1). The number of patients treated with loop diuretics decreased from 66 to 33 (p<0.001) and the mean dose of furosemide (or equivalent) in those who continued decreased from 61±5 mg/day to 45.8±20 mg/day (p<0.001). There were no hospitalizations for HF in the 3 months of follow-up. None of the biomarkers showed statistically differences at 3 months of follow-up (Table 1).
Conclusions
The introduction of SGLT2i allowed a significant reduction of diuretics in chronic HF patients and diabetes, without evidence of worsening lung congestion assessed neither by LUS nor by HF biomarkers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Domingo
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - A Teis
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - N Alonso
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - T Julian
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - D Bares
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - E Barcelo
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - E Revuelta-Lopez
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - B Gonzalez
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - P Codina
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - G Cediel
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - E Santiago-Vacas
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - J Santesmases
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - E Zamora
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - J Lupon
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
| | - A Bayes-Genis
- University Hospital Germans Trias and Pujol de Badalona , Badalona , Spain
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9
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Codina Verdaguer P, Zamora E, Levy WC, Domingo M, Santiago-Vacas E, Cediel G, Santesmases J, Ruiz-Cueto M, Diez-Quevedo C, Roig T, Troya MI, Casquete D, Sarrias A, Lupon J, Bayes-Genis A. Sudden cardiac death in heart failure. A 20 years perspective from a Mediterranean cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although sudden cardiac death (SCD) has progressively decreased in the last decade, it remains an important cause of death in patients with heart failure (HF). Differences based on clinical management and regional characteristics might be important.
Purpose
To assess the prevalence of SCD along 20 years of study in HF outpatients of different aetiologies managed in a multidisciplinary HF Clinic, and compare this prevalence with the expected proportional occurrence according to the acknowledged Seattle Proportional Risk Model (SPRM) score.
Methods
In a prospective observational registry of real-life HF outpatients, modes of death were classified as SCD (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death) and non-SCD (progression of HF, acute myocardial infarction, stroke, procedural, other cardiovascular causes and non-cardiovascular).
Results
From August 2001 to May 2021, 2772 outpatients with known cause of death and with SPRM score available were included. Out of them, 1351 (48.7%) died during a median follow-up of 3.8 years [IQR 1.6–7.8], up to 20 years. Observed prevalence of SCD in the 1351 dead patients was 13.6% while predicted SPRM prevalence was 39.6%. Annual SPRM predicted SCD mortality rate was 3.0% while observed SCD annual mortality rate was 1.3%. Figure 1 depicts cumulative incidence of causes of death through the study period. A lower prevalence of SCD was observed in every quintile of SPRM risk (Figure 2). This lower prevalence of SCD was observed independently of left ventricular ejection fraction group, ischemic or non-ischaemic aetiology and implantable cardiac defibrillator (ICD). Although the baseline SPRM predicted risk of SCD showed a significant decreasing trend (p=0.005) along the periods of admission at the Unit, the lower observed prevalence of SCD was seen in all periods of admission.
Conclusions
The prevalence of SCD through a perspective of 20 years in a Mediterranean HF outpatient cohort managed in a multidisciplinary HF Clinic was significantly lower than that expected according to the SPRM independently of degree of predicted risk, ischaemic aetiology, period of admission and implanted ICD. Regional lifestyle and dietary habits may have an impact on the lower rate of SCD in this Mediterranean cohort, and deserve further in-depth analyses.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - E Zamora
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - W C Levy
- University of Washington, Heart Institute , Seattle , United States of America
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - M Ruiz-Cueto
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - T Roig
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M I Troya
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - D Casquete
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - A Sarrias
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
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10
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Aimo A, Lupon J, Spitaleri G, Domingo M, Codina P, Santiago-Vacas E, Cediel G, Zamora E, Troya MI, Santesmases J, Romero-Gonzalez GA, Nunez J, Martini N, Emdin M, Bayes-Genis A. Global warming, renal function and heart failure: a 20-year follow-up study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a growing concern about the possible effects of global warming on human health. In HF outpatients, renal function significantly worsens during summer. More specific analyses on the impact of increasing temperatures on body homeostasis are lacking.
Purpose
We investigated the relationship between the trend of temperatures from 2002 to 2021 and renal function in heart failure (HF) outpatients.
Methods
All creatinine and estimated glomerular filtration rate (eGFR) values of HF outpatients followed at one tertiary hospital in a Mediterranean area of Spain were retrieved from electronic health records. eGFR was calculated through the CKD-EPI formula. Temperature data from the local municipality were derived from the Meteocat service; as temperatures from the years 2004–2005 were not available, these years were not analysed. Summer was defined as the timespan from June to September included. We calculated average values of creatinine and eGFR during summer and the rest of the same year, considering each patient and each year. Similarly, we averaged temperature values during summer and the rest of the same year.
Results
We derived 6,307 couples of average creatinine/eGFR values in summer and in the rest of the year from 2,194 patients. Across all the years (2002–2003 and 2006–2021), creatinine was slightly higher in summer than in the rest of the year (1.26 vs. 1.21 mg/dL, p<0.001), and eGFR was lower (65 vs. 67 mL/min/1.73 m2, p<0.001). Temperatures in summer and the rest of the year increased gradually, albeit not linearly, from 2002 to 2021 (Figure 1). The absolute (Δ) and percent changes (Δ%) in median temperatures between summer and the rest of the year increased across years (r=0.149, p=0.001 and r=0.144, p=0.002, respectively), as well as Δ and Δ% of the monthly median of maximal temperatures (r=0.119, p<0.001 and r=0.052, p<0.001, respectively) (Figure 1). The Δ and Δ% temperatures between summer and the rest of the year displayed several significant correlations with Δ and Δ% creatinine and eGFR after adjusting for several variables including age, sex, HF therapies, and creatinine outside of summer (Figure 2).
Conclusions
Over a 20-year timespan there has been an increase in 1) temperatures in summer and in the rest of the year, and 2) the temperature excursion between summer and the rest of the year. Changes in temperatures between summer and the rest of the year correlated with the magnitude of the decrease in renal function during summer, likely because of worse dehydration with higher temperatures. Therefore, the progressive rise in temperature may have detrimental effects on renal function during summer in HF outpatients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Aimo
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Codina
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Zamora
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M I Troya
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | | | - J Nunez
- INCLIVA Foundation , Valencia , Spain
| | - N Martini
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
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11
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Casquete D, Numan L, Codina P, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Crespo E, Santesmases J, Ruiz-Cueto M, Bares D, Altabella M, Barcelo E, Lupon J, Bayes-Genis A. Should we continue trusting bodyweight for HF volume telemonitoring? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Telemonitoring of body weight, blood pressure and heart rate has extensively been used to facilitate early recognition of heart failure (HF) decompensations in order to prevent hospital admissions. Mixed results have been shown by different clinical trials regarding the effectiveness of telemonitoring in HF management. It is recognized that HF decompensation starts with an increase in intra cardiac filling pressure. The relationship between daily pulmonary artery pressure (PAP) values measurements and body weight is not completely established.
Purpose
To study the relationship between daily changes in body weight and invasive daily measurements such as diastolic PAP assessed by a pulmonary artery pressure sensor (CardioMEMS).
Methods
Eleven patients with left sided chronic HF implanted with a CardioMEMS device were included in the study (age 75±9 years, ejection fraction 52±10%). Daily measured body weight and pulmonary artery pressures were recorded during 6 months. The primary endpoint was to assess the correlation between the “PAP deviation” – defined as the difference between daily diastolic PAP and mean diastolic PAP over the study period – and the “weight deviation” – defined as the difference between daily body weight determinations and mean body weight.
Results
During the 6-months study period, 1766 body weight and diastolic PAP measurements were recorded (158±47 daily measurements per patient). We found a weak although significant correlation between changes in body weight and changes in diastolic PAP (Figure 1). When analyzing data individually, no patient presented a strong correlation between the two variables.
Conclusions
Our results suggest that repeated measurements of body weight have limited utility in detecting left sided heart failure decompensations. More complex and patient-specific thresholds for the biometric measurements are needed to improve early detection of decompensation in HF patients. For the development of early detection algorithms, we may learn from invasive methods, such as the CardioMEMS device.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Casquete
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - L Numan
- University Medical Center Utrecht, Division of Heart and Lung , Utrecht , The Netherlands
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - E Crespo
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - M Ruiz-Cueto
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - D Bares
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - M Altabella
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - E Barcelo
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Cardiology , Badalona , Spain
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12
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Aimo A, Teis A, Kasa G, Junca G, Lupon J, Domingo M, Ferrer E, Vallejo N, Cediel G, Codina P, Lopez-Ayerbe J, Martini N, Emdin M, Bayes-Genis A, Delgado V. Ratio between left and right ventricular end-diastolic volumes and outcomes in patients with heart failure and preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Reference left and right ventricular (LV/RV) volumes normalized to age and gender have been published. However, the relative dilation of the LV compared to the RV in patients with heart failure (HF) symptoms and its prognostic association have not been evaluated.
Purpose
The present study investigated the relative dilation of the LV compared to the RV among patients with HF and preserved LV ejection fraction (HFpEF). We explored the association between LV/RV ratio (defined as the ratio between LV end-diastolic volume index [LVEDVi] and RV end-diastolic volume index [RVEDVi]) and outcomes.
Methods
Clinical and imaging data from consecutive ambulatory patients diagnosed with HFpEF between April 2011 and November 2021, and undergoing a cardiac magnetic resonance examination were retrieved. The endpoints were 1) all-cause death or first HF hospitalization, and 2) cardiovascular death or first HF hospitalization, 3) repeated HF hospitalizations.
Results
A total of 159 patients (median age 58 years [interquartile range 49–69], 64% men) were included. Median LVEF was 60% (54–70%), and the LV/RV ratio was 1.21 (1.07–1.40). Over a 3.5-year follow-up (1.5–5.0), all-cause death or first HF hospitalization occurred in 23 patients (15%) and cardiovascular death or first HF hospitalization in 22 (14%). Spline curve analysis showed a bimodal relationship between LV/RV and both outcomes, with a steep increase in risk <1.0 and ≥1.4 (Figure 1). Accordingly, patients with either LV/RV <1.0 or ≥1.4 had a much shorter survival free from both endpoints than patients with LV/RV 1.0–1.3 (Figure 2). An LV/RV <1 was associated with a higher risk of all-cause death or first HF hospitalization (hazard ratio [HR] 5.95, 95% confidence interval [CI] 1.67–21.28; p=0.006) and a higher risk of cardiovascular death or first HF hospitalization (HR 5.68, 95% CI 1.58–20.35; p=0.008). Furthermore, an LV/RV ≥1.4 was associated with a higher risk of all-cause death or first HF hospitalization (HR 4.10, 95% CI 1.58–10.61; p=0.004) and a higher risk of cardiovascular death or first HF hospitalization (HR 3.71, 95% CI 1.41–9.79; p=0.008). Nine patients (6%) had more than 1 HF hospitalization. The crude incidence of HF hospitalizations was much higher in patients with an LV/RV <1.0 (16.6 per 100 patient/years) or ≥1.4 (10.29 per 100 patient/years) than in those with LV/RV 1–1.3 (1.88 per 100 patient/years). Multivariable binomial negative regression showed significant association between LV/RV and recurrent HF hospitalizations after adjustment by age, gender and New York Heart Association class: LV/RV <1.0 vs. 1.0–1.3, incidence rate ratio 9.0 per 100 patient/years (4.1–19.6), p<0.001; LV/RV ≥1.4 vs. 1.0–1.3, incidence rate ratio 5.3 per 100 patient/years (1.5–8.4), p=0.009.
Conclusions
Among patients with HFpEF, an RVEDVi larger than the LVEDVi, or an LVEDVi ≥40% larger than the RVEDVi were significantly associated with worse outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Aimo
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - A Teis
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Kasa
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Junca
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Ferrer
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - N Vallejo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Codina
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - N Martini
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | | | - V Delgado
- Germans Trias i Pujol Hospital , Badalona , Spain
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13
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Gonzalez B, Zamora E, Rivas C, Pulido A, Crespo E, Velayos P, Diaz V, Altabella M, Bares D, Codina P, Domingo M, Santiago-Vacas E, Cediel G, Lupon J, Bayes-Genis A. Quality of life in patients with heart failure and improved ejection fraction: one year changes and prognostic implication. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inconsistent and controversial results have been reported about the association of quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). The 2021 universal definition of HF specifically describes the criteria for the patients with HF and improved LVEF (HFimpEF): HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF >40%.
Purpose
1) To assess whether patients with HF and reduced LVEF (HFrEF) at first visit in an outpatient HF Clinic that fulfil the HFimpEF criteria one year later presented a higher improvement in QoL assessed by the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) than those patients that did not fulfil HFimpEF criteria. 2) To assess the prognostic role of QoL on outcomes in HFimpEF patients.
Methods
In a prospective registry of real-life HF outpatients LVEF and QoL evaluated by MLWHFQ were assessed at first visit at the HF Clinic and at one year of follow-up.
Results
From August 2001 to August 2021, baseline and one year LVEF and MLWFQ scores were available in 1040 patients with an initial LVEF ≤40%. Table 1 shows baseline demographic and clinical characteristics of patients. In summary, mean age was 65.2±11.7 years, 75.9% of the patients were men, the main aetiology was ischaemic heart disease (52.9%) and patients were mostly in New York heart Association (NHYA) class II (71.1%) and III (21.6%). Baseline LVEF was 28.5% ± 7.3 and baseline MLWHFQ score was 30.2±19.5. At one year, mean LVEF increased to 38.0±12.2 while MLWHFQ scores improved to 17.4±16.0. There were 361 patients that fulfilled the HFimpEF criteria (34.7%). These patients significantly and markedly improved both LVEF (from 28.7±6.6 to 50.9±7.6, p<0.001) and QoL (from 32.9±20.6 to 16.9±16.0, p<0.001). Although in patients that did not fulfil the criteria of HFimpEF both LVEF (from 28.4±7.6 to 31.1±7.9, p<0.001) and QoL (from 28.7±18.8 to 17.6±15.9, p<0.001) also significantly improved, the improvement in QoL was significantly higher in HFimpEF patients (−16.0±23.8 vs. −11.1±20.3, p=0.001), taking into account that baseline MLWHFQ score was worse in HFimpEF patients (p=0.001). However, at one year QoL was similar when both groups were compared (p=0.50). MLWHFQ score at one year proved to be superior to QoL improvement (using a cut-off of at least 5 points) from the prognostic point of view.
Conclusions
QoL improved both in patients with and without HFimpEF criteria, and QoL perception at one year was similar in both groups, suggesting the influence of other factors other than LVEF in QoL perception. QoL at one year revealed to be superior to QoL changes from baseline from the prognostic point of view.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Gonzalez
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Zamora
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - C Rivas
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - A Pulido
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Crespo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Velayos
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - V Diaz
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Altabella
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - D Bares
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Codina
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
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14
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Monguio-Tortajada M, Prat-Vidal C, Gastelurrutia P, Camara-Rosell ML, Cediel G, Teis A, Revuelta-Lopez E, Roura S, Galvez-Monton C, Lupon J, Vilarrodona A, Munoz-Guijosa C, Querol S, Bayes-Genis A. Immunomodulatory effect of first-in-human PeriCord cardiac bioimplant: preliminary data of the PERISCOPE clinical trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The PERISCOPE is a first-in-human, phase I, double blind, one centre clinical trial to test the safety of the PeriCord, an advanced therapy medicinal product (PEI18–140), for the treatment of patients with infarcted myocardial tissue. The PeriCord is a GMP-complying allogeneic engineered tissue graft consisting on a decellularised pericardial matrix colonised with umbilical cord Wharton's jelly mesenchymal stromal cells. The PeriCord implantation has shown to promote damaged tissue revascularisation, reduce infarct size, adverse remodelling and fibrosis, and ultimately improve cardiac function preclinically.
Purpose
To assess the safety and monitor the monocyte and cytokine response after PeriCord implantation in patients with infarcted myocardial tissue.
Methods
The PERISCOPE clinical trial has been approved by AEMPS and the Local Ethics Committee of our institution (Eudra-CT 2018–001964–49).
Twelve patients with transmural myocardial infarction (>50% by MRI) who were candidates for surgical revascularisation were included: two roll-in and 10 randomised into a Control group (n=5; CABG) or Treatment group (n=5; n=7 in total; CABG and PeriCord implantation over the transmural myocardial scar). In conjunction with clinical follow-up, whole blood was sampled at baseline and 3-, 6-, and 9-days post-surgery for monocyte populations analysis by flow cytometry and plasma cytokine and monocyte chemoattractant chemokine levels by multiplex ELISA.
Results
The target patient enrolment has been met and no adverse effects related to PeriCord implantation were observed so far.
Recruitment of CCR2+ activated monocytes in peripheral blood peaked on day 3 post-surgery in both groups (increase in the %CCR2+ monocytes of 6.1±5.7% in Control, p=0.38; and 6.5±1.8% in PeriCord Treated patients, p=0.0004), concomitant with a surge in the monocyte chemoattractant CCL2 plasma levels. At the same time, there was a decrease in the number of “non-classical” monocytes regardless of treatment (decrease in CD14-/CD16+ monocytes of 16.7±11.1% in Control, p<0.01; and 24.0±15.0% in PeriCord Treated patients, p<0.001) and a marked reduction in CX3CR1 expression in monocytes of PeriCord treated patients (decrease of 53.2±20.6% in mean fluorescence intensity at day 3, p<0.01), while plasma CX3CL1 levels were undetectable. Both populations recovered on day 9 only in treated patients (p<0.05).
Conclusions
Implantation of the PeriCord in myocardial infarction patients did not promote adverse reactions and modulated circulating monocyte subsets that have been associated with post-infarction myocardial tissue healing (CCR2 and CX3CR1). These results will be analysed for correlation with therapeutic benefits by the end of patient follow-up.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III, Generalitat de Catalunya
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Affiliation(s)
- M Monguio-Tortajada
- Health Science Research Institute Germans Trias i Pujol, ICREC Research Program , Badalona , Spain
| | - C Prat-Vidal
- Banc de Sang i Teixits (BST) , Barcelona , Spain
| | - P Gastelurrutia
- Institut de Recerca Biomèdica de Bellvitge (IDIBELL) , Hospitalet de Llobregat , Spain
| | - M L Camara-Rosell
- Germans Trias i Pujol University Hospital, Cardiac Surgery Service , Badalona , Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Cardiology Service , Badalona , Spain
| | - A Teis
- Germans Trias i Pujol University Hospital, Cardiology Service , Badalona , Spain
| | - E Revuelta-Lopez
- Health Science Research Institute Germans Trias i Pujol, ICREC Research Program , Badalona , Spain
| | - S Roura
- Health Science Research Institute Germans Trias i Pujol, ICREC Research Program , Badalona , Spain
| | - C Galvez-Monton
- Health Science Research Institute Germans Trias i Pujol, ICREC Research Program , Badalona , Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Cardiology Service , Badalona , Spain
| | | | - C Munoz-Guijosa
- Germans Trias i Pujol University Hospital, Cardiac Surgery Service , Badalona , Spain
| | - S Querol
- Banc de Sang i Teixits (BST) , Barcelona , Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Cardiology Service , Badalona , Spain
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15
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Cediel G, Teis A, Codina P, Julve J, Domingo M, Santiago-Vacas E, Castelblanco E, Amigó N, Lupón J, Mauricio D, Alonso N, Bayés-Genís A. GlycA and GlycB as Inflammatory Markers in Chronic Heart Failure. Am J Cardiol 2022; 181:79-86. [PMID: 36008162 DOI: 10.1016/j.amjcard.2022.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/01/2022]
Abstract
The role of inflammation in heart failure (HF) has been extensively described, but it is uncertain whether inflammation exerts a different prognostic influence according to etiology. We aimed to examine the inflammatory state in chronic HF by measuring N-acetylglucosamine/galactosamine (GlycA) and sialic acid (GlycB), evolving proton nuclear magnetic resonance biomarkers of systemic inflammation, and explore their prognostic value in patients with chronic HF. The primary end point was a composite of all-cause death and HF readmission. A total of 429 patients were included. GlycB correlated with interleukin-1 receptor-like 1 in the whole cohort (r2 = 0.14, p = 0.011) and the subgroup of nonischemic etiology (r2 = 0.31, p <0.001). No association was found with New York Heart Association functional class or left ventricular ejection fraction. In patients with nonischemic HF (52.2%, n = 224), GlycA and GlycB exhibited significant association with the composite end point (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.06 to 1.33, p = 0.004 and HR 2.13, 95% CI 1.43 to 3.13, p <0.001; respectively) and GlycB with HF readmission after multivariable adjustment (HR 2.25, 95% CI 1.54 to 3.30, p <0.001). GlycB levels were also associated with a greater risk of HF-related recurrent admissions (adjusted incidence rate ratio 1.33, 95% CI = 1.07 to 1.65, p = 0.009). None of the markers were associated with the clinical end points in patients with ischemic HF. In conclusion, GlycA and GlycB represent an evolving approach to inflammation status with prognostic value in long-term outcomes in patients with nonischemic HF.
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Affiliation(s)
- German Cediel
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain; Center for Biomedical Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Teis
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain; Center for Biomedical Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Pau Codina
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Mar Domingo
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Evelyn Santiago-Vacas
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain; Center for Biomedical Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Esmeralda Castelblanco
- Department of Internal Medicine, Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, St Louis, Missouri; Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain
| | - Nuria Amigó
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Ciencias Médicas Básicas, Universidad Rovira i Virgili, Tarragona, Spain; Biosfer Teslab - Metabolomic Platform, Universidad Rovira i Virgili, Tarragona, Spain
| | - Josep Lupón
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain; Center for Biomedical Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain; Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Faculty of Medicine, University of Vic (UVIC), Vic, Spain
| | - Nuria Alonso
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain; Department of Endocrinology & Nutrition, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antoni Bayés-Genís
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain; Center for Biomedical Research on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
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16
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Aimo A, Lupon J, Spitaleri G, Domingo M, Codina P, Santiago-Vacas E, Cediel G, Zamora E, Troya M, Santesmases J, Romero-Gonzalez GA, Nunez J, Martini N, Emdin M, Bayes-Genis A. Global warming, renal function and heart failure over 20 years. Int J Cardiol 2022; 365:100-105. [DOI: 10.1016/j.ijcard.2022.07.043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022]
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17
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Spitaleri G, Zamora E, Cediel G, Codina P, Santiago-Vacas E, Domingo M, Lupón J, Santesmases J, Diez-Quevedo C, Troya MI, Boldo M, Altimir S, Alonso N, González B, Bayes-Genis A. Cause of Death in Heart Failure Based on Etiology: Long-Term Cohort Study of All-Cause and Cardiovascular Mortality. J Clin Med 2022; 11:jcm11030784. [PMID: 35160236 PMCID: PMC8837120 DOI: 10.3390/jcm11030784] [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: 11/16/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022] Open
Abstract
We assessed differences in long-term all-cause and cardiovascular (CV) mortality in heart failure (HF) outpatients based on the etiology of HF. Consecutive patients admitted to the HF Clinic from August 2001 to September 2019 (N = 2587) were considered for inclusion. HF etiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (DCM), hypertensive heart disease, alcoholic cardiomyopathy, drug-induced cardiomyopathy (DICM), valvular heart disease, and hypertrophic cardiomyopathy. All-cause death and CV death were the primary end points. Among 2387 patients included in the analysis (mean age 66.5 ± 12.5 years, 71.3% men), 1317 deaths were recorded (731 from CV cause) over a maximum follow-up of 18 years (median 4.1 years, interquartile range (IQR) 2–7.8). Considering IHD as the reference, only DCM had a lower risk of all-cause death (adjusted hazard ratio (aHR) 0.68, 95% confidence interval (CI) 0.56–0.83, p < 0.001), and only DICM had a higher risk of all-cause death (aHR 1.47, 95% CI 1.02–2.11, p = 0.04). However, almost all etiologies had a significantly lower risk of CV death than IHD. Among the studied HF etiologies, DCM and DICM have the lowest and highest risk of all-cause death, respectively, whereas IHD has the highest adjusted risk of CV death.
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Affiliation(s)
- Giosafat Spitaleri
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Elisabet Zamora
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - German Cediel
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Pau Codina
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Evelyn Santiago-Vacas
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Mar Domingo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Josep Lupón
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Santesmases
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
| | - Crisanto Diez-Quevedo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Maria Isabel Troya
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Maria Boldo
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Salvador Altimir
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Núria Alonso
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Beatriz González
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain; (G.S.); (E.Z.); (G.C.); (P.C.); (E.S.-V.); (M.D.); (J.L.); (J.S.); (C.D.-Q.); (M.I.T.); (M.B.); (S.A.); (N.A.); (B.G.)
- Department of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-934978915; Fax: +34-934978939
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18
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Domingo M, Lupón J, Girerd N, Conangla L, de Antonio M, Moliner P, Santiago‐Vacas E, Codina P, Cediel G, Spitaleri G, González B, Diaz V, Rivas C, Velayos P, Núñez J, Bayes‐Genís A. Lung ultrasound in outpatients with heart failure: the wet-to-dry HF study. ESC Heart Fail 2021; 8:4506-4516. [PMID: 34725962 PMCID: PMC8712798 DOI: 10.1002/ehf2.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS In ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing decompensation and recompensation, and in outcomes prediction. METHODS AND RESULTS Heart failure outpatients attended to establish HF decompensation were included. LUS was blindly performed at baseline (LUS1) and at clinical recompensation (LUS2). B-lines were counted in eight scanned areas. Diagnosis of no HF decompensation vs. right-sided, left-sided, or global HF decompensation, and patients' management were performed by physicians blinded to LUS1. Outcome was the composite of all-cause death or HF-related hospitalization. Two hundred and thirty-three suspicions of HF decompensation were included in 187 patients (71.4 ± 11.3 years, 66.8% men). Mean B-line (LUS1) was 17.6 ± 11.2 vs. 3.7 ± 4.5 for episodes with and without HF decompensation, respectively (P < 0.001). Global HF decompensation showed the highest number of B-lines (20.6 ± 11), followed by left-sided (19.7 ± 11.6) and right-sided (13.5 ± 9.8). B-lines declined to 6.9 ± 6.7 (LUS2) (P < 0.001 vs. LUS1) after treatment, within a mean time of 24.2 ± 23.7 days [median 13.5 days (interquartile range 6-40)]. B-lines were significantly associated with the composite endpoint at 30 days (hazard ratio [HR] 1.04 [95% confidence interval 1.01-1.07], P = 0.02), but not at 60 (P = 0.22) or 180 days (P = 0.54). In multivariable analysis, B-line number remained as an independent predictor of the composite endpoint at 30 days, [HR 1.04 (1.01-1.07), P = 0.014], with a 4% increase risk per B-line added. B-lines correlated significantly with CA125 (R = 0.30, P = 0.001). CONCLUSIONS Lung ultrasound supports the diagnostic work-up of congestion and decongestion in chronic HF outpatients and identifies patients at high risk of short-term events.
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Affiliation(s)
- Mar Domingo
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Josep Lupón
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCTUniversité de LorraineVandoeuvre‐lès‐NancyFrance
| | - Laura Conangla
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Marta de Antonio
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Pedro Moliner
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Evelyn Santiago‐Vacas
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Pau Codina
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - German Cediel
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Giosafat Spitaleri
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Beatriz González
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Violeta Diaz
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Carmen Rivas
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Patricia Velayos
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
| | - Julio Núñez
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
- Cardiology DepartmentHospital Clínico Universitario, INCLIVAValènciaSpain
- Department of MedicineUniversitat de ValènciaValènciaSpain
| | - Antoni Bayes‐Genís
- Heart Failure Clinic, Cardiology ServiceGermans Trias i Pujol HospitalCarretera del Canyet s/nBarcelona08916Spain
- Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
- CIBERCVInstituto de Salud Carlos IIIMadridSpain
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19
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Escabia C, Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Alonso N, Troya M, Santesmases J, Crespo E, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in patients with type 2 diabetes and heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF) and type 2 diabetes mellitus (T2D).
Purpose
To prospectively assess dynamic trajectories of GFR estimated by CKD-EPI in a real-life cohort of HF patients based on the presence or absence of T2D over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the subgroups according to baseline T2D up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2386 patients were consecutively included from August 2001 to December 2018. 43.2% of the patients had a history of T2D. Mean age was 67.0±12.6 years, 28.9% were women and 71.0% had HF with reduced ejection fraction (EF<40%). 25080 eGFR values were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Diabetic patients had a worse baseline eGFR and presented a persistent decline over time. On the contrary non-diabetic patients presented an early decrease, mid-term improvement and a late progressive decline (Figure 1).
Conclusions
eGFR long-term trajectories in diabetic and non-diabetic patients with chronic HF were significantly different.
Funding Acknowledgement
Type of funding sources: None. eGFR evolution according to baseline T2D
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Affiliation(s)
- C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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20
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Garcia-Garcia C, Andrea R, Sanz E, Sanchez-Salado JC, Aboal J, Pastor P, Buera I, Sionis A, Lopez T, Perez-Rodriguez M, Ariza A, Baneras J, Tomas C, Cediel G, Rueda F. Mortality risk in cardiogenic shock depending on aetiology in a Mediterranean cohort. Prognostic accuracy of CardShock vs IABP score: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification, although the CS aetiology could influence in this prediction.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients depending on the CS aetiology comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed comparing ACS and non-ACS patients. Cardshock and IABP score have been compared to assess 90-days mortality risk in both groups.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. Patient were classified in ACS (n=232, 60.7%) and non-ACS (n=150, 39.3%). In ACS group, 77.6% were STEMI, reperfussion in 84.7% of cases, all with primary angioplasty, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. Main non-ACS aetiologies were severe heart failure (36.2%), malignant arrhythmias (22.1%), valve disease (8.0%) and myocarditis (7.4%). ACS group had less prevalence of women (17.7% vs 36%, p=0.001) and previous myocardial infarction (13.9% vs 24.8%, p=0.007). Mechanical assistance device was implanted more in ACS patients (43.1% vs 16.7%, p<0.001, mainly intraaortic balloon pump (35.6% vs 9.8%, p<0.001) and ECMO (10.7% vs 3%, p=0.01). Both shock risk scores were higher in ACS patients, Cardshock (4.5 vs 4.0, p=0.006) and IABP (2.4 vs 1.9, p=0.005). In-hospital mortality was higher in ACS (37.1 vs 26.7%, p=0.035) although this difference loss the significance at 90-days (40.9 vs 31.8%, p=0.074) and 6-months (45.2 vs 35.8%, p=0.176). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score in ACS patients (area under the curve -AUC- 0.74 vs 0.66) respectively, p=0.047, although both scores were similar in non-ACS (AUC 0.64 vs 0.62, p=0.693), Figures 1–2.
Conclusions
Cardiogenic shock due to ACS had higher in-hospital mortality than non-ACS CS, although this difference decreased at 90 days and 6 months. IABP score provided better 90-days mortality risk prediction than CardShock score in ACS patients, but both scores are similar in non-ACS cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Regiό Sanitaria de Girona, Girona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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21
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Spitaleri G, Cediel G, Santiago-Vacas E, Codina P, Domingo M, Zamora E, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Altimir S, Alonso N, Rivas C, Lupon J, Bayes-Genis A. Differences in long-term all-cause and cardiovascular mortality according to heart failure aetiology in ambulatory patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is the final stage of many cardiac disorders. Mortality in heart HF remains challenging despite improvement in outcomes proved in clinical trials in HF with reduced ejection fraction and it can be influenced by the aetiology of HF.
Purpose
To assess differences in long-term mortality (up to 18 years) in a real-life cohort of HF outpatients according to the aetiology of HF.
Methods
Consecutive patients with HF admitted at the HF Clinic from August 2001 to September 2019 were included. Follow-up was closed at 30.9.2020. HF aetiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (CM) –including non-compaction CM–, hypertensive CM, alcohol-derived CM, drug-derived CM, valvular disease, hypertrophic CM and others. For the present analysis, this latter group was excluded due to the big heterogeneity and limited number of patients in each subtype of aetiology. All-cause death and cardiovascular death were the primary end-points. Fine & Gray method for competing risk was used for cardiovascular mortality analysis.
Results
Out of 2387 patients included (age 66.5±12.5 years, 71.3% men, LVEF 35.4%±14.2, mainly in NYHA class II [65.5%] and III [26.5%]), 1317 deaths were recorded (731 from cardiovascular cause) during a maximum follow-up of 18 years (median 4.1 years [IQR 2–7.8] for the total cohort, 5.3 years [IQR 2.6–9.7] for survivors). Figure 1 shows Cox regression multivariable analysis for all-cause death and cardiovascular mortality. Considering IHD aetiology as reference, only dilated CM showed significantly lower risk of all-cause death, and only drug-induced CM showed higher risk of all-cause death. However, when cardiovascular mortality was considered almost all aetiologies showed significant lower risk of cardiovascular death than IHD. Figure 2 shows adjusted survival curves (A) and adjusted incidence curves of cardiovascular death (B) based on HF aetiology.
Conclusions
After adjusting for multiple prognostic factors among the studied HF aetiologies, dilated CM and drug-related CM showed the lowest and the highest risk of all-cause death, respectively. Patients with IHD showed the highest adjusted risk of cardiovascular death.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Spitaleri
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Santiago-Vacas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Troya
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - S Altimir
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
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22
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Spitaleri G, Cediel G, Santiago-Vacas E, Codina P, Domingo M, Zamora E, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Alonso N, Gonzalez B, Nunez J, Lupon J, Bayes-Genis A. Kidney function derangements during summer in ambulatory heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is characterized by alterations in kidney function that are associated with poor prognosis and can be related to the evolution of the disease or induced by medical treatment. High temperatures during summer may result in some degree of dehydration, especially in patients treated with diuretics, and may contribute to transient glomerular filtration rate (eGFR) reduction.
Objective
To assess creatinine and eGFR changes during summer in ambulatory heart failure patients.
Methods
Consecutive patients with HF admitted at our HF Clinic (Spain) from August 2001 to December 2020 were included. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We included in the analysis creatinine and eGFR values that were assessed at planned visits only, discarding urgent renal function assessments. Creatinine and eGFR values were grouped according to the period of the year (summer [from June to September, both included] vs. the rest of the year). Changes in creatinine and eGFR between the rest of the year and summer for each patient were evaluated using paired samples t-test.
Results
Out of 37360 creatinine and eGFR values, 25458 were included in the analysis for a total of 2423 patients (median number of observations for each patient: 8, IQR 4–15). Mean creatinine and eGFR were 1.4±1.0 mg/dl and 63.0±27.7 ml/min, respectively. Table 1 shows baseline patient characteristics. Creatinine increased significantly during summer (1.44±0.9 mg/dl vs. 1.48±1.1 mg/dl, p<0.001). Similarly, eGFR was lower in summer as compared to the rest of the year 60.6±25.4 ml/min vs. 59.4±26.0 ml/min, p<0.001.
Conclusions
In ambulatory HF patients in a Mediterranean area, we found significant worsening of renal function during summer, likely related to an imbalance between water intake and fluid loss. To prevent summer-driven kidney stress, diuretic treatment should be carefully adjusted during the hottest months of the year.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- G Spitaleri
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Santiago-Vacas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Troya
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
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23
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Santiago-Vacas E, Domingo M, Codina P, Cediel G, Spitaleri G, Zamora E, Gual F, Teis A, Santesmases J, Velayos P, Pulido A, Crespo E, Nunez J, Lupon J, Bayes-Genis A. How predict right ventricular-pulmonary circulation coupling improvement in chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular-pulmonary circulation coupling (RVPAC), which can be measured by the relation between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) by echocardiography, has been postulated as an independent prognostic factor of hospitalizations and mortality in heart failure (HF) patients.
Purpose
Our aim was to know the predictors of RVPAC improvement in a chronic HF cohort.
Methods
Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit and 1 year. A TAPSE/SPAP ratio <0.36 mm/mmHg was identified as the most deleterious. Significant RVPAC improvement at 1 year was defined as TAPSE/SPAP ratio ≥0.36 mm/mmHg together with a ≥10% improvement from baseline RVPAC. Multivariable logistic regression analysis (conditional backward stepwise) was performed to select variables independently associated with significant RVPAC improvement. A predictive model including age and the previously selected variables was created.
Results
From August 2001 to July 2017, 554 patients with TAPSE and SPAP data in the initial visit were included. Mean follow-up time was 4.6±3.7 years. At first visit 252 (45.5%) patients had RVPAC <0.36 mm/mmHg. Out of them, RVPAC at 1 year improved in 55 (21.8%). In multivariable analysis, the presence of baseline atrial fibrillation/flutter (OR 0.12 [95% CI 0.05–0.28], p<0.001), SPAP (OR 0.96 [95% CI 0.92–0.99], p=0.014) and female gender (OR 0.34 [95% CI 0.12–0.91], p=0.03) were related to lesser probability of RVPAC improvement at 1 year. A model with such variables, together with age, showed an AUC of 0.824 to predict significant RVPAC improvement.
Conclusions
Atrial fibrillation/flutter, increasing SPAP and female gender hamper RVPAC improvement at 1 year in HF patients with baseline TAPSE/SPAP ratio <0.36.
Funding Acknowledgement
Type of funding sources: None. Multivariate regression analysis
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Affiliation(s)
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - F Gual
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Teis
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - P Velayos
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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24
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Garcia-Garcia C, Lopez T, Sanz E, Sanchez-Salado JC, Aboal J, Tomas C, Baneras J, Sionis A, Andrea R, Perez-Rodriguez M, Ariza A, Pastor P, Buera I, Cediel G, Rueda F. Mortality risk in cardiogenic shock: head to head comparision CardShock vs IABP score in a Mediterranean cohort: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed. Cardshock and IABP score have been compared to assess 90-days mortality risk in a Mediterranean cohort.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. The most common cause of CS was ACS (61%, n=233); of them, 77.6% were STEMI, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. STEMI patients were reperfused in 84.7% of cases, all with primary angioplasty. Main non-ACS aetiologies were severe acute heart failure, malignant arrhythmias and myocarditis. Mechanical assistance device was implanted in one third of patients (n=119), mainly intraaortic balloon pump (26.1%), ECMO in 7.8% and Impella in 4.5%. Average Cardshock score was 4.3 (SD 1.74) and mean IABP score was 2.2 (SD 1.61). In-hospital mortality was 33% (126 patients) and 90-days mortality was 37.3% (141 patients). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score (area under the curve 0.72 vs 0.66) respectively, p=0.042; Figure 1.
Conclusions
Even though invasive management with STEMI reperfusion and mechanical assistance devices, cardiogenic shock in-hospital mortality remains 33% in a contemporary Mediterranean cohort. In this population, IABP shock score provided better 90-days mortality risk prediction than CardShock score
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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25
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Casquete D, Codina P, Domingo M, Santiago E, Cediel G, Spitaleri G, Zamora E, Santesmases J, Boldo M, Rivas C, Gonzalez B, Velayos P, Pulido A, Lupon J, Bayes-Genis A. Natriuretic peptide dynamics with remote pulmonary artery pressure monitoring. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Real-life clinical practice has confirmed the value of pulmonary artery (PA) pressure-guided therapy in patients with heart failure (HF) and history of repeated HF hospitalizations (HFH), to greater extent to that reported in the pivotal clinical trial CHAMPION-HF. The value of hemodynamic monitoring in a population of patients with HF and elevated natriuretic peptides, but without recent HFH, is unknown.
Objective
To assess N-terminal-pro-brain natriuretic peptide (NTproBNP) dynamics before and 6 months after PA pressure sensor implantation.
Methods
Ten patients managed in a multidisciplinary HF clinic implanted with the CardioMEMS PA pressure sensor were consecutively included from June 2019 to July 2020. Mean age was 63.1±23.5 years, 30% were women, 40% had HF with reduced EF (EF <40%). NTproBNP was measured at baseline and six months after sensor implantation. Wilcoxon matched-pairs signed-rank test was used to compare NTproBNP values at baseline and at 6 months. Fractional polynomial fit plot was used to represent changes in mean PA pressure over time. Linear regression was used to predict the change in NTproBNP based on the change in PA pressures.
Results
Mean daily pressure transmission rate was 92.4±5.1%. During the six-month study period 90% of patients had a change in medication related to PA pressure, with an average of 0.21 [0.17–0.66] changes per patient per month. Mean PA pressure at baseline was 28.5±9.5 mmHg, and decreased by 5.5 mmHg at 6 months (p=0.01) (Figure 1). NTproBNP was also significantly lower six months post CardioMEMS implantation; decreasing from 1696 pg/ml [976–2930] at baseline to 1046 pg/ml [616–2076] after six months (p=0.04) (Figure 2). There was a weak correlation between the change in NTproBNP and the change in mean PA pressure (R2=0.22, p=0.17).
Conclusions
NTproBNP values were significantly lower 6-months following implantation of a PA pressure sensor to guide HF management. Mean PA pressures were also significantly reduced.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Germans Trias i Pujol Figure 1. Change in mean PA pressure over time.Figure 2. Change in NTproBNP after PAP monitoring.
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Affiliation(s)
- D Casquete
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Santiago
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - P Velayos
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
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26
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Iborra Egea O, Spitaleri G, Domingo M, Revuelta Lopez E, Codina P, Cediel G, Santiago Vacas E, Cserkoova A, Pascual Figal D, Nunez J, Lupon J, Bayes Genis A. Empagliflozin in heart failure with preserved ejection fraction: decoding its molecular mechanism of action using artificial intelligence. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Rationale The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) to treat heart failure with preserved ejection fraction (HFpEF) is under investigation in ongoing clinical trials, but the exact mechanism of action is unclear. Here we aimed to use artificial intelligence (AI) to characterize the mechanism of action of empagliflozin in HFpEF at the molecular level.
Methods
We retrieved information regarding HFpEF pathophysiological motifs and differentially expressed genes/proteins, together with empagliflozin target information and bioflags, from specialized publicly available databases. Artificial neural networks and deep learning AI were used to model the molecular effects of empagliflozin in HFpEF.
Results
The model predicted that empagliflozin could reverse 59% of the protein alterations found in HFpEF. The effects of empagliflozin in HFpEF appeared to be predominantly mediated by inhibition of NHE1 (Na+/H+ exchanger 1), with SGLT2 playing a less prominent role. The elucidated molecular mechanism of action had an accuracy of 94%. Empagliflozin's pharmacological action mainly affected cardiomyocyte oxidative stress modulation, and greatly influenced cardiomyocyte stiffness, myocardial extracellular matrix remodelling, heart concentric hypertrophy, and systemic inflammation. Validation of these in silico data was performed in vivo in patients with HFpEF by measuring the declining plasma concentrations of NOS2, the NLPR3 inflammasome, and TGF-β1 during 12 months of empagliflozin treatment.
Conclusion
Using AI modelling, we identified that the main effect of empagliflozin in HFpEF treatment is exerted via NHE1 and is focused on cardiomyocyte oxidative stress modulation. These results support the potential use of empagliflozin in HFpEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos IIICentro de investigaciόn biomédica en red cardiovascular (CIBERCV) Summary figureTable 1
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Affiliation(s)
- O Iborra Egea
- Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Revuelta Lopez
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | | | - A Cserkoova
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - D Pascual Figal
- Hospital Universitario Virgen Arrixaca, Cardiology, Murcia, Spain
| | - J Nunez
- University of Valencia, Cardiology, Valencia, Spain
| | - J Lupon
- University of Valencia, Cardiology, Valencia, Spain
| | - A Bayes Genis
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
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27
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Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Santesmases J, Troya M, Escabia C, Gonzalez B, Rivas C, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF).
Purpose
To assess the GFR dynamics estimated by CKD-EPI in a real-life cohort of HF patients over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the whole cohort and subgroups according to vital status up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2423 patients were consecutively included from August 2001 to December 2018. Mean age was 67.0±12.7 years, 28,8% were women and 71.1% had HF with reduced ejection fraction (EF<40%). Out of 37360 eGFR values, 25458 were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Significant changes occurred along the whole trajectory. An initial decline in eGFR was observed during the first three years of follow-up. Subsequently, there was an upward trend during the following five years and after that period a progressive decline was seen until the end of follow-up (Figure 1). In the sub-group of patients who died during follow-up the eGFR slope showed a persistent decline over time of ∼1ml/min/1.73m2 per year. On the contrary, patients who survived to follow-up maintained a stable eGFR (Figure 2).
Conclusions
The eGFR long-term trajectory in patients with chronic HF showed a snaky pattern with an early decrease, mid-term improvement and late progressive decline. Patients who died during follow-up presented a progressive decline from the beginning.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Long-term evolution of eGFRFigure 2. eGFR evolution according to vital status
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Affiliation(s)
| | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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28
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Araya C, Corvalán C, Cediel G, Taillie LS, Reyes M. Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases. Front Nutr 2021; 8:601526. [PMID: 33842518 PMCID: PMC8032866 DOI: 10.3389/fnut.2021.601526] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF. Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile. Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B12, folate, and fiber) using multivariate regression after controlling for covariates. Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05). Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.
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Affiliation(s)
- C Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.,Escuela de Nutrición y Dietética, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - G Cediel
- Department of Nutrition, University of São Paulo, São Paulo, Brazil.,School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia
| | - L S Taillie
- Department of Nutrition, Carolina Population Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - M Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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29
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Teis A, Cediel G, Amigó N, Julve J, Aranyó J, Andrés-Cordón J, Puig-Jové C, Castelblanco E, Gual-Capllonch F, Ferrer-Sistach E, Vallejo N, Juncà G, López-Ayerbe J, De Antonio M, Domingo M, Santiago-Vacas E, Codina P, Mauricio D, Lupón J, Alonso N, Bayes-Genis A. Particle size and cholesterol content of circulating HDL correlate with cardiovascular death in chronic heart failure. Sci Rep 2021; 11:3141. [PMID: 33542459 PMCID: PMC7862293 DOI: 10.1038/s41598-021-82861-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Evidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0–8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p < 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p < 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p < 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 [95% CI 1.01–1.47], p = 0.041 and HR 1.04 [95% CI 1.01–1.07], p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.
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Affiliation(s)
- Albert Teis
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain. .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
| | - G Cediel
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - N Amigó
- Biosfer Teslab, SL, Reus, Spain.,Metabolomics Platform, Rovira i Virgili University (URV), Instituto de Investigación Sanitaria Pere Virigili (IISPV), Tarragona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
| | - J Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - J Aranyó
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - J Andrés-Cordón
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - C Puig-Jové
- Endocrinology and Nutrition Department, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - E Castelblanco
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Gual-Capllonch
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - E Ferrer-Sistach
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - N Vallejo
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - G Juncà
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - J López-Ayerbe
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - M De Antonio
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - M Domingo
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - E Santiago-Vacas
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - P Codina
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - D Mauricio
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Lleida Biomedical Research Institute's Dr. Pifarré Foundation (IRBLleida), University of Lleida, Lleida, Spain
| | - J Lupón
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - Nuria Alonso
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. .,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain. .,Endocrinology and Nutrition Department, Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - A Bayes-Genis
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research on cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Barcelona, Spain
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30
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Garcia-Garcia C, Rueda F, Lupon J, Oliveras T, Labata C, Ferrer M, Cediel G, De Diego O, Rodriguez-Leor O, Carrillo X, Bayes-Genis A. Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study. European Heart Journal. Acute Cardiovascular Care 2020; 9:S161-S168. [DOI: 10.1177/2048872618797599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
Methods:
Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011–August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used.
Results:
A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively (p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35–11.39) in patients with primary ventricular fibrillation (p=0.012) and 1.72 (95% confidence interval 1.23–2.40) in patients without primary ventricular fibrillation (p=0.001).
Conclusions:
Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.
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Affiliation(s)
- C Garcia-Garcia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - F Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - J Lupon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - T Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - C Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - M Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - G Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O De Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - O Rodriguez-Leor
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - X Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Spain
| | - A Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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31
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García-García C, Oliveras T, Serra J, Vila J, Rueda F, Cediel G, Labata C, Ferrer M, Carrillo X, Dégano IR, De Diego O, El Ouaddi N, Montero S, Mauri J, Elosua R, Lupón J, Bayes-Genis A. Trends in Short- and Long-Term ST-Segment-Elevation Myocardial Infarction Prognosis Over 3 Decades: A Mediterranean Population-Based ST-Segment-Elevation Myocardial Infarction Registry. J Am Heart Assoc 2020; 9:e017159. [PMID: 33054490 PMCID: PMC7763375 DOI: 10.1161/jaha.120.017159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Coronary artery disease remains a major cause of death despite better outcomes of ST-segment-elevation myocardial infarction (STEMI). We aimed to analyze data from the Ruti-STEMI registry of in-hospital, 28-day, and 1-year events in patients with STEMI over the past 3 decades in Catalonia, Spain, to assess trends in STEMI prognosis. Methods and Results Between February 1989 and December 2017, a total of 7589 patients with STEMI were admitted consecutively. Patients were grouped into 5 periods: 1989 to 1994 (period 1), 1995 to 1999 (period 2), 2000 to 2004 (period 3), 2005 to 2009 (period 4), and 2010 to 2017 (period 5). We used Cox regression to compare 28-day and 1-year STEMI mortality and in-hospital complication trends across these periods. Mean patient age was 61.6±12.6 years, and 79.3% were men. The 28-day all-cause mortality declined from period 1 to period 5 (10.4% versus 6.0%; P<0.001), with a 40% reduction after multivariable adjustment (hazard ratio [HR], 0.6; 95% CI, 0.46-0.80; P<0.001). One-year all-cause mortality declined from period 1 to period 5 (11.7% versus 9.0%; P=0.001), with a 24% reduction after multivariable adjustment (HR, 0.76; 95% CI, 0.60-0.98; P=0.036). A significant temporal reduction was observed for in-hospital complications including postinfarct angina (-78%), ventricular tachycardia (-57%), right ventricular dysfunction (-48%), atrioventricular block (-45%), pericarditis (-63%), and free wall rupture (-53%). Primary ventricular fibrillation showed no significant downslope trend. Conclusions In-hospital STEMI complications and 28-day and 1-year mortality rates have dropped markedly in the past 30 years. Reducing ischemia-driven primary ventricular fibrillation remains a major challenge.
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Affiliation(s)
- Cosme García-García
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Teresa Oliveras
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Jordi Serra
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Joan Vila
- Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Ferran Rueda
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - German Cediel
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Carlos Labata
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Marc Ferrer
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Xavier Carrillo
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain
| | - Irene R Dégano
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Oriol De Diego
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Nabil El Ouaddi
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Santiago Montero
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Josepa Mauri
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,Catalan Health Service Generalitat de Catalunya Barcelona Spain
| | - Roberto Elosua
- CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Grup d'Epidemiologia i Genètica Cardiovasculars (EGEC) REGICOR Study Group IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) Barcelona Spain
| | - Josep Lupón
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
| | - Antoni Bayes-Genis
- Heart Institute Hospital Universitari Germans Trias i Pujol Badalona Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV) Badalona Spain.,Department of Medicine Autonomous University of Barcelona Barcelona Spain
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32
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Peiró ÓM, Cediel G, Bonet G, Rojas S, Quintern V, Carrasquer A, González-Del-Hoyo M, Sanz E, Bardají A. Soluble urokinase plasminogen activator receptor as a long-term prognostic biomarker in acute coronary syndromes. Biomarkers 2020; 25:402-409. [PMID: 32551985 DOI: 10.1080/1354750x.2020.1778090] [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] [Indexed: 01/25/2023]
Abstract
Purpose: The aim of our study was to analyse the long-term prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in the setting of an acute coronary syndrome (ACS).Methods: We included 340 patients with an ACS who underwent coronary angiography and plasma suPAR concentration was measured. Patients were classified into low suPAR concentrations (<2.6 ng/mL) and high suPAR concentrations (≥2.6 ng/mL) and long-term events were evaluated. suPAR prognostic value was assessed beyond a clinical model that included age, GRACE score, estimated glomerular filtration rate, cardiac troponin-I peak and left ventricular ejection fraction <40%.Results: Higher suPAR concentrations were associated with an increased prevalence of cardiovascular risk factors. After multivariate adjustment, suPAR ≥2.6 ng/mL were independently associated with an increased risk of all-cause death (HR 2.3; 95%CI 1.2-4.4; p = .017), major adverse cardiovascular events (MACE) (HR 1.7; 95%CI 1.1-2.5; p = .020) and heart failure (HR 4.1; 95%CI 1.3-12.6; p = .015), but not with myocardial infarction. For long-term all-cause death significant improvement of reclassification and discrimination were seen after addition of suPAR to a clinical model.Conclusions: In the setting of an ACS, suPAR is associated with long-term all-cause death, heart failure and MACE, and provides incremental prognostic value beyond traditional risks factors.
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Affiliation(s)
- Óscar Manuel Peiró
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Sergio Rojas
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Quintern
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Anna Carrasquer
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Maribel González-Del-Hoyo
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Esther Sanz
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
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33
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Garcia-Garcia C, Rueda F, Vila J, De Diego O, Oliveras T, Labata C, Serra J, Ferrer M, El Ouaddi N, Cediel G, Elosua R, Lupon J, Bayes-Genis A. P1729Cardiogenic shock in ST elevation myocardial infarction: prevalence, management and acute phase and one-year mortality over the last three decades. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) is an ominous complication of ST elevation myocardial infarction (STEMI). However, the widespread use of reperfusion therapies and invasive management could have reduced the prevalence of CS and improved the prognosis of these patients in the last decades.
Purpose
The aim is to analyze the changes over last three decades in the prevalence, management and acute phase prognosis and 1-year mortality of STEMI patients complicated with CS.
Method
Between February 1989 and December 2017, 7,589 STEMI patients were consecutively admitted in the Coronary Care Unit of a University Hospital and were included in a prospective registry. Depending on the year of admission, patients were classified in five groups: 1989–1994: n=1,337, period 1; 1995–1999: n=960, period 2; 2000–2004: n=1,059, period 3; 2005–2009: n=1,535, period 4 and 2010–2015: n=2,698, period 5). We analyze the trend in prevalence of CS, management and 28-day and 1-year mortality over these five periods.
Results
The global prevalence of CS was 6.1% (466 patients), mean age was 67.7 (SD 11.7) years and 68.7% were men. Prevalence of CS in STEMI decreased from period 1 to 5 (7.3%, 6.4%, 5.5%, 5.8%, 6.0%, p<0.001), although it has been reduced more in women (10.1% in period 1 vs 8.3%, period 5, p<0.001) than in men (6.5% vs 5.4%, period 1 vs 5, respectively (p<0.001). Reperfusion therapy increased from 25.8% in period 1 (all with thrombolysis) vs 83.8% in period 5 (all with primary angioplasty). Intra-aortic balloon contrapulsation was only available from period 3 to 5, and it's used were firstly increased (20.7%, 36% and 37.9%, respectively, p<0.001). Ventricular assistance device (Impella CP) it was only available in 2017 and it was implanted in 10.5% of CS due to STEMI. Although 28-day case fatality is very high (60.7%, 283 patients), it has been reduced from period 1 to 5 (69.6%, 77.3%, 64.7%, 55.9% and 57.8%, respectively, p=0.012). This reduction in 28-day case fatality was higher in women (75.5% in period 1 vs 58.6% in period 5, p=0.12) than in men (66.8% vs 57.3, period 1–5, p=0.019). One-year mortality has been reduced between periods 1–5 (73.7% vs 61.8%, p=0.012). After multivariate adjustment, both 28-day (HR 0.63, 95% CI: 0.45–0.89, p=0.008) and 1-year mortality (HR 0.64, 95% CI: 0.45–0.90, p=0.010) have declined in the last period.
Kaplan-Meier curves, 1-year mortality
Conclusions
Cardiogenic shock development in STEMI patients has been reduced from 7.3% to 6.1% in the last three decades. The whole improvement in management of these patients achieves a 37% of reduction in 28-day case fatality and 1-year all-cause mortality. Despite this improvement, acute phase (28-day) case fatality of STEMI complicated with CS remains over 57% in the primary angioplasty era.
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Affiliation(s)
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Vila
- Hospital del Mar, Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - N El Ouaddi
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - R Elosua
- Hospital del Mar, Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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34
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Gonzalez Del Hoyo MI, Cediel G, Carrasquer A, Bonet G, Vasquez-Nunez K, Dominguez-Benito F, Ali S, Bardaji A. P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF.
Purpose
This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF.
Methods
A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE).
Results
A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint.
Conclusions
cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.
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Affiliation(s)
| | - G Cediel
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
| | - A Carrasquer
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - G Bonet
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - K Vasquez-Nunez
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | | | - S Ali
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | - A Bardaji
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
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Peiró ÓM, Farré N, Cediel G, Bonet G, Rojas S, Quintern V, Bardají A. Stromal cell derived factor-1 and long-term prognosis in acute coronary syndrome. Biomark Med 2019; 13:1187-1198. [PMID: 31559838 DOI: 10.2217/bmm-2019-0133] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore long-term prognostic value of SDF-1 in acute coronary syndrome (ACS). Materials & methods: We included 254 patients with ACS. Plasma SDF-1 was measured and patients were classified into tertiles of SDF-1. Results: Multivariate analysis showed third tertile of SDF-1 as an independent predictor of all-cause death (HR: 2.5; 95% CI: 1.2-5.2; p = 0.011) and the composite of major adverse cardiovascular and cerebrovascular events (HR: 1.8; 95% CI: 1.1-3.1; p = 0.031). SDF-1 added to a clinical model can improve all-cause death prediction (net reclassification improvement 0.362; 95% CI: 0.423-0.681; p = 0.027). Conclusion: SDF-1 is an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events in long-term follow-up of patients with ACS and adds prognostic information beyond traditional cardiovascular risks factors.
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Affiliation(s)
- Óscar M Peiró
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Nuria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Sergio Rojas
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Quintern
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.,Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
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36
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Bazan V, Cediel G, Llibre C, Sarrias A, Romeo I, Ibars S, Escudero F, Valdivielso S, Bisbal F, Villuendas R, Bayes-Genis A, Padilla F. Contemporary Yield of 24-hour Holter Monitoring: Role of Inter-Atrial Block Recognition. J Atr Fibrillation 2019; 12:2225. [PMID: 32002114 DOI: 10.4022/jafib.2225] [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: 03/30/2019] [Revised: 04/14/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The diagnostic yield of 24-hour ECG Holter monitoring (24H) is currently overcome by alternative ECG monitoring techniquesand it needs to be optimized. The recognition of inter-atrial block (IAB) has emerged as a reliable indicator of patients at risk of atrial fibrillation relapses, and its role enhancing the yield of 24H is yet to be determined. We hypothesized that a presumably low yield of 24H may be ameliorated by means of incorporating the assessment for IAB. METHODS We retrospectively analyzed 1017 consecutive 24H registers performed in a Multidisciplinary Integrated Health Care Institution, in which a restrictive definition of diagnostic 24H findings was used. A univariate and multivariate regression analysis served to determine the variables associated with a higher 24H's yield, including the requesting medical specialty, type of indication and a number of clinical, echocardiographic and ECG variables, including IAB. RESULTS The mean age of our population was 62 ± 17 years (55% males). The majority of 24H were indicated from the Cardiology department (48%). The overall yield was 12.8%, higher for the assessment of the integrity of the electrical conduction system (26.1%) and poorer for the assessment of syncope (3.2%) and cryptogenic stroke (4.6%). The variables associated with higher diagnostic performance were indication from Cardiology (p < 0.001), IAB (p = 0.004), structural heart disease (p = 0.008) and chronic renal failure (p = 0.009). Patients ≤ 50 years old only retrieved a 7% yield. In the multivariate analysis, indication from Cardiology and IAB remained significant predictors of higher 24H's yield. In a secondary analysis including echocardiographic data, only identification of IAB remained statistically significant. CONCLUSIONS The recognition of IAB and the type of indication are major determinants of a higher 24H's diagnostic yield and may help to optimize the selection of candidates.
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Affiliation(s)
- Victor Bazan
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | - German Cediel
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | - Cinta Llibre
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | - Axel Sarrias
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | - Isabel Romeo
- Cardiology Department. Hospital UniversitariMútua de Terrassa. Terrassa. Spain
| | - Sònia Ibars
- Cardiology Department. Hospital UniversitariMútua de Terrassa. Terrassa. Spain
| | - Francisco Escudero
- Cardiology Department. Hospital UniversitariMútua de Terrassa. Terrassa. Spain
| | - Sandra Valdivielso
- Cardiology Department. Hospital UniversitariMútua de Terrassa. Terrassa. Spain
| | - Felipe Bisbal
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | - Roger Villuendas
- Cardiology Department. Hospital Germans Triasi i Pujol. Badalona. Spain
| | | | - Ferran Padilla
- Cardiology Department. Hospital UniversitariMútua de Terrassa. Terrassa. Spain
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Peiró ÓM, García-Osuna Á, Ordóñez-Llanos J, Cediel G, Bonet G, Rojas S, Quintern V, Bardají A. Long-term prognostic value of growth differentiation factor-15 in acute coronary syndromes. Clin Biochem 2019; 73:62-69. [PMID: 31369736 DOI: 10.1016/j.clinbiochem.2019.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Growth Differentiation Factor-15 (GDF-15) predicts death and cardiovascular events in acute coronary syndromes (ACS). We aimed to assess the long-term prognostic value of GDF-15 in ACS. METHODS We included 358 patients with ACS who underwent coronary angiography. Plasma GDF-15 was measured and clinical data and long-term events were registered. Incremental value of GDF-15 for prognosing all-cause death above a clinical model including GRACE score, left ventricular ejection fraction <40%, prior myocardial infarction and age was assessed. RESULTS GDF-15 concentrations >1800 ng/L were associated with an increased prevalence of cardiovascular risk factors. During 6.5 years of follow-up 56 patients died, 7 had values of GDF-15 < 1200 ng/L, 7 between 1200 and 1800 ng/L and 42 > 1800 ng/L. After adjustment for potential confounders, GDF-15 > 1800 ng/L were independently associated with all-cause death (HR 4.09; 95% CI 1.57-10.71; p = .004) and the composite of major adverse cardiovascular events (MACE) (HR 2.48; 95% CI 1.41-4.34; p = .001). For long-term all-cause death a significant increase of ROC curve was seen after addition of GDF-15 to a clinical model 0.876 (95% CI 0.823-0.928; p = .014). Same improvements were found for net reclassification improvement (0.776; 95% CI 0.494-1.037; p < .001) and integrated discrimination improvement (0.112; 95% CI 0.055-0.169; p < .001). Multivariate competing risk model showed a significant association between GDF-15 > 1800 ng/L and the incidence of heart failure but not of myocardial infarction. CONCLUSIONS In the setting of ACS, GDF-15 is associated with long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factor.
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Affiliation(s)
- Óscar M Peiró
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Álvaro García-Osuna
- Department of Clinical Biochemistry, Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Biochemistry and Molecular Biology, Universitat Autònoma, Barcelona, Spain
| | - Jordi Ordóñez-Llanos
- Department of Clinical Biochemistry, Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Biochemistry and Molecular Biology, Universitat Autònoma, Barcelona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Sergio Rojas
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Quintern
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain.
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38
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Carrillo X, Vilalta V, Cediel G, Fernandez-Nofrerias E, Rodriguez-Leor O, Mauri J, Abdul Jawad-Altisent O, Garcia-Garcia C, Serra J, Bayes-Genis A. Trends in prevalence and outcomes of acute coronary syndrome associated with cocaine consumption: The RUTI-cocaine study. Int J Cardiol 2019; 283:23-27. [DOI: 10.1016/j.ijcard.2018.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/08/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022]
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Cediel G, González-Del-Hoyo M, Bonet G, Carrasquer A, Boqué C, Bardají A. Clinical Acceptance of the Universal Definition of Myocardial Infarction. Rev Esp Cardiol (Engl Ed) 2019; 72:353-355. [PMID: 29910070 DOI: 10.1016/j.rec.2018.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
- German Cediel
- Departamento de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | | | - Gil Bonet
- Departamento de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Anna Carrasquer
- Departamento de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Carme Boqué
- Servicio de Urgencias, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Alfredo Bardají
- Departamento de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
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40
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Cediel G, González-del-Hoyo M, Bonet G, Carrasquer A, Boqué C, Bardají A. Aceptación clínica de la definición universal del infarto de miocardio. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.03.018] [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: 10/17/2022]
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41
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Cediel G, Sandoval Y, Sexter A, Carrasquer A, González-Del-Hoyo M, Bonet G, Boqué C, Schulz K, Smith SW, Bayes-Genis A, Apple FS, Bardaji A. Risk Estimation in Type 2 Myocardial Infarction and Myocardial Injury: The TARRACO Risk Score. Am J Med 2019; 132:217-226. [PMID: 30419227 DOI: 10.1016/j.amjmed.2018.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite adverse prognoses of type 2 myocardial infarction and myocardial injury, an effective, practical risk stratification method remains an unmet clinical need. We sought to develop an efficient clinical bedside tool for estimating the risk of major adverse cardiovascular events at 180 days for this patient population. METHODS The derivation cohort included patients with type 2 myocardial infarction or myocardial injury admitted to a tertiary hospital between 2012 and 2013 (n = 611). The primary outcome was a major adverse cardiovascular event (death or readmission for heart failure or myocardial infarction). The score included clinical variables significantly associated with the outcome. External validation was conducted using the UTROPIA cohort (n = 401). RESULTS The TARRACO Score included cardiac troponin (cTn) concentrations and 5 independent clinical predictors of adverse cardiovascular events: age, hypertension, absence of chest pain, dyspnea, and anemia. The score exhibited good discriminative accuracy (area under the curve = 0.74; 95% CI, 0.70-0.79). Patients were classified into low-risk (score 0-6) and high-risk (score ≥7) categories. Major adverse cardiovascular events rates were 5 times more likely in high-risk patients compared with those at low risk (78.9 vs 15.4 events/100 patient-years, respectively; logrank P < .001). The external validation showed equivalent prognostic capacity (area under the curve=0.71, 0.65-0.78). CONCLUSION A novel risk score based on bedside clinical variables and cTn concentrations allows risk stratification for death and cardiac-related rehospitalizations in patients with type 2 myocardial infarctions and myocardial injury. This score identifies patients at the highest risk of adverse events, a subset of patients who may benefit from close observation, medical intensification, or both.
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Affiliation(s)
- German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Anne Sexter
- Chronic Disease Research Group, Minneapolis, Minn
| | - Anna Carrasquer
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Maribel González-Del-Hoyo
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Gil Bonet
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain
| | - Carme Boqué
- Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain; Emergency Department, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minn
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, CIBERCV Autonomous University of Barcelona, Spain
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis
| | - Alfredo Bardaji
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain.
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Moliner P, Lupon J, Cediel G, De Antonio M, Domingo M, Zamora E, Nunez J, Santiago E, Gonzalez B, Rivas C, Diaz V, Santesmases J, Diez-Quevedo C, Boldo M, Bayes-Genis A. P1815Prediction of sudden death in outpatients with heart failure: a bio-clinical approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1815] [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: 11/13/2022] Open
Affiliation(s)
- P Moliner
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M De Antonio
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - E Santiago
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - V Diaz
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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43
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Garcia-Garcia C, Rueda F, Oliveras T, Serra J, Labata C, Ferrer M, De Diego O, Cediel G, Rodriguez-Leor O, Carrillo X, Lupon J, Bayes-Genis A. P779Cardiogenic shock in STEMI patients:prevalence, management and acute phase mortality over the last three decades. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p779] [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: 11/14/2022] Open
Affiliation(s)
| | - F Rueda
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - T Oliveras
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Serra
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Labata
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Ferrer
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - O De Diego
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - X Carrillo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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Gastelurrutia P, Lupón J, Moliner P, Yang X, Cediel G, de Antonio M, Domingo M, Altimir S, González B, Rodríguez M, Rivas C, Díaz V, Fung E, Zamora E, Santesmases J, Núñez J, Woo J, Bayes-Genis A. Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction. Mayo Clin Proc Innov Qual Outcomes 2018; 2:176-185. [PMID: 30225447 PMCID: PMC6124320 DOI: 10.1016/j.mayocpiqo.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Results Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF. Conclusion Comorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.
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Key Words
- GDS, Geriatric Depression Scale
- HF, heart failure
- HFmrEF, heart failure and mildly reduced ejection fraction
- HFpEF, heart failure and preserved left ventricular ejection fraction
- HFrEF, heart failure and reduced left ventricular ejection fraction
- LVEF, left ventricular ejection fraction
- MLHFQ, Minnesota Living with Heart Failure Questionnaire
- NYHA, New York Heart Association
- OARS, Older Americans Resources and Services
- QOL, quality of life
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Affiliation(s)
- Paloma Gastelurrutia
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Pedro Moliner
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Xiaobo Yang
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - German Cediel
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marta de Antonio
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Salvador Altimir
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Beatriz González
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Margarita Rodríguez
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carmen Rivas
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Violeta Díaz
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Erik Fung
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Elisabet Zamora
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Javier Santesmases
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain.,Clinic University Hospital, INCLIVA, Department of Medicine, University of València, València, Spain
| | - Jean Woo
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
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45
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Gonzalez-Del-Hoyo MI, Merce J, Sanz-Girgas E, Serrano I, Bonet G, Cediel G, Carrasquer A, Bardaji A. P1114Clinical characteristics and prognosis of electrical storm. Europace 2018. [DOI: 10.1093/europace/euy015.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J Merce
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - E Sanz-Girgas
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - I Serrano
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - G Bonet
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - G Cediel
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - A Carrasquer
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
| | - A Bardaji
- Hospital Universitario Joan XXIII, CARDIOLOGY, Tarragona, Spain
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46
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Cediel G, Carrasquer A, Gonzalez_Del_Hoyo M, Sanchez R, Boque C, Bardaji A. P6434Early risk stratification of patients with positive troponin and without acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6434] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Cediel G, Gonzalez-del-Hoyo M, Carrasquer A, Sanchez R, Boqué C, Bardají A. Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury. Heart 2016; 103:616-622. [DOI: 10.1136/heartjnl-2016-310243] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/04/2016] [Accepted: 09/23/2016] [Indexed: 11/03/2022] Open
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48
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Affiliation(s)
- A Bardají
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, España.
| | - G Cediel
- Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, España
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