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Antequera-González B, Martínez-Micaelo N, Sureda-Barbosa C, Galian-Gay L, Siliato-Robles MS, Ligero C, Evangelista A, Alegret JM. Specific Multiomic Profiling in Aortic Stenosis in Bicuspid Aortic Valve Disease. Biomedicines 2024; 12:380. [PMID: 38397982 PMCID: PMC10887224 DOI: 10.3390/biomedicines12020380] [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: 01/05/2024] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND PURPOSE Bicuspid aortic valve (BAV) disease is associated with faster aortic valve degeneration and a high incidence of aortic stenosis (AS). In this study, we aimed to identify differences in the pathophysiology of AS between BAV and tricuspid aortic valve (TAV) patients in a multiomics study integrating metabolomics and transcriptomics as well as clinical data. METHODS Eighteen patients underwent aortic valve replacement due to severe aortic stenosis: 8 of them had a TAV, while 10 of them had a BAV. RNA sequencing (RNA-seq) and proton nuclear magnetic resonance spectroscopy (1H-NMR) were performed on these tissue samples to obtain the RNA profile and lipid and low-molecular-weight metabolites. These results combined with clinical data were posteriorly compared, and a multiomic profile specific to AS in BAV disease was obtained. RESULTS H-NMR results showed that BAV patients with AS had different metabolic profiles than TAV patients. RNA-seq also showed differential RNA expression between the groups. Functional analysis helped connect this RNA pattern to mitochondrial dysfunction. Integration of RNA-seq, 1H-NMR and clinical data helped create a multiomic profile that suggested that mitochondrial dysfunction and oxidative stress are key players in the pathophysiology of AS in BAV disease. CONCLUSIONS The pathophysiology of AS in BAV disease differs from patients with a TAV and has a specific RNA and metabolic profile. This profile was associated with mitochondrial dysfunction and increased oxidative stress.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
| | - Carlos Sureda-Barbosa
- Cardiac Surgery Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Laura Galian-Gay
- Cardiology Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.)
| | - M. Sol Siliato-Robles
- Cardiac Surgery Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Carmen Ligero
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Artur Evangelista
- Cardiology Department, Hospital Vall d’Hebron (CIBERCV), Universitat Autonoma de Barcelona, 08035 Barcelona, Spain; (L.G.-G.)
| | - Josep M. Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain; (B.A.-G.); (C.L.)
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
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Antequera-González B, Collell-Hernández R, Martínez-Micaelo N, Marimon-Blanch C, Carbonell-Prat B, Escribano J, Alegret JM. miR-130a expression is related to aortic dilation in bicuspid aortic valve children. Pediatr Res 2024:10.1038/s41390-024-03018-5. [PMID: 38273119 DOI: 10.1038/s41390-024-03018-5] [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] [Received: 04/12/2023] [Revised: 10/03/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Bicuspid aortic valve disease (BAV) is present in 0.5-2% of the population and can promote aortic dilation, eventually leading to fatal consequences. Although some biomarkers have been proposed in adults, no studies have tested these candidates in children. We aimed to evaluate four miRNAs previously described to be related to BAV disease and aortic dilation in adults in a paediatric cohort. METHODS Eighty participants ≤17 years old (4-17; mean 12) were included. From the BAV group, 40% had a dilated aorta (z score >2). RT‒qPCR were performed in plasma samples to quantify miR-122, miR-130a, miR-486, and miR-718 using the delta-delta Ct method. Functional and enrichment analyses of miR-130a were also performed. RESULTS miR-130a expression in plasma was found to be significantly lower in BAV patients with a dilated aorta versus nondilated patients (p = 0.008) and healthy TAV controls (p = 0.004). Furthermore, miR-130a expression in plasma was inversely correlated with ascending aorta (r = 0.318, p = 0.004) and aortic root z scores (r = 0.322; p = 0.004). Enrichment analysis showed that miR-130a target genes are related to the TGFβ signalling pathway. CONCLUSIONS miR-130a expression in plasma is decreased in aortic-dilated BAV children compared to nondilated BAV children, helping differentiate low- to high-risk patients. IMPACT miR-130a expression in plasma is related to aortic dilation in bicuspid aortic valve (BAV) children. To our knowledge, this is the first study that analyses miRNA patterns in bicuspid aortic valve children with aortic dilation. miR-130a expression in plasma could be a biomarker in order to help differentiate low-to high-risk BAV children, which is vitally important for advanced care planning.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Rosa Collell-Hernández
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Cristina Marimon-Blanch
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Bàrbara Carbonell-Prat
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Joaquín Escribano
- Pediatric Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain
| | - Josep M Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204, Reus, Spain.
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204, Reus, Spain.
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Ligero C, Bazan V, Guerra JM, Rodríguez-Mañero M, Viñolas X, Alegret JM. Influence of body mass index on recurrence of atrial fibrillation after electrical cardioversion. PLoS One 2023; 18:e0291938. [PMID: 37738256 PMCID: PMC10516430 DOI: 10.1371/journal.pone.0291938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Several studies have shown an independent relationship between body mass index (BMI) and the incidence of atrial fibrillation (AF). However, little is known about the influence of BMI on AF recurrence after electrical cardioversion (ECV). METHODS We selected 1121 patients who reverted to sinus rhythm after scheduled ECV and were included in three prospective Spanish registries of ECV in persistent AF. The patients were classified according to baseline BMI into three categories (normal weight, overweight, obesity). We assessed the influence of BMI on the rate of AF recurrence at 3 months. RESULTS We identified 538 patients (48%) who had AF recurrence in the first 3 months after successful ECV. The patients who suffered AF recurrence had a higher BMI than those who remained in sinus rhythm (29.66±4.57 vs. 28.87±4.64 Kg/m2, respectively; p = 0.004). We observed a higher incidence of AF recurrence in the overweight and obese patients (BMI ≥25 kg/m2) than in those classified as normal weight (50.5% vs. 35.6%, respectively; p<0,001). BMI≥25 Kg/m2 was shown to be independently related to of AF recurrence in the multivariate analysis (OR = 1.75, 95% confidence interval = 1.20-2.58; p = 0.004). CONCLUSIONS Increased BMI is independently related to AF recurrence after ECV. BMI should also be taken into account when making decisions about the indication for ECV in persistent AF.
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Affiliation(s)
- Carmen Ligero
- Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain
| | - Victor Bazan
- Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - José M. Guerra
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Moisés Rodríguez-Mañero
- Hospital Clínico Universitario de Santiago, Universidad de Santiago, Santiago de Compostela, Spain
| | - Xavier Viñolas
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M. Alegret
- Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain
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Antequera-González B, Faiges M, Martínez-Micaelo N, Galian-Gay L, Ligero C, Ferré-Vallverdú M, Masana L, Amigó N, Evangelista A, Alegret JM. Glycoprotein and Lipoprotein Profiles Assessed by 1H-NMR and Its Relation to Ascending Aortic Dilatation in Bicuspid Aortic Valve Disease. J Clin Med 2022; 12:jcm12010332. [PMID: 36615132 PMCID: PMC9821550 DOI: 10.3390/jcm12010332] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The bicuspid aortic valve (BAV) confers a high risk of ascending aorta dilatation (AAoD), although its progression seems highly variable. Furthermore, the implication of lipoprotein metabolism and inflammation in the mechanisms that underlie AAoD is not fully established. The aim of this study consisted of evaluating the impact of the lipoprotein and glycoprotein profiles in AAOD as well as its progression in BAV aortopathy. METHODS Using 1H-nuclear magnetic resonance (1H-NMR), we analyzed and compared the lipoprotein and glycoprotein profiles of plasma samples from 152 BAV patients with dilated and nondilated ascending aorta. Additionally, these profiles were also compared for 119 of these patients who were prospectively followed-up clinically and by echocardiography in the long-term (5 years). Ascending aorta dilation velocity (mm/year) was calculated for this analysis. RESULTS Several parameters related to the lipoprotein profile including remnant cholesterol, small LDL and IDL-cholesterol were found to be significantly increased in the dilated group compared to those in the nondilated group. The glycoprotein A-nuclear magnetic resonance (NMR) signal, a novel inflammation biomarker, was also observed to be increased in the dilated group. After performing multivariate analysis, remnant cholesterol remained an independent variable related to AAoD. In the long-term follow-up, proatherogenic lipoprotein parameters were related to ascending aorta dilatation velocity ascending. After a lineal regression analysis, non-HDL particles remained as an independent predictor of ascending aorta dilation velocity. CONCLUSIONS Patients with BAV and AAoD presented a more pro-atherogenic profile assessed by 1H-NMR, especially related to triglyceride-rich lipoproteins. This pro-atherogenic profile seems to contribute to the higher growth rate of ascending aorta diameter.
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Marta Faiges
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Laura Galian-Gay
- Cardiology Department, Hospital General Universitari Vall d’Hebron, VHIR, CIBER-CV, 08035 Barcelona, Spain
| | - Carmen Ligero
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - María Ferré-Vallverdú
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Lluís Masana
- Vascular Medicine and Metabolism Unit, IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Núria Amigó
- Biosfer Teslab SL, DEEEA, Metabolomics Platform, Universitat Rovira i Virgili, IISPV, CIBERDEM, 43007 Tarragona, Spain
| | - Arturo Evangelista
- Cardiology Department, Hospital General Universitari Vall d’Hebron, VHIR, CIBER-CV, 08035 Barcelona, Spain
| | - Josep M. Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Cardiology Department, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, 43204 Reus, Spain
- Correspondence:
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Ruiz-López A, Li CHP, Valdovinos P, Rodríguez Á, Bonet A, Tauron M, Ligero C, Millan X, Alegret JM, Viladés D, Arzamendi D. Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device. JACC Case Rep 2022; 4:727-731. [PMID: 35734523 PMCID: PMC9207944 DOI: 10.1016/j.jaccas.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
An 80-year-old woman with mitral valve repair failure was admitted with hemolytic anemia secondary to the impact of a regurgitant jet on the annuloplasty ring. Transcatheter repair to treat both mitral regurgitation and hemolysis was favored because of surgical risk. Transcatheter edge-to-edge repair represents an alternative for treating hemolysis associated with mitral regurgitation. (Level of Difficulty: Advanced.)
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García Miranda HR, Alegret JM, Valdovinos P, Tajes H. A Case of an Elderly Patient With Recurrent Spontaneous Coronary Artery Dissection. Cureus 2022; 14:e23633. [PMID: 35494940 PMCID: PMC9050996 DOI: 10.7759/cureus.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/05/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of myocardial infarction (MI), and its prevalence among women is increasing. Epidemiological information indicates that SCAD is responsible for one-third of MI cases in women of reproductive age. Little information is described on SCAD in elderly patients. The patient in the case presented here was an 81-year-old woman with a history of SCAD who presented with oppressive thoracic chest pain associated with electrical changes that derailed into ventricular fibrillation. Coronary angiography confirmed a SCAD recurrence, and conservative medical treatment was established. Different pathophysiological pathways have been proposed for SCAD extension or recurrence. Nonetheless, there is yet much to be discovered about this disease and its presentation in different age groups.
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Lopez A, Dentamaro I, Galian L, Calvo F, Alegret JM, Sanchez V, Citro R, Moreo A, Chirillo F, Colonna P, Carrero MC, Bossone E, Moral S, Sao-Aviles A, Gutiérrez L, Teixido-Tura G, Rodríguez-Palomares J, Evangelista A. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve. J Clin Med 2021; 10:jcm10225264. [PMID: 34830546 PMCID: PMC8621265 DOI: 10.3390/jcm10225264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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Affiliation(s)
- Angela Lopez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Ilaria Dentamaro
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Galian
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Francisco Calvo
- Cardiology Department, Hospital Alvaro Cunqueiro, 36213 Vigo, Spain;
| | - Josep M. Alegret
- Cardiology Department, Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Violeta Sanchez
- Cardiology Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Rodolfo Citro
- Cardiology Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Antonella Moreo
- Cardiology Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy;
| | - Fabio Chirillo
- Cardiology Department, Bassano del Grappa General Hospital, 36061 Bassano Del Grappa, Italy;
| | - Paolo Colonna
- Cardiology Department, Polyclinic Hospital of Bari, 70124 Bari, Italy;
| | - María Celeste Carrero
- Instituto Cardiovascular San Isidro, Sanatorio Las Lomas, Buenos Aires 3031, Argentina;
| | - Eduardo Bossone
- Cardiology Department, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Napoli, Italy;
| | - Sergio Moral
- Servei de Cardiologia, Hospital Josep Trueta, 17007 Girona, Spain;
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Gisela Teixido-Tura
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
- Heart Institute, Teknon Medical Center-Quirón Salud, 08022 Barcelona, Spain
- Correspondence:
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Ferre-Vallverdu M, Ligero C, Vidal-Perez R, Martinez-Rubio A, Vinolas X, Alegret JM. Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm. Clin Interv Aging 2021; 16:739-745. [PMID: 33953552 PMCID: PMC8092854 DOI: 10.2147/cia.s305619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The European Heart Rhythm Association (EHRA) score is a proven and validated tool for assessing the symptoms of atrial fibrillation (AF). Little is known about the variables related to this score and how it changes after cardioversion. Methods We analyzed 744 patients undergoing elective cardioversion in whom AF-related symptoms were assessed at baseline and after 6 months of follow-up using the EHRA score. We assessed the association between the EHRA score and other clinical and echocardiographic variables at baseline and after 6 months of follow-up. Results At 6 months of follow-up, we observed a reduction in the EHRA score in 50% and worsening in 2.8% of patients who remained in sinus rhythm (SR) compared with 34.6% and 11.3%, respectively, of patients with AF episodes (p<0.0001). Patients who maintained SR at 6 months were less symptomatic than those with AF (EHRA score 1.13 ± 0.35 vs 1.42 ± 0.59; p<0.0001). The independent predictors for reduction in the EHRA score after cardioversion were NYHA ≥II at baseline and maintenance of SR (p<0.0001). Conclusion The greatest improvement in AF-related symptoms was in patients who remained in SR at 6 months after cardioversion and in patients with worse NYHA functional class at baseline.
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Affiliation(s)
- Maria Ferre-Vallverdu
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Carmen Ligero
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Xavier Vinolas
- Department of Cardiology, Hospital de la Sta, Creu i St Pau, Barcelona, Spain
| | - Josep M Alegret
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
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El Amrani A, Viñolas X, Arias MA, Bazan V, Valdovinos P, Alegret JM. Pharmacological Cardioversion after Pre-Treatment with Antiarrythmic Drugs Prior to Electrical Cardioversion in Persistent Atrial Fibrillation: Impact on Maintenance of Sinus Rhythm. J Clin Med 2021; 10:1029. [PMID: 33802253 PMCID: PMC7958960 DOI: 10.3390/jcm10051029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Antiarrhythmic drugs (AADs) are frequently initiated in patients with persistent atrial fibrillation (AF) prior to electrical cardioversion (ECV), achieving pharmacological cardioversion (PCV) in some cases. Little is known about the mode of cardioversion and the effect of the type of AAD used in the maintenance of sinus rhythm (SR). METHODS From three national surveys of patients with persistent AF referred for ECV, we selected those who were pre-treated with AADs (amiodarone or group Ic AADs). We analyzed the effect of the type of cardioversion (pharmacological vs. electrical) and the AAD used in the maintenance of SR at three months. RESULTS Among the 665 patients selected, 151 had a successful PCV prior to the planned ECV. In the remaining 514 patients, 460 had a successful ECV. A successful PCV was related to a higher rate of SR maintenance than a successful ECV (77.9% vs. 57.5%; p < 0.0001). After a successful PCV, the maintenance of SR was identical in those patients treated with amiodarone and those treated with group Ic AADs (77.4% vs. 77.5%; p = 0.99), whereas after a successful ECV, amiodarone was clearly superior to group Ic AADs (61.3% vs. 43.0%; p = 0.001). Considering patients with successful PCV and ECV together, PCV was an independent factor related to the maintenance of SR. CONCLUSIONS In patients with persistent AF, successful PCV selects a subgroup with a high probability of maintenance of SR. With regard to drugs, amiodarone was superior to group Ic AADs in patients with ECV, whereas in PCV, no differences were observed.
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Affiliation(s)
- Amine El Amrani
- Department of Cardiology, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.E.A.); (P.V.)
| | - Xavier Viñolas
- Department of Cardiology, Hospital de la Sta. Creu i St. Pau, 08026 Barcelona, Spain;
| | - Miguel Angel Arias
- Department of Cardiology, Hospital Virgen de la Salud, 45004 Toledo, Spain;
| | - Victor Bazan
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Pilar Valdovinos
- Department of Cardiology, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.E.A.); (P.V.)
| | - Josep M. Alegret
- Department of Cardiology, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain; (A.E.A.); (P.V.)
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10
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Ballesta-Ors J, Clua-Espuny JL, Gentille-Lorente DI, Lechuga-Duran I, Fernández-Saez J, Muria-Subirats E, Blasco-Mulet M, Lorman-Carbo B, Alegret JM. Results, barriers and enablers in atrial fibrillation case finding: barriers in opportunistic atrial fibrillation case finding-a cross-sectional study. Fam Pract 2020; 37:486-492. [PMID: 32219320 DOI: 10.1093/fampra/cmaa023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is often asymptomatic, and screening is not routinely undertaken. OBJECTIVE Evaluate the feasibility and effectiveness of a population-based case finding program and to identify the enablers of and/or barriers to its implementation. METHODS We conducted a cross-sectional study of a health care case finding program for AF from 1 January 2016, to 31 December 2017, that included 48 336 people ≥60 years of age in the region of Terresde l'Ebre (Catalonia, Spain). We analysed the effect on the prevalence of AF and, stratified by age, on the incidence of new diagnoses of AF. We assessed the sociodemographic and clinical variables related to the realization of a case finding. RESULTS A total of 32 090 (62.4%) people were screened for AF. We observed a significant increase in the AF prevalence after 2 years of program intervention (5.9-7.7%; P < 0.001). The detection of new AF cases was significantly higher in the case finding group across the whole of the age range, and 765 (2.6%) new AF cases were diagnosed using case finding. The factors that were significantly associated with an underuse of case finding were: age <70 years, urban residence, institutionalized status, Pfeiffer score ≥2, Charlson score >3 and number of visits <7/year. CONCLUSIONS A health care program of case finding is feasible and is associated with a significant increase in the prevalence and incidence of AF. The results depend on factors such as the ease of access to health care, age, place of residence and comorbidities.
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Affiliation(s)
- Juan Ballesta-Ors
- Department of Primary Care, Catalonian Health Institute, Equip d'Investigació en Atenció Primària IDIAP Jordi Gol, University Rovira Virgili, Tortosa, Spain
| | - Josep L Clua-Espuny
- Department of Primary Care, Catalonian Health Institute, Equip d'Investigació en Atenció Primària IDIAP Jordi Gol, University Rovira Virgili, Tortosa, Spain
| | | | - Iñigo Lechuga-Duran
- Department of Cardiology, Catalonian Health Institute, Hospital Verge de la Cinta, Tortosa, Spain
| | - José Fernández-Saez
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Spain
| | - Eulalia Muria-Subirats
- Department of Primary Care, Catalonian Health Institute, Equip d'Investigació en Atenció Primària IDIAP Jordi Gol, University Rovira Virgili, Tortosa, Spain
| | - María Blasco-Mulet
- Department of Primary Care, Catalonian Health Institute, Equip d'Investigació en Atenció Primària IDIAP Jordi Gol, University Rovira Virgili, Tortosa, Spain
| | - Blanca Lorman-Carbo
- Department of Primary Care, Catalonian Health Institute, Equip d'Investigació en Atenció Primària IDIAP Jordi Gol, University Rovira Virgili, Tortosa, Spain
| | - Josep M Alegret
- Department of Cardiology, Hospital San Juan, Reus, Spain.,Cardiovascular Research Group, IISPV, Departament de Medicina i Cirugia, Universitat Rovira i Virigili, Reus, Spain
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11
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Hernández Rojas Z, Dalmau Llorca MR, Aguilar Martín C, Gonçalves AQ, Casajuana M, Fernández-Sáez J, Rodríguez Cumplido D, Forcadell Drago E, Carrasco-Querol N, Pepió Vilaubí JM, Alegret JM. Cost-effectiveness of direct oral anticoagulants versus vitamin K antagonist in atrial fibrillation: A study protocol using Real-World Data from Catalonia (FantasTIC Study). Medicine (Baltimore) 2020; 99:e22054. [PMID: 32899067 PMCID: PMC7478774 DOI: 10.1097/md.0000000000022054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Anticoagulant therapy is used for stroke prevention and proved to be effective and safe in the long term. The study aims to analyse the cost-effectiveness relationship of using of direct-acting oral anticoagulants vs vitamin K antagonists to prevent ischaemic stroke in patients with nonvalvular atrial fibrillation, including all the active ingredients marketed in Spain, prescribed for 2 years in the Primary Care service of the Institut Català de la Salut. METHODS Population-based cohort study, in which the cost of the 2 treatment groups will be evaluated. Direct costs (pharmacy, primary care, emergency and hospitalization) and indirect costs (lost productivity) will be included from a social perspective. Effectiveness (assessed as the occurrence of a health event, the 1 of primary interest being stroke) will be determined, with a 2-year time horizon and a 3% discount rate. The average cost of the 2 groups of drugs will be compared using a regression model to determine the factors with the greatest influence on determining costs. We will carry out a univariate ('one-way') deterministic sensitivity analysis. DISCUSSION We hope to provide relevant information about direct and indirect costs of oral anticoagulants, which, together with aspects of effectiveness and safety, could help shape the consensual decision-making of evaluating bodies.
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Affiliation(s)
- Zojaina Hernández Rojas
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa, Tarragona, Spain
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
- GAVINA Research Grup
| | - Maria Rosa Dalmau Llorca
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa, Tarragona, Spain
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
- GAVINA Research Grup
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
- GAVINA Research Grup
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
- GAVINA Research Grup
- Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Marc Casajuana
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - José Fernández-Sáez
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
- GAVINA Research Grup
- Unitat de Recerca, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain
- Facultat d’Enfermeria, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | | | - Emma Forcadell Drago
- GAVINA Research Grup
- Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, Spain
| | - Josep Maria Pepió Vilaubí
- GAVINA Research Grup
- Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Josep M. Alegret
- Grup de Recerca Cardiovascular, Departament de Cardiologia, Hospital Universitari de Sant Joan, Institut de Investigació Sanitaria Pere Virgili (IISPV), Reus, Spain
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Spain
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12
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Antequera-González B, Martínez-Micaelo N, Alegret JM. Bicuspid Aortic Valve and Endothelial Dysfunction: Current Evidence and Potential Therapeutic Targets. Front Physiol 2020; 11:1015. [PMID: 32973551 PMCID: PMC7472870 DOI: 10.3389/fphys.2020.01015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022] Open
Abstract
Bicuspid aortic valve (BAV), the most frequent congenital heart malformation, is characterized by the presence of a two-leaflet aortic valve instead of a three-leaflet one. BAV disease progression is associated with valvular dysfunction (in the form of stenosis or regurgitation) and aortopathy, which can lead to aneurysm and aortic dissection. This morphological abnormality modifies valve dynamics and promotes eccentric blood flow, which gives rise to alterations of the flow pattern and wall shear stress (WSS) of the ascending aorta. Recently, evidence of endothelial dysfunction (ED) in BAV disease has emerged. Different studies have addressed a reduced endothelial functionality by analyzing various molecular biomarkers and cellular parameters in BAV patients. Some authors have found impaired functionality of circulating endothelial progenitors in these patients, associating it with valvular dysfunction and aortic dilation. Others focused on systemic endothelial function by measuring artery flow-mediated dilation (FMD), showing a reduced FMD in BAV individuals. Novel biomarkers like increased endothelial microparticles (EMP), which are related to ED, have also been discovered in BAV patients. Finally, latest studies indicate that in BAV, endothelial-to-mesenchymal transition (EndoMT) may also be de-regulated, which could be caused by genetic, hemodynamic alterations, or both. Different hypothesis about the pathology of ED in BAV are nowadays being debated. Some authors blamed this impaired functionality just on genetic abnormalities, which could lead to a pathological aorta. Nevertheless, thanks to the development of new and high-resolution imaging techniques like 4D flow MRI, hemodynamics has gained great attention. Based on latest studies, alterations in blood flow seem to cause proper modification of the endothelial cells (ECs) function and morphology. It also seems to be associated with aortic dilation and decreased vasodilators expression, like nitric oxide (NO). Although nowadays ED in BAV has been reported by many, it is not clear which its main cause may be. Comprehending the pathways that promote ED and its relevance in BAV could help further understand and maybe prevent the serious consequences of this disease. This review will discuss the ED present in BAV, focusing on the latest evidence, biomarkers for ED and potential therapeutic targets (Figure 1).
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Affiliation(s)
- Borja Antequera-González
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), University of Rovira i Virgili, Reus, Spain
| | - Neus Martínez-Micaelo
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), University of Rovira i Virgili, Reus, Spain
| | - Josep M Alegret
- Group of Cardiovascular Research, Pere Virgili Health Research Institute (IISPV), University of Rovira i Virgili, Reus, Spain.,Department of Cardiology, University Hospital Sant Joan de Reus, University of Rovira i Virgili, Reus, Spain
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13
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Martínez-Micaelo N, Ligero C, Antequera-González B, Junza A, Yanes O, Alegret JM. Plasma Metabolomic Profiling Associates Bicuspid Aortic Valve Disease and Ascending Aortic Dilation with a Decrease in Antioxidant Capacity. J Clin Med 2020; 9:jcm9072215. [PMID: 32668689 PMCID: PMC7408840 DOI: 10.3390/jcm9072215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The bicuspid aortic valve (BAV) is the most common cardiac congenital disease and is associated with an increased risk of developing ascending aorta dilation; which can have fatal consequences. Currently; no established risk biomarkers exist to facilitate the diagnosis and prognosis of BAV. METHODS Using an untargeted metabolomic approach; we identified the levels of metabolites in plasma samples and compared them depending on the bicuspid or tricuspid morphology of the aortic valve. Including those patients with ascending aortic dilation and/or aortic stenosis (n = 212), we analyzed the role possibly played by alpha-Tocopherol in BAV disease; considering its association with the pathophysiological characteristics of BAV and biomarkers related to inflammation, oxidative stress and endothelial damage, as well as characteristics related to alpha-Tocopherol functionality and metabolism. RESULTS We found that BAV patients; especially those with ascending aortic dilation; presented lower antioxidant capacity; as determined by decreased plasma levels of alpha-Tocopherol; paraoxonase 1 and high-density lipoprotein (HDL), as well as increased levels of C-reactive protein (CRP; a biomarker of inflammation) and endothelial microparticles (EMPs; an endothelial damage biomarker). By applying random forest analyses; we evaluated the significant screening capacity of alpha-Tocopherol; CRP and EMPs to classify patients depending on the morphology of the aortic valve. DISCUSSION Our findings support the role of decreased antioxidant capacity; increased inflammation and endothelial damage in the pathogenesis of BAV and the progression of aortic dilation. Moreover; determining the plasma levels of alpha-Tocopherol; CRP and EMPs could improve BAV diagnosis in large populations.
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Affiliation(s)
- Neus Martínez-Micaelo
- Grup de Recerca Cardiovascular, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (C.L.); (B.A.-G.)
- Correspondence: (N.M.-M.); (J.M.A.); Tel.: +34-977310300 (N.M.-M.); Fax: +34-977315144 (N.M.-M.)
| | - Carme Ligero
- Grup de Recerca Cardiovascular, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (C.L.); (B.A.-G.)
- Servei de Cardiologia, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Borja Antequera-González
- Grup de Recerca Cardiovascular, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (C.L.); (B.A.-G.)
| | - Alexandra Junza
- Metabolomics Platform, Institut d’Investigació Sanitària Pere Virgili (IISPV), Department of Electronic Engineering, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.J.); (O.Y.)
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28029 Madrid, Spain
| | - Oscar Yanes
- Metabolomics Platform, Institut d’Investigació Sanitària Pere Virgili (IISPV), Department of Electronic Engineering, Universitat Rovira i Virgili, 43007 Tarragona, Spain; (A.J.); (O.Y.)
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28029 Madrid, Spain
| | - Josep M. Alegret
- Grup de Recerca Cardiovascular, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (C.L.); (B.A.-G.)
- Servei de Cardiologia, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43201 Reus, Spain
- Correspondence: (N.M.-M.); (J.M.A.); Tel.: +34-977310300 (N.M.-M.); Fax: +34-977315144 (N.M.-M.)
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14
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Martínez-Micaelo N, Beltrán-Debón R, Aragonés G, Faiges M, Alegret JM. MicroRNAs Clustered within the 14q32 Locus Are Associated with Endothelial Damage and Microparticle Secretion in Bicuspid Aortic Valve Disease. Front Physiol 2017; 8:648. [PMID: 28928672 PMCID: PMC5591958 DOI: 10.3389/fphys.2017.00648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/16/2017] [Indexed: 01/03/2023] Open
Abstract
Background: We previously described that PECAM+ circulating endothelial microparticles (EMPs) are elevated in bicuspid aortic valve (BAV) disease as a manifestation of endothelial damage. In this study, we hypothesized that this endothelial damage, is functionally related to the secretion of a specific pattern of EMP-associated miRNAs. Methods: We used a bioinformatics approach to correlate the PECAM+ EMP levels with the miRNA expression profile in plasma in healthy individuals and BAV patients (n = 36). In addition, using the miRNAs that were significantly associated with PECAM+ EMP levels, we inferred a miRNA co-expression network using a Gaussian graphical modeling approach to identify highly co-expressed miRNAs or miRNA clusters whose expression could functionally regulate endothelial damage. Results: We identified a co-expression network composed of 131 miRNAs whose circulating expression was significantly associated with PECAM+ EMP levels. Using a topological analysis, we found that miR-494 was the most important hub within the co-expression network. Furthermore, through positional gene enrichment analysis, we identified a cluster of 19 highly co-expressed miRNAs, including miR-494, that was located in the 14q32 locus on chromosome 14 (p = 1.9 × 10−7). We evaluated the putative biological role of this miRNA cluster by determining the biological significance of the genes targeted by the cluster using functional enrichment analysis. We found that this cluster was involved in the regulation of genes with various functions, specifically the “cellular nitrogen compound metabolic process” (p = 2.34 × 10−145), “immune system process” (p = 2.57 × 10−6), and “extracellular matrix organization” (p = 8.14 × 10−5) gene ontology terms and the “TGF-β signaling pathway” KEGG term (p = 2.59 × 10−8). Conclusions: Using an integrative bioinformatics approach, we identified the circulating miRNA expression profile associated with secreted PECAM+ EMPs in BAV disease. Additionally, we identified a highly co-expressed miRNA cluster that could mediate crucial biological processes in BAV disease, including the nitrogen signaling pathway, cellular activation, and the transforming growth factor beta signaling pathway. In conclusion, EMP-associated and co-expressed miRNAs could act as molecular effectors of the intercellular communication carried out by EMPs in response to endothelial damage.
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Affiliation(s)
- Neus Martínez-Micaelo
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Raúl Beltrán-Debón
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Gerard Aragonés
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Marta Faiges
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain
| | - Josep M Alegret
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i VirgiliReus, Spain.,Servei de Cardiologia, Hospital Universitari de Sant Joan, Universitat Rovira i VirgiliReus, Spain
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15
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Rodríguez-Calvo R, Girona J, Alegret JM, Bosquet A, Ibarretxe D, Masana L. Role of the fatty acid-binding protein 4 in heart failure and cardiovascular disease. J Endocrinol 2017; 233:R173-R184. [PMID: 28420707 DOI: 10.1530/joe-17-0031] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/18/2017] [Indexed: 01/05/2023]
Abstract
Obesity and ectopic fat accumulation in non-adipose tissues are major contributors to heart failure (HF) and cardiovascular disease (CVD). Adipocytes act as endocrine organs by releasing a large number of bioactive molecules into the bloodstream, which participate in a communication network between white adipose tissue and other organs, including the heart. Among these molecules, fatty acid-binding protein 4 (FABP4) has recently been shown to increase cardiometabolic risk. Both clinical and experimental evidence have identified FABP4 as a relevant player in atherosclerosis and coronary artery disease, and it has been directly related to cardiac alterations such as left ventricular hypertrophy (LVH) and both systolic and diastolic cardiac dysfunction. The available interventional studies preclude the establishment of a direct causal role of this molecule in CVD and HF and propose FABP4 as a biomarker rather than as an aetiological factor. However, several experimental reports have suggested that FABP4 may act as a direct contributor to cardiac metabolism and physiopathology, and the pharmacological targeting of FABP4 may restore some of the metabolic alterations that are conducive to CVD and HF. Here, we review the current knowledge regarding FABP4 in the context of HF and CVD as well as the molecular basis by which this protein participates in the regulation of cardiac function.
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Affiliation(s)
- Ricardo Rodríguez-Calvo
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Josefa Girona
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Josep M Alegret
- Department of CardiologyCardiovascular Research Group, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Reus, Spain
| | - Alba Bosquet
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
| | - Lluís Masana
- Vascular Medicine and Metabolism UnitResearch Unit on Lipids and Atherosclerosis, 'Sant Joan' University Hospital, Universitat Rovira i Virgili, Institut de Investigació Sanitaria Pere Virgili (IISPV), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain
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16
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Martínez-Micaelo N, Beltrán-Debón R, Baiges I, Faiges M, Alegret JM. Specific circulating microRNA signature of bicuspid aortic valve disease. J Transl Med 2017; 15:76. [PMID: 28399937 PMCID: PMC5387230 DOI: 10.1186/s12967-017-1176-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 12/29/2016] [Accepted: 04/02/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We aimed to determine the circulating miRNA expression profile associated with BAV and aortic dilation to provide diagnostic and prognostic biomarkers for BAV and/or aortic dilation. METHODS AND RESULTS We applied a miRNome-wide microarray approach using plasma samples (n = 24) from healthy tricuspid aortic valve individuals, BAV patients and BAV patients with aortic dilation to compare and identify the specific miRNAs associated with BAV and aortic dilation. In a second stage, the expression patterns of the miRNA candidates were validated by RT-qPCR in an independent cohort (n = 43). The miRNA microarray data and RT-qPCR analyses revealed that the expression levels of circulating miR-122, miR-130a and miR-486 are significantly influenced by the morphology of the aortic valve (bicuspid/tricuspid) and could be functionally involved in the regulation of TGF-β1 signalling. Furthermore, the expression pattern of miR-718 in the plasma was strongly influenced by dilation of the ascending aorta. miR-718 expression was inversely correlated with the aortic diameter (R = -0.63, p = 3.1 × 10-5) and was an independent predictor of aortic dilation (β = -0.41, p = 0.022). The genes targeted by miR-718 are involved in the regulation of vascular remodelling. CONCLUSIONS We propose that miR-122, miR-130a, miR-486 and miR-718 are new molecular features associated with BAV and aortic dilation principally by the activation of TGF-β1 pathway and vascular remodelling mediated by VEGF signalling pathways.
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Affiliation(s)
- Neus Martínez-Micaelo
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Raúl Beltrán-Debón
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Isabel Baiges
- Centre for Omic Sciences (COS), Universitat Rovira i Virgili, Reus, Spain
| | - Marta Faiges
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Josep M Alegret
- Grup de Recerca Cardiovascular, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain. .,Servei de Cardiologia, Hospital Universitari de Sant Joan, Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, c/Dr Josep Laporte, 1, 43204, Reus, Spain.
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Alegret JM, Martínez-Micaelo N, Aragonès G, Beltrán-Debón R. Circulating endothelial microparticles are elevated in bicuspid aortic valve disease and related to aortic dilation. Int J Cardiol 2016; 217:35-41. [PMID: 27179206 DOI: 10.1016/j.ijcard.2016.04.184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 04/30/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The mechanisms underlying aortic dilation in bicuspid aortic valve (BAV) disease are unknown. Circulating endothelial microparticles (EMPs) have emerged as biomarkers of endothelial damage. We sought to evaluate the relationships among EMPs, BAV disease, and aortic dilation. METHODS Four evaluations were used. Circulating EMPs (PECAM(+), E-selectin(+)) were compared between BAV patients and tricuspid aortic valve (TAV) control subjects. The variables related to circulating EMPs were investigated in BAV patients. Circulating EMP levels were compared between BAV and TAV patients with a dilated aorta. Finally, circulating EMPs in BAV patients were evaluated over time with respect to aortic valve surgery (AVS) or aortic surgery. RESULTS We observed higher levels of circulating PECAM(+) EMPs in the BAV patients than in the control subjects (3.98±0.2 vs. 2.39±0.4 per log PECAM(+) EMPs/μl, p=0.001). Aortic dilation was the most significant variable that correlated with the PECAM(+) EMP levels in the BAV patients (β=0.321, p=0.008). The BAV patients with aortic dilation exhibited higher PECAM(+)EMP levels than the TAV patients with dilated aortas, and this correlation was independent of aortic valve function. We observed a drastic decrease in the circulating PECAM(+) EMPs following AVS and aortic root replacement (4.27±0.6 and 1.75±0.3 per log PECAM(+)EMPs/μl, p=0.002). CONCLUSION The observed pattern of higher circulating PECAM(+) EMP levels links BAV disease to endothelial damage and aortic dilation. Circulating PECAM(+) EMPs were identified as a biological variable related to aortic dilation in patients with BAV disease.
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Affiliation(s)
- Josep M Alegret
- Grup de Recerca Cardiovascular, Servei de Cardiologia, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain.
| | - Neus Martínez-Micaelo
- Grup de Recerca Cardiovascular, Servei de Cardiologia, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Gerard Aragonès
- Grup de Recerca Cardiovascular, Servei de Cardiologia, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Raúl Beltrán-Debón
- Grup de Recerca Cardiovascular, Servei de Cardiologia, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
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Alegret JM, Masana L, Martinez-Micaelo N, Heras M, Beltrán-Debón R. LDL cholesterol and apolipoprotein B are associated with ascending aorta dilatation in bicuspid aortic valve patients. QJM 2015; 108:795-801. [PMID: 25660598 DOI: 10.1093/qjmed/hcv032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The factors related to ascending aorta dilation (AAD) in patients with bicuspid aortic valve (BAV) are not completely understood. In addition, the role of cholesterol metabolism in AAD has not been studied. METHODS We analyzed the relationship between different lipid parameters and the ascending aorta diameter/presence of aortic dilatation in 91 consecutive patients with BAV. RESULTS We observed a positive linear correlation between the total cholesterol, low-density lipoprotein (LDL) cholesterol and apolipoprotein B (ApoB) levels and the ascending aorta diameter. The patients with AAD had higher LDL cholesterol and ApoB levels. Whereas LDL cholesterol and ApoB were identified as independent factors predictors of the aortic root diameter, only ApoB predicted the diameter of the ascending aorta. On the other hand, the levels of ApoB were an independent factor related to the dilatation of the aortic root. CONCLUSIONS We have observed that cholesterol is associated with ascending aorta diameter and dilation in BAV patients. Further experimental and clinical studies are needed to explain the pathobiology of this association.
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Affiliation(s)
- J M Alegret
- From the Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain and
| | - L Masana
- Unitat de Recerca en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Hospital Universitari de Sant Joan, IISPV, CIBERDEM, Reus, Spain
| | - N Martinez-Micaelo
- From the Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain and
| | - M Heras
- Unitat de Recerca en Lípids i Arteriosclerosi, Universitat Rovira i Virgili, Hospital Universitari de Sant Joan, IISPV, CIBERDEM, Reus, Spain
| | - R Beltrán-Debón
- From the Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain and
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Calvo N, Beltrán-Debón R, Rodríguez-Gallego E, Hernández-Aguilera A, Guirro M, Mariné-Casadó R, Millá L, Alegret JM, Sabench F, del Castillo D, Vinaixa M, Rodríguez M&A, Correig X, García-Álvarez R, Menendez JA, Camps J, Joven J. Liver fat deposition and mitochondrial dysfunction in morbid obesity: An approach combining metabolomics with liver imaging and histology. World J Gastroenterol 2015; 21:7529-7544. [PMID: 26140000 PMCID: PMC4481449 DOI: 10.3748/wjg.v21.i24.7529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the usefulness of magnetic resonance imaging (MRI) and spectroscopy (MRS) for assessment of non-alcoholic fat liver disease (NAFLD) as compared with liver histological and metabolomics findings.
METHODS: Patients undergoing bariatric surgery following procedures involved in laparoscopic sleeve gastrectomy were recruited as a model of obesity-induced NAFLD in an observational, prospective, single-site, cross-sectional study with a pre-set duration of 1 year. Relevant data were obtained prospectively and surrogates for inflammation, oxidative stress and lipid and glucose metabolism were obtained through standard laboratory measurements. To provide reliable data from MRI and MRS, novel procedures were designed to limit sampling variability and other sources of error using a 1.5T Signa HDx scanner and protocols acquired from the 3D or 2D Fat SAT FIESTA prescription manager. We used our previously described 1H NMR-based metabolomics assays. Data were obtained immediately before surgery and after a 12-mo period including histology of the liver and measurement of metabolites. Values from 1H NMR spectra obtained after surgery were omitted due to technical limitations.
RESULTS: MRI data showed excellent correlation with the concentration of liver triglycerides, other hepatic lipid components and the histological assessment, which excluded the presence of non-alcoholic steatohepatitis (NASH). MRI was sufficient to follow up NAFLD in obese patients undergoing bariatric surgery and data suggest usefulness in other clinical situations. The information provided by MRS replicated that obtained by MRI using the -CH3 peak (0.9 ppm), the -CH2- peak (1.3 ppm, mostly triglyceride) and the
-CH=CH- peak (2.2 ppm). No patient depicted NASH. After surgery all patients significantly decreased their body weight and steatosis was virtually absent even in patients with previous severe disease. Improvement was also observed in the serum concentrations of selected variables. The most relevant findings using metabolomics indicate increased levels of triglyceride and monounsaturated fatty acids in severe steatosis but those results were accompanied by a significant depletion of diglycerides, polyunsaturated fatty acids, glucose-6-phosphate and the ATP/AMP ratio. Combined data indicated the coordinated action on mitochondrial fat oxidation and glucose transport activity and may support the consideration of NAFLD as a likely mitochondrial disease. This concept may help to explain the dissociation between excess lipid storage in adipose tissue and NAFLD and may direct the search for plasma biomarkers and novel therapeutic strategies. A limitation of our study is that data were obtained in a relatively low number of patients.
CONCLUSION: MRI is sufficient to stage NAFLD in obese patients and to assess the improvement after bariatric surgery. Other data were superfluous for this purpose.
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Alegret JM, Viñolas X, Martínez-Rubio A, Pedrote A, Beiras X, García-Sacristán JF, Crespo-Mancebo F, Ruiz-Mateas F. Gender Differences in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion. J Womens Health (Larchmt) 2015; 24:466-70. [PMID: 25978301 DOI: 10.1089/jwh.2014.5014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Current recommendations on the rhythm control strategy for treatment of atrial fibrillation (AF) are more restrictive than a decade ago. Gender may play a role in decisions on the management of AF, including application of electrical cardioversion. METHODS We analyzed clinical characteristics by gender in patients participating in the observational survey about stable patients underlying cardioversion in Spain (CARDIOVERSE) study (n=915), a survey of the practice of electrical cardioversion in 67 Spanish hospitals. We compared these data with those from a previous survey of electrical cardioversion in Spain (REVERSE study) performed 8 years previously. RESULTS Patients undergoing electrical cardioversion were mainly men (76%). This finding was observed in all age groups, independently of symptoms. Men were younger (62±10 years vs. 69±9 years; p<0.001), more frequently asymptomatic and had a lower prevalence of hypertension and a lower stroke risk. Among asymptomatic patients, the predominance of men was especially evident in older age groups (<65 years, men 76%, women 24%; ≥65 years, men 92%, women 8% (p<0.001). Compared with the REVERSE study, we observed a decrease in the percentage of women among patients undergoing electrical cardioversion (37% REVERSE vs. 24% CARDIOVERSE; p<0.001), mainly in older than 65 years. CONCLUSIONS Our results support the hypothesis that gender is a determinant in decisions on the most appropriate strategy for managing AF. We observed a decrease in the percentage of women undergoing electrical cardioversion during the last decade, especially in older asymptomatic patients.
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Affiliation(s)
- Josep M Alegret
- 1 Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili , Reus, Spain
| | | | | | - Alonso Pedrote
- 4 Hospital Universitario Virgen del Rocío , Sevilla, Spain
| | - Xulio Beiras
- 5 Complejo Hospitalario Universitario de Vigo , Vigo, Spain
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Alegret JM, Viñolas X, Arias MA, Martínez-Rubio A, Rebollo P, Ràfols C, Martínez-Sande JL. New oral anticoagulants vs vitamin K antagonists: benefits for health-related quality of life in patients with atrial fibrillation. Int J Med Sci 2014; 11:680-4. [PMID: 24843316 PMCID: PMC4025166 DOI: 10.7150/ijms.8916] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/01/2014] [Indexed: 11/19/2022] Open
Abstract
New oral anticoagulants (NOAC) have demonstrated their efficacy as an alternative to vitamin K antagonists (VKA) in the prophylaxis of cardioembolic events in patients with atrial fibrillation (AF). However, evidence on the benefits of NOAC in health-related quality of life (HRQoL) is lacking.We evaluated changes in HRQoL related to oral anticoagulation therapy employing a specific questionnaire in a cohort of 416 patients with AF undergoing electrical cardioversion. In terms of HRQoL, we observed a progressive adaptation to treatment with VKA; satisfaction with NOAC remained constant. Older age, higher left ventricular ejection fraction and NOAC were associated with better HRQoL.
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Affiliation(s)
- Josep M Alegret
- 1. Grup de Recerca Cardiovascular, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | | | | | | | | | - Carles Ràfols
- 6. Medical Department, Bayer HealthCare, Barcelona, Spain
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Alegret JM, Aragonès G, Elosua R, Beltrán-Debón R, Hernández-Aguilera A, Romero-Menor C, Camps J, Joven J. The relevance of the association between inflammation and atrial fibrillation. Eur J Clin Invest 2013; 43:324-31. [PMID: 23397981 DOI: 10.1111/eci.12047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 12/20/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relevance of the association between inflammation and atrial fibrillation (AF) is not firmly established. The clinical importance is considerable because inflammation is usually not targeted as a treatment option, minimizing a probable benefit. MATERIALS AND METHODS We have used a case-control study with a Mendelian randomization rationale to assess whether proposed risk factors that have a genetic component and are readily detected in circulating blood are causally related to AF. The studied variables were C-reactive protein (CRP) and a representative of the chemokine system, the monocyte chemoattractant protein-1 (CCL2). RESULTS Plasma CRP and CCL2 concentrations were significantly higher in AF patients than in the unaffected population. However, when segregated between paroxysmal and permanent, the difference for CRP was only observed in patients with a permanent condition. Plasma CCL2 was raised in both subgroups. Confounding factors were carefully considered, and multivariable analyses revealed that circulating CCL2 was significant and CRP was negligible to explain the presence of AF. The duration of the episode also bore a significant predictive value. Odd ratios for AF as a function of genotype did not differ from 1·0 for any of the individual CRP and CCL2 polymorphisms, or any combinations. CONCLUSIONS Elevated plasma CRP concentration per se does not increase atrial fibrillation risk. Values obtained for CCL2 suggest that inflammation is probably a consequence of AF. Our data also suggest that the effect of the duration of the episode should be further studied in the assessment of the actual role of inflammation.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain.
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Alegret JM, Ligero C, Vernis JM, Beltrán-Debón R, Aragonés G, Duran I, Palazón O, Hernández-Aparicio A. Factors related to the need for surgery after the diagnosis of bicuspid aortic valve: one center´s experience under a conservative approach. Int J Med Sci 2013; 10:176-82. [PMID: 23329890 PMCID: PMC3547216 DOI: 10.7150/ijms.5399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/02/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIM Bicuspid aortic valve (BAV) increases the risk of aortic valve dysfunction and ascending aorta aneurysm and, consequently, the need for aortic valve replacement and/or aortic repair. However, there is no universal consensus about the surgical criteria and the predictors for surgery. The aim of this study was to investigate related factors to the need for surgery in the setting of a strict long-term follow-up with relatively conservative surgical criteria. METHODS We prospectively followed 120 patients after the diagnosis of BAV. Predisposing factors for a future need for aortic valve replacement and ascending aorta repair were assessed. Aortic surgery was indicated when the ascending aorta diameter was ≥ 55 mm and was recommended based on patient characteristics and in the presence of a severe aortic valve dysfunction with an aortic diameter ≥ 50 mm. RESULTS During follow-up (mean, 86 months), 34 patients (28%) (mean age, 56 ± 12 years) were surgically treated. Aortic valve dysfunction (n=22; 64%) and ascending aorta dilatation (n=12; 36%) were the indications for surgery. Aortic regurgitation was the most frequent valve dysfunction at the time of diagnosis for BAV, but aortic stenosis was the most frequent indication for surgery. The presence at surgery of either aortic regurgitation or stenosis was clearly related to age, with regurgitation predominating in patients under 55 years, and aortic stenosis in older patients.Multivariate Cox analysis showed that aortic stenosis (hazard ratio 4.1, p=0.001), indexed ascending aorta dilatation (hazard ratio 3.0, p=0.03) and left ventricular end-diastolic diameter ≥ 60 mm (hazard ratio=4.0, p=0.01) at diagnosis were factors associated with future surgery. Aortic dissection was not observed in patients that did not undergo surgery. CONCLUSIONS A relatively conservative approach for the indication of ascending aortic surgery in BAV is safe. In this setting, the presence of aortic or left ventricle dilatation and aortic stenosis at diagnosis of BAV were predictive of the need for surgery in the follow-up.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia. Hospital Universitari de Sant Joan. Institut d'Investigació Sanitària Pere Virgili. Universitat Rovira i Virgili, Reus, Spain.
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Alegret JM, Viñolas X, Romero-Menor C, Pons S, Villuendas R, Calvo N, Pérez-Rodon J, Sabaté X. Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice. BMC Cardiovasc Disord 2012; 12:42. [PMID: 22708978 PMCID: PMC3441848 DOI: 10.1186/1471-2261-12-42] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines. METHODS The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010. RESULTS We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA ≥ II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p=0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs. CONCLUSIONS Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Hospital Universitari de Sant Joan, Institut d’Investigacions Sanitàries Pere Virgili, Universitat Rovira i Virgili, C/Dr. Laporte, s/n, Reus, 43205, Spain
| | | | | | | | | | | | | | - Xavier Sabaté
- Hospital de Bellvitge, Hospitalet de Llobregat, Spain
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Alegret JM, Viñolas X, Villacastín J, Martínez JG, Pachón N, Crespo F. Uso e implicaciones clínicas del mantenimiento de la anticoagulación tras una cardioversión eficaz. Med Clin (Barc) 2011; 137:14-6. [DOI: 10.1016/j.medcli.2010.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/26/2010] [Accepted: 09/02/2010] [Indexed: 11/17/2022]
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Permanyer E, Alegret JM, Muñoz-Guijosa C, Padró JM. Inferior vena cava obstruction by a cardiac mass: unusual presentation of primary antiphospholipid syndrome. Thorac Cardiovasc Surg 2011; 59:182-3. [PMID: 21480144 DOI: 10.1055/s-0030-1250501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present a previously healthy 43-year-old woman with a cardiac mass that caused almost total occlusion of the inferior vena cava at its junction with the right atrium. The resected mass proved to be a thrombus. Preoperative imaging tests could not distinguish it from other intracardiac tumors such as myxoma. A postoperative immunological study revealed a primary antiphospholipid syndrome. This case presents an unusual diagnosis of antiphospholipid syndrome and a rare location of a cardiac thrombus.
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Affiliation(s)
- E Permanyer
- Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Alonso-Villaverde C, Aragonès G, Beltrán-Debón R, Fernández-Sender L, Rull A, Camps J, Alegret JM, Joven J. Treatment of hypertriglyceridemia and HIV: fenofibrate-induced changes in the expression of chemokine genes in circulating leukocytes. AIDS Res Ther 2009; 6:26. [PMID: 19930642 PMCID: PMC2783021 DOI: 10.1186/1742-6405-6-26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 11/23/2009] [Indexed: 11/10/2022] Open
Abstract
Fenofibrate changed the expression of chemokine genes in circulating leukocytes of HIV-infected patients with hypertriglyceridemia. The data suggest that fenofibrate when effective in the treatment of lipoprotein abnormalities, may act as a modulator of systemic inflammation. This particular action, therefore, may also influence the clinical course of the disease.
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Alegret JM, Viñolas X, Sagristá J, Hernández-Madrid A, Berruezo A, Moya A, Martínez Sande JL, Pastor A. Perfil clínico de los pacientes con fibrilación auricular persistente remitidos a cardioversión: Registro sobre la cardioversión en España (REVERSE). Rev Esp Cardiol 2008. [DOI: 10.1157/13123082] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alegret JM, Viñolas X, Sagristá J, Hernández-Madrid A, Berruezo A, Moya A, Martínez Sande JL, Pastor A. [Clinical characteristics of patients with persistent atrial fibrillation referred for cardioversion: Spanish Cardioversion Registry (REVERSE)]. Rev Esp Cardiol 2008; 61:630-634. [PMID: 18570785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The objectives were to investigate the treatment and clinical characteristics of patients referred for cardioversion in Spain and to compare them with those reported in the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) and RACE (RAte Control versus Electrical cardioversion) studies. The prospective study involved 1515 consecutive patients with persistent atrial fibrillation who were referred for cardioversion at 96 Spanish hospitals. Half of the patients were being treated with Vaughan-Williams group-I or -III antiarrhythmic drugs. The most frequently used approach to anticoagulation was to administer dicoumarins 34 weeks before and after cardioversion. Our patients were younger than those in the AFFIRM and RACE studies. Compared with AFFIRM patients, our patients had a lower prevalence of previous embolism, ischemic heart disease, hypertension, diabetes, and systolic dysfunction. Compared with RACE patients, our patients had a lower prevalence of ischemic heart disease and previous embolism, but a slightly higher prevalence of hypertension and diabetes. We conclude that patients referred for cardioversion in Spain clearly had a lower cardiovascular risk profile than those in the AFFIRM study, and appeared to have a lower risk profile than those in the RACE study.
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Alegret JM, Viñolas X, Sagristá J, Hernandez-Madrid A, Pérez L, Sabaté X, Mont L, Medina A. Predictors of success and effect of biphasic energy on electrical cardioversion in patients with persistent atrial fibrillation. Europace 2007; 9:942-6. [PMID: 17545688 DOI: 10.1093/europace/eum107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought predictors of successful electrical cardioversion (ECV) and the effect of biphasic energy in patients considered candidates for rhythm control. METHODS AND RESULTS The patients were drawn from a registry, which included prospectively 1355 consecutive patients with persistent atrial fibrillation who underwent ECV in 96 Spanish hospitals. Successful ECV was considered excluding patients with an early relapse. Factors related to successful cardioversion were evaluated using logistic regression with the patients segregated with respect to the use of monophasic or biphasic energy. Sinus rhythm was restored in 92% of the patients, of which, 5% had an early relapse. Thus, we considered that a successful ECV was achieved in 87% of patients. Body surface area was the only factor independently related to failure of the monophasic energy cardioversion (OR = 0.20; P = 0.001). No single factor was predictive of biphasic energy cardioversion failure. Biphasic energy was more effective in restoring sinus rhythm in patients with body surface area >2.05 m(2) (83% success in monophasic vs. 92% in biphasic; P = 0.02). CONCLUSION Body surface area was the only factor related to the success of ECV, but only in patients treated with monophasic energy. Biphasic energy should be the technique-of-choice in patients with a large body surface area.
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Affiliation(s)
- Josep M Alegret
- Sección de Cardiología, Hospital Universitari de Sant Joan de Reus, c/Sant Joan s/n, 43201 Reus, Spain.
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Alegret JM, Palomares R, Duran I, Vernis JM, Palazón O. [Effect of age on valvular dysfunction and aortic dilatation in patients with a bicuspid aortic valve]. Rev Esp Cardiol 2006; 59:503-6. [PMID: 16750148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Aortic regurgitation was the commonest functional anomaly among younger patients in a group of 63 individuals with a diagnosis of bicuspid aortic valve. With increasing age, a rise in the number with combined aortic valve disease and aortic stenosis was observed. Aortic dilatation was found in 65% of cases. Dilatation was independently associated with age and transvalvular aortic gradient.
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Affiliation(s)
- Josep M Alegret
- Sección de Cardiología, Hospital Universitari de Sant Joan de Reus, Facultat de Medicina, Universitat Rovira i Virgili, Reus, Barcelona, Spain.
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Alegret JM, Palomares R, Duran I, Vernis JM, Palazón Ó. Efecto de la edad en la disfunción valvular y la dilatación aórtica en pacientes con válvula aórtica bicúspide. Rev Esp Cardiol 2006. [DOI: 10.1157/13087903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alegret JM, Palazón O, Duran I, Vernis JM. Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve. Int J Cardiovasc Imaging 2005; 21:213-7. [PMID: 16015430 DOI: 10.1007/s10554-004-3901-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 09/22/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the utility of transthoracic echocardiography (TTE) with second harmonic combined with transesophageal echocardiography (TEE) in defining aortic valve morphology in a subset of patients with a high prevalence of bicuspid aortic valve. METHODS AND MATERIALS Patients (n = 174) with dilated aortic root were consecutively evaluated using, initially, TTE. The aortic valve structure was assigned as tricuspid, bicuspid or undefined. In those assigned as bicuspid or undefined, TEE was performed. Other factors that could affect valve morphology assignment were recorded and evaluated in multivariate analysis. RESULTS TTE was able to characterise 89% of the tricuspid valves and 56% of the bicuspid. Bicuspid structure was the only variable that, in the multivariate analysis, was related to the inability to definitively assign aortic valve morphology (OR = 0.13). TEE was performed in 59 patients and the morphology was definitively assigned in 56 of them (95%). TEE diagnosed 15 bicuspid valves in addition to confirming the 17 identified by TTE. Overall, using TTE combined with TEE we were able to correctly assign valvular morphology in 98% of patients. CONCLUSION In a subset of patients with a high prevalence of bicuspid aortic valve, combination of TTE and TEE should be considered to define aortic valve morphology. TEE identifies an important number of patients with BAV.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Departament de Medicina Interna, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, C/ Sant Joan s/n, 43201 Reus, Spain.
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Alegret JM, Vernis JM, Palazón O, Borràs X, Duran I. Factors related to aortic regurgitation in the presence of a dilated aortic root. Am J Cardiol 2005; 95:417-20. [PMID: 15670560 DOI: 10.1016/j.amjcard.2004.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 09/27/2004] [Accepted: 09/24/2004] [Indexed: 11/20/2022]
Abstract
The relation among aortic regurgitation (AR) and aortic root diameter, anthropometric variables, and aortic valve morphology was assessed in 142 patients with dilated aortic roots. The diameter of the aortic root indexed for body surface area and aortic valve sclerosis were related to the presence and severity of AR.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Department de Medicina Interna, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain.
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Alegret JM, Duran I, Palazón O, Vernis JM, Ameijide A, Rabassa A, Masana L. Prevalence of and predictors of bicuspid aortic valves in patients with dilated aortic roots. Am J Cardiol 2003; 91:619-22. [PMID: 12615278 DOI: 10.1016/s0002-9149(02)03324-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Department de Medicina Interna, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain.
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Alegret JM, Borrás X, Carreras F, Duran I, Pons-Lladó G. Restrictive left ventricular filling and preserved ventricular function: a limitation in the noninvasive estimation of pulmonary wedge pressure by Doppler echocardiography. J Am Soc Echocardiogr 2002; 15:334-8. [PMID: 11944011 DOI: 10.1067/mje.2002.118527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary wedge pressure (PWP) can be estimated from the ratio of transmitral early peak flow velocity to flow propagation velocity measured by Doppler. Discrepancies observed in the application of the method prompted us to design this prospective study, aimed at detecting potential limitations of the method. We studied a total of 32 patients admitted to a cardiac intensive care unit, using a Swan-Ganz catheter. Correlation between invasive- and Doppler-estimated PWP was fairly good (r = 0.58). Analysis of discrepant cases led to the identification of a subgroup of 6 patients in whom PWP was largely underestimated because of unexpectedly high values of flow propagation velocity (71 +/- 15 cm/s vs 37 +/- 10 cm/s in the rest of the group; P =.0001). All of them had in common a restrictive Doppler filling pattern and preserved left ventricular systolic function. Exclusion of this group showed an improvement in the correlation coefficient to r = 0.72. In conclusion, PWP can be estimated by the Doppler early peak flow velocity to flow propagation velocity ratio, although a significant underestimation of PWP may be observed in patients with a restrictive filling pattern and preserved ventricular function.
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Affiliation(s)
- Josep M Alegret
- Cardiology Section, Hospital Universitavi de Sant Joan, c/Sant Joan s/n, 43201-Reus, Spain.
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Pálinkás A, Antonielli E, Picano E, Pizzuti A, Varga A, Nyúzó B, Alegret JM, Bonzano A, Tanga M, Coppolino A, Forster T, Baralis G, Delnevo F, Csanády M. Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation. Eur Heart J 2001; 22:2201-8. [PMID: 11913482 DOI: 10.1053/euhj.2001.2891] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined. OBJECTIVE To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective. multicentre, international study. METHODS Four hundred and eight patients (257 males, mean age: 66 +/- 10 years) with non-valvular atrial fibrillation lasting more than 48 h but less than 1 year underwent transthoracic echocardiography and transoesophageal echocardiography before either electrical (n=324) or pharmacological (n=84) cardioversion. RESULTS Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emptying flow velocity was significantly higher in patients with successful than in those with unsuccessful cardioversion (32.4 +/- 17.7 vs 23.5 +/- 13.6 cm x s(-1); P<0.0001). At multivariate logistic regression analysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0.011, OR=4.9, CI 95%=1.9-12.7), the mean left atrial appendage flow velocity >31 cm x s(-1) (P=0.0013, OR=2.8, CI 95%=1.5-5.4) and the left atrial diameter <47 mm (P=0.093, OR=2.0, CI 95%=1.2-3.4). These independent predictors of cardioversion success outperformed other univariate predictors such as left ventricular end-diastolic diameter <58 mm, ejection fraction >56% and the absence of left atrial spontaneous echo contrast. CONCLUSION In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.
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Affiliation(s)
- A Pálinkás
- 2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical Faculty, University of Sciences, Szeged, Hungary
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Alegret JM, Martí V, Rodriguez-Font E, Alonso C, Guindo J, Domínguez De Rozas JM. Effects of thrombolysis in the evolution of right bundle-branch block complicating an acute anterior myocardial infarction. Acta Cardiol 2001; 56:297-301. [PMID: 11712825 DOI: 10.2143/ac.56.5.2005690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is scant information about the effects of thrombolysis in the evolution of right bundle-branch block (RBBB) in the setting of acute anterior myocardial infarction. The aim of this study has been to analyse these effects and its impact on prognosis. METHODS We studied 54 patients who presented a RBBB related to an acute anterior myocardial infarction. We defined two groups: those who received thrombolytic treatment and those who did not. We analysed the evolution of RBBB (transience, moment of onset, moment of disappearance) and its relationship with in-hospital mortality.Twenty-one patients (39%) received thrombolytic treatment (groupT) and 33 patients (61%) (group NT) did not. RESULTS The incidence of late appearance (> 6 h) of RBBB was less frequent in group T compared with group NT (10% vs. 33%, p = 0.04). The incidence of transient block was similar in the two groups (57% vs. 45%, p ns). However, early disappearance of RBBB (in < 6 hours) was more common in group T than in group NT (33% vs. 9%, p = 0.04). Mortality was higher in patients with RBBB present at 24 h after admission) than in those with RBBB resolved in less than 24 hours (in group NT, 55% vs. 8%, p = 0.02 and in group T 50% vs. 0%, p = 0.02, respectively). CONCLUSIONS Thrombolysis seems to influence the moment of onset and disappearance of RBBB by promoting its early disappearance and avoiding its late appearance. Disappearance of RBBB is associated with a better prognosis.
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Affiliation(s)
- J M Alegret
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Alegret JM, Viñolas X, Palazón O, Vernis JM, Ferrer A, Oter R. [Intermittent pre-excitation after adenosine administration]. Rev Esp Cardiol 2000; 53:1132-5. [PMID: 10956609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We describe a case of 2:1 intermittent preexcitation after adenosine administration in a patient with an accessory pathway that did not show preexcitation on the basal ECG. We review the mechanisms involved that explain this event and the possible utility of adenosine to show accessory pathways that do not show preexcitation on the ECG.
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Affiliation(s)
- J M Alegret
- Sección de Cardiología. Hospital Universitari de Sant Joan. Reus. Departamento de Cardiología.aHospital de la Santa Creu i Sant Pau. Barcelona
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Alegret JM, Borràs X, Alonso C, Carreras F, Gurguí M, Cámara ML, Coll B, Pons-Lladó G. [Emergency valvular replacement in infective endocarditis: hospital and long term clinical course. Analysis of 45 patients]. Med Clin (Barc) 2000; 114:299-301. [PMID: 10774519 DOI: 10.1016/s0025-7753(00)71275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND To define the evolution of patients with infective endocarditis who require urgent valve replacement in our environment. PATIENTS AND METHODS We followed 45 consecutive cases of infective endocarditis that require valve replacement during their hospitalization. 32 patients had native valve infective endocarditis, 7 early prosthesis valve endocarditis and 6 late prosthesis valve endocarditis. Patients were followed for a long-term period, clinical and echocardiographycally. RESULTS In 39 cases valve replacement was performed before ending antibiotic therapy. The main indications for surgery were refractory heart failure (24 patients) and shock (11 patients). The mortality rate was 24%: 19% in native valve infective endocarditis, 43% in early prosthetic valve endocarditis and 33% in late prosthesis valve endocarditis. The first cause of death was septic shock (46%). We followed 31 over 34 survivors for a mean time 65 (DS 49) months. We found two relapses and six deaths (1 sudden death, 2 endocarditis) and 72% of patients presented class I NYHA. We detected 17% prosthetic leaks (34% in the prosthetic valve endocarditis group). CONCLUSIONS The need of urgent valve replacement in the context of infective endocarditis is associated with a high mortality rate, and should be considered a serious condition. Long term prognosis is, however, acceptable, although 17% of patients had prosthesis leak, specially those with prosthetic valve endocarditis.
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Affiliation(s)
- J M Alegret
- Departament de Cardiologia i Cirurgia Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona
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Martí V, Ramírez J, Lamich R, García J, Guiteras P, Aymat RM, Alegret JM, Augé JM. [Coronary stent placement for recurrent angina secondary to myocardial bridging]. Rev Med Chil 1998; 126:1362-6. [PMID: 10349180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Myocardial bridging of the epicardic coronary arteries is not an uncommon finding in angiographic or necropsic studies. Patients who have symptoms usually improve with medical treatment. However, in refractory patients a surgical myotomy of overlying myocardium and/or a coronary bypass may be needed. We report two patients with long myocardial bridges in the mid-left anterior descending coronary artery, who had recurrent angina refractory to conventional treatment. In both patients two consecutive coronary stents were successfully implanted. At five and six months follow-up they are asymptomatic and with good exercise tolerance.
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Affiliation(s)
- V Martí
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Rodríguez Font E, Viñolas Prat X, Alegret JM, Varela MC, Torner P, Oter R. [Image of pseudocapture caused by micro-dislodgment of the electrode in a VDD pacemaker]. Rev Esp Cardiol 1997; 50:909-12. [PMID: 9470458 DOI: 10.1016/s0300-8932(97)74699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The new AV sequential pacemakers have improved the suitability for the election of the best pacing mode for each patient. The complexity of the systems may mask some dysfunctions. In the presented case, a failure to capture due to micro-dislodgment, may have been missed in a simple pacemaker control, because of the combination of several factors: the presence of normal AV conduction at that moment, the concordance between the pacemaker stimulus and the conducted QRS complex and the similar morphology of the conducted and paced QRS complex.
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Affiliation(s)
- E Rodríguez Font
- Departamento de Cardiología y Cirugía Cardíaca, Hospital de la Santa Creu i Sant Pau, Barcelona
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Abstract
The presence of liver methastasis and serotonin in plasma in the carcinoid tumor are responsible for the carcinoid syndrome. We present a case of tricuspid and pulmonary valvular disease secondary to this syndrome. The finding of liver hyperechogenic nodules added to the described valvular disease by subcostal echocardiogram oriented the diagnosis.
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Affiliation(s)
- J M Alegret
- Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona
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