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Pascual-Figal DA, Hernández-Vicente A, Pastor-Pérez F, Martínez-Sellés M, Solé-González E, Alvarez-García J, García-Pavía P, Varela-Román A, Sánchez PL, Delgado JF, Noguera-Velasco JA, Bayes-Genis A. N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study. Eur J Heart Fail 2024. [PMID: 38606524 DOI: 10.1002/ejhf.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients. METHODS AND RESULTS Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.09), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group. CONCLUSIONS Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
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Affiliation(s)
- Domingo A Pascual-Figal
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | | | - Francisco Pastor-Pérez
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- CIBERCV, Madrid, Spain
| | - Manuel Martínez-Sellés
- CIBERCV, Madrid, Spain
- Hospital Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - Pablo García-Pavía
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Alfonso Varela-Román
- CIBERCV, Madrid, Spain
- Hospital Clínico Universitario de Santiago, A Coruña, Spain
| | - Pedro Luis Sánchez
- CIBERCV, Madrid, Spain
- Hospital Clinico de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Juan F Delgado
- CIBERCV, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose A Noguera-Velasco
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
| | - Antoni Bayes-Genis
- CIBERCV, Madrid, Spain
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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2
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Luna-Lopez R, Segura de la Cal T, Sarnago Cebada F, Martin de Miguel I, Hinojosa W, Cruz-Utrilla A, Velazquez MT, Delgado JF, Mendoza A, Arribas Ynsaurriaga F, Escribano-Subías P. Triple vasodilator therapy in pulmonary arterial hypertension associated with congenital heart disease. Heart 2024; 110:346-352. [PMID: 37903556 DOI: 10.1136/heartjnl-2023-323015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE This study assessed the long-term effects of triple therapy with prostanoids on patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), as there is limited information on the safety and efficacy of this treatment approach. METHODS A retrospective cohort study was conducted on patients with PAH-CHD who were actively followed up at our centre. All patients were already receiving dual combination therapy at maximum doses. Clinical characteristics, including functional class (FC), 6-minute walking test distance (6MWTD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, were documented before initiating triple therapy and annually for a 2-year follow-up period. RESULTS A total of 60 patients were included in the study, with a median age of 41 years and 68% being women. Of these, 32 had Eisenmenger syndrome, 9 had coincidental shunts, 18 had postoperative PAH and 1 had a significant left-to-right shunt. After 1 year of triple combination initiation, a significant improvement in 6MWTD was observed (406 vs 450; p=0.0027), which was maintained at the 2-year follow-up. FC improved in 79% of patients at 1 year and remained stable in 76% at 2 years. NT-proBNP levels decreased significantly by 2 years, with an average reduction of 199 ng/L. Side effects were experienced by 33.3% of patients but were mostly mild and manageable. Subgroup analysis showed greater benefits in patients without Eisenmenger syndrome and those with pre-tricuspid defects. CONCLUSIONS Triple therapy with prostanoids is safe and effective for patients with PAH-CHD, improving FC, 6MWTD and NT-proBNP levels over 2 years. The treatment is particularly beneficial for patients with pre-tricuspid defects and non-Eisenmenger PAH-CHD.
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Affiliation(s)
- Raquel Luna-Lopez
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Segura de la Cal
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Sarnago Cebada
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Irene Martin de Miguel
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Williams Hinojosa
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Cruz-Utrilla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Teresa Velazquez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Juan F Delgado
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Alberto Mendoza
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Pilar Escribano-Subías
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
- Pulmonary Hyertension Unit, Department of Cardiology. Hospital Universitario 12 de Octubre, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERCV, Madrid, Spain
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3
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Escobar C, Palacios B, Gonzalez V, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain. BMC Health Serv Res 2023; 23:1340. [PMID: 38041087 PMCID: PMC10693147 DOI: 10.1186/s12913-023-10376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To describe healthcare resource utilization (HCRU) and costs, in patients with newly diagnosed heart failure (HF) according to ejection fraction (EF) in Spain. METHODS Retrospective cohort study that analyzed anonymized, integrated and computerised medical records in Spain. Patients with ≥ 1 new HF diagnosis between January 2013 and September 2019 were included and followed-up during a 4-year period. Rates per 100 person-years of HCRU and costs were estimated. RESULTS Nineteen thousand nine hundred sixty-one patients were included, of whom 43.5%, 26.3%, 5.1% and 25.1% had HF with reduced, preserved, mildly reduced and unknown EF, respectively. From year 1 to 4, HF rates of outpatient visits decreased from 1149.5 (95% CI 1140.8-1159.3) to 765.5 (95% CI 745.9-784.5) and hospitalizations from 61.7 (95% CI 60.9-62.7) to 15.7(14.7-16.7) per 100 person-years. The majority of HF-related healthcare resource costs per patient were due to hospitalizations (year 1-4: 63.3-38.2%), followed by indirect costs (year 1-4: 12.2-29.0%), pharmacy (year 1-4: 11.9-19.9%), and outpatient care (year 1-4: 12.6-12.9%). Mean (SD) per patient HF-related costs decreased from 2509.6 (3518.5) to 1234.6 (1534.1) Euros (50% cost reduction). At baseline, 70.1% were taking beta-blockers, 56.3% renin-angiotensin system inhibitors, 11.8% mineralocorticoid receptor antagonists and 8.9% SGLT2 inhibitors. At 12 months, these numbers were 72.3%, 65.4%, 18.9% and 9.8%, respectively. CONCLUSIONS Although the economic burden of HF decreased over time since diagnosis, it is still substantial. This reduction could be partially related to a survival bias (sick patients died early), but also to a better HF management. Despite that, there is still much room for improvement.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, 28046, Spain
| | | | | | | | | | | | - Nahila Justo
- Evidera, Stockholm, 113 21, Sweden
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, 17177, Sweden
| | | | | | | | - Juan F Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, Madrid, 28041, Spain.
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4
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Pölzl G, Altenberger J, Comín-Colet J, Delgado JF, Fedele F, García-González MJ, Gustafsson F, Masip J, Papp Z, Störk S, Ulmer H, Maier S, Vrtovec B, Wikström G, Zima E, Bauer A. Repetitive levosimendan infusions for patients with advanced chronic heart failure in the vulnerable post-discharge period: The multinational randomized LeoDOR trial. Eur J Heart Fail 2023; 25:2007-2017. [PMID: 37634941 DOI: 10.1002/ejhf.3006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023] Open
Abstract
AIM The LeoDOR trial explored the efficacy and safety of intermittent levosimendan therapy in the vulnerable phase following a hospitalization for acute heart failure (HF). METHODS AND RESULTS In this prospective multicentre, double-blind, two-armed trial, patients with advanced HF were randomized 2:1 at the end of an index hospitalization for acute HF to intermittent levosimendan therapy or matching placebo for 12 weeks. All patients had left ventricular ejection fraction (LVEF) ≤30% during index hospitalization. Levosimendan was administered according to centre preference either as 6 h infusion at a rate of 0.2 μg/kg/min every 2 weeks, or as 24 h infusion at a rate of 0.1 μg/kg/min every 3 weeks. The primary efficacy assessment after 14 weeks was based on a global rank score consisting of three hierarchical groups. Secondary clinical endpoints included the composite risk of tiers 1 and 2 at 14 and 26 weeks, respectively. Due to the COVID-19 pandemic, the planned number of patients could not be recruited. The final modified intention-to-treat analysis included 145 patients (93 in the combined levosimendan arm, 52 in the placebo arm), which reduced the statistical power to detect a 20% risk reduction in the primary endpoint to 60%. Compared with placebo, intermittent levosimendan had no significant effect on the primary endpoint: the mean rank score was 72.55 for the levosimendan group versus 73.81 for the placebo group (p = 0.863). However, there was a signal towards a higher incidence of the individual clinical components of the primary endpoint in the levosimendan group versus the placebo group both after 14 weeks (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.12-7.68; p = 0.021) and 26 weeks (HR 1.64, 95% CI 0.87-3.11; p = 0.122). CONCLUSIONS Among patients recently hospitalized with HF and reduced LVEF, intermittent levosimendan therapy did not improve post-hospitalization clinical stability.
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Affiliation(s)
- Gerhard Pölzl
- Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Johann Altenberger
- Cardiac Rehabilitation Center Grossgmain, Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical Private University, Salzburg, Austria
| | - Josep Comín-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona Hospitalet de Llobregat, CIBER CV, Barcelona, Spain
| | - Juan F Delgado
- Department of Cardiology, University Hospital 12 de Octubre, CIBERCV, Madrid, Spain
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Josep Masip
- Research Direction. Consorci Sanitary Integral, University of Barcelona, Barcelona, Spain
| | - Zoltán Papp
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan Störk
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Dept. Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Maier
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Bojan Vrtovec
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gerhard Wikström
- Department of Cardiology, Institute of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Endre Zima
- Cardiac Intensive Care Unit, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Axel Bauer
- Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
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5
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Lago A, Delgado JF, Rezzani GD, Cottet C, Ramírez Tapias YA, Peltzer MA, Salvay AG. Multi-Component Biodegradable Materials Based on Water Kefir Grains and Yeast Biomasses: Effect of the Mixing Ratio on the Properties of the Films. Polymers (Basel) 2023; 15:2594. [PMID: 37376239 DOI: 10.3390/polym15122594] [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: 04/07/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The use of biopolymeric materials is restricted for some applications due to their deficient properties in comparison to synthetic polymers. Blending different biopolymers is an alternative approach to overcome these limitations. In this study, we developed new biopolymeric blend materials based on the entire biomasses of water kefir grains and yeast. Film-forming dispersions with varying ratios of water kefir to yeast (100/0, 75/25, 50/50 25/75 and 0/100) underwent ultrasonic homogenisation and thermal treatment, resulting in homogeneous dispersions with pseudoplastic behaviour and interaction between both biomasses. Films obtained by casting had a continuous microstructure without cracks or phase separation. Infrared spectroscopy revealed the interaction between the blend components, leading to a homogeneous matrix. As the water kefir content in the film increased, transparency, thermal stability, glass transition temperature and elongation at break also increased. The thermogravimetric analyses and the mechanical tests showed that the combination of water kefir and yeast biomasses resulted in stronger interpolymeric interactions compared to single biomass films. The ratio of the components did not drastically alter hydration and water transport. Our results revealed that blending water kefir grains and yeast biomasses enhanced thermal and mechanical properties. These studies provided evidence that the developed materials are suitable candidates for food packaging applications.
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Affiliation(s)
- Agustina Lago
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
| | - Juan F Delgado
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
- Instituto de Tecnología en Polímeros y Nanotecnología (ITPN), CONICET-Universidad de Buenos Aires, Av. Las Heras 2214, Ciudad Autónoma de Buenos Aires C1127, Argentina
| | - Guillermo D Rezzani
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
| | - Celeste Cottet
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
- Comisión de Investigaciones Científicas (CIC), Calle 526, La Plata B1900, Argentina
| | - Yuly A Ramírez Tapias
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
| | - Mercedes A Peltzer
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
| | - Andrés G Salvay
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Argentina
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6
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Escobar C, Palacios B, Gonzalez V, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Burden of Illness beyond Mortality and Heart Failure Hospitalizations in Patients Newly Diagnosed with Heart Failure in Spain According to Ejection Fraction. J Clin Med 2023; 12:2410. [PMID: 36983410 PMCID: PMC10054096 DOI: 10.3390/jcm12062410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe the rates of adverse clinical outcomes, including all-cause mortality, heart failure (HF) hospitalization, myocardial infarction, and stroke, in patients newly diagnosed with HF to provide a comprehensive picture of HF burden. METHODS This was a retrospective and observational study, using the BIG-PAC database in Spain. Adults, newly diagnosed with HF between January 2013 and September 2019 with ≥1 HF-free year of enrolment prior to HF diagnosis, were included. RESULTS A total of 19,961 patients were newly diagnosed with HF (43.5% with reduced ejection fraction (EF), 26.3% with preserved EF, 5.1% with mildly reduced EF, and 25.1% with unknown EF). The mean age was 69.7 ± 19.0 years; 53.8% were men; and 41.0% and 41.5% of patients were in the New York Heart Association functional classes II and III, respectively. The baseline HF treatments included beta-blockers (70.1%), renin-angiotensin system inhibitors (56.3%), mineralocorticoid receptor antagonists (11.8%), and SGLT2 inhibitors (8.9%). The post-index incidence rates of all-cause mortality, HF hospitalization, and both combined were 102.2 (95% CI 99.9-104.5), 123.1 (95% CI 120.5-125.7), and 182 (95% CI 178.9-185.1) per 1000 person-years, respectively. The rates of myocardial infarction and stroke were lower (26.2 [95% CI 25.1-27.4] and 19.8 [95% CI 18.8-20.8] per 1000 person-years, respectively). CONCLUSIONS In Spain, patients newly diagnosed with HF have a high risk of clinical outcomes. Specifically, the rates of all-cause mortality and HF hospitalization are high and substantially greater than the rates of myocardial infarction and stroke. Given the burden of adverse outcomes, these should be considered targets in the comprehensive management of HF. There is much room for improving the proportion of patients receiving disease-modifying therapies.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | | | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
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7
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Pascual J, Mazuecos A, Sánchez-Antolín G, Solé A, Ventura-Aguiar P, Crespo M, Farrero M, Fernández-Rivera C, Garrido IP, Gea F, González-Monte E, González-Rodríguez A, Hernández-Gallego R, Jiménez C, López-Jiménez V, Otero A, Pascual S, Rodríguez-Laiz GP, Ruiz JC, Sancho A, Santos F, Serrano T, Tabernero G, Zarraga S, Delgado JF. Best practices during COVID-19 pandemic in solid organ transplant programs in Spain. Transplant Rev (Orlando) 2023; 37:100749. [PMID: 36889117 PMCID: PMC9894830 DOI: 10.1016/j.trre.2023.100749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Clinical management of transplant patients abruptly changed during the first months of COVID-19 pandemic (March to May 2020). The new situation led to very significant challenges, such as new forms of relationship between healthcare providers and patients and other professionals, design of protocols to prevent disease transmission and treatment of infected patients, management of waiting lists and of transplant programs during state/city lockdown, relevant reduction of medical training and educational activities, halt or delays of ongoing research, etc. The two main objectives of the current report are: 1) to promote a project of best practices in transplantation taking advantage of the knowledge and experience acquired by professionals during the evolving situation of the COVID-19 pandemic, both in performing their usual care activity, as well as in the adjustments taken to adapt to the clinical context, and 2) to create a document that collects these best practices, thus allowing the creation of a useful compendium for the exchange of knowledge between different Transplant Units. The scientific committee and expert panel finally standardized 30 best practices, including for the pretransplant period (n = 9), peritransplant period (n = 7), postransplant period (n = 8) and training and communication (n = 6). Many aspects of hospitals and units networking, telematic approaches, patient care, value-based medicine, hospitalization, and outpatient visit strategies, training for novelties and communication skills were covered. Massive vaccination has greatly improved the outcomes of the pandemic, with a decrease in severe cases requiring intensive care and a reduction in mortality. However, suboptimal responses to vaccines have been observed in transplant recipients, and health care strategic plans are necessary in these vulnerable populations. The best practices contained in this expert panel report may aid to their broader implementation.
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Affiliation(s)
- Julio Pascual
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | | | - Amparo Solé
- Lung Transplant Unit, Hospital Universitario y Politécnico la Fe, Universitat de Valencia, Valencia, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | | | - Iris P Garrido
- Department of Cardiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Gea
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio González-Rodríguez
- Department of Hepatology, Hospital Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Carlos Jiménez
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Alejandra Otero
- Liver Transplant Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Sonia Pascual
- Liver Unit, ISABIAL, CIBERehd, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Gonzalo P Rodríguez-Laiz
- Hepatobiliary Surgery and Liver Transplantation Unit, ISABIAL Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Juan Carlos Ruiz
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Asunción Sancho
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Valencia, Spain
| | - Francisco Santos
- Department of Pneumology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Trinidad Serrano
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Guadalupe Tabernero
- Department of Nephrology, Hospital Clínico Universitario de Salamanca, Ibsal, Salamanca, Spain
| | - Sofía Zarraga
- Department of Nephrology, Hospital Universitario Cruces, Barakaldo, Spain
| | - Juan F Delgado
- Department of Cardiology, Institute i+12, CIBERCV, Hospital Universitario 12 de Octubre, Madrid, Spain
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8
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García-Álvarez A, Blanco I, García-Lunar I, Jordà P, Rodriguez-Arias JJ, Fernández-Friera L, Zegri I, Nuche J, Gomez-Bueno M, Prat S, Pujadas S, Sole-Gonzalez E, Garcia-Cossio MD, Rivas M, Torrecilla E, Pereda D, Sanchez J, García-Pavía P, Segovia-Cubero J, Delgado JF, Mirabet S, Fuster V, Barberá JA, Ibañez B. β3‐adrenergic agonist treatment in chronic pulmonary hypertension associated with heart failure (
SPHERE‐HF
): a double blind, placebo‐controlled, randomized clinical trial. Eur J Heart Fail 2022; 25:373-385. [PMID: 36404400 DOI: 10.1002/ejhf.2745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/02/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS Pulmonary hypertension (PH) associated with left heart disease is an increasingly prevalent problem, orphan of targeted therapies, and related to a poor prognosis, particularly when pre- and post-capillary PH combine. The current study aimed to determine whether treatment with the selective β3 adrenoreceptor agonist mirabegron improves outcomes in patients with combined pre- and post-capillary PH (CpcPH). METHODS AND RESULTS The β3 Adrenergic Agonist Treatment in Chronic Pulmonary Hypertension Secondary to Heart Failure (SPHERE-HF) trial is a multicentre, randomized, parallel, placebo-controlled clinical trial that enrolled stable patients with CpcPH associated with symptomatic heart failure. A total of 80 patients were assigned to receive mirabegron (50 mg daily, titrated till 200 mg daily, n = 39) or placebo (n = 41) for 16 weeks. Of them, 66 patients successfully completed the study protocol and were valid for the main analysis. The primary endpoint was the change in pulmonary vascular resistance (PVR) on right heart catheterization. Secondary outcomes included the change in right ventricular (RV) ejection fraction by cardiac magnetic resonance or computed tomography, other haemodynamic variables, functional class, and quality of life. The trial was negative for the primary outcome (placebo-corrected mean difference of 0.62 Wood units, 95% confidence interval [CI] -0.38, 1.61, p = 0.218). Patients receiving mirabegron presented a significant improvement in RV ejection fraction as compared to placebo (placebo-corrected mean difference of 3.0%, 95% CI 0.4, 5.7%, p = 0.026), without significant differences in other pre-specified secondary outcomes. CONCLUSIONS SPHERE-HF is the first clinical trial to assess the potential benefit of β3 adrenergic agonists in PH. The trial was negative since mirabegron did not reduce PVR, the primary endpoint, in patients with CpcPH. On pre-specified secondary outcomes, a significant improvement in RV ejection fraction assessed by advanced cardiac imaging was found, without differences in functional class or quality of life.
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Affiliation(s)
- Ana García-Álvarez
- Department of Cardiology, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isabel Blanco
- Universitat de Barcelona, Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, University Hospital La Moraleja, Madrid, Spain
| | - Paloma Jordà
- Department of Cardiology, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | | | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | - Isabel Zegri
- Cardiology Department, Hospital Santa Creu I Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jorge Nuche
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria i+12, Universdad Complutense, Madrid, Spain
| | - Manuel Gomez-Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro-IDIPHISA, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Susanna Prat
- Department of Cardiology, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Sandra Pujadas
- Cardiology Department, Hospital Santa Creu I Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Maria D Garcia-Cossio
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria i+12, Universdad Complutense, Madrid, Spain
| | - Mercedes Rivas
- Cardiology Department, Hospital Santa Creu I Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Cardiology, University Hospital Puerta de Hierro-IDIPHISA, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Daniel Pereda
- Universitat de Barcelona, Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiovascular Surgery, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
| | - Javier Sanchez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Philips Healthcare Iberia, Madrid, Spain
| | - Pablo García-Pavía
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro-IDIPHISA, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital Puerta de Hierro-IDIPHISA, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria i+12, Universdad Complutense, Madrid, Spain
| | - Sonia Mirabet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Santa Creu I Sant Pau, IIb-Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joan A Barberá
- Universitat de Barcelona, Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic Barcelona-IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- IIS-Fundación Jiménez Diaz University Hospital, Madrid, Spain
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9
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain. BMC Health Serv Res 2022; 22:1241. [PMID: 36209120 PMCID: PMC9547468 DOI: 10.1186/s12913-022-08614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. METHODS: Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. RESULTS Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9-27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. CONCLUSIONS HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| | | | | | | | | | | | - Nahila Justo
- Evidera, Stockholm, Sweden; Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, Stockholm, Sweden
| | | | | | | | - Juan F Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, Madrid, Spain.
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10
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med 2022; 11:jcm11175199. [PMID: 36079133 PMCID: PMC9456780 DOI: 10.3390/jcm11175199] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | - Luis Varela
- AstraZeneca Farmaceutica, 28033 Madrid, Spain
| | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
- Correspondence:
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11
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Delgado JF, Bueno H. ¿Podemos mejorar la atención a la insuficiencia cardiaca en España? Med Clin (Barc) 2022; 159:90-91. [DOI: 10.1016/j.medcli.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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12
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Caravaca Perez P, González-Juanatey JR, Nuche J, Matute-Blanco L, Serrano I, Martínez Selles M, Vázquez García R, Martínez Dolz L, Gómez-Bueno M, Pascual Figal D, Crespo-Leiro MG, García-Osuna Á, Ordoñez-Llanos J, Cinca Cuscullola J, Guerra JM, Delgado JF. Renal Function Impact in the Prognostic Value of Galectin-3 in Acute Heart Failure. Front Cardiovasc Med 2022; 9:861651. [PMID: 35463785 PMCID: PMC9021836 DOI: 10.3389/fcvm.2022.861651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Galectin-3 (Gal-3) is an inflammatory marker associated with the development and progression of heart failure (HF). A close relationship between Gal-3 levels and renal function has been observed, but data on their interaction in patients with acute HF (AHF) are scarce. We aim to assess the prognostic relationship between renal function and Gal-3 during an AHF episode. Materials and Methods This is an observational, prospective, multicenter registry of patients hospitalized for AHF. Patients were divided into two groups according to estimated glomerular filtration rate (eGFR): preserved renal function (eGFR ≥ 60 mL/min/1.73 m2) and renal dysfunction (eGFR <60 mL/min/1.73 m2). Cox regression analysis was performed to evaluate the association between Gal-3 and 12-month mortality. Results We included 1,201 patients in whom Gal-3 values were assessed at admission. The median value of Gal-3 in our population was 23.2 ng/mL (17.3–32.1). Gal-3 showed a negative correlation with eGFR (rho = −0.51; p < 0.001). Gal-3 concentrations were associated with higher mortality risk in the multivariate analysis after adjusting for eGFR and other prognostic variables [HR = 1.010 (95%-CI: 1.001–1.018); p = 0.038]. However, the prognostic value of Gal-3 was restricted to patients with renal dysfunction [HR = 1.010 (95%-CI: 1.001–1.019), p = 0.033] with optimal cutoff point of 31.5 ng/mL, with no prognostic value in the group with preserved renal function [HR = 0.990 (95%-CI: 0.964–1.017); p = 0.472]. Conclusions Gal-3 is a marker of high mortality in patients with acute HF and renal dysfunction. Renal function influences the prognostic value of Gal-3 levels, which should be adjusted by eGFR for a correct interpretation.
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Affiliation(s)
- Pedro Caravaca Perez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (Imas12), Madrid, Spain
| | - José R. González-Juanatey
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Facultad de Medicina, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago, Santiago de Compostela, Spain
| | - Jorge Nuche
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Lucia Matute-Blanco
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IBRLLEIDA, Lleida, Spain
| | - Isabel Serrano
- Department of Cardiology, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, Tarragona, Spain
| | - Manuel Martínez Selles
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain
| | - Rafael Vázquez García
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Departamento de Medicina, Universidad de Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, Spain
| | - Luis Martínez Dolz
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario y Politécnico La Fe, IIS La Fe, Valencia, Spain
| | - Manuel Gómez-Bueno
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Domingo Pascual Figal
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - María G. Crespo-Leiro
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomedica A Coruña, Universidade da Coruña, A Coruña, Spain
| | - Álvaro García-Osuna
- Servicio de Bioquímica-IIB Sant Pau, Departamento de Bioquímica y Biología Molecular, Universitat Autónoma, Barcelona, Spain
- Fundación Para la Bioquímica y la Patología Molecular, Barcelona, Spain
| | - Jordi Ordoñez-Llanos
- Servicio de Bioquímica-IIB Sant Pau, Departamento de Bioquímica y Biología Molecular, Universitat Autónoma, Barcelona, Spain
- Fundación Para la Bioquímica y la Patología Molecular, Barcelona, Spain
| | - Juan Cinca Cuscullola
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, IIB Sant Pau Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José M. Guerra
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, IIB Sant Pau Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan F. Delgado
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (Imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Juan F. Delgado
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13
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Blázquez‐Bermejo Z, Farré N, Caravaca Perez P, Llagostera M, Morán‐Fernández L, Fort A, de Juan Bagudá J, García‐Cosio MD, Ruiz‐Bustillo S, Delgado JF. Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure. ESC Heart Fail 2022; 9:656-666. [PMID: 34766460 PMCID: PMC8788037 DOI: 10.1002/ehf2.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS The outpatient diuretic dose is a marker of diuretic resistance and prognosis in chronic heart failure (HF). Still, the impact of the preadmission dose on diuretic efficiency (DE) and prognosis in acute HF is not fully known. METHODS AND RESULTS We conducted an observational and prospective study. All patients admitted for acute HF treated with intravenous diuretic and at least one criterion of congestion on admission were evaluated. Decongestion [physical examination, hemoconcentration, N-terminal pro-brain natriuretic peptide (NT-proBNP) change, and lung ultrasound], DE (weight loss and urine output per unit of 40 mg furosemide), and urinary sodium were monitored on the fifth day of admission. DE was dichotomized into high-low based on the median value. A multivariate Cox regression analysis was conducted to find predictors of HF readmission or mortality. A total of 105 patients were included between July 2017 and July 2019. Mean age was 74.5 ± 12.0 years, 64.8% were male, 33.3% had de novo HF, and mean left ventricular ejection fraction was 46 ± 17%. Median follow-up was 26 [15-35] months. Low DE based on weight loss was associated with a higher previous dose of furosemide (odds ratio [OR] 1.01 [1.00-1.02]), thiazide treatment before admission (OR 9.37 [2.19-40.14]), and lower diastolic blood pressure (OR 0.95 [0.91-0.98]) in the multivariate regression model. Only previous dose of furosemide (OR 1.01 [1.00-1.02]) and haemoglobin at admission (OR 0.76 [0.58-0.99]) were associated with low DE based on urine output in the multivariate analysis. The correlation between the previous dose of furosemide and DE based on weight loss was poor (r = -0.12; P = 0.209) and with DE based on urine output was weak to moderate (r = -0.33; P < 0.001). Low DE based on weight loss and urine output was associated with lesser decongestion measured by NT-proBNP (P = 0.011; P = 0.007), hemoconcentration (P = 0.006; P = 0.044), and lung ultrasound (P = 0.034; P = 0.029), but not by physical examination (P = 0.506; P = 0.560). Survival and event-free survival in acute decompensated HF (ADHF) were lower than in de novo HF; a preadmission dose of furosemide > 80 mg in ADHF identified patients with particularly poor prognosis (log-rank < 0.001). In ADHF, the preadmission dose of furosemide (hazard ratio [HR] 1.34 [1.08-1.67] per 40 mg) and NT-proBNP at admission (HR 1.03 [1.01-1.06] per 1000 pg/mL) were independently associated with mortality or HF readmission in the multivariate Cox regression analysis. CONCLUSIONS The outpatient dose of furosemide before acute HF admission predicts DE and must be taken into account when deciding on the initial diuretic dose. In ADHF, the outpatient dose of furosemide can predict long-term prognosis better than DE during hospitalization.
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Affiliation(s)
- Zorba Blázquez‐Bermejo
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
| | - Nuria Farré
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Biomedical Research Group on Heart Disease (GREC)Hospital del Mar Medical Research Group (IMIM)BarcelonaSpain
- Department of MedicineUniversidad Autónoma de BarcelonaBarcelonaSpain
| | - Pedro Caravaca Perez
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | | | - Laura Morán‐Fernández
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - Aleix Fort
- Cardiology DepartmentHospital del MarBarcelonaSpain
| | - Javier de Juan Bagudá
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - María Dolores García‐Cosio
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
| | - Sonia Ruiz‐Bustillo
- Cardiology DepartmentHospital del MarBarcelonaSpain
- Biomedical Research Group on Heart Disease (GREC)Hospital del Mar Medical Research Group (IMIM)BarcelonaSpain
- Department of MedicineUniversitat Pompeu FabraBarcelonaSpain
| | - Juan F. Delgado
- Cardiology DepartmentHospital Universitario 12 de OctubreMadridSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
- Faculty of MedicineUniversidad Complutense de MadridMadridSpain
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Solla-Buceta M, González-Vílchez F, Almenar-Bonet L, Lambert-Rodríguez JL, Segovia-Cubero J, González-Costello J, Delgado JF, Pérez-Villa F, Crespo-Leiro MG, Rangel-Sousa D, Martínez-Sellés M, Rábago-Juan-Aracil G, De-la-Fuente-Galán L, Blasco-Peiró T, Hervás-Sotomayor D, Garrido-Bravo IP, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Complicaciones infecciosas relacionadas con la asistencia circulatoria mecánica de corta duración en candidatos a trasplante cardiaco urgente. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Varela L, Delgado JF. Epidemiología y tratamiento de la insuficiencia cardiaca en España: estudio PATHWAYS-HF. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Caravaca Pérez P, Nuche J, López-Azor JC, Salguero-Bodes R, Arribas Ynsaurriaga F, Delgado JF. Response by Caravaca Pérez et al to Letter Regarding Article, "Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure". Circ Heart Fail 2021; 15:e009258. [PMID: 34963307 DOI: 10.1161/circheartfailure.121.009258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pedro Caravaca Pérez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.)
| | - Jorge Nuche
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.N.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.)
| | - Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.)
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (R.S.-B., F.A.Y., J.F.D.)
| | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (R.S.-B., F.A.Y., J.F.D.)
| | - Juan F Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares, Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., J.C.L.-A., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (R.S.-B., F.A.Y., J.F.D.)
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Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro MG, Delgado JF, Díez J, Formiga F, Manito N. Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review. Front Cardiovasc Med 2021; 8:754499. [PMID: 34859070 PMCID: PMC8631913 DOI: 10.3389/fcvm.2021.754499] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| | | | - Pedro Caravaca-Pérez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.,Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiovascular Diseases Programme, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain.,Departments of Nephrology, Cardiology, and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain.,Navarra Institute for Health Research, Pamplona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Heart Failure and Heart Transplantation Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Vieira KS, Delgado JF, Lima LS, Souza PF, Crapez MAC, Correa TR, Aguiar VMC, Baptista Neto JA, Fonseca EM. Human health risk assessment associated with the consumption of mussels (Perna perna) and oysters (Crassostrea rhizophorae) contaminated with metals and arsenic in the estuarine channel of Vitória Bay (ES), Southeast Brazil. Mar Pollut Bull 2021; 172:112877. [PMID: 34428624 DOI: 10.1016/j.marpolbul.2021.112877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
The estuarine channel of Vitória Bay was evaluated regarding bioaccumulation of metals (Al, Ba, Mn, Fe, Zn, Cu, Cr, Pb, Ni, Cd, Hg) and As in mollusks. Mussels from an aquaculture farm and transplanted into the estuary, whereas oysters were collected in situ in the same area. Concentrations of Al, Mn, Fe, Cr and As were higher in P. perna, whereas C. rhizophorae bioaccumulated more Ba, Zn and Cu. Arsenic concentrations in P. perna exceeded the limit of the Brazilian legislation in the outer estuary. Salinity seemed to influence metal uptake differently for each bivalve, with P. perna absorbing more metal at higher salinities and C. rhizophorae in areas of lower salinity. Hazard index (HI) >1 revealed risk for both bivalves for high level consumers. Target Cancer Risk (TCR) for As revealed threat for human health associated with the consumption of mussels and oysters from the study area.
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Affiliation(s)
- K S Vieira
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - J F Delgado
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - L S Lima
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - P F Souza
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - M A C Crapez
- Departamento de Biologia Marinha, Laboratório de Microbiologia Marinha/MICROMAR - Universidade Federal Fluminense - Outeiro de São João Batista, s/n - 24.001-970, Centro, Niterói, RJ, Brazil
| | - T R Correa
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - V M C Aguiar
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil.
| | - J A Baptista Neto
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - E M Fonseca
- Departamento de Geologia Marinha/LAGEMAR - Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
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Delgado JF, Salvay AG, de la Osa O, Wagner JR, Peltzer MA. Impact of the film-forming dispersion pH on the properties of yeast biomass films. J Sci Food Agric 2021; 101:5636-5644. [PMID: 33709441 DOI: 10.1002/jsfa.11216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Yeast biomass, mainly composed of proteins and polysaccharides (mannans and β-glucans), has been proposed to develop films. pH can affect the solubility of polysaccharides, the structure of the cell wall, and the interactions between proteins. Considering the potential impact of these effects, the pH of yeast film-forming dispersions was studied from 4 to 11. RESULTS In tensile tests, samples increased their elongation by increasing pH, from 7 ± 2% (pH 4) to 29 ± 5% (pH 11), but Young's modulus was not significantly modified. Regarding thermal degradation, the maximum degradation rate temperature was shifted 46 °C from pH 4 to 11. Differences in water vapour permeability, colour, opacity, and roughness of films were also found. According to the results of differential protein solubility assay, hydrophobic interactions and hydrogen bonding were promoted at pH 4, but disulfide bonds were benefited at pH 11, in addition to partial β-glucan dissolution and break-up of the alkali-sensitive linkage in molecules from the cell wall. CONCLUSION The results lead to the conclusion that film-functional characteristics were greatly benefited at pH 11 in comparison with the regular pH of dispersion (pH 6). These results could help in understanding and selecting the pH conditions to enhance the desired properties of yeast biomass films. © 2021 Society of Chemical Industry.
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Affiliation(s)
- Juan F Delgado
- Laboratorio de Obtención, Modificación, Caracterización y Evaluación de Materiales (LOMCEM), Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal, Provincia de Buenos Aires, 1876, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires, 1425, Argentina
- Grupo de Biotecnología y Materiales Biobasados, Instituto de Tecnología en Polímeros y Nanotecnología (ITPN-UBA-CONICET), Universidad de Buenos Aires, Avenida Las Heras 2214, Ciudad Autónoma de Buenos Aires, 1127, Argentina
| | - Andrés G Salvay
- Laboratorio de Obtención, Modificación, Caracterización y Evaluación de Materiales (LOMCEM), Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal, Provincia de Buenos Aires, 1876, Argentina
| | - Orlando de la Osa
- Laboratorio de Obtención, Modificación, Caracterización y Evaluación de Materiales (LOMCEM), Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal, Provincia de Buenos Aires, 1876, Argentina
| | - Jorge R Wagner
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires, 1425, Argentina
- Laboratorio de Investigación en Funcionalidad y Tecnología de Alimentos (LIFTA), Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal, Provincia de Buenos Aires, 1876, Argentina
| | - Mercedes A Peltzer
- Laboratorio de Obtención, Modificación, Caracterización y Evaluación de Materiales (LOMCEM), Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal, Provincia de Buenos Aires, 1876, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires, 1425, Argentina
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Caravaca Pérez P, Nuche J, Morán Fernández L, Lora D, Blázquez-Bermejo Z, López-Azor JC, de Juan Bagudá J, García-Cosío Carmena MD, Escribano Subías P, Salguero-Bodes R, Arribas Ynsaurriaga F, Delgado JF. Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure. Circ Heart Fail 2021; 14:e008166. [PMID: 34129364 DOI: 10.1161/circheartfailure.120.008166] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. METHODS Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0-9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. RESULTS Median UNa after FST in the 65 patients included was 113 (97-122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P=0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P<0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months. CONCLUSIONS Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.
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Affiliation(s)
- Pedro Caravaca Pérez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Jorge Nuche
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.N.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Laura Morán Fernández
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - David Lora
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Zorba Blázquez-Bermejo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Javier de Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - María Dolores García-Cosío Carmena
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Pilar Escribano Subías
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
| | - Juan F Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C.P., J.N., L.M.F., Z.B.-B., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares (CIBERCV), Spain (P.C.P., J.N., L.M.F., J.C.L.-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain (P.C.P., J.N., L.M.F., D.L., Z.B.-B., J.C.L-A., J.d.J.B., M.D.G.-C.C., P.E.S., R.S.-B., F.A.Y., J.F.D.).,Facultad de Medicina, Universidad Complutense de Madrid, Spain (P.E.S., R.S.-B., F.A.Y., J.F.D.)
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21
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Velázquez Martín M, Maneiro Melón N, de Miguel Poch E, Sarnago F, Delgado JF, Escribano P. Fístula entre bronquio y arteria pulmonar. Una grave complicación de la angioplastia pulmonar en la hipertensión pulmonar tromboembólica crónica. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Salamanca-Bautista P, Álvarez-García J, Aramburu-Bodas Ó, Ferrero-Gregori A, Arias-Jiménez JL, Delgado JF, Formiga F, Vázquez R, Manzano L, Puig T, Llàcer P, Vives-Borras M, Cinca J, Montero-Pérez-Barquero M. Modes of death in heart failure according to age, sex and left ventricular ejection fraction. Intern Emerg Med 2021; 16:643-652. [PMID: 32813117 DOI: 10.1007/s11739-020-02468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396). Mode of death was pre-specified. Out of 3546 patients, 485 (13.7%) died during the 9-month follow-up. Cardiovascular (CV) causes were the most frequent, regardless of the age, sex and LVEF. More than half of patients died due to worsening HF in both groups of patients, followed by other non-CV causes in those attended by internists, and sudden cardiac death in those cared by cardiologists. Stroke was more common among elderly patients, women and HF with preserved LVEF. Non-CV causes, particularly infectious diseases, accounted for a remarkable proportion of deaths, especially in the elderly and in HF patients with preserved LVEF. Functional class, age and anaemia had a strong influence on both CV and non-CV death. CV death due to refractory HF was the most prevalent among our population, irrespective of age, sex or LVEF. However, a significant proportion of HF patients died from non-CV causes, particularly elderly with mid-range and preserved LVEF. These patients could benefit significantly from a multidisciplinary follow-up.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Óscar Aramburu-Bodas
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Luis Arias-Jiménez
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Juan F Delgado
- Cardiology Department, Fundación de Investigación i+12, Hospital Universitario Doce de Octubre, CIBERCV, Facultad de Medicina UCM, Madrid, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
| | - Teresa Puig
- Epidemiology and Public Health Department, Hospital de la Santa Creu I Sant Pau, II-B SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital de Manises, Valencia, Spain
| | - Miquel Vives-Borras
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
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23
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Delgado JF, Cepeda JM, Llorens P, Jacob J, Comín J, Montero M, Miró Ò, López de Sá E, Manzano L, Martín-Sánchez FJ, Formiga F, Masip J, Pérez-Calvo JI, Herrero-Puente P, Manito N. Consensus on improving the comprehensive care of patients with acute heart failure. Rev Clin Esp 2021; 221:163-168. [PMID: 38108502 DOI: 10.1016/j.rce.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.
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Affiliation(s)
- J F Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Facultad de Medicina UCM, CIBERCV, Madrid, España.
| | - J M Cepeda
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Alicante), España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; ISABIAL Alicante; Universitat Miguel Hernández, Elche (Alicante), España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Comín
- Servicio de Cardiología, Hospital del Mar (IMAS), Barcelona, España
| | - M Montero
- IMIBIC, Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ò Miró
- Área de Urgencias, Hospital Clínic de Barcelona; Grupo de Investigación Urgencias: Procesos y Patologías, IDIBAPS; Universitat de Barcelona, Barcelona, España
| | - E López de Sá
- Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario La Paz, Madrid, España
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J Masip
- Unidad de Cuidados Intensivos, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Universidad de Barcelona, Sant Joan Despí (Barcelona), España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Central Universitario Lozano Blesa, Zaragoza, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - N Manito
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
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24
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Solla-Buceta M, González-Vílchez F, Almenar-Bonet L, Lambert-Rodríguez JL, Segovia-Cubero J, González-Costello J, Delgado JF, Pérez-Villa F, Crespo-Leiro MG, Rangel-Sousa D, Martínez-Sellés M, Rábago-Juan-Aracil G, De-la-Fuente-Galán L, Blasco-Peiró T, Hervás-Sotomayor D, Garrido-Bravo IP, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Infectious complications associated with short-term mechanical circulatory support in urgent heart transplant candidates. ACTA ACUST UNITED AC 2021; 75:141-149. [PMID: 33648882 DOI: 10.1016/j.rec.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. METHODS Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. RESULTS We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n=47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n=58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P=.009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P=.025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P=.471). CONCLUSIONS Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period.
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Affiliation(s)
- Miguel Solla-Buceta
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | | | - Luis Almenar-Bonet
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Universitat de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Luis Lambert-Rodríguez
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Fundación de Investigación I+12, Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Félix Pérez-Villa
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - María G Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Diego Rangel-Sousa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | | | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris P Garrido-Bravo
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Sonia Mirabet-Pérez
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidade da Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
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25
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García-Cosío MD, González-Vilchez F, López-Vilella R, Barge-Caballero E, Gómez Bueno M, Martínez-Selles M, María Arizón J, Rangel Sousa D, González-Costello J, Mirabet S, Pérez-Villa F, Molina BD, Rábago G, Portolés Ocampo A, de la Fuente Galán L, Garrido I, Delgado JF. Influence of Gender in Advanced Heart Failure Therapies and Outcome Following Transplantation. Front Cardiovasc Med 2021; 8:630113. [PMID: 33718453 PMCID: PMC7946818 DOI: 10.3389/fcvm.2021.630113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.
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Affiliation(s)
- María Dolores García-Cosío
- Servicio de Cardiología, Hospital 12 de Octubre Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | | | - Raquel López-Vilella
- Servicio de Cardiología, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Eduardo Barge-Caballero
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Gómez Bueno
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Manuel Martínez-Selles
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Jose María Arizón
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Diego Rangel Sousa
- Servicio de Cardiología, Hospital Universitario Virgen Del Rocío, Seville, Spain
| | - José González-Costello
- Servicio de Cardiología, Hospital Universitari De Bellvitge, Hospitalet de Llobregat, Spain
| | - Sonia Mirabet
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Félix Pérez-Villa
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Beatriz Díaz Molina
- Servicio de Cardiología, Hospital Universitario Central De Asturias, Oviedo, Spain
| | - Gregorio Rábago
- Servicio de Cirugía Cardiaca, Clínica Universidad De Navarra, Navarra, Spain
| | - Ana Portolés Ocampo
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Iris Garrido
- Servicio de Cardiología, Hospital Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Juan F. Delgado
- Servicio de Cardiología, Hospital 12 de Octubre Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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26
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Caravaca Perez P, González-Juanatey JR, Nuche J, Guerra JM, Martínez Selles M, Delgado JF. Reply to G. Betts's letter referring to "Serum potassium dynamics during acute heart failure hospitalization". Clin Res Cardiol 2021; 110:606-607. [PMID: 33475832 DOI: 10.1007/s00392-020-01796-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Pedro Caravaca Perez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 de Octubre, Avenida de Andalucía s/n, 28041, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Madrid, Spain
| | - José R González-Juanatey
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Facultad de Medicina, Universidad de Santiago, Santiago de Compostela, Spain
| | - Jorge Nuche
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jose M Guerra
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Manuel Martínez Selles
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain
| | - Juan F Delgado
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Department of Cardiology, Hospital Universitario 12 de Octubre, Avenida de Andalucía s/n, 28041, Madrid, Spain.
- Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
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Vieira KS, Crapez MAC, Lima LS, Delgado JF, Brito EBCC, Fonseca EM, Baptista Neto JA, Aguiar VMC. Evaluation of bioavailability of trace metals through bioindicators in a urbanized estuarine system in southeast Brazil. Environ Monit Assess 2021; 193:18. [PMID: 33389181 DOI: 10.1007/s10661-020-08809-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
The mussel Perna perna is one of the most used bioindicators of coastal areas and the most economically exploited species in Brazil through mariculture. In the present study, P. perna was used to investigate metal pollution in the estuarine area of Vitória Bay. Four sampling sites were located along an estuarine branch of Vitória Bay and stations were sampled during three campaigns. Trace metals in the tissues of P. perna were evaluated as well as dissolved trace metals and other ancillary variables in the water column. Dissolved Cd, Pb, Cu, Ni, and Fe concentrations surpassed the tolerance limits stablished by legislation in all the sampling campaigns. P. perna exhibited concentrations in disagreement with the Brazilian legislation for Cr and As. A general trend of higher concentrations in outer stations was observed for most metals, what suggested the occurrence of flocculation process in the lower estuary, reducing the concentrations of dissolved elements and increasing their bioavailability for the biota through the particulate form. Cd was highlighted with elevated concentrations in dissolved fraction but not detected in P. perna, probably due to chlor-complex formation under influence of more saline waters. Al, Ba, Mn, Fe, Cu, Zn, Ni, Cr, Pb, and As were considered bioavailable, once they were accumulated in the mussels' tissues. Hazard index (HI) and target cancer risk (TCR) showed that the consumption of mussels from the study area offers health risk issues, being iron and arsenic the main contributors for the high indexes.
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Affiliation(s)
- K S Vieira
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - M A C Crapez
- Departamento de Biologia Marinha, Laboratório de Microbiologia Marinha/MICROMAR, Universidade Federal Fluminense, Outeiro de São João Batista, s/n - 24.001-970, Centro, Niterói, RJ, Brasil
| | - L S Lima
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - J F Delgado
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - E B C C Brito
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - E M Fonseca
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - J A Baptista Neto
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil
| | - V M C Aguiar
- Departamento de Geologia Marinha/LAGEMAR, Universidade Federal Fluminense, Av. General Milton Tavares de Souza s/n - 24210-340 - Gragoatá, Niterói, RJ, Brazil.
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28
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Delgado JF, Oliva J, González-Franco Á, Cepeda JM, García-García JÁ, González-Domínguez A, Garcia-Casanovas A, Jiménez Merino S, Comín-Colet J. Budget impact of ferric carboxymaltose treatment in patients with chronic heart failure and iron deficiency in Spain. J Med Econ 2020; 23:1418-1424. [PMID: 33073660 DOI: 10.1080/13696998.2020.1838872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The treatment of iron deficiency (ID) with ferric carboxymaltose (FCM) improves the functional class and quality of life of chronic heart failure (CHF) patients with reduced left ventricular ejection fraction (LVEF), and reduces the rate of hospitalization due to worsening CHF. This study aims to evaluate the budget impact for the Spanish National Health System (SNHS) of treating ID in reduced LVEF CHF with FCM compared to non-iron treatment. METHODS We simulated a hypothetical cohort of 1000 CHF patients with ID and reduced LVEF based on the Spanish population characteristics. A decision-analytic model was also built using the data from the largest FCM clinical trial (CONFIRM-HF) that lasted for a year. We considered the use of healthcare resources from a national prospective study. A deterministic sensitivity analysis was carried out varying the corresponding baseline data by ±25%. RESULTS The cost of treating the simulated population with FCM was €2,570,914, while that of the non-iron treatment was €3,105,711, which corresponds to a cost saving of €534,797 per 1,000 patients in one year. Cost savings were mainly due to a decrease in the number of hospitalizations. All sensitivity analysis showed cost savings for the SNHS. CONCLUSIONS FCM results in an annual cost saving of €534.80 per patient, and would thus be expected to reduce the economic burden of CHF in Spain.
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Affiliation(s)
- Juan F Delgado
- Cardiology Service, Hospital Universitario 12 de Octubre, Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
| | - Álvaro González-Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Asturias, Spain
- Heart Failure and Atrial Fibrillation Group, Spanish Society of Internal Medicine (SEMI)
| | - Jose María Cepeda
- Department of Internal Medicine, Hospital Vega Baja de Orihuela, Alicante, Spain
| | | | | | | | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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29
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Velázquez Martín M, Maneiro Melón N, de Miguel Poch E, Sarnago F, Delgado JF, Escribano P. Bronchopulmonary artery fistula. A life-threatening complication of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. ACTA ACUST UNITED AC 2020; 74:548-549. [PMID: 33234493 DOI: 10.1016/j.rec.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Maite Velázquez Martín
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain.
| | - Nicolás Maneiro Melón
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain
| | - Eduardo de Miguel Poch
- Departamento de Neumología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain
| | - Fernando Sarnago
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain
| | - Juan F Delgado
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV),Spain
| | - Pilar Escribano
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense, Madrid,Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV),Spain
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30
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Caravaca Perez P, González-Juanatey JR, Nuche J, Morán Fernández L, Lora Pablos D, Alvarez-García J, Bascompte Claret R, Martínez Selles M, Vázquez García R, Martínez Dolz L, Cobo-Marcos M, Pascual Figal D, Crespo-Leiro MG, Nuñez Villota J, Cinca Cuscullola J, Delgado JF. Serum potassium dynamics during acute heart failure hospitalization. Clin Res Cardiol 2020; 111:368-379. [DOI: 10.1007/s00392-020-01753-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
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Blázquez-Bermejo Z, Farré N, Llagostera M, Caravaca Perez P, Morán-Fernández L, Fort A, De-Juan J, Ruiz S, Delgado JF. The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry. PLoS One 2020; 15:e0240098. [PMID: 33007024 PMCID: PMC7531800 DOI: 10.1371/journal.pone.0240098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Diuretic resistance (DR) is a common condition during a heart failure (HF) hospitalization, and is related to worse prognosis. Although the risk factors for DR during a HF hospitalization are widely described, we do not know whether the risk of chronic DR could be predicted during admission. Material and methods We conducted a multicenter, prospective observational study between July 2017 and July 2019. All patients admitted for acute HF with intravenous diuretic treatment and at least one criterion of congestion on admission were invited to participate. Patients on renal replacement therapy, under intravenous diuretic treatment for >72 hours before screening and those who were unable to sign the informed consent were excluded. We monitored decongestion (physical exam, hemoconcentration, NTproBNP change and lung ultrasound) and DR (diuresis and weight loss per unit of 40mg furosemide and fractional excretion of sodium) on the fifth day of admission. Chronic DR was evaluate two months after hospitalization and was defined as persistent signs of congestion despite ≥80 mg furosemide per day. We compared variables from the hospitalization between patients with and without chronic DR. A multivariate logistic regression analysis was conducted to find predictors of chronic DR. Results A total of 105 patients were included in the study. Mean age was 74.5±12.0 years, 64.8% were male and mean LVEF was 46±17%. In the two months follow-up, five patients have died and one patient has had a heart transplant. Of the 99 remaining patients, 21 patients (21.2%) had chronic DR. The dose of furosemide before admission and the decrease in NT-proBNP ≤30% during admission were predictors of chronic DR in the multivariate analysis. Conclusions We can predict during a HF hospitalization which patients will develop chronic DR. The dose of furosemide before admission and the change in NT-proBNP are independent predictors of chronic DR.
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Affiliation(s)
| | - Nuria Farré
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Biomedical Research Group on Heart Disease (GREC), Hospital del Mar Medical Research Group (IMIM), Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Pedro Caravaca Perez
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Morán-Fernández
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Aleix Fort
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Javier De-Juan
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sonia Ruiz
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Biomedical Research Group on Heart Disease (GREC), Hospital del Mar Medical Research Group (IMIM), Barcelona, Spain
| | - Juan F. Delgado
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Nuche J, Montero-Cabezas JM, Lareo A, Huertas S, Jiménez López-Guarch C, Velázquez Martín M, Alonso Charterina S, Revilla Ostolaza Y, Delgado JF, Arribas Ynsaurriaga F, Escribano Subías P. Influence of long-standing pulmonary arterial hypertension and its severity on pulmonary artery aneurysm development. Heart Vessels 2020; 35:1290-1298. [DOI: 10.1007/s00380-020-01600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
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Velázquez Martín M, Montero Cabezas JM, Huertas S, Nuche J, Albarrán A, Delgado JF, Alonso S, Sarnago F, Arribas F, Escribano Subias P. Clinical relevance of adding intravascular ultrasound to coronary angiography for the diagnosis of extrinsic left main coronary artery compression by a pulmonary artery aneurysm in pulmonary hypertension. Catheter Cardiovasc Interv 2020; 98:691-700. [PMID: 32790221 DOI: 10.1002/ccd.29194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We sought to assess the clinical value of adding intravascular ultrasound (IVUS) evaluation to coronary angiography (CA) to guide extrinsic left main coronary artery (LMCA) compression diagnosis and treatment in pulmonary hypertension (PH). BACKGROUND LMCA compression due to a pulmonary artery aneurysm (PAA) is a severe complication of PH. Although guidelines encourage the use of IVUS for LMCA disease evaluation, it has hardly been used in this scenario. METHODS We analyzed morbimortality of type 1 and 4 PH patients with clinically suspected LMCA compression by a PAA between 2010 and 2018 in a reference unit. LMCA compression was prospectively assessed with CA ± IVUS. Angiographic-LMCA compression was considered conclusive when LMCA stenosis>50% was present in four predetermined projections; inconclusive, when LMCA stenosis>50% was present in <4 projections and negative if no stenosis>50% was present. Patients with conclusive and inconclusive CA underwent IVUS. IVUS-LMCA compression was defined as systolic minimum lumen area < 6 mm2 . RESULTS LMCA compression was suspected in 23/796 patients (3%). CA was conclusive for compression in 7(30.5%), inconclusive in 9(39%), and negative in 7(30.5%). IVUS confirmed LMCA compression in 6/7(86%) patients with conclusive CA and in 2/9(22%) with inconclusive CA. Patients fulfilling IVUS criteria for LMCA compression underwent stent implantation. At 20 months follow-up a composite end-point of death, stent restenosis/thrombosis, or lung transplant was reported in three patients (13%). CONCLUSIONS CA can misdiagnose LMCA extrinsic compression. IVUS discriminates better whether significant compression by a PAA exists or not, avoiding unnecessary LMCA stenting. Patients treated following this strategy show a low rate of major clinical events at 20 months follow-up.
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Affiliation(s)
| | | | - Sergio Huertas
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Jorge Nuche
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Agustín Albarrán
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Juan F Delgado
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Sergio Alonso
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Sarnago
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Fernando Arribas
- Department of Cardiology, University Hospital 12 de Octubre, Madrid, Spain
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Papp Z, Agostoni P, Alvarez J, Bettex D, Bouchez S, Brito D, Černý V, Comin-Colet J, Crespo-Leiro MG, Delgado JF, Édes I, Eremenko AA, Farmakis D, Fedele F, Fonseca C, Fruhwald S, Girardis M, Guarracino F, Harjola VP, Heringlake M, Herpain A, Heunks LM, Husebye T, Ivancan V, Karason K, Kaul S, Kivikko M, Kubica J, Masip J, Matskeplishvili S, Mebazaa A, Nieminen MS, Oliva F, Papp JG, Parissis J, Parkhomenko A, Põder P, Pölzl G, Reinecke A, Ricksten SE, Riha H, Rudiger A, Sarapohja T, Schwinger RH, Toller W, Tritapepe L, Tschöpe C, Wikström G, von Lewinski D, Vrtovec B, Pollesello P. Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use. Card Fail Rev 2020; 6:e19. [PMID: 32714567 PMCID: PMC7374352 DOI: 10.15420/cfr.2020.03] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.
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Affiliation(s)
- Zoltán Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen Debrecen, Hungary
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Julian Alvarez
- Department of Surgery, School of Medicine, University of Santiago de Compostela Santiago de Compostela, Spain
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital of Zurich Zurich, Switzerland
| | - Stefan Bouchez
- Department of Anaesthesiology, University Hospital Ghent, Belgium
| | - Dulce Brito
- Cardiology Department, Centro Hospitalar Universitario Lisboa Norte, CCUI, Faculdade de Medicina, Universidade de Lisboa Lisbon, Portugal
| | - Vladimir Černý
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J.E. Purkinje University Usti nad Labem, Czech Republic
| | - Josep Comin-Colet
- Heart Diseases Institute, Hospital Universitari de Bellvitge Barcelona, Spain
| | - Marisa G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC) La Coruña, Spain
| | - Juan F Delgado
- Heart Failure and Transplant Program, Cardiology Department, University Hospital 12 Octubre Madrid, Spain
| | - Istvan Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen Debrecen, Hungary
| | - Alexander A Eremenko
- Department of Cardiac Intensive Care, Petrovskii National Research Centre of Surgery, Sechenov University Moscow, Russia
| | - Dimitrios Farmakis
- Department of Cardiology, Medical School, University of Cyprus Nicosia, Cyprus
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, La Sapienza University of Rome Rome, Italy
| | - Cândida Fonseca
- Heart Failure Clinic, São Francisco Xavier Hospital, CHLO Lisbon, Portugal
| | - Sonja Fruhwald
- Department of Anaesthesiology and Intensive Care Medicine, Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz Graz, Austria
| | - Massimo Girardis
- Struttura Complessa di Anestesia 1, Policlinico di Modena Modena, Italy
| | - Fabio Guarracino
- Dipartimento di Anestesia e Terapie Intensive, Azienda Ospedaliero-Universitaria Pisana Pisa, Italy
| | - Veli-Pekka Harjola
- Emergency Medicine, Meilahti Central University Hospital, University of Helsinki Helsinki, Finland
| | - Matthias Heringlake
- Department of Anaesthesiology and Intensive Care Medicine, University of Lübeck Lübeck, Germany
| | - Antoine Herpain
- Department of Intensive Care, Hôpital Erasme Brussels, Belgium
| | - Leo Ma Heunks
- Department of Intensive Care Medicine, Amsterdam UMC Amsterdam, the Netherlands
| | - Tryggve Husebye
- Department of Cardiology, Oslo University Hospital Ullevaal Oslo, Norway
| | - Višnja Ivancan
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Croatia
| | - Kristjan Karason
- Departments of Cardiology and Transplantation, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Sundeep Kaul
- Intensive Care Unit, National Health Service Leeds, UK
| | - Matti Kivikko
- Global Medical Affairs, R&D, Orion Pharma Espoo, Finland
| | - Janek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University Torun, Poland
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari Integral, University of Barcelona Barcelona, Spain
| | | | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals Paris, France
| | | | - Fabrizio Oliva
- Department of Cardiology, Niguarda Ca'Granda Hospital Milan, Italy
| | - Julius-Gyula Papp
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, University of Szeged Szeged, Hungary
| | - John Parissis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Athens, Greece
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Centre MD Strazhesko Institute of Cardiology Kiev, Ukraine
| | - Pentti Põder
- Department of Cardiology, North Estonia Medical Centre Tallinn, Estonia
| | - Gerhard Pölzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck Innsbruck, Austria
| | - Alexander Reinecke
- Klinik für Innere Medizin III, Kardiologie, Universitätsklinikum Schleswig-Holstein Kiel, Germany
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Hynek Riha
- Cardiothoracic Anaesthesiology and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine Prague, Czech Republic
| | - Alain Rudiger
- Department of Medicine, Spittal Limmattal Schlieren, Switzerland
| | | | - Robert Hg Schwinger
- Medizinische Klinik II, Klinikum Weiden, Teaching Hospital of University of Regensburg Weiden, Germany
| | - Wolfgang Toller
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz Graz, Austria
| | - Luigi Tritapepe
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Italy
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow Klinikum, Charité - University Medicine Berlin Berlin, Germany
| | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University Uppsala, Sweden
| | - Dirk von Lewinski
- Department of Cardiology, Myokardiale Energetik und Metabolismus Research Unit, Medical University of Graz Graz, Austria
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Centre, Department of Cardiology, University Clinical Centre Ljubljana, Slovenia
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35
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Fernández-Ruiz M, Andrés A, Loinaz C, Delgado JF, López-Medrano F, San Juan R, González E, Polanco N, Folgueira MD, Lalueza A, Lumbreras C, Aguado JM. COVID-19 in solid organ transplant recipients: A single-center case series from Spain. Am J Transplant 2020; 20:1849-1858. [PMID: 32301155 PMCID: PMC9800471 DOI: 10.1111/ajt.15929] [Citation(s) in RCA: 307] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/25/2023]
Abstract
The clinical characteristics, management, and outcome of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after solid organ transplant (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%], and heart [22.2%]) recipients diagnosed with COVID-19 by March 23, 2020 at a tertiary-care center at Madrid. Median age at diagnosis was 71.0 ± 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine) was used in 50.0% of patients and had to be prematurely discontinued in 2 of them. Other antiviral regimens included hydroxychloroquine monotherapy (27.8%) and interferon-β (16.7%). As of April 4, the case-fatality rate was 27.8% (5/18). After a median follow-up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C-reactive protein levels at various points were significantly higher among recipients who experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS-CoV-2 infection has a severe course in SOT recipients.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Juan F. Delgado
- Department of Cardiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - María D. Folgueira
- Department of Microbiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - José M. Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
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Papp Z, Agostoni P, Alvarez J, Bettex D, Bouchez S, Brito D, Černý V, Comin-Colet J, Crespo-Leiro MG, Delgado JF, Édes I, Eremenko AA, Farmakis D, Fedele F, Fonseca C, Fruhwald S, Girardis M, Guarracino F, Harjola VP, Heringlake M, Herpain A, Heunks LMA, Husebye T, Ivancan V, Karason K, Kaul S, Kivikko M, Kubica J, Masip J, Matskeplishvili S, Mebazaa A, Nieminen MS, Oliva F, Papp JG, Parissis J, Parkhomenko A, Põder P, Pölzl G, Reinecke A, Ricksten SE, Riha H, Rudiger A, Sarapohja T, Schwinger RHG, Toller W, Tritapepe L, Tschöpe C, Wikström G, von Lewinski D, Vrtovec B, Pollesello P. Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use. J Cardiovasc Pharmacol 2020; 76:4-22. [PMID: 32639325 PMCID: PMC7340234 DOI: 10.1097/fjc.0000000000000859] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Levosimendan is currently in active clinical evaluation in the United States. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and noncardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute HF arena in recent times and charts a possible development trajectory for the next 20 years.
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Affiliation(s)
- Zoltán Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Julian Alvarez
- Department of Surgery, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital of Zurich, Zurich, Switzerland
| | - Stefan Bouchez
- Department of Anaesthesiology, University Hospital, Ghent, Belgium
| | - Dulce Brito
- Cardiology Department, Centro Hospitalar Universitario Lisboa Norte, CCUI, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vladimir Černý
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J.E. Purkinje University, Usti nad Labem, Czech Republic
| | - Josep Comin-Colet
- Heart Diseases Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Marisa G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC), La Coruña, Spain
| | - Juan F. Delgado
- Heart Failure and Transplant Program, Cardiology Department, University Hospital 12 Octubre, Madrid, Spain
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Alexander A. Eremenko
- Department of Cardiac Intensive Care, Petrovskii National Research Centre of Surgery, Sechenov University, Moscow, Russia
| | - Dimitrios Farmakis
- Department of Cardiology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, La Sapienza University of Rome, Rome, Italy
| | - Cândida Fonseca
- Heart Failure Clinic, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal
| | - Sonja Fruhwald
- Department of Anaesthesiology and Intensive Care Medicine, Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Massimo Girardis
- Struttura Complessa di Anestesia 1, Policlinico di Modena, Modena, Italy
| | - Fabio Guarracino
- Dipartimento di Anestesia e Terapie Intensive, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Veli-Pekka Harjola
- Emergency Medicine, Meilahti Central University Hospital, University of Helsinki, Helsinki, Finland
| | - Matthias Heringlake
- Department of Anaesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck, Germany
| | - Antoine Herpain
- Department of Intensive Care, Hôpital Erasme, Brussels, Belgium
| | - Leo M. A. Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Tryggve Husebye
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Višnja Ivancan
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre, Zagreb, Croatia
| | - Kristjan Karason
- Departments of Cardiology and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sundeep Kaul
- Intensive Care Unit, National Health Service, Leeds, United Kingdom
| | - Matti Kivikko
- Global Medical Affairs, R&D, Orion Pharma, Espoo, Finland
| | - Janek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Torun, Poland
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain
| | | | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | | | - Fabrizio Oliva
- Department of Cardiology, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Julius G. Papp
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - John Parissis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Centre MD Strazhesko Institute of Cardiology, Kiev, Ukraine
| | - Pentti Põder
- Department of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Gerhard Pölzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Reinecke
- Klinik für Innere Medizin III, Kardiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hynek Riha
- Department of Anaesthesiology and Intensive Care Medicine, Cardiothoracic Anaesthesiology and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alain Rudiger
- Department of Medicine, Spittal Limmattal, Schlieren, Switzerland
| | | | - Robert H. G. Schwinger
- Medizinische Klinik II, Klinikum Weiden, Teaching Hospital of University of Regensburg, Weiden, Germany
| | - Wolfgang Toller
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Luigi Tritapepe
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow Klinikum, Charité—University Medicine Berlin, Berlin, Germany
| | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Dirk von Lewinski
- Department of Cardiology, Myokardiale Energetik und Metabolismus Research Unit, Medical University of Graz, Graz, Austria
| | - Bojan Vrtovec
- Department of Cardiology, Advanced Heart Failure and Transplantation Centre, University Clinical Centre, Ljubljana, Slovenia
| | - Piero Pollesello
- Critical Care Proprietary Products, Orion Pharma, Espoo, Finland.
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Nuche J, Palomino-Doza J, Ynsaurriaga FA, Delgado JF, Ibáñez B, Oliver E, Subías PE. Potential Molecular Pathways Related to Pulmonary Artery Aneurysm Development: Lessons to Learn from the Aorta. Int J Mol Sci 2020; 21:ijms21072509. [PMID: 32260370 PMCID: PMC7177585 DOI: 10.3390/ijms21072509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease caused by pulmonary vascular remodeling. Current vasodilator treatments have substantially improved patients’ survival. This improved survival has led to the appearance of complications related to conditions previously underdiagnosed or even ignored, such as pulmonary artery aneurysm (PAA). The presence of a dilated pulmonary artery has been shown to be related to an increased risk of sudden cardiac death among PAH patients. This increased risk could be associated to the development of left main coronary artery compression or pulmonary artery dissection. Nevertheless, very little is currently known about the molecular mechanisms related to PAA. Thoracic aortic aneurysm (TAA) is a well-known condition with an increased risk of sudden death caused by acute aortic dissection. TAA may be secondary to chronic exposure to classic cardiovascular risk factors. In addition, a number of genetic variants have been shown to be related to a marked risk of TAA and dissection as part of multisystemic syndromes or isolated familial TAA. The molecular pathways implied in the development of TAA have been widely studied and described. Many of these molecular pathways are involved in the pathogenesis of PAH and could be involved in PAA. This review aims to describe all these common pathways to open new research lines that could help lead to a better understanding of the pathophysiology of PAH and PAA and their clinical implications.
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Affiliation(s)
- Jorge Nuche
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Julián Palomino-Doza
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Juan F. Delgado
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Borja Ibáñez
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Eduardo Oliver
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
| | - Pilar Escribano Subías
- Centro de Investigaciones Biomédicas en Red de enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain; (J.N.); (J.P.-D.); (F.A.Y.); (J.F.D.); (B.I.)
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: (E.O.); (P.E.S.)
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Cottet C, Ramirez-Tapias YA, Delgado JF, de la Osa O, Salvay AG, Peltzer MA. Biobased Materials from Microbial Biomass and Its Derivatives. Materials (Basel) 2020; 13:E1263. [PMID: 32168751 PMCID: PMC7143539 DOI: 10.3390/ma13061263] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/15/2023]
Abstract
There is a strong public concern about plastic waste, which promotes the development of new biobased materials. The benefit of using microbial biomass for new developments is that it is a completely renewable source of polymers, which is not limited to climate conditions or may cause deforestation, as biopolymers come from vegetal biomass. The present review is focused on the use of microbial biomass and its derivatives as sources of biopolymers to form new materials. Yeast and fungal biomass are low-cost and abundant sources of biopolymers with high promising properties for the development of biodegradable materials, while milk and water kefir grains, composed by kefiran and dextran, respectively, produce films with very good optical and mechanical properties. The reasons for considering microbial cellulose as an attractive biobased material are the conformational structure and enhanced properties compared to plant cellulose. Kombucha tea, a probiotic fermented sparkling beverage, produces a floating membrane that has been identified as bacterial cellulose as a side stream during this fermentation. The results shown in this review demonstrated the good performance of microbial biomass to form new materials, with enhanced functional properties for different applications.
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Affiliation(s)
- Celeste Cottet
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
- Scientific Research Commission (CIC), B1900 La Plata, Buenos Aires, Argentina
| | - Yuly A. Ramirez-Tapias
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
- National Scientific and Technical Research Council (CONICET), C1425FQB CABA, Buenos Aires, Argentina
| | - Juan F. Delgado
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
- National Scientific and Technical Research Council (CONICET), C1425FQB CABA, Buenos Aires, Argentina
| | - Orlando de la Osa
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
| | - Andrés G. Salvay
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
| | - Mercedes A. Peltzer
- Materials Development and Evaluation Laboratory (LOMCEM), Department of Science and Technology, National University of Quilmes, B1876BXD Bernal, Argentina; (C.C.); (Y.A.R.-T.); (J.F.D.); (O.d.l.O.); (A.G.S.)
- National Scientific and Technical Research Council (CONICET), C1425FQB CABA, Buenos Aires, Argentina
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Barge-Caballero G, Castel-Lavilla MA, Almenar-Bonet L, Garrido-Bravo IP, Delgado JF, Rangel-Sousa D, González-Costello J, Segovia-Cubero J, Farrero-Torres M, Lambert-Rodríguez JL, Crespo-Leiro MG, Hervás-Sotomayor D, Portolés-Ocampo A, Martínez-Sellés M, De la Fuente-Galán L, Rábago-Juan-Aracil G, González-Vílchez F, Mirabet-Pérez S, Muñiz J, Barge-Caballero E. Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry. Interact Cardiovasc Thorac Surg 2020; 29:670-677. [PMID: 31257414 DOI: 10.1093/icvts/ivz155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). RESULTS There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). CONCLUSIONS In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
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Affiliation(s)
- Gonzalo Barge-Caballero
- Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Iris P Garrido-Bravo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Doce de Octubre, Instituto de Investigación i+12, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | | | - María G Crespo-Leiro
- Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Luis De la Fuente-Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Clínico Universitario, Valladolid, Spain
| | | | | | | | - Javier Muñiz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña (UDC), INIBIC, A Coruña, Spain
| | - Eduardo Barge-Caballero
- Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Dominguez F, Zorio E, Jimenez-Jaimez J, Salguero-Bodes R, Zwart R, Gonzalez-Lopez E, Molina P, Bermúdez-Jiménez F, Delgado JF, Braza-Boïls A, Bornstein B, Toquero J, Segovia J, Van Tintelen JP, Lara-Pezzi E, Garcia-Pavia P. Clinical characteristics and determinants of the phenotype in TMEM43 arrhythmogenic right ventricular cardiomyopathy type 5. Heart Rhythm 2020; 17:945-954. [PMID: 32062046 DOI: 10.1016/j.hrthm.2020.01.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy type V (ARVC-5) is the most aggressive heterozygous form of ARVC. It is predominantly caused by a fully penetrant mutation (p.S358L) in the nondesmosomal gene TMEM43-endemic to Newfoundland, Canada. To date, all familial cases reported worldwide share a common ancestral haplotype. It is unknown whether the p.S358L mutation by itself causes ARVC-5 or whether the disease is influenced by genetic or environmental factors. OBJECTIVE The purpose of this study was to examine the phenotype, clinical course, and the impact of exercise on patients with p.S358L ARVC-5 without the Newfoundland genetic background. METHODS We studied 62 affected individuals and 73 noncarriers from 3 TMEM43-p.S358L Spanish families. The impact of physical activity on the phenotype was also evaluated. RESULTS Haplotype analysis revealed that the 3 Spanish families were unrelated to patients with ARVC-5 with the Newfoundland genetic background. Two families shared 10 microsatellite markers in a 4.9 cM region surrounding TMEM43; the third family had a distinct haplotype. The affected individuals showed a 38.7% incidence of sudden cardiac death, which was higher in men. Left ventricular involvement was common, with 40% of mutation carriers showing a left ventricular ejection fraction of <50%. Compared with noncarriers, the R-wave voltage in lead V3 was lower (3.2 ± 2.8 mV vs 7.5 ± 3.6 mV; P < .001) and QRS complex in right precordial leads wider (104.7 ± 24.0 ms vs 88.2 ± 7.7 ms; P = .001). A history of vigorous exercise showed a trend toward more ventricular arrhythmias only in women (P = .053). CONCLUSION ARVC-5 is associated with a high risk of sudden cardiac death and characteristic clinical and electrocardiographic features irrespective of geographical origin and genetic background. Our data suggest that, as in desmosomal ARVC, vigorous physical activity could aggravate the phenotype of TMEM43 mutation carriers.
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Affiliation(s)
- Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - Esther Zorio
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario La Fe, Valencia, Spain; CAFAMUSME Research group, IIS La Fe, Valencia, Spain
| | - Juan Jimenez-Jaimez
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rafael Salguero-Bodes
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, i+12, Facultad de Medicina UCM, Madrid, Spain
| | - Robert Zwart
- Department of Genome Analysis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Gonzalez-Lopez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - Pilar Molina
- CAFAMUSME Research group, IIS La Fe, Valencia, Spain; Department of Pathology, Instituto de Medicina Legal y Ciencias Forenses and Histology Unit, Universitat de València, Valencia, Spain
| | | | - Juan F Delgado
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, i+12, Facultad de Medicina UCM, Madrid, Spain
| | - Aitana Braza-Boïls
- Department of Cardiology, Hospital Universitario La Fe, Valencia, Spain; CAFAMUSME Research group, IIS La Fe, Valencia, Spain
| | - Belen Bornstein
- Department of Biochemistry, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Jorge Toquero
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier Segovia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - J Peter Van Tintelen
- Department of Genetics, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Enrique Lara-Pezzi
- CIBERCV, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain.
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Nuche J, Salguero-Bodes R, Valverde-Gómez M, Delgado JF, Arribas-Ynsaurriaga F, Palomino-Doza J. Nueva mutación de la región conversora de la cadena pesada de la beta-miosina relacionada con miocardiopatía hipertrófica de mal pronóstico. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nuche J, Salguero-Bodes R, Valverde-Gómez M, Delgado JF, Arribas-Ynsaurriaga F, Palomino-Doza J. A new mutation affecting the converter region of the beta-myosin heavy chain related to hypertrophic cardiomyopathy with poor prognosis. Rev Esp Cardiol (Engl Ed) 2020; 73:180-183. [PMID: 31416728 DOI: 10.1016/j.rec.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jorge Nuche
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - María Valverde-Gómez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Juan F Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Fernando Arribas-Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Julián Palomino-Doza
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Spain.
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Delgado JF, Ferrero Gregori A, Fernández LM, Claret RB, Sepúlveda AG, Fernández-Avilés F, González-Juanatey JR, García RV, Otero MR, Segovia Cubero J, Pascual Figal D, Crespo-Leiro MG, Alvarez-García J, Cinca J, Ynsaurriaga FA. Patient-Associated Predictors of 15- and 30-Day Readmission After Hospitalization for Acute Heart Failure. Curr Heart Fail Rep 2019; 16:304-314. [DOI: 10.1007/s11897-019-00442-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Coma ME, Peltzer MA, Delgado JF, Salvay AG. Water kefir grains as an innovative source of materials: Study of plasticiser content on film properties. Eur Polym J 2019. [DOI: 10.1016/j.eurpolymj.2019.109234] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barge-Caballero E, González-Vílchez F, Delgado JF, Mirabet-Pérez S, González-Costello J, Pérez-Villa F, Martínez-Sellés M, Segovia-Cubero J, Hervás-Sotomayor D, Blasco-Peiró T, De la Fuente-Galán L, Lambert-Rodríguez JL, Rangel-Sousa D, Almenar-Bonet L, Garrido-Bravo IP, Rábago-Juan-Aracil G, Muñiz J, Crespo-Leiro MG. Empleo del balón de contrapulsación intraaórtico como puente al trasplante cardiaco en España: resultados del estudio ASIS-TC. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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46
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Siri M, Ruocco MJF, Achilli E, Pizzuto M, Delgado JF, Ruysschaert JM, Grasselli M, Alonso SDV. Effect of structure in ionised albumin based nanoparticle: Characterisation, Emodin interaction, and in vitro cytotoxicity. Mater Sci Eng C Mater Biol Appl 2019; 103:109813. [PMID: 31349435 DOI: 10.1016/j.msec.2019.109813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 01/22/2023]
Abstract
A γ-irradiated bovine albumin serum-based nanoparticle was characterised structurally, and functionally. The nanoparticle was characterised by A.F.M., D.L.S, zeta potential, T.E.M., gel-electrophoresis, and spectroscopy. We studied the stability of the nanoparticle at different pH values and against time, by fluorescence spectroscopy following the changes in the tryptophan environment in the nanoparticle. The nanoparticle was also functionalized with Folic Acid, its function as a nanovehicle was evaluated through its interaction with the hydrophobic drug Emodin. The binding and kinetic properties of the obtained complex were evaluated by biophysical methods as well as its toxicity in tumor cells. According to its biophysics, the nanoparticle is a spherical nanosized vehicle with a hydrodynamic diameter of 70 nm. Data obtained describe the nanoparticle as nontoxic for cancer cell lines. When combined with Emodin, the nanoparticle proved to be more active on MCF-7 cancer cell lines than the nanoparticle without Emodin. Significantly, the albumin aggregate preserves the main activity-function of albumin and improved characteristics as an excellent carrier of molecules. More than carrier properties, the nanoparticle alone induced an immune response in macrophages which may be advantageous in vaccine and cancer therapy formulation.
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Affiliation(s)
- Macarena Siri
- Laboratorio de Biomembranas (LBM), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, IMBICE-CONICET-CICPBA, Argentina
| | - Maria Julieta Fernandez Ruocco
- Laboratorio de Biomembranas (LBM), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, IMBICE-CONICET-CICPBA, Argentina; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Estefanía Achilli
- Laboratorio de Materiales Biotecnológicos (LaMaBio), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, IMBICE-CONICET-CICPBA, Argentina
| | - Malvina Pizzuto
- Laboratory of the Structure and Function of Biological Membranes, Center for Structural Biology and Bioinformatics, Université Libre de Bruxelles, CP 206/02, Bd du Triomphe, 1050 Brussels, Belgium
| | - Juan F Delgado
- Laboratorio de Obtención, Modificación, Caracterización y Evaluación de Materiales (LOMCEM), Conicet, Universidad Nacional de Quilmes, Argentina
| | - Jean-Marie Ruysschaert
- Laboratory of the Structure and Function of Biological Membranes, Center for Structural Biology and Bioinformatics, Université Libre de Bruxelles, CP 206/02, Bd du Triomphe, 1050 Brussels, Belgium
| | - Mariano Grasselli
- Laboratorio de Materiales Biotecnológicos (LaMaBio), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, IMBICE-CONICET-CICPBA, Argentina
| | - Silvia Del V Alonso
- Laboratorio de Biomembranas (LBM), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, IMBICE-CONICET-CICPBA, Argentina.
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González-Vílchez F, Delgado JF, Palomo J, Mirabet S, Díaz-Molina B, Almenar L, Arizón JM, Rangel-Sousa D, Pérez-Villa F, Garrido IP, de la Fuente L, Gómez-Bueno M, Sanz ML, Crespo-Leiro MG. Conversion From Immediate-Release Tacrolimus to Prolonged-Release Tacrolimus in Stable Heart Transplant Patients: A Retrospective Study. Transplant Proc 2019; 51:1994-2001. [PMID: 31227301 DOI: 10.1016/j.transproceed.2019.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lifelong adherence with post-transplant immunosuppression is challenging, with nonadherence associated with greater acute rejection (AR) risk. METHODS This retrospective study evaluated conversion from immediate-release tacrolimus (IRT) to prolonged-release tacrolimus (PRT), between January 2008 and December 2012 in stable adult heart transplant recipients. Cumulative incidence rate (IR) of AR and infection pre- and postconversion, safety, tacrolimus dose and trough levels, concomitant immunosuppression, and PRT discontinuation were analyzed (intention-to-treat population). RESULTS Overall, 467 patients (mean age, 59.3 [SD, 13.3] years) converted to PRT at 5.1 (SD, 4.9) years post transplant and were followed for 3.4 (SD, 1.5) years. During the 6 months post conversion, 5 patients (1.1%; 95% CI, 0.35%-2.48%) had an AR episode and IR was 2.2/100 patient-years (95% CI, 0.91-5.26). Incidence of rejection preconversion varied by time from transplant to conversion. Infection IR was similar post- and preconversion (9.2/100 patient-years [95% CI, 7.4-11.3] vs 10.6/100 patient-years [95% CI, 8.8-12.3], respectively; P = .20). Safety variables remained similar post conversion. The IR of mortality/graft loss was 2.3/100 patient-years (95% CI, 1.7-3.1). CONCLUSIONS Conversion from IRT to PRT in heart transplant recipients in Spain was associated with no new safety concerns and appropriate immunosuppressive effectiveness.
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Affiliation(s)
- Francisco González-Vílchez
- Registro Español de Transplante Cardiaco, Sección de Insuficiencia Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Transplante Cardiaco, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Juan F Delgado
- Hospital Universitario 12 de Octubre, CIBERCV, UCM, Madrid, Spain
| | - Jesús Palomo
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Luis Almenar
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Iris P Garrido
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luis de la Fuente
- Hospital Universitario Clínico de Valladolid, CIBERCV, Valladolid, Spain
| | | | - María L Sanz
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Transplante Cardiaco, Servicio de Cardiologia, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), CIBERCV, As Xubias, A Coruña, Spain
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48
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López-Gil M, Fontenla A, Delgado JF, Rodríguez-Muñoz D. Subcutaneous implantable cardioverter defibrillators in patients with left ventricular assist devices: case report and comprehensive review. Eur Heart J Case Rep 2019; 3:5481191. [PMID: 31449611 PMCID: PMC6601396 DOI: 10.1093/ehjcr/ytz057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/06/2019] [Indexed: 12/03/2022]
Abstract
Background Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, many of whom have been or will be implanted with an implantable cardioverter defibrillator (ICD). Interaction between both devices is a matter of concern. Subcutaneous ICD (S-ICD) obtains its signals through subcutaneous vectors, which poses special challenges with regards to adequate performance following LVAD implantation. Case summary We describe the case of a 24-year-old man implanted with an S-ICD because of idiopathic dilated cardiomyopathy, severe biventricular dysfunction, and self-limiting sustained ventricular tachycardias. After the implantation of a HeartMate 3™ (Left Ventricular Assist System, Abbott) several months later, the S-ICD became useless because of inappropriate sensing due to electromagnetic interference and attenuation of QRS voltage. Discussion We reviewed the reported cases in PubMed about the concomitant use of S-ICD and LVAD. Seven case reports about the performance of S-ICD in patients with an LVAD were identified, with discordant results. From these articles, we analyse the potential causes for these differing results. Pump location and operating rates in LVAD, as well as changes in the subcutaneous-electrocardiogram detected by the S-ICD after LVAD implantation are related to sensing disturbances when used in the same patient.
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Affiliation(s)
- María López-Gil
- Cardiac Electrophysiology & Arrhythmia Unit, Cardiology Department, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain.,I+12 Investigation Institute, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain
| | - Adolfo Fontenla
- Cardiac Electrophysiology & Arrhythmia Unit, Cardiology Department, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain.,I+12 Investigation Institute, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain
| | - Juan F Delgado
- I+12 Investigation Institute, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain.,Heart Failure and Heart Transplantation Program, Cardiology Department, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Avda. de Séneca, 2 Madrid, Spain.,CIBER CV, C/ Melchor Fernández Almagro 3, Madrid, Spain
| | - Daniel Rodríguez-Muñoz
- Cardiac Electrophysiology & Arrhythmia Unit, Cardiology Department, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain
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49
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Navarro-García JA, Delgado C, Fernández-Velasco M, Val-Blasco A, Rodríguez-Sánchez E, Aceves-Ripoll J, Gómez-Hurtado N, Bada-Bosch T, Mérida-Herrero E, Hernández E, Praga M, Salguero R, Solís J, Arribas F, Delgado JF, Bueno H, Kuro-O M, Ruilope LM, Ruiz-Hurtado G. Fibroblast growth factor-23 promotes rhythm alterations and contractile dysfunction in adult ventricular cardiomyocytes. Nephrol Dial Transplant 2019; 34:1864-1875. [DOI: 10.1093/ndt/gfy392] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Cardiac dysfunction and arrhythmia are common and onerous cardiovascular events in end-stage renal disease (ESRD) patients, especially those on dialysis. Fibroblast growth factor (FGF)-23 is a phosphate-regulating hormone whose levels dramatically increase as renal function declines. Beyond its role in phosphorus homeostasis, FGF-23 may elicit a direct effect on the heart. Whether FGF-23 modulates ventricular cardiac rhythm is unknown, prompting us to study its role on excitation–contraction (EC) coupling.
Methods
We examined FGF-23 in vitro actions on EC coupling in adult rat native ventricular cardiomyocytes using patch clamp and confocal microscopy and in vivo actions on cardiac rhythm using electrocardiogram.
Results
Compared with vehicle treatment, FGF-23 induced a significant decrease in rat cardiomyocyte contraction, L-type Ca2+ current, systolic Ca2+ transients and sarcoplasmic reticulum (SR) load and SR Ca2+-adenosine triphosphatase 2a pump activity. FGF-23 induced pro-arrhythmogenic activity in vitro and in vivo as automatic cardiomyocyte extracontractions and premature ventricular contractions. Diastolic spontaneous Ca2+ leak (sparks and waves) was significantly increased by FGF-23 via the calmodulin kinase type II (CaMKII)-dependent pathway related to hyperphosphorylation of ryanodine receptors at the CaMKII site Ser2814. Both contraction dysfunction and spontaneous pro-arrhythmic Ca2+ events induced by FGF-23 were blocked by soluble Klotho (sKlotho).
Conclusions
Our results show that FGF-23 reduces contractility and enhances arrhythmogenicity through intracellular Ca2+ mishandling. Blocking its actions on the heart by improving sKlotho bioavailability may enhance cardiac function and reduce arrhythmic events frequently observed in ESRD.
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Affiliation(s)
- José Alberto Navarro-García
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Delgado
- Biomedical Research Institute Alberto Sols (CSIC-UAM)/CIBER-CV, Madrid, Spain
| | | | | | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jennifer Aceves-Ripoll
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Teresa Bada-Bosch
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eduardo Hernández
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Praga
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Solís
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Juan F Delgado
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Héctor Bueno
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Makoto Kuro-O
- Division of Anti-ageing Medicine, Centre for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Luis Miguel Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
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Pölzl G, Allipour Birgani S, Comín-Colet J, Delgado JF, Fedele F, García-Gonzáles MJ, Gustafsson F, Masip J, Papp Z, Störk S, Ulmer H, Vrtovec B, Wikström G, Altenberger J. Repetitive levosimendan infusions for patients with advanced chronic heart failure in the vulnerable post-discharge period. ESC Heart Fail 2018; 6:174-181. [PMID: 30378288 PMCID: PMC6351894 DOI: 10.1002/ehf2.12366] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/16/2018] [Accepted: 08/30/2018] [Indexed: 12/11/2022] Open
Abstract
Hospitalization for acute heart failure (HF) is associated with a substantial morbidity burden and with associated healthcare costs and an increased mortality risk. However, few if any major medical innovations have been witnessed in this area in recent times. Levosimendan is a first‐in‐class calcium sensitizer and potassium channel opener indicated for the management of acute HF. Experience in several clinical studies has indicated that administration of intravenous levosimendan in intermittent cycles may reduce hospitalization and mortality rates in patients with advanced HF; however, none of those trials were designed or powered to give conclusive insights into that possibility. This paper describes the rationale and protocol of LeoDOR (levosimendan infusions for patients with advanced chronic heart failure), a randomized, double‐blind, placebo‐controlled, international, multicentre trial that will explore the efficacy and safety of intermittent levosimendan therapy, in addition to optimized standard therapy, in patients following hospitalization for acute HF. Salient features of LeoDOR include the use of two treatment regimens, in order to evaluate the effects of different schedules and doses of levosimendan during a 12 week treatment phase, and the use of a global rank primary endpoint, in which all patients are ranked across three hierarchical groups ranging from time to death or urgent heart transplantation or implantation of a ventricular assist device to time to rehospitalization and, lastly, time‐averaged proportional change in N‐terminal pro‐brain natriuretic peptide. Secondary endpoints include changes in HF symptoms and functional status at 14 weeks.
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Affiliation(s)
- Gerhard Pölzl
- Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | | | - Josep Comín-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Delgado
- Department of Cardiology, University Hospital 12 de Octubre, CIBERCV, Madrid, Spain
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Zoltán Papp
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan Störk
- Department of Internal Medicine and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Hanno Ulmer
- Department for Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Bojan Vrtovec
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gerhard Wikström
- Department of Cardiology, Institute of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Johann Altenberger
- Cardiac Rehabilitation Center Grossgmain, Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical Private University, Salzburg, Austria
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