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Mullens W, Damman K, Dhont S, Banerjee D, Bayes-Genis A, Cannata A, Chioncel O, Cikes M, Ezekowitz J, Flammer AJ, Martens P, Mebazaa A, Mentz RJ, Miró Ò, Moura B, Nunez J, Ter Maaten JM, Testani J, van Kimmenade R, Verbrugge FH, Metra M, Rosano GMC, Filippatos G. Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024. [PMID: 38606657 DOI: 10.1002/ejhf.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
Sodium and fluid restriction has traditionally been advocated in patients with heart failure (HF) due to their sodium and water avid state. However, most evidence regarding the altered sodium handling, fluid homeostasis and congestion-related signs and symptoms in patients with HF originates from untreated patient cohorts and physiological investigations. Recent data challenge the beneficial role of dietary sodium and fluid restriction in HF. Consequently, the European Society of Cardiology HF guidelines have gradually downgraded these recommendations over time, now advising for the limitation of salt intake to no more than 5 g/day in patients with HF, while contemplating fluid restriction of 1.5-2 L/day only in selected patients. Therefore, the objective of this clinical consensus statement is to provide advice on fluid and sodium intake in patients with acute and chronic HF, based on contemporary evidence and expert opinion.
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Affiliation(s)
- Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Hasselt, Belgium
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sebastiaan Dhont
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Hasselt, Belgium
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Antonio Cannata
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases, University of Medicine Carol Davila, Bucharest, Romania
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Center Zagreb, Zagreb, Croatia
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Òscar Miró
- Department of Emergency, Hospital Clínic, 'Processes and Pathologies, Emergencies Research Group' IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Brenda Moura
- Hospital das Forças Armadas and Cintesis - Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Julio Nunez
- Cardiology Department and Heart Failure Unit, Hospital Clínico Universitario de Valencia, University of Valencia, INCLIVA, Valencia, Spain
| | - Jozine M Ter Maaten
- University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jeffrey Testani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Marco Metra
- Cardiology, ASST Spedali Civili, and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Cardiology Clinical Academic Group, Molecular and Clinical Research Institute, St Georges University of London, London, UK
- Cardiology, San Raffaele Cassino, Rome, Italy
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Bodi V, Gavara J, Lopez-Lereu MP, Monmeneu JV, de Dios E, Perez-Sole N, Bonanad C, Marcos-Garces V, Canoves J, Minana G, Nunez J, Moratal D, Chorro FJ, Rodríguez-Palomares JF, Freixa A, Borrás R, Ortiz-Pérez JT, Rios-Navarro C. Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A CMR Study. JACC Cardiovasc Imaging 2023:S1936-878X(23)00094-3. [PMID: 37052556 DOI: 10.1016/j.jcmg.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Little is known about the occurrence and implications of persistent microvascular obstruction (MVO) after reperfused ST-segment elevation myocardial infarction (STEMI). OBJECTIVES The authors used cardiac magnetic resonance (CMR) to characterize the impact of persistent MVO on adverse left ventricular remodeling (ALVR). METHODS A prospective registry of 471 STEMI patients underwent CMR 7 (IQR: 5-10) days and 198 (IQR: 167-231) days after infarction. MVO (≥1 segment) and ALVR (relative increase >15% at follow-up CMR) of left ventricular end-diastolic index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were determined. RESULTS One-week MVO occurred in 209 patients (44%) and persisted in 30 (6%). Extent of MVO (P = 0.026) and intramyocardial hemorrhage (P = 0.001) at 1 week were independently associated with the magnitude of MVO at follow-up CMR. Compared with patients without MVO (n = 262, 56%) or with MVO only at 1 week (n = 179, 38%), those with persistent MVO at follow-up (n = 30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, 50%; P = 0.003) and ALVR-LVESVI (20%, 21%, 53%; P < 0.001). After adjustment, persistent MVO at follow-up (≥1 segment) was independently associated with ΔLVEDVI (relative increase, %) (P < 0.001) and ΔLVESVI (P < 0.001). Compared with a 1:1 propensity score-matched population on CMR variables made up of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs 50%; P = 0.003) and ALVR-LVESVI (12% vs 53%; P = 0.001). CONCLUSIONS MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodeling. These findings fuel the need for further research on microvascular injury repair.
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Affiliation(s)
- Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
| | - Jose Gavara
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | | | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Grupo ASCIRES, Valencia, Spain
| | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Nerea Perez-Sole
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Victor Marcos-Garces
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Joaquim Canoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Freixa
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Roger Borrás
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
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3
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Marcos-Garcés V, Perez N, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Merenciano-González H, Gabaldon-Pérez A, Ferrero-De-Loma-Osorio Á, Martínez-Brotons Á, Bondanza L, Sánchez-Gómez JM, Albiach C, Nunez J, Bayés-Genís A, Chorro FJ, Ruiz-Granell R, Bodi V. Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients. Front Cardiovasc Med 2023; 10:991307. [PMID: 36818338 PMCID: PMC9937054 DOI: 10.3389/fcvm.2023.991307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Implantable cardioverter defibrillators (ICD) are effective as a primary prevention measure of ventricular tachyarrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) and depressed left ventricular ejection fraction (LVEF). The implications of using cardiac magnetic resonance (CMR) instead of echocardiography (Echo) to assess LVEF prior to the indication of ICD in this setting are unknown. Materials and methods We evaluated 52 STEMI patients (56.6 ± 11 years, 88.5% male) treated with ICD in primary prevention who underwent echocardiography and CMR prior to ICD implantation. ICD implantation was indicated based on the presence of heart failure and depressed LVEF (≤ 35%) by echocardiography, CMR, or both. Prediction of ICD therapies (ICD-T) during follow-up by echocardiography and CMR before ICD implantation was assessed. Results Compared to echocardiography, LVEF was lower by cardiac CMR (30.2 ± 9% vs. 37.4 ± 7.6%, p < 0.001). LVEF ≤ 35% was detected in 24 patients (46.2%) by Echo and in 42 (80.7%) by CMR. During a mean follow-up of 6.1 ± 4.2 years, 10 patients received appropriate ICD-T (3.16 ICD-T per 100 person-years): 5 direct shocks to treat very fast ventricular tachycardia or ventricular fibrillation, 3 effective antitachycardia pacing (ATP) for treatment of ventricular tachycardia, and 2 ineffective ATP followed by shock to treat ventricular tachycardia. Echo-LVEF ≤ 35% correctly predicted ICD-T in 4/10 (40%) patients and CMR-LVEF ≤ 35% in 10/10 (100%) patients. CMR-LVEF improved on Echo-LVEF for predicting ICD-T (area under the curve: 0.76 vs. 0.48, p = 0.04). Conclusion In STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | - Nerea Perez
- INCLIVA Health Research Institute, Valencia, Spain
| | - Jose Gavara
- INCLIVA Health Research Institute, Valencia, Spain,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Maria P. Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - Jose V. Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Hector Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | - Ana Gabaldon-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | | | | | - Lourdes Bondanza
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cristina Albiach
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco J. Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Ruiz-Granell
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain,*Correspondence: Vicente Bodi,
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4
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Gabaldon-Perez A, Bonanad C, Garcia-Blas S, Marcos-Garcés V, D’Gregorio JG, Fernandez-Cisnal A, Valero E, Minana G, Merenciano-González H, Mollar A, Bodi V, Nunez J, Sanchis J. Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older Adults. J Clin Med 2023; 12:jcm12031181. [PMID: 36769828 PMCID: PMC9918164 DOI: 10.3390/jcm12031181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
A non-neglectable percentage of patients with non-ST elevation myocardial infarction (NSTEMI) show non-obstructive coronary arteries (MINOCA). Specific data in older patients are scarce. We aimed to identify the clinical predictors of MINOCA in older patients admitted for NSTEMI and to explore the long-term prognosis of MINOCA. This was a single-center, observational, consecutive cohort study of older (≥70 years) patients admitted for NSTEMI between 2010 and 2014 who underwent coronary angiography. Univariate and multivariate Cox regression were performed to analyze the association of variables with MINOCA and all-cause mortality and with major adverse cardiac events (MACE), defined as a combined endpoint of all-cause mortality and nonfatal myocardial infarction and a combined endpoint of cardiovascular mortality, nonfatal myocardial infarction, and unplanned revascularization. The registry included 324 patients (mean age 78.8 ± 5.4 years), of which 71 (21.9%) were diagnosed with MINOCA. Predictors of MINOCA were female sex, left bundle branch block, pacemaker rhythm, chest pain at rest, peak troponin level, previous MI, Killip ≥2, and ST segment depression. Regarding prognosis, patients with obstructive coronary arteries (stenosis ≥50%) and the subgroup of MINOCA patients with plaques <50% had a similar prognosis; while MINOCA patients with angiographically smooth coronary arteries had a reduced risk of MACE. We conclude that the following: (1) in elderly patients admitted for NSTEMI, certain universally available clinical, electrocardiographic, and analytical variables are associated with the diagnosis of MINOCA; (2) elderly patients with MINOCA have a better prognosis than those with obstructive coronary arteries; however, only those with angiographically smooth coronary arteries have a reduced risk of all-cause mortality and MACE.
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Affiliation(s)
- Ana Gabaldon-Perez
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-961-973-500
| | - Sergio Garcia-Blas
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Víctor Marcos-Garcés
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Jessika Gonzalez D’Gregorio
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Agustín Fernandez-Cisnal
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Gema Minana
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Héctor Merenciano-González
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Anna Mollar
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Vicente Bodi
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Julio Nunez
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
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5
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Aimo A, Lupon J, Spitaleri G, Domingo M, Codina P, Santiago-Vacas E, Cediel G, Zamora E, Troya MI, Santesmases J, Romero-Gonzalez GA, Nunez J, Martini N, Emdin M, Bayes-Genis A. Global warming, renal function and heart failure: a 20-year follow-up study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a growing concern about the possible effects of global warming on human health. In HF outpatients, renal function significantly worsens during summer. More specific analyses on the impact of increasing temperatures on body homeostasis are lacking.
Purpose
We investigated the relationship between the trend of temperatures from 2002 to 2021 and renal function in heart failure (HF) outpatients.
Methods
All creatinine and estimated glomerular filtration rate (eGFR) values of HF outpatients followed at one tertiary hospital in a Mediterranean area of Spain were retrieved from electronic health records. eGFR was calculated through the CKD-EPI formula. Temperature data from the local municipality were derived from the Meteocat service; as temperatures from the years 2004–2005 were not available, these years were not analysed. Summer was defined as the timespan from June to September included. We calculated average values of creatinine and eGFR during summer and the rest of the same year, considering each patient and each year. Similarly, we averaged temperature values during summer and the rest of the same year.
Results
We derived 6,307 couples of average creatinine/eGFR values in summer and in the rest of the year from 2,194 patients. Across all the years (2002–2003 and 2006–2021), creatinine was slightly higher in summer than in the rest of the year (1.26 vs. 1.21 mg/dL, p<0.001), and eGFR was lower (65 vs. 67 mL/min/1.73 m2, p<0.001). Temperatures in summer and the rest of the year increased gradually, albeit not linearly, from 2002 to 2021 (Figure 1). The absolute (Δ) and percent changes (Δ%) in median temperatures between summer and the rest of the year increased across years (r=0.149, p=0.001 and r=0.144, p=0.002, respectively), as well as Δ and Δ% of the monthly median of maximal temperatures (r=0.119, p<0.001 and r=0.052, p<0.001, respectively) (Figure 1). The Δ and Δ% temperatures between summer and the rest of the year displayed several significant correlations with Δ and Δ% creatinine and eGFR after adjusting for several variables including age, sex, HF therapies, and creatinine outside of summer (Figure 2).
Conclusions
Over a 20-year timespan there has been an increase in 1) temperatures in summer and in the rest of the year, and 2) the temperature excursion between summer and the rest of the year. Changes in temperatures between summer and the rest of the year correlated with the magnitude of the decrease in renal function during summer, likely because of worse dehydration with higher temperatures. Therefore, the progressive rise in temperature may have detrimental effects on renal function during summer in HF outpatients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Aimo
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Codina
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Zamora
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M I Troya
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | | | - J Nunez
- INCLIVA Foundation , Valencia , Spain
| | - N Martini
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
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6
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Gavara J, Rios Navarro C, Lopez-Lereu MP, Monmeneu JV, De Dios E, Perez-Sole N, Marcos-Garces V, Canoves J, Nunez J, Chorro FJ, Rodriguez-Palomares JF, Freixa A, Borras R, Ortiz-Perez JT, Bodi V. Impact of persistent MVO late after STEMI on adverse left ventricular remodelling: a CMR study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite successful revascularization at the epicardial level, microvascular obstruction (MVO) appears soon after reperfusion in up to 50% of cases. Early MVO has been solidly associated with adverse resulting cardiac structure and heightened risk of future cardiovascular events. Although clinical and experimental studies demostrated the spontaneous repair of MVO, little is known about the occurrence and implications of persistent MVO late after infarction.
Purpose
We used cardiovascular magnetic resonance (CMR) to characterize the impact of persistent MVO late after reperfused ST-segment elevation myocardial infarction (STEMI) on adverse left ventricular (LV) remodelling (ALVR).
Methods
A prospective registry of 471 STEMI patients underwent CMR 7 [5–10] and 198 [167–231] days post infarction, and MVO (>1 segment) and ALVR (relative increase >15% at follow-up CMR) of LV end-diastolic (LVEDVI) and end-systolic volume indices (LVESVI) were determined.
Results
One-week MVO occurred in 209 patients (44%) and persisted in 30 of these (6%). Most patients with persistent MVO (22/30, 73%) displayed extensive (>2.5% of LV mass) MVO at 1 week. Compared with patients without MVO (n=262, 56%) or with MVO only at 1 week (n=179, 38%), those with persistent MVO at follow-up (n=30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, 50% p=0.003) and ALVR-LVESVI (20%, 21%, 53% p<0.001). After adjustment, the extent (% of LV mass) of MVO at follow-up was independently associated with ΔLVEDVI (relative increase, %) (p=0.01) and ΔLVESVI (p=0.03). Compared to a 1:1 matched population of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs. 50%, p=0.003) and ALVR-LVESVI (12% vs. 53%, p=0.001).
Conclusion
MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodelling. These findings fuel the need for further research on microvascular injury repair.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” [grant numbers PI20/00637, PI15/00531, FI18/00320, and CIBERCV16/11/00486] and by Conselleria de Educaciόn – Generalitat Valenciana (PROMETEO/2021/008).
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Affiliation(s)
- J Gavara
- Polytechnic University of Valencia , Valencia , Spain
| | - C Rios Navarro
- Research Foundation Hospital of Valencia (INCLIVA) , Valencia , Spain
| | | | | | - E De Dios
- University of Valencia , Valencia , Spain
| | - N Perez-Sole
- Research Foundation Hospital of Valencia (INCLIVA) , Valencia , Spain
| | - V Marcos-Garces
- Research Foundation Hospital of Valencia (INCLIVA) , Valencia , Spain
| | - J Canoves
- Hospital Clínico Universitario de Valencia , Valencia , Spain
| | - J Nunez
- Hospital Clínico Universitario de Valencia , Valencia , Spain
| | - F J Chorro
- Hospital Clínico Universitario de Valencia , Valencia , Spain
| | | | - A Freixa
- Barcelona Hospital Clinic , Barcelona , Spain
| | - R Borras
- Barcelona Hospital Clinic , Barcelona , Spain
| | | | - V Bodi
- Hospital Clínico Universitario de Valencia , Valencia , Spain
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Aimo A, Lupon J, Spitaleri G, Domingo M, Codina P, Santiago-Vacas E, Cediel G, Zamora E, Troya M, Santesmases J, Romero-Gonzalez GA, Nunez J, Martini N, Emdin M, Bayes-Genis A. Global warming, renal function and heart failure over 20 years. Int J Cardiol 2022; 365:100-105. [DOI: 10.1016/j.ijcard.2022.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022]
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Marcos-Garcés V, Perez N, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Merenciano-González H, Gabaldon-Pérez A, Cànoves J, Racugno P, Bonanad C, Minana G, Nunez J, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Pérez JT, Rodríguez-Palomares JF, Bodi V. Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction. Int J Cardiol 2021; 349:150-154. [PMID: 34826497 DOI: 10.1016/j.ijcard.2021.11.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients. METHODS We performed a multicenter prospective registry of reperfused STEMI patients (n = 1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, non-fatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failure (HF). RESULTS During a median follow-up of 5.52 [2.63-7.44] years, 216 first MACE (58 CV deaths, 71 NF-MI and 87 HF) were registered. Mean age was 59.3 ± 12.3 years and most patients (82.8%) were male. Based on the four variables independently associated with MACE, we computed an 8-point risk score: time to reperfusion >4.15 h (1 point), GRACE risk score > 155 (3 points), CMR-LVEF <40% (3 points), and MVO >1.5 segments (1 point). This score permitted MACE risk stratification: MACE per 100 person-years was 1.96 in the low-risk category (0-2 points), 5.44 in the intermediate-risk category (3-5 points), and 19.7 in the high-risk category (6-8 points): p < 0.001 in multivariable Cox survival analysis. CONCLUSIONS A novel risk score including clinical (time to reperfusion >4.15 h and GRACE risk score > 155) and CMR (LVEF <40% and MVO >1.5 segments) variables allows for simple and straightforward MACE risk stratification early after STEMI. External validation should confirm the applicability of the risk score.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain
| | - Nerea Perez
- Health Research Institute - INCLIVA, Valencia, Spain
| | - Jose Gavara
- Health Research Institute - INCLIVA, Valencia, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | | | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | | | - Ana Gabaldon-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Paolo Racugno
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Filipa Valente
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain; Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Health Research Institute - INCLIVA, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
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10
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Gavara J, Perez N, Marcos-Garces V, Monmeneu JV, Lopez-Lereu MP, Rios-Navarro C, De Dios E, Bonanad C, Cánoves J, Moratal D, Palau P, Miñana G, Nunez J, Chorro FJ, Bodi V. Combined assessment of stress cardiovascular magnetic resonance and angiography to predict the effect of revascularization in chronic coronary syndrome patients. Eur J Prev Cardiol 2021; 29:407-416. [PMID: 34686874 DOI: 10.1093/eurjpc/zwab170] [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] [Received: 07/01/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
AIMS The role of revascularization in chronic coronary syndrome (CCS) and the value of ischaemia vs. anatomy to guide decision-making are in constant debate. We explored the potential of a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance (CMR) and presence of multivessel disease by angiography to predict the effect of revascularization on all-cause mortality in CCS. METHODS AND RESULTS The study group comprised 1066 CCS patients submitted to vasodilator stress CMR pre-cardiac catheterization (mean age 66 ± 11 years, 69% male). Stress CMR-derived ischaemic burden (extensive if >5 ischaemic segments) and presence of multivessel disease in angiography (two- or three-vessel or left main stem disease) were computed. The influence of revascularization on all-cause mortality was explored and adjusted hazard ratios (HRs) with the corresponding 95% confidence intervals were obtained. During a median 7.51-year follow-up, 557 (52%) CMR-related revascularizations and 308 (29%) deaths were documented. Revascularization exerted a neutral effect on all-cause mortality in the whole study group [HR 0.94 (0.74-1.19), P = 0.6], in patients without multivessel disease [n = 598, 56%, HR 1.12 (0.77-1.62), P = 0.6], and in those with multivessel disease without extensive ischaemic burden [n = 181, 17%, HR 1.66 (0.91-3.04), P = 0.1]. However, compared to non-revascularized patients, revascularization significantly reduced all-cause mortality in patients with simultaneous multivessel disease and extensive ischaemic burden (n = 287, 27%): 3.77 vs. 7.37 deaths per 100 person-years, HR 0.60 (0.40-0.90), P = 0.01. CONCLUSIONS In patients with CCS submitted to catheterization, evidence of simultaneous extensive CMR-related ischaemic burden and multivessel disease identifies the subset in whom revascularization can reduce all-cause mortality.
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Affiliation(s)
- Jose Gavara
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain
| | - Nerea Perez
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain
| | - Victor Marcos-Garces
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), Calle del Marqués de San Juan 6, 46015 Valencia, Spain
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), Calle del Marqués de San Juan 6, 46015 Valencia, Spain
| | - Cesar Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain
| | - Elena De Dios
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Avenida Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Clara Bonanad
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Joaquim Cánoves
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain
| | - Patricia Palau
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Gema Miñana
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Julio Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Avenida Monforte de Lemos 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Avenida Monforte de Lemos 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Vicente Bodi
- Instituto de Investigacion Sanitaria INCLIVA, Calle de Menéndez y Pelayo 4, 46010 Valencia, Spain.,Department of Cardiology, Hospital Clinico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Avenida Monforte de Lemos 3-5, 28029 Madrid, Spain.,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
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11
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Wussler D, Bayes-Genis A, Belkin M, Strebel I, Kozhuharov N, Revuelta-Lopez E, Nowak A, Lupon J, Gualandro DM, Shrestha S, Breidthardt T, Nunez J, Mueller C. CA 125 in the diagnosis and risk stratification of acute heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent evidence confirms the elevation of CA 125 in non-tumor processes such as acute heart failure (AHF). However, the utility of this novel biomarker for diagnosis, prognosis, and therapy guidance in AHF remains unclear.
Purpose
To investigate the potential of CA 125 for diagnosis, prognosis and therapy guidance in unselected AHF patients presenting with acute dyspnea to the emergency department (ED).
Methods
We quantified CA 125 in a blinded fashion among patients presenting with acute dyspnea to the ED in a multicenter diagnostic study. Final diagnosis of AHF including AHF-phenotype was centrally adjudicated by two independent cardiologists. To further characterize CA 125's potential in AHF correlations with established biochemical and imaging markers were assessed. Diagnostic accuracy for AHF was quantified by the area under the receiver operating characteristic curve (AUC). All-cause mortality within 360 days was the prognostic endpoint.
Results
Among 470 patients eligible for this analysis, 268 (57.0%) had adjudicated AHF. CA 125 concentrations at presentation were significantly higher among AHF patients vs. patients with other final diagnoses (45.8 U/ml [interquartile range (IQR), 18.5–110.3] vs. 16.2 U/ml [IQR, 9.6–31.6], p<.001). Patients with worsening heart failure had significant higher CA 125 levels compared to other heart failure phenotypes (p=.018). There was a significant positive correlation of CA 125 and high-sensitivity cardiac troponin T and NTproBNP and a significant negative correlation of CA 125 and left ventricular ejection fraction (correlation coefficients 0.204, 0.220, −0.331, respectively; all ps<.001). CA 125's AUC for AHF was significantly lower compared to NTproBNP's in the overall population (0.72, 95% confidence interval (CI) 0.67–0.76 vs. 0.93, 95% CI 0.90–0.95, p<.001, Figure 1) and in predefined subgroups according to age, gender and renal function. Among 268 AHF patients, 84 (31.3%) died within 360 days of follow-up. CA 125 plasma concentrations above the median indicated increased risk of all-cause mortality (hazard ratio 2.06, 95% CI 1.31–3.24; p=.002, Figure 2). CA 125's prognostic accuracy for 360-days mortality was comparable with NT-proBNP's and high-sensitivity cardiac troponin T's. CA 125 did not independently predict all-cause mortality at 360 days when used in validated multivariable regression models and had no interactions with medical therapies at discharge.
Conclusion
CA 125 may aid physicians in the risk stratification and rapid triage of patients with suspected AHF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation Figure 1. ROC curve comparisonFigure 2. Kaplan-Meier curve 360 days mortality
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Affiliation(s)
- D Wussler
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Department of Cardiology, Badalona, Spain
| | - M Belkin
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - N Kozhuharov
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - E Revuelta-Lopez
- Germans Trias i Pujol Hospital, Servicio de Bioquimica, Badalona, Spain
| | - A Nowak
- University Hospital Zurich, Psychiatry, Zurich, Switzerland
| | - J Lupon
- Germans Trias i Pujol Hospital, Department of Cardiology, Badalona, Spain
| | - D M Gualandro
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - S Shrestha
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Breidthardt
- University Hospital Basel, Department of Internal Medicine, Basel, Switzerland
| | - J Nunez
- Hospital Clinico Universitario, Department of Cardiology, Valencia, Spain
| | - C Mueller
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
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12
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Escabia C, Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Alonso N, Troya M, Santesmases J, Crespo E, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in patients with type 2 diabetes and heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF) and type 2 diabetes mellitus (T2D).
Purpose
To prospectively assess dynamic trajectories of GFR estimated by CKD-EPI in a real-life cohort of HF patients based on the presence or absence of T2D over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the subgroups according to baseline T2D up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2386 patients were consecutively included from August 2001 to December 2018. 43.2% of the patients had a history of T2D. Mean age was 67.0±12.6 years, 28.9% were women and 71.0% had HF with reduced ejection fraction (EF<40%). 25080 eGFR values were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Diabetic patients had a worse baseline eGFR and presented a persistent decline over time. On the contrary non-diabetic patients presented an early decrease, mid-term improvement and a late progressive decline (Figure 1).
Conclusions
eGFR long-term trajectories in diabetic and non-diabetic patients with chronic HF were significantly different.
Funding Acknowledgement
Type of funding sources: None. eGFR evolution according to baseline T2D
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Affiliation(s)
- C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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13
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Spitaleri G, Cediel G, Santiago-Vacas E, Codina P, Domingo M, Zamora E, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Alonso N, Gonzalez B, Nunez J, Lupon J, Bayes-Genis A. Kidney function derangements during summer in ambulatory heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is characterized by alterations in kidney function that are associated with poor prognosis and can be related to the evolution of the disease or induced by medical treatment. High temperatures during summer may result in some degree of dehydration, especially in patients treated with diuretics, and may contribute to transient glomerular filtration rate (eGFR) reduction.
Objective
To assess creatinine and eGFR changes during summer in ambulatory heart failure patients.
Methods
Consecutive patients with HF admitted at our HF Clinic (Spain) from August 2001 to December 2020 were included. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We included in the analysis creatinine and eGFR values that were assessed at planned visits only, discarding urgent renal function assessments. Creatinine and eGFR values were grouped according to the period of the year (summer [from June to September, both included] vs. the rest of the year). Changes in creatinine and eGFR between the rest of the year and summer for each patient were evaluated using paired samples t-test.
Results
Out of 37360 creatinine and eGFR values, 25458 were included in the analysis for a total of 2423 patients (median number of observations for each patient: 8, IQR 4–15). Mean creatinine and eGFR were 1.4±1.0 mg/dl and 63.0±27.7 ml/min, respectively. Table 1 shows baseline patient characteristics. Creatinine increased significantly during summer (1.44±0.9 mg/dl vs. 1.48±1.1 mg/dl, p<0.001). Similarly, eGFR was lower in summer as compared to the rest of the year 60.6±25.4 ml/min vs. 59.4±26.0 ml/min, p<0.001.
Conclusions
In ambulatory HF patients in a Mediterranean area, we found significant worsening of renal function during summer, likely related to an imbalance between water intake and fluid loss. To prevent summer-driven kidney stress, diuretic treatment should be carefully adjusted during the hottest months of the year.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- G Spitaleri
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Santiago-Vacas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Troya
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
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14
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Marcos Garces V, Minana G, Nunez J, Monmeneu JV, Lopez-Lereu MP, Gavara J, Rios-Navarro C, Perez N, De Dios E, Fernandez-Cisnal A, Nunez E, Chorro FJ, Sanchis J, Bodi V. Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The prognostic value and therapeutic implications of ischemia as derived from vasodilator stress cardiovascular magnetic resonance (CMR) could differ in men and women, but it has not been stablished.
Purpose
We assessed the influence of the ischemic burden as derived from CMR on the risk of death and the effect of revascularization across sex.
Methods
We evaluated 6,237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used.
Results
A total of 2,371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularization. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived ischemic burden across sex (p-value for interaction=0.039). Women exhibited an adjusted lower risk of death along most of the continuous ischemic burden but equalled men's risk when extensive ischemia was present. Likewise, CMR-related revascularization was shown to be differentially associated with the risk of mortality across sex (p-value for interaction=0.025). In patients with non-extensive ischemia, revascularization was related to a higher risk of death, with a greater extent in women. At higher ischemic burden, revascularization was associated with a lower risk in men, with more uncertain results in women.
Conclusions
CMR-derived ischemic burden allows predicting the risk of death and gives insight into the potential effect of revascularization in men and women with CCS. Compared to men, women with nonextensive ischemia displayed a lower risk and a similar risk with a higher ischemic burden. The impact of CMR-related revascularization on mortality risk was also significantly different according to ischemic burden and sex.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the Instituto de Salud Carlos III and cofunded by the European Regional Development Fund (ERDF).
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Affiliation(s)
- V Marcos Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - G Minana
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - M P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - A Fernandez-Cisnal
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - E Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - F J Chorro
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
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15
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Lorenzo Hernandez M, Nunez J, Minana G, Palau P, Lopez-Lereu M, Monmeneu J, Marcos V, Rios-Navarro C, Gavara J, Perez N, De Dios E, Nunez G, Nunez E, Chorro F, Bodi V. Sex differences on new-onset heart failure in patients with known or suspected chronic coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The impact of sex in patients with chronic coronary syndrome (CCS) has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with CCS.
Objectives
We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected CCS undergoing vasodilator stress cardiac magnetic resonance (CMR).
Methods
We prospectively evaluated 5,899 consecutive HF-free patients submitted to stress CMR for known or suspected CCS. Ischemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional-hazards regression model adjusted for competing events (death, myocardial infarction, and non-CMR-related revascularization).
Results
A total of 2,289 (38.8%) patients were women, and 539 (9.1%) underwent CMR-related revascularization. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered a myocardial infarction, 420 (7.1%) underwent CMR-non-related revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs 0.83 per 100 person/years, p=0.002) (Figure 1). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (HR=1.61, 95% CI: 1.21–2.13, p=0.001). Compared with men, the risk of new-onset HF was higher in women with LVEF >53%.
Conclusions
Compared with men, women with CCS are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER) Figure 1
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Affiliation(s)
| | - J Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - G Minana
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - P Palau
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | | | | | - V Marcos
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - G Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - F.J Chorro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Bodi
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
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16
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Santas Olmeda E, Minana G, Palau P, De La Espriella R, Lorenzo M, Nunez G, Heredia R, Chorro FJ, Nunez J. Right heart dysfunction and readmission risk across left ventricular ejection fraction status in patients with acute heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Right heart dysfunction (RHD) parameters, such as right ventricular to pulmonary artery uncoupling or significant tricuspid regurgitation (TR) are increasingly important in heart failure (HF), especially in patients with preserved ejection fraction. In this study, we aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF).
Methods
We included 3,383 consecutive patients discharged for acute HF (AHF). Of them, in 1,435 (42.4%) pulmonary artery systolic pressure (PASP) could not be accurately measured, leaving a final sample size of 1,948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion (TAPSE)/PASP<0.36 and a significant functional TR (n=196, 10.2%). Negative binomial regression analyses were used to evaluate the risk of recurrent admissions.
Results
At a median follow up of 2.2 years (IQR=0.63–4.71), 3,782 readmissions were registered in 1,296 patients (66.5%). Patients with advanced RHD showed higher rates of readmissions, but only if LVEF≥40% (p<0.001). In multivariable analyses, this differential association persisted for CV and HF recurrent admissions (p-value for interaction=0.016 and p=0.020; respectively). Advanced RHD was independently associated with the risk of recurrent CV and HF admissions if HF with LVEF≥40% (IRR: 1.99, 95% CI: 1.47–2.69, p<0.001; and IRR: 2.02, 95% CI: 1.45–2.81, p<0.001; respectively). In contrast, it was not associated with readmission risks if LVEF<40%.
Conclusion
Following an admission for AHF, advanced RHD was strongly associated with a higher risk of recurrent CV and HF admissions, but only in patients with LVEF≥40%.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Santas Olmeda
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - G Minana
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - P Palau
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - R De La Espriella
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - M Lorenzo
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - G Nunez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - R Heredia
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - F J Chorro
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - J Nunez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
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17
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Bonanad C, Garcia-Blas S, Diez Villanueva P, Ariza A, Tarazona FJ, Bertomeu-Gonzalez V, Facila L, Torres J, Nunez J, Cordero A. Clinical benefit of direct oral anticoagulants vs. vitamin-K antagonist in octogenarians with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Direct oral anticoagulants (DOACs) have demonstrated to the be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with atrial fibrillation (AF). AF prevalence increases exponentially with age but octogenarians were underrepresented in clinical trials.
Methods
We performed a metanalysis with currently available studies that assessed the effect of DOACS vs. VKA in patients with age ≥80 and AF after performing a systematic search. The primary endpoints analyzed were stroke and all-cause death. Secondary endpoints were major bleeding, according to each study definitions, intracranial bleeding and gastrointestinal (GI) bleeding. The raw numbers of incident end-points reported in each study were used. A random effects model was selected because significant heterogeneity was observed; sensitivity analyses tested potential sources of heterogeneity, publication bias and the small-study effect.
Results
A total of 147,067 patients from 16 studies were included, 71,913 treated with DOACs and 75,154 with VKA. Inclusion criteria for the study was age ≥80 in 13 studies, ≥85 in two and ≥90 in one. Mean age of patients included all the studies was 86.2 (2.6) years. According to the study drug, 34,448 received rivaroxaban; 20,295 apixaban; 14,641 dabigatran, 492 edoxaban and; 2,037 any DOAC. No difference in mean age was observed according to the study drug.
Stroke incidence was available in the 16 studies. DOACs treatment was associated to 28% reduction of stroke (RR: 0.72 95% CI 0.63–0.82; p<0.001) (figure). All-cause mortality could be assessed in 12 studies and DOACs treatment was associated to 18% in mortality (RR: 0.82, 95% CI 0.70–0.96; p=0.012) (figure). DOACs treatment was not associated to reductions in major bleeding (RR: 0.85, 95% CI 0.69–1.04; p=0.108); in contrast, the highest effect of DOACs treatment was a 43% reduction of intracranial bleeding (RR: 0.47, 95% CI 0.36–0.60; p<0.001) (Figure 4). Finally, DOACs treatment was not associated higher of GI bleeding risk (RR: 1.08, 95% CI 0.76–1.53; p=0.678). Metaregression identified inclusion site in North-America (p<0.001), the ELDERCARE-AF results (p=0.023), control arm different than VKA (p=0.006) and the prevalence of hypertension (p=0.042) were outlined as main sources of heterogeneicity for stroke risk reduction. The type of DOAC was the main source of source of heterogeneicity for all-cause mortality (p<0.001) and major bleeding (p=0.03) risk reduction. No small-study effect was found for any endpoint except for intracranial bleeding (Harbor test p=0.029).
Conclusions
Treatment with DOACs in octogenarians reduces the incidence of stroke, all-cause mortality and intracranial bleeding as compared to VKA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Bonanad
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | - S Garcia-Blas
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - L Facila
- General University Hospital of Valencia Consortium, Valencia, Spain
| | - J Torres
- University Hospital of Jaen, Jaen, Spain
| | - J Nunez
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | - A Cordero
- University Hospital of San Juan, Alicante, Spain
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18
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Santiago-Vacas E, Domingo M, Codina P, Cediel G, Spitaleri G, Zamora E, Gual F, Teis A, Santesmases J, Velayos P, Pulido A, Crespo E, Nunez J, Lupon J, Bayes-Genis A. How predict right ventricular-pulmonary circulation coupling improvement in chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular-pulmonary circulation coupling (RVPAC), which can be measured by the relation between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) by echocardiography, has been postulated as an independent prognostic factor of hospitalizations and mortality in heart failure (HF) patients.
Purpose
Our aim was to know the predictors of RVPAC improvement in a chronic HF cohort.
Methods
Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit and 1 year. A TAPSE/SPAP ratio <0.36 mm/mmHg was identified as the most deleterious. Significant RVPAC improvement at 1 year was defined as TAPSE/SPAP ratio ≥0.36 mm/mmHg together with a ≥10% improvement from baseline RVPAC. Multivariable logistic regression analysis (conditional backward stepwise) was performed to select variables independently associated with significant RVPAC improvement. A predictive model including age and the previously selected variables was created.
Results
From August 2001 to July 2017, 554 patients with TAPSE and SPAP data in the initial visit were included. Mean follow-up time was 4.6±3.7 years. At first visit 252 (45.5%) patients had RVPAC <0.36 mm/mmHg. Out of them, RVPAC at 1 year improved in 55 (21.8%). In multivariable analysis, the presence of baseline atrial fibrillation/flutter (OR 0.12 [95% CI 0.05–0.28], p<0.001), SPAP (OR 0.96 [95% CI 0.92–0.99], p=0.014) and female gender (OR 0.34 [95% CI 0.12–0.91], p=0.03) were related to lesser probability of RVPAC improvement at 1 year. A model with such variables, together with age, showed an AUC of 0.824 to predict significant RVPAC improvement.
Conclusions
Atrial fibrillation/flutter, increasing SPAP and female gender hamper RVPAC improvement at 1 year in HF patients with baseline TAPSE/SPAP ratio <0.36.
Funding Acknowledgement
Type of funding sources: None. Multivariate regression analysis
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Affiliation(s)
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - F Gual
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Teis
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - P Velayos
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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19
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Iborra Egea O, Spitaleri G, Domingo M, Revuelta Lopez E, Codina P, Cediel G, Santiago Vacas E, Cserkoova A, Pascual Figal D, Nunez J, Lupon J, Bayes Genis A. Empagliflozin in heart failure with preserved ejection fraction: decoding its molecular mechanism of action using artificial intelligence. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Rationale The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) to treat heart failure with preserved ejection fraction (HFpEF) is under investigation in ongoing clinical trials, but the exact mechanism of action is unclear. Here we aimed to use artificial intelligence (AI) to characterize the mechanism of action of empagliflozin in HFpEF at the molecular level.
Methods
We retrieved information regarding HFpEF pathophysiological motifs and differentially expressed genes/proteins, together with empagliflozin target information and bioflags, from specialized publicly available databases. Artificial neural networks and deep learning AI were used to model the molecular effects of empagliflozin in HFpEF.
Results
The model predicted that empagliflozin could reverse 59% of the protein alterations found in HFpEF. The effects of empagliflozin in HFpEF appeared to be predominantly mediated by inhibition of NHE1 (Na+/H+ exchanger 1), with SGLT2 playing a less prominent role. The elucidated molecular mechanism of action had an accuracy of 94%. Empagliflozin's pharmacological action mainly affected cardiomyocyte oxidative stress modulation, and greatly influenced cardiomyocyte stiffness, myocardial extracellular matrix remodelling, heart concentric hypertrophy, and systemic inflammation. Validation of these in silico data was performed in vivo in patients with HFpEF by measuring the declining plasma concentrations of NOS2, the NLPR3 inflammasome, and TGF-β1 during 12 months of empagliflozin treatment.
Conclusion
Using AI modelling, we identified that the main effect of empagliflozin in HFpEF treatment is exerted via NHE1 and is focused on cardiomyocyte oxidative stress modulation. These results support the potential use of empagliflozin in HFpEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos IIICentro de investigaciόn biomédica en red cardiovascular (CIBERCV) Summary figureTable 1
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Affiliation(s)
- O Iborra Egea
- Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Revuelta Lopez
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | | | - A Cserkoova
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - D Pascual Figal
- Hospital Universitario Virgen Arrixaca, Cardiology, Murcia, Spain
| | - J Nunez
- University of Valencia, Cardiology, Valencia, Spain
| | - J Lupon
- University of Valencia, Cardiology, Valencia, Spain
| | - A Bayes Genis
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
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20
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Santas Olmeda E, Palau P, De La Espriella R, Minana G, Soler M, Lorenzo M, Nunez G, Chorro FJ, Nunez J. Sex-related differences in mortality following an admission for acute heart failure across left ventricular ejection fraction spectrum. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Prognosis in heart failure (HF) may differ between women and men. However, data is conflicting and sex-related differences in prognosis may be determined by left ventricular ejection fraction (LVEF) status. We sought to evaluate the prognostic differences between women and men with HF following an admission for acute HF (AHF).
Methods
We included 4,812 patients consecutively admitted for AHF in a multicenter registry from 3 hospitals in Valencia (Spain). Study endpoints were all-cause, cardiovascular (CV), and HF-related mortality at 6-months follow-up. Multivariable Cox regression models were fitted to investigate sex-related differences across LVEF status.
Results
2,243 (46.6%) patients were women and 2,569 (53.4%) were men. 2,608 (54.2%) patients had HF with preserved ejection fraction. At 6-months follow-up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) CV and HF-related deaths, respectively. LVEF was not independently associated to mortality risk (HR=1.02; 95% CI 0.99–1.05; p=0.135). After multivariate adjustment, we found no sex-related differences in all-cause mortality (p-value for interaction=0.168). However, a significant interaction between sex and the risk of CV and HF mortality was found across LVEF status (p-value for interaction= 0.030 and 0.007; respectively). Compared to men, women had a significant lower risk of CV-mortality and HF-mortality at LVEF<25% and <42%, respectively. On the contrary, women showed a higher risk of HF-mortality at the upper extreme of LVEF (>75%) (Figure, panel A and B).
Conclusions
Following an admission for AHF, no sex-related differences were found in the risk of all-cause mortality. However, compared to men, women showed a lower risk of CV and HF-mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF-death at the upper extreme.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Santas Olmeda
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - P Palau
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - R De La Espriella
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - G Minana
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - M Soler
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - M Lorenzo
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - G Nunez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - F J Chorro
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - J Nunez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
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21
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Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Santesmases J, Troya M, Escabia C, Gonzalez B, Rivas C, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF).
Purpose
To assess the GFR dynamics estimated by CKD-EPI in a real-life cohort of HF patients over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the whole cohort and subgroups according to vital status up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2423 patients were consecutively included from August 2001 to December 2018. Mean age was 67.0±12.7 years, 28,8% were women and 71.1% had HF with reduced ejection fraction (EF<40%). Out of 37360 eGFR values, 25458 were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Significant changes occurred along the whole trajectory. An initial decline in eGFR was observed during the first three years of follow-up. Subsequently, there was an upward trend during the following five years and after that period a progressive decline was seen until the end of follow-up (Figure 1). In the sub-group of patients who died during follow-up the eGFR slope showed a persistent decline over time of ∼1ml/min/1.73m2 per year. On the contrary, patients who survived to follow-up maintained a stable eGFR (Figure 2).
Conclusions
The eGFR long-term trajectory in patients with chronic HF showed a snaky pattern with an early decrease, mid-term improvement and late progressive decline. Patients who died during follow-up presented a progressive decline from the beginning.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Long-term evolution of eGFRFigure 2. eGFR evolution according to vital status
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Affiliation(s)
| | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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22
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Reese-Petersen AL, Willumsen N, Palau P, Nunez J, Sun S, Jensen TM, Kamall B, Karsdal MA, Genovese F. Evaluation of a novel biomarker of type XXVIII collagen formation, PRO-C28, in samples from cancer and heart failure with preserved ejection fraction patients. J Pharm Biomed Anal 2021; 204:114272. [PMID: 34358813 DOI: 10.1016/j.jpba.2021.114272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Abstract
Increased turnover of extracellular matrix proteins is seen in many different diseases and is an underlying and driving feature of pathogenesis. An increased ratio of formation over degradation of extracellular matrix proteins, such as collagens, leads to accumulation of proteins in the tissues, ultimately impairing organ function. Understanding how this balance is regulated is key to providing deeper insight into high extracellular matrix turnover diseases. Type XXVIII collagen is a novel collagen with limited information available in relation to expression, tissue prevalence and clinical implication. We generated a novel, technically robust ELISA to measure a C-terminal fragment of type XXVIII collagen in plasma and serum (PRO-C28). PRO-C28 was found to be significantly elevated in circulation in patients with heart failure with preserved ejection fraction (HFpEF) and in patients with lung cancer. Additionally, PRO-C28 correlated significantly to NT-proBNP levels in HFpEF patients. PRO-C28 levels were elevated in diseases characterized by high ECM-turnover. This suggests that type XXVIII collagen may play a role in fibroproliferative disorders in the heart and the lungs.
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Affiliation(s)
| | | | - Patricia Palau
- Servicio de Cardiología, Hospital General de Castellón, Universitat Jaume I, Castellón, Spain
| | - Julio Nunez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Shu Sun
- Nordic Bioscience A/S, Biomarkers and Research, Herlev, Denmark
| | | | - Bibi Kamall
- Nordic Bioscience A/S, Biomarkers and Research, Herlev, Denmark
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23
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Bonanad Lozano C, Gabaldon-Perez A, Garcia-Blas S, Gavara J, Rios-Navarro C, Perez-Sole N, De Dios E, Marcos-Garces V, Merenciano-Gonzalez H, Monmeneu-Menadas JV, Lopez-Lereu MP, Nunez J, Chorro FJ, Bodi V. Stress cardiovascular magnetic resonance and mortality in a registry of 2496 elderly patients with chronic coronary syndrome. Prognosis and decision-making. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional (FEDER)
Introduction and objectives. Management of the elderly with chronic coronary syndrome (CCS) is challenging. We explore the prognostic value and the usefulness for decision-making of the ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS.
Methods. The study group was made up of 2496 patients older than 70 years submitted to vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Its association with all-cause mortality and the effect of CMR-guided revascularization were analyzed retrospectively.
Results. During a median follow-up of 4.58 years, 430 deaths (17.2%) were recorded. A larger ischemic burden was an independent predictor of mortality: hazard ratio [95% confidence intervals]: 1.04 [1.01-1.07] for each additional ischemic segment, p = 0.006). This association also occurred in patients over 80 years of age and in women (p < 0.001). Compared to non-revascularized patients, revascularization associated with worse outcomes at low ischemic burden and exerted protective prognostic effect in patients with extensive ischemia both in the whole group (p for interaction = 0.003) and in 496 patients matched 1:1 by a propensity score (p = 0.06).
Conclusions. Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with CCS and might be helpful to guide decision-making in this scenario.
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Affiliation(s)
- C Bonanad Lozano
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - A Gabaldon-Perez
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - S Garcia-Blas
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - J Gavara
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - C Rios-Navarro
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - N Perez-Sole
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - E De Dios
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - V Marcos-Garces
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | | | | | - MP Lopez-Lereu
- University Hospital Clinic, Imaging Unit-ERESA, Valencia, Spain
| | - J Nunez
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - FJ Chorro
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
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24
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Rios-Navarro C, Gavara J, Nunez J, Bonanad Lozano C, Revuelta-Lopez E, Monmeneu JV, Lopez-Lereu MP, De Dios E, Perez-Sole N, Vila JM, Oltra R, Chorro FJ, Bayes-Genis A, Bodi V. EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”
Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting.
Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI.
Methods. We prospectively included 106 patients with a first STEMI treated with primary percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours post-reperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction (LVEF) was evaluated.
Results. The mean age of the sample was 59 ± 13 years and 76% were male. Patients were dichotomized according to EpCAM median (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (p-value = 0.02) and greater infarct size (p-value = 0.02). At presentation, only EpCAM values were significantly associated with the presence of MVO in univariate (Odds Ratio [95% confidence interval] (OR [95% CI]): 0.58 [0.38-0.88], p-value = 0.01) and multivariate logistic regression models (OR [95% CI]: 0.54 [0.34-0.85], p-value = 0.007). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: depressed LVEF (p-value = 0.009) and higher left ventricular end-systolic volume (p-value = 0.04).
Conclusions. EpCAM is associated with occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI. Future studies are needed to confirm EpCAM as biomarker, and eventually biotarget in STEMI pathophysiology.
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Affiliation(s)
- C Rios-Navarro
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - J Gavara
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - J Nunez
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - C Bonanad Lozano
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - E Revuelta-Lopez
- Germans Trias i Pujol Hospital, Instituto del Corazón, Badalona, Spain
| | - JV Monmeneu
- University Hospital Clinic, Imaging Unit-ERESA, Valencia, Spain
| | - MP Lopez-Lereu
- University Hospital Clinic, Imaging Unit-ERESA, Valencia, Spain
| | - E De Dios
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - N Perez-Sole
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - JM Vila
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
| | - R Oltra
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - FJ Chorro
- University Hospital Clinic, Department of Cardiology, Valencia, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Instituto del Corazón, Badalona, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Cardiology. INCLIVA. University of Valencia., Valencia, Spain
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25
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Gavara J, Marcos-Garces V, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Perez N, Merenciano H, Gabaldon A, Cànoves J, Racugno P, Bonanad C, Minana G, Nunez J, Nunez E, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Rodríguez-Palomares JF, Ortiz-Pérez JT, Bodi V. Magnetic Resonance Assessment of Left Ventricular Ejection Fraction at Any Time Post-Infarction for Prediction of Subsequent Events in a Large Multicenter STEMI Registry. J Magn Reson Imaging 2021; 56:476-487. [PMID: 34137478 DOI: 10.1002/jmri.27789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the most accurate imaging technique for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of LVEF assessment at any time after ST-segment elevation myocardial infarction (STEMI) for subsequent major adverse cardiac event (MACE) prediction is uncertain. PURPOSE To explore the prognostic impact of MRI-derived LVEF at any time post-STEMI to predict subsequent MACE (cardiovascular death or re-admission for acute heart failure). STUDY TYPE Prospective. POPULATION One thousand thirteen STEMI patients were included in a multicenter registry. FIELD STRENGTH/SEQUENCE 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. ASSESSMENT Post-infarction MRI-derived LVEF (reduced [r]: <40%; mid-range [mr]: 40%-49%; preserved [p]: ≥50%) was sequentially quantified at 1 week and after >3 months of follow-up. STATISTICAL TESTS Multi-state Markov model to determine the prognostic value of each LVEF state (r-, mr- or p-) at any time point assessed to predict subsequent MACE. A P-value <0.05 was considered to be statistically significant. RESULTS During a 6.2-year median follow-up, 105 MACE (10%) were registered. Transitions toward improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to a higher incidence of subsequent MACE. The observed transitions from r-LVEF, mr-LVEF, and p-LVEF states to MACE were: 15.3%, 6%, and 6.7%, respectively. Regarding the adjusted transition intensity ratios, patients in r-LVEF state were 4.52-fold more likely than those in mr-LVEF state and 5.01-fold more likely than those in p-LVEF state to move to MACE state. Nevertheless, no significant differences were found in transitions from mr-LVEF and p-LVEF states to MACE state (P-value = 0.6). DATA CONCLUSION LVEF is an important MRI index for simple and dynamic post-STEMI risk stratification. Detection of r-LVEF by MRI at any time during follow-up identifies a subset of patients at high risk of subsequent events. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Jose Gavara
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Victor Marcos-Garces
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Elena de Dios
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Nerea Perez
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Hector Merenciano
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ana Gabaldon
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Paolo Racugno
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Eduardo Nunez
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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Gabaldon-Perez A, Garcia-Blas S, Gavara J, Rios-Navarro C, Perez-Sole N, De Dios E, Marcos-Garces V, Merenciano-Gonzalez H, Monmeneu JV, Lopez-Lereu MP, Nunez J, Chorro FJ, Bonanad C, Bodi V. Stress cardiovascular magnetic resonance and mortality in a registry of 2496 elderly patients with chronic coronary syndrome. Prognosis and decision-making. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. In recent guidelines, non-invasive imaging techniques play a pivotal role in the management of chronic coronary syndrome (CCS). The elderly represent a large percentage of our routine CCS population and risk stratification in this scenario is challenging. The potential of vasodilator stress cardiovascular magnetic resonance (CMR) for this purpose is unknown.
Purpose. We explore the prognostic value and the usefulness for decision-making of the ischemic burden determined by vasodilator stress CMR imaging in a large cohort of elderly patients with known or suspected CCS.
Methods. The study group was made up of 2496 patients older than 70 years submitted to vasodilator stress CMR for known or suspected CCS in our health department from 2001 to 2016 (mean age 76 ± 4 years, 52% male). Clinical and vasodilator stress CMR characteristics were prospectively recorded. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Its association with all-cause mortality and the effect of vasodilator stress CMR-guided revascularization (within the following 3 months) were analyzed retrospectively.
Results. During a median follow-up of 4.58 years, 430 deaths (17.2%) were recorded. A larger ischemic burden was an independent predictor of mortality: hazard ratio [95% confidence intervals]: 1.04 [1.01-1.07] for each additional ischemic segment, p = 0.006). This association also occurred in patients over 80 years of age and in women (p < 0.001). Compared to non-revascularized patients, revascularization associated with worse outcomes at low ischemic burden and exerted protective prognostic effect in patients with extensive ischemia both in the whole group (p for interaction = 0.003) and in 496 patients matched 1:1 by a propensity score (p = 0.06).
Conclusions. Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with known or suspected CCS and might be helpful to guide decision-making in this scenario.
Abstract Figure 1
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Affiliation(s)
- A Gabaldon-Perez
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - S Garcia-Blas
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - J Gavara
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - C Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - N Perez-Sole
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - E De Dios
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - V Marcos-Garces
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | | | | | | | - J Nunez
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - FJ Chorro
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - C Bonanad
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
| | - V Bodi
- University Clinical Hospital of Valencia, Cardiology Department, Valencia, Spain
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Golse N, Nunez J, Mazzotta A, Cano L, Bergeat D, Sulpice L, Jeddou H, Abdelrafee A, Sa Cunha A, Cherqui D, Adam R, Boudjema K, Vibert E. Personalized Preoperative Nomograms Predicting Postoperative Risks after Resection of Perihilar Cholangiocarcinoma. World J Surg 2021; 44:3449-3460. [PMID: 32474628 DOI: 10.1007/s00268-020-05618-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Curative treatment of perihilar tumors requires major hepatectomy responsible for high morbidity and mortality. Current nomograms are based on definitive pathological analysis, not usable for patient selection. Our aim was to propose preoperative predictors for severe morbidity (Dindo-Clavien ≥3) and mortality at sixth month after resection of perihilar tumors. PATIENTS AND METHODS We reviewed perioperative data of 186 patients operated with major hepatectomy for perihilar tumors between 2012 and 2018 in two high-volume centers. Univariate and multivariate analysis were performed to determine the preoperative predictors of morbidity and mortality. A stepwise regression in forward direction was developed to select variables for definitive models. Hosmer-Lemeshow test, Akaike information criteria and area under the ROC curves were calculated to validate both nomograms. RESULTS Resections were indicated for perihilar and intrahepatic cholangiocarcinoma in 125 and 61 cases, respectively. Severe complications occurred in 76 patients (40.8%). Nineteen patients (10.2%) deceased before the sixth postoperative month. The predictors of severe morbidity were: male gender, portal vein embolization, planned biliary resection, low psoas muscle area/height2 and low hemoglobinemia. The predictors of early mortality were: age, high bilirubinemia, hypoalbuminemia, biliary drainage and long drainage-to-surgery interval. For both models, the p values of Hosmer-Lemeshow tests were of 0.9 and 0.99, respectively, the Akaike information criteria were of 35.5 and 37.7, respectively, and area under the curves was of 0.73 and 0.86, respectively. CONCLUSION We developed two accurate and practical nomograms based on exclusively preoperative data to predict early outcomes following the resection of perihilar tumors. If validated in larger series, these tools could be integrated in the decision-making process for patient selection.
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Affiliation(s)
- Nicolas Golse
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France.
- FHU Hepatinov, 94800, Villejuif, France.
- Physiopathogénèse et Traitement des Maladies du Foie, Inserm, Université Paris-Saclay, UMR-S 1193, Villejuif, France.
- Centre Hépato-Biliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94804, Villejuif, France.
| | - Julio Nunez
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
| | - Alessandro Mazzotta
- Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France
| | - Luis Cano
- Nutrition Metabolism and Cancer, INRA, INSERM, Unit 991, CHU Rennes, Univ Rennes, Univ Bretagne Loire, Rennes, France
| | - Damien Bergeat
- Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France
| | - Laurent Sulpice
- Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France
| | - Heithem Jeddou
- Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France
| | - Ahmed Abdelrafee
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
- FHU Hepatinov, 94800, Villejuif, France
- Physiopathogénèse et Traitement des Maladies du Foie, Inserm, Université Paris-Saclay, UMR-S 1193, Villejuif, France
| | - Daniel Cherqui
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
- FHU Hepatinov, 94800, Villejuif, France
- Physiopathogénèse et Traitement des Maladies du Foie, Inserm, Université Paris-Saclay, UMR-S 1193, Villejuif, France
| | - René Adam
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
- FHU Hepatinov, 94800, Villejuif, France
- INSERM, Unit 985, 94800, Villejuif, France
- Univ Paris-Sud, UMR-S 985, 94800, Villejuif, France
| | - Karim Boudjema
- Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, Rennes 1 University, 35033, Rennes, France
| | - Eric Vibert
- Department of Surgery, Assistance Publique Hôpitaux de Paris, Paul-Brousse Hospital, Centre Hépato-Biliaire, 94800, Villejuif, France
- FHU Hepatinov, 94800, Villejuif, France
- Physiopathogénèse et Traitement des Maladies du Foie, Inserm, Université Paris-Saclay, UMR-S 1193, Villejuif, France
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Marchese U, Allard MA, Tobome R, Nunez J, Gelli M, Pittau G, Ciaccio O, Sa Cunha A, Cherqui D. Middle and left hepatic vein trunk control during laparoscopic liver resection (with video). Surg Endosc 2021; 35:1476-1481. [PMID: 33398568 DOI: 10.1007/s00464-020-08116-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND While inflow control can be easily applied by Pringle maneuver, outflow control of the left liver has not been formally described. We report here a safe and reproductible technique of middle and left hepatic veinous trunk control (MLHVC) before parenchymal transection during laparoscopic left hepatectomy. METHODS A retrospective review of laparoscopic liver resection was conducted from January 2013 to March 2018 from our prospective database. All cases of laparoscopic left hepatectomy (LLH) were included, and intra- and postoperative outcomes data collected. We collected cases where the middle and left hepatic vein trunk control has been attempted and clamping used, and we analyzed outcomes associated with this maneuver. RESULTS MLHVC was attempted in 28 cases (77.8) of the 36 LLH identify in a monocentric study. It was technically not feasible only in 3 cases (8.3%) and clamping applied in 15 cases (41.7%). No significant intraoperative unexpected event occurred. CONCLUSION We present here a technique for left liver outflow control that can be safely added to the armamentarium of laparoscopic liver surgery.
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Affiliation(s)
- Ugo Marchese
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Marc-Antoine Allard
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Romaric Tobome
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Julio Nunez
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Maximilliano Gelli
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Gabriella Pittau
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Oriana Ciaccio
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Antonio Sa Cunha
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France
| | - Daniel Cherqui
- Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France.
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Marcos-Garces V, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Perez N, Cànoves J, Gonzalez J, Minana G, Nunez J, de la Espriella R, Santas E, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Rodríguez-Palomares JF, Ortiz-Pérez JT, Bodi V. Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction. Circ Cardiovasc Imaging 2020; 13:e011491. [PMID: 33297764 DOI: 10.1161/circimaging.120.011491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF<40% (≥50%: 7%, 40%-49%: 9%, <40%: 27%, P<0.001). Most patients displayed echocardiography-LVEF≥50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF<50% (n=490, 44%), the MACE rate was also low in those with CMR-LVEF≥40% (24/278, 9%) but significantly increased in patients with CMR-LVEF<40% (55/212, 26%; P<0.001). Compared with echocardiography-LVEF, CMR-LVEF significantly improved MACE prediction in the group of patients with echocardiography-LVEF<50% (C statistic, 0.80 versus 0.72; net reclassification improvement index, 0.73; integrated discrimination improvement index, 0.10) but not in those with echocardiography-LVEF≥50% (C statistic 0.66 versus 0.66; net reclassification improvement index, 0.17; integrated discrimination improvement index, 0.01). Conclusions A straightforward strategy based on a selective use of CMR for risk prediction in ST-segment-elevation myocardial infarction patients with echocardiography-LVEF<50% can provide insights into patient care. The cost-effectiveness of this approach, as well as the direct implications in clinical management, should be further explored.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Jose Gavara
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (M.P.L.-L., J.V.M.)
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Elena de Dios
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Nerea Perez
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Jessika Gonzalez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.)
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - Enrique Santas
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.)
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Spain (D.M.)
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
| | - Filipa Valente
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (F.V., J.F.R.-P.)
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.)
| | | | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (D.L., J.T.O.-P.).,Cardiovascular Institute, Hospital Clínic, Barcelona, Spain (J.T.O.-P.)
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Spain (V.M.G., J.C., J. Gonzalez, G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain (J. Gavara, C.R.-N., E.d.D., N.P., G.M., J.N., R.d.l.E., E.S., F.J.C., V.B.).,Faculty of Medicine and Odontology, University of Valencia, Spain (J.C., G.M., J.N., F.J.C., V.B.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain (G.M., J.N., F.J.C., V.B.)
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Codina P, De Antonio M, Domingo M, Santiago-Vacas E, Zamora E, Santesmases J, Subirana I, Buchaca D, Diez-Quevedo C, Boldo M, Rivas C, Velayos P, Nunez J, Lupon J, Bayes-Genis A. Head-to-head comparison of MAGGIC-HF, SHFM and BCN-Bio HF scores. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Three heart failure (HF) web-based risk scores are currently used in clinical practice. Two only include clinical variables; one adds biomarkers, known to refine pathophysiological pathways in HF and to improve mortality prediction.
Objective
To assess inter-score agreement and to compare mortality prediction discrimination between MAGGIC-HF risk score, Seattle HF Model (SHFM) and Barcelona Bio-HF Risk Calculator (BCN Bio-HF), which includes both clinical and biomarker variables (NTproBNP).
Methods
Out of 1745 consecutive patients with HF from different etiologies admitted at our Unit from May 2006 to November 2018, 1689 with NTproBNP measurement at first visit were included. Absolute and consistency intraclass correlation coefficient (ICC) at individual level among the three risk estimation tools was assessed. Bland Altman graphics were used to illustrate the differences between scores across the broad spectrum of mortality risk. Discrimination of the three prediction tools was compared by AUC of the ROC curves for 1-, 3- and 5-year all-cause mortality. Patients used previously to derivate the BCN Bio-HF were excluded.
Results
Patients age 66.3±13.3 years, 70.4% men, LVEF 36.4%±14.4, ischemic etiology 43.7%. Absolute ICC was poor for the three tools (from 0.18 [–0.006 to 0.35] to 0.53 [0.42 to 0.62], while consistency ICC was slightly better (from 0.28 [0.24 to 0.33] to 0.57 [0.53 to 0.60], being highest the ICC of MAGGIC-HF and BCN Bio-HF. Correlation was better among scores in low-mortality risk profile patients but clinical scores tended to infraestimate the risk in comparison with the BCN Bio-HF in high-risk patients (Figure). Discrimination was numerically better with the BCN Bio-HF at every time risk (Table), significantly better when compared with SHFM.
Conclusions
In comparison with other clinical scores, the BCN Bio-HF calculator predicted better higher mortality risk. Correlation was globally poor for the three tools at individual level, although improved in the low risk patients. Discrimination tended to be numerically better with the BCN Bio-HF calculator, reaching statistical significance when compared with the SHFM.
Bland Altman agreement among tools
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - I Subirana
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | | | - M Boldo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - P Velayos
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- University General Hospital of Valencia, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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31
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Codina P, De Antonio M, Santiago-Vacas E, Domingo M, Zamora E, Santesmases J, Subirana I, Buchaca D, Alonso N, Troya M, Velayos P, Pulido A, Nunez J, Lupon J, Bayes-Genis A. How mortality risk estimated by MAGGIC-HF, SHFM and BCN-Bio HF scores is modified after 12-month management in a multidisciplinary HF Clinic. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Heart failure (HF) contemporary management has significantly improved over the past two decades leading to better survival. How application of the contemporary HF management guidelines affects the risk of death estimated by available web-based risk scores is not elucidated.
Objective
To assess changes in mortality risk prediction after a after a 12-month management period in a multidisciplinary HF Clinic.
Methods
Out of 1,689 consecutive patients with HF admitted at our ambulatory HF Clinic from May 2006 to November 2018, those who completed one year follow-up were considered for the study. Patients without NTproBNP measurement or with more than 3 missing variables for risk estimation were excluded. Three contemporary web-based HF risk scores were evaluated: MAGGIC-HF, Seattle HF Model (SHFM) and the Barcelona Bio-HF Calculator containing NTproBNP (BCN Bio-HF). Risk of all-cause death at one year and at 3 years were calculated at baseline and re-evaluated after 12-month management in a multidsisciplinary HF Clinic. Wilcoxon paired data test was used to compare changes in mortality risk estimation over time and test equality of matched pairs for comparing estimated change among tools. 442 patients used to derive the Barcelona Bio-HF Calculator were excluded for discrimination purposes.
Results
1,157 patients were included (age 65.7±12.7 years, 70.4% men). A significant reduction in mortality risk estimation was observed with the three HF risk scores evaluated at 12-months (Table). The BCN Bio-HF model showed significantly different changes in risk estimation, fact that indeed was partnered with numerically better discrimination. AUC at 1 and 3 years, respectively, were: BCN Bio-HF (0.773 and 0.775), MAGGIC HF (0.686 and 0.748) and SHFM (0.773 and 0.739).
Conclusions
The three web-based risk scores evaluated showed a significant reduction in mortality risk estimation after 12 month management in a multidisciplinary HF Clinic. The BCN Bio-HF score showed higher reduction in estimated risk, together with better discrimination, likely because it incorporates contemporary treatment and use of biomarkers.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | | | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - I Subirana
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - P Velayos
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- Hospital General Universitario de Valencia, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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32
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Zamora E, De Antonio M, Domingo M, Santiago-Vacas E, Codina P, Santesmases J, Troya M, Diez-Quevedo C, Boldo M, Alonso N, Gonzalez B, Rivas C, Nunez J, Lupon J, Bayes-Genis A. Heart failure hospitalization trends during a very long-term follow-up up to 18 years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart Failure (HF) is the first cause of hospitalizations in people older than 65 years. Often patients suffer recurrent hospital admissions.
Objective
To assess recurrent HF-related hospitalizations during very long-term follow-up in a cohort of HF outpatients managed in an ambulatory structured HF Unit.
Methods
End of follow-up was 31.8.2019 (at least 1-year follow-up for alive patients, up to 18 years). Heart failure hospitalizations were defined as unplanned hospitalizations of at least 24 hours due to worsening heart failure and were identified from clinic records, hospital wards, or electronic Catalan history record. Death was recorded from the same sources and Spanish Health System and Spanish Death Registry. Lost information during follow-up was adequately censored (1 patient for survival status and 37 for HF-related hospitalizations).
Results
A total of 2355 patients were included. Follow-up span a total of 12,472 patients-years. 1682 HF-related hospitalizations were recorded in 725 patients (13.5 per 100 patients-years). Number of admissions ranged from 0 in 1630 patients to 22 in 1 patient (patients with hospitalizations, median 2 [Q1-Q3, 1–3]; 118 patients had 4 or more hospitalizations). HF hospitalization density incidence was higher during the 10 first years in patients with HF hospitalizations in the precedent year before HF Clinic baseline visit (table). By contrast, if only patients who died during follow-up were considered (N=1299), hospitalization trends significantly increased in their last period of life: 11.7%, 8.9%, 13.6%, 20.8% and 44.9% from the first to the last period (quintile) of their trajectory, respectively.
Conclusions
HF hospitalizations occur during the whole HF trajectory, with an increasing trend at the end of the every patient trajectory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M Boldo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- University General Hospital of Valencia, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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33
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Santiago-Vacas E, Codina P, Domingo M, De Antonio M, Zamora E, Santesmases J, Julian M, Diez-Quevedo C, Troya M, Boldo M, Altimir S, Nunez J, Gonzalez B, Lupon J, Bayes-Genis A. Sacubitril/valsartan and circulating neprilysin hypothesis in patients with HFpEF. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Neprilysin serum levels (sNEP) exhibited significant prognostic value in patients with heart failure (HF). In the PARADIGM-HF study benefit of sacubitril/valsartan was observed in patients with reduced ejection fraction (HFrEF), while in the PARAGON-HF benefit was only observed in the subgroup of patients with LVEF <57%.
Objective
To assess the prognostic value of sNEP in ambulatory patients with HF and preserved ejection fraction (HFpEF) and LVEF >57% (group 1), in comparison with patients with LVEF ≤57% (group 2).
Methods
Consecutive patients with HF attended at the Unit from May 2006 to February 2016 were considered for the study. The primary end-point was the composite of cardiovascular death or HF hospitalization. All-cause death, cardiovascular death, HF hospitalization and the composite of all-cause death or HF hospitalization were secondary end-points. Competing risk methods (R package by Bob Gray for SPSS) were used when required.
Results
sNEP was measured in 1428 patients (age 67.7±12.7, 70.3% men, LVEF 35.8% ±14, 48.9% from ischemic etiology), 144 of which had a LVEF >57% (age 70.1±15, 43.8% men, 53.5% from hypertensive or valvular etiologies). sNEP levels did not significantly differ between the two groups of patients (p=0.31). During a mean follow-up of 6±3.9 years, 856 deaths were recorded (459 from cardiovascular causes) and 523 patients suffered at least one HF hospitalization. The primary end-point occurred in 941 patients (in 111 of the 144 patients with LVEF >57%). Table 1 shows sNEP age- and sex-adjusted hazard ratios for the primary and secondary end-points.
Conclusions
sNEP prognostic value in patients with HFpEF and LVEF >57% outperforms that observed in patients with lower LVEF. These data support the personalized use of sNEP in identifying HFpEF patients that may benefit from treatment with sacubitril/valsartan.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.T Julian
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - S Altimir
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- University General Hospital of Valencia, Valencia, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
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34
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Perez-Terol I, Rios-Navarro C, de Dios E, Morales JM, Gavara J, Perez-Sole N, Diaz A, Minana G, Segura-Sabater R, Bonanad C, Bayés-Genis A, Husser O, Monmeneu JV, Lopez-Lereu MP, Nunez J, Chorro FJ, Ruiz-Sauri A, Bodi V, Monleon D. Magnetic resonance microscopy and correlative histopathology of the infarcted heart. Sci Rep 2019; 9:20017. [PMID: 31882712 PMCID: PMC6934559 DOI: 10.1038/s41598-019-56436-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
Delayed enhancement cardiovascular magnetic resonance (MR) is the gold-standard for non-invasive assessment after myocardial infarction (MI). MR microscopy (MRM) provides a level of detail comparable to the macro objective of light microscopy. We used MRM and correlative histopathology to identify infarct and remote tissue in contrast agent-free multi-sequence MRM in swine MI hearts. One control group (n = 3 swine) and two experimental MI groups were formed: 90 min of ischemia followed by 1 week (acute MI = 6 swine) or 1 month (chronic MI = 5 swine) reperfusion. Representative samples of each heart were analysed by contrast agent-free multi-sequence (T1-weighting, T2-weighting, T2*-weighting, T2-mapping, and T2*-mapping). MRM was performed in a 14-Tesla vertical axis imager (Bruker-AVANCE 600 system). Images from MRM and the corresponding histopathological stained samples revealed differences in signal intensities between infarct and remote areas in both MI groups (p-value < 0.001). The multivariable models allowed us to precisely classify regions of interest (acute MI: specificity 92% and sensitivity 80%; chronic MI: specificity 100% and sensitivity 98%). Probabilistic maps based on MRM images clearly delineated the infarcted regions. As a proof of concept, these results illustrate the potential of MRM with correlative histopathology as a platform for exploring novel contrast agent-free MR biomarkers after MI.
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Affiliation(s)
- Itziar Perez-Terol
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain
| | - Cesar Rios-Navarro
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Elena de Dios
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Jose M Morales
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain.,Unidad Central de Investigación Biomédica, University of Valencia, Valencia, Spain.,Pathology Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Jose Gavara
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Nerea Perez-Sole
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Ana Diaz
- Unidad Central de Investigación Biomédica, University of Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | | | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Antoni Bayés-Genis
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Husser
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain
| | | | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Amparo Ruiz-Sauri
- Pathology Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain. .,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain. .,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain.
| | - Daniel Monleon
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain. .,Pathology Department, School of Medicine, University of Valencia, Valencia, Spain. .,Centro de Investigación Biomédica en Red - Fragilidad y Envejecimiento Saludable (CIBER-FES), Madrid, Spain.
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35
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Santas Olmeda E, De La Espriella R, Minana G, Valero E, Palau P, Amiguet M, Gonzalez J, Soler M, Sanchis J, Chorro FJ, Nunez J. P3543Rehospitalization burden in heart failure with mid-range ejection fraction and morbidity burden. Is it a distinct phenotype? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Heart failure with mid-range ejection fraction (HFmrEF) has been recognized as a distinct HF phenotype, but wether patients on this category fare worse, similarly, or better than those with HF with reduced EF (HFrEF) or preserved EF (HFpEF) in terms of rehospitalization risk over time remains unclear. We therefore sought to characterize the mordibity burden of HFmrEF patients by evaluating the risk of recurrent hospitalizations following an admission for acute HF.
Methods
We prospectively included 2,961 consecutive patients discharged for acute HF in our institution from 2004 to 2017. Patients were categorized according to their ejection fraction (EF) obtained by an echocardiography during the index admission: HFmrEF (EF 41–49%), HFrEF (EF≤40%) and HFpEF (EF≥50%). Negative binomial regression method was used to evaluate the association between EF status and recurrent all-cause and HF-related admissions. Risk estimates were expressed as incidence ratio ratios (IRR).
Results
Mean age of the cohort was 73.9±11.1 years, 49% were women, and 46.0% had suffered from previous HF admissions. 472 patients (15.9%) had HFmrEF, 956 (32.3%) had HFrEF, and 1,533 (51.8%) had HFpEF. At a median (interquartile range) follow-up of 2.4 (4.4) years, 1,821 (61.5%) patients died and 6,035 all-cause readmissions were registered in 2,026 patients (68.4%), being 2,163 of them HF-related. Rates of all-cause readmission per 100 patients-years of follow-up were 43.4, 47.1 and 50.1 per HFrEF, HFmrEF and HFpEF categories, respectively. After multivariable adjustment, and compared to patients with HFrEF, HFmrEF status was not associated with a higher risk of all-cause or HF-related recurrent admissions (IRR=1.06; 95% confidence interval (CI), 0.93–1.20; p=0.89), and IRR=1.07; 95% CI, 0.91–1.26; p=0.389, respectively), whereas HFpEF status was associated with a non-significant increase in the risk of all-cause recurrent admissions but a similar risk of HF-related readmissions (IRR=1.10; 95% confidence interval (CI), 0.99–1.22; p=0.06, and IRR=1.01; 95% CI, 0.88–1.16; p=0.900, respectively)
Conclusion
Following an admission for acute HF, patients with HFmrEF have a similar all-cause and HF-related rehospitalization burden when compared to patients with HFrEF, by means of recurrent events analysis.
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Affiliation(s)
- E Santas Olmeda
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - R De La Espriella
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - G Minana
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - E Valero
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - P Palau
- Hospital General de Castellόn. Universitat Jaume I, Castellon, Spain
| | - M Amiguet
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - J Gonzalez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - M Soler
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - J Sanchis
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - F J Chorro
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
| | - J Nunez
- Hospital Clinic Universitari. Universitat de València, Valencia, Spain
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36
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Soler Costa M, Nunez J, Ruiz V, Bonanad C, Formiga F, Valero E, Martinez Selles M, Marin F, Ruescas A, Garcia Blas S, Minana G, Abu-Assi E, Bueno H, Ariza-Sole A, Sanchis J. 5877Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities.
Purpose
Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients.
Methods
The study group consisted of 1 training (n=920, 76±7 years) and 1 testing (n=532; 84±4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis.
Results
A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR=1.90, 95% CI 1.20–3.03, p=0.006); 2 comorbidities (16% mortality, HR=1.29, 95% CI 0.81–2.04, p=0.30); and 0–1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic= 0.80) and calibration (Hosmer-Lemeshow test, p=0.20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic=0.80; Hosmer-Lemeshow test, p=0.70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR=2.37, 95% CI 1.25–4.49, p=0.008; 2 comorbidities: 14% mortality, HR=1.59, 95% CI 0.82–3.07, p=0.20; 0–1 comorbidities: 7.5% reference category).
Kaplan-Meyer curves for mortality
Conclusion
A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS
Acknowledgement/Funding
This work was supported by grants from Spain's Ministry of Economy and Competitiveness through the Carlos III Health Institute
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Affiliation(s)
- M Soler Costa
- University Hospital Clinic of Valencia, Valencia, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - V Ruiz
- University of Valencia, Facultad de Enfermería, Valencia, Spain
| | - C Bonanad
- University Hospital Clinic of Valencia, Valencia, Spain
| | - F Formiga
- University Hospital of Bellvitge, Unitat de Medicina Geriátrica, Barcelona, Spain
| | - E Valero
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - A Ruescas
- University of Valencia, Fisioterapia, Valencia, Spain
| | - S Garcia Blas
- University Hospital Clinic of Valencia, Valencia, Spain
| | - G Minana
- University Hospital Clinic of Valencia, Valencia, Spain
| | - E Abu-Assi
- Hospital Alvaro Cunqueiro, Cardiology, Vigo, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - A Ariza-Sole
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - J Sanchis
- University Hospital Clinic of Valencia, Valencia, Spain
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Moliner P, Lupon J, De Antonio M, Domingo M, Santiago-Vacas E, Zamora E, Santesmases J, Diez-Quevedo C, Troya MI, Boldo M, Altimir S, Alonso N, Gonzalez B, Nunez J, Bayes-Genis A. P4150Causes of death in a heart failure clinic in Spain along 17 years. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Advances in heart failure (HF) treatment have achieved a reduction of death in HF patients in the last two decades. Indeed, not only mortality has been reduced but also the mode of death might have been modified through these years.
Purpose
To assess the causes of death in outpatients attended in a HF Unit since the year 2002 up to the year 2018.
Methods
Causes of death were classified as follows: progression of HF (worsening HF or treatment-resistant HF, in the absence of another cause); sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death); acute myocardial infarction; stroke; procedural (post-diagnostic or post-therapeutic); other cardiovascular causes (e.g., rupture of an aneurysm, peripheral ischemia, or aortic dissection), and non-cardiovascular. Patients who died of unknown cause were excluded from the analysis. Fatal events were identified from the clinical records of patients with HF, hospital wards, the emergency room, general practitioners, or by contacting the patient's relatives. Furthermore, data were verified from the databases of the Catalan and Spanish Health Systems. Trends on every cause of death were assessed by linear regression.
Results
Since August 2001 to May 2018, 2295 HF patients were admitted to the HF clinic (age 66.4±12.8 years, 71% men, 49% from ischemic aetiology, mean LVEF 35.2% ± 14). During the 17 years of the study, 1201 deaths were recorded. Seventy-eight patients (6.5% of deaths) were excluded due to unknown cause of death. The evolution in the mode of death by years is shown in the figure. Two trends were observed: a decrease in sudden death (p=0.05) and a very significant linear increase in non-cardiovascular causes of death (p<0.001). The decrease of sudden death was mainly driven from changes observed in the first 10 years (p=0.014); thereafter the incidence of sudden death remained stable (p=0.18). Remarkably we did not observe significant changes in HF progression as mode of death (p=0.17).
Conclusions
During the 17 years of the study, a very significant trend towards higher percentage of non-cardiovascular deaths was progressively observed. On the other hand, percentage of sudden death showed a gradual decrease, mainly driven from the changes observed in the first 10 years.
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Affiliation(s)
- P Moliner
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M De Antonio
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M Domingo
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - E Zamora
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Santesmases
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M I Troya
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - M Boldo
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - S Altimir
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - N Alonso
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - B Gonzalez
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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38
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Jimenez-Candil J, Castro JC, Hernandez J, Nunez J, Morinigo JL, Bravo L, Sanchez PL. P2874Predictors of Electrical Strom among ICD patients: the importance of the burden of non-sustained VTs. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among ICD patients, the burden of non-sustained ventricular tachycardias (NSVT) occurring during the first 6 months after implant is associated independently with an increase in cardiac death. It is unknown whether there are differences between the incidence of Electrical Storm (ES) and the cause of cardiac mortality (CM) according to the burden of NSVT.
Purpose
To determine the relationship between the burden of NSVT occurring early after ICD implant and the risk of ES in the long-term among ICD patients with left ventricular dysfunction.
Methods
In this prospective study, 416 patients (age: 65±11; LVEF: 30±8; ischemic etiology: 62%, primary prevention: 63%) with LVEF <45% and ICD without cardiac resynchronization therapy were followed-up for 41±27 after implant. ICD programming was standardized. NSVT was defined as any ventricular tachyarrhythmia with >5 beats at ≥150 bpm terminating spontaneously before therapy that occurred within the first six months after ICD implant.
Results
A total of 31 patients (7.5%) presenting with ES during the follow-up. After classifying the subjects into three groups according to the burden of NSVT (tertiles): no NSVT (N=166, group 1); 1–5 NSVT (n=130, group 2) and >5 NSVT (n=120, group 3), the cumulative incidence of ES was higher in group 3: 2.4% vs. 3.1% vs. 19.2%, with an average of time from implant to ES significantly shorter (mean [95% CI, months]): 97 (94–100) vs. 103 (99–106) vs. 86 (79–93); p<0.001 for groups 1–2 vs. 3 (log-rank test). Figure. All ESs were due to monomorphic VT in individuals with ≤5 NSVT; however, 19% of ESs were caused by polymorphic VT or VF among patients with >5 NSVT (p<0.05). By multivariate analysis (Cox-regression), LVEF, % (HR=1.06; p=0.026) and >5 TVNS (HR=4.66; p=0.001) were identified as independent predictors of ES. Cardiac mortality (CM) was independently higher in subjects with >5 NSVT (HR=1.7; p=0.03). The most frequent cause of CM was cardiac failure irrespective of NSVT burden (93% in patients with ≤5 NSVT and 79% in >5 NSVT); however CM due to ES was exclusive of individuals with >5 NSVT: 15% vs. 0% (p<0.05).
Figure 1
Conclusions
1. The burden of NSVT occurring during the first 6 months after an ICD implant is associated independently with a higher risk of ES in the long-term. 2. The adjusted risk of ES is 4-fold higher in individuals with >5 NSVT. 3. The most frequent etiology of CM is heart failure; CM due to ES is exclusive of patients with >5 NSVT causing the 15% of deaths in such population.
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Affiliation(s)
| | - J C Castro
- University Hospital of Salamanca, Salamanca, Spain
| | - J Hernandez
- University Hospital of Salamanca, Salamanca, Spain
| | - J Nunez
- University Hospital of Salamanca, Salamanca, Spain
| | - J L Morinigo
- University Hospital of Salamanca, Salamanca, Spain
| | - L Bravo
- University Hospital of Salamanca, Salamanca, Spain
| | - P L Sanchez
- University Hospital of Salamanca, Salamanca, Spain
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Merenciano Gonzalez HM, Marcos-Garces V, Gavara J, Rios-Navarro C, Ortiz JT, Rodriguez J, Mendieta G, Rodriguez-Palomares JF, Valente F, Garcia-Dorado D, Lopez-Lereu MP, Monmeneu JV, Nunez E, Nunez J, Bodi V. P6397Ejection fraction by cardiac magnetic resonance 6 months after STEMI: impact on risk stratification in chronic phase. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular ejection fraction (LVEF) has traditionally been used as the cornerstone for risk stratification after STEMI and it can be accurately quantified by cine cardiovascular magnetic resonance (CMR). In recent years, the additional prognostic value of contrast CMR-derived infarct size (IS) and microvascular obstruction (MVO) soon after infarction has been demonstrated. The usefulness of CMR-derived LVEF in chronic phase for risk stratification late after STEMI is unclear.
Purpose
We hypothesized that 6-month CMR-derived LVEF can contribute in the prediction of clinical events late after STEMI beyond pre-discharge LVEF, IS and MVO.
Methods
Data were obtained from a prospective registry of reperfused STEMI patients (n=456) who were stable 6 months after infarction and in whom 1-week and 6-month CMR-derived LVEF, IS and MVO were sequentially quantified. Major adverse cardiac events (MACE) were defined as a combined clinical end-point that included death or re-admission for acute decompensated heart failure (r-ADHF), whichever occurred first, occurring after the 6-month CMR.
Results
During a mean and median follow-up of 6 years, 56 late MACE (12%, 32 deaths and 24 r-ADHF) were registered. From 1-week to 6-month, CMR parameters exhibited significant dynamic changes (p<0.001): LVEF improved (52±12 vs. 56±13%), IS decreased (21±14 vs. 18±12% of LV mass) and MVO vanished (2±4 vs. 0±1% of LV mass). At 6-month CMR, 60 patients (13%) displayed reduced LVEF (<40%), 69 (15%) mid-range LVEF (40–50%) and 327 (72%) preserved LVEF (≥50%). Late MACE rates were 28% in patients with reduced LVEF, 14% in those with mid-range LVEF and 9% in those with preserved LVEF at 6-month CMR (p<0.001 for the trend). After adjustment for baseline characteristics and for 1-week and 6-month CMR parameters, more preserved LVEF at 6 months independently associated with a lower risk of MACE late after STEMI (hazard ratio 0.96 [0.94–0.98] per 1% increase).
Conclusions
Dramatic dynamic changes occur in CMR parameters within the first months after STEMI. Reassessment of CMR-derived LVEF in chronic phase in those patients who remain stable provides relevant prognostic information for long-term risk stratification.
Acknowledgement/Funding
Funded by “Instituto de Salud Carlos III”/FEDER (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and Generalitat Valenciana (GV/2018/116).
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Affiliation(s)
| | - V Marcos-Garces
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Gavara
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - J T Ortiz
- Hospital Clinic de Barcelona, Department of Cardiology, Barcelona, Spain
| | - J Rodriguez
- Hospital Clinic de Barcelona, Department of Cardiology, Barcelona, Spain
| | - G Mendieta
- Hospital Clinic de Barcelona, Department of Cardiology, Barcelona, Spain
| | | | - F Valente
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - D Garcia-Dorado
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - M P Lopez-Lereu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - J V Monmeneu
- ERESA, Cardiovascular Magnetic Resonance Unit, Valencia, Spain
| | - E Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
| | - V Bodi
- University Hospital Clinic of Valencia, Department of Cardiology, Valencia, Spain
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40
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Mariac C, Vigouroux Y, Duponchelle F, García-Dávila C, Nunez J, Desmarais E, Renno J. Metabarcoding by capture using a single COI probe (MCSP) to identify and quantify fish species in ichthyoplankton swarms. PLoS One 2018; 13:e0202976. [PMID: 30208069 PMCID: PMC6135497 DOI: 10.1371/journal.pone.0202976] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/13/2018] [Indexed: 12/04/2022] Open
Abstract
The ability to determine the composition and relative frequencies of fish species in large ichthyoplankton swarms could have extremely important ecological applications However, this task is currently hampered by methodological limitations. We proposed a new method for Amazonian species based on hybridization capture of the COI gene DNA from a distant species (Danio rerio), absent from our study area (the Amazon basin). The COI sequence of this species is approximately equidistant from all COI of Amazonian species available. By using this sequence as probe we successfully facilitated the simultaneous identification of fish larvae belonging to the order Siluriformes and to the Characiformes represented in our ichthyoplankton samples. Species relative frequencies, estimated by the number of reads, showed almost perfect correlations with true frequencies estimated by a Sanger approach, allowing the development of a quantitative approach. We also proposed a further improvement to a previous protocol, which enables lowering the sequencing effort by 40 times. This new Metabarcoding by Capture using a Single Probe (MCSP) methodology could have important implications for ecology, fisheries management and conservation in fish biodiversity hotspots worldwide. Our approach could easily be extended to other plant and animal taxa.
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Affiliation(s)
- C. Mariac
- Institut de Recherche pour le Développement, Université de Montpellier, Unité Mixte de Recherche Diversité Adaptation et Développement des Plantes (UMR DIADE), Montpellier, France
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
- * E-mail:
| | - Y. Vigouroux
- Institut de Recherche pour le Développement, Université de Montpellier, Unité Mixte de Recherche Diversité Adaptation et Développement des Plantes (UMR DIADE), Montpellier, France
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
| | - F. Duponchelle
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
- Institut de Recherche pour le Développement, Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques (UMR BOREA), MNHN—CNRS-7208—UPMC—UCBN—IRD-207, Montpellier, France
| | - C García-Dávila
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
- Instituto de Investigaciones de la Amazonía Peruana (IIAP), Laboratorio de Biología y Genética Molecular (LBGM), Iquitos, Perú
| | - J. Nunez
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
- Institut de Recherche pour le Développement, Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques (UMR BOREA), MNHN—CNRS-7208—UPMC—UCBN—IRD-207, Montpellier, France
| | - E. Desmarais
- Institut des Sciences de l’Évolution (UMR ISEM), Université Montpellier—CNRS—IRD—EPHE, Place Eugène Bataillon—France
| | - J.F. Renno
- Laboratoire Mixte International—Evolution et Domestication de l’Ichtyofaune Amazonienne (LMI—EDIA), IIAP—UAGRM—IRD, UMR BOREA, Paris, France
- Institut de Recherche pour le Développement, Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques (UMR BOREA), MNHN—CNRS-7208—UPMC—UCBN—IRD-207, Montpellier, France
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Cordero A, Facila L, Castro A, Lidon RM, Nunez J, Galve E, Gonzalez-Juanatey JR. P6265Prevalence of clinical features of familial hypercholesterolemia in patients admitted for an acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/15/2022] Open
Affiliation(s)
- A Cordero
- University Hospital of San Juan, Alicante, Spain
| | - L Facila
- University General Hospital of Valencia, Valencia, Spain
| | - A Castro
- University Hospital La Paz, Madrid, Spain
| | - R M Lidon
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - E Galve
- University Hospital Vall d'Hebron, Barcelona, Spain
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42
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Rheude T, Pellegrini C, Nunez J, Trenkwalder T, Joner M, Mayr NP, Bodi V, Koenig W, Kasel AM, Schunkert H, Kastrati A, Hengstenberg C, Husser O. P4500Prognostic value of galectin-3 according to carbohydrate antigen 125 in transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Rheude
- German Heart Center of Munich, Munich, Germany
| | | | - J Nunez
- University of Valencia, Valencia, Spain
| | | | - M Joner
- German Heart Center of Munich, Munich, Germany
| | - N P Mayr
- German Heart Center of Munich, Munich, Germany
| | - V Bodi
- University of Valencia, Valencia, Spain
| | - W Koenig
- German Heart Center of Munich, Munich, Germany
| | - A M Kasel
- German Heart Center of Munich, Munich, Germany
| | - H Schunkert
- German Heart Center of Munich, Munich, Germany
| | - A Kastrati
- German Heart Center of Munich, Munich, Germany
| | - C Hengstenberg
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - O Husser
- German Heart Center of Munich, Munich, Germany
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Moliner P, Lupon J, Cediel G, De Antonio M, Domingo M, Zamora E, Nunez J, Santiago E, Gonzalez B, Rivas C, Diaz V, Santesmases J, Diez-Quevedo C, Boldo M, Bayes-Genis A. P1815Prediction of sudden death in outpatients with heart failure: a bio-clinical approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Moliner
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M De Antonio
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Nunez
- University Hospital Clinic of Valencia, Valencia, Spain
| | - E Santiago
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - V Diaz
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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44
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De Antonio M, Lupon J, Gavidia-Bovadilla G, Lopez-Ayerbe J, Moliner P, Domingo M, Ferrer E, Perera A, Nunez J, Zamora E, Vallejo N, Gual F, Teis A, Junca G, Bayes-Genis A. P5656Heart failure with preserved ejection fraction (HFpEF) infrequently evolves towards a HFpEF-declined phenotype. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M De Antonio
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - J Lopez-Ayerbe
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - P Moliner
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - E Ferrer
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Perera
- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - J Nunez
- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - E Zamora
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - N Vallejo
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - F Gual
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Teis
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - G Junca
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Badalona, Spain
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45
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Gonzalez J, Nunez J, Ruiz V, Bonanad C, Valero E, Sastre C, Ruescas A, Mollar A, Garcia Blas S, Minana G, Carratala A, Sanchis J. P2516Low relative lymphocyte count as a marker of frailty in patients with acute coronary syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cambronero-Cortinas E, Bonanad C, Monmeneu JV, Lopez-Lereu MP, Gavara J, de Dios E, Rios C, Perez N, Racugno P, Paya A, Escribano D, Minana G, Pellicer M, Cànoves J, Nunez J, Chorro FJ, Moratal D, Bodi V. Incidence, Outcomes, and Predictors of Ventricular Thrombus after Reperfused ST-Segment–Elevation Myocardial Infarction by Using Sequential Cardiac MR Imaging. Radiology 2017; 284:372-380. [DOI: 10.1148/radiol.2017161898] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther Cambronero-Cortinas
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Clara Bonanad
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Jose V. Monmeneu
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - María Pilar Lopez-Lereu
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Jose Gavara
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Elena de Dios
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Cesar Rios
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Nerea Perez
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Paolo Racugno
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Ana Paya
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - David Escribano
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Gema Minana
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Mauricio Pellicer
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Joaquim Cànoves
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Julio Nunez
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Francisco J. Chorro
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - David Moratal
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
| | - Vicente Bodi
- From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València,
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Garcia Blas S, Ortega-Paz L, Valero E, Brugaletta S, Minana G, Dantas A, Garabito M, Nunez J, Carratala A, Sabate M, Sanchis J. P473Intracoronary cell-free DNA is associated with microvascular damage in ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wichmann J, Nunez J, Vliegenthart R, Otani K, Schoepf U, De Cecco C, Vogl T, Wenger N. Zusammenhang zwischen Komplikationen in der Schwangerschaft und späterer koronarer Atherosklerose in afroamerikanischen Frauen: eine Koronar-CT-Angiografie Studie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Wichmann
- Universitätsklinikum Frankfurt am Main, Institut für Diagnostische und Interventionelle Radiologie, Frankfurt am Main
| | - J Nunez
- Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC, USA
| | - R Vliegenthart
- University Medical Center Groningen, Department of Radiology, Groningen, Niederlande
| | - K Otani
- Siemens Japan K. K., Imaging & Therapy Systems Division, Healthcare Sector, Japan, Tokio
| | - U Schoepf
- Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC, USA
| | - C De Cecco
- Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC, USA
| | - T Vogl
- Universitätsklinikum Frankfurt am Main, Institut für Diagnostische und Interventionelle Radiologie, Frankfurt am Main
| | - N Wenger
- Emory University School of Medicine, Division of Cardiology, Department of Medicine, Atlanta, GA, USA
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Li S, Nunez J, Nunez E, Sanchis J, Levy WC. PERFORMANCE OF THE SEATTLE HEART FAILURE MODEL IN PATIENTS DISCHARGED AFTER ACUTE HEART FAILURE HOSPITALIZATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hervas A, Ruiz-Sauri A, Gavara J, Monmeneu JV, de Dios E, Rios-Navarro C, Perez-Sole N, Perez I, Monleon D, Morales JM, Minana G, Nunez J, Bonanad C, Diaz A, Vila JM, Chorro FJ, Bodi V. A Multidisciplinary Assessment of Remote Myocardial Fibrosis After Reperfused Myocardial Infarction in Swine and Patients. J Cardiovasc Transl Res 2016; 9:321-33. [DOI: 10.1007/s12265-016-9698-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
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