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Ruiz-Ortiz M, Benito-León J. Spinal Segmental Myoclonus in Primary Progressive Multiple Sclerosis. Tremor Other Hyperkinet Mov (N Y) 2024; 14:7. [PMID: 38434714 PMCID: PMC10906331 DOI: 10.5334/tohm.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Background A wide variety of associated movement disorders has been described in multiple sclerosis. Phenomenology Shown A 57-year-old woman with primary progressive multiple sclerosis developed spinal segmental myoclonus associated with focal myelitis. Educational Value Movement disorders in multiple sclerosis are phenomenologically diverse and have varied pathophysiological mechanisms, making it essential to identify them to initiate appropriate treatment.
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Affiliation(s)
- Mariano Ruiz-Ortiz
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
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2
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Seoane D, Roca-Rodríguez L, Ruiz-Ortiz M, Franco-Domingo N, Laespada-García MI, Sánchez-Tejerina D, González-Crespo MR, Villarejo-Galende A, González-Sánchez M. Limbic encephalitis secondary to neuro-Behcet disease: an uncommon presentation. Rev Neurol 2023; 77:61-64. [PMID: 37403244 PMCID: PMC10662178 DOI: 10.33588/rn.7702.2022049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Limbic encephalitis (LE) can have a wide range of etiologies, most frequently infectious (especially viral) or autoimmune. Behcet's disease (BD) can present with heterogeneous neurological manifestations. However, LE is not considered a typical presentation of neuro-Behcet's disease (NBD). CASE REPORT A 40-years-old male presented with new-onset subacute headaches, memory problems and apathy. A review of systems revealed an unrecorded past history of recurrent oral sores for years, recent malaise and fever, as well as an episode of bilateral panuveitis four months before presentation. His general and neurologic examination revealed slight fever, an isolated oral aphtha, anterograde amnesia and signs of bilateral retinal vasculitis. Brain magnetic resonance imaging displayed a pattern of limbic meningoencephalitis, and his cerebrospinal fluid showed mononuclear inflammation. The patient met BD diagnostic criteria. Considering LE is a very rare presentation of NBD, alternative etiologies were thoroughly assessed and excluded, including infectious, autoimmune and paraneoplastic encephalitis. Therefore, he was diagnosed with NBD, and he recovered well after immunosuppression. DISCUSSION Only two cases of NBD presenting with LE have been previously reported. We report a third case of this rare presentation and compare it with the previous two. We aim to highlight this association and contribute to enlarge the rich clinical spectrum of NBD.
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Affiliation(s)
- D Seoane
- Hospital Universitario 12 de Octubre, Madrid, España
| | | | - M Ruiz-Ortiz
- Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | | | | | - A Villarejo-Galende
- Universidad Complutense de Madrid, Madrid, España
- Hospital Universitario 12 de Octubre, Madrid, España
- CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
- Instiiuto de Investigación Hospital 12 de Octubre, Madrid, España
| | - M González-Sánchez
- Hospital Universitario 12 de Octubre, Madrid, España
- CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
- Instiiuto de Investigación Hospital 12 de Octubre, Madrid, España
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3
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Arrambide G, Espejo C, Carbonell-Mirabent P, Dieli-Crimi R, Rodríguez-Barranco M, Castillo M, Auger C, Cárdenas-Robledo S, Castilló J, Cobo-Calvo Á, Galán I, Midaglia L, Nos C, Otero-Romero S, Río J, Rodríguez-Acevedo B, Ruiz-Ortiz M, Salerno A, Tagliani P, Tur C, Vidal-Jordana A, Zabalza A, Sastre-Garriga J, Rovira A, Comabella M, Hernández-González M, Montalban X, Tintore M. The kappa free light chain index and oligoclonal bands have a similar role in the McDonald criteria. Brain 2022; 145:3931-3942. [PMID: 35727945 DOI: 10.1093/brain/awac220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
Intrathecal production of kappa free light chains (KFLC) occurs in multiple sclerosis and can be measured using the KFLC index. KFLC index values can be determined more easily than oligoclonal bands (OB) detection and seem more sensitive than the immunoglobulin (Ig)G index to diagnose multiple sclerosis. We assessed the value of OB, KFLC index cut-offs 5.9, 6.6, and 10.61, and IgG index to diagnose multiple sclerosis with prospectively acquired data from a clinically isolated syndrome (CIS) inception cohort. We selected patients with sufficient data to determine OB positivity, MRI dissemination in space (DIS) and time (DIT), IgG index, and sufficient quantities of paired CSF and blood samples to determine KFLC indexes (n = 214). We used Kendall´s Tau coefficient to estimate concordance; calculated the number of additional diagnoses when adding each positive index to DIS and positive OB; performed survival analyses for OB and each index with the outcomes second attack and 2017 MRI DIS and DIT; and estimated the diagnostic properties of OB and the different indexes for the abovementioned outcomes at five years. OB were positive in 138 patients (64.5%), KFLC-5.9 in 136 (63.6%), KFLC-6.6 in 135 (63.1%), KFLC-10.61 in 126 (58.9%) and IgG index in 101 (47.2%). The highest concordance was between OB and KFLC-6.6 (τ=0.727) followed by OB and KFLC-5.9 (τ=0.716). Combining DIS plus OB or KFLC-5.9 increased the number of diagnosed patients by 11 (5.1%), with KFLC-6.6 by 10 (4.7%), with KFLC-10.61 by 9 (4.2%), and with IgG index by 3 (1.4%). Patients with positive OB or indexes reached second attack and MRI DIS and DIT faster than patients with negative results (P < 0.0001 except IgG index in second attack: P = 0.016). In multivariable Cox models [aHR (95% CI)], the risk for second attack was very similar between KFLC-5.9 [2.0 (0.9-4.3), P = 0.068] and KFLC-6.6 [2.1 (1.1-4.2), P = 0.035]. The highest risk for MRI DIS and DIT was demonstrated with KFLC-5.9 [4.9 (2.5-9.6), P < 0.0001], followed by KFLC-6.6 [3.4 (1.9-6.3), P < 0.0001]. KFLC-5.9 and KFLC-6.6 had a slightly higher diagnostic accuracy than OB for second attack (70.5, 71.1, and 67.8) and MRI DIS and DIT (85.7, 85.1, and 81.0). KFLC indexes 5.9 and 6.6 performed slightly better than OB to assess multiple sclerosis risk and in terms of diagnostic accuracy. Given the concordance between OB and these indexes, we suggest using DIS plus positive OB or positive KFLC index as a modified criterion to diagnose multiple sclerosis.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Romina Dieli-Crimi
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia. 111321 Bogotá, Colombia
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mariano Ruiz-Ortiz
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Hernández-González
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
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Zabalza A, Arrambide G, Tagliani P, Cárdenas-Robledo S, Otero-Romero S, Esperalba J, Fernandez-Naval C, Trocoli Campuzano J, Martínez Gallo M, Castillo M, Bonastre M, Resina Sallés M, Beltran J, Carbonell-Mirabent P, Rodríguez-Barranco M, López-Maza S, Melgarejo Otálora PJ, Ruiz-Ortiz M, Pappolla A, Rodríguez Acevedo B, Midaglia L, Vidal-Jordana A, Cobo-Calvo A, Tur C, Galán I, Castilló J, Río J, Espejo C, Comabella M, Nos C, Sastre-Garriga J, Tintore M, Montalban X. Humoral and Cellular Responses to SARS-CoV-2 in Convalescent COVID-19 Patients With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/2/e1143. [PMID: 35105687 PMCID: PMC8808353 DOI: 10.1212/nxi.0000000000001143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/21/2021] [Indexed: 01/22/2023]
Abstract
Background and Objectives Information about humoral and cellular responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and antibody persistence in convalescent (COVID-19) patients with multiple sclerosis (PwMS) is scarce. The objectives of this study were to investigate factors influencing humoral and cellular responses to SARS-CoV-2 and its persistence in convalescent COVID-19 PwMS. Methods This is a retrospective study of confirmed COVID-19 convalescent PwMS identified between February 2020 and May 2021 by SARS-CoV-2 antibody testing. We examined relationships between demographics, MS characteristics, disease-modifying therapy (DMT), and humoral (immunoglobulin G against spike and nucleocapsid proteins) and cellular (interferon-gamma [IFN-γ]) responses to SARS-CoV-2. Results A total of 121 (83.45%) of 145 PwMS were seropositive, and 25/42 (59.5%) presented a cellular response up to 13.1 months after COVID-19. Anti–CD20-treated patients had lower antibody titers than those under other DMTs (p < 0.001), but severe COVID-19 and a longer time from last infusion increased the likelihood of producing a humoral response. IFN-γ levels did not differ among DMT. Five of 7 (71.4%) anti-–CD20-treated seronegative patients had a cellular response. The humoral response persisted for more than 6 months in 41/56(81.13%) PwMS. In multivariate analysis, seropositivity decreased due to anti-CD20 therapy (OR 0.08 [95% CI 0.01–0.55]) and increased in males (OR 3.59 [1.02–12.68]), whereas the cellular response decreased in those with progressive disease (OR 0.04 [0.001–0.88]). No factors were associated with antibody persistence. Discussion Humoral and cellular responses to SARS-CoV-2 are present in COVID-19 convalescent PwMS up to 13.10 months after COVID-19. The humoral response decreases under anti-CD20 treatment, although the cellular response can be detected in anti–CD20-treated patients, even in the absence of antibodies.
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Herrera C, Bruna V, Comella A, De La Rosa A, Diaz-Gonzalez L, Ruiz-Ortiz M, Lacalzada-Almeida J, Lucia A, Boraita A, Bayes-De-Luna A, Martinez-Selles M. Correlation between atrial electrocardiographic indexes and left atrial enlargement in competitive athletes. From the ALMUDAINA case-control study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2716] [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
Left atrial (LA) remodelling and enlargement in athletes is a well-kown component of the athlete's heart. However, information about the correlation between of LA enlargement and atrial electrophysiological features in athletes is scarce.
Purpose
Our aim was to characterize LA enlargement, P-wave duration, and the prevalence of interatrial block (IAB) in competitive athletes (with and without LA enlargement) and in controls.
Methods
ALMUDAINA (Analysis of Left atrial Measurements of Ultrasound Dilation Among International and National Athletes) was a nationwide, cross-sectional study involving 9 hospitals and sport clinics across Spain. Cases fulfilled the international consensus definition of a competitive athlete and were currently engaged in skill, power, mixed or endurance disciplines at a national or international level. The following P-wave parameters were analysed: 1) duration 2) voltage in lead I and 3) the presence of interatrial block (IAB). LA enlargement was defined as an indexed volume by body surface area ≥34 ml/m2, measured by transthoracic echocardiography. A contemporary cohort of otherwise healthy and active controls was used as a comparison group.
Results
Baseline clinical and echocardiographic characteristics of both cohorts are summarised in table 1 whereas electrocardiographic characteristics are displayed in table 2, respectively. 356 subjects were included, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Athletes showed a higher mean LA indexed volume (29.8±8.6 vs. 25.6±8.0 mL/m2, P=0.006) and higher prevalence of LA enlargement (113 [36.7%] vs. 5 [10.4%], P<0.001), but there were no relevant differences in P-wave duration (106.3±12.5 ms vs 108.2±7.7 ms; P=0.31), voltage in lead I (0.08±0.04 vs. 0.08±0,04 mV; P=0.79) and the prevalence of IAB (40 [13.0%] vs. 4 [8.3%], P=0.36). Only a case of advance IAB was detected, in an athlete without LA enlargement. Among athletes, those with LA enlargement (113, 36.7%) had higher P-wave duration (110.3±14.1 vs. 103.0±10.9 ms, P<0.001) and a higher prevalence of interatrial blockade (23 [20.4%] vs. 17 [8.8%], P=0.004), but similar voltage of P-wave in lead I (0.08±0.003 vs. 0.08±0.05 mV, P=0.689). In a multivariate analysis, competitive training was independently associated with LA enlargement (odds ratio [OR] 14.7, 95% confidence interval [CI] 4.7–44.0; P<0.001) but was not associated with P-wave duration (OR 1.02, 95% CI: 0.99–1.04; P=0.19) or IAB (OR 1.4, 95% CI 0.7–3.1; P=0.34).
Conclusions
LA enlargement is prevalent in adult competitive athletes. However, ECG indexes of atrial electrophysiology were not different from healthy controls. Our data suggest that LA enlargement and IAB are two different entities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Herrera
- University Hospital Gregorio Maranon, Madrid, Spain
| | - V Bruna
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - A Comella
- Universidad de Vic-Universidad Central de Catalunya, Laboratorio de fisiología del ejercicio de Bayés Esport. Research Group M3O., Vic, Spain
| | - A De La Rosa
- Hospiten Roca, Cardiology, Las Palmas de Gran Canaria, Spain
| | | | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | | | - A Lucia
- University Hospital 12 de Octubre, Instituto de investigaciόn Hospital 12 de Octubre, Madrid, Spain
| | - A Boraita
- Centro de Medicina del Deporte, Cardiology, Madrid, Spain
| | - A Bayes-De-Luna
- Hospital de la Santa Creu i Sant Pau, Fundaciόn de Investigaciόn Cardiovascular. ICCC-Instituto de Investigaciόn., Barcelona, Spain
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Villarejo-Galende A, Azcárate-Díaz FJ, Laespada-García MI, Rábano-Suárez P, Ruiz-Ortiz M, Domínguez-González C, Calleja-Castaño P, Martínez-Salio A, Moreno-García S, Pérez-Martínez DA. [From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants]. Rev Neurol 2021; 72:307-312. [PMID: 33908617 DOI: 10.33588/rn.7209.2020664] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIM COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS Narrative description of the adopted measures; Online survey among participants. RESULTS One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.
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Affiliation(s)
- A Villarejo-Galende
- Universidad Complutense de Madrid, Madrid, España.,Hospital Universitario 12 de Octubre, Madrid, España.,CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
| | | | | | | | - M Ruiz-Ortiz
- Hospital Universitario 12 de Octubre, Madrid, España
| | - C Domínguez-González
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER). ISCIII, Madrid, España.,Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | | | - D A Pérez-Martínez
- Universidad Complutense de Madrid, Madrid, España.,Hospital Universitario 12 de Octubre, Madrid, España.,CIBERNED. Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Madrid, España
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García-Pérez D, Ruiz-Ortiz M, Panero I, Eiriz C, Moreno LM, García-Reyne A, García A, Martín-Medina P, Salvador-Álvarez E, Hernández-Lain A, Serrano A, Gil-Etayo FJ, Castaño-León AM, Paredes I, Pérez-Núñez Á. Snorting the Brain Away: Cerebral Damage as an Extension of Cocaine-Induced Midline Destructive Lesions. J Neuropathol Exp Neurol 2021; 79:1365-1369. [PMID: 33146379 DOI: 10.1093/jnen/nlaa097] [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] [Indexed: 11/14/2022] Open
Abstract
Cocaine consumption is associated with a variety of clinical manifestations. Though cocaine intranasal inhalation always determines nasal mucosal damages, extensive septum perforations, and midline destructions-known as cocaine-induced midline destructive lesions (CIMDL)-affect only a limited fraction of patients. CIMDL is viewed as a cocaine-associated autoimmune phenomenon in which the presence of atypical anti-neutrophil cytoplasmic antibody (ANCA) promotes and/or defines the disease phenotype. A 51-year-old man presented with an intracranial tumor-like lesion by its space-occupying effect. CT also revealed the destruction of the nasal septum and skull base. A diagnosis of CIMDL was made in light of the patient's history as well as findings of the physical and endoscopic examinations, imaging studies, and laboratory testing. There was no evidence of other pathologies. Histopathological results from cerebral biopsy led us to consider the intracranial pathology as an extension of the CIMDL. CIMDL is the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of predisposed patients. The reported case is the first CIMDL consistent with brain extension mimicking a tumor-like lesion. While the presence of atypical ANCA seems to promote and/or define the disease phenotype, the specific role of these and other circulating autoantibodies needs further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Serrano
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
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8
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Blanco-Palmero VA, Azcárate-Díaz FJ, Ruiz-Ortiz M, Laespada-García MI, Rábano-Suárez P, Méndez-Guerrero A, Aramendi-Ramos M, Eguiburu JL, Pérez-Rivilla A, Marchán-López A, Rubio-Fernández M, Carro E, González de la Aleja J. Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms. J Neurol 2021; 268:3116-3124. [PMID: 33606070 PMCID: PMC7892700 DOI: 10.1007/s00415-021-10444-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 infection can associate diverse neurological manifestations. Several studies have provided proof to support the theory of neurotropic involvement of SARS-CoV-2. Alpha-synuclein has been described as a native antiviral factor within neurons, and upregulation of this protein can be seen in animals that suffered other neuroinvasive infections. To assess if increased expression of this protein takes place in COVID-19 patients with neurological symptoms, we analyzed serum total alpha-synuclein levels in three groups: seven COVID-19 patients with myoclonus, Parkinsonism and/or encephalopathy; thirteen age- and sex-matched COVID-19 patients without neurological involvement and eight age- and sex-matched healthy controls. We did not find differences among them. In a subset of four patients, the change in serum alpha-synuclein before and after the onset of neurological symptoms was not significant either. Cerebrospinal fluid alpha-synuclein levels were also similar between neurological COVID-19 and healthy controls. Overall, these results cannot support the hypothesis of alpha-synuclein upregulation in humans with neurological symptoms in COVID-19. Further research taking into account a larger group of COVID-19 patients including the whole spectrum of neurological manifestations and disease severity is needed.
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Affiliation(s)
- V A Blanco-Palmero
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain. .,Group of Neurodegenerative Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain. .,Networked Biomedical Research Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
| | - F J Azcárate-Díaz
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
| | - M Ruiz-Ortiz
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
| | - M I Laespada-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
| | - P Rábano-Suárez
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
| | - A Méndez-Guerrero
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
| | - M Aramendi-Ramos
- Department of Clinical Analysis, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J L Eguiburu
- Department of Clinical Analysis, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Pérez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Marchán-López
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Rubio-Fernández
- Group of Neurodegenerative Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Networked Biomedical Research Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - E Carro
- Group of Neurodegenerative Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Networked Biomedical Research Center in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - J González de la Aleja
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n 28041, Madrid, Spain
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9
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Bonilla Palomas J, Anguita-Sanchez M, Elola F, Bernal J, Fernandez-Perez C, Ruiz-Ortiz M, Jimenez-Navarro M, Bueno H, Cequier A, Marin F. Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1187] [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 one of the most pressing current public health concerns. However, in Spain there is a lack of population data.
Purpose
To investigate trends in HF hospitalization and in-hospital mortality rates.
Methods
We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated.
Results
A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p<0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p<0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p<0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p<0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p<0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p<0.001).
Conclusions
From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - F.J Elola
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - J.L Bernal
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - C Fernandez-Perez
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - M Ruiz-Ortiz
- Hospital Universitario Reina Sofía, Cόrdoba, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Cequier
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
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Bonilla Palomas J, Anguita-Sanchez M, Elola F, Bernal J, Fernandez-Perez C, Ruiz-Ortiz M, Jimenez-Navarro M, Bueno H, Cequier A, Marin F. Impact of hospital volume on in-hospital mortality and 30-day cardiac readmission of hospitalized patients with heart faliure. A population based study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1180] [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
Heart failure (HF) is a major health care problem. Epidemiological data from hospitalized patients are scarce and the association between hospital volume and patient outcomes is largely unknown.
Purpose
The aim of this study was to analyze the relationship between hospital volume and outcomes (in-hospital mortality and 30-day cardiac readmission).
Methods
We conducted an observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) within 30 days after discharge by using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Information on the number of HF discharges at each hospital in 2015 was analysed to classify centres into 2 categories (high- and low-volume hospitals). To discriminate between high- and low-volume centers, a K-means clustering algorithm was used. The association between volume and RSMR or RSRR was tested with the Pearson correlation coefficient and linear regression models.
Results
A total of 117 233 episodes of HF were selected during 2015. The mean age was 80±10 years and 46% were women. The crude in-hospital mortality rate was 12.1% and 30-day cardiac readmission rate was 18%. The cut-off point was set at 517 HF discharges per hospital during 2015. High volume hospitals had a statistically lower RSMR (10.3±2.8 vs 11.3±3.6; p<0.001) and higher RSRR (10.7±1.9 vs 9.2±1.6; p<0.001) than low volume hospitals. Low-volume hospitals showed higher dispersion of outcomes than high-volume, both for RSMR and RSRR (Figure).
Conclusions
We found that patients hospitalized for HF in 2105 had lower in-hospital mortality if they were admitted to a high-volume hospital. We have also found that high-volume hospitals had higher 30-day cardiac readmission rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - F.J Elola
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - J.L Bernal
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - C Fernandez-Perez
- Fundaciόn Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - M Ruiz-Ortiz
- Hospital Universitario Reina Sofía, Cόrdoba, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Cequier
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
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Ruiz-Ortiz M, Díaz-Santiáñez M, Azcárate-Díaz FJ, Gonzalo-Martínez JF, Moreno-García S, Ruiz-García R, Calleja-Castaño P. Allodynia, rigidity and gait disturbance. Pract Neurol 2020; 21:practneurol-2020-002669. [PMID: 33055102 DOI: 10.1136/practneurol-2020-002669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/03/2022]
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Méndez-Guerrero A, Laespada-García MI, Gómez-Grande A, Ruiz-Ortiz M, Blanco-Palmero VA, Azcarate-Diaz FJ, Rábano-Suárez P, Álvarez-Torres E, de Fuenmayor-Fernández de la Hoz CP, Vega Pérez D, Rodríguez-Montalbán R, Pérez-Rivilla A, Sayas Catalán J, Ramos-González A, González de la Aleja J. Acute hypokinetic-rigid syndrome following SARS-CoV-2 infection. Neurology 2020; 95:e2109-e2118. [PMID: 32641525 DOI: 10.1212/wnl.0000000000010282] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report a case of a patient infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who acutely developed a hypokinetic-rigid syndrome. METHODS Patient data were obtained from medical records from the Hospital Universitario 12 de Octubre in Madrid, Spain. [123I]-ioflupane dopamine transporter (DaT) SPECT images were acquired 4 hours after a single dose of 185 MBq of 123I-FP-CIT. Quantitative analysis was performed with DaTQUANT software providing the specific binding ratio and z score values of the striatum. RESULTS We report a previously healthy 58-year-old man who developed hyposmia, generalized myoclonus, fluctuating and transient changes in level of consciousness, opsoclonus, and an asymmetric hypokinetic-rigid syndrome with ocular abnormalities after a severe SARS-CoV-2 infection. DaT-SPECT confirmed a bilateral decrease in presynaptic dopamine uptake asymmetrically involving both putamina. Significant improvement in the parkinsonian symptoms was observed without any specific treatment. CONCLUSION This case study provides clinical and functional neuroimaging evidence to support that SARS-CoV-2 can gain access to the CNS, affecting midbrain structures and leading to neurologic signs and symptoms.
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Affiliation(s)
- Antonio Méndez-Guerrero
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - María Isabel Laespada-García
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Adolfo Gómez-Grande
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mariano Ruiz-Ortiz
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Víctor Antonio Blanco-Palmero
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco Javier Azcarate-Diaz
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Rábano-Suárez
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eva Álvarez-Torres
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Pablo de Fuenmayor-Fernández de la Hoz
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Diana Vega Pérez
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Rodríguez-Montalbán
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alfredo Pérez-Rivilla
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Sayas Catalán
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Ramos-González
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesús González de la Aleja
- From the Departments of Neurology (A.M.-G., M.I.L.-G., M.R.-O., V.A.B.-P., F.J.Z.-D., P.R.-S, C.P.d.F.-F.d.l.H., J.G.d.l.A.), Nuclear Medicine (A.G.-G., D.V.P.), Anesthesiology (E.A.-T., R.R.-M.), Microbiology (A.P.-Z.), Pneumology (J.S.C.), and Neuroradiology (A.R.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
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Anguita M, Sambola Ayala A, Elola J, Bernal JL, Fernandez C, Ferreiro JL, Bueno H, Marin F, Bonilla JL, Nunez-Villota J, Sanmartin M, Raposeiras S, Jimenez-Navarro MF, Filgueiras D, Ruiz-Ortiz M. P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0277] [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
Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial.
Purpose
To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years.
Methods
We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015.
Results
A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006).
Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval.
Conclusions
Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.
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Affiliation(s)
- M Anguita
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | | | - J Elola
- IMAS, Cardiology, Madrid, Spain
| | | | | | - J L Ferreiro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - F Marin
- Hospital Universitario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - J L Bonilla
- Hospital San Juan de la Cruz (Úbeda)., Cardiology, Cordoba, Spain
| | - J Nunez-Villota
- University Hospital Clinic of Valencia, Cardiology, Valencia, Spain
| | - M Sanmartin
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - S Raposeiras
- Complejo Hospitalario Universitario de Vigo., Cardiology, Vigo, Spain
| | | | - D Filgueiras
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
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14
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Sambola Ayala A, Anguita M, Elola J, Bernal JL, Fernandez C, Ferreiro JL, Bueno H, Marin F, Bonilla JL, Nunez-Villota J, Sanmartin M, Raposeiras S, Jimenez-Navarro MF, Filgueiras D, Ruiz-Ortiz M. P3605Lower benefit of women than men with ST-elevation myocardial infarction networks system in Spain: a study of 325,017 episodes over 10 years (2005–2015). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0464] [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
Sex differences are known to exist in the management of women presenting with ST elevation myocardial infarction (STEMI).Few studies have examined whether the clinical management and prognosis differs by sex when the STEMI network system is applied.
Purpose
To assess whether the STEMI network system improves management and prognosis both in men and women in Spain and to analyze possible differences according to sex.
Methods
We conducted a retrospective longitudinal study using information provided by the minimal database system (MDBS) of the Spanish National Health System (SNHS) to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality and expected mortality, multiplied by the crude rate of mortality. The RSMR was calculated using multilevel risk adjustment models developed by the Medicare and Medicaid Services. The year of the development of organized systems of care for STEMI patients in the different Autonomous Communities was double-checked using data from the National Cardiac Catheterization and Interventional Cardiology Annual Registry. RSMR was used to compare outcomes related with gender and with the presence of regional AMI networks and the performance of PCI. Temporal trends for in-hospital mortality during the observed period were modeled using Poisson regression analysis with year as the only independent variable. In all models, incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) were calculated.
Results
A total of 325,017 STEMI were identified among patients aged 35–94 years old. Of them 273,182 were selected after exclusions, and 106,277 (38.8%) were women. Women were on average 10 years older than men and had more comorbidities burden. The overall proportion of STEMI patients underwent to PCI increased, when a regional STEMI network was present from 2005–2015: (63.7% vs 48.2% in men; and 47.4% vs 32.9% in women; p<0.001). Differences in crude mortality between sexes was 15%, maintaining through 10 years, despite a higher increased of PCI (figure 1).However, women were less likely to be treated with PCI even though when STEMI network was stablished (63.7% vs 48.2% in men, 47.4% vs 32.9% in women, p<0.001) (figure 1).The mean crude in-hospital mortality rate for the whole study period was higher in women (9.3% vs 18.3%; unadjusted OR: 2.18, 95% CI: 2.12.-2.23, p<0.0001). RSMR was lower for women when STEMI network were working (17.7% vs. 19.7%; p<0.001).PCI and the presence of STEMI network were associated with a lower in-hospital mortality in STEMI women (adjusted OR, 0.48; 95% CI 0.41–0.52 and OR, 0.84; 95% CI 0.79–0.89, p<0.001, respectively).
Conclusions
Women were less likely to be treated with PCI and had higher in-hospital risk-adjusted mortality than men, despite the existence of STEMI network system.
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Affiliation(s)
| | - M Anguita
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - J Elola
- IMAS, Cardiology, Madrid, Spain
| | | | | | - J L Ferreiro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - F Marin
- Hospital Universitario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - J L Bonilla
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - J Nunez-Villota
- University Hospital Clinic of Valencia, Cardiology, Valencia, Spain
| | - M Sanmartin
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - S Raposeiras
- Complejo Hospitalario Universitario de Vigo., Cardiology, Vigo, Spain
| | | | - D Filgueiras
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
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15
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Esteve Pastor MA, Rivera-Caravaca JM, Roldan V, Roldan Rabadan I, Muniz J, Cequier A, Bertomeu-Martinez V, Badimon L, Rana-Miguez P, Ruiz-Ortiz M, Anguita M, Lip GYH, Marin F. P4800Estimated effect of NOACs compared to Vitamin K Antagonists in real-world atrial fibrillation patients: Data from FANTASIA Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1176] [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
Despite of the effectiveness and safety profile of Non-vitamin K Antagonists Oral Anticoagulants (NOACs) even in real-world (RW) Atrial Fibrillation (AF) patients, Vitamin K Antagonists (VKAs) have remained widely used in clinical practice worldwide but the comparison with acenocoumarol therapy in RW is unknown.
Purpose
To estimate the potential absolute benefit in clinical adverse events if the AF patients anticoagulated with VKA therapy had been treated with NOACs.
Methods
We analyzed anticoagulated AF patients who were prospectively recruited into the multicentre FANTASIIA registry. Patients were treated with VKAs for at least 6 months prior to inclusion. The estimation of clinical adverse events avoided was calculated applying absolute risk reductions, relative risk reductions and hazard ratios from the meta-analysis of RW use of NOACs relative to VKAs.
Results
We analyzed 1,470 patients under VKA therapy (mean age 74.1±9.5 years; 56.4% male). Stroke rate with acenocoumarol treatment was 0.88%/year. The estimated rates for stroke using NOACs would be 0.80%/year for Dabigatran 150 mg; 0.76%/year for Rivaroxaban and 0.74%/year for Apixaban instead of VKA. No significant differences were observed between the different NOACs and VKA in stroke rate. Major bleeding with acenocoumarol was 3.40%/year. The estimated rates for major bleeding using NOACs would be 2.75%/year for Dabigatran 150 mg; 3.37%/year for Rivaroxaban and 2.18%/year for Apixaban instead of VKA. Apixaban was the only NOAC that showed a significant estimated reduction rates (p=0.046). Finally, the all-cause mortality rate with acenocoumarol was 4.69%/year. The estimated rates of all-cause mortality using NOACs would be 3.28%/year for Dabigatran 150mg; 4.88%/year for Rivaroxaban and 2.67%/year for Apixaban. Dabigatran and Apixaban showed significant estimated reduction rates with the highest reduction with Apixaban (Table).
Annual Rate reduction of adverse events
Conclusion
The absolute estimated effect of NOACs in the AF patients anticoagulated with VKA showed a significant reduction in adverse clinical events. Apixaban performed the highest estimated reduction in major bleeding and all-cause mortality in comparison with acenocoumarol.
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Affiliation(s)
- M A Esteve Pastor
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - J M Rivera-Caravaca
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
| | - V Roldan
- University Hospital Morales Meseguer, Hematology and Clinical Oncology, Murcia, Spain
| | | | - J Muniz
- Instituto Universitario de Ciencias de la Salud, A Coruna, Spain
| | - A Cequier
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - L Badimon
- Cardiovascular Research Center (CSIC-ICCC), Barcelona, Spain
| | | | | | - M Anguita
- University Hospital Reina Sofia, Cordoba, Spain
| | - G Y H Lip
- Liverpool Heart and Chest Hospital, Centre of Cardiovascular Science, Liverpool, United Kingdom
| | - F Marin
- Hospital Clinico Univeristario Virgen de la Arrixaca, IMIB Arrixaca, CIBER-CV, Spain, Murcia, Spain
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16
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Sanchez JJ, Ruiz-Ortiz M, Ogayar C, Mesa D. P3707CHA2DS2 VASC score as predictor of the incidence of stroke in patients with stable coronary artery disease and sinus rhythm in the long-term follow-up. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0561] [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
Cerebral vascular disease and coronary artery disease (CAD) share risk factors. Our aim was to study CHA2DS2VASC score as predictor of stroke incidence in a sample of patients with sinus ryhtm and stable CAD (sCAD) during long term follow-up.
Methods
The CICCOR registry (“Chronic ischaemic heart disease in Cordoba”) is a prospective monocentric cohort study. Between February 2000 and January 2004 all patients with sCAD who attended two outpatient cardiology clinics in a city of the South of Spain were recruited. We analyzed the relationship between baseline CHA2DS2VASC score and the incidence of stroke in a sample of patients with sCAD without atrial fibrillation during long term follow-up. Patients without sinus rythm were excluded.
Results
1268 patients with sCAD were recruited (median age 68±10 years, 73% male). 69 patients showed atrial fibrillation and were excluded. The median follow-up was 11.2 years (maximum follow-up of 17 years). During this period, only 2 patients were lost, and 136 patients (11.5% of the sample) suffered stroke. Baseline mean CHA2DS2 VASC score was 3.21. Most patients showed CHA2DS2 VASC score lower than 4 (81.4% of the sample). Higher CHA2DS2 VASC score at baseline was associated with higher risk of suffering stroke during follow-up (Hazard Ratio = 1.31 (1.16–1.48); p<0.001). Mean results are shown in the table.
Table 1 No stroke (n=1063) Stroke (n=136) Hazard ratio (CI 95%) p Sex male (%) 777 (88.8) 98 (11.2) High blood pressure (%) 561 (86.6) 86 (13.3) Diabetes mellitus (%) 317 (86.4) 50 (13.6) 75 years and older (%) 205 (83.7) 40 (16.3) Mean CHADS VASC score 3.17 3.55 1.31 (1.16–1.48) <0.001 CHADS VASC score higher than 4 (%) 185 (84.1) 35 (15.9) 2.00 (1.33–3.01) 0.001
Stroke incidence according to CHADSVASC
Conclusion
Higher CHA2DS2 VASC score was significantly associated with higher stroke incidence during long term follow-up in this real-world sample of patients with sCAD in sinus rythm.
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Affiliation(s)
| | - M Ruiz-Ortiz
- University Hospital Reina Sofia, cardiology, Cordoba, Spain
| | - C Ogayar
- University Hospital Reina Sofia, cardiology, Cordoba, Spain
| | - D Mesa
- University Hospital Reina Sofia, cardiology, Cordoba, Spain
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17
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Laespada-Garcia MI, Bermejo-Guerrero L, Rabano-Suarez P, Ruiz-Ortiz M, Azcarate-Diaz FJ, Ramos-Gonzalez A, Herrero-San Martin AO. [«Salt and pepper» sign in the onset of a non-vascular pontine pathology]. Rev Neurol 2019; 69:133-134. [PMID: 31310003 DOI: 10.33588/rn.6903.2019068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - M Ruiz-Ortiz
- Hospital Universitario 12 de Octubre, Madrid, Espana
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18
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Rivera Caravaca JM, Marin F, Esteve-Pastor MA, Ferreira I, Badimon L, Rafols C, Ruiz-Ortiz M, Anguita M. P3853Switching to non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients taking vitamin K antagonists: a 1-year report of the SULTAN registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3853] [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: 11/12/2022] Open
Affiliation(s)
- J M Rivera Caravaca
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Department of Cardiology, Murcia, Spain
| | - F Marin
- Scientific Committee of the SULTAN registry, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Cardiology, Murcia, Spain
| | - M A Esteve-Pastor
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Department of Cardiology, Murcia, Spain
| | - I Ferreira
- Scientific Comitee of the SULTAN registry, Madrid, Spain
| | - L Badimon
- Scientific Comitee of the SULTAN registry, Madrid, Spain
| | - C Rafols
- Bayer Hispania S.L., Madrid, Spain
| | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Department of Cardiology, Cordoba, Spain
| | - M Anguita
- Scientific Comitee of the SULTAN registry, Madrid, Spain
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19
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Esteve Pastor MA, Rivera-Caravaca JM, Roldan V, Roldan-Rabadan I, Muniz J, Cequier A, Bertomeu-Martinez V, Badimon L, Rana-Miguez P, Ruiz-Ortiz M, Anguita M, Lip GYH, Marin F. P6240Long term cardiovascular risk prediction in Real-World atrial fibrillation patients: Validation of the 2MACE score in the FANTASIIA registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6240] [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 A Esteve Pastor
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - J M Rivera-Caravaca
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - V Roldan
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - I Roldan-Rabadan
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J Muniz
- Instituto Universitario de Ciencias de la Salud, CIBER-CV, A Coruna, Spain
| | - A Cequier
- University Hospital of Bellvitge, Department of Cardiology, CIBER-CV, Barcelona, Spain
| | - V Bertomeu-Martinez
- University Hospital San Juan de Alicante, Department of Cardiology, CIBER-CV, Alicante, Spain
| | - L Badimon
- Cardiovascular Research Center (CSIC-ICCC), CIBER-CV, Barcelona, Spain
| | | | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Department of Cardiology, Cordoba, Spain
| | - M Anguita
- University Hospital Reina Sofia, Department of Cardiology, Cordoba, Spain
| | - G Y H Lip
- Birmingham City Hospital, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
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20
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Esteve Pastor MA, Rivera-Caravaca JM, Roldan V, Roldan-Rabadan I, Muniz J, Cequier A, Bertomeu-Martinez V, Rana-Miguez P, Badimon L, Ruiz-Ortiz M, Anguita M, Lip GYH, Marin F. P3509Performance of the Cockcroft-Gault, MDRD and CKD-EPI Formulae in Atrial Fibrillation patients.The FANTASIIA Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3509] [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 A Esteve Pastor
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - J M Rivera-Caravaca
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - V Roldan
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - I Roldan-Rabadan
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J Muniz
- Instituto Universitario de Ciencias de la Salud, CIBER-CV, A Coruna, Spain
| | - A Cequier
- University Hospital of Bellvitge, Department of Cardiology, CIBER-CV, Barcelona, Spain
| | - V Bertomeu-Martinez
- University Hospital San Juan de Alicante, Department of Cardiology, CIBER-CV, Alicante, Spain
| | | | - L Badimon
- Cardiovascular Research Center (CSIC-ICCC), CIBER-CV, Barcelona, Spain
| | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Department of Cardiology, Cordoba, Spain
| | - M Anguita
- University Hospital Reina Sofia, Department of Cardiology, Cordoba, Spain
| | - G Y H Lip
- Birmingham City Hospital, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
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21
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Esteve Pastor MA, Rivera-Caravaca JM, Roldan V, Roldan Rabadan I, Muniz J, Cequier A, Bertomeu-Martinez V, Badimon L, Rana-Miguez P, Ruiz-Ortiz M, Anguita M, Lip GYH, Marin F. P982Is there an obesity paradox for adverse outcomes in patients with atrial fibrillation? insights from the FANTASIIA registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p982] [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 A Esteve Pastor
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology. IMIB-Arrixaca. CIBER-CV, Murcia, Spain
| | - J M Rivera-Caravaca
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - V Roldan
- University Hospital Morales Meseguer, Department of Hematology and Clinical Oncology, Murcia, Spain
| | - I Roldan Rabadan
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J Muniz
- Instituto Universitario de Ciencias de la Salud, CIBER-CV, A Coruna, Spain
| | - A Cequier
- University Hospital of Bellvitge, Department of Cardiology. CIBER-CV, Barcelona, Spain
| | - V Bertomeu-Martinez
- University Hospital San Juan de Alicante, Department of Cardiology. CIBER-CV, Alicante, Spain
| | - L Badimon
- Cardiovascular Research Center (CSIC-ICCC), CIBER-CV, Barcelona, Spain
| | | | - M Ruiz-Ortiz
- University Hospital Reina Sofia, Department of Cardiology., Cordoba, Spain
| | - M Anguita
- University Hospital Reina Sofia, Department of Cardiology., Cordoba, Spain
| | - G Y H Lip
- Birmingham City Hospital, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Deparment of Cardiology. IMIB-Arrixaca. CIBER-CV, Murcia, Spain
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