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Vazirani R, Delia MA, Blanco-Ponce E, Martín-García AC, Fernández-Cordón C, Uribarri A, Andrés M, Vedia O, Sionis A, Corbí-Pascual M, Salamanca J, Pérez-Castellanos A, Carmona JDM, Raposeiras-Roubín S, Aritza-Conty D, Lopez-País J, Guillén-Marzo M, Lluch-Requerey C, Escudier JM, Martínez-Sellés M, Núñez-Gil IJ. Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort. Int J Cardiol 2024; 405:131971. [PMID: 38490270 DOI: 10.1016/j.ijcard.2024.131971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive. OBJECTIVE To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS. MATERIAL AND METHODS Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization. RESULTS The prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr <0.71), patients within Q4 (Cr > 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively). CONCLUSIONS TTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain.
| | | | | | - Aitor Uribarri
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Mireia Andrés
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Oscar Vedia
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, II-B Sant Pau, Universitat Autònoma de Barcleona, CIBER-CV, Barcelona, Spain.
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - José David Martínez Carmona
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Malaga, Spain, Instituto de Investigación Biomédica de Málaga-IBIMA, CIBERCV
| | | | - David Aritza-Conty
- Department of Cardiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Javier Lopez-País
- Department of Cardiology, Hospital Universitario de Orense, Orense, Spain
| | - Marta Guillén-Marzo
- Department of Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | | | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
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García‐Gomis D, López J, Calderón A, Andrés M, Ponte I, Roque A. Proteasome-dependent degradation of histone H1 subtypes is mediated by its C-terminal domain. Protein Sci 2024; 33:e4970. [PMID: 38591484 PMCID: PMC11002908 DOI: 10.1002/pro.4970] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
Histone H1 is involved in chromatin compaction and dynamics. In human cells, the H1 complement is formed by different amounts of somatic H1 subtypes, H1.0-H1.5 and H1X. The amount of each variant depends on the cell type, the cell cycle phase, and the time of development and can be altered in disease. However, the mechanisms regulating H1 protein levels have not been described. We have analyzed the contribution of the proteasome to the degradation of H1 subtypes in human cells using two different inhibitors: MG132 and bortezomib. H1 subtypes accumulate upon treatment with both drugs, indicating that the proteasome is involved in the regulation of H1 protein levels. Proteasome inhibition caused a global increase in cytoplasmatic H1, with slight changes in the composition of H1 bound to chromatin and chromatin accessibility and no alterations in the nucleosome repeat length. The analysis of the proteasome degradation pathway showed that H1 degradation is ubiquitin-independent. The whole protein and its C-terminal domain can be degraded directly by the 20S proteasome in vitro. Partial depletion of PA28γ revealed that this regulatory subunit contributes to H1 degradation within the cell. Our study shows that histone H1 protein levels are under tight regulation to prevent its accumulation in the nucleus. We revealed a new regulatory mechanism for histone H1 degradation, where the C-terminal disordered domain is responsible for its targeting and degradation by the 20S proteasome, a process enhanced by the regulatory subunit PA28γ.
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Affiliation(s)
- D. García‐Gomis
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - J. López
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - A. Calderón
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - M. Andrés
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - I. Ponte
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - A. Roque
- Biochemistry and Molecular Biology Department, Biosciences FacultyUniversitat Autònoma de BarcelonaBarcelonaSpain
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Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Correction to: Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024:10.1007/s10741-024-10401-1. [PMID: 38625655 DOI: 10.1007/s10741-024-10401-1] [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: 04/17/2024]
Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Moisés Rodríguez-González
- Pediatric Cardiology Division of Puerta del Mar University Hospital, Mar University, Hospital, Cadiz, Spain
| | - Ana Castellano-Martinez
- Pediatric Cardiology Division of Puerta del Mar University Hospital, Mar University, Hospital, Cadiz, Spain
| | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
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Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024:10.1007/s10741-024-10394-x. [PMID: 38483658 DOI: 10.1007/s10741-024-10394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/09/2024]
Abstract
Takotsubo syndrome (TTS) in the pediatric population is an infrequent but relevant cause of morbidity and mortality, with limited studies addressing its clinical course and prognosis. We aimed to analyze the clinical features and prognosis of pediatric TTS in a nation-wide multicenter registry and considering the published literature. We included a total of 54 patients from 4 different hospitals in Spain, as well as pediatric TTS patients from the published literature. Comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between pediatric and adult population features. Patients with pediatric TTS are more commonly male and exhibit a higher prevalence of physical triggers. The left ventricular ejection fraction (LVEF) was significantly lower in the pediatric population (30.5 + 10.4 vs 36.9 + 16.9, p < 0.05), resulting in more than fivefold rates of cardiogenic shock on admission compared to the general adult TTS population (Killip IV 74.1% vs 10.5%, p < 0.001) with similar rates of death and recurrence between groups. TTS in the pediatric population presents a distinctive clinical profile, with higher prevalence of atypical symptoms and physical triggers, as well as higher rates of cardiogenic shock on admission and similar mortality and recurrence rates than those of the adult population. This study provides valuable insights into understanding pediatric TTS and underscores the necessity for further research in this age group.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
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Fernández-Cordón C, Núñez-Gil IJ, Martín de Miguel I, Pérez-Castellanos A, Vedia O, Almendro-Delia M, López-País J, Uribarri A, Duran-Cambra A, Martín-García A, Raposeiras-Roubin S, Blanco-Ponce E, Corbí-Pascual M, Guillén Marzo M, Andrés M, Feltes G, Martínez-Selles M. Takotsubo Syndrome, Stressful Triggers, and Risk of Recurrence. Am J Cardiol 2023; 205:58-62. [PMID: 37586122 DOI: 10.1016/j.amjcard.2023.07.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
The risk of recurrence in takotsubo syndrome (TTS) appears to be low, although previous studies have shown conflicting results and factors associated with recurrences are unclear. The aim of this study is to evaluate the incidence and predictors of TTS recurrences. Adult patients included in the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO) between January 2003 and September 2019 were identified. Patients were categorized based on recurrences during follow-up and a multivariate logistic regression model was used to identify factors associated with recurrences. A total of 1097 patients (mean age 71.0±11.9 years, 87% females) were included, repeated TTS events were documented in 44 patients (4.0%), including 13 patients with prior TTS and 31 patients with recurrent TTS during a median follow-up of 279 days. Two patients (0.02%) had two episodes of recurrence. Compared to patients who had no recurrence of TTS, those with recurrent TTS more frequently had no identifiable stressful trigger in the index admission (20 [64.5%] vs 352 [33.0%], p <0.001). Primary TTS, defined as TTS without physical trigger, was also more common in the recurrence group (93.5% vs 68.3%, p <0.001). The only factor independently associated with recurrences was the absence of an identifiable trigger (odds ratio 3.7 [95% confidence interval 1.8-7.8], p=0.001). In conclusion, our data indicate that for patients presenting with TTS, the rate of early recurrent TTS is approximately 4% per year. Among TTS patients, those who have no identifiable trigger events appear to have a higher rate of recurrence.
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Affiliation(s)
| | - Iván Javier Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Spain
| | - Irene Martín de Miguel
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Alberto Pérez-Castellanos
- Cardiology Department, Instituto de Investigación Sanitaria Islas Baleares, Hospital Universitario Son Espases, Spain
| | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier López-País
- Cardiology Department, Hospital Clínico Universitario de Santiago, Santiago, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Albert Duran-Cambra
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustín Martín-García
- Cardiology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Emilia Blanco-Ponce
- Cardiology Department, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | | | | | - Mireia Andrés
- Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gisela Feltes
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Spain; Cardiology Department, Hospital Vithas Arturo Soria, Madrid, Spain
| | - Manuel Martínez-Selles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Spain.
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Raposeiras-Roubín S, Núñez-Gil IJ, Jamhour K, Abu-Assi E, Conty DA, Vedia O, Almendro-Delia M, Sionis A, Martin-Garcia AC, Corbí-Pascual M, Martínez-Sellés M, Uribarri A, Guillén M, Acuña JMG, País JL, Blanco E, Linares Vicente JA, Flecha ASG, Andrés M, Pérez-Castellanos A, Alonso J, Rosselló X, Romo AI, Feltes G. Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry. Rev Port Cardiol 2023; 42:237-246. [PMID: 36634757 DOI: 10.1016/j.repc.2022.02.010] [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: 08/05/2021] [Revised: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No evidence-based therapy has yet been established for Takotsubo syndrome (TTS). Given the putative harmful effects of catecholamines in patients with TTS, beta-blockers may potentially decrease the intensity of the detrimental cardiac effects in those patients. OBJECTIVE The purpose of this study was to assess the impact of beta-blocker therapy on long-term mortality and TTS recurrence. METHODS The cohort study used the national Spanish Registry on TakoTsubo Syndrome (RETAKO). A total of 970 TTS post-discharge survivors, without pheochromocytoma, left ventricular outflow tract obstruction, sustained ventricular arrhythmias, and significant bradyarrhythmias, between January 1, 2003, and July 31, 2018, were assessed. Cox regression analysis and inverse probability weighting (IPW) propensity score analysis were used to evaluate the association between beta-blocker therapy and survival free of TTS recurrence. RESULTS From 970 TTS patients, 582 (60.0%) received beta-blockers. During a mean follow-up of 2.5±3.3 years, there were 87 deaths (3.6 per 100 patients/year) and 29 TTS recurrences (1.2 per 100 patient/year). There was no significant difference in follow-up mortality or TTS recurrence in unadjusted and adjusted Cox analysis (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.59-1.27, and 0.95, 95% CI 0.57-1.13, respectively). After weighting and adjusting by IPW, differences in one-year survival free of TTS recurrence between patients treated and untreated with beta-blockers were not found (average treatment effect -0.01, 95% CI -0.07 to 0.04; p=0.621). CONCLUSIONS In this observational nationwide study from Spain, there was no significant association between beta-blocker therapy and follow-up survival free of TTS recurrence.
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Affiliation(s)
| | - Iván J Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Karim Jamhour
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Emad Abu-Assi
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Aitor Uribarri
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Guillén
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | | | - Javier Lopez País
- Cardiology Department, Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | - Emilia Blanco
- Cardiology Department, Hospital Arnau de Vilanova, Lérida, Spain
| | | | | | - Mireia Andrés
- Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Joaquín Alonso
- Cardiology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Gisela Feltes
- Cardiology Department, Hospital Nuestra Señora de América, Madrid, Spain
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Andrés M, García MC, Fajardo A, Grau L, Pagespetit L, Plasencia V, Martínez I, Abadía C, Sanahuja A, Bella F. Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission. Rev Clin Esp 2022; 222:578-583. [PMID: 35798645 PMCID: PMC9239913 DOI: 10.1016/j.rceng.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.
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Affiliation(s)
- M. Andrés
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain,Corresponding author
| | - M.-C. García
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Fajardo
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Grau
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Pagespetit
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - V. Plasencia
- Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), Spain
| | - I. Martínez
- Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - C. Abadía
- Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Sanahuja
- Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - F. Bella
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
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Pereyra E, Fernández-Rodríguez D, González-Sucarrats S, Almendro-Delia M, Martín A, de Miguel IM, Andrés M, Duran-Cambra A, Sánchez-Grande-Flecha A, Worner-Diz F, Núñez-Gil IJ. Antiplatelet therapy at discharge and long-term prognosis in Takotsubo syndrome: Insights from the Spanish National Registry (RETAKO). Rev Port Cardiol 2022; 41:S0870-2551(22)00359-6. [PMID: 36241580 DOI: 10.1016/j.repc.2021.06.029] [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: 05/02/2021] [Accepted: 06/07/2021] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Endothelial dysfunction and platelet activation have been highlighted as possible mediators in Takotsubo syndrome (TTS). Nevertheless, to date, evidence on the usefulness of antiplatelet therapy in TTS remains controversial. The aim of our study is to evaluate long-term prognosis in TTS patients treated with antiplatelet therapy (APT) at hospitalization discharge. MATERIAL AND METHODS An ambispective cohort study from the Spanish National Takotsubo Registry database was performed (June 2002 to March 2017). Patients were divided into two groups: those who received APT at hospital discharge (APT cohort) and those who did not (non-APT cohort). Primary endpoint was all-cause death. Secondary endpoints included the composite of recurrence or readmission and a composite of death, recurrence or readmission. RESULTS From a total of 741 patients, 728 patients were alive at discharge. Follow-up was performed in 544 patients, who were included in the final analysis: 321 patients (59.0%) in the APT cohort and 223 patients (41.0%) in the non-APT cohort. The APT cohort had a better clinical presentation and received more heart failure and acute coronary syndrome-like therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers: 75.1% vs. 51.1%; p<0.001, betablockers: 71.3% vs. 50.7%; p<0.001, statins: 67.9% vs. 33.2%; p<0.001). After adjusting for confounder factors, APT at discharge was a protective factor for all-cause death (adjusted hazard ratio (HR) 0.315, 95% confidence interval (CI): 0.106-0.943; p=0.039) and the composite endpoint of all-cause death, recurrence or readmission (adjusted HR 0.318, 95% CI: 0.164-0.619; p=0.001) at month 25 of follow-up. CONCLUSION Patients with TTS receiving APT at discharge presented better prognosis up to two-years of follow-up compared with their counterparts not receiving APT.
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Affiliation(s)
- Eduardo Pereyra
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | | | | | - Agustín Martín
- Department of Cardiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Mireia Andrés
- Department of Cardiology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Fernando Worner-Diz
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
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Mato S, Salmerón-Villalobos J, de Anta NC, Ramis-Zaldivar J, Garcia N, Wang L, Colmenero A, Verdú J, Andrés M, Celis V, Ortega M, Campo E, Balagué O, Salaverria I. REFINING THE GENETIC LANDSCAPE OF AGGRESSIVE B-CELL LYMPHOMA BY INTEGRATIVE MOLECULAR ANALYSIS. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Calzado S, Hernández-Meneses M, Llopis J, Boix-Palop L, Ríos JDDL, Andrés M, Cuquet J, Quintana E, Gasch O, Miró J. Pacientes con Endocarditis Tributaria de Cirugía que no se Intervienen. Evaluación del Impacto del Traslado al Centro de Referencia. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stiermaier T, Walliser A, El-Battrawy I, Pätz T, Mezger M, Rawish E, Andrés M, Almendro-Delia M, Martinez-Sellés M, Uribarri A, Pérez-Castellanos A, Guerra F, Novo G, Mariano E, Musumeci MB, Arcari L, Cacciotti L, Montisci R, Akin I, Thiele H, Brunetti ND, Núñez-Gil IJ, Santoro F, Eitel I. Happy Heart Syndrome: Frequency, Characteristics, and Outcome of Takotsubo Syndrome Triggered by Positive Life Events. JACC Heart Fail 2022; 10:459-466. [PMID: 35772855 DOI: 10.1016/j.jchf.2022.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association with a preceding stressor is a characteristic feature of takotsubo syndrome (TTS). Negative emotions before TTS are common and led to the popular term "broken heart syndrome." In contrast, pleasant triggers ("happy heart syndrome") are rare and are scarcely investigated. OBJECTIVES The authors analyzed the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry. METHODS Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant emotional events with patients with negative emotional events. RESULTS Of 2,482 patients in the registry, 910 patients (36.7%) exhibited an emotional trigger consisting of 873 "broken hearts" (95.9%) and 37 "happy hearts" (4.1%). Consequently, the prevalence of pleasant emotional triggers was 1.5% of all TTS cases. Compared with patients with TTS with negative preceding events, patients with happy heart syndrome were more frequently male (18.9% vs 5.0%; P < 0.01) and had a higher prevalence of atypical ballooning patterns (27.0% vs 12.5%; P = 0.01), particularly midventricular ballooning. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke (8.1% vs 12.3%; P = 0.45), and long-term mortality rates (2.7% vs 8.8%; P = 0.20) were similar in "happy hearts" and "broken hearts." CONCLUSIONS Happy heart syndrome is a rare type of TTS characterized by a higher prevalence of male patients and atypical, nonapical ballooning compared with patients with negative emotional stressors. Despite similar short- and long-term outcomes in our study, additional data are needed to explore whether numerically lower event rates in "happy hearts" would be statistically significant in a larger sample size. (GErman-Italian-Spanish Takotsubo Registry [GEIST Registry]; NCT04361994).
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Affiliation(s)
- Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | | | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; German Center for Cardiovascular Research, Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Toni Pätz
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Matthias Mezger
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Elias Rawish
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Mireia Andrés
- Cardiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Aitor Uribarri
- Cardiology Service, Valladolid University Hospital, Valladolid, Spain
| | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Umberto I-Lancisi-Salesi University Hospital, Ancona, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit, University of Palermo, P. Giaccone University Hospital, Palermo, Italy
| | - Enrica Mariano
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Maria Beatrice Musumeci
- Department of Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Roberta Montisci
- Division of Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; German Center for Cardiovascular Research, Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Ivan J Núñez-Gil
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
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Andrés M, García MC, Fajardo A, Grau L, Pagespetit L, Plasencia V, Martínez I, Abadía C, Sanahuja A, Bella F. Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea. Rev Clin Esp 2022; 222:578-583. [PMID: 35541500 PMCID: PMC9072947 DOI: 10.1016/j.rce.2022.04.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Antecedentes y objetivos A pesar de los datos cada vez mayores que respaldan la importancia de la transmisión aérea en la infección por el SARS-CoV-2, en la inmensa mayoría de los brotes nosocomiales descritos de COVID-19 no se ha considerado relevante. El objetivo de este estudio consiste en describir un brote nosocomial de infección por el SARS-CoV-2 cuyas características indican que la transmisión por aerosoles desempeñó un papel importante. Métodos Se trata de un análisis descriptivo de un brote nosocomial de infección por el SARS-CoV-2 en una planta de medicina interna que tuvo lugar en diciembre de 2020. Todos los casos se confirmaron mediante una PCR positiva para SARS-CoV-2. Resultados Entre el 5 y el 17 de diciembre, 21 pacientes y 44 profesionales sanitarios contrajeron una infección nosocomial por el SARS-CoV-2. De los 65 casos, 51 (78,5%) se diagnosticaron entre el 6 y el 9 de diciembre. La tasa de afectación en los pacientes fue del 80,8%. Entre los profesionales sanitarios, la tasa fue mayor en los que habían trabajado al menos una jornada laboral completa en la planta (56,3%) que en los que habían estado ocasionalmente en ella (25,8%; p = 0,005). Tres días antes de detectar el primer caso positivo se identificó una avería en 2 extractores de aire, que afectó a la ventilación de 3 habitaciones. Dieciséis casos cursaron de forma asintomática, 48 manifestaron síntomas leves y 2 precisaron ingreso en la unidad de cuidados intensivos. Todos los casos se recuperaron finalmente. Conclusiones La elevada tasa de afectación, la naturaleza explosiva del brote y la coincidencia en el tiempo con la avería de los extractores de aire en algunas habitaciones de la planta indican que la transmisión aérea desempeñó un papel fundamental en el desarrollo del brote.
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Affiliation(s)
- M Andrés
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - M-C García
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - A Fajardo
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - L Grau
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - L Pagespetit
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - V Plasencia
- Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), España
| | - I Martínez
- Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - C Abadía
- Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - A Sanahuja
- Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - F Bella
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
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Núñez-Gil IJ, Vedia O, Almendro-Delia M, Raposeiras-Roubín S, Sionis A, Martin-García AC, Martin-García A, Andrés M, Blanco E, Martín-de-Miguel I, Uribarri A, Corbí-Pascual M, Feltes G, Bosch X, Fabregat-Andres O, López-Pais J, Sánchez-Grande-Flecha A, Guillen-Marzo M. Fe de errores a «Implicaciones clínicas y pronósticas en síndrome de Takotsubo y cáncer: percepciones del registro RETAKO» [Med Clin (Barc). 2020;155(12):521-528]. Med Clin (Barc) 2022; 159:155. [DOI: 10.1016/j.medcli.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nuñez-Gil IJ, Andrés M, Benito B, Bernardo E, Vedia O, Ferreira-Gonzalez I, Barba I. Serum Metabolomic Analysis Suggests Impairment of Myocardial Energy Production in Takotsubo Syndrome. Metabolites 2021; 11:metabo11070439. [PMID: 34357333 PMCID: PMC8303832 DOI: 10.3390/metabo11070439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Takotsubo syndrome is a complex entity that, although it usually has a good prognosis, can be life threatening. While recent advances have improved the knowledge of takotsubo syndrome, many aspects of its etiology still remain uncertain. Metabolomics, a hypothesis generating approach, could provide novel pathophysiology information about this disease. METHODS AND RESULTS Serum samples were obtained from takotsubo (n = 19) and acute myocardial infarction patients (n = 8) at the cath lab and, in the case of takotsubo, again once the patient had recovered, 3 months after the main event. 1H NMR spectra of the serum were acquired at 9.4T using a CPMG pulse sequence (32 ms effective delay). Supervised and unsupervised pattern recognition approaches where applied to the data. Pattern recognition was able to differentiate between takotsubo and acute myocardial infarction during the acute phase with 95% accuracy. Myocardial infarction patients showed an increase in lipid signals, a known risk factor for the disease while takotsubo patients showed a relative increase in acetate that could suggest a reduced turnover of the Krebs cycle. When comparing acute and recovered phases, we could detect an increase in alanine and creatine once patients recovered. CONCLUSIONS Our results demonstrate that takotsubo syndrome is metabolically different than AMI, showing limited myocardial energy production capacity during the acute phase. We achieved high classification success against AMI; however, this study should be considered as a proof of concept regarding clinical application of metabolic profiling in takotsubo cardiomyopathy.
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Affiliation(s)
- Iván J. Nuñez-Gil
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.J.N.-G.); (E.B.); (O.V.)
| | - Mireia Andrés
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (M.A.); (B.B.)
| | - Begoña Benito
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (M.A.); (B.B.)
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Esther Bernardo
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.J.N.-G.); (E.B.); (O.V.)
| | - Oscar Vedia
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.J.N.-G.); (E.B.); (O.V.)
| | - Ignacio Ferreira-Gonzalez
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (M.A.); (B.B.)
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (I.F.-G.); (I.B.)
| | - Ignasi Barba
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (M.A.); (B.B.)
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVicUCC), Can Baumann, Ctra, de Roda, 70, 08500 Vic, Spain
- Vall d’Hebron Institut d’Oncologia (VHIO), CELLEX CENTER C/ Natzaret 115-117, 08035 Barcelona, Spain
- Correspondence: (I.F.-G.); (I.B.)
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Rubio-San-Simón A, Hladun Alvaro R, Juan Ribelles A, Castañeda Heredia A, Guerra-García P, Verdú-Amorós J, Andrés M, Cañete A, Rives S, Pérez-Martínez A, Mora J, Patiño-García A, Lassaleta A, Llort A, Ramírez M, Mata C, Gallego S, Martín-Broto J, Cruz O, Morales La Madrid A, Solano P, Martínez Romera I, Fernández-Teijeiro A, Bautista F, Moreno L. The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP). Clin Transl Oncol 2021; 23:2489-2496. [PMID: 34076861 DOI: 10.1007/s12094-021-02649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates. METHODS Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020. RESULTS Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions. CONCLUSIONS The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.
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Affiliation(s)
- A Rubio-San-Simón
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - R Hladun Alvaro
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - A Juan Ribelles
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | | | - P Guerra-García
- Paediatric Oncology-Haematology Department, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - J Verdú-Amorós
- Paediatric Oncology-Haematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - M Andrés
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - A Cañete
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - S Rives
- Paediatric Oncology-Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Pérez-Martínez
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - J Mora
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Patiño-García
- Paediatric Oncology-Haematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Lassaleta
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - A Llort
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - M Ramírez
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - C Mata
- Paediatric Oncology-Haematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - S Gallego
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - J Martín-Broto
- Medical Oncology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - O Cruz
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - P Solano
- Paediatric Oncology-Haematology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - I Martínez Romera
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - A Fernández-Teijeiro
- Paediatric Oncology-Haematology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - F Bautista
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain. .,Paediatric Oncology, Haematology and Haematopoietic Stem Cell Transplant Department, Hospital Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - L Moreno
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
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Ruiz-Simón S, Calabuig I, Gomez-Garberi M, Andrés M. POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal
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Tedeschi S, Pascart T, Latourte A, Godsave C, Kundaki B, Naden R, Taylor W, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andrés M, Bardin T, Doherty M, Ea HK, Filippou G, Fitzgerald J, Gutierrez M, Iagnocco A, Jansen T, Kohler M, Lioté F, Matza M, Mccarthy G, Ramonda R, Reginato A, Richette P, Singh J, Sivera F, So A, Stamp L, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. POS1124 IDENTIFYING POTENTIAL CLASSIFICATION CRITERIA FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE (CPPD): RESULTS FROM THE INITIAL PHASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. ACR/EULAR are jointly sponsoring development of CPPD classification criteria using a multi-phase process.Objectives:To report preliminary results from the first two phases of a four-phase process for developing CPPD classification criteria.Methods:CPPD classification criteria development is overseen by a 12-member Steering Committee. Item generation (Phase I) included a scoping literature review of five literature databases and contributions from a 35-member Combined Expert Committee and two Patient Research Partners. Item reduction and refinement (Phase II) involved a Combined Expert Committee meeting, discussions among Clinical, Imaging, and Laboratory Advisory Groups, and an item rating exercise to assess the influence of individual items toward classification. The Steering Committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development.Results:Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The Advisory Groups eliminated items they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases (see Table 1). As numerous imaging items were rated +3, the Steering Committee recommended focusing on imaging of the knee, wrist, and one additional affected joint for calcification suggestive of CPP crystal deposition.Conclusion:The ACR/EULAR CPPD classification criteria working group has adopted both data- and expert-driven approaches, leading to 56 candidate items broadly categorized as clinical, imaging, and laboratory features. Remaining steps for criteria development include domain establishment, item weighting through a multi-criteria decision analysis exercise, threshold score determination, and criteria validation.Table 1.Categories of items retained for future phases of classification criteria developmentAge in decade at symptom onsetAcute inflammatory arthritis (e.g. knee, wrist, 1st MTP joint*)Recurrence and pattern of joint involvement (e.g. 1 self-limited episode, >1 self-limited episode)Physical findings (e.g. palpable subcutaneous tophus*, psoriasis*)Co-morbidities and family history (e.g. Gitelman disease, hemochromatosis, familial CPPD)Osteoarthritis location and features (e.g. 2nd or 3rd MCP joint, wrist)Synovial fluid findings (e.g. CPP crystals present, CPP crystals absent on 1 occasion* or 2 occasions*, monosodium urate crystals present*)Laboratory findings (e.g. hypomagnesemia, hyperparathyroidism, rheumatoid factor*, anti-CCP*)Plain radiograph: calcification in regions of fibro- or hyaline cartilage+Plain radiograph: calcification of the synovial membrane/capsule/tendon+Conventional CT: calcification in regions of fibro- or hyaline cartilage+Conventional CT: calcification of the synovial membrane/capsule/tendon+Ultrasound: CPP crystal deposition in fibro- or hyaline cartilage+Ultrasound: CPP crystal deposition in synovial membrane/capsule/tendons+Dual-energy CT: CPP crystal deposition in fibro- or hyaline cartilage+Dual-energy CT: CPP crystal deposition in synovial membrane/capsule/tendon+*Potential negative predictor +Assessed in the knee, wrist, and/or 1 additional affected jointDisclosure of Interests:Sara Tedeschi Consultant of: NGM Biopharmaceuticals, Tristan Pascart: None declared, Augustin Latourte Consultant of: Novartis, Cattleya Godsave: None declared, Burak Kundaki: None declared, Raymond Naden: None declared, William Taylor: None declared, Nicola Dalbeth Speakers bureau: Abbvie and Janssen, Consultant of: AstraZeneca, Dyve, Selecta, Horizon, Arthrosi, and Cello Health, Tuhina Neogi: None declared, Fernando Perez-Ruiz: None declared, Ann Rosenthal: None declared, Fabio Becce Consultant of: Horizon Therapeutics, Grant/research support from: Siemens Healthineers, Eliseo Pascual: None declared, Mariano Andrés: None declared, Thomas Bardin: None declared, Michael Doherty: None declared, Hang Korng Ea: None declared, Georgios Filippou: None declared, John FitzGerald: None declared, Marwin Gutierrez: None declared, Annamaria Iagnocco: None declared, Tim Jansen Speakers bureau: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Consultant of: Abbvie, Amgen, BMS, Grunenthal, Olatec, Sanofi Genzyme, Minna Kohler Speakers bureau: Lilly, Consultant of: Novartis, Frederic Lioté: None declared, Mark Matza: None declared, Geraldine McCarthy Consultant of: PK Med, Roberta Ramonda: None declared, Anthony Reginato: None declared, Pascal Richette: None declared, Jasvinder Singh Speakers bureau: Simply Speaking, Consultant of: Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, Francisca Sivera: None declared, Alexander So: None declared, Lisa Stamp: None declared, Janeth Yinh: None declared, Chio Yokose: None declared, Robert Terkeltaub Consultant of: Sobi, Horizon Therapeutics, Astra-Zeneca, Selecta, Grant/research support from: Astra-Zeneca, Hyon Choi: None declared, Abhishek Abhishek Consultant of: NGM Biopharmaceuticals.
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Fierro A, Pérez-Rojí G, Blanco A, López P, Andrés M, González-Quintanilla V, Pérez-Pereda S, Fontanillas N, Pascual J. Headache as main reason for consultation to a hospital Emergency Department in Spain: a prospective study. Neurologia 2021; 38:S0213-4853(21)00089-X. [PMID: 34083062 DOI: 10.1016/j.nrl.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Headache is common in the general population and a frequent reason for medical consultation. OBJECTIVES To describe the characteristics of patients attending the Emergency Department (ED) for headache. METHODS A descriptive study with prospective collection of 100 consecutive patients over 15 years old who attended our ED due to headache as the main complaint. RESULTS Headache accounted for 1,4% of ED visits. The most common age range is between 31 and 45 years and the majority of the patients are females (61%). We diagnosed 67 primary and 33 secondary headaches. The most frequent diagnosis was migraine, with 36% of cases. One out of 3 patients had a history of headache and 4 out of 5 consulted by their own decision. Only a small percentage of patients were admitted as inpatients (12%), and 3 out of 5 were referred to Primary Care. Complementary tests were performed on 84% of the patients. One CT scan was performed for every 3 patients. A total of 80% patients was correctly diagnosed by the ED physicians. CONCLUSIONS Headache is a frequent complaint in the ED, where primary headaches are the most common with migraine being the most frequent reason for consultation. In our setting, there is a good screening and diagnosis of headaches, as well as an adequate use of the available resources in the ED for their diagnosis and management.
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Affiliation(s)
- A Fierro
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla e IDIVAL y Universidad de Cantabria, Santander, España
| | - G Pérez-Rojí
- Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Blanco
- Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - P López
- Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Andrés
- Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - V González-Quintanilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla e IDIVAL y Universidad de Cantabria, Santander, España
| | - S Pérez-Pereda
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla e IDIVAL y Universidad de Cantabria, Santander, España
| | | | - J Pascual
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla e IDIVAL y Universidad de Cantabria, Santander, España.
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Núñez-Gil IJ, Vedia O, Almendro-Delia M, Raposeiras-Roubín S, Sionis A, Martin-García AC, Martin-García A, Andrés M, Blanco E, Martín-de-Miguel I, Uribarri A, Corbí-Pascual M, Feltes G, Bosch X, Fabregat-Andres O, López-Pais J, Sánchez-Grande-Flecha A, Guillen-Marzo M. Takotsubo syndrome and cancer, clinical and prognostic implications, insights of RETAKO. Med Clin (Barc) 2020; 155:521-528. [PMID: 32430206 DOI: 10.1016/j.medcli.2020.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVES A relationship between neoplasms and Takotsubo syndrome (TS) has been postulated. Our goal was to determine its prevalence in patients with TS, compare the clinical profile of TS with or without cancer and study its long-term evolution. MATERIALS AND METHODS The oncological situation of patients included in the National Registry on TAKOtsubo syndrome (RETAKO), admitted between 2002 and 2019, provided by 38 hospitals throughout the country is analysed. Any history of malignancy or tumour, even benign, that received chemotherapy, radiotherapy or specific surgery, current or past, was considered. RESULTS Any type of neoplasm was described in 129 (11.8%), within a cohort of 1,097 patients with TS. The cohort of patients with neoplasm, with a lower percentage of women (79.1 vs. 88.3%; P=.003), showed a non-significant tendency at an older age, hyperuricaemia, sleep apnoea and lower LVEF on admission, with a similar cardiovascular risk factor profile, but more chronic anaemia and immunosuppression. The most common neoplasm was breast cancer. During their hospital stay, the cancer patients suffered more complications, highlighting heart failure/shock, acute renal failure and a trend towards combined infections. On follow-up, they presented higher mortality and more combined MACE events, with a non-significant trend in the occurrence of cardiovascular recurrences or readmissions. CONCLUSIONS The prevalence of neoplasms in patients with TS is high. The clinical presentation is different in relation to patients who do not have neoplasms and they probably represent a risk factor for a worse hospital and long term prognosis.
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Affiliation(s)
- Iván J Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
| | - Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | | | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Agustín C Martin-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, IBSAL, CIBER-CV, Salamanca, España
| | - Ana Martin-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, IBSAL, CIBER-CV, Salamanca, España
| | - Mireia Andrés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Emilia Blanco
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, España
| | - Irene Martín-de-Miguel
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital de Valladolid, Valladolid, España
| | | | - Gisela Feltes
- Servicio de Cardiología, Hospital Nuestra Señora de América, Madrid, España
| | - Xavier Bosch
- Servicio de Cardiología, Hospital Clínic, Barcelona, España
| | - Oscar Fabregat-Andres
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, España
| | - Javier López-Pais
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
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Oterino Serrano C, Alonso E, Andrés M, Buitrago NM, Pérez Vigara A, Parrón Pajares M, Cuesta López E, Garzón Moll G, Martin Espin I, Bueno Barriocanal M, De Ceano-Vivas la Calle M, Calvo Rey C, Bret-Zurita M. Pediatric chest x-ray in covid-19 infection. Eur J Radiol 2020; 131:109236. [PMID: 32932176 PMCID: PMC7448740 DOI: 10.1016/j.ejrad.2020.109236] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features. OBJECTIVE To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children. MATERIALS AND METHODS Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available. RESULTS Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common. CONCLUSION The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.
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Affiliation(s)
- C Oterino Serrano
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - E Alonso
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - M Andrés
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - N M Buitrago
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - A Pérez Vigara
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - M Parrón Pajares
- Pediatric Radiology Section. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - E Cuesta López
- Cardiothoracic Radiology Section. Hospital Universitario La Paz, Madrid, Spain.
| | - G Garzón Moll
- Radiology Department Chief. Hospital Universitario La Paz, Madrid, Spain.
| | - I Martin Espin
- Emergency Department. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - M Bueno Barriocanal
- Emergency Department. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | | | - C Calvo Rey
- Department of Infectious Disease Chief. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
| | - M Bret-Zurita
- Pediatric Radiology Section Chief. Hospital Universitario La Paz. Hospital Infantil, Madrid, Spain.
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Monzó M, Quilis Marti N, Ranieri L, San-Martín A, Andrés M. THU0411 STRUCTURED CARDIOVASCULAR ASSESSMENT INCLUDING CAROTID ULTRASOUND IN GOUT: ANALYSIS OF SUBSEQUENT EVENTS IN THE FOLLOW UP. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Gout is an independent cardiovascular (CV) risk factor. This excess of morbidity and mortality requires optimal management, especially in high-risk individuals. So, the inclusion of subclinical atherosclerosis screening by carotid ultrasound in the initial evaluation may help to accurately stratify the CV risk. However, longitudinal outcomes using this technique are not available in gout.Objectives:To analyze the new CV events occurred in patients with gout after structured CV assessment incorporating carotid ultrasound.Methods:Retrospective analysis of an inception cohort of new patients with crystal-proven gout. At baseline, a structured CV assessment was performed considering age, gender, traditional risk factors, CV and renal disease, laboratory data, SCORE and Framingham risk tools and carotid ultrasound; according to 2013 ESC guidelines, CV risk was stratified as low, moderate, high or very high. The cohort includes 356 patients, mean aged 64 years (SD 14.0) mostly males (86.0%), 21.8% with tophaceous gout and mean serum urate at diagnosis of 8.2mg/dL (SD 1.8). The CV risk stratification was: low in 20 (5.6%), moderate in 47 (13.2%), high in 34 (9.6%), and very high risk in 242 (68.0%). Major CV events (coronary disease (CD), heart failure (HF), stroke, peripheral artery disease (PAD) and CV death) were recorded during the follow-up by electronic case reports review. A binary composite endpoint of “new major CV event” was used. The incidence after inclusion in the cohort was estimated. To evaluate potential baseline predictors (clinical and gout-related) of CV events, a Cox regression model was built.Results:Mean follow-up in the cohort was 41.5 months (SD 16.8). Forty new major CV events have been identified (incidence 3.25%/patient-year), distributed as follows: HF 1.46 (n=18), CV death 0.65 (n=8), CD 0.49 (n=6), stroke 0.33 (n=4), and PAD 0.33%/patient-year (n=4). Per risk stratification, the incidence of a new event was 0.16%/patient-year in the high-risk group and 3.01%/patient-year in the very high-risk, while no events occurred in low and moderate groups. The table shows the univariate and multivariate analysis of baseline variables. An independent association and a trend towards significance were noted for age and to be classified at a very high CV risk at baseline, respectively.Univariate regressionMultivariate regressionHR (95%CI)PHR (95%CI)PAge1.07 (1.04-1.11)<0.0011.04 (1.00-1.08)0.031Female gender3.27 (1.68-6.33)<0.0011.24 (0.55-2.81)0.605Body mass index1.00 (0.94-1.06)0.863--Glomerular filtration rate0.98 (0.97-0.99)<0.0011.00 (0.99-1.01)0.766Very high CV risk at baseline9.54 (2.30-39.64)0.0024.11 (0.89-19.02)0.070Serum urate at diagnosis1.19 (1.00-1.42)0.0521.12 (0.94-1.33)0.227ULT at diagnosis0.81 (0.29-2.27)0.688--Tophi1.33 (0.66-2.66)0.422--Years since first flare1.00 (0.97-1.03)0.772--Number of flares suffered0.99 (0.97-1.00)0.255--Number of involved joints1.00 (0.89-1.12)0.976--Joint pattern at presentation-Monoarticular1.00(ref)-1.00(ref)--Oligoarticular1.86 (0.91-3.80)0.0891.35 (0.65-2.82)0.421-Polyarticular2.75 (1.05-7.22)0.0391.34 (0.48-3.76)0.579HR: Hazard ratio; 95%CI: 95% confidence interval.Conclusion:First longitudinal study assessing the use of subclinical atherosclerosis screening as part of CV risk assessment in new patients with gout. Those classified at the very high-risk group presented the majority of events, being HF the most frequent. Age, and likely to be classified as very high risk, independently predicted a new CV event during follow-up, data that may be of interest in terms of management of the patient with gout at the time of diagnosis.Disclosure of Interests: :Mar Monzó: None declared, Neus Quilis Marti: None declared, Laura Ranieri: None declared, Alejandro San-Martín: None declared, Mariano Andrés Grant/research support from: Grünenthal, Consultant of: Grünenthal, Menarini, Speakers bureau: Grünenthal, Horizon
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Peral ML, Calabuig I, Martín-Carratalá A, Andrés M, Pascual E. THU0406 IDENTIFICATION OF INTRACELLULAR VACUOLES IN SYNOVIAL FLUID WITH CALCIUM PYROPHOSPHATE AND MONOSODIUM URATE CRYSTALS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Synovial fluid analysis using polarized microscopy is the gold standard for the diagnosis of crystal-related arthritis. In our experience, we have noted that, when calcium pyrophosphate (CPP) crystals are observed, they sometimes appear within intracellular vacuoles. However, this phenomenon is not seen in those samples containing monosodium urate (MSU) crystals. This finding has been scantly reported in the literature, but may be useful in clinical practice to ensure accurate crystal identification.Objectives:Our study aims to assess whether the presence of vacuoles contributes to identifying the type of crystal, and also to gauge the frequency of their presentation.Methods:We conducted an observational study in a rheumatology unit between February and June of 2019. Synovial fluids containing CPP or MSU crystals, obtained in daily clinical practice, were consecutively included for analysis. Two observers simultaneously analyzed the presence of vacuoles by ordinary light and phase contrast microscopy in less than 24 hours after their extraction, using a microscope equipped with two viewing stations. The primary study variable was to determine whether CPP and MSU crystals are seen inside intracellular vacuoles, and to calculate the frequency of this finding for each type of crystal, estimating their 95% confidence interval (95% CI) and comparing rates using Fisher’s exact test.Results:Twenty-one samples were obtained. Data is given in the Table. MSU crystals were present in 7 (33.3%) and CPP crystals in 14 (66.6%). Interestingly, none of the MSU samples showed crystal-containing vacuoles (95% CI 0-35.4%). On the contrary, cytoplasmic vacuoles containing crystals were present in all of the CPP samples (95% CI 78.5-100%). The findings were confirmed by phase-contrast microscopy. Differences were statistically significant (p<0.001).Table.SAMPLES ACCORDING TO TYPE OF MICROCRYSTAL(n=21)SAMPLES WITH VACUOLS(UNDER ORDINARY LIGHT)SAMPLES WITH VACUOLS(UNDER PHASE CONTRAST)CPP (14; 66.6%)14 (100%)(95%CI 78.5-100%)14 (100%)(95%CI 78.5-100%)MSU (7; 33.3%)0 (0%)(95%CI 0-35.4%)0 (0%)(95%CI 0-35.4%)Conclusion:The presence of vacuoles may be a useful and easy way to differentiate MSU and CPP crystals when performing synovial fluid microscopy in clinical practice, since it appears to be a distinctive feature in CPP crystal fluids.References:[1]Kohn NN, Hughes RE, McCarty DJ Jr, Faires JS. The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the «pseudogout syndrome». II. Identification of crystals. Ann InternMed. 1962 May;56:738-45.[2]Pascual E, Sivera F, Andrés M. Synovial Fluid Analysis for Crystals. CurrOpRheumatol 2011;23:161-169.[3]McCarty DJ, Koopman WJ. Arthritis and allied conditions: A textbook of rheumatology, volumen 1. Lea &Febiger. 1993.[4]Pascual E, Sivera F. Synovial fluid crystal Analysis. En Gout and other crystal arthropathies. Terkeltaub R ed. Elsevier; 2012: p.20-34.[5]Hwang HS, Yang CM, Park SJ, Kim HA. Monosodium Urate Crystal-Induced Chondrocyte Death via Autophagic Process. Int J Mol Sci. 2015 Dec 8;16(12):29265-77.Image 1. Microscopy with ordinary light. Cells with cytoplasmic vacuoles are observed, as well as abundant intra and extracellular CPP crystals.Image 2. Microscopy with phase contrast technique. Cells with intracellular vacuoles are observed inside which have microcrystals with parallelepiped morphology, compatible with CPP.Disclosure of Interests: :None declared
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López González MDC, Nofuentes E, Ruíz Alcaraz S, Gayá García-Manso I, García Sevila R, Vela-Casasempere P, Andrés M. SAT0530 DESCRIPTION AND OUTCOMES OF A SERIES OF 21 PATIENTS WITH INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES IN A MULTIDISCIPLINARY UNIT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A significant proportion of patients with idiopathic interstitial pneumonia shows autoimmune features, but do not meet the criteria to be classified as a systemic autoimmune disease. In 2015, a joint working group of the European Respiratory Society (ERS) and the American Thoracic Society (ATS) proposed classification criteria for the category called interstitial pneumonia with autoimmune features (IPAF).Objectives:To evaluate the clinical, serological and morphological characteristics of a series of 21 patients with IPAF as well as the treatment that was applied and the evolution they presented.Methods:A retrospective cohort study was conducted. The patients who met ERS/ATC IPAF classification criteria in the period from 2012 to 2019 were collected from our interstitial lung disease (ILD) database, including 546 patients. All cases were systematically assessed in a multidisciplinary committee. Clinical, serological, morphological, as well as treatment and outcome variables were collected. A Descriptive analysis is shown.Results:21 patients were included in the study, 12 of them (57.1%) women. The mean age at diagnosis was 61.6 years (SD 14.0), and the median follow-up time was 2.9 years (IQR 4.9). All showed ILD by HRCT, 10 (47.6%) patients had autoimmune features at the moment of the diagnosis, and 20 (95.2%) were positive for some auto-antibody. 12 (57.1%) fulfilled two of the three domains, and 9 (42.9%) fulfilled the three IPAF domains. Characteristics are described in Table 1. Lung biopsy was performed in 9 cases (42.9%). The mean FVC at diagnosis was 70.4% (DS 21.0) and DLCO 46.7% (DS 21.5). Regarding the treatment during the disease, mofetil mycophenolate (MMF) was used in 8 (38.1%) patients, cyclophosphamide (CYC) in 3 (14.3%), rituximab (RTX) in 2 (9.5%) and azathioprine in 2 (9.5%). In 1 case (4.8%), CYC and RTX were used in combination. Oral glucocorticoids (GCC) were prescribed in 14 patients (66.7%), 4 of them alone, and 6 cases (28.6%) required high-dose methylprednisolone in 250-1000 mg regimens. Antifibrotic drugs (nintedanib or pirfenidone) were used in 5 cases (23.8%) in combination with immunosuppressants and/or GCC. Five patients (23.8%) required home oxygen supplementation. Outcomes to date: 7 (33.3%) patients had readmissions due to ILD acute exacerbation; 2 (9.5%) required lung transplantations, and 3 (14.3%) died during follow-up, 1 (4.8%) due to respiratory causes.Table 1.CLINICAL DOMAINSEROLOGIC DOMAINMORPHOLOGIC DOMAINn%n%MORPHOLOGYRADIOLOGYn%Raynaud’s phenomenon733,3ANA ≥ 1:320 (mottled, diffuse, homogeneous)1257,1NSIP1571,4Inflammatory arthritis/ polyarticular morning joint stiffness ≥ 60 min419Anti-Ro1152,4UIP523,8Digital oedema419ANA nucleolar314,3LIP14,8Mechanic hands14,8ANA centromere14,8Others00Distal digital ulceration14,8Anti-PM-Scl75419HISTOPATHOLOGYn%Palmar telangiectasia14,8Anti-SRP29,5NSIP419Gottron’s sign14,8Anti-PM-Scl10029,5Interstitial lymphoid aggregates with germinal center29,5Others00Rheumatoid factor≥ 2 ULN29,5Diffuse lymphocytoplasmic infiltration14,8Anti-Jo114,8UIP14,8PL-714,8Others00PL-1214,8MULTICOMPARTIMENTAL AFFECTIONn%Anti-Mi2A14,8Pulmonary vasculopathy523,8Anti-CENPA14,8Pleural effusion14,8TIF1-gamma14,8Intrinsic airways disease14,8Others00Unexplained pericardial effusion00Conclusion:IPAF was more frequent in women; ANA were the prevalent antibodies; NSIP was the most repeated radiological and pathological pattern; and the combination of GC plus MMF was the most used treatment scheme. Despite our low numbers, acute exacerbations, requirement of lung transplantation and deaths have occurred, which demonstrates the severity of the disease.References:[1]Fischer A, et al. An official ERS/ATS research statement: interstitial pneumonia with autoimmune features. Eur Respir J. 2015 Oct;46(4):976–87.Disclosure of Interests:María del Carmen López González: None declared, ESTER NOFUENTES: None declared, Sandra Ruíz Alcaraz: None declared, Ignacio Gayá García-Manso: None declared, Raquel García Sevila: None declared, Paloma Vela-Casasempere: None declared, Mariano Andrés Grant/research support from: Grünenthal, Consultant of: Grünenthal, Menarini, Speakers bureau: Grünenthal, Horizon
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Calabuig I, Martínez-Sanchis A, Andrés M. THU0418 CAROTID ATHEROSCLEROSIS AND SONOGRAPHIC SIGNS OF URATE CRYSTAL DEPOSITS IN GOUT: AN ASSOCIATION STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Carotid subclinical atherosclerosis is prevalent in patients with gout, although poorly predicted by cardiovascular risk assessment tools. Gout itself is deemed to contribute to its development. However, a previous report did not show an association between clinical characteristics of gout and the presence of subclinical atherosclerosis [1].Objectives:To explore the association between sonographic signs of urate crystal deposits and carotid atherosclerosis.Methods:Consecutive new patients with crystal-proven gout attended in a tertiary Rheumatology unit were eligible for the study. It included musculoskeletal and carotid ultrasound assessment, performed by a trained sonographer blinded to clinical data. Patients were examined during intercritical periods; flare prophylaxis with low-dose colchicine or other agents was permitted, but patients under urate-lowering treatment were excluded. The musculoskeletal scans evaluated wrists, 2nd MCPs and 1st MTPs joints, and triceps and patellar tendons, for the presence of signs suggestive of urate crystal deposits (double contour, hyperechoic aggregates, and tophi), following OMERACT definitions. Also, local power-Doppler (PD) signal was registered and graded as 0 to 3. The sum of locations showing crystal deposits or positive PD signal (≥1) was estimated in order to assess crystal and inflammatory burden, respectively. Carotid arteries were scanned for increased intima-media thickness (IMT) and presence of atheroma plaques, according to Mannheim consensus. The association analysis was done by logistic regression, considering increased IMT or atheroma plaques as the dependent variables.Results:Eighty-eight new patients with gout were enrolled, mean aged 62.0 years (SD 14.5), 89.8% males. Mean gout duration was 5.9 years (SD 9.0), clinical tophi were observed in 16.1% of patients and mean serum urate level at diagnosis was 8.4 mg/dl (SD 1.5). All participants showed at least one sonographic sign of crystal deposits at the examined locations, with a mean sum of 9.4 (SD 4.0). Regarding individual signs, their mean (SD) sum was as follows: 4.6 (2.1) for tophi, 3.9 (2.8) for aggregates and 0.9 (1.0) for double contour. The mean sum of locations with positive PD signal was 1.1 (SD 1.0). Regarding carotid scans, increased IMT was seen in 26 patients (30.6%) and atheroma plaques in 51 (58.0%). Table 1 shows the results of the association analysis. Positive PD signal was significantly associated with the presence of atheroma plaques, while tophi showed a trend with both increased IMT and atheroma plaques.Conclusion:Sonographic deposits were consistently observed in new patients with gout. Crystal and inflammatory load, here shown as tophi and positive PD signal, seem associated with carotid atherosclerosis. This new finding may contribute to understanding the complex relationship between gout and atherosclerosis.References:[1]Ann Rheum Dis. 2017;76:1263.Disclosure of Interests: :Irene Calabuig: None declared, Agustín Martínez-Sanchis: None declared, Mariano Andrés Grant/research support from: Grünenthal, Consultant of: Grünenthal, Menarini, Speakers bureau: Grünenthal, Horizon
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Uribarri A, Núñez-Gil IJ, Conty DA, Vedia O, Almendro-Delia M, Duran Cambra A, Martin-Garcia AC, Barrionuevo-Sánchez M, Martínez-Sellés M, Raposeiras-Roubín S, Guillén M, Garcia Acuña JM, Matute-Blanco L, Linares Vicente JA, Sánchez Grande Flecha A, Andrés M, Pérez-Castellanos A, Lopez-Pais J. Short- and Long-Term Prognosis of Patients With Takotsubo Syndrome Based on Different Triggers: Importance of the Physical Nature. J Am Heart Assoc 2019; 8:e013701. [PMID: 31830875 PMCID: PMC6951081 DOI: 10.1161/jaha.119.013701] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Takotsubo syndrome (TTS) is an acute reversible heart condition initially believed to represent a benign pathology attributable to its self‐limiting clinical course; however, little is known about its prognosis based on different triggers. This study compared short‐ and long‐term outcomes between TTS based on different triggers, focusing on various physical triggering events. Methods and Results We analyzed patients with a definitive TTS diagnosis recruited for the Spanish National Registry on TTS (RETAKO [Registry on Takotsubo Syndrome]). Short‐ and long‐term outcomes were compared between different groups according to triggering factors. A total of 939 patients were included. An emotional trigger was detected in 340 patients (36.2%), a physical trigger in 293 patients (31.2%), and none could be identified in 306 patients (32.6%). The main physical triggers observed were infections (30.7%), followed by surgical procedures (22.5%), physical activities (18.4%), episodes of severe hypoxia (18.4%), and neurological events (9.9%). TTS triggered by physical factors showed higher mortality in the short and long term, and within this group, patients whose physical trigger was hypoxia were those who had a worse prognosis, in addition to being triggered by physical factors, including age >70 years, diabetes mellitus, left ventricular eyection fraction <30% and shock on admission, and increased long‐term mortality risk. Conclusions TTS triggered by physical factors could present a worse prognosis in terms of mortality. Under the TTS label, there could be as yet undiscovered very different clinical profiles, whose differentiation could lead to individual better management, and therefore the perception of TTS as having a benign prognosis should be generally ruled out.
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Affiliation(s)
- Aitor Uribarri
- Cardiology Department Hospital Clínico Universitario de Valladolid CIBERCV Valladolid Spain
| | - Iván J Núñez-Gil
- Instituto Cardiovascular Hospital Clínico San Carlos Madrid Spain
| | - D Aritza Conty
- Cardiology Department Hospital de Navarra Pamplona Spain
| | - Oscar Vedia
- Instituto Cardiovascular Hospital Clínico San Carlos Madrid Spain
| | | | | | - Agustin C Martin-Garcia
- Cardiology Department Hospital Clínico Universitario de Salamanca Instituto de Investigación Biomédica de Salamanca (IBSAL) CIBERCV Salamanca Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department Hospital General Universitario Gregorio Marañón CIBERCV Universidad Europea Universidad Europea de Madrid Madrid Spain
| | | | - Marta Guillén
- Cardiology Department Hospital Joan XXIII Tarragona Spain
| | | | | | | | | | - Mireia Andrés
- Cardiology Department Hospital Universitario Vall d'Hebron Barcelona Spain
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Barba I, Andrés M, Garcia-Dorado D. Metabolomics and Heart Diseases: From Basic to Clinical Approach. Curr Med Chem 2019; 26:46-59. [PMID: 28990507 DOI: 10.2174/0929867324666171006151408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The field of metabolomics has been steadily increasing in size for the last 15 years. Advances in analytical and statistical methods have allowed metabolomics to flourish in various areas of medicine. Cardiovascular diseases are some of the main research targets in metabolomics, due to their social and medical relevance, and also to the important role metabolic alterations play in their pathogenesis and evolution. Metabolomics has been applied to the full spectrum of cardiovascular diseases: from patient risk stratification to myocardial infarction and heart failure. However - despite the many proof-ofconcept studies describing the applicability of metabolomics in the diagnosis, prognosis and treatment evaluation in cardiovascular diseases - it is not yet used in routine clinical practice. Recently, large phenome centers have been established in clinical environments, and it is expected that they will provide definitive proof of the applicability of metabolomics in clinical practice. But there is also room for small and medium size centers to work on uncommon pathologies or to resolve specific but relevant clinical questions. OBJECTIVES In this review, we will introduce metabolomics, cover the metabolomic work done so far in the area of cardiovascular diseases. CONCLUSION The cardiovascular field has been at the forefront of metabolomics application and it should lead the transfer to the clinic in the not so distant future.
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Affiliation(s)
- Ignasi Barba
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Mireia Andrés
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - David Garcia-Dorado
- Cardiovascular Diseases Research Group, Department of Cardiology, Vall d'Hebron University Hospital and Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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Almendro-Delia M, Núñez-Gil IJ, Lobo M, Andrés M, Vedia O, Sionis A, Martin-García A, Cruz Aguilera M, Pereyra E, Martín de Miguel I, Linares Vicente JA, Corbí-Pascual M, Bosch X, Fabregat Andrés O, Sánchez Grande Flecha A, Pérez-Castellanos A, Pais JL, De Mora Martín M, Escudier Villa JM, Martín Asenjo R, Guillen Marzo M, Rueda Sobella F, Aceña Á, García Acuña JM, García-Rubira JC, Figueras J, Barrabes J, Andrés M, Núñez Gil I, Mejía H, Vedia O, Feltes G, Worner F, Bascompte Claret R, Pereyra E, Jiménez Candil J, García Sánchez M, Martín García A, Martín García A, Bodi V, Bonanad C, Bastante T, Cruz Aguilera M, Palazuelos J, Sancho Carmona D, López Pais J, Alonso J, Almendro Delia M, Lobo M, Rodríguez de Leiras S, García Rubira J, Corbí-Pascual M, Córdoba Soriano J, De Mora Martín M, Pérez B, Martín Asensio R, Rueda Sobella F, Santos Pardo I, Manzano Nieto M, Escudier Villa J, Fabregat Andrés O, Ridocci-Soriano F, Parias Ángel M, Gaebelt H, Aceña A, Martin Reyes R, Bergua C, Sanz Puértolas P, Echeverria Lucotti I, Vidal Pérez R, Sionis A, Duran Cambra A, Tómas Ortiz J, Bosch Genover X, Guillen Marzo M, Bardají R, García Acuña J, Sánchez Grande Flecha A, García González M, García de la Villa Redondo G, Pérez Castellanos A, Piqueras-Flores J, Ruíz Valdepeas Herrero L, Linares Vicente J, Ruiz Arroyo J, García J, Giner Caro J, Martínez Selles M, Martín de Miguel I. Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome. JACC: Heart Failure 2018; 6:928-936. [DOI: 10.1016/j.jchf.2018.05.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 02/06/2023]
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Pérez-Castellanos A, Martínez-Sellés M, Mejía-Rentería H, Andrés M, Sionis A, Almendro-Delia M, Martín-García A, Aguilera MC, Pereyra E, Linares Vicente JA, García de la Villa B, Núñez-Gil IJ. Síndrome de tako-tsubo en varones: infrecuente, pero con mal pronóstico. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pérez-Castellanos A, Martínez-Sellés M, Mejía-Rentería H, Andrés M, Sionis A, Almendro-Delia M, Martín-García A, Aguilera MC, Pereyra E, Linares Vicente JA, García de la Villa B, Núñez-Gil IJ. Tako-tsubo Syndrome in Men: Rare, but With Poor Prognosis. ACTA ACUST UNITED AC 2017; 71:703-708. [PMID: 29122513 DOI: 10.1016/j.rec.2017.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. METHODS We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. RESULTS Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P < .01), longer intensive care stay (4.2 ± 3.7 vs 3.2 ± 3.2 days; P = .03) and a higher frequency of severe heart failure (22 [33.3%] vs 95 [20.3%]; P = .02). However, dynamic obstruction at the left-ventricular outflow tract occurred exclusively in women (39 [7.9%] vs 0 [0.0%]; P = .02). The incidence of functional mitral regurgitation was also higher in women (52 [10.6%] vs 2 [2.9%]; P = .04). CONCLUSIONS Tako-tsubo syndrome shows wide differences by sex in terms of its incidence, presentation, and outcomes. Prognosis is worse in men.
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Affiliation(s)
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense y Universidad Europea, Madrid, Spain
| | - Hernán Mejía-Rentería
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Mireia Andrés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Ana Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigacion Biomédica de Salamanca (IBSAL), CIBER de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | | | - Eduardo Pereyra
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | | | | | - Iván J Núñez-Gil
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
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García-Núñez B, Lόpez-Salguero S, Sivera F, Andrés M. AB0362 Serum Lipid Level Changes Associated with Tocilizumab Treatment: Our Experience in Two University Hospitals:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Quilis N, Andrés M, Vela P, Pascual E. THU0494 Skin Events with Febuxostat in Gout Patients with Previous Skin Reactions To Allopurinol. A Retrospective Review:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrés M, Begazo A, Sivera F, Vela P, Pascual E. AB0815 Intraarticular Triamcinolone plus Mepivacaine Provides A Rapid and Sustained Relief for Acute Gouty Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de la Torre-Aboki J, García-González C, Andrés M, Vela P. SAT0628-HPR Cardiovascular Risk Assessment in Inflammatory Arthritis Patients in A Nurse-led Clinic and Supported by Ultrasonography. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bernal J, Andrés M, Sivera F, Carmona L, Vela P, Pascual E. THU0517 Women with Gout Show A Poorer Cardiovascular Profile after Structured Assessment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dueñas Cid N, Tobeña M, Pernas Juan C, Hernandez D, Menso Maria M, Szafranska J, Sebio A, Paez D, Virgili A, Vethencourt Andrea C, del Carpio Luis P, Andrés M, Balart J, Martin M. P-224 Locally advanced rectal cancer: a single institution experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anguera G, Tibau A, Andrés-Pretel F, Andrés M, Seruga B, Templeton A, Jerez Y, Vera-Badillo F, Barnadas A, Martin M, Amir E, Ocańa A. 1215 Role of cooperative groups and funding source in clinical studies that support approved therapy for breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Núñez-Gil IJ, Almendro-Delia M, Andrés M, Sionis A, Martin A, Bastante T, Córdoba-Soriano JG, Linares JA, González Sucarrats S, Sánchez-Grande-Flecha A, Fabregat-Andrés O, Pérez B, Escudier-Villa JM, Martin-Reyes R, Pérez-Castellanos A, Rueda Sobella F, Cambeiro C, Piqueras-Flores J, Vidal-Perez R, Bodí V, García de la Villa B, Corbí-Pascua M, Biagioni C, Mejía-Rentería HD, Feltes G, Barrabés J. Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis. Eur Heart J Acute Cardiovasc Care 2015; 5:308-16. [PMID: 26045512 DOI: 10.1177/2048872615589512] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/10/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Takotsubo syndrome (TKS) usually mimics an acute coronary syndrome. However, several clinical forms have been reported. Our aim was to assess if different stressful triggers had prognostic influence on TKS, and to establish a working classification. METHODS We performed an analysis including patients with TKS between 2003-2013 from our prospective local database and the RETAKO National Registry, fulfilling Mayo criteria. Patients were divided in two groups regarding their potential triggers: (a) none/psychic stress as 'primary forms' and (b) physical factors (asthma, surgery, trauma, etc.) as 'secondary forms'. RESULTS Finally, 328 patients were included, 90.2% women, with a mean age of 69.7 years. Patients were divided into primary TKS (n=265) and 63 secondary TKS groups. Age, gender, previous functional class and cardiovascular risk profile displayed no differences between groups before admission. However, primary-TKS patients suffered a main complaint of chest pain (89.4% vs 50.7%, p<0.0001) with frequent vegetative symptoms. Regarding treatment before admission, there were no differences either. During admission, differences were related to more intensive antithrombotic and anxiolytic drug use in the primary TKS group. Inotropic and mechanical ventilation use was higher in the secondary cohort. After discharge, a more frequent prescription of beta-blockers and statins in primary-TKS patients was seen. Secondary forms displayed more in-hospital stay and evolutive complications: death (hazard ratio (HR): 3.41; 95% confidence interval (CI): 1.14-10.16, p=0.02), combined event variable (MACE) (HR: 1.61; 95% CI: 1.01-2.6, p=0.04) and recurrences (HR: 1.85; 95% CI: 1.06-3.22, p=0.02). CONCLUSION Secondary TKS could present or mark worse short and long-term prognoses in terms of mortality, recurrences and readmissions. We propose a simple working nomenclature for TKS.
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Affiliation(s)
| | | | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona
| | - Ana Martin
- Servicio de Cardiología, H Universitario de Salamanca
| | | | | | - José A Linares
- Servicio de Cardiología, H Clínico Lozano Blesa, Zaragoza
| | | | | | - Oscar Fabregat-Andrés
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia
| | - Beatriz Pérez
- Servicio de Cardiología, Hospital Carlos Haya, Málaga
| | | | | | | | - Ferrán Rueda Sobella
- Servicio de Cardiología, Hospital Universitario GermansTrias i Pujol, Badalona, Barcelona
| | - Cristina Cambeiro
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela
| | | | | | - Vicente Bodí
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia
| | | | - Miguel Corbí-Pascua
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela
| | - Corina Biagioni
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid
| | | | - Gisela Feltes
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid
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Andrés M, Quintanilla M, Sivera F, Vela P, Ruiz-Nodar J. FRI0325 Silent Deposit of MSU Crystals Associates with a More Severe Coronary Calcification in Asymptomatic Hyperuricemic Patients with Acute Coronary Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vela P, Jovani V, Andrés M, Pascual E. SAT0311 The Shape of Calcium Pyrophosphate Crystals Determines their Intensity of Birefringence. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrés M, Sivera F, Pérez-Vicente S, Vela P, Carmona L. AB1139 Centre Characteristics Determine Ambulatory Care and Referrals in Patients with Spondyloarthritis:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andrés M, Quintanilla M, Sivera F, Vela P, Ruiz-Nodar J. AB0924 Echocardiography Findings in Asymptomatic Hyperuricemic Patients with Silent Deposit of MSU Crystals:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Begazo A, Andrés M, Vela P. FRI0104 Ultrasonographic Synovitis in Patients with Rheumatoid Arthritis and Optimization of Subcutaneous Biologic Drugs. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quilis N, Gil S, Andrés M, Vela P, Pascual E. FRI0327 Febuxostat Appears Effective and Safe in Gout Patients with Severe Chronic Kidney Disease:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andrés M, Francés R, Pascual E. SAT0328 Uric Acid Enhances Monosodium Urate Induced Pro-Inflammatory Response in Gouty Patients: A Basic and Translational Research Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rosales Z, Andrés M, Sivera F, Loza E. AB1208 Educational Needs for Young Rheumatologists in Spain. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Núñez-Gil IJ, Sionis A, Andrés M, Almendro Delia M, Martin A, Lozano Á, Córdoba Soriano JG, Linares Vicente JA, González Sucarrats S, Sánchez Grande Flecha A, Mejía-Rentería HD, Biagioni C, Feltes G, Barrabés JA. Takotsubo cardiomyopathy and elderly adults: still a benign condition? J Am Geriatr Soc 2015; 63:404-7. [PMID: 25688623 DOI: 10.1111/jgs.13276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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Núñez Gil IJ, Andrés M, Almendro Delia M, Sionis A, Martín A, Bastante T, Córdoba Soriano JG, Linares Vicente JA, González Sucarrats S, Sánchez-Grande Flecha A. Characterization of Tako-tsubo Cardiomyopathy in Spain: Results from the RETAKO National Registry. ACTA ACUST UNITED AC 2014; 68:505-12. [PMID: 25544669 DOI: 10.1016/j.rec.2014.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 05/16/2014] [Accepted: 07/07/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND AIMS The etiology and epidemiology of tako-tsubo cardiomyopathy remain uncertain. The symptoms of this condition are often similar to those of myocardial infarction and, although it usually has a good prognosis, it is not without complications. Our aim was to characterize this disease in our setting using a dedicated registry (Spanish REgistry for TAKOtsubo cardiomyopathy). METHODS The prospective registry included 202 incident patients in 23 hospitals from 2012 to 2013. The patients' clinical characteristics and analytical, echocardiographic, and imaging results were recorded, as were the events during follow-up. Patients were included when the attending physician considered the case proven, and incidence was calculated relative to the catheterizations requested for a presumptive diagnosis of acute coronary syndrome. RESULTS The patients were predominantly women (90%), with a mean age of 70 years, and many had cardiovascular risk factors, such as hypertension (67%), dyslipidemia (41%), diabetes mellitus (15%), and smoking (15%). The incidence of tako-tsubo cardiomyopathy was 1.2%, and there was no clear weekly or seasonal distribution pattern. Chest pain was the predominant symptom, a triggering factor (emotional, physical, or both) was present in 72%, and most patients consulted within the first 6h after symptom onset. The median duration of hospitalization was 7 days. There were heart failure symptoms in 34.0%, arrhythmia in 26.7%, and 2.4% of patients died. CONCLUSIONS The incidence of tako-tsubo cardiomyopathy is low. This disease primarily affects postmenopausal women, and occurs after a situation of emotional stress in more than half of affected individuals. It is characterized by anginal pain, shows no seasonal distribution, and has a good prognosis, although it is not without morbidity and mortality.
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Affiliation(s)
- Iván J Núñez Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Mireia Andrés
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ana Martín
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de la Princesa, Madrid, Spain
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Andrés M, Marco P, Perdiguero M, Pascual EP, Vela P. Dealing with refractoriness in obstetric primary antiphospholipid syndrome--often not a matter of success. Lupus 2014; 23:964-5. [PMID: 24836586 DOI: 10.1177/0961203314536250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
- M Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | - P Marco
- Servicio de Hematología y Hemostasia, Hospital General Universitario de Alicante, Alicante, Spain Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - M Perdiguero
- Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, Spain
| | - E Pérez Pascual
- Servicio de Obstetricia y Ginecología, Hospital General Universitario de Alicante, Alicante, Spain
| | - P Vela
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
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Figueras J, Barrabés JA, Andrés M, Otaegui I, Lidón RM, Garcia-Dorado D. Angiographic findings at different time intervals from hospital admission in first non-ST elevation myocardial infarction. Int J Cardiol 2013; 166:761-4. [DOI: 10.1016/j.ijcard.2012.09.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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Andrés M, Rosario MP, Loza E, Moller I, Naredo E. SAT0500 Ultrasound-Guided Injections for Rheumatoid Arthritis and Spondyloarthritis: A Systematic Literature Review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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