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Lopez-López A, Franco-Gutiérrez R, Pérez-Pérez AJ, Regueiro-Abel M, Elices-Teja J, Abou-Jokh-Casas C, González-Juanatey C. Impact of Hyperkalemia in Heart Failure and Reduced Ejection Fraction: A Retrospective Study. J Clin Med 2023; 12:3595. [PMID: 37240702 PMCID: PMC10219257 DOI: 10.3390/jcm12103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Hyperkalemia is a common finding in patients with heart failure and reduced ejection fraction (HFrEF), though its prognostic significance is controversial. There is no consensus on optimal potassium levels in these patients. The primary endpoint of this study was to determine the 5-year incidence of hyperkalemia in a cohort of patients with HFrEF. Secondary endpoints were to determine predictors of hyperkalemia and its impact on overall 5-year mortality; (2) Methods: retrospective, longitudinal, single-center observational study of patients with HFrEF followed-up in a specialized unit between 2011 and 2019. Hyperkalemia was considered as potassium concentration > 5.5 mEq/L; (3) Results: Hyperkalemia was observed in 170 (16.8%) of the 1013 patients. The 5-year hyperkalemia-free survival rate was 82.1%. Hyperkalemia was more frequent at the beginning of follow-up. Factors associated with hyperkalemia in the multivariate analysis were baseline potassium (HR 3.13, 95%CI 2.15-4.60; p < 0.001), creatinine clearance (HR 0.99, 95%CI 0.98-0.99; p = 0.013), right ventricular function (HR 0.95, 95%CI 0.91-0.99; p = 0.016) and diabetes mellitus (HR 1.40, 95%CI 1.01-1.96; p = 0.047). The overall survival rate at 5 years was 76.4%. Normal-high potassium levels (5-5.5 mEq/L) were inversely associated with mortality (HR 0.60, 95%CI 0.38-0.94; p = 0.025); (4) Conclusions: Hyperkalemia is a common finding in patients with HFrEF with an impact on the optimization of neurohormonal treatment. In our retrospective study, potassium levels in the normal-high range seem to be safe and are not associated with increased mortality.
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Affiliation(s)
- Andrea Lopez-López
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Raúl Franco-Gutiérrez
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Alberto José Pérez-Pérez
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Margarita Regueiro-Abel
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Juliana Elices-Teja
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Charigan Abou-Jokh-Casas
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
| | - Carlos González-Juanatey
- Cardiology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (A.L.-L.); (R.F.-G.); (A.J.P.-P.); (M.R.-A.); (J.E.-T.); (C.A.-J.-C.)
- Biodiscovery HULA-USC Group, Instituto de Investigación Sanitaria de Santiago de Compostela IDIS, 27003 Lugo, Spain
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Franco-Gutiérrez V, Pérez-Guillén V, Gil-Aguilar MT, Franco-Gutiérrez R, Álvarez-Zapico MJ, García-Zamora E, Pérez-Vázquez P. Comparative Analysis of the Efficiency of Two Treatment Protocols for Posterior Canal Benign Paroxysmal Positional Vertigo. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:69-76. [PMID: 35397826 DOI: 10.1016/j.otoeng.2022.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. MATERIALS AND METHODS A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients' medical visits were compared. RESULTS Average and total cost of care and loss of productivity for the company due to patients' medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. CONCLUSIONS The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations.
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Affiliation(s)
- Virginia Franco-Gutiérrez
- Servicio de Otorrinolaringología, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, Spain.
| | - Vanessa Pérez-Guillén
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | - Enrique García-Zamora
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paz Pérez-Vázquez
- Servicio de Otorrinolaringología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Flores-Ríos X, Calviño-Santos RA, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Marzoa-Rivas R, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Vázquez-González N, Muñiz-García J, Vázquez-Rodríguez JM. Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease. Rev Esp Cardiol (Engl Ed) 2021; 74:1054-1061. [PMID: 33257214 DOI: 10.1016/j.rec.2020.09.028] [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] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial. METHODS We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N=306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system. RESULTS The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9±6236.8 € vs 14 038.7±4958.5 €; P <.001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5±4568.0 vs SelR 2653.9±5709.1; P=.697). Total cost was 22 081.3±7505.6 for the ComR arm and 16 692.6±7669.9 for the SelR group (P <.001). CONCLUSIONS In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty. Study registred at ClinicalTrial.gov (Identifier: NCT01179126).
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Affiliation(s)
- Xacobe Flores-Ríos
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Ramón A Calviño-Santos
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rodrigo Estévez-Loureiro
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Jesús Peteiro-Vázquez
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jorge Salgado-Fernández
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alejandro Rodríguez-Vilela
- Servicio de Cardiología, Complexo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | | | - Alberto Bouzas-Mosquera
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Ángel Rodríguez-Fernández
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Raquel Marzoa-Rivas
- Servicio de Cardiología, Complexo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | | | - Guillermo Aldama-López
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Pablo Piñón-Esteban
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Nicolás Vázquez-González
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Javier Muñiz-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | - José Manuel Vázquez-Rodríguez
- Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Flores-Ríos X, Calviño-Santos RA, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Marzoa-Rivas R, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Vázquez-González N, Muñiz-García J, Vázquez-Rodríguez JM. Evaluación económica de revascularización completa y revascularización guiada por ecocardiografía de estrés en el SCACEST con enfermedad multivaso. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.09.002] [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]
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Franco-Gutiérrez V, Pérez-Guillén V, Gil-Aguilar MT, Franco-Gutiérrez R, Álvarez-Zapico MJ, García-Zamora E, Pérez-Vázquez P. Comparative analysis of the efficiency of two treatment protocols for posterior canal benign paroxysmal positional vertigo. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(20)30201-6. [PMID: 33483093 DOI: 10.1016/j.otorri.2020.11.006] [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: 09/24/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common vertigo of labyrinthine origin, its social and healthcare impact is remarkable. It has recently been shown that single session treatment is as safe and effective as weekly treatment, which could have impact on direct and indirect costs related to the disease. The objective of this study is to determine whether single session treatment of unilateral posterior canal BPPV canalolithiasis is more efficient than conventional treatment. MATERIALS AND METHODS A prospective randomized controlled trial was performed in 53 consecutive patients diagnosed with unilateral posterior canal BPPV canalolithiasis previously untreated: 26 patients were assigned to single session treatment and 27 patients to weekly treatment. Average and total cost of care, consultation time and the impact in terms of temporary disability and loss of productivity for the company due to patients' medical visits were compared. RESULTS Average and total cost of care and loss of productivity for the company due to patients' medical visits were significantly lower in the single session group. Consultation time was also better in this group when travelling time was considered. CONCLUSIONS The single session protocol is fast, effective and reduces direct and indirect cost of care related to disease justifying high resolution consultations.
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Affiliation(s)
- Virginia Franco-Gutiérrez
- Servicio de Otorrinolaringología, Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España.
| | - Vanessa Pérez-Guillén
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Raúl Franco-Gutiérrez
- Servicio de Cardiología, Hospital Universitario Lucus Augusti, Lugo, Galicia, España
| | | | - Enrique García-Zamora
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Paz Pérez-Vázquez
- Servicio de Otorrinolaringología, Hospital de Cabueñes, Gijón, Asturias, España
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Calviño-Santos R, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Mesías-Prego A, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Soler-Martín R, Seoane-Pillado T, Vázquez-González N, Muñiz J, Vázquez-Rodríguez JM. Angiographically Guided Complete Revascularization Versus Selective Stress Echocardiography-Guided Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The CROSS-AMI Randomized Clinical Trial. Circ Cardiovasc Interv 2019; 12:e007924. [PMID: 31554422 DOI: 10.1161/circinterventions.119.007924] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent trials suggest that complete revascularization in patients with acute ST-segment-elevation myocardial infarction and multivessel disease is associated with better outcomes than infarct-related artery (IRA)-only revascularization. There are different methods to select non-IRA lesions for revascularization procedures. We assessed the clinical outcomes of complete angiographically guided revascularization versus stress echocardiography-guided revascularization in patients with ST-segment-elevation myocardial infarction. METHODS We performed a randomized clinical trial in patients with multivessel disease who underwent a successful percutaneous coronary intervention of the IRA to test differences in prognosis (composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up) between complete angiographically guided revascularization (n=154) or stress echocardiography-guided revascularization (n=152) of the non-IRA lesions in an elective procedure before hospital discharge. RESULTS The trial was prematurely stopped after the inclusion of 77% of the planned study population. As many as 152 (99%) patients in the complete revascularization group and 44 (29%) patients in the selective revascularization group required a percutaneous coronary intervention procedure of a non-IRA lesion before discharge. The primary end point occurred in 21 (14%) patients of the stress echocardiography-guided revascularization group and 22 (14%) patients of the complete angiographically guided revascularization group (hazard ratio, 0.95; 95% CI, 0.52-1.72; P=0.85). CONCLUSIONS In patients with ST-segment-elevation myocardial infarction and multivessel disease, stress echocardiography-guided revascularization may not be significantly different to complete angiographically guided revascularization, thereby reducing the need for elective revascularization before hospital discharge. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01179126.
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Affiliation(s)
- Ramón Calviño-Santos
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | | | - Jesús Peteiro-Vázquez
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).,CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.)
| | - Jorge Salgado-Fernández
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).,CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.)
| | | | - Raúl Franco-Gutiérrez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain (R.F.-G., C.G.-J.)
| | - Alberto Bouzas-Mosquera
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).,CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.)
| | - José Ángel Rodríguez-Fernández
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Alejandro Mesías-Prego
- Department of Cardiology, Hospital Universitario Arquitecto Marcide, Ferrol, Spain (A.R.-V., A.M.-P.)
| | | | - Guillermo Aldama-López
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Pablo Piñón-Esteban
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Xacobe Flores-Ríos
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Rita Soler-Martín
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Teresa Seoane-Pillado
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.)
| | - Nicolás Vázquez-González
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).,CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.)
| | - Javier Muñiz
- CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.).,Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, INIBIC (Instituto de Investigación Biomédica de A Coruña), Spain (J.M.)
| | - José Manuel Vázquez-Rodríguez
- Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).,CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain (J.P.-V., J.S.-F., A.B.-M., N.V.-G., J.M., J.M.V.-R.)
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Franco-Gutiérrez R, Pérez-Pérez AJ, Franco-Gutiérrez V, Ocaranza-Sánchez R, Testa-Fernández A, López-Reboiro ML, López-López A, Santás-Álvarez M, Crespo-Leiro MG, González-Juanatey C. La presencia de placa carotídea es predictor de eventos adversos cardiacos y cerebrovasculares en sujetos sometidos a coronariografía. ACM 2019; 89:5-11. [DOI: 10.24875/acm.m19000015] [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: 11/17/2022] Open
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Franco-Gutiérrez R, Pérez-Pérez AJ, Franco-Gutiérrez V, Ocaranza-Sánchez R, Testa-Fernández A, López-Reboiro ML, López-López A, Santás-Álvarez M, Crespo-Leiro MG, González-Juanatey C. Carotid plaque is a predictor of major adverse cardiac and cerebrovascular events in patients undergoing coronary angiography. Arch Cardiol Mex 2019; 89:1-7. [PMID: 31448766 DOI: 10.24875/acme.m19000001] [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] [Indexed: 11/17/2022] Open
Abstract
Background Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions CP is an independent predictor of MACCE in patients undergoing coronary angiography.
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Affiliation(s)
| | | | | | | | - Ana Testa-Fernández
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Lugo. Spain
| | - Manuel L López-Reboiro
- Department of Internal Medicine, Hospital Universitario Lucus Augusti (HULA), Lugo. Spain
| | - Andrea López-López
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Lugo. Spain
| | | | - María G Crespo-Leiro
- Department of Cardiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto Investigación Biomédica A Coruña (INIBIC), Universidad da Coruña (UDC), A Coruña. Spain
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Vidal-Perez R, Franco-Gutiérrez R, Pérez-Pérez AJ, Franco-Gutiérrez V, Gascón-Vázquez A, López-López A, Testa-Fernández AM, González-Juanatey C. Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography. World J Cardiol 2019; 11:24-37. [PMID: 30705740 PMCID: PMC6354075 DOI: 10.4330/wjc.v11.i1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/16/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques (CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events (AE) in obese subjects.
AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography (EE).
METHODS From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality, myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.
RESULTS Of the 652 patients who fulfilled the inclusion criteria, 226 (34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them (33.6%) had CP. During a mean follow-up time of 8.2 (2.1) years, 27 AE were found (11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1% (0.6), 95.1% (1.4) and 86.5% (2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE (HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate (HR 0.98, 95%CI 0.96-0.99; P = 0.023), peak metabolic equivalents (HR 0.83, 95%CI 0.70–0.99, P = 0.034) and moderate mitral regurgitation (HR 5.02, 95%CI 1.42–17.75, P = 0.012).
CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.
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Affiliation(s)
- Rafael Vidal-Perez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo 27003, Spain
| | | | | | | | - Alberto Gascón-Vázquez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo 27003, Spain
- Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - Andrea López-López
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo 27003, Spain
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Franco-Gutiérrez R, Pérez-Pérez AJ, Franco-Gutiérrez V, Testa-Fernández AM, López-López A, Pérez-Férnandez R, López-Reboiro ML, Regueiro-Abel M, Crespo-Leiro MG, González-Juanatey C. Usefulness of carotid ultrasonography in the assessment of coronary artery disease extension in patients undergoing exercise echocardiography. Echocardiography 2018; 36:336-344. [PMID: 30592779 DOI: 10.1111/echo.14251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/22/2018] [Revised: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate whether carotid disease is associated with coronary artery disease (CAD) extension in patients undergoing treadmill exercise stress echocardiography (EE). METHODS We retrospectively studied 156 patients without previous vascular disease who underwent EE, carotid ultrasonography, and coronary angiography between 2002 and 2013. Low-, intermediate-, and high-risk EE were defined as negative, localized ischemia, and multivessel/extensive ischemia EE respectively; carotid disease according to Mannheim and American Society of Echocardiography Consensus and CAD extension from zero to three vessel disease as stenosis ≥50% by visual assessment. RESULTS Of the 156 patients, 67 (42.9%), 43 (27.6%), 22 (14.1%), and 24 (15.4%) had zero, one, two, and three vessel disease respectively. Age (P = 0.047), male sex (P = 0.010), diabetes mellitus (P = 0.039), smoking habit (P = 0.015), fasting plasma glucose (P = 0.021), European Systematic COronary Risk Evaluation (P = 0.003), pretest CAD probability (P = 0.003), high-risk EE (P < 0.001), and carotid plaque presence (CP) (P < 0.001) were associated in univariate analysis with more extensive CAD. Predictors of CAD extension in multivariate analysis were high-risk EE (odds ratio [OR] 2.42, P < 0.001), CP presence (OR 1.75, P = 0.004), and pretest CAD probability >65% (OR 1.49, P = 0.023). CP was also associated with multivessel CAD in the 53 patients with low- or intermediate-risk EE (P = 0.001). CONCLUSIONS CP is associated with CAD extension in patients with ischemic heart disease suspicion undergoing EE. Patients with CP could benefit from a more aggressive therapeutic strategy regarding patients without carotid disease and similar risk EE, especially in intermediate- and/or low-risk test where guidelines recommend initially optimal medical treatment.
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Affiliation(s)
| | | | | | | | - Andrea López-López
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Ruth Pérez-Férnandez
- Department of Cardiology, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruna, Spain
| | | | | | - María Generosa Crespo-Leiro
- Department of Cardiology, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto Investigacion Biomedica A Coruña (INIBIC), Universidad da Coruña (UDC), A Coruna, Spain
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Franco-Gutiérrez R, Pérez-Pérez AJ, Franco-Gutiérrez V, Testa-Fernández AM, Vidal-Pérez RC, López-Reboiro ML, Puebla-Rojo VM, Santás-Álvarez M, Crespo-Leiro MG, González-Juanatey C. Usefulness of carotid ultrasonography in the diagnosis of coronary artery disease in patients undergoing exercise echocardiography. Cardiovasc Ultrasound 2018; 16:26. [PMID: 30296943 PMCID: PMC6176507 DOI: 10.1186/s12947-018-0143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Relationship between carotid and coronary artery disease (CAD) in patients undergoing invasive and non-invasive test is unclear. The aim of the study is to evaluate whether carotid disease is associated with CAD in patients submitted to exercise echocardiography (EE) and if it improves the EE ability to predict CAD. METHODS We retrospectively studied 156 subjects without previous vascular disease who underwent EE, carotid ultrasonography and coronary angiography between 2002 and 2013. Positive EE was defined as exercise induced wall motion abnormalities, carotid disease according to Manheim and American Society of Echocardiography Consensus and significant CAD as stenosis ≥50%. RESULTS Eighty-nine (57.1%) subjects had significant CAD. Factors associated with CAD in multivariate analysis were fasting plasma glucose (odds ratio [OR] 1.02, p = 0.031), pre-test probability of CAD > 65% (OR 3.71, p < 0.001), positive EE (OR 10.51, p < 0.001) and carotid plaque (CP) presence (OR 2.95, p = 0.013). There was neither statistical significant difference in area under the curve after addition of CP to EE results (0.77 versus 0.81, p = 0.525) nor sensitivity, specificity, predictive values or efficiency. CP presence reclassified as very high-risk according to Systematic COronary Risk Evaluation 13 patients (34.2%) with negative EE and 22 (33.3%) without CAD. CONCLUSION CP is associated with CAD in patients undergoing EE, however its addition to EE does not improve CAD prediction, probably due to insufficient statistical power. CP reclassified one third of patients to very high-risk category despite negative EE or CAD absence, these subjects benefit from aggressive primary prevention interventions.
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Affiliation(s)
- Raúl Franco-Gutiérrez
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - Alberto José Pérez-Pérez
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - Virginia Franco-Gutiérrez
- Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla n° 25, Santander, 39008 Spain
| | - Ana María Testa-Fernández
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - Rafael Carlos Vidal-Pérez
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - Manuel Lorenzo López-Reboiro
- Department of Internal Medicine, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, Lugo, 27003 Spain
| | - Víctor Manuel Puebla-Rojo
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - Melisa Santás-Álvarez
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
| | - María Generosa Crespo-Leiro
- Department of Cardiology, Complejo Hospitalario Universitario A Coruña (CHUAC), As Xubias de Arriba n° 84, A Coruña, 15006 Spain
- Intitituto de Investigación Biomédica A Coruña (INIBIC), Xubias de Arriba n° 84, A Coruña, 15006 Spain
- Universidad de La Coruña (UDC), Calle de la Maestranza n° 9, A Coruña, 15001 Spain
| | - Carlos González-Juanatey
- Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Avenida doctor Ulises Romero n° 1, 27003 Lugo, Spain
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