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Ferrera C, Vilacosta I, Rodríguez Palomares JF, Iglesias FC, Barros A, Molluna MA, Mosquera V, Tarrío R, Orodea AR, Sepúlveda DT, Ramos I, Castellanos LM, Sao A, Evangelista A. Prognostic impact of shock in patients with type A acute aortic syndrome. Results of a nationwide multicenter study. Hellenic J Cardiol 2024:S1109-9666(24)00109-X. [PMID: 38729346 DOI: 10.1016/j.hjc.2024.05.005] [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: 02/24/2024] [Revised: 04/01/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To evaluate the clinical characteristics, imaging findings, treatment and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery in this patient population. METHODS The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January-2018 to December-2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified in two groups according to the clinical presentation with or without shock. Shock was defined as persistent systolic blood pressure <80mmHg despite adequate volume resuscitation. RESULTS 97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock-group (45.4% vs 10.1%, p=0.001). Patients in the Shock-group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p<0.001), acute renal failure (28.9% vs 18.2%, p=0.018) and need for orotracheal intubation (40% vs 9.1%, p<0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p=0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p<0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)). CONCLUSIONS Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular. Hospital Clínico San Carlos, Madrid. Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular. Hospital Clínico San Carlos, Madrid. Spain
| | | | | | - Antonio Barros
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Víctor Mosquera
- Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Rubén Tarrío
- Servicio de Cirugía Cardiaca, Hospital Son Espases, Palma de Mallorca, Spain
| | - Ana Revilla Orodea
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid. Centro de Investigación en red de enfermedades cardiovasculares (CIBERCV), Madrid, Spain
| | - David Toral Sepúlveda
- Servicio de Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Inés Ramos
- Instituto Cardiovascular. Hospital Clínico San Carlos, Madrid. Spain
| | | | - Augusto Sao
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Artur Evangelista
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Maroto LC, Ferrera C, Cobiella J, Carnero M, Beltrao R, Martínez I, Campelos P, Martín-Sánchez FJ, Carrero AM, Domínguez MJ, Álvarez E, Fernández F, Cabeza B, Colorado E, Villacastín JP, Vilacosta I. Improvement of Early Outcomes in Type A Acute Aortic Syndrome After an Aorta Code Implementation. Ann Thorac Surg 2024; 117:770-778. [PMID: 37488005 DOI: 10.1016/j.athoracsur.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Reduction of variability through process reengineering can improve surgical results for patients with type A acute aortic syndrome. We compare short-term results before and after implementation of an Aorta Code for patients with type A acute aortic syndrome who underwent surgery. METHODS The Aorta Code was implemented in a 5-hospital healthcare network in 2019. This critical pathway was based on a simple diagnostic algorithm, ongoing training, immediate patient transfer, and treatment by an expert multidisciplinary team. We retrospectively compared all patients operated on in our center before (2005-2018) and after (January 2019 to February 2023) its implementation. RESULTS One hundred two and 70 patients underwent surgery in the precode and code periods, respectively. In the code period the number of patients operated on per year increased (from 7.3 to 16.8), and the median elapsed time until diagnosis (6.5 hours vs 4.2 hours), transfer (4 hours vs 2.2 hours), and operating room (2.7 hours vs 1.8 hours) were significantly shorter (P < .05). Aortic root repair and total arch replacement were more frequent (66.7% vs 82.9% [P = .003] and 20.6% vs 40% [P = .001]). Cardiopulmonary bypass and ischemia times were also shorter (179.7 minutes vs 148.2 minutes [P = .001] and 105 minutes vs 91.2 minutes [P = .022]). Incidence of prolonged mechanical ventilation (53.9% vs 34.3%, P = .011), major stroke (17.7% vs 7.1%, P = .047), and 30-day mortality (27.5% vs 7.1%, P = .001) decreased significantly. CONCLUSIONS An Aorta Code can be successfully implemented by using a standardized protocol within a hospital network. The number of cases increased; time to diagnosis, transfer, and operating room were reduced; and 30- day mortality significantly decreased.
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Affiliation(s)
- Luis C Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - Carlos Ferrera
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Rosa Beltrao
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Isaac Martínez
- Department of Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Paula Campelos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ana M Carrero
- Emergency Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - María J Domínguez
- Emergency Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Esther Álvarez
- Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Fátima Fernández
- Emergency Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Beatriz Cabeza
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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Vilacosta I, Ferrera C, San Román A. [Acute aortic syndrome]. Med Clin (Barc) 2024; 162:22-28. [PMID: 37640592 DOI: 10.1016/j.medcli.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Acute aortic syndrome embraces a group of heterogenous pathological entities involving the aortic wall with a common clinical profile. The current epidemiology, clinical presentation, diagnosis and treatment strategy are discussed in this review. Besides, the importance of multidisciplinary aortic teams, aortic centers and the implementation of an aortic code are emphasized.
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Affiliation(s)
- Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | - Alberto San Román
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Barrionuevo-Sánchez MI, Viana-Tejedor A, Ariza-Solé A, Del Prado N, Rosillo N, Sánchez-Salado JC, Lorente V, Jorge-Pérez P, Noriega FJ, Ferrera C, Alegre O, Llaó I, Bernal JL, Triguero L, Fernández-Pérez C, González-Costello J, Marcos M, de la Cuerda F, Carmona J, Cequier A, Fernández-Ortiz A, Pérez-Villacastín J, Comin-Colet J, Elola FJ. Impact of annual volume of cases and Intensive Cardiac Care Unit availability on mortality of patients with acute myocardial infarction- related cardiogenic shock treated at revascularization capable centers. Eur Heart J Acute Cardiovasc Care 2023:7192937. [PMID: 37294681 DOI: 10.1093/ehjacc/zuad061] [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] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/02/2023] [Accepted: 06/07/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with high mortality. The purpose of this study was to assess the impact of Hospital structure-related variables on mortality in patients with CS treated at percutaneous and surgical revascularization capable centers (psRCC) from a large nationwide registry. METHODS Retrospective observational study including consecutive patients with main or secondary diagnosis of CS and ST elevation myocardial infarction (STEMI). Patients discharged from Spanish National Healthcare System psRCC were included (2016-2020). The association between the volume of CS cases attended by each center, availability of Intensive Cardiac Care Unit (ICCU) and heart transplantation (HT) programs and in-hospital mortality was assessed by multilevel logistic regression models. RESULTS The study population consisted of 3,074 CS-STEMI episodes, of whom 1,759 (57.2%) occurred in 26 centers with ICCU. A total of 17/44 hospitals (38.6%) were high-volume centers and 19/44 (43%) centers had HT programs availability. Treatment at HT centers was not associated with a lower mortality (p = 0.121). Both high volume of cases and ICCU showed a trend to an association with lower mortality in the adjusted model (OR: 0.87 and 0.88, respectively). The interaction between both variables was significantly protective (OR 0.72; p = 0.024). After propensity score matching, mortality was lower in high volume hospitals with ICCU [OR = 0.79; p = 0.007]. CONCLUSIONS Most CS-STEMI patients were attended at psRCC with high volume of cases and ICCU available. The combination of high-volume and ICCU availability showed the lowest mortality. These data should be taken into account when designing regional networks for CS management.
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Affiliation(s)
- M Isabel Barrionuevo-Sánchez
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Albert Ariza-Solé
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Carlos Sánchez-Salado
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Jorge-Pérez
- Hospital Universitario de Canarias. La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Oriol Alegre
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Triguero
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Servicio de Medicina Preventiva, Área Sanitaria de Santiago y Barbanza, Instituto de Investigaciones Sanitarias de Santiago. Santiago de Compostela (A Coruña), Spain
| | - José González-Costello
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Marcos
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco de la Cuerda
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jesús Carmona
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angel Cequier
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
| | | | | | - Josep Comin-Colet
- Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona. Spain
- Bioheart. Grup de Malalties Cardiovasculars. Institut d'Investigació Biomèdica de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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Ramos-López N, Ferrera C, Luque T, Enríquez-Vázquez D, Mahía-Casado P, Galván-Herráez L, Pedrajas JM, Salinas P, Fraile PZ, Islas F, Real C, Mejía-Rentería H, Jiménez-Quevedo P, Gonzalo N, Nuñez-Gil I, Nombela-Franco L, Tirado G, Macaya F, Escaned J, Hernández AMM, Bustamante J, Serrano MP, García EB, Pozzi MAO, Higueras J, Agustín AD, Viana-Tejedor A, Fernández-Ortiz A. Impact of a pulmonary embolism response team initiative on hospital mortality of patients with bilateral pulmonary embolism. Med Clin (Barc) 2023:S0025-7753(23)00017-9. [PMID: 36801109 DOI: 10.1016/j.medcli.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE (HR-PE) and intermediate-high risk PE (IHR-PE) are encouraged in PE guidelines. We aimed to assess the impact of a PERT initiative on mortality in these groups of patients, compared with standard care. METHODS We conducted a prospective, single-center registry, including consecutive patients with HR-PE and IHR-PE with PERT activation from February-2018 to December-2020 (PERT group, n=78 patients) and compared it with an historic cohort of patients admitted to our hospital in a previous 2-year period (2014-2016), managed with standard of care (SC-group, n=108 patients). RESULTS Patients in the PERT group were younger and less comorbid. The risk profile at admission and the percentage of HR-PE was similar in both cohorts (13% in SC-group and 14% in PERT-group, p=0.82). Reperfusion therapy was more frequently indicated in PERT-group (24.4% vs 10.2%, p=0.01), with no differences in fibrinolysis treatment, while catheter-directed therapy (CDT) was more frequent in PERT group (16.7% vs 1.9%, p<0.001). Reperfusion and CDT were associated with lower in-hospital mortality (2.9% vs 15.1%, p=0.001 for reperfusion and 1.5% vs 16.5%, p=0.001 for CDT). The primary outcome, 12-month mortality, was lower in the PERT-group (9% vs 22.2%, p=0.02), There were no differences in 30-day readmissions. In multivariate analysis PERT activation was associated with lower mortality at 12 months (HR 0.25, 95% confidence interval 0.09-0.7, p=0.008). CONCLUSION A PERT initiative in patients with HR-PE and IHR-PE was associated with a significant reduction in 12-month mortality compared with standard of care, and also with an increase in the use of reperfusion, especially catheter-directed therapies.
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Affiliation(s)
- Noemi Ramos-López
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Ferrera
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Tania Luque
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | - José María Pedrajas
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.
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Viana-Tejedor A, Andrea-Riba R, Scardino C, Ariza-Solé A, Bañeras J, García-García C, Jiménez Mena M, Vila M, Martínez-Sellés M, Pastor G, García Acuña JM, Loma-Osorio P, García Rubira JC, Jorge Pérez P, Pastor P, Ferrera C, Noriega FJ, Pérez Macías N, Fernández-Ortiz A, Pérez-Villacastín J. Coronary angiography in patients without ST-segment elevation following out-of-hospital cardiac arrest. COUPE clinical trial. Rev Esp Cardiol (Engl Ed) 2023; 76:94-102. [PMID: 35750580 DOI: 10.1016/j.rec.2022.05.013] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following out-of-hospital cardiac arrest (OHCA) in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. We aimed to assess whether emergency CAG and PCI would improve survival with good neurological outcome in this population. METHODS In this multicenter, randomized, open-label, investigator-initiated clinical trial, we randomly assigned 69 survivors of OHCA without STEMI to undergo immediate CAG or deferred CAG. The primary efficacy endpoint was a composite of in-hospital survival free of severe dependence. The safety endpoint was a composite of major adverse cardiac events including death, reinfarction, bleeding, and ventricular arrhythmias. RESULTS A total of 66 patients were included in the primary analysis (95.7%). In-hospital survival was 62.5% in the immediate CAG group and 58.8% in the delayed CAG group (HR, 0.96; 95%CI, 0.45-2.09; P=.93). In-hospital survival free of severe dependence was 59.4% in the immediate CAG group and 52.9% in the delayed CAG group (HR, 1.29; 95%CI, 0.60-2.73; P=.4986). No differences were found in the secondary endpoints except for the incidence of acute kidney failure, which was more frequent in the immediate CAG group (15.6% vs 0%, P=.002) and infections, which were higher in the delayed CAG group (46.9% vs 73.5%, P=.003). CONCLUSIONS In this underpowered randomized trial involving patients resuscitated after OHCA without STEMI, immediate CAG provided no benefit in terms of survival without neurological impairment compared with delayed CAG. CLINICALTRIALS gov Identifier: NCT02641626.
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Affiliation(s)
- Ana Viana-Tejedor
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Rut Andrea-Riba
- Instituto Cardiovascular, Hospital Clinic Barcelona, Universidad de Barcelona, Institut D́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Claudia Scardino
- Servicio de Cardiología. Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Bañeras
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Cosme García-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Manuel Jiménez Mena
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Monserrat Vila
- Servicio de Cardiología, Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Gemma Pastor
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José María García Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Pablo Loma-Osorio
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Institut d Investigación Biomedica Dr. Josep Trueta de Girona, Girona, Spain
| | | | - Pablo Jorge Pérez
- Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Pastor
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lleida - IRBLL, Lleida, Spain
| | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J Noriega
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Natalia Pérez Macías
- Unidades de Investigación Clínica y Ensayos Clínicos (UICEC), Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Julián Pérez-Villacastín
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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García-Galindo A, Agujetas R, López-Mínguez JR, Ferrera C. Assessment of valve implantation in the descending aorta as an alternative for aortic regurgitation patients not treatable with conventional procedures. Biomech Model Mechanobiol 2022; 22:575-591. [PMID: 36550245 PMCID: PMC10097802 DOI: 10.1007/s10237-022-01665-3] [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: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aortic Regurgitation (AR) produces the entrance of an abnormal amount of blood in the left ventricle. This disease is responsible for high morbidity and mortality worldwide and may be caused by an aortic valve dysfunction. Surgical and transcatheter aortic valve replacement (TAVR) are the current options for treating AR. They have replaced older procedures such as Hufnagel's one. However, some physicians have reconsidered this procedure as a less aggressive alternative for patients not eligible for surgical or TAVR. Although Hufnagel suggested a 75% regurgitation reduction when a valve is placed in the descending aorta, a quantification of this value has not been reported. METHODS In this paper, CFD/FSI numerical simulation is conducted on an idealized geometry. We quantify the effect of placing a bileaflet mechanical heart valve in the descending aorta on a moderate-severe AR case. A three-element Windkessel model is employed to prescribe pressure outlet boundary conditions. We calculate the resulting flow rates and pressures at the aorta and first-generation vessels. Moreover, we evaluate several indices to assess the improvement due to the valve introduction. RESULTS AND CONCLUSIONS Regurgitation fraction (RF) is reduced from 37.5% (without valve) to 18.0% (with valve) in a single cardiac cycle. This reduction clearly shows the remarkable efficacy of the rescued technique. It will further ameliorate the left ventricle function in the long-term. Moreover, the calculations show that the implantation in that location introduces fewer incompatibilities' risks than a conventional one. The proposed methodology can be extended to any particular conditions (pressure waveforms/geometry) and is designed to assess usual clinical parameters employed by physicians.
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Affiliation(s)
- A García-Galindo
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - R Agujetas
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - J R López-Mínguez
- Sección de Cardiologıa Intervencionista, Servicio de Cardiologıa, Hospital Universitario de Badajoz, Avda. de Elvas s/n, E-06006, Badajoz, Spain
| | - C Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain.
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8
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Martínez-Sellés M, Hernández-Pérez FJ, Uribarri A, Martín Villén L, Zapata L, Alonso JJ, Amat-Santos IJ, Ariza-Solé A, Barrabés JA, Barrio JM, Canteli Á, Alonso-Fernández-Gatta M, Corbí Pascual MJ, Díaz D, Crespo-Leiro MG, de la Torre-Hernández JM, Ferrera C, García González MJ, García-Carreño J, García-Guereta L, García Quintana A, Jorge Pérez P, González-Juanatey JR, López de Sá E, Sánchez PL, Monteagudo M, Palomo López N, Reyes G, Rosell F, Solla Buceta MA, Segovia-Cubero J, Sionis Green A, Stepanenko A, Iglesias Álvarez D, Viana Tejedor A, Voces R, Fuset Cabanes MP, Gimeno Costa JR, Díaz J, Fernández-Avilés F. Cardiogenic shock code 2023. Expert document for a multidisciplinary organization that allows quality care. Rev Esp Cardiol (Engl Ed) 2022; 76:261-269. [PMID: 36565750 DOI: 10.1016/j.rec.2022.10.014] [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: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
Despite the efforts made to improve the care of cardiogenic shock (CS) patients, including the development of mechanical circulatory support (MCS), the prognosis of these patients continues to be poor. In this context, CS code initiatives arise, based on providing adequate, rapid, and quality care to these patients. In this multidisciplinary document we try to justify the need to implement the SC code, defining its structure/organization, activation criteria, patient flow according to care level, and quality indicators. Our specific purposes are: a) to present the peculiarities of this condition and the lessons of infarction code and previous experiences in CS; b) to detail the structure of the teams, their logistics and the bases for the management of these patients, the choice of the type of MCS, and the moment of its implantation, and c) to address challenges to SC code implementation, including the uniqueness of the pediatric SC code. There is an urgent need to develop protocolized, multidisciplinary, and centralized care in hospitals with a large volume and experience that will minimize inequity in access to the MCS and improve the survival of these patients. Only institutional and structural support from the different administrations will allow optimizing care for CS.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Universidad Europea, Madrid, Spain; Universidad Complutense, Madrid, Spain.
| | | | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis Martín Villén
- Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Luis Zapata
- Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joaquín J Alonso
- Universidad Europea, Madrid, Spain; Servicio Cardiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Albert Ariza-Solé
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José A Barrabés
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - José María Barrio
- Sección de Anestesia Cardiaca-Unidad de Cuidados Posquirúrgicos Cardiacos, Servicio de Anestesiología, Hospital General Universitario Gregorio Marañón, CIBERES, Madrid, Spain
| | - Ángela Canteli
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Marta Alonso-Fernández-Gatta
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Miguel J Corbí Pascual
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital General de Albacete, Albacete, Spain
| | - Domingo Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - María G Crespo-Leiro
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Universidad de A Coruña (UDC), A Coruña, Spain
| | | | - Carlos Ferrera
- Unidad de Cuidados Agudos Cardiológicos, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Martín J García González
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Jorge García-Carreño
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis García-Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio García Quintana
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Pablo Jorge Pérez
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Pedro Luis Sánchez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - María Monteagudo
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nora Palomo López
- Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Guillermo Reyes
- Servicio de Cirugía Cardiaca, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Rosell
- Servicio de Emergencias Sanitarias (061), La Rioja Salud, La Rioja, Spain
| | - Miguel Antonio Solla Buceta
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Alessandro Sionis Green
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alexander Stepanenko
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Diego Iglesias Álvarez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Ana Viana Tejedor
- Universidad Complutense, Madrid, Spain; Unidad de Cuidados Agudos Cardiológicos, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Roberto Voces
- Grupo ECMO, Hospital Universitario de Cruces, Bilbao, Vizcaya, Spain
| | - María Paz Fuset Cabanes
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, Servicio de Emergencias Sanitarias de Cataluña, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Díaz
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Universidad Complutense, Madrid, Spain
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9
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Martínez-Sellés M, Hernández-Pérez FJ, Uribarri A, Martín Villén L, Zapata L, Alonso JJ, Amat-Santos IJ, Ariza-Solé A, Barrabés JA, Barrio JM, Canteli Á, Alonso-Fernández-Gatta M, Corbí Pascual MJ, Díaz D, Crespo-Leiro MG, de la Torre-Hernández JM, Ferrera C, García González MJ, García-Carreño J, García-Guereta L, García Quintana A, Jorge Pérez P, González-Juanatey JR, López de Sá E, Sánchez PL, Monteagudo M, Palomo López N, Reyes G, Rosell F, Solla Buceta MA, Segovia-Cubero J, Sionis Green A, Stepanenko A, Iglesias Álvarez D, Viana Tejedor A, Voces R, Fuset Cabanes MP, Gimeno Costa JR, Díaz J, Fernández-Avilés F. Código shock cardiogénico 2023. Documento de expertos para una organización multidisciplinaria que permita una atención de calidad. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Evangelista Masip A, López-Sainz Á, Barros Membrilla AJ, Calvo Iglesias F, López Ayerbe J, Azqueta Molluna M, Mosquera Rodríguez VX, Arregui Montoya F, Tarrío Fernández R, Revilla Orodea A, Sánchez Sánchez V, Cantero Pérez EM, Ferrera C, Toral Sepúlveda D, Nistal F, Fernández Golfín C, Sao A, Rodríguez-Palomares J. Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome. Rev Esp Cardiol (Engl Ed) 2022; 75:816-824. [PMID: 35527170 DOI: 10.1016/j.rec.2022.01.017] [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] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
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Affiliation(s)
| | - Ángela López-Sainz
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Jordi López Ayerbe
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Francisco Arregui Montoya
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ana Revilla Orodea
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - David Toral Sepúlveda
- Servei de Cirurgia Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Nistal
- Servicio de Cirugía Cardiaca, Hospital Universitario Valdecilla, Santander, Spain
| | | | - Augusto Sao
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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11
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Ferrera C, Vilacosta I, Serrano FJ, Maroto Castellanos LC. Healthcare network for patients with acute aortic syndrome. Response. Rev Esp Cardiol (Engl Ed) 2022; 75:775. [PMID: 35753610 DOI: 10.1016/j.rec.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Carlos Ferrera
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco Javier Serrano
- Servicio de Cirugía Vascular, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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12
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Viana-Tejedor A, Andrea-Riba R, Scardino C, Ariza-Solé A, Bañeras J, García-García C, Jiménez Mena M, Vila M, Martínez-Sellés M, Pastor G, García Acuña JM, Loma-Osorio P, García Rubira JC, Jorge Pérez P, Pastor P, Ferrera C, Noriega FJ, Pérez Macías N, Fernández-Ortiz A, Pérez-Villacastín J. Coronariografía urgente en los pacientes con parada cardiaca extrahospitalaria sin elevación del segmento ST. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.004] [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: 12/01/2022]
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13
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Ferrera C, Vilacosta I, Serrano FJ, Maroto Castellanos LC. Red asistencial para la atención al paciente con síndrome aórtico agudo. Respuesta. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.002] [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: 11/29/2022]
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14
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Jerónimo A, Olmos C, Vilacosta I, Ortega-Candil A, Rodríguez-Rey C, Pérez-Castejón MJ, Fernández-Pérez C, Pérez-García CN, García-Arribas D, Ferrera C, Carreras JL. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections. J Nucl Cardiol 2022; 29:594-608. [PMID: 32748277 DOI: 10.1007/s12350-020-02285-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Utility of 18F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). METHODS AND RESULTS From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. CONCLUSIONS The yield of 18F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
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Affiliation(s)
- Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Aida Ortega-Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Rodríguez-Rey
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - María Jesús Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - José Luis Carreras
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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15
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Bouzas-Cruz N, Castrodeza J, Gonzalez-Fernandez O, Ferrera C, Woods A, Tovey S, Robinson-Smith N, McDiarmid AK, Parry G, Samuel J, Schueler S, MacGowan GA. Does infection predispose to thrombosis during long term ventricular assist device support? Artif Organs 2022; 46:1399-1408. [PMID: 35167124 DOI: 10.1111/aor.14209] [Citation(s) in RCA: 3] [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: 04/15/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections and thrombotic events remain life-threatening complications in patients with ventricular assist devices (VAD). METHODS We describe the relationship between both events in our cohort of patients (n=220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. RESULTS Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection (n=168, 0.33 event-per-person-year-EPPY), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD-specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of CRP during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p=0.03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis there was no significant effect of infection predisposing to CTE. CONCLUSIONS Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events.
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Affiliation(s)
- Noelia Bouzas-Cruz
- Dept of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier Castrodeza
- Dept of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Carlos Ferrera
- Dept of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Andrew Woods
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Sian Tovey
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nicola Robinson-Smith
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Adam K McDiarmid
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Gareth Parry
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Julie Samuel
- Depts of Microbiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephan Schueler
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Depts of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom.,Newcastle University Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
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Ferrera C, Vilacosta I, Busca P, Martín Martínez A, Serrano FJ, Maroto Castellanos LC. Código Aorta: proyecto piloto de una red asistencial para la atención al paciente con síndrome aórtico agudo. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Ferrera C, Vilacosta I, Busca P, Martín Martínez A, Serrano FJ, Maroto Castellanos LC. Aorta Code: a pilot study of a health care network for patients with acute aortic syndrome. Rev Esp Cardiol (Engl Ed) 2022; 75:95-98. [PMID: 34507916 DOI: 10.1016/j.rec.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Carlos Ferrera
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Busca
- Servicio de Urgencias Médicas de Madrid, SUMMA-112, Madrid, Spain
| | | | - Francisco Javier Serrano
- Servicio de Cirugía Vascular, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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18
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Vilacosta I, San Román JA, di Bartolomeo R, Eagle K, Estrera AL, Ferrera C, Kaji S, Nienaber CA, Riambau V, Schäfers HJ, Serrano FJ, Song JK, Maroto L. Acute Aortic Syndrome Revisited: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2106-2125. [PMID: 34794692 DOI: 10.1016/j.jacc.2021.09.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
The purpose of this paper is to describe all available evidence on the distinctive features of a group of 4 life-threatening acute aortic pathologies gathered under the name of acute aortic syndrome (AAS). The epidemiology, diagnostic strategy, and management of these patients has been updated. The authors propose a new and simple diagnostic algorithm to support clinical decision making in cases of suspected AAS, thereby minimizing diagnostic delays, misdiagnoses, and unnecessary advanced imaging. AAS-related entities are reviewed, and a guideline to avoid imaging misinterpretation is provided. Centralization of patients with AAS in high-volume centers with high-volume surgeons is key to improving clinical outcomes. Thus, the role of multidisciplinary teams, an "aorta code" (streamlined emergent care pathway), and aortic centers in the management of these patients is boosted. A tailored patient treatment approach for each of these acute aortic entities is needed, and as such has been summarized. Finally, a set of prevention measures against AAS is discussed.
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Affiliation(s)
- Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - J Alberto San Román
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Kim Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, UTHealth, Houston, Texas, USA; Memorial Hermann Heart and Vascular Institute. University of Texas, Houston, Texas, USA
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital, Osaka, Japan
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, The Royal Brompton and Harefield MHS Trust, London, United Kingdom
| | - Vicenç Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Hans-Joachim Schäfers
- Klinik für Thorax- und Herz-Gefäßchirurgie Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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19
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Garcia-Arribas D, Fernandez Ramos A, Viana DR, Rosillo S, Caro-Codon J, Armada E, Carrion I, Ferrera C, Noriega FJ, Lopez De Sa E. Arrythmic storm in patients with and without an implantable cardioverter defibrillator. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Available data on arrhythmic storm (AS) is frequently obtained from retrospective observational series of patients who carry an implantable cardioverter defibrillator (ICD). Therefore, this selection bias limits the evidence regarding mortality and prognosis of patients with AS who do not have an ICD.
Purpose
Describe and compare the epidemiological and clinical characteristics, treatment, and outcomes of patients with and without an ICD, admitted for AS in the Acute Coronary Care Unit.
Methods
Between 2006 and 2020, 187 episodes of AS in 165 patients were identified in two third level hospitals. There were 71 patients without ICD and 116 patients with ICD. Clinical characteristics, treatment and outcome were analysed.
Results
Baseline characteristics are depicted in Figure 1. Risk profile of ICD carriers was worse (they were older, more frequently smokers, had more often hypertension, dyslipidemia, chronic kidney disease and thyroid disturbances, and had worse NYHA class). Known ejection fraction was also worse.
AS aetiology was also different. Myocardial infarction was present only in non ICD carriers (56.3% vs 0, p<0.001) and was the most frequent cause of AS in this group. Ion disturbances were also more common among ICD carriers (60.3% vs 33.6%, p<0.001), but it was the most frequent aetiology of AS in non ICD carriers. Heart failure or cardiogenic shock (36.6% vs 26.7%, p=0.154), infection (7% vs 13.8%, p=0.156) and bradycardia with acquired long QT syndrome (11.3% vs 9.5%, p=0.695) were similar in both groups. There were two episodes of myocarditis among non ICD carriers.
The predominant arrythmia was also different. Ventricular fibrillation was more common in non ICD carriers (43.7% vs 4.3%) while monomorphic ventricular tachycardia was more frequent in ICD carriers (38.8% vs 83.6%, p<0.001).
Non ICD carriers had worse levels of pH (7.30 vs 7.42, p<0.001) and lactate (4.4mmol/L vs 2.0mmol/L, p>0.001) and required inotropic and vasopressor drugs more frequently due to haemodynamic instability (57.7% vs 10.3%, p<0.001), mechanical support with intra-aortic balloon pump (40.8% vs 1.7%, p<0.001), ECMO (8.5% vs 0%, p<0.001), and other mechanical assist devices (5.6% vs 0%, p=0.010), and oral intubation (71.8% vs 17.2%, p<0.001).
Pharmacologic treatment is described in Figure 2.
Non ICD carriers required more frequently percutaneous coronary intervention (59.2% vs 4.3%, p<0.001) and less frequently ventricular ablation (28.2 vs 46.6%, p=0.013). Therapeutic hypothermia was used only in non ICD patients due to out of hospital cardiac arrest (33.8% vs 0%, p<0.001).
In-hospital mortality was higher in non ICD carriers (28.2% vs 11.2%, p=0.003).
Conclusion
Despite a worse cardiovascular profile in ICD carriers, AS is associated with a worse haemodynamic situation and mortality in non ICD carriers, due to different aetiology of the AS and to the absence of protection against sustained arrythmias.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Beca para la Formaciόn e Investigaciόn en Cuidados Críticos Cardiolόgicos concedida por la Asociaciόn de Cardiopatía Isquémica y Cuidados Críticos Cardiolόgicosde la SEC Figure 1. Baseline CharacteristicsFigure 2. Pharmacological treatment
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Affiliation(s)
- D Garcia-Arribas
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - A Fernandez Ramos
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - D R Viana
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - S Rosillo
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - J Caro-Codon
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - E Armada
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - I Carrion
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - C Ferrera
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - F J Noriega
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - E Lopez De Sa
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
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20
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Perez Garcia CN, Olmos C, Garcia Arribas D, Lopez J, Ladron R, San Roman JA, Jeronimo A, Islas F, Ferrera C, Saenz-Bejar C, Vilacosta I. Impact of frailty on elderly patients with infective endocarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known.
The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not.
Methods
A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale.
Results
The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1.
Regarding comorbidity, chronic anemia (40.8% vs 25%; p<0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014).
The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients.
Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection.
The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group.
One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232).
Conclusions
The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C N Perez Garcia
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - D Garcia Arribas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Lopez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Ladron
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - J A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - A Jeronimo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Ferrera
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | | | - I Vilacosta
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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21
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Garcia-Arribas D, Fernandez Ramos A, Viana A, Rosillo S, Caro-Codon J, Armada E, Carrion I, Ferrera C, Noriega F, Lopez De Sa E. Arrythmic storm in patients with and without a myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Available data on arrhythmic storm (AS) is frequently obtained from retrospective observational series of patients who carry an implantable cardioverter defibrillator or who undergo ablation, and typically, patients with ST-elevation myocardial infarction (STEMI) as the cause of the AS are excluded. Therefore, this selection bias limits the evidence regarding mortality and prognosis of patients with AS due to STEMI.
Purpose
Describe and compare the epidemiological and clinical characteristics, treatment, and outcomes of patients admitted for AS in the Acute Coronary Care Unit due to STEMI and other causes.
Methods
Between 2006 and 2020, 187 episodes of AS in 165 patients were identified in two third level hospitals. There were 40 patients with STEMI and 147 patients with other causes of AS. Clinical characteristics, treatment and outcome were analysed.
Results
Baseline characteristics are depicted in Figure 1. Risk profile of patients without STEMI was worse (they were older, had more often hypertension, and thyroid disturbances, and had worse NYHA class). Patients with STEMI were more frequently smokers. Ejection fraction was higher among STEMI patients.
Predisposing features for AS (apart from myocardial ischemia) were also different. Ion disturbances were more common among STEMI patients (37.4% vs 67.5%, p=0.001). Heart failure or cardiogenic shock (27.9% vs 40.0%, p=0.140), infection (12.2% vs 7.5%, p=0.399) and bradycardia with acquired long QT syndrome (10.2% vs 10.0%, p=0.695) were similar in both groups. There were two episodes of myocarditis in patients without STEMI.
The predominant arrythmia was also different. Ventricular fibrillation was more common in STEMI patients (4.8% vs 72.5%) while monomorphic ventricular tachycardia was more frequent patients without STEMI (80.3% vs 7.5%, p<0.001).
STEMI patients had worse levels of pH (7.40 vs 7.25, p<0.001) and lactate (2.25mmol/L vs 5.56mmol/L, p>0.001) and required inotropics and vasopressors more frequently due to haemodynamic instability (15.0% vs 77.5%, p<0.001), mechanical support with intra-aortic balloon pump (5.4 vs 57.5%, p<0.001), ECMO (2.0% vs 7.5%, p=0.082), and other mechanical assist devices (0 vs 10.0%, p<0.001), and oral intubation (23.8% vs 90.0%, p<0.001).
Pharmacologic treatment is described in Figure 2.
Obviously, STEMI patients required more often percutaneous coronary intervention (8.2% vs 87.5%, p<0.001) and less frequently ventricular ablation (50.3% vs 0, p<0.001). Therapeutic hypothermia was more commonly used in STEMI patients due to out of hospital cardiac arrest (2.0% vs 52.5%, p<0.001).
In-hospital mortality was higher in STEMI patients (11.6% vs 42.5%, p<0.001).
Conclusion
Despite a worse cardiovascular profile in patients without STEMI, AS is associated with a worse haemodynamic situation and mortality in STEMI patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Beca para la Formaciόn e Investigaciόn en Cuidados Críticos Cardiolόgicos concedida por la Asociaciόn de Cardiopatía Isquémica y Cuidados Críticos Cardiolόgicosde la SEC Figure 1. Baseline CharacteristicsFigure 2. Pharmacological treatment
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Affiliation(s)
- D Garcia-Arribas
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - A Fernandez Ramos
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - A Viana
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - S Rosillo
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - J Caro-Codon
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - E Armada
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
| | - I Carrion
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - C Ferrera
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - F.J Noriega
- Hospital Clinic San Carlos, Cardiology, Madrid, Spain
| | - E Lopez De Sa
- University Hospital La Paz - Carlos III - Madrid Health Service, Madrid, Spain
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22
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Gómez-Polo JC, Ferrera C, Ruiz-Pizarro V, García-Amado CR, Gómez-Álvarez Z, Romero-Delgado T, Javier Noriega F, Macaya C, Fernández-Ortiz y A, Viana-Tejedor A. Impacto pron�stico de la realizaci�n de una coronariograf�a precoz en pacientes con infarto de miocardio sin elevaci�n del segmento ST. RECIC 2021. [DOI: 10.24875/recic.m19000085] [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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23
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Martinez-Gomez E, McInerney A, Tirado-Conte G, de Agustin JA, Jimenez-Quevedo P, Escudero A, Pozo Osinalde E, Viana-Tejedor A, Goirigolzarri J, Marroquin L, Vivas D, Ferrera C, Noriega F, Restrepo-Cordoba MA, Gonzalo N, Escaned J, Fernández-Ortiz A, Amat-Santos I, Estevez-Loureiro R, Macaya C, Nombela-Franco L. Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review. Catheter Cardiovasc Interv 2021; 98:E617-E625. [PMID: 33856097 DOI: 10.1002/ccd.29703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. METHODS We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. RESULTS Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. CONCLUSIONS Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.
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Affiliation(s)
- Eduardo Martinez-Gomez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Angela McInerney
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Jose Alberto de Agustin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Andrés Escudero
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Eduardo Pozo Osinalde
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ana Viana-Tejedor
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Josebe Goirigolzarri
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - David Vivas
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Carlos Ferrera
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Francisco Noriega
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - Nieves Gonzalo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Javier Escaned
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Carlos Macaya
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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24
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Pérez-García CN, Ramos-López N, Fragiel-Saavedra M, Ortega A, Bustos A, Font-Urgelles J, Real C, Vivas D, Ferrera C, Vilacosta I. Takayasu´s Disease Presenting as a Hypertensive Urgency. Circ Cardiovasc Imaging 2021; 14:e011827. [PMID: 33794666 DOI: 10.1161/circimaging.120.011827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Nicolás Pérez-García
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
| | - Noemí Ramos-López
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Aida Ortega
- Nuclear Medicine Department (A.O.), Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Bustos
- Radiology Department (A.B.), Hospital Clínico San Carlos, Madrid, Spain
| | - Judit Font-Urgelles
- Rheumatology Department (J.F.-U.), Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Real
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
| | - David Vivas
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ferrera
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Cardiovascular Institute (C.N.P.-G., N.R.-L., C.R., D.V., C.F., I.V.), Hospital Clínico San Carlos, Madrid, Spain
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25
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Bouzas-Cruz N, Koshy A, Gonzalez-Fernandez O, Ferrera C, Green T, Okwose N, Woods A, Tovey S, Robinson-Smith N, McDiarmid A, Parry G, Gonzalez-Juanatey J, Schueler S, MacGowan G. Markers of Right Ventricle Dysfunction Predict Exercise Capacity on Left Ventricular Assist Device (LVAD) Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1252] [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: 10/21/2022] Open
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26
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Ferrera C, Vilacosta I, Saiz-Pardo Sanz M, Cabeza B, Ortega A, Maroto-Castellanos L. Aortitis: a simulator of intramural aortic hematoma. Rev Esp Cardiol (Engl Ed) 2021; 74:355-357. [PMID: 33160888 DOI: 10.1016/j.rec.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Carlos Ferrera
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Beatriz Cabeza
- Servicio de Radiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Aida Ortega
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, Spain
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27
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Bouzas-Cruz N, Koshy A, Gonzalez-Fernandez O, Ferrera C, Green T, Okwose NC, Woods A, Tovey S, Robinson-Smith N, Mcdiarmid AK, Parry G, Gonzalez-Juanatey JR, Schueler S, Jakovljevic DG, Macgowan G. Markers of Right Ventricular Dysfunction Predict Maximal Exercise Capacity After Left Ventricular Assist Device Implantation. ASAIO J 2021; 67:284-289. [PMID: 33627602 DOI: 10.1097/mat.0000000000001245] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although left ventricular assist device (LVAD) improves functional capacity, on average LVAD patients are unable to achieve the aerobic capacity of normal healthy subjects or mild heart failure patients. The aim of this study was to examine if markers of right ventricular (RV) function influence maximal exercise capacity. This was a single-center prospective study that enrolled 20 consecutive HeartWare ventricular assist device patients who were admitted at the Freeman Hospital (Newcastle upon Tyne, United Kingdom) for a heart transplant assessment from August 2017 to October 2018. Mean peak oxygen consumption (Peak VO2) was 14.0 ± 5.0 ml/kg/min, and mean peak age and gender-adjusted percent predicted oxygen consumption (%VO2) was 40.0% ± 11.5%. Patients were subdivided into two groups based on the median peak VO2, so each group consisted of 10 patients (50%). Right-sided and pulmonary pressures were consistently higher in the group with poorer exercise tolerance. Patients with poor exercise tolerance (peak VO2 below the median) had higher right atrial pressures at rest (10.6 ± 6.4 vs. 4.3 mmHg ± 3.2; p = 0.02) and the increase with passive leg raising was significantly greater than those with preserved exercise tolerance (peak VO2 above the median). Patients with poor functional capacity also had greater RV dimensions (4.4 cm ± 0.5 vs. 3.7 cm ± 0.5; p = 0.02) and a higher incidence of significant tricuspid regurgitation (moderate or severe tricuspid regurgitation in five patients in the poor exercise capacity group vs. none in the preserved exercise capacity group; p = 0.03). In conclusion, echocardiographic and hemodynamic markers of RV dysfunction discriminate between preserved and nonpreserved exercise capacity in HeartWare ventricular assist device patients.
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Affiliation(s)
- Noelia Bouzas-Cruz
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Cardiology Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Aaron Koshy
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Oscar Gonzalez-Fernandez
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Carlos Ferrera
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Thomas Green
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Cardiology Department, University of Santiago de Compostela, Santiago de Compostela, Spain
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Andrew Woods
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Sian Tovey
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Nicola Robinson-Smith
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Adam K Mcdiarmid
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Gareth Parry
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Jose R Gonzalez-Juanatey
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Stephan Schueler
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
| | - Guy Macgowan
- From the Department of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Newcastle University, Biosciences and Translational and Clinical Research Institutes, Newcastle upon Tyne, United Kingdom
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García-Arribas D, Olmos C, Vilacosta I, Perez-García CN, Ferrera C, Jerónimo A, Carnero M, Ortega Candil A, Sáez C, García-Granja PE, Sarriá C, López J, San Román JA, Maroto L. Infective endocarditis in patients with aortic grafts. Int J Cardiol 2021; 330:148-157. [PMID: 33592240 DOI: 10.1016/j.ijcard.2021.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/30/2021] [Accepted: 02/10/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infective endocarditis (IE) in patients with a valve-tube ascending aortic graft (AAG) is a rare entity with a challenging diagnosis and treatment. This study describes the clinical features, diagnosis and outcome of these patients. METHODS Between 1996 and 2019, 1654 episodes of IE were recruited in 3 centres, of which 37 patients (2.2%) had prosthetic aortic valve and AAG-IE (21 composite valve graft, 16 supracoronary graft) and conformed our study group. RESULTS Patients with aortic grafts were predominantly male (91.9%) and the mean age was 67.7 years. Staphylococci were the most frequently isolated microorganisms (32%). Viridans group streptococci were only isolated in patients with composite valve graft. TEE was positive in 89.2%. PET/CT was positive in all 15 patients in whom it was performed. Surgical treatment was performed in 62.2% of patients. In-hospital mortality was 16.2%. Heart failure and the type of infected graft (supracoronary aortic graft) were associated with mortality. Mortality among operated patients was 21.7%. Interestingly, 14 patients received antibiotic therapy alone, and only one died. Mortality was lower among patients with a composite valve graft compared to those with a supracoronary graft (4.8% vs 31.3%; p = 0.03). CONCLUSIONS In patients with AAG and prosthetic aortic valve IE, mortality is not higher than in other patients with prosthetic IE. Multimodality imaging plays an important role in the diagnosis and management of these patients. Heart failure and the type of surgery were risk factors associated with in-hospital mortality. Although surgical treatment is usually recommended, a conservative management might be a valid alternative treatment in selected patients.
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Affiliation(s)
- Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain.
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carlos Nicolás Perez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Manuel Carnero
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Aida Ortega Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, C/ Diego de León, 62, Madrid 28006, Spain
| | - Pablo-Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, C/ Diego de León, 62, Madrid 28006, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - José Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, Valladolid 47003, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain
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Jeronimo Baza A, Olmos C, Vilacosta I, Ortega-Candil A, Rodriguez-Rey C, Perez-Castejon M, Fernandez-Perez C, Perez-Garcia C, Garcia-Arribas D, Ferrera C, Carreras J. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established.
Purpose
To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE.
Methods
From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE.
Results
After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE.
Conclusions
In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
ROC curves SUVmax and SUV ratio for PI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | - C Ferrera
- Hospital Clinico San Carlos, Madrid, Spain
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Ramos Lopez N, Luque Diaz T, Ferrera C, Enriquez Vazquez D, Mahia Casado P, Noriega Sanz F, Manas Hernandez A, Abelaira Freire J, Islas Ramirez F, Perez Serrano M, Higueras Nafria J, Galvan Herraez L, Pedrajas J, Fernandez Ortiz A, Salinas Sanguino P. Impact of a PERT initiative on hospital mortality of patients with bilateral pulmonary embolism. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Implication of rapid-response teams have demonstrated significant improvement in several cardiovascular diseases, such as myocardial infarction and stroke. Thus, pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE are encouraged in the guidelines.
Purpose
We aimed to assess the impact of a PERT initiative on hospital mortality. PERT was designed to manage patients with bilateral PE with RV/LV ratio >0.9 and positive biomarkers.
Methods
We prospectively recruited all consecutive patients with intermediate-high and high-risk bilateral PE who required PERT activation from February-2018 to September-2019 (PERT group, n=56 patients). We compared them with patients with bilateral PE admitted to our hospital in a previous 2-year period (2014–2016), managed with standard of care (SC-group, n=172 patients). As a secondary analysis, we focused on patients with a RV/LV ratio>0.9 (n=52, in the SC-group; n=55, 98% in the PERT-group).
Results
Results are shown on Table. The SC-group had a lower risk profile at admission (lower PESI score, heart rate, and higher oxygen saturation), compared to PERT-group. The proportion of patients with RV enlargement on CT (RV/LV >0.9) was lower in the retrospective cohort (p<0.001). Peak Troponin I was significantly higher in the PERT-group (Table). Reperfusion treatment was more frequently needed in PERT patients. On the contrary, there was no difference in the use of vasopressors (5.8% vs 12.5%, p=0.098) and orotracheal intubation (4.1% vs 5.4%, p=0.689) between groups. In-hospital mortality was lower in the PERT-group in the whole cohort (Table) and much lower when considering patients with RV/LV ratio>0.9 (17.6% vs 1.8%, p=0.005).
Conclusion
PERT initiative is associated with a significant reduction in mortality compared to the standard of care in patients with bilateral high-risk PE.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Ramos Lopez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - T Luque Diaz
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Ferrera
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | - P Mahia Casado
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - F.J Noriega Sanz
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | | | - F Islas Ramirez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - M Perez Serrano
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | | | - J Pedrajas
- Hospital Clinic San Carlos, Internal Medicine, Madrid, Spain
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Agujetas R, Barrio-Perotti R, Ferrera C, Pandal-Blanco A, Walters DK, Fernández-Tena A. Construction of a hybrid lung model by combining a real geometry of the upper airways and an idealized geometry of the lower airways. Comput Methods Programs Biomed 2020; 196:105613. [PMID: 32593974 DOI: 10.1016/j.cmpb.2020.105613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/14/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Health care costs represent a substantial an increasing percentage of global expenditures. One key component is treatment of respiratory diseases, which account for one in twelve deaths in Europe. Computational simulations of lung airflow have potential to provide considerable cost reduction and improved outcomes. Such simulations require accurate in silico modeling of the lung airway. The geometry of the lung is extremely complex and for this reason very simple morphologies have primarily been used to date. The objective of this work is to develop an effective methodology for the creation of hybrid pulmonary geometries combining patient-specific models obtained from CT images and idealized pulmonary models, for the purpose of carrying out experimental and numerical studies on aerosol/particle transport and deposition in inhaled drug delivery. METHODS For the construction of the hybrid numerical model, lung images obtained from computed tomography were exported to the DICOM format to be treated with a commercial software to build the patient-specific part of the model. At the distal terminus of each airway of this portion of the model, an idealization of a single airway path is connected, extending to the sixteenth generation. Because these two parts have different endings, it is necessary to create an intermediate solid to link them together. Physically realistic treatment of truncated airway boundaries in the model was accomplished by mapping of the flow velocity distribution from corresponding conducting airway segments. RESULTS The model was verified using two sets of simulations, steady inspiration/expiration and transient simulation of forced spirometry. The results showed that the hybrid model is capable of providing a realistic description of air flow dynamics in the lung while substantially reducing computational costs relative to models of the full airway tree. CONCLUSIONS The model development outlined here represents an important step toward computational simulation of lung dynamics for patient-specific applications. Further research work may consist of investigating specific diseases, such as chronic bronchitis and pulmonary emphysema, as well as the study of the deposition of pollutants or drugs in the airways.
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Affiliation(s)
- R Agujetas
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and ICCAEx, Universidad de Extremadura, Spain.
| | - R Barrio-Perotti
- Departamento de Energía, Universidad de Oviedo and GRUBIPU-ISPA, Spain.
| | - C Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and ICCAEx, Universidad de Extremadura, Spain.
| | - A Pandal-Blanco
- Departamento de Energía, Universidad de Oviedo and GRUBIPU-ISPA, Spain.
| | - D K Walters
- School of Aerospace and Mechanical Engineering, University of Oklahoma, United States.
| | - A Fernández-Tena
- Facultad de Enfermería, Universidad de Oviedo, Instituto Nacional de Silicosis and GRUBIPU-ISPA, Spain.
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32
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Jerónimo A, Ferrández-Escarabajal M, Ferrera C, Noriega FJ, Diz-Díaz J, Fernández-Jiménez R, McInerney A, Fernández-Ortiz A, Viana-Tejedor A. Cardiogenic Shock Clinical Presentation, Management, and In-Hospital Outcomes in Patients Admitted to the Acute Cardiac Care Unit of a Tertiary Hospital: Does Gender Play a Role? J Clin Med 2020; 9:jcm9103117. [PMID: 32992550 PMCID: PMC7601399 DOI: 10.3390/jcm9103117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/31/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiogenic shock (CS), as the most severe form of heart failure, is associated with very high mortality rates despite therapeutic advances in the last decades. Gender differences in outcomes have been widely reported regarding several cardiovascular diseases. The aim of our study was to evaluate potential gender disparities in clinical presentation, management, and in-hospital outcomes of all (n = 138) patients admitted to the Acute Cardiac Care Unit of a tertiary hospital from 2013 to 2019. Information on demographic characteristics, past medical history, haemodynamic and clinical status at admission, therapeutic management, and in-hospital outcomes was retrospectively collected. Women represented 31.88% of the cohort, were significantly older than the men and had a lower proportion of smokers, chronic obstructive pulmonary disease, and previous acute myocardial infarction (AMI). Most CSs in both groups were AMI-related. Left ventricular ejection fraction at admission was higher in women, who were less likely to receive vasopressors. No differences were observed regarding mechanical circulatory support use and in-patient outcomes, with age being the only factor associated with in-hospital mortality on multivariate analysis.
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Affiliation(s)
- Adrian Jerónimo
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Marcos Ferrández-Escarabajal
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Carlos Ferrera
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Francisco J. Noriega
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Jesús Diz-Díaz
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Rodrigo Fernández-Jiménez
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
- Centro Nacional de Investigación Cardiovascular (CNIC), 28029 Madrid, Spain
| | - Angela McInerney
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Antonio Fernández-Ortiz
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Ana Viana-Tejedor
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
- Correspondence: ; Tel.: +34-91-330-33-000 (ext. 20655)
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Bottino R, Tirado-Conte G, McInerney A, Noriega F, Nuñez-Gil I, Salinas P, Ferrera C, Jimenez-Quevedo P, Viana-Tejedor A, Nombela-Franco L. Late Migration of a Paravalvular Leak Closure Device. Int Heart J 2020; 61:843-847. [DOI: 10.1536/ihj.19-512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Roberta Bottino
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Gabriela Tirado-Conte
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Angela McInerney
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Francisco Noriega
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Ivan Nuñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Pablo Salinas
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Pilar Jimenez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Ana Viana-Tejedor
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC. Universidad Complutense
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Ferrera C, Vilacosta I, Cabeza B, Cobiella J, Martínez I, Saiz-Pardo Sanz M, Bustos A, Serrano FJ, Maroto L. Diagnosing Aortic Intramural Hematoma: Current Perspectives. Vasc Health Risk Manag 2020; 16:203-213. [PMID: 32606717 PMCID: PMC7292252 DOI: 10.2147/vhrm.s193967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/23/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.
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Affiliation(s)
- Carlos Ferrera
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Beatriz Cabeza
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Isaac Martínez
- Department of Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ana Bustos
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Muñoz-Sánchez BN, Cabezas MG, Ferrera C, Herrada MA, Montanero JM. A method for measuring the interfacial tension for density-matched liquids. J Colloid Interface Sci 2020; 566:90-97. [PMID: 31991368 DOI: 10.1016/j.jcis.2020.01.043] [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: 10/15/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
We propose a method to measure the interfacial tension characterizing the interface between two immiscible liquids of practically the same density. In this method, a cylindrical liquid bridge made of one the liquids is vibrated laterally inside a tank filled with the other. The first resonance frequency is determined and equated to the first eigenfrequency of the m=1 linear mode to infer the interfacial tension value. The method does not involve the density jump across the interface. Therefore, its accuracy is affected neither by the smallness of the Bond number nor by errors of the density difference. The experimental setup is relatively simple, and the procedure does not use image processing techniques. The results satisfactorily agree with those measured by TIFA-AI (Theoretical Fitting Image Analysis-Axisymmetric Interfaces) for the same liquid bridges when the density difference is sufficiently large for TIFA-AI to be valid. We conduct numerical simulations of the Navier-Stokes equations to determine the best parameter conditions for the proposed method. The transfer function characterizing the frequency response of the fluid configuration is measured in some experiments to quantify non-linear effects and to study the role played by the outer bath vibration.
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Affiliation(s)
- B N Muñoz-Sánchez
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Cientfíca Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain
| | - M G Cabezas
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Cientfíca Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain.
| | - C Ferrera
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Cientfíca Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain
| | - M A Herrada
- Depto. de Ingeniería Aeroespacial y Mecánica de Fluidos, Universidad de Sevilla, E-41092 Sevilla, Spain
| | - J M Montanero
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Cientfíca Avanzada (ICCAEx), Universidad de Extremadura, E-06006 Badajoz, Spain
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Freitas-Ferraz AB, Tirado-Conte G, Vilacosta I, Olmos C, Sáez C, López J, Sarriá C, Pérez-García CN, García-Arribas D, Ciudad M, García-Granja PE, Ladrón R, Ferrera C, Di Stefano S, Maroto L, Carnero M, San Román JA. Contemporary epidemiology and outcomes in recurrent infective endocarditis. Heart 2019; 106:596-602. [DOI: 10.1136/heartjnl-2019-315433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
ObjectiveRecurrent infective endocarditis (IE) is a major complication of patients surviving a first episode of IE. This study sought to analyse the current state of recurrent IE in a large contemporary cohort.Methods1335 consecutive episodes of IE were recruited prospectively in three tertiary care centres in Spain between 1996 and 2015. Episodes were categorised into group I (n=1227), first-IE episode and group II (n=108), recurrent IE (8.1%). After excluding six patients, due to lack of relevant data, group II was subdivided into IIa (n=87), reinfection (different microorganism), and IIb (n=15), relapse (same microorganism within 6 months of the initial episode).ResultsThe cumulative burden and incidence of recurrence was slightly lower in the second decade of the study (2006–2015) (7.17 vs 4.10 events/100 survivors and 7.51% vs 3.82, respectively). Patients with reinfections, compared with group I, were significantly younger, had a higher frequency of HIV infection, were more commonly intravenous drug users (IVDU) and prosthetic valve carriers, had less embolic complications and cardiac surgery, with similar in-hospital mortality. IVDU was found to be an independent predictor of reinfection (HR 3.92, 95% CI 1.86 to 8.28).In the relapse IE group, prosthetic valve endocarditis (PVE) and periannular complications were more common. Among patients treated medically, those with PVE had a higher relapse incidence (4.82% vs 0.43% in native valve IE, p=0.018). Staphylococcus aureus and PVE were independent predictors of relapse (HR 3.14, 95% CI 1.11 to 8.86 and 3.19, 95% CI 1.13 to 9.00, respectively) and in-hospital-mortality was similar to group I. Three-year all-cause mortality was similar in recurrent episodes compared with single episodes.ConclusionRecurrent IE remains a frequent late complication. IVDU was associated with a fourfold increase in the risk of reinfection. PVE treated medically and infections caused by S. aureus increased the risk of relapse. In-hospital and long-term mortality was comparable among groups.
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Luque Diaz TS, Travieso A, Corrochano D, Noriega F, Nombela-Franco L, Jimenez-Quevedo P, Ferrera C, Viana-Tejedor A. P3741Incidence and outcomes of delirium in patients undergoing transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction and objective
Delirium is a frequent problem in the intensive care unit (ICU), often underdiagnosed, and is associated with increased mortality. We sought to evaluate the incidence and implact on prognosis of delirium in patients admitted to ICU after transcatheter aortic valve replacemente (TAVR).
Methods
We included 294 patients admitted to ICU from February 2013 to December 2017 after transfemoral aortic valve implantation. Incidence of delirium was assessed using DSM-IV diagnostic criteria. Risk factors were evaluated, as well as overall mortality and incidence of hospital readmissions.
Results
The mean clinical follow-up was 526 days. Delirium was diagnosed in 60 patients (20.4%). In most cases (78.3%), it occurred in the first 24 hours after the procedure. Age, cognitive impairment and peripheral artery disease were risk factors for the development of Delirum, without finding differences by sex, cardiovascular risk factors (except dyslipidemia) or the usual treatment with benzodiazepines or neuroleptics. Severe bleeding during the procedure was also associated with a higher incidence, but no risk augmentation was seen with the use of general anaesthesia, the urgency of the procedure, use of a transient pacemaker for more than 24 hours after the intervention or the development of a peripheral vascular complication during admission (both related to patient immobility).
The development of Delirium was associated with longer hospital stay (10.8 vs 7.9 days, p=0.004) and with higher mortality (38.8% vs 20.4%, p=0.007). No differences were found in hospital readmissions during follow-up (54.3% vs 48.2%, p=0.453).
Conclusion
Delirium is a frequent complication after TAVR. Age, cognitive impairment and peripheral arteriy disease were risk factors for its development, but no factors that determine patient immobility, use of general anesthesia or the urgency of the procedure. Delirum after TAVR is associated with longer in-hospital stay and with higher mortality.
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Affiliation(s)
| | - A Travieso
- Hospital Clinic San Carlos, CARDIOLOGY, Madrid, Spain
| | - D Corrochano
- University Hospital Severo Ochoa, Leganes-Madrid, Spain
| | - F Noriega
- Hospital Clinic San Carlos, CARDIOLOGY, Madrid, Spain
| | | | | | - C Ferrera
- Hospital Clinic San Carlos, CARDIOLOGY, Madrid, Spain
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Ferrera C, Vilacosta I, Fernández C, López J, Sarriá C, Olmos C, Carnero-Alcázar M, Vivas D, Di Stefano S, Sáez C, Cobiella J, García-Arribas D, Maroto Castellanos LC, San Román JA. Early surgery for acute-onset infective endocarditis. Eur J Cardiothorac Surg 2019; 54:1060-1066. [PMID: 29873701 DOI: 10.1093/ejcts/ezy208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/28/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Acute onset of infective endocarditis has been previously linked to the development of septic shock and a worse prognosis. The purpose of this study was to analyse the clinical features and in-hospital evolution of patients with acute-onset endocarditis as well as the potential role of early surgery in the treatment of these patients. METHODS From 1996 to 2014, 1053 consecutive patients with left-sided endocarditis were prospectively included. Patients were classified into 2 groups according to the clinical presentation: patients with acute-onset endocarditis (n = 491) and patients with non-acute endocarditis (n = 562). Acute-onset endocarditis was considered when the time between the appearance of symptoms and diagnosis was <15 days. RESULTS At admission, acute renal failure, septic shock and cerebral embolism predominated among patients with acute-onset endocarditis. Staphylococcus aureus was more frequently isolated in patients with an acute onset (27.7% vs 7.8% P < 0.001). During hospitalization, patients with acute onset developed systemic embolism and septic shock more frequently. Death was much more common in this group (42.7 vs 30.1%, P < 0.001). Paravalvular complications, nosocomial infection, heart failure, S. aureus and septic shock were predictors of mortality. Acute-onset presentation of endocarditis was strongly associated with increased mortality. Among patients with acute-onset endocarditis, early surgery, performed within the first 2 days after diagnosis, was associated with a 64% of reduction in mortality. CONCLUSIONS Patients with endocarditis and acute onset of symptoms are at high risk of septic in-hospital complications and mortality. Early surgery, performed within the first 2 days after diagnosis, plays a central role in the treatment of these patients.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Fernández
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Salvatore Di Stefano
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Cobiella
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
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40
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Viana-Tejedor A, Ariza-Solé A, Martínez-Sellés M, Mena MJ, Vila M, García C, García Acuña JM, Bañeras J, García Rubira JC, Pérez PJ, Querol CT, Pastor G, Andrea R, Osorio PL, Alonso N, Martínez C, Pérez Rodríguez M, Noriega FJ, Ferrera C, Salinas P, Gil IN, Ortiz AF, Macaya C. Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial. Eur Heart J Acute Cardiovasc Care 2019; 9:S131-S137. [PMID: 31237435 DOI: 10.1177/2048872618813843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. AIMS We aim to assess whether emergency CAG and PCI, when indicated, will improve survival with good neurological outcome in post-OHCA patients without STEMI who remain comatose. METHODS COUPE is a prospective, multicentre and randomized controlled clinical trial. A total of 166 survivors of OHCA without STEMI will be included. Potentially non-cardiac aetiology of the cardiac arrest will be ruled out prior to randomization. Randomization will be 1:1 for emergency (within 2 h) or deferred (performed before discharge) CAG. Both groups will receive routine care in the intensive cardiac care unit, including therapeutic hypothermia. The primary efficacy endpoint is a composite of in-hospital survival free of severe dependence, which will be evaluated using the Cerebral Performance Category Scale. The safety endpoint will be a composite of major adverse cardiac events including death, reinfarction, bleeding and ventricular arrhythmias. CONCLUSIONS This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.
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Affiliation(s)
- Ana Viana-Tejedor
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | - Montserrat Vila
- Cardiology Department, Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cosme García
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, CIBERCV, Barcelona, Spain
| | - J M García Acuña
- Cardiology Department, Hospital Universitario de Santiago de Compostela, CIBERCV, Spain
| | - Jordi Bañeras
- Cardiology Department, Hospital Universitario Vall d'Hebron, CIBERCV, Barcelona, Spain
| | | | - Pablo J Pérez
- Cardiology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Carlos T Querol
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida - IRBLL, Lleida, Spain
| | - Gemma Pastor
- Cardiology Department, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Rut Andrea
- Instituto Cardiovascular, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Institut de Investigacions Mèdiques Pi i Sunyer, Spain
| | - Pablo L Osorio
- Cardiology Department, Institut d Investigación Biomedica Dr. Josep Trueta de Girona, CIBERCV, Girona, Spain
| | - Norberto Alonso
- Cardiology Department, Hospital Universitario de León, Spain
| | - Cristina Martínez
- Intensive Care Medicine Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - María Pérez Rodríguez
- Cardiology Department. Hospital Universitari de Tarragona Joan XXIII. Tarragona, Spain
| | - Francisco J Noriega
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Ferrera
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pablo Salinas
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván Núñez Gil
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernández Ortiz
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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41
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Ruiz-Pizarro V, Ferrera C, Gómez-Polo JC, Palacios-Rubio J, Rico-García Amado C, Fernández-Ortiz A, Viana-Tejedor A. Sex differences in treatment and prognosis of acute coronary syndrome with interventional management. Cardiovasc Revasc Med 2019; 20:183-186. [PMID: 30905407 DOI: 10.1016/j.carrev.2018.06.021] [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: 02/12/2018] [Revised: 06/09/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital. METHODS Patients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography. RESULTS From the total cohort of 1214 patients, 290 (24%) were women. Women were older (71 ± 12.8 vs 64 ± 13.4 years, p < 0.001) and showed lower ischemic risk and higher hemorrhagic risk scores (GRACE 159 ± 45 vs 171 ± 42, p = 0.005; CRUSADE 41 ± 19 vs 28 ± 17, p < 0.001). There were no significant differences in time to coronary angiography and revascularization rates between sex groups. A lower proportion of women received high-potency antiplatelet agents (29% vs 41.3%, p = 0.004). In-hospital evolution and one-year mortality were similar between groups. CONCLUSIONS In our population, there were no gender differences in management and prognosis of ACS. Differences in risk profile among groups could have an influence on antiplatelet therapy.
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Affiliation(s)
- Virginia Ruiz-Pizarro
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain.
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Juan Carlos Gómez-Polo
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Julián Palacios-Rubio
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Carmen Rico-García Amado
- Cardiology department, Hospital Universitario Severo Ochoa, Avenida de Orellana, s/n, 28911 Leganés, (Madrid), Spain
| | - Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Ana Viana-Tejedor
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
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42
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Pérez-García CN, Olmos C, Islas F, Marcos-Alberca P, Pozo E, Ferrera C, García-Arribas D, Pérez de Isla L, Vilacosta I. Morphological characterization of vegetation by real-time three-dimensional transesophageal echocardiography in infective endocarditis: Prognostic impact. Echocardiography 2019; 36:742-751. [PMID: 30805998 DOI: 10.1111/echo.14293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/22/2018] [Accepted: 01/24/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Vegetation size is a prognostic predictor in infective endocarditis (IE) and guides surgical management. The aim of this study was to evaluate the accuracy of real-time 3-dimensional transesophageal echocardiography (RT3DTEE) compared to 2DTEE in the diagnosis and characterization of vegetation, as well as its potential clinical impact. METHODS Two hundred and three consecutive patients with IE were recruited (2009-2016) and retrospectively analyzed. Vegetation diameters and area from 68 patients were measured by 2DTEE and RT3DTEE at admission. The association between size and systemic embolisms was evaluated with logistic regression models. Differences in the discriminative power for the best dimensions' cutoff points were assessed by comparing the area under the ROC curves (AUC). RESULTS Vegetation size and area were larger by RT3DTEE (P < 0.001) than by 2DTEE, and RT3DTEE was especially relevant in the characterization of nonfiliform vegetation, Morphology was strongly associated with friability, being sessile vegetation less likely to embolize, compared to filiform and raceme-shaped ones (15.4% vs 46% vs 50%). Major diameter by RT3DTEE had better embolic predictive performance than 2DTEE (AUC 0.76 [0.57-0.89] vs 0.71 [0.53-0.86]; P = 0.611). The best cutoff points associated with embolic events during the infection were 17 mm for RT3DTEE and 15 mm for 2DTEE. Based exclusively on vegetation size, the proportion of patients meeting a surgical indication according to current guidelines is higher using RT3DTEE. CONCLUSIONS RT3DTEE allows a better characterization of IE vegetation than 2DTEE, what may have a clinical impact on surgical management and also prognostic due to a more accurate prediction of embolic risk.
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Affiliation(s)
- Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Pedro Marcos-Alberca
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Eduardo Pozo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Leopoldo Pérez de Isla
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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43
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Nogales-Romo MT, Ferrera C, Salinas P, Martínez-Losas P, Nombela-Franco L, Núñez-Gil IJ, Noriega FJ, del Trigo M, Gonzalo N, Jiménez-Quevedo P, Escaned J, Fernández-Ortiz A, Macaya C, Viana-Tejedor A. Angiographic characteristics and long-term prognostic impact of coronary artery disease in survivors after sudden cardiac arrest with a non-diagnostic electrocardiogram. Catheter Cardiovasc Interv 2018; 93:9-15. [DOI: 10.1002/ccd.27713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/12/2018] [Accepted: 05/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | - Carlos Ferrera
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Pablo Salinas
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Pedro Martínez-Losas
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Luis Nombela-Franco
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Iván Javier Núñez-Gil
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | | | - María del Trigo
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Nieves Gonzalo
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Pilar Jiménez-Quevedo
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Javier Escaned
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Antonio Fernández-Ortiz
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Carlos Macaya
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
| | - Ana Viana-Tejedor
- Department of Cardiology; Cardiovascular Institute, Hospital Clínico San Carlos; Madrid Spain
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44
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Gomez Polo JC, Vilacosta I, Gomez-Alvarez Z, Vivas D, Martin-Garcia AG, Fortuny-Frau E, Ferrera C, Garcia-Bouza M, Olmos C, Ramchandany B, Martin-Benitez JC, Carnero M, Higueras J, Fernadez C, Maroto-Castellanos LC. 3275Short term use of corticosteroids in the prophylaxis of atrial fibrillation after cardiac surgery and impact on the levels of acute phase proteins in this context. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - I Vilacosta
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - Z Gomez-Alvarez
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - D Vivas
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - A G Martin-Garcia
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - E Fortuny-Frau
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - C Ferrera
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - M Garcia-Bouza
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - B Ramchandany
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | | | - M Carnero
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - J Higueras
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - C Fernadez
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
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45
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Gomez-Alvarez Z, Gomez Polo JC, Ferrera C, Ruiz-Pizarro V, Rico C, Noriega FJ, Fernandez-Ortiz A, Viana-Tejedor A. P1750Hypocalcemia at admission: a predictor of prognosis in patients with acute coronary syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Z Gomez-Alvarez
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | | | - C Ferrera
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - V Ruiz-Pizarro
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - C Rico
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - F J Noriega
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - A Fernandez-Ortiz
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
| | - A Viana-Tejedor
- Hospital Clinic San Carlos, Cardiovascular Institute., Madrid, Spain
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46
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Cruz Utrilla A, Ferrera C, Nunez-Gil I, Sanchez-Enrique C, Noriega F, Fernandez-Ortiz A, Valverde-Higueras T, Martinez-Vives P, Garcia-Arribas D, Fernandez-Vega A, Macaya C, Viana-Tejedor A. P697Idiopatic severe pericardial effusion. Do we need to drain them all? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Cruz Utrilla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Ferrera
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - I Nunez-Gil
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | - F Noriega
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | | | - P Martinez-Vives
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - D Garcia-Arribas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Fernandez-Vega
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Macaya
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Viana-Tejedor
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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47
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Olmos C, Vilacosta I, Fernández-Pérez C, Bernal JL, Ferrera C, García-Arribas D, Pérez-García CN, San Román JA, Maroto L, Macaya C, Elola FJ. The Evolving Nature of Infective Endocarditis in Spain: A Population-Based Study (2003 to 2014). J Am Coll Cardiol 2017; 70:2795-2804. [PMID: 29191329 DOI: 10.1016/j.jacc.2017.10.005] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little information exists regarding population-based epidemiological changes in infective endocarditis (IE) in Europe. OBJECTIVES This study sought to analyze temporal trends in IE in Spain from 2003 to 2014. METHODS This retrospective, population-based, temporal trend study analyzed the incidence, epidemiological and clinical characteristics, and outcome of all patients discharged from hospitals included in the Spanish National Health System with a diagnosis of IE, from January 2003 to December 2014. RESULTS Overall, 16,867 episodes of IE were identified during the study period, 66.3% in men. The rate of IE significantly increased, from 2.72 in 2003 to 3.49 per 100,000 person-years in 2014, and this rise was higher among older adults. The most frequent microorganisms were staphylococci (28.7%), followed by streptococci (20.4%) and enterococci (13.1%). Twenty-three percent of patients underwent cardiac surgery. The in-hospital mortality rate was 20.4%. Throughout the study period, the proportion of patients with previously known heart valve disease and diabetes mellitus significantly increased, whereas the prevalence of intravenous drug use decreased. Regarding microorganisms, Staphylococcus aureus and streptococci slightly declined, whereas coagulase-negative staphylococci and enterococci consistently increased over the years. In-hospital complications and cardiac surgery rates significantly increased across the years. The risk-adjusted in-hospital mortality rate diminished (0.2% per year) during the study period. CONCLUSIONS The incidence of IE episodes significantly increased over the decade of the study period, particularly among older adults. Relevant changes in clinical and microbiological profile included older patients with more comorbidity and a rise in enterococci and coagulase-negative staphylococcal infections. Adjusted mortality rates slightly declined over the study period.
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Affiliation(s)
- Carmen Olmos
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Fernández-Pérez
- Department of Preventive Medicine, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Ferrera
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - J Alberto San Román
- Cardiology Department, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - Luis Maroto
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
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48
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Ferrera C, Vilacosta I, Gómez-Polo JC, Villanueva-Medina S, Cabeza B, Ortega L, Cañadas V, Carnero-Alcázar M, Martínez-López I, Maroto-Castellanos L, Serrano-Hernando FJ. Evolution and prognosis of intramural aortic hematoma. Insights from a midterm cohort study. Int J Cardiol 2017; 249:410-413. [DOI: 10.1016/j.ijcard.2017.09.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/19/2017] [Accepted: 09/18/2017] [Indexed: 01/16/2023]
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Fernández-Tena A, Marcos AC, Agujetas R, Ferrera C. Simulation of the human airways using virtual topology tools and meshing optimization. Biomech Model Mechanobiol 2017; 17:465-477. [PMID: 29105007 DOI: 10.1007/s10237-017-0972-9] [Citation(s) in RCA: 2] [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: 09/11/2017] [Accepted: 10/24/2017] [Indexed: 02/04/2023]
Abstract
A method is proposed to improve the quality of the three-dimensional airway geometric models using a commercial software, checking the number of elements, meshing time, and aspect ratio and skewness parameters. The use of real and virtual topologies combined with patch-conforming and patch-independent meshing algorithms results in four different models being the best solution the combination of virtual topology and patch-independent algorithm, due to an excellent aspect ratio and skewness of the elements, and minimum meshing time. The result is a reduction in the computational time required for both meshing and simulation due to a smaller number of cells. The use of virtual topologies combined with patch-independent meshing algorithms could be extended in bioengineering because the geometries handling is similar to this case. The method is applied to a healthy person using their computed tomography images. The resulting numerical models are able to simulate correctly a forced spirometry.
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Affiliation(s)
- A Fernández-Tena
- Universidad de Oviedo and Hospital Universitario Central de Asturias, 33011, Oviedo, Spain
| | - A C Marcos
- Dpto. de Expresión Gráfica, Universidad de Extremadura, 06006, Badajoz, Spain
| | - R Agujetas
- Dpto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, 06006, Badajoz, Spain
| | - C Ferrera
- Dpto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, 06006, Badajoz, Spain.
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50
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Gomez Polo J, Vilacosta I, Martin-Garcia A, Fortuny E, Fernandez-Perez C, Garcia-Bouza M, Carnero M, Vivas D, Higueras J, Cobiella J, Ferrera C, Martin-Benitez J, Acedo Diaz-Pache M, Olmos C, Maroto L. P2702Use of corticosteroids in the prophylaxis of atrial fibrillation after cardiac surgery (ECOFA study). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2702] [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] [Indexed: 11/13/2022] Open
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